There have been a few articles come up recently that talk about the dishonesty of some supplement companies using a practice referred to as “protein spiking”- essentially using single amino acids and other substances instead of whole proteins in an attempt to cut costs, thus altering (reducing) the true total protein content of the product (as compared to what is on the label).  As a consumer, I consider this a rip off.  But as a Registered Dietitian, I consider this a much bigger problem.

Before I go any further, let me first explain exactly what it means to be a Registered Dietitian.  Many people do not understand the difference between “nutritionist” and “registered dietitian (RD).”  Believe it or not, in many states, anyone can call themselves a “nutritionist.”  There really is NOT a ton of regulation for the use of that title or the training required.  On the contrary, Registered Dietitians (RD’s) are required to have a four year college degree with a specific subset of mandatory coursework.  In addition to an extensive list of nutrition courses, RD’s are required to take biology, chemistry, biochemistry, organic chemistry, and anatomy and physiology to name a few.  Upon completion of this coursework and a four year degree, RD’s complete a year long supervised practice internship within the nutrition field, a good part of which is spent in an acute care hospital setting working with doctors and pharmacists to treat patients with a broad range of medical conditons.  A HUGE part of the training to become a Registered Dietitian is learning the biochemistry behind specific disease states and the subsequent appropriate nutrition therapy.    Thus, we don’t just learn about “eating healthy” and “weight loss”- we learn a whole lot more about science and medicine. 

So with all that being said, I’m going to put on my “Clinical RD” hat for a minute and get back to the topic as to why this “protein spiking” is especially concerning to me.

In an attempt to reduce costs, some supplement companies have decided to put large amounts of free amino acids instead of whole proteins into their products.  This is done because protein in food products is often measured based on nitrogen content, and free amino acids contain nitrogen.  The difference is, single amino acids do not provide the same nutritional content as complete proteins (which contain ALL of the essential amino acids), and thus are not utilized in the body the same way. Although we typically associate protein powders with those looking to build muscle, not all protein supplement users are athletes or gym goers.  Some health conditions require an increased protein intake and often these patients will use protein supplements.  So if I have a patient that requires a specific amount of protein each day for something more significant than just a desire to build muscle, such as healing a major wound or recovering from a severe burn injury, and that patient uses one of these mislabeled protein supplements, he or she is not going to get the results we would anticipate and his/her health may be further compromised.

But aside from the mislabeling issue, are there in fact possible health risks associated with these “spiked proteins?”  Well, that has a lot to do with which amino acids in particular these companies are using to spike their products.   The article that I had initially read stated that companies were using the amino acid glycine in their products.  Glycine is a relatively cheap, non-essential amino acid, which means it can be synthesized within the body (from serine) with a sweet taste, often used in flavoring.  Glycine is metabolized in three different pathways within the body.  In one of those pathways it is eventually metabolized to oxalate which is a major component in a common type of kidney stone.  

Now realistically, in an individual with healthy kidney function and a well balanced diet with adequate fluid intake, this shouldn’t pose too much of an issue.  However, in a person with compromised kidney function or in someone prone to or at higher risk for calcium oxalate stones, this could theoretically be a major concern.  Additionally, looking at the dietary intake of a person who we would typically expect to use protein supplements (athletes, fitness enthusiasts) we would most likely find that the individual is already consuming a high protein diet.  A high protein diet, especially from animal proteins, in and of itself can increase a person’s risk for kidney stones through a few different mechanisms.  One mechanism stems from the fact that the amino acid methionine, largely found in animal proteins,can increase calcium in the urine.  Combine this with a high glycine intake (from spiked protein powders) and that could potentially be cause for concern (increased calcium in the urine plus excessive glycine converting to oxalate = increased risk for calcium oxalate stones).  Furthermore, taurine was also listed as one of the amino acids used in spiking and some studies have shown that taurine has a potential diuretic effect.  This along with a high protein diet can lead to dehydration if a person is not drinking enough water and thus even further increase the risk for kidney stones.

One example of a population that this would be a huge concern for would be those people undergoing weight loss surgery, or other forms of gastric surgery (i.e. those performed to treat GI cancers).  The standard post-operative diet for sleeve gastrectomy and roux-en-Y gastric bypass patients consists largely of liquids, with a major emphasis on protein supplements.  It is typically recommended that these patients use high quality whey isolate supplements, however some patients cannot afford these products or simply do not like the taste and thus turn to other products on the market.  To make matters worse, a common post-operative complication of any GI surgery is dehydration.  I would hate to think that these patients are also now increasing their risk for kidney stones due to their clinically vulnerable post-operative state AND the use of mislabeled protein supplements. But it’s certainly feasible.

As if that weren’t enough, another major concern I have is the fact that some companies are using creatine monohydrate as a so called “spiking agent” in their protein supplements without necessarily listing it on the label.  The most recent studies have shown that as a supplement creatine is generally safe to use in recommended dosages in healthy individuals.  However it is recommended that creatine supplements NOT be used by people with compromised kidney function.  Patients that have End Stage Renal Disease (ESRD) requiring dialysis have increased protein needs due to the depleting nature of regular dialysis.  Some of these patients may decide on their own to use protein supplements to help support their body’s increased protein needs.  If such an individual were to unknowingly use a product that was spiked with creatine monohydrate, they may be putting themselves at risk for further compromise.  

Creatine supplements are also commonly used by both athletes and gym goers for their potential benefit in assisting with overall strength and performance.  As mentioned above, when used accordingly this is a generally safe practice.  However, if a person is already taking the recommended (or larger) dosage of creatine and unknowingly using a protein supplement that may have been spiked with creatine monohydrate, this could lead to a person significantly surpassing the recommended dosages and possibly increase the risk for health consequences.

When all is said and done, we as consumers have a right to know what is in the products we are buying.  Although the potential health risks associated with this “protein spiking” may be more pronounced in certain populations, I would still advise using great caution when it comes to choosing supplements.  It’s unfortunate that companies are getting away with both deceiving consumers and possibly putting consumers at risk, however you the consumer can do something about it.  Look for products that have undergone thorough third party testing, preferably by a reputable organization such as NSF or Informed Choice.  Choose brands that are known for having high quality standards.  Look at pricing schemes.  If a particular type of product generally falls within a relative pricing range among most brands and then there is an outlier that’s claiming to be the same type of product but it is being sold for much less, question it.  Check the labels of the products you are buying.  Read the ingredients.  If things don’t add up, question it.  Just because your favorite social media personality is promoting a specific brand or product does not necessarily mean its high quality.  Do your research.  Stay informed.  Because in the end it can make a big difference, and not just for your wallet, but for your health.