Thursday, February 07, 2008

Updates on Health Check

Well, there have been some changes with Health Check, but unfortunately only with their website's FAQ section which seems to be growing on an almost daily basis. It's now a whopping 27 questions long whereas six months ago, it was only 9!

Here are some of the newer frequently asked questions:

What are the Health Check's criteria for sodium/salt?

What limits have you set for sugar?

Could products without the symbol be healthier than Health Check products?

Some good questions there. Unfortunately the answers on their website (at least as of today's version of their website) are not particularly informative.

Let's look at them. Let's start with that last question,

"Could products without the symbol be healthier than Health Check products?".

Here's their complete answer,
"Health Check is a voluntary program, and we can only evaluate the products that are submitted to us. Companies that choose not to participate in Health Check may meet our criteria, but participation is their choice. We encourage consumers to read the nutrition facts panel and compare products, and know that they can always use Health Check as a quick reference to say "this product fits within a balanced diet following Canada's Food Guide."
Did you notice that they didn't in fact answer the question? The question was actually a yes or no question; it certainly didn't call for a long winded circular non-answer.

(The answer of course is "Yes, products without the symbol could be healthier than Health Check products".)

Regarding sugar and salt, here are a few choice quotes from their answers,
"The Health Check criteria for sodium for packaged products already in the program are mainly based on the values from Health Canada's Heart Health Claim (480 mg for single foods such as crackers and 960 mg for entrées such as a frozen dinner/entree) which is meant to help reduce the risk of developing heart disease.) These claims are widely accepted by the majority of health professionals and dietitians in Canada."
"Until recently, Health Check did not have sugar criteria, because there are no accepted scientific national or international limits we could use to establish criteria."
Oh really?

The Canadian Stroke Network on page 8 of their winter 2008 newsletter recommended that foods containing more than 400mg of sodium be labeled as high in sodium. Frankly so too do the Heart and Stroke Foundation, Blood Pressure Canada, the Canadian Hypertension Education Program, the Canadian Hypertension Society and the Societe Quebecoise D'Hypertension Arterielle, all of who on page 2 of a 2007 joint public recommendations document advised us not to consume foods that contain greater than 10% of our total