ABOUT MILK,
CALCIUM & BONE HEALTH.

What are the functions of the nutrients found in milk?

Energy: 129 calories (540 kJ) for 2% white milk
  Nutrient Nutritional Benefit
  Protein Builds and repairs body tissues, including bones; builds antibodies, the part of blood that fights infection.
  Carbohydrates Supply energy and assist in the utilization of fats
  Fat Assists in the absorption of fat-soluble vitamins
  Vitamin A Helps normal bone and tooth development; maintains the health of skin and membranes
  Thiamin Releases energy from carbohydrates
  Niacin Assists normal growth and development; maintains a normal nervous system and gastrointestinal tract
  Folate Contributes to red blood cell formation
  Pantothenic Acid Aids in release of energy from carbohydrates and in breakdown and metabolism of fat
  Phosphorus Helps in the formation and maintenance of strong bones and teeth
  Vitamin D Enhances calcium and phosphorus utilization in the formation and maintenance of healthy bones and teeth
  Riboflavin Maintains healthy skin and eyes maintains a normal nervous system; releases energy to body cells during metabolism
  Vitamin B6 Helps in many aspects of protein metabolism; and assists in the formation of red blood cells
  Vitamin B12 Contributes to red blood cell formation; helps maintain healthy nerve and gastrointestinal tissues
  Calcium Helps in the formation and maintenance of strong bones and teeth, promotes healthy nerve function and normal blood clotting
  Magnesium Maintains strong bones and teeth; helps in energy metabolism and tissue formation
  Potassium Helps in the correct functioning of nerves
  Sellenium A factor in the correct functioning of the immune system
  Zinc Contributes to energy metabolism and tissue formation

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What are the P4B nutrition recommendations based on?

P4B's nutrition recommendations are based on 2 documents: Eating Well with Canada's Food Guide (published in 2007) and the Dietary Reference Intakes (DRIs) for calcium (published in 2010). Canada's Food Guide recommends that children ages 9 to 18 consume 3 to 4 servings of from the Milk and Alternatives food group every day.

The Recommended Dietary Allowance (RDA, as per the DRIs) for calcium for children ages 9 to 18 is 1,300 mg per day. The upper end of the range - that is, 4 servings of milk or alternatives per day - provides about 1,200 mg of calcium, which is close to the RDA for calcium for this age group.

We will always refer to the upper end of the range of milk and alternatives servings recommended in Canada's Food Guide in the Power4Bones program because it comes closest to meeting the RDA for calcium for this age group.

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Why does the P4B program encourage grade 5 students to consume 4 servings of milk or alternatives every day?

Health Canada recommends that children ages 9 to 18 consume 3 to 4 servings from the Milk and Alternatives food group daily as per Canada's Food Guide. According to the Dietary Reference Intakes for calcium released in 2010, the Recommended Dietary Allowance (RDA) for children ages 9 to 18 is 1,300 mg per day.

In the Canadian diet, the Milk and Alternatives food group is the best source of calcium and other bone-building nutrients. One serving of milk or an alternative, such as 250 mL (1 cup) of milk, 170 mL (3/4 cup) of yogurt or 50 g (13/4 oz.) of cheese, provides about 300 mg of calcium, so 4 servings are needed to almost reach the requirement.

The additional 100 mg of calcium needed per day can easily be consumed when the child eats other foods containing small amounts of calcium (such as canned fish with bones, some vegetables and some legumes).

The 2010 RDA for vitamin D is 600 IU for people ages 1 to 70. To help meet vitamin D requirements, Health Canada recommends that all Canadians drink 500 mL (2 cups) of milk per day.

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The P4B recommendations are based on Canada's Food Guide, but isn't the Food Guide outdated?

A brand new Canada's Food Guide was launched in February 2007. The Food Guide is revised regularly and it is based on scientific research. It provides guidance on what we should eat and in what amounts to get all the nutrients we need. It also reflects the foods that are most available in our country.

250 mL (1 cup) of milk, 170 mL (3/4 cup) of yogurt or 50 g (13/4 oz.) of cheese are examples of one Food Guide serving of milk and alternatives. Canada's Food Guide currently recommends 3 to 4 servings per day from the Milk and Alternatives food group for children ages 9 to 18. The upper recommendation of 4 servings per day is most helpful in meeting the current calcium recommendation (1,300 mg per day) for this age group.

