What are the guidelines for using protein powder in a patient with diabetes mellitus (DM)?

Protein Powder Use in Diabetes

Protein powder is safe and can be used by patients with diabetes without kidney disease, targeting 15-20% of total calories (approximately 0.8-1.3 g/kg body weight), with individualization based on age, weight goals, and renal function. 1

General Protein Requirements

For patients with diabetes and normal kidney function, there is no single ideal protein amount, but standard intake should be 15-20% of total energy or 0.8-1.3 g/kg body weight for those under 65 years. 1, 2

• Patients over 65 years should aim for 15-20% of total energy from protein due to increased requirements in older adults 2
• Evidence is inconclusive for recommending a specific protein amount to optimize glycemic control or cardiovascular risk measures, so goals must be individualized 1
• Protein intake should be calculated as grams per kilogram of body weight rather than a fixed percentage to avoid protein malnutrition during calorie restriction 3

Protein Powder for Weight Loss

For overweight or obese patients with type 2 diabetes attempting weight loss, higher protein intake of 1.5-2 g/kg body weight (20-30% of total calories) can be beneficial. 3, 4

• Higher protein diets (23-32% of energy) during weight loss reduce blood pressure and body weight slightly but significantly more than lower protein diets for up to one year 2
• Increased protein improves satiety, increases thermogenesis, and limits lean muscle mass loss during calorie restriction 3, 4
• Blood lipids, fasting glucose, and HbA1c improve similarly regardless of higher or lower protein intake in patients with GFR >60 mL/min/1.73 m² 2

Protein Powder Selection Criteria

Choose protein powders low in simple carbohydrates and sugars to minimize glycemic impact. 5

• Limit products high in saturated fat to <7% of total calories 5
• Minimize trans fat intake completely 5
• Limit dietary cholesterol to 200 mg/day, as diabetic patients are more sensitive to dietary cholesterol than the general population 1, 5
• Plant protein sources may provide greater cholesterol reduction compared to animal proteins 2

Critical Metabolic Effects

Protein increases insulin secretion as potently as carbohydrate but does not increase plasma glucose concentrations in type 2 diabetes. 1

• This insulin-stimulating effect means protein powder should never be used to treat or prevent hypoglycemia 1, 5
• Carbohydrate sources high in protein should not be used for hypoglycemia treatment because the concurrent insulin response can worsen hypoglycemia or delay recovery 6
• Treat hypoglycemia with 15-20 grams of pure glucose or carbohydrate sources without significant protein content 6

Kidney Disease Considerations

For patients with diabetic kidney disease (microalbuminuria or macroalbuminuria), do not reduce protein below 0.8-1.0 g/kg body weight. 1

• Reducing dietary protein below usual intake does not alter glycemic measures, cardiovascular risk measures, or the course of GFR decline 1
• Patients with GFR <60 mL/min/1.73 m² do not show faster decline of kidney function with protein intakes around 0.8 g/kg body weight compared to lower intakes 2
• The relationship between protein intake and albumin excretion rate is very weak except in hypertensive patients with uncontrolled diabetes 3

Common Pitfalls to Avoid

Do not restrict protein below 1 g/kg body weight in diabetic patients without chronic kidney disease. 3

• The misconception that protein converts to blood glucose and worsens glycemic control has been disproven 4
• The misconception that high protein intake causes diabetic kidney disease has been disproven 4
• Long-term effects of very high protein diets (>20% of calories) on LDL cholesterol and kidney function remain unknown, so assess renal function before recommending increased intake 5, 6
• Monitor blood glucose closely if supplementation is initiated, as protein stimulates insulin secretion 5

Practical Implementation

Calculate protein needs based on body weight and clinical context rather than using a one-size-fits-all approach. 3

• Weight-stable patients under 65: 0.8-1.3 g/kg body weight 2
• Weight-stable patients over 65: aim for upper end of range (15-20% of energy) 2
• Weight loss in obese patients with normal kidney function: 1.5-2 g/kg body weight 3, 4
• Patients with kidney disease: 0.8-1.0 g/kg body weight 1
• Focus on whole food protein sources as primary intake, using protein powder as a supplement when dietary intake is insufficient 5