Nutrition Science, Marketing Nutrition, Health Claims, and Public Policy

Nutrition Science, Marketing Nutrition, Health Claims, and Public Policy explains strategies to guide consumers toward making informed food purchases. The book begins with coverage of nutrition science before moving into nutrition marketing, social marketing and responsibility, consumer perception and insight, public health policy and regulation, case studies, and coverage on how to integrate holistic health into mainstream brand marketing. Intended for food and nutrition scientists who work in marketing, manufacturing, packaging, as well as clinical nutritionists, health care policymakers, and graduate and post graduate students in nutrition and business-related studies, this book will be a welcomed resource.

• Includes case studies, points-of-view, literature reviews, recent developments, data and methods
• Explores intrinsic and extrinsic motivators for consumer purchasing behaviors
• Covers each aspect of “Seed to Patient pathway

• Language: English
• Publisher: Academic Press
• Release date: Apr 12, 2023
• ISBN: 9780323856164

Book preview

Chapter 1

Introduction

Dilip Ghosh¹, Diana Bogueva²,³ and R. Smarta⁴†,    ¹Nutriconnect, Sydney, NSW, Australia,    ²Curtin University Sustainability Policy (CUSP) Institute, Curtin University, Perth, WA, Australia,    ³Centre for Advanced Food Engineering (CAFE), the University of Sydney, Sydney, NSW, Australia,    ⁴Interlink Marketing Consultancy Pvt. Ltd., Mumbai, Maharashtra, India

Abstract

Health promotion is a set of actions to foster good health and wellbeing. Telling people how to look after their health is just one part of health promotion. There is a constant battle between the food and nutrition scientists versus the food advertisers and marketers. Advertisements and other marketing communications are extensively used, particularly in the food and nutrition domain. In addition to mass media advertising and public service announcements, messages are placed on product labels and television shows, and social media.

Keywords

Health promotion; food and nutrition; consumer; public service announcements; nutrition communication; branding and commercialization

Health promotion is a set of actions to foster good health and wellbeing. Telling people how to look after their health is just one part of health promotion. There is a constant battle between the food and nutrition scientists versus the food advertisers and marketers. Advertisements and other marketing communications are extensively used, particularly in the food and nutrition domain. In addition to mass media advertising and public service announcements (PSAs), messages are placed on product labels and television shows, and social media.

Research indicates that these health-related communications, such as product advertising, PSAs, and related marketing communications including deceptive promotion of health claims can have significant and measurable effects on consumer cognitions, emotions, and behaviors. Some messages enhance health by discouraging unhealthy or risky consumption; others do the opposite.

Consumer food purchase behavior is influenced by the quality inferred based on product characteristics, which can be differentiated into extrinsic (e.g., price, claims, and labels) and intrinsic (e.g., taste) factors. Food and nutrition advertising and related marketing communications are not always based on extrinsic and intrinsic characteristics. The true success of any product depends on many factors such as evidence-based science, marketing and communication, visibility on social platforms, consumer perception, and definitely, compliance with policy and regulation. In this book, we have been trying to focus on all these inter-connected issues and develop a consensus proposition for all stakeholders.

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†Deceased.

Part 1

Nutrition Science

Outline

Chapter 2 Evidence-based nutrition communication: opportunities and challenges

Chapter 3 Clinical applications of whey protein

Chapter 4 Prospects of using biologically active substances to prevent depression

Chapter 5 Nutrition needs for lifestyle changes and managing disorders

Chapter 2

Evidence-based nutrition communication: opportunities and challenges

Dilip Ghosh,    Nutriconnect, Sydney, NSW, Australia

Abstract

Nutrition communication can be defined as the process by which nutrition knowledge is converted into dietary change. Nutrition education and nutrition information are the two important attributes by which people are informed, and sometimes empowered. Nutritionists and dietitians have a great role to play in applied nutritional sciences by communicating and interpreting the science in a language that fits with the lifestyles of people to benefit their health. Due to the unprecedented consumer push, all media including print and electronic disseminate research outcomes involving certain foods and nutrients almost daily using many channels. The collaborative enterprise between the press and the public will likely lead to great benefits for society, increasing the credibility of scientific research, and the public’s knowledge, and ultimately leading to empowered, healthier populations. Clinicians, epidemiologists, and public health experts also play a key role in clarifying the findings of studies to the public.

Keywords

Nutrition; communication; social marketing; media; education; healthcare professionals; digital technology; dietitians and nutritionists

2.1 Introduction

Nutrition communication can be defined as the process by which nutrition knowledge is converted into dietary change. Two important attributes of nutrition communication are nutrition education—the process by which people are informed, and sometimes empowered by, nutrition information. But other actions are considered to improve peoples' diets such as restricting misinformation about nutrition or manipulating the composition, availability, or price of foods. Dietary goals for individuals and food-based dietary guidelines for populations constitute the starting point for nutrition communication, and obviously, if these could be more evidence-based we would be in a much stronger position to develop more effective nutrition communication.

