By Dale Mayerson and Karen Thompson

Health Canada recently published Part 1 of the new Canada’s Food Guide. One of the recommendations is that Canadians “choose protein foods that come from plants more often”. Dietitians across Ontario are considering this statement when planning menus for long term care (LTC) homes.

Protein 101

Protein is made up of 20 amino acids, 9 of which are essential and must be provided by the diet. After the body breaks down the proteins that we eat, we use these amino acids to create new cells – this includes skin, muscle, bone, blood, tendons, ligaments, organs and enzymes that are all made out of protein. In total, about 16% of the body is protein. This is quite high when considering that up to 70% of the body is water. Since our bodies are constantly breaking down and rebuilding body structures, we need a small but ongoing supply of protein foods to keep us healthy. Animal sources of protein provide complete protein that has all of the required amino acids.  Plant sources of protein provide incomplete protein, since each source does not contain all of the required amino acids. When plant sources of proteins are eaten together, it is possible to obtain all essential amino acids needed, e.g. legumes and grains.  Adequate protein is especially important for seniors, where breakdown is happening faster than rebuilding.

LTC Menu Planning Recommendations for Protein

There have been a number of changes to the recommendations around protein over the years. In the 1993 standards, the Ontario Ministry of Health specified that daily protein items on the menu needed to provide “2 servings weighing 50 to 100 grams cooked weight of meat containing 7 grams of protein for each 30 gram serving, or the equivalent grams of protein in alternatives”. The emphasis at this time reflected the eating patterns of the majority and was slanted towards providing animal protein as the “centre of the plate” items, i.e. meat, poultry, fish and eggs were the main options. A usual serving size of plant protein such as vegetarian chilli typically would only meet this standard when served in an excessively large portion. For many standard or regular menus, beans and lentils were often served only in salads or soups or were included in stews along with meat.

The current regulations governing LTC and part 1 of the new CFG recommendations allow for consideration of a broader range of protein sources.  The LTC regulations 79/10 are less specific, indicating that LTC menus provide for “adequate nutrients, fibre and energy for the residents based on the current Dietary Reference Intakes (DRIs)” and that they provide for a variety of foods, including fresh seasonal foods, each day from all food groups in keeping with Canada’s Food Guide.  There is less focus on providing a specific amount of protein at each meal and more on providing an adequate amount throughout the day

Both animal and plant proteins should be encouraged on the menu based on resident wishes. According to the Dietary Reference Intakes for males 70+ years old, the Recommended Daily Allowance for protein is 46 grams per day, and this should be from a variety of sources. This number is actually quite low for older residents because there is often a greater need for protein related to skin integrity.  Another standard frequently used for this population is to provide 1 gram of protein per kg of body weight – if someone weighs 70kg, the goal would be to provide 70g protein daily.   Canada’s Food Guide specifies the following foods as recommended protein foods: legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.

Acceptance of Plant Proteins

While it is good to have expanded menu options, this can only be done with resident support and approval.  Those who are used to meat and potatoes as an expected dinner may not be satisfied with plant protein items. Will black beans, tofu and chick peas be as popular on the menu as beef, chicken or fish? Many homes, particularly those in areas where there is considerable ethnic diversity in their populations are already offering this type of menu choice while other homes may be experimenting with this for the first time.  Animal based meals will still be on the menu, but menu planners may be looking forward to testing new plant-based ideas for the population they are serving. The unknown is whether this generation of seniors now in LTC will be willing and interested in trying food items that were previously unknown to them? This is a broad generalization, since Canada has been growing beans and lentils for decades and many who grew up during the depression may have been raised on these less expensive, high protein plant foods.

Menu planners will need to test recipes with residents, possibly focusing on the home’s Residents Council members, or the home food committee if one exists. Testing recipes can be a fun and challenging experience, and both residents and staff should have input into the development of new recipes and menu ideas.

Nutritional Differences between Animal and Plant Protein Choices

Protein: With the exception of gelatine, animal foods provide all 9 essential amino acids. This is desirable because it gives the body all the necessary raw material needed to create body structures. In contrast, a plant food may be missing a single amino acid. Each group of plant food is missing a different amino acid, so combining them is the best way to ensure that all amino acids are available, even in the absence of animal foods. Some examples of combinations that provide all essential amino acids are bean burrito (black beans and corn) or hummus (chick peas and sesame seeds).

Fibre: Fibre is found in all plant foods and lacking in all animal foods. Fibre is an important nutrient for everyone, but especially for seniors. Many residents in LTC have constipation, which could be due to lack of physical activity, poor fluid intake, side effect of medications, and more. Providing more fibre-rich foods on the menu is helpful to alleviate this situation. Soluble fibre also helps to lower blood cholesterol.

Vitamins and Minerals: Both plant and animal foods provide vitamins and minerals, however there are some differences. For example, vitamin C is found in plants while vitamin B12 is found in animal foods. Certain minerals may be more easily absorbed from animal foods, since plants have a binding agent that may limit mineral absorption. Everyone benefits from a wide variety of both plant and animal foods throughout the day to ensure that all nutrient needs are met.

Antioxidants and phytochemicals: These nutrients, which are primarily from plants, protect the body from cancer, heart disease, vision loss and many other illnesses. Antioxidants reduce the damage to cells caused by oxidation. Phytochemicals provide the body with nutrients to protect cell and organ structures. Examples of phytochemicals include lycopene and lutein.

Comparison:

Source: Canadian Nutrient File

Menu planners await the Health Canada release of Part 2 of Canada’s Food Guide. Once further guidance or direction has been provided, these considerations will become part of the menu planning process.  It is likely that it will make it easier to provide options that provide more plant protein entrees and to better serve a growing vegetarian clientele.  Residents can look forward to new recipes and flavours.

Dale Mayerson, BSc, RD, CDE, and Karen Thompson, BA Sc, RD are Registered Dietitians with extensive experience in Long-term care.  They are co-authors of “Menu Planning in Long Term Care and Retirement Homes:  A Comprehensive Guide” and have participated for many years on the Ontario Long Term Care Action Group, an advocacy group of Dietitians in Canada.