Tuesday, August 17, 2010

Dietitians - a question for you.

The question's simple and I don't think there's necessarily a "right" answer though I'm sure you'll be able to guess where I lean.

But before I get to my question, I need to give you some background.

This Sunday's local paper brought with it a magazine called, Ottawa Family Life. In the magazine was an article written by a local dietitian. The article was about calcium.

The author (and this time I'm going to leave the RD's name out as unlike other times this one isn't shilling for the food industry), who clearly subscribes to the there's a calcium emergency out there and milk's a magic, miracle food camps, gives a whole long list of things parents should do to ensure their kids get enough dairy.

Among the suggestions:

  • Make milk the main beverage at meals.

  • Make hot cocoa with milk instead of water.

  • Make cream soups with milk instead of water.

  • Have chocolate milk as a snack.

  • Choose milk or chocolate milk as the post-game sport drink of choice.

  • Drink milk yourself to show your child how important it is.

  • They also recommend that if your child is lactose intolerant that you look for vitamin D and calcium fortified juices to serve them.

    Now I'm not going to get into the fallacy of a societal calcium emergency or magic milk claims (though for readers who are curious where my thoughts lie - weight bearing exercise and adequate vitamin D intake are likely more important for bone health than calcium), I'm going to focus on calories. They're never mentioned.

    So here's a registered dietitian telling parents to serve their children chocolate milk as snacks, actually suggesting that kids need a post-game sports drink (they certainly don't) and that it ought to be chocolate milk, that kids who are lactose intolerant get calcium and vitamin D from fortified juices (despite calls to limit juice consumption in children to 1/2 - 1 cup daily) and that basically any dish that can be spiked with milk should be.

    Chocolate milk twice a day, even just a glass twice a day, would provide your child with the caloric equivalent of nearly a litre of Coca Cola a day along with 12 teaspoons of sugar.

    Making this all the more astounding to me is the fact that when I Googled this dietitian I found out that they work (or at least worked) at the Ottawa Civic's Weight Management Clinic and therefore is certainly no stranger to the risks of not paying attention to calories.

    So here's my question for all my dietitian readers (and anyone else who might want to weigh in).

    Given the problem of adult and childhood obesity, should that be an overarching consideration when writing articles or giving talks and interviews that provide dietary advice to society, especially those involving recommendations for children?

    (Another way to think about it? If 65-70% of the adult population routinely developed scurvy over the course of their lives, do you think there'd ever be an article written on dietary advice for children that didn't include a discussion on the importance of citrus fruit?)

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    1. Adam Betzelt, RD9:45 am

      It seems the author got caught up in the calcium bandwagon without considering her message within a broader context.

      In an adult population, post-workout recovery drinks are really only appropriate for those training daily and at a relatively high duration and intensity. Otherwise it's just a high glycemic liquid dessert. Furthermore, most children don't get that kind of training volume or are capable of a high enough intensity to warrant a sugary post-workout drink.

      Dietitians who write these articles should be responsible for considering the consequences of their message - sure it might promote an increase in calcium intake, but at what cost.

    2. I agree with Adam about the post-workout advice for children.

      There are other things to know about milk and calcium. Let's have a look at the dietitian's advice in your article.

      - Have milk at every meal. I say, yes, it is a good way to get calcium from milk, it is a high and easily absorbed source. It contains protein that will help to reach satiety and for a longer period of time. That being said, it is not the only source of calcium (other dairy products, tofu made with calcium sulfate, fish, enriched soy beverages, sesame seeds, black eyed peas,...) and variety remains best to get/provide everything you/they need. So, no I don't think it should be milk, only, at every single meal.

      -Making hot cocoa and soups with milk instead of water is a good thing. It certainly adds calcium to it, but protein as well, which is also good for what is mentioned above (satiety). If we feel full earlier and for a longer period of time, we will eat less. That is, of course, if we take enough time to eat our meals. Not to mention fiber do an incredible job as well on satiety and can surely help to decrease the obesity epidemic we live in.

      - Having milk chocolate as a snack (no exercise involved) is indeed like having dessert instead, especially for kids that do not need a post-workout recovery drink. But comparing milk to Coca-Cola isn't right. In terms of calories/sugar intake only, maybe, but of course milk is healthier than Coke. Coca-cola won't bring you anything good at all. Milk will.

