Calcium, Vitamin D & the Milk Myth

I recently gave a talk on childhood nutrition. My holistic approach is sometimes a bit unconventional, but it’s grounded in science. As a functional medicine physician, I’ve taken a special interest in nutrition. Beyond that, my experiences as a mother have pushed me to learn more. While much of the research presented here is directed toward children, these principles apply to adults as well.

I’m surprised by how much misinformation there is about nutrition, even among physicians and well-educated parents. Hopefully this helps to clear some things up.

In this 4 part series, I’ll address:

This week my focus is on the importance of calcium and vitamin D, and the myth that cow’s milk is the best way to get adequate amounts. It may shock you, but I don’t think that cow’s milk is a necessary (or even healthy) part of a child’s diet. My own daughter has never been offered milk on a regular basis. We transitioned straight from breastfeeding to water around age 2.

 

Children in the Unites States drink too much milk!

Dairy is a staple in most children’s lives. Although official World Health Organization (WHO) recommendations are to breastfeed until age 2 or longer, the general opinion and practice in the U.S. is to switch from formula or breastfeeding to cow’s milk at 12 months of life.

I find that many children don’t do well with dairy, as milk is one of the major contributors to food allergies and sensitivities. Beyond that, it is often offered in higher than recommended quantities, even among physicians. I informally polled a group of over 10,000 physician moms, and found that many of them were exceeding the recommendations for milk intake by the American Academy of Pediatrics (AAP).

 

We know that calcium is important for bone health.

Calcium is especially important during adolescence when bone building peaks between ages 12-15 years of age. Adequate calcium helps prevent osteoporosis. Calcium can also protect against lead toxicity by decreasing the absorption of lead in the gastrointestinal tract. It is also very important during pregnancy and breastfeeding, as adequate maternal levels protect a growing baby by preventing mobilization of lead stores from maternal bone.

 

However, two things are not certain.

First, it’s not clear if dairy products are the best source of calcium for most people. Despite aggressive marketing by the dairy industry, the verdict is still out as to whether or not milk really builds healthy bones.

Second, we don’t truly understand how much calcium we really need. Our current recommended intakes are based on short-term studies. Long-term studies are more relevant, but the few we have actually cast doubt on the need for high calcium intake that is currently recommended. Studies in other countries (India, Peru and Japan) where calcium intake is low do not show an increased rate of bone fractures, but other variables make this data hard to interpret. Read more from the Harvard School of Public Health.

 

The recommended calcium requirements depend on who you ask.

The recommended dietary allowance for calcium varies based on who you ask. The healthiest amounts have not yet been established.

The recommendations for calcium that are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine of the National Academies (formerly National Academy of Sciences) are:

  • 1-3 years – 700 mg
  • 4-8 years – 1000 mg
  • 9-18 years – 1300 mg
  • 19-50 years – 1000 mg
  • 51-70+ years – 1000 to 1200 mg

The UCSF Medical Center has published the following recommendations:

  • 1-3 years – 500 mg
  • 4-8 years – 800 mg
  • 9-18 years – 1300 mg
  • 19-50 years – 1000 mg
  • 51-70+ years – 1200 mg

 

The current recommendations for milk.

The AAP recommends 2 cups (16 oz) of milk or it’s equivalent for children ages 2-8. 16 oz of milk provides about 600 mg calcium and 200 IU Vit D (if fortified). “Milk and water are the healthiest choices, and water is the best option between meals.”

The American Heart Association (AHA) recommendations are similar.

I think there are a few things that are important to point out. First, “or it’s equivalent” means that ~600 mg plant-based calcium would fulfill these same recommendations. Second, AAP is sponsored by Milk Life. America’s Milk Companies have much to gain by perpetuating the myth that drinking a lot of milk is healthy.

 

There are some problems with milk.

Many people do not tolerate dairy. Milk is among only 8 foods that account for 90% of food allergies in the U.S. Dairy allergy or sensitivity may be due to milk proteins (casein or whey) or milk sugar (lactose), and depends on several factors including:

  • People with gut issues and increased intestinal permeability (aka leaky gut) will tend to react more.
  • People with gluten related disorders are often intolerant of casein as well, because it’s molecular structure is so similar to that of gluten.
  • Patients with Small Intestine Bacterial Overgrowth (SIBO) cannot tolerate the sugars in milk because it feeds the bacteria in the small intestine.
  • Raw vs pasteurized milk are tolerated differently, because raw milk contains the enzymes and lactase to facilitate better digestion.

Some people who do not tolerate cow’s milk do fine with sheep or goat’s milk because the casein components are different.

Cow’s milk has been associated with:

 

Raw vs Pasteurized?

For those who do tolerate milk and dairy, consuming raw vs pasteurized products is a big debate.

Most mainstream organizations, including the FDA and the AAP, are strongly opposed to raw milk. This is based on a concern for foodborne illness and the premise that raw milk can have unsafe levels of bacteria like E Coli and Listeria.

Opponents also argue that raw milk is not more nutritious. However, at least two large studies demonstrate the protective effects of raw milk. The GABRIELA study demonstrates the protective effect of raw milk consumption on childhood asthma and atopy. The PASTURE study demonstrates the protective effect of raw milk from common respiratory infections.

