Browsing the protein selection

Erin Russell shares her insights into the various sources of dietary protein and emerging trends in plant-based meat alternatives.

With a large movement towards plant-based diets for ethical, sustainability, cost or perceived health benefi ts, it can be difficult to navigate the most appropriate protein source for your diet, especially if you have infl ammatory bowel disease. We spoke with dietitian Erin Russell to learn more about the potential benefi ts and concerns in sourcing protein from the diff erent options available.

Discovering protein: What is it and what are the suggested requirements?

Protein is one of the three macronutrients in our diet (protein, carbohydrates and fats). Protein has an important role in maintaining muscle mass and is used for building and repairing cells in the body. Guidelines suggest that people with IBD who are in remission have no increased protein needs compared to the rest
of the population. The Australian Guide to Healthy Eating recommends adults consume 2-3 serves of lean meat or alternatives per day (see below). This is slightly higher for males.

On the other hand, during a severe flare of IBD, protein requirements may increase by 20 to 50 per cent due to the body’s active inflammatory state and catabolic response. It can be difficult for you to estimate this increase yourselves, and clinical symptoms such as bowel habits, nausea and feeling unwell may decrease your intake. Dietitians use many clinical factors to estimate a person’s protein requirements, so it is recommended you seek a referral to an Accredited Practising Dietitian if you need further support in working out your protein needs.

What protein source is best when taking IBD into consideration?

a. meat and animal products
b. meat alternatives (i.e. processed vegetable protein to mimic meat)
c. whole plant-based protein

a. Meat and animal products (beef, lamb, pork, chicken, fish, seafood, etc. as well as dairy products and eggs)

Importantly, this group can be quite varied – from processed salami, to lean chicken breast, to eggs, to tuna – it’s difficult to comment on these as a group.

However, in general, processed meats, e.g. sausages, bacon, ham and salami, are categorised as ‘discretionary’ foods and it’s recommended that they should not be consumed every day. With current research trends in IBD and for general health, it is suggested these foods are avoided in large quantities. Meat and animal products are the most traditional source of protein in the Australian diet, and are a rich source of iron, B12 and zinc. These vitamins and minerals are also most easily absorbed from an animal-based source.

The link between animal protein intake and IBD has been explored but it is not well established. There is no convincing evidence to suggest that patients with IBD need to avoid animal protein, or that a vegetarian/plant-based diet is more beneficial.

b. Meat alternatives – ‘fake’ or ‘mock’ meat

Recent trends in plant-based diets has led to an increase in meat alternatives on the market. This includes products such as quorn, facon (fake bacon), mince, fake sausages/burgers/schnitzels/chicken pieces etc. These products can seem appealing as they are often easy to cook, have a meat like taste and texture, and are also a protein source.

The products may be made from various base ingredients such as soy, eggs, mushrooms, gluten, legumes and nuts. Often the products also need a number of preservatives, emulsifiers, salt and processing to achieve a meat like texture and flavour.

There have not been any specific studies for meat alternatives and their direct impact for patients with IBD, however some assumptions can be made based on their nutrition composition. Current research in Victoria around the impact of emulsifiers and sulphates suggest they may be having a negative impact for people with ulcerative colitis. For example, emulsifiers have only been studied in mice with IBD, but initial outcomes suggest that emulsifiers may have an adverse effect on gut bacteria and increase inflammation.

At present, there are no regulations for vitamin and mineral fortification in these plant-based meat alternatives. Therefore, the products may not reflect similar content of iron, B12 and zinc found in animal products. If plant-based meat alternatives become a direct substitute for animal products, then without supplementation, there is a risk of micronutrient deficiencies.

c. Plant-based protein – whole forms (lentils, beans, chickpeas, soy, tofu, tempeh, nuts and seeds)

Vegetarian and vegan diets have not been shown to be better for people with IBD, but there may be other reasons to choose these diets, such as environmental or ethical concerns.

Plant-based protein – largely from legumes, nuts, and seeds – has always been present in vegetarian and vegan diets. They are known to be high in fibre and protein, low in saturated fats and generally quite affordable. In terms of micronutrients, B12 is difficult to find, iron is not as easily absorbed and large portions are required to satisfy zinc requirements. Supplements may be required.

A few other considerations for plant-based proteins are that they:

• Are high in insoluble fibre, and may not be appropriate for patients following a modified fibre diet (e.g. stricturing Crohn’s disease)
• Have variable FODMAP (Fermentable Oligo-, Di-, Mono-saccharides And Polyols) content and large portions may not be tolerated well by people with IBS (irritable bowel syndrome) symptoms.

	Chicken breast (100g cooked)	Mock chicken breast (100g)	Firm tofu (100g)
Energy	690kJ	1070kJ	640kJ
Protein	31g	20g	17g
Sodium	75mg	500mg	10mg
Cost	$1.20	$3.80	$0.80

So, perhaps another option is more suitable:

d. It depends!

Avoiding whole food groups may leave you at risk of micronutrient deficiencies.

Risk and prevalence of missing out on vital nutrients is outlined on the CCA website: crohnsandcolitis.org.au/about-crohns-colitis/living-with-inflammatory-bowel-disease/diet/missing-vital-nutrients

Erin’s recommendations:

• Protein needs in IBD patients varies, depending on the disease state.
• There is no need to avoid meat or animal products but try to avoid processed meats.
• Meat alternatives provide little benefit to the diet – they are higher in preservatives, lack micronutrients, and are expensive. However, they can provide a protein source and may be convenient.
• Plant-based protein can be higher in FODMAPs, and portions need to be considered for IBS symptoms. They are high in fibre, and affordable.
• Some variety is ideal – this means including a variety of different nutrients and fibres for gut health.

As always, please seek assistance from an Accredited Practising Dietitian if you have any questions or concerns with your diet, or if you are planning to make a large change to your diet.

Ask your gastroenterologist or GP for a referral, otherwise you can search the Dietitians Association of Australia. https://daa.asn.au/find-an-apd/

About the author

Erin Russell is an Accredited Practising Dietitian within the Gastroenterology Department at Eastern Health in Melbourne. Working with hospital inpatients and outpatients, Erin has a
particular interest in the relationship between IBD and diet.