What are the P4B nutrition recommendations based on?
P4B's nutrition recommendations are based the Dietary Reference Intakes (DRIs) for calcium (published in 2010) and research on bone health.
The Recommended Dietary Allowance (RDA, as per the DRIs) for calcium for children ages 9 to 18 is 1,300 mg per day. Four servings of milk or milk alternatives per day - provides about 1,200 mg of calcium, which is close to the RDA for calcium for this age group. The additional 100 mg of calcium can easily be found in other foods (e.g., some vegetables, canned fish with bones and some legumes).
We refer to the upper end of the range because it comes closest to meeting the RDA for calcium for this age group.
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 If we don’t meet our calcium needs through the foods we eat, calcium will be withdrawn from our bones, which can cause bone weakness.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.
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.
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.
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.
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.
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.
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:
Recommended Dietary Allowance, mg
Institute of Medicine. Dietary Reference Intakes for calcium and vitamin D. Washington, DC: National Academies Press, 2011.)
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!
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.
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.
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.
high-protein foods rob the body's bones of calcium, leading
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.
should I do if I think I am allergic to milk?
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. 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 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.
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.
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.
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.
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.
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.
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.
Vegetarianism can be a healthy way for kids and adults to eat if it is well planned.
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).