Nutrition information is designed unilaterally in the education activities, whereas communication is a two-way process involving a sender and a receiver and allows a wider perspective with a feedback mechanism (Gavaravarapu, 2019). The process of communication also understands that people are individuals in communities, and they do not operate in a vacuum and that an individual’s food habits are influenced by his/her social, cultural, and economic milieu. An individual cannot be viewed outside the context of family, peers, social structure, community, culture and physical environment. A population-based approach to nutrition communication is complementary to an individualistic approach in theory, but in practice this is very crucial for attracting attention in food policy-making circles.

2.2 Exciting opportunities for dietitians and nutritionists

Nutritionists and dietitians have a great role to play in applied nutritional sciences by communicating and interpreting the science in a language that fits with the lifestyles of people to benefit their health (Goldberg & Hellwig, 2003). In today’s world, the role of the registered dietitian goes far beyond traditional settings. Every day, consumers and professionals access nutrition information through a variety of media such as television, radio broadcasts, newspaper, magazine articles, public health campaigns, websites, books, newsletters, and brochures, to name a few. Because of the growing public interest in nutrition, well-qualified dietitians are nicely positioned to disseminate nutritional messages, accurately, and effectively.

Interpersonal communication skills are essential to dietetic practice in both inpatient and outpatient settings (Cant & Aroni, 2008). Existing dietetic competency standards and continuing professional development programs are usually based on clinical skill acquisition (Cant & Aroni, 2008; Whitehead, 2015), and thought that skills are adequate. But one recent report demonstrated that dietitians have reduced confidence in the knowledge and use of these skills, particularly when dealing with people who are struggling to find the motivation to change their eating behaviors (Notaras et al., 2018).

2.3 Communication approaches

Currently, nutrition communication is regarded as an umbrella channel used for a wide array of education and other programs that aim to influence the nutritional status of individuals predominantly but sometime as a group. Some of the approaches developed, adapted, and implemented over the years are as follow:

2.3.1 Social marketing

The basic 3 principles of social marketing are used to trade products to consumers using selling ideas, attitudes, and c to the people. The strategy adopts the four ‘P’s of marketing - Product (here, behavior change or a shift in attitude), Price (the cost, in terms of time and effort, of changing behaviors), Place (enabling environment conducive to behavior change) and Promotion (reaching audience through suitable media and reinforcing the message)

2.3.2 Advocacy

Advocacy is a strong strategic effort involving a continuous and adaptive process of using available scientific evidence and information to develop convincing arguments for communicating to decision-makers, such as regulators and policymakers through various interpersonal channels and media. In countries where direct endorsement is restricted such as Australia, but advocacy model is in use to influence political and social leaders and healthcare professionals towards raising public opinion, adopt necessary policy changes and allocate resources for a cause (here nutrition).

2.3.3 Entertainment-education

Entertainment channels such as multimedia, television programs, radio programs, podcasts, games, films, music, and websites are integrating with nutrition lessons for educating and amusing the audience. This is not recommended as a standalone approach to bring about a behavioral change in consumers.

2.3.4 Media and nutrition communication

The general public around the world has enormous trust and confidence in media as a source of information. The real concern with some of the electronic resources and social media channels allowing dissemination of information without peer review and fact-checking and this could lead to confusion and mistrust of the public in terms of nutrition-related beliefs, perceptions, and behaviors.

Among traditional media, newspapers play an important role in disseminating information on various aspects of health and nutrition. Apart from the newspapers, other print materials used by research organizations, government, and international organizations as well as voluntary organizations for nutrition communication are flip charts, flashcards, pamphlets, posters, booklets, manuals, charts, and leaflets. These print media have been used with the intention that they would help reinforce other forms of nutrition communication, especially interpersonal methods. Despite being a dominant avenue for food advertising, more often, TV is seen as a vital source of health and nutrition information. More recently smartphone-based mobile applications (apps) are also the tools available for the users for providing interactive nutrition education, calorie counting, and activity tracking.

