Dietary protein requirements for the average person are about 50g/day per the U.S. RDA, and 100g/day by European standards. Adequate dietary protein allows for:
Repair of tissues and cellular proteins: a daily necessity for normal physiology
Synthesis of important proteins by the liver: including transport proteins, which move hormones, minerals, and other important components through the blood
Immune cell regeneration: synthesis of new immunoglobulins and antibodies
Blood: generation of the blood protein hemoglobin which carries oxygen in the blood
In chronic illness, protein demands increase due to the body being under constant physiological stress. Stress hormones such as epinephrine and norepinephrine, degrade existing proteins and inhibit creation of new ones. The degradation of existing proteins, and inhibition of new protein creation can detrimentally affect every system of the body, worsening the chronic illness.
What this looks like:
1. Protein transporters line the entire gut and absorb various macro- and micro nutrients. When degraded, absorption of nutrients can be reduced during digestion.
2. Degraded proteins increase the amount of amino acids in circulation, stressing the kidney to excrete more nitrogen.
3. Degraded proteins may “hang around” and avoid cellular clean-up, leading to oxidative stress.
4. Inhibited protein creation can slow wound-healing, blood clotting, weaken the immune system, lead to hormone irregularities, among other things…
In addition to protein breakdown due to chronic illness itself, severely ill patients have the added concern of accelerated muscle loss, a process known as sarcopenia. Without allowing the forces of gravity to stress the body’s tissue, protein from muscle is rapidly lost, weakening bone with it. Astronauts know these effects well, and struggle to maintain muscle mass on expedition due to the zero-gravity conditions.
The loss of lower body lean mass in a bedbound patient can be 100-200 grams/week, with the effects most pronounced in the first few weeks (1). For the bedbound ME/CFS patient confined for months or years, the loss is substantial!
To maintain daily protein balance, intake must exceed those losses.
In general, it is customary best-practice to recommend exercise for bedbound patients to preserve muscle mass, but this is not an option for ME/CFS. So, severe, bed-bound patients must then increase dietary proteins, best from animal sources, at every meal. A prudent increase of 20-30%, or 120-130g/day, is recommended to maintain muscle tissue and support protein utilization at every organ system. These same recommendations can be made for less severe patients, without harm.
In addition to higher dietary protein intake, severely ill, bedbound patients may also consider supplements that preserve muscle tissue. Creatine is well known to preserve muscle mass in the elderly. Exogenous ketone powders are also promising in preventing lean muscle loss (3).
1. English, KL and Paddon-Jones, D. (2010) Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care. 13(1): 34–39. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276215/
2. Candow DG, Chilibeck PD, Forbes SC. (2014) Creatine supplementation and aging musculoskeletal health. Endocrine. 45(3):354-61. https://www.ncbi.nlm.nih.gov/pubmed/24190049
3. Deutz NE, et al. (2013) Effect of β-hydroxy-β-methylbutyrate (HMB) on lean body mass during 10 days of bed rest in older adults. Clin Nutr. 32(5):704-12. https://www.ncbi.nlm.nih.gov/pubmed/23514626