      - As for vitamin D, there are also other sources (fish, eggs, shiitake, enriched soy beverages)

      All in all, calcium and vitamin D's daily needs can easily be satisfied with milk and other dairy products (calcium mostly), because of their high source. And since the Milk and substitutes food group is one of the less consumed of the Canadian Food Guide, this may cause the whole panic attack about Canadians lacking Calcium and Vitamin D. But I still believe, that we, as RD, have to promote all foods, variety, at every meal, to make it easier and tastier to get what we all need.

    3. Christina RD11:24 am

      Hi Yoni,
      This is comparing two opinions that are at different ends of the spectrum. You have posted that you encourage your clients to have as little dairy as keeps them happy and this dietitian's article is focusing on increasing dairy without considering a bigger picture such as sugar intake or calories. My view is closer to what the You Docs explain

    4. Mavis, CLWM11:27 am

      I don't believe you can make a single recommendation like this and be appropriate. The lifestyle a family leads is more important than any single food. A family that hikes and bikes and eats balanced meals, avoids TV and sleeps well can withstand chocolate milk for snacks. A family that sits around watching TV allday, has poor fiber intake and has sleepiness should not use sugar fortified milk. Unfortunately, the moms that will glob onto this article will use this as re-enforcer to feed their kids more sugar. There is more calcium in a serving of soybeans than milk. I can't find soybeans at Sobeys, but chocolate milk.....

    5. Anonymous2:09 pm

      I agree with Adam.
      I am actually concerned by the number of family I see that automatically equate milk and chocolate milk as the same. While they are both excellent sources of calcium and vitamin D, which are important, do we need to sugar/chocolate coat our vitamins and minerals and what sort of eating habits are kids forming at a young age by drinking such sweetened beverages and equating them with 'healthy'. We would not promote chocolate covered veggies to get kids to eat their veggies, so I am sure why we do this will milk. That being said,I beleive in moderation and I see chocolate milk as a treat/dessert, but not for daily consumption.

    6. I enjoy reading your blog, but in all fairness, if you read her article she starts by suggesting one should encourage milk instead of other sugar sweetened beverages for your tweens and teens. She also points out other strategies to increase calcium consumption that are not dairy based, and adds that exercise helps build bone strength. I think it's a good article, and as a mom and an RD, I would rather my child drink chocolate milk than soda if he was offered a sweetened beverage, but we prefer to drink water between meals.

      I understand the concern that these recommendations would encourage families to make food choices that would only add to the problem of overweight and obesity. Creamy soups, caloric beverages as snacks, post-workout drinks for a bout of regular physical activity, and the other points that are brought up in your blog paint a picture of energy-laden suggestions which would generally be ill-advised for an overweight child trying to grow into a healthy weight. However I believe these points were taken out of context and it would have been fairer to link the article to be read in its entirety. The author was making recommendations to increase calcium intake and build strong bones, not focusing on weight management strategies.

      As an RD, I prefer recommending nutrient rich foods, within caloric needs, to supplements. Non-fat dairy products are nutrient rich choices that pack a lot of nutrients for a modest amount of calories. If they are included in a balanced and varied diet they can help people achieve nutrient adequacy, especially in regards to calcium, and help promote satiety and acceptability of a calorie controlled diet.

    7. Thanks for all the comments folks.

      Aurora, I don't think I've taken anything out of context.

      Sadly the context I'm working with is a society where obesity and overweight rates in children continue to grow and where it's now abnormal for adults to have healthy body weights.

      To advocate for sugar sweetened milk and an overall increase in caloric intake in such an environment, without specific discussion on energy or calories, as an RD with an expert opinion and influence on readers, I believe is highly irresponsible.