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Why is calcium so important?

Calcium is an essential nutrient. This means it is a nutrient our bodies can't make, so we need to get enough of it from the food we eat. Calcium helps to build strong bones and teeth. Calcium is also needed for muscles like the heart to contract, for blood to clot and for nerve impulses to transmit in the body.

Our bones act as a storehouse for calcium. If we don’t meet our calcium needs through the foods we eat, calcium will be withdrawn from our bones, which can cause bone weakness. Therefore, we need to stock our bones well when we are children and maintain them as we get older.

Foods from the Milk and Alternatives food group are all sources of calcium. However, only fluid milk also contains vitamin D, which helps our bodies absorb calcium and is just as important for bone health.

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What other nutrients, aside from calcium and vitamin D, are involved in bone health?

In addition to calcium and vitamin D, phosphorus, magnesium, vitamin A, fluoride and protein are all important for bone health. On behalf of the Canadian and US governments, the Institute of Medicine has set science-based recommended intakes for each of these nutrients.

These nutrient recommendations informed the development of Canada's Food Guide. We can meet the nutrient recommendations by eating the number of recommended servings of a variety of foods from each of the 4 food groups.

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Why is it important to get vitamin D through my diet?

Bones need more than just calcium to be strong. They need vitamin D to use calcium and optimize bone mineralization. Without vitamin D, our bodies absorb only about 10 to 15% of the calcium we eat. According to the 2010 Dietary Reference Intakes (DRIs), the Recommended Dietary Allowance (RDA) for vitamin D is 600 IU for people ages 1 to 70.

Other than fluid milk, the few food sources of vitamin D include liver, fish oils, eggs and fortified margarine. The mandatory fortification of milk with vitamin D in Canada in the 1970s was part of a national public health campaign to prevent vitamin D deficiency. Only fluid milk is required to be fortified with vitamin D. While cheese and yogurt are nutritious choices, they typically are not made using milk fortified with vitamin D.

Humans make vitamin D naturally when our skin is exposed to a sufficient amount and strength of sunlight, but certain factors block this process, including age, season, use of sunscreen, clothing and northern latitudes. Because of public health concerns about sun exposure and skin cancer, vitamin D recommendations are based solely on intake from food sources. Since food sources of vitamin D are quite limited, without fluid milk, it may be very difficult for older adults and young children to meet their vitamin D requirements.
In the new Food Guide, Health Canada recommends that all Canadians drink 500 mL (2 cups) of milk each day to help ensure they meet their vitamin D requirements. In addition to meeting food group serving recommendations, Canadians over 50 years are also recommended to take a 400 IU supplement of vitamin D daily (as we age, our bodies use vitamin D less efficiently).

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Is soy beverage high in calcium and Vitamin D?

Unfortified soy beverages contain, on average, 28 mg of calcium per 250 mL (1 cup) serving and no vitamin D, compared with 315 mg of calcium and 100 IU of vitamin D in cows' milk. Milk also has considerably more riboflavin and vitamins B5, B12, A and D than unfortified soy beverages do.

Health Canada does allow manufacturers to fortify soy beverage with nutrients (including calcium and vitamin D) to mimic the nutrient content of cows' milk. However, not all soy beverages are fortified with the same amount of calcium and/or vitamin D. Always check the product label to see how much calcium and vitamin D is provided per serving.

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How is goats' milk different from cows' milk?

There are more nutritional similarities than differences between goats' and cows' milk. They have a similar fat, protein and carbohydrate content, and both are excellent sources of calcium and riboflavin. Because the lactose content is similar, goats' milk is not any better tolerated than cows' milk by lactose maldigesters.

Unlike cows' milk, goats' milk contains very little folic acid, is low in vitamin B12, and is not fortified with vitamin D. Some processors may voluntarily add vitamins A and D to their product, but this is not required by law.

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What's the best type of milk for kids?

Whole or 2% milk is a good choice for most young children and whole milk is recommended by the Canadian Paediatric Society for infants up to 2 years of age. After age 2, the family's preferred type of milk is fine for children, although skim milk is not recommended for children under 5 years. The only difference between the different types of milk is the fat content; the nutrient composition is the same.

It is important to remember, however, that children need plenty of nutritious, energy-rich foods to grow and develop to their full height and size. Because fat is the greatest source of energy in the diet, it gives children, with their small tummies, more energy in a smaller amount of food. Canada's Food Guide reminds parents and caregivers not to restrict children's intake of nutritious foods because of fat content.