2.3.5 Tools

In today’s digital world, there are many tools available to researchers to inform the public, especially regarding nutrition and food science, to enhance understanding, and improve the ability of media, policymakers, and the public to judge credible research (Garza et al., 2019). The strategies and associated platforms available to the research community for translating and disseminating research findings are broadly classified as education, communication, and marketing. The relative effectiveness of these 3 approaches, used in isolation or combination, is an active area of research (NIH, WHO, 2014). The National Academies of Sciences, Engineering, and Medicine recently published Communicating Science Effectively: A Research Agenda, which encourages more attention to developing the science of science communication (The National Academies of Sciences E & Medicine, 2017). Effective dissemination depends on the nature of the information, including its practicality and utility. These include how it is delivered by the provider; and the interest, willingness, and ability of the recipient to accept and act on the information. The WHO has developed a Knowledge Translation Toolkit for disseminating targeted public health information (WHO, 2014). Nonetheless, scientific and media literacy remains a major gap for informed decision-making by consumers. It is accepted globally that among the numerous information sources, health care providers and academic-based nutrition scientists may be the most trusted sources for health or nutrition information (Criss et al., 2015). The quality and accuracy of nutrition information vary markedly within and across these sources. Consistent and trustful exposure to nutrition information has the positive effect of raising the public’s awareness (van Dillen et al., 2003). Communication, marketing, and education are inextricably linked to effective dissemination and the uptake of scientific information and this is very unlikely that any single-pronged approach will be effective.

2.4 Food labels as a medium of nutrition communication

Food labels are one of the potentially powerful tools of communication to promote public health nutrition. The nutrition-label panel provides much information to the public to make healthier choices. However, in some countries where literacy level is limited, the question is, how useful is the nutrition information provided on the pack if the individual is not able to understand the significance of numbers/symbols printed on the pack? There is a need to promote nutrition literacy first and take up consumer education activities alongside experimenting with newer symbol-based forms of labeling for easy comprehension.

2.5 Communication issues

In the digital era, communicating the findings of scientific research to the public has become easier and faster than ever before. Bombarding Information to target or mass people almost 24 h a day through many channels, including mass media, the internet, social networks, and even smartphone (WhatsApp) chat groups. Most of these channels are also used to disseminate the results of scientific studies to the public, almost immediately after their publication in scientific journals (Hart et al., 2017; Jang et al., 2017; McClain, 2017).

Communication of research findings to the community is an essential part of research work, and the current information dissemination routes represent an extraordinary opportunity for science. Nevertheless, the current scenario also involves novel challenges (Ventola, 2014), such as over- and under-representation, selective dissemination, and hiding the facts of methodological limitations of research. These issues are important as they may have implications for the public’s health, and for the effectiveness of future preventive and health promotion campaigns and policy development.

2.6 Issue #1: communication bias

The combination of outcomes from statistically significant and null findings is known as publication bias (Turner et al., 2008). But most scientific journals tend to be more willing to publish the former rather than the latter. This communication bias can yield an additional layer of reporting bias to the dissemination continuum, since the general media tends to cover (selective) the research findings which already been published. For example, the media usually tends to pay greater attention to studies involving popular substances (e.g., tea, coffee, chocolate, fish oil), and link to positive health connotation which general population likes. To reduce this bias, the media should consider the findings from systematic reviews and meta-analyses rather than from single studies before disseminating through their channels. This would allow providing more complete, nuanced information to the public, without losing novelty and impact.

2.7 Issue #2: inconsistent results and implications for the credibility

In recent years, some skepticism towards nutritional observational research has been observed, even among healthcare professionals and researchers. As a result, these findings are increasingly facing the public’s reluctance (Penders et al., 2017). Researchers have been implementing many efforts, such as very large, well-characterized cohorts; the conduct of systematic reviews, meta-analyses, and umbrella meta-analyses (Poole et al., 2017), but still the frequent observation of inconsistent findings are surfaced across studies (Gunter et al., 2017).

2.8 Issue #3: isolated exposures—but real life is unadjusted

Many of the health effects of many foods are disseminated based on limited exposure studies where a true, un-confounded protective health effect of a given food or substance is overlooked. Careful communication of research findings, together with the integration of results from other studies, may allow better dissemination of these nuances, potentially maximizing the health benefits of recommendations while minimizing the potential harms.

2.9 The miscommunication: the other side of the coin

The perception among many researchers is that public trust in nutrition science is eroding, mostly due to the increasingly rapid dissemination of information regardless of quality. The entire ecosystem of nutrition information and communication is constantly struggling with shortcomings, such as opportunism, and in some cases fraud. News media sources often do not provide enough detail or content for consumers to discern the veracity of research findings, and a good number of well-aware consumers are being confused by news reports.

2.10 Are consumers really confused?

Mainstream media continue to report that consumers are confused because nutrition advice is always changing to explain resistance to change (Goldberg, 2000). The best example is the controversy of eating butter versus, margarine. Another example is the health benefits or bad effects of drinking coffee. The real reason for the consumer confusion is the fact that the media continue to avidly report the so-called results of current research (especially the findings of epidemiologic studies) without considering the cause and effect relationships. In most cases, they depend on the rigor of the experimental design but without commentary, context, or interpretation. There should be two-way communication between nutritionists and media to disseminate research about food, nutrition, and health in a method that is responsible and contextual and teaches consumers to examine more critically what they read or hear.