I would argue that conventional milk has significant risks as well. Bovine growth hormone (rBGH) has long been used to increase milk production. But its use also causes mastitis and calls for increased antibiotics. Thus, both hormones and antibiotics are passed into the milk supply. This raises concern for precocious puberty and antibiotic-resistance.

 

There are better sources of dietary calcium.

In general, I recommend minimizing or avoiding cow’s milk, depending on your child. A better option might be organic goat or sheep’s milk products if they are well tolerated. If your child has a diverse diet, I think it is best to focus on calcium from non-dairy foods. The USDA provides a helpful database of foods and nutrients at http://ndb.nal.usda.gov/ndb/nutrients/index.

There are plenty of non-dairy sources of calcium. For comparison, 1 cup of milk has about 300 mg of calcium. Some alternative calcium sources include:

  • ½ cup tofu – 350 mg
  • 1 cup non-dairy fortified milk (nut, hemp, flax) – 200-300 mg
  • 1 oz (~2 Tb) Sesame Seeds – 280 mg
  • 1 cup collard greens, cooked – 268 mg
  • 1 cup spinach, cooked – 245 mg
  • 1 cups kale, raw – 200 mg
  • 1 cup white beans – 191 mg
  • 1 oz (2.7 Tb) chia seeds – 179 mg
  • 1 cup pinto beans – 175 mg
  • 1 cup navy beans – 123 mg
  • 5 figs – 112 mg
  • ¼ cup almonds – 96 mg
  • 1 orange – 60 mg

 

Vitamin D also plays a role in calcium absorption and bone health.

Vitamin D plays an important role in the absorption of calcium and phosphorus, and is essential for healthy bones and teeth.

The RDI of Vitamin D for children and adolescents was recently increased. AAP published the following recommendations in February 2011:

  • 0-12 months – 400 IU/ day
  • 1-18 years – 600 IU/ day

There are two sources of vitamin D. One source is sun exposure, which is negated by sunscreens and sunglasses. Another source is dietary, including:

  • fortified milk and yogurt
  • fortified milk substitutes
  • eggs
  • fish
  • cod liver oil
  • shiitake mushrooms
  • fortified cereals
  • fortified juices

Find a detailed list here http://pediatriceducation.org/2009/01/05/

Vitamin D intake is important to consider. Breastfed infants and most children need to supplement with Vitamin D. Adequate levels are complicated by genetic factors, as the Vitamin D Receptor (VDR) polymorphism is relatively common. While it is a simple blood test, most physicians do not routinely test for Vitamin D levels in children.

Many people think of milk as a protein, but it’s actually a carbohydrate. Did you know that 1 cup of 2% milk has 12 grams of sugar? Stay tuned next week for more about sugar intake in the United States. This one might surprise you!

If you missed Part I on Pesticides, GMOs and Organic Foods, you can read that here. If you missed Part II on Food Allergies & Sensitivities, you can read that here.

Share..Buffer this pageShare on FacebookShare on Google+Tweet about this on TwitterShare on LinkedInShare on YummlyShare on VKShare on TumblrShare on StumbleUponShare on RedditPrint this pagePin on PinterestFlattr the authorEmail this to someoneDigg this

You might also like...

WELCOME!

I'm a functional medicine physician, gluten-free foodie, holistic mom & yogi. I think physicians should be role models when it comes to nutrition and healthy living. This is where I share that passion. Thanks for joining me!

As always, I respect your privacy.

FIND ME ON FACEBOOK

FOLLOW ME ON INSTAGRAM

  • Im still reeling from last weekends conference  finding inspirationhellip
    I'm still reeling from last weekend's conference & finding inspiration just about everywhere. It's a sign. Harness your power. Be…
  • My children want more ripplefoods milk! A friend introduced ushellip
    My children want more  @ripplefoods  milk! A friend introduced us to this  #dairyfree  pea milk that is plant-based, higher in…
  • This is a mangosteen A special Southeast Asian fruit giftedhellip
    This is a mangosteen. A special Southeast Asian fruit gifted to us by a good friend & amazing chef  @chicagofoodwalks .…
  • Name this fruit GO
    Name this fruit... GO.
  • Its my first day in my NEW OFFICE SPACE! Morehellip
    It's my first day in my NEW OFFICE SPACE! More details to come, but this place already feels like  #home .…
  • Stop the madness! We know that pesticides have adverse effectshellip
    Stop the madness! We know that pesticides have adverse effects on the health of children, adults, animals, everyone! Of course…
  • Spent the weekend surrounded by inspiring leaders  innovators inhellip
    Spent the weekend surrounded by inspiring leaders & innovators in health & wellness. This is the future of medicine &…
  • Happy to be here in San Diego connecting with fellowhellip
    Happy to be here in San Diego connecting with fellow health & wellness leaders and innovators at  #MSS2017 . Found my…
  • Im traveling today Headed to a conference in San Diegohellip
    I'm traveling today. Headed to a conference in San Diego that I'm so excited about. Meanwhile, searching for a healthy…
  • We made it to the promised land drought this morninghellip
    We made it to the promised land  @drought  this morning. Green juice makes me happy.  #drought   #greenjuice   #imaddicted   #royaloak   #drchristinemaren …

Categories

All Rights Reserved © 2017, Disclaimer