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If a child doesn't like milk, how can you ensure an adequate intake of calcium?

If your kids don't drink enough milk, you can help them get the nutrients and energy they need by serving a combination of foods made with milk (e.g., cereal with milk, milk and fruit smoothies, soup made with milk) or milk alternatives such as yogurt and cheese.

Check out the table of food sources of calcium below. If a child doesn't consume foods from the Milk and Alternatives food group, calcium requirements may be met, with careful planning, through other food sources. However, completely avoiding any food group can put individuals at risk of certain nutrient deficiencies.
Those who are concerned that they or their children are not getting enough calcium through food should speak to their doctor and a Registered Dietitian. These health professionals can advise you on an eating plan personalized to meet specific needs and can provide information on specific vitamin and mineral supplements if needed.

The calcium requirements for children are as follows:

Age Recommended Dietary Allowance, mg
1-3 700 mg
4-8 1000 mg
99-18 1300 mg
(source: Institute of Medicine. Dietary Reference Intakes for calcium and vitamin D. Washington, DC: National Academies Press, 2011.)
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How much calcium should children ages 9 to 18 consume each day?

From age 9 up to 18, the requirement for calcium is 1,300 mg each day. Children in this age group can easily meet their calcium needs by consuming the maximum recommended number of servings from the Milk and Alternatives food group in Canada's Food Guide (i.e., 4 servings per day).

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My teenagers won't drink milk because they think they will put on weight. Should they take a supplement?

Peak bone growth occurs during puberty/adolescence and getting enough calcium as a teenager can help prevent osteoporosis in later years. Children ages 9 to 18 require 1,300 mg of calcium per day. Experts agree that food is the best source of nutrients, and for calcium this means food from the Milk and Alternatives food group.

It is important for weight-conscious teens and adults to recognize that milk is not fattening. In fact, studies show that adequate or higher intakes of dietary calcium and milk and milk product consumption are associated with less body fat in children and adolescents.

Canada's Food Guide recommends that youngsters between 9 and 18 years consume 3 to 4 servings from the Milk and Alternatives food group each day. The upper end of the range (4 servings) provides about 1,200 mg of calcium per day - close to the current recommendations.

If a person doesn't consume foods from the Milk and Alternatives food group, he or she may meet calcium requirements, with careful planning, through other food sources. However, completely avoiding any food group can put individuals at risk of certain nutrient deficiencies. Other food sources of calcium that the body can absorb are listed in the table below.

Those who are concerned that they or their children are not getting enough calcium through food should speak to their doctor and a Registered Dietitian. These health professionals can advise you on an eating plan personalized to meet specific needs and can provide information on specific vitamin and mineral supplements if needed.

Can I get calcium from vegetables?

While some vegetables do contain calcium, you need to consider:
  • the quantity of calcium the food contains
  • the amount of calcium the body can absorb from the vegetable
  • the amount of the vegetable that a person would have to consume to meet calcium requirements
Vegetables that offer highly absorbable calcium include broccoli, kale and bok choy. However, we would have to eat at least 4.5 cups of raw broccoli to get the same amount of calcium we would get from 1 cup of milk!

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Are supplements a good source of calcium?

Although a calcium supplement does provide some calcium, supplements cannot replace a healthy diet because their nutritional value is not equivalent to that of calcium-rich foods such as milk. For example, milk also contains vitamin D, which helps the body absorb the calcium better.

In general, a diet low in calcium tends to be low in other essential nutrients. Those who are concerned that they or their children are not getting enough calcium through food should speak to their doctor and a Registered Dietitian. These health professionals can advise you on an eating plan personalized to meet specific needs and can provide information on specific vitamin and mineral supplements if needed.

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Does salt affect calcium loss in the urine?

There is evidence to suggest that excess dietary sodium can increase calcium loss in the urine. However, it is important to remember that even if we have a relatively high salt intake, our bones will remain healthy as long as our calcium intake is adequate. Have several servings of calcium-rich foods every day and minimize your intake of salt and salty foods and snacks, especially those that provide little nutrition.

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Should adults take a calcium supplement?

For most people, meeting food-group serving recommendations and eating a variety of foods from each of the food groups, as suggested by Canada's Food Guide, will provide all the nutrients we need each day. The average healthy person does not require vitamin or mineral supplements even on a stressful day.