2.11 Digital technology and nutrition communication

Digital technology is so powerful now that contributes to framing the social world through individual–technology dynamic interaction and influencing how people understand and experience it with the opportunity to create content on food and nutrition and share it online (Granheim, 2019; Granheim et al., 2020).

It has been suggested that the sum of digital influences on health and nutrition goes beyond social media, digital health promotion interventions and digital food marketing are creating a new layer to food environments, the digital food environment (Granheim, 2019).

The evolving science-communication landscape has imposed extreme challenges to the credibility and trustworthiness of nutrition and health communicators. In today’s Internet-mediated democratization of expertise, where every blogger and website owner becomes a subject-matter expert (self-proclaimed), has been problematic for genuine science communicators (Rowe & Alexander, 2018).

2.12 The success of the use of social media in nutrition interventions

Maintaining a healthy diet is a challenging task for adolescents (ages 10–19) and young adults (ages 18–25) (Dick & Ferguson, 2015). American national health surveys demonstrated that over 80% of adolescents are not meeting recommendations for a healthy diet. Over time, this can lead to greater risks for cardiovascular disease, diabetes, and other chronic diseases. The survey showed social media is potentially engaging individuals, particularly adolescents and young adults in maintaining healthy diets and learning about nutrition (Chau et al., 2018).

In recent years, nutrition education interventions have increasingly relied on computing and information technologies, particularly mobile platforms and social media (DiFilippo et al., 2015), particularly for adolescents and young adults, as they exhibit high levels of smartphone and social media usage (Smartphone Ownership Highest Among Young Adults, 2015). Novel computing and mobile-based platforms are also very popular to facilitate counseling and communication with clinicians and encourage behavior logging and self-assessments (Ajie & Chapman-Novakofski, 2014). Friends and social media groups play more influential roles in adolescence and young adulthood (Fortin & Yazbeck, 2015) than family members (Bruening et al., 2012; Christakis & Fowler, 2007; Wouters & Geenen, 2013).

The overall results show that use of social media in public health interventions for improving nutrition education and interventions among adolescents and young adults is limited but promising (Chau et al., 2018).

2.13 Nutrition communication and social determinants

Substantial evidence now indicates that well-designed public health communications to prevent risky behaviors and promote healthy behaviors can be successful in a variety of health areas, including smoking, energy balance, cancer prevention, and early detection and treatment. The impact of social determinants such as socioeconomic status, social integration, race and ethnicity, place, environmental support, and social policies—on individual health behaviors including dietary habits and interventions has a significant impact (Viswanath & Bond, 2007).

2.14 Cultural sensitivity in nutrition communication

Migration to a Western country is often associated with the adoption of less healthful dietary habits and a higher risk of obesity and related disorders, generally called nutrition transition. The development of increasingly multicultural societies creates new challenges for health promotion initiatives with one nutrition policy and framework. There is a growing recognition that effective health communication must be culturally sensitive (Garnweidner et al., 2012). Attributes of cultural sensitivity have been described as knowledge, consideration, understanding, respect, and tailoring. Studies indicated that the dietitians and other health care professionals during professional service delivery must consider a wide range of factors related to individual identity, background, religious beliefs, and context.

2.15 Nutrition labeling on food purchases

The nutrition facts label is a crucial source of information for consumers for nutrition- and health-related information on food products (An et al., 2021; Miller L & Cassady, 2015). This guides consumers in the identification and selection of healthier food items that are nutrient-rich and low in energy density (Roberto C & Khandpur, 2014). However, nutrition labeling around the world has been criticized as being less visible, difficult to comprehend, and of limited effectiveness (Abdukadirov, 2018). Front-of-package (FOP) nutrition labels use simple symbols with highly visible logos and numbers that can easily detect during the point of purchase whether their food choices are healthy or not (Department of health, the food standards agency in Scotland, Northern Ireland, & Wales, 2016; Malam et al., 2009; Thorndike et al., 2014). Another FOP label is the Australasian health star rating system (Hamlin & McNeill, 2016). The health star rating system is based on many stars, one-half (least healthy) to five-star (most healthy), with more stars indicating a higher nutritional value of the food. The health star rating system considers the energy and contents of the food in terms of both positive (e.g., protein, dietary fiber, fruit/vegetable, and nut/legume) and negative (e.g., saturated fat, sugar, and sodium) components (Hamlin & McNeill, 2016). Indeed, other FOP labels exist, such as health warning labels, high sugar labels, and daily intake guides. The health warning labels generally prevent misinterpretation of the information presented through the use of highly explicit messages (Health Canada, 2016). The daily intake guide was first implemented by the Australian food industry, in which the percentage of an individual’s recommended daily intake is provided for each of the primary nutrients of the food item (Australian Food & Grocery Council, 2019).

Medium to large-scale, population-representative RCTs has demonstrated the effect of FOP labels on population subgroups and the mid-to-long-term efficacy on purchase behavior modification. One recent review article (An et al., 2021) found FOP labels are effective for participants to make healthier food purchase decisions when they used traffic lights labels, health warning labels, and symbol labels.