    8. Anonymous7:41 am

      While I do believe that milk obviously has more nutrients than a cola, I feel strongly that promoting a sugar laden, chocolate beverage is not setting kids and families up for long term success. The habits children form at a young age are often those that they carry throughout life. When given the choice of regular milk vs chocolate milk, of course kids (for the most part) are going to choose the chocolate milk- what kid would not like a sugary, chocolaty drink that is 'healthy'. Interestingly, I speak to a lot of well intentioned parents who automatically just give their children chocolate milk, as they have all been told it is just as healthy as white milk (i.e. they don't even encourage white milk first). I am very concerned that in our desperation to help our over-sugared kids meet their nutrient needs (calcium, vit. D etc.) that we are losing the big picture and sacrificing overall healthy eating (back to basics!). I would be interested to learn when the 'push' on chocolate milk began, as it seems to have become a really big issue in the past 5 years or so. When I was younger, this was not an issue, we all drank white milk and thrived well and chocolate milk (like ice cream) was a treat. Furthermore when I did my training, about 15 years ago, we were not having these debates in my educational institution. I feel that as Dietitians we should be promoting foods that at naturally lower in sugar (i.e. White milk) as the best choice. Perhaps I am being far too narrow in my personal thoughts on this issue, but it seems to plainly obvious to me- promote white milk (natural, no added sugar) or promote chocolate flavored sugary milk? I will stick with the white milk, as there are lots of other places that kids are still getting added sugars- I don't think that we have to worry about a sugar deficiency anytime soon. I would love to hear how other dietitians feel about this issue, as I quite often feel alone on this issue. Thanks, Martha

    9. I took my advice for drinks for my son (when he was younger) from Rosemary Stanton's book Food for Under Fives.

      While she offers diltued OJ as a source of vitamins she emphasizes minimizing this (using fruit instead) and making sure plain water is a normal way to quench thirst.
      My son enjoys pop as a treat but will still normally pick plain water as a drink with meals or when thirsty.

      It is a sample of one but it seems he acquired a taste for one of the healthiest drinks and that has stuck.

    10. I agree with you, Yoni. We are a society that is sadly misinformed about proper nutrition. I'm currently reading In Defence of Food and it explains very well the role that industry (such as dairy and meat farmers) plays in government recommendations regarding food.

      If milk was really liquid gold (that's how the milk industry describes it) then how come Americans and other milk-guzzling nations have the highest rate of milk consumption but also the highest rate of osteoporosis? Unfortunately our food habits are controlled by culture and marketing. I would love to see people educate themselves and then make decisions.

    11. What about other options to dairy milk and how would these fit into a healthy life style for children and/or adults? I'm thinking specifically of home made almond or rice or seed milk blended with fresh fruit. (no sugar or additives) There would certainly be a nutritive value to alternatives, right?


    12. Pat Vanderkooy, RD7:58 pm

      I like your blog, Yoni. I must confess however that the title of this posting seemed to zero in on Dietitians as a target - a sure way of making some people feel defensive! Nevertheless, I'm sure you have questions for fellow MDs too :) You asked a fair question and you got some great responses.

      I've been an RD for 30 years now and I am quite certain that the real culprit behind these issues is the profit motive of the food industry. There is great profit to be made from products concocted with corn sugar, white flour, canola oil, salt and a little real food mixed in. We don't need (but we pay for) the fancy packaging and the advertisements, and we really don't need to buy and eat more (our nation eats about 300 more calories per day per person, compared to a few decades ago!!). The trouble with food is that we do need some for health and energy, unlike tobacco and alcohol, but it's just too easy to get addicted to the taste of fat, sugar and salt and that is a problem, like tobacco and alcohol. I would guess that chocolate-flavoured beverage (it's NOT called chocolate milk because of the added sugar/calories!) has a good enough profit margin, so the industry simply sees it as another way to sell a milk-based product. Consuming a lot of food products with added sugar, fat and salt is like begging to become addicted to processed foods, held ransom to a food system that wants consumers to buy more, without regard to what it does to their health and weight. Now that some consumers are catching on, I notice the food industry has begun to shift more to "value-added" products. How convenient - adjust the addition of sugar, fat and salt (voluntarily of course!), add less than a penny's worth of something supposedly healthy or disease-fighting and presto - back to making profit!!

      My advice as a dietitian: let's buy our food as close to the source/farmer as possible, develop good food preparation skills and spend time at home preparing and eating food together. That way, we would know what's in our food, we wouldn't add so much sugar, fat and salt (because we would actually see how much it is!) AND we could be better connected with our families. Some winter evening soon, boil up some fair trade cocoa and sugar (about 4:1 ratio) in a little water to make your own chocolate syrup. Add some of this mixture to hot, frothy milk. Now THAT is chocolate milk!