Daily calcium requirements vary depending on age and sex. If you are eating the recommended number of servings from the Milk and Alternatives food group, then you can probably be assured that you are meeting your calcium requirements. If a person doesn't consume foods from the Milk and Alternatives food group, calcium requirements may be met, with careful planning, through other food sources. However, completely avoiding any food group can put individuals at risk of certain nutrient deficiencies.

Those who are concerned that they or their children are not getting enough calcium through food should speak to their doctor and a Registered Dietitian. These health professionals can advise you on an eating plan personalized to meet specific needs and can provide information on specific vitamin and mineral supplements if needed.

Health Canada does recommend that in addition to following Canada's Food Guide, adults over age 50 should take a vitamin D supplement of 400 IU daily.

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Does caffeine interfere with calcium absorption?

Too much caffeine can have a negative effect on calcium balance and bone health. However, studies show that those who get an adequate daily amount of calcium have greater protection against the possible adverse effects of caffeine on bone health. Following Canada's Food Guide and meeting Milk and Alternatives serving recommendations can provide the calcium needed for good health.

Health Canada recommends that children 12 and under consume no more than 2.5 mg of caffeine per kilogram of body weight per day. Based on average body weights of children, this means a daily caffeine intake of no more than:

  • 45 mg for children ages 4-6 (approximate amount of caffeine in a 355 mL/12 oz.) can of cola)
  • 62.5 mg for children ages 7-9
  • 85 mg for children ages 10-12 (approximate amount of caffeine in 2 355 mL/12 oz. cans of cola)
For teens 13 and over, Health Canada suggests the same guideline: no more than 2.5 mg of caffeine per kilogram of body weight per day. Adults should not exceed 400 mg of caffeine per day, which is equal to 3 or 4 cups (each 250 mL) of coffee a day.

Source: http://www.hc-sc.gc.ca/fn-an/securit/addit/caf/food-caf-aliments-eng.php

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Do high-protein foods rob the body's bones of calcium, leading to osteoporosis?

Current scientific evidence does not support the theory that high-protein food "steals" or leeches calcium from our bones. Evidence suggests that a high protein intake is not related to negative calcium balance or to other negative measures of bone health, including osteoporosis. In fact, protein intake has been shown to have a positive effect on bone health.

Canadians can meet calcium and protein requirements by following Canada's Food Guide. Generally speaking, eating foods rich in calcium throughout life, combined with regular weight-bearing exercise, has proven to be the best prescription for maintaining the health of our bones.

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What do magnesium, phosphorus, fluoride and vitamin A do for our bones and what foods contain these nutrients?

Magnesium, phosphorus and fluoride act like cement to help maintain bone strength. These minerals are found in many different foods. Magnesium is especially abundant in green, leafy vegetables; whole-grain products; milk; nuts; beans; bananas; and apricots.

Phosphorus is especially plentiful in meat, milk products, nuts, peas and beans. Most people get adequate fluoride from their local water supply if it has been fluoridated and from fluoridated toothpaste.

Vitamin A helps with bone remodelling (breaking down and rebuilding bone). Vitamin A occurs in some animal foods and in plant foods in the form of carotenoids, which are converted to vitamin A in the body. Food sources include liver; milk products; fish; and dark green and yellow, orange and red vegetables and fruit (e.g., carrots, sweet potatoes and kale).

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Proven cows' milk allergy is rare: it occurs in fewer than 1% of adults and fewer than 3% of children. Most affected children outgrow the allergy by age 3. If you suspect you have a milk allergy, consult your doctor, who can refer you to a specialist, before making changes to your diet. Testing by a credentialed allergist will confirm or rule out a milk allergy.

If a cows' milk allergy has been diagnosed, you should see a Registered Dietitian specializing in food allergies. The dietitian will advise you on a diet that does not contain milk products but is nutritionally adequate.

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What is lactose intolerance?

Milk contains a natural sugar called lactose. People who are lactose intolerant or, more precisely, who are lactose maldigesters, lack enough of the enzyme (lactase) needed to completely digest the lactose. Lactose intolerance refers to the symptoms of gastrointestinal discomfort that some people feel after drinking milk or eating foods that contain lactose.