Nutrition density is another issue that may require a more holistic approach. Still, there is strong debate on how to use nutrition density issues along with restricting single nutrients in public health messaging internationally. There is a lack of consensus on the precise definition of a nutrient dense food or which nutrients should be used as markers of healthiness,, particularly for children (Lockyer et al., 2020).

2.16 The state of nutrition education and communication for and by physicians

The general practitioner (GP) is being more and more confronted with patients who suffer from nutrition-related diseases, like coronary heart disease, type 2 diabetes, and obesity. In most countries, GPs are uniquely positioned to provide effective health promotion advice about nutrition. Based on published research, five nutrition communication styles are identified, namely informational, reference, motivational, confrontational, and holistic style (Sonja et al., 2006) and different country has their own set of style (s).

In a 2018 survey of University of Florida physicians (92%), only 25% knew the American Heart Association recommendation for vegetable and fruit intake while 46% knew the recommendation for physical activity (Aggarwal et al., 2019). A recent UK study demonstrates considerable variability in the number of nutrition-related learning objectives in UK postgraduate medical training (Ganis & Christides, 2021). Improvement of nutrition-related competencies in graduate and postgraduate medical training is a growing area of research and interest in health care and education of health care providers. While the National Academy of Sciences recommends 25 h of nutrition education in medical schools and the American Society for Nutrition recommends 44 h, the current average is less than 20 h (Adams et al., 2015). In 2019, JAMA Internal Medicine published an opinion article by Dr. Neal Barnard entitled, Ignorance of Nutrition is No Longer Defensible (Barnard, 2019). In this article, he describes a case in which a diabetic patient is discharged from the hospital without no mention of nutrition—the root cause of the disease and related comorbidities and complications. The need for nutrition as the foundation of health care is now widely recognized by health care professionals and the public. Despite appreciating the importance of nutrition in general and in chronic diseases, clinicians seldom counsel their patients on nutrition issues (Frame, 2021).

Medical education remains insufficient to support clinicians to provide nutrition care as part of routine clinical practice (Crowley et al., 2019) and many organizations are calling for improved nutrition education for physicians (Food Law & Policy Clinic, 2019).

2.17 Conclusion

In this century, the world is ever more interconnected, and widespread dissemination of scientific research findings to the public has become instantaneous through a digital platform. Due to this unprecedented consumer push, all media including print and electronic disseminate research outcomes involving certain foods and nutrients almost daily using many channels. Also, in an era of mass media and post-truth (Higgins, 2016; McCartney, 2016), an informed and mature readership is more necessary than ever. The public and the media should become familiar with concepts such as bias, validity, confounding, or reverse causation – among others. This would enhance the ability of readers to critically evaluate the information being communicated, identifying methodological and communication flaws before implementing any lifestyle changes or changing their food choices based on the reported information.

The collaborative enterprise between the press and the public will likely lead to great benefits for society, increasing the credibility of scientific research, and the public’s knowledge, and ultimately leading to empowered, healthier populations.

Clinicians could help their patients to interpret the results of scientific research. Epidemiologists and public health experts also play a key role in clarifying the findings of studies to the public, however, often they do not get as much media coverage as the press releases. Therefore, authors, editors, press offices, and the media should work collaboratively to ensure that the information that is provided to the public is accurate, balanced, comprehensive, and as free of bias as possible.

Globally, 11 million deaths are attributable to suboptimal diet annually, and nutrition care has been shown to improve health outcomes (Lepre et al., 2021). A combination of integrated, multi-component, and multi-media approaches is likely to be more successful than a single approach. The nutrition-related policy should be developed and customized based on the socio-economic scenario of the country.

Lockyer et al. (2020) have recommended the following directions to improve nutrition science communication and related knowledge and shape opinions:

• True and validated discussion, particularly in social media.

• Consistent messages and tones across different stakeholders.

• Bridging the trust gap by focusing on positive messaging, using emotions, and showing human faces.

• Using a range of communication channels, for example, printed/television/radio/social media, as these reach different demographics.

• Including experts, for example, educators, behavioral scientists, journalists, and social media influencers, rather than politicians and businessmen.

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Cainzos-Achirica et al., 2018 Cainzos-Achirica M, Bilald U, Al Rifai M, et al. Communication issues in nutritional observational research. Preventive Medicine. 2018;115:76–82.

Granheim, 2017) Granheim, S.I. (2017). The digital food environment. UNSCN Nutrition 2019;44:115–21 Health Canada. Front-of-package nutrition labeling. Available from https://www.dietitians.ca/Downloads/Public/Front-of-Package-Nutrition-LabellingSept2017.aspx Accessed April 2022.

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Chapter 3

Clinical applications of whey protein

Nikhil Kelkar,    Clinical Nutrition Excellence Academy, Hexagon Nutrition Ltd., Mumbai, Maharashtra, India

Abstract

Whenever we come across the word Whey Protein, we immediately tend to associate it with Body Building or Sports Nutrition. Though a lot of Whey protein is consumed for the above two applications, quite a lot of it is used for meeting day-to-day nutritional needs and clinical nutrition as well. Among the protein sources available, whey protein has a protein digestibility–corrected amino acid score of 1.0 and biological value of 104 making it the most easily digestible and assimilated protein. It is easily broken into constituent amino acids and hence, is available for muscle accrual post exercise or faster recovery after an injury or surgery. This makes it a very versatile protein with numerous clinical nutrition applications.

Keywords

Whey protein; high biological value; branched chain amino acids; clinical nutrition

3.1 Introduction

Whenever we come across the word Whey Protein, we iccly tend to associate it with Body Building or Sports Nutrition. Though a lot of Whey protein is consumed for the above two applications, a lot of it is used for meeting day-to-day nutritional needs and clinical nutrition application as well. Among the protein sources available, whey protein has a protein digestibility–corrected amino acid score (PDCAAS) of 1.0 and biological value (BV) of 104 making it the most easily digestible and assimilated protein. It is easily broken into constituent amino acids and hence, is available for muscle accrual post exercise or faster recovery after an injury or surgery. This makes it a very versatile protein with numerous clinical nutrition applications.

With all these different applications, usage of Whey Protein is increasing day by day. The Global Whey Protein market is estimated to grow from approximately 8 Billion USD in 2019 to 18 Billion USD by 2027.

As we write this book, we are going through the COVID-19 pandemic which has claimed millions of lives globally and the aftereffects are still not predictable. Consumers are seeking to gain more control over their health with an increased focus on proactive dietary changes and supplement use. Furthermore, we are now more used to ordering online which has increased access to different products and brands in the same category, which was not the case otherwise when you had to physically go to a supermarket, etc., to buy it. In my routine interactions with consumers, dietitians, food technologists, and researchers, I am increasingly seeing the interest in whey protein, when it comes to contribution to health, disease-specific nutrition, and performance.

Ranging for a variety of applications, Whey protein is being made available in different forms like:

1. Powders

• Pure isolates and concentrates- flavored, and non-flavored

• Specially formulated nutrition supplements with other macronutrients like fats and carbohydrates and micronutrients like vitamins and minerals intended for special dietary use.

2. Liquids

• Ready to drink nutrition formulas for clinical and sports applications

• Ready to drink whey protein shakes

• Ready to drink whey protein water/sparkling water

3. Functional ingredient

• Whey proteins are now increasingly added as a functional ingredient in a variety of cereal-based convenience foods such as oats nutri-bars, ready-to-cook pancake mixes, biscuits, chocolates, and mousse to enhance their protein value.

In sports nutrition, Whey protein is more popular as its rich in branched chain amino acids (BCAA) and also contains tryptophan and cysteine which are essential for muscle recovery. L-tryptophan a precursor for 5-hydroxy-tryptamine is known to enhance endurance and perceived level of effort at a task. Pre-exercise supplementation is associated with improved exercise times and lower perceived exertion rate along with better pain tolerance. Take a small amount before going to the gym or starting a long endurance ride (e.g., 10 g at 30 min before exercise), with a larger dose of 20 g immediately on completion of the exercise.

Whatever level or field of sport, preparation for a return to normal competition requires a carefully directed training and nutrition program, incorporating plenty of protein to help avoid weight gain, and maintain lean muscle mass. Whey protein will have a key role to play in both rebuilding muscle and improving recovery.

Today whey protein is not just sought after by exercising individuals, but those aiming at a healthier and active lifestyle as well. Whey protein sees remarkable application in the wellness category catering to women, healthy aging, children trying to meet nutrient gaps, fussy eaters, and working individuals looking for nutrition on the go. No wonder, on the supermarket shelves, we are seeing everything from Whey Protein Water to Whey protein fortified chocolates, chips, biscuits, bars, etc. In addition to the nutritional benefits, it has a neutral taste and good miscibility, giving good sensory acceptance across ages, and conditions. Consumers are now aware of the importance of protein in the diet and look for ways to include a high biological value protein in their diets. Whey protein is considered a gold standard in proteins and has versatile applications.

In our body, there are direct storage reserves for Carbohydrates and Fats, however, there are no direct storage reserves for protein. Muscle mass contains 85% protein on a dry weight basis and muscle breakdown happens as a day-to-day wear and tear and more so, post an exercise or hypercatabolic conditions like chronic disease conditions. Rebuilding muscle to improve strength, growth, and endurance requires extra protein, and the only way to do it without detriment to other tissues is to obtain it as dietary protein. Along similar lines, the usage of whey protein in clinical conditions such as sarcopenia and other disease-specific conditions is outlined in the next few pages.