With a little experimentation, some lactose maldigesters find they can tolerate small servings of milk spread throughout the day, especially when taken with other foods. Hard cheeses, such as Cheddar and Swiss, and yogurt are low in lactose and may be better tolerated by lactose maldigesters. Another option is lactose-free milk, such as Lactaid or Lacteeze.

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What is lactose-free milk?

In lactose-free milk, about 99% of the naturally occurring sugar called lactose has been broken down. The lactose is broken down by adding the enzyme lactase during processing. Although these products can be beneficial for lactose maldigesters, they are generally unnecessary if milk is consumed in moderate amounts and combined with other foods.

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Should children limit their fat intake?

No. Canada's Food Guide recommends that children not restrict nutritious foods because of fat content. Fat can serve as a valuable source of energy to support growth and development, especially when it is in the form of nutrient-rich foods such as peanut butter and cheese.

Children need fat in their diet because they need lots of energy for growth and development. The key to ensuring a healthy diet is providing a variety of foods, including naturally higher-fat choices, from the 4 food groups to meet the serving recommendations in Canada's Food Guide.

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What is a healthy weight for a child?

Children grow and develop at individual rates. Their body weights and shapes are continually changing as a normal part of healthy development. Plus, bodies naturally come in a variety of shapes and sizes. That is why it is very difficult to pinpoint a healthy weight for a child at a particular age.

You may have seen growth charts for children where their weight and height are plotted against a standard according to their age. These charts are not recommendations, but simply indicate where a child is compared with other children. If your child is growing at a healthy rate and is eating according to Canada's Food Guide, then most likely he or she is at a healthy weight. If you have concerns about your child's growth and development, speak to your doctor.

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When should a child be on a supplement?

If a child has a food allergy or a medical condition that results in the avoidance of foods from an entire food group, the child may be missing out on specific nutrients. However, if the child is eating the recommended number of servings from each food group each day and eating a variety of foods, as per Canada's Food Guide, it is likely that the child is meeting nutrient needs.

If a child's diet seems so unbalanced that supplements are thought to be required, it is a good idea to seek the help of a Registered Dietitian. An RD can advise you on an eating plan personalized to meet specific needs. Food is the best source of nutrients, but an RD can provide information on specific vitamin and mineral supplements if necessary.

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How do you get kids to try different foods?

Expose youngsters to a wide variety of foods from each of the 4 food groups at a very early age. The more often children are exposed to different foods, the more likely it is that they will taste them and learn to accept them. Don't be discouraged if your child refuses a new food experience. Sometimes it takes 10 or more attempts before a child accepts a new food.
Parents and caregivers can help children accept a wider selection of foods by
Being a role model. Set an example by eating a variety of foods and trying new and exciting foods yourself.
Presenting foods in fun ways by combining different colours, textures and shapes.

  • Offering small quantities of the new food alongside familiar foods the child likes.
  • Serving a new food when the child is with friends. Children are more apt to try new foods when they are with their peers.
  • Encouraging children to become familiar with different foods by having kids help grow, buy, prepare or serve foods. Children are more likely to try new foods when they are involved with the food in some way.
  • Not using food as a reward. If you do, the child may form a preference for the food being offered as a reward (e.g., sweets) and a dislike for the food that you are trying to get them to eat (e.g., Brussels sprouts).
  • Respecting that children have individual food preferences. Never force a child to eat a food they don't want to eat.

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Is vegetarianism a healthy way for kids to eat?

Vegetarianism can be a healthy way for kids and adults to eat if it is well planned and meets Canada's Food Guide serving recommendations. There are different ways of eating that all fall under the umbrella term "vegetarianism." Veganism is the most restrictive (no animal products are consumed) and the least often followed. It also requires the most care to ensure nutritional adequacy.

During childhood, adolescence and pregnancy, extra care must be taken in planning a vegetarian diet to ensure nutrient needs are met. Vegetarian diets that include milk and milk products will help ensure adequate intakes of calcium, vitamin D, riboflavin and vitamin B12 - nutrients for which shortages are a concern when milk is eliminated from the diet.

For advice on how to plan a vegetarian diet for your child, consult a Registered Dietitian. You can find a dietitian through the Dietitians of Canada web site (dietitians.ca) under "Find a Dietitian," or phone your local health unit. The key nutrients to make sure your child gets enough of with a vegetarian diet include calcium, iron, vitamin D, vitamin B12 and calories (energy).

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