3.2 Whey protein and its types

Whey is the liquid by-product of milk processing that has various nutritional applications in the health supplement industry (Hoffman & Falvo, 2004; Patel, 2015). It is a rich source of bioactive compounds like antioxidants, and essential amino acids, particularly the branched-chain amino acids, immunomodulatory molecules, and other functional peptides (Patel, 2015). Whey can be obtained from different kinds of milk like buffalo, cow, or goat milk but predominantly it comes from cow milk or bovine milk. The organic composition of the whey depends on the source and the level of processing (Ramos et al., 2021). Whey is processed using different methods to obtain varying grades of protein. Depending on the process of coagulation used there are two types of whey protein viz., rennet whey (pH of 5.6 or more) and acid whey (pH usually below 5.1) (Ramos et al., 2021). Based on the concentration and attributes of the whey protein, three main types of whey protein are used in clinical products. Whey protein concentrate is a concentrated form of whey that contains 2%–89% protein along with some fat and lactose. Whey protein isolates on the other hand is a purer form of whey giving 90%–95% protein and negligible amounts of lactose and fat. Whey protein hydrolysate is like whey protein isolate and is the partially digested form of whey with enzyme treatment, suitable for people suffering from poor digestibility and hypo-allergenicity (Patel, 2015).

Whey protein has many clinical applications in the food and supplement industry owing to its nutritional characteristics and neutral flavor. It also has good gelation properties, thermal stability, foaming, and emulsification properties making it suitable for a wide variety of nutraceutical products like food supplements, beverages, bakery applications, energy bars, and yogurts (Patel, 2015) (Table 3.1).

Table 3.1

3.3 Components of whey protein

Whey forms about 20% of the milk protein and is further processed to obtain various grades of whey protein (Hoffman & Falvo, 2004). Lactose forms the major portion of the whey followed by protein, minerals, and other lipids. The lactose in whey promotes the absorption of minerals such as calcium, magnesium, and phosphorous. A typical whey protein concentrate has protein in the range of 35%–80% along with lactose and other minerals. Further processing and purification give higher protein content of 90%–95% and negligible amounts of lactose as seen in the whey protein isolates or hydrolysates. The whey protein is a globular protein with lactoglobulin chains-α (12%–25%) and β (35%–65%) and various other immune-modulatory substances (Hoffman & Falvo, 2004) like immunoglobulins (10%), bovine serum albumin (10%), lactoferrin (3%), and lactoperoxidase (0.3%) (Ramos et al., 2021). A typical composition of whey protein is given in Table 3.2 (Hoffman & Falvo, 2004). It is also a rich source of BCAA viz., leucine, isoleucine, and valine. Leucine is the predominant BCAA which acts as a precursor for the regulation of skeletal muscle synthesis (Hulmi et al., 2010).

Table 3.2

It is also a rich source of sulfur-containing amino acid cysteine which is a precursor for glutathione- a potent antioxidant (Hoffman & Falvo, 2004).

3.4 Bioactive peptides in whey

3.4.1 β-Lactoglobulin

β-Lactoglobulin is a predominate biopeptide in whey obtained from bovine milk and is absent in human milk (Marshall, 2004; Ramos et al., 2021). It is a globular protein that acts as a carrier for vitamin D, fatty acids, retinol, cholesterol, and calcium. It is stable at low pH and hence, protects these hydrophobic molecules from stomach acids during transport. It also plays a role in developing passive immunity with IgG (Immunoglobulin G) and has a rich amino acid profile that helps stimulate muscle growth. It also has cysteine which is a precursor for glutathione a potent antioxidant produced by the liver that has anti-carcinogenic properties (Ramos et al., 2021). It acts as a carrier for retinoic acid, a hydrophobic molecule, and also regulates the lymphatic system. It is a good source of essential and branched-chain amino acids (Marshall, 2004).

3.4.2 α-Lactalbumin

α-Lactalbumin is also a globular protein found in bovine as well as human milk (Marshall, 2004). It is rich in sulfur-containing amino acid cysteine which acts as a coenzyme for lactose. It has high tryptophan content (6%) which acts as a precursor for serotonin, which plays a role in cognition. α-lactalbumin is therefore indicated in the treatment of chronic stress-induced cognitive decline (Ramos et al., 2021). It is also a rich source of essential and branched-chain amino acids (Marshall, 2004).

3.5 Bovine serum albumin

Bovine serum albumin (BSA) is a larger protein that binds to fatty acids thereby protecting them from phenolic oxidation (Marshall, 2004; Ramos et al., 2021). Additionally, it has potent antioxidant activity that helps inhibit cell proliferation in breast cancer cells via the autocrine regulatory factors (Ramos et al., 2021). It is a good source of essential amino acids (Marshall, 2004).

3.6 Immunoglobulins

Immunoglobulins enter whey through mammalian physiological fluids. It offers antimicrobial protection to the gut against pathogenic microorganisms, confers passive immunity, and helps improve performance in sports persons by enhancing recovery (Ramos et al., 2021).

3.7 Lactoferrin

Lactoferrin is another globular protein present in whey that acts as a transport protein for iron. It possesses antimicrobial properties against bacteria, fungi, and viruses as well. It stimulates the humoral immune response via the production of antibodies and proliferation and stimulation of monocytes and neutrophils. It also enhances bone growth by promoting the growth of osteoblasts and inhibiting osteoclasts (Ramos et al., 2021). It promotes the growth of beneficial bacteria in the gut. It is naturally present in breast milk, and other body secretions like saliva, bile, mucus, and blood (Marshall, 2004).

3.8 Quality of whey protein

Whey protein is a complete protein with PDCAAS of 1.0 and a biological value of 104. Whey protein concentrate has a higher proportion of branched-chain amino acids with potent insulinotropic properties. The branched-chain amino acids - leucine, valine, and isoleucine - are more insulinogenic than other amino acids (Hoffman & Falvo, 2004). The comparison of whey with other high-quality proteins is given in Table 3.3. Whey protein has better biological value than egg and hence, it is considered a gold standard protein in clinical applications.

Table 3.3

Source: Adapted from: U.S Dairy Export Council, Reference Manual for US Whey Products 2nd Edition, 999 and Sarwar, 1997.

Whey protein has a higher proportion of branched-chain amino acids than casein and soy. It is more soluble in the acidic environment of the stomach, leading to more rapid digestion which is a desirable trait as far as proteins are concerned. In a recent comparison of two protein sources, the greatest postprandial insulin response was associated with whey compared to casein and was attributed to the more rapid appearance of amino acids in plasma when derived from whey (Sarwar Gilani et al., 2012). The comparative amino acid profile for whey along with other commonly used protein sources is given in Table 3.4. Whey being an animal protein contains all essential amino acids and is a complete protein unlike soy or pea protein. The amino acid profile of whey is better than egg and milk protein.

Table 3.4

Whey is also called a fast protein as it shows rapid gastric emptying, intestinal hydrolysis, and absorption. It essentially forms soluble aggregates during the gastric phase of digestion causing a higher amino acid pool post prandially and faster absorption and accrual in the muscle. Caseinate, on the other hand, forms coagula and shows delayed gastric emptying. Hence, whey is the preferred source of protein for faster recovery in clinical applications (Bilsborough & Mann, 2006).

Whey is preferred over Casein and Soy because of the differences in the amino acid composition and absorption kinetics between the two proteins. Whey protein has the highest absorption rate followed by casein and soy protein isolate as shown in Table 3.5.

Table 3.5

3.9 Mechanism of absorption of whey protein

Whey Protein Concentrate (WPC) and Whey Protein Isolate (WPI) are high biological value proteins that are fast absorbed and readily assimilated, thereby rapidly increasing the postprandial amino acid levels after ingestion. This makes it suitable for use in athletes or sportspersons post work out as well as in malnourished and hypercatabolic states for recovery and growth purposes (Ramos et al., 2021).

Whey is a rich source of cysteine which acts as a precursor for a potent intracellular antioxidant- glutathione. Cysteine helps prevent oxidative tissue damage due to its sulfhydryl thiol group. The antioxidant properties of glutathione in whey are being considered for its anti-aging properties as well. Glutathione being an endogenous antioxidant helps prevent lipid peroxidation. It also scavenges reactive oxygen species (ROS) like hydrogen peroxide. Consumption of whey protein increases the intracellular glutathione levels which may be beneficial in various disease conditions. Lactoferrin present in whey is known to activate innate immunity and enhance macrophage cytotoxicity. It activates the neutrophils, and natural killer cells (NK cells) and induces colony-stimulating factor activity. In addition to antimicrobial activity, lactoferrin is known to chelate iron, thereby denying the essential nutrient for growth to the microorganisms. It also acts as an antimicrobial agent for Gram-negative bacteria by acting on their lipopolysaccharide layer. Lactoferrin also has anti-inflammatory properties and helps modulate the tumor necrosis factor (TNF) and Interleukin 6 (IL-6) thus reducing inflammation and mortality rates (Marshall, 2004).

Lactalbumin has iron-chelating properties and also can chelate heavy metals, thus, reducing oxidative stress. Certain bio-peptides in whey such as beta-lactoglobulin are known to reduce blood pressure. Beta-lactoglobulin also inhibits the conversion of angiotensin I to angiotensin II (vasoconstrictor). It also has other cardio-protective benefits like lowering cholesterol by changing the solubility of micellar cholesterol in the intestine (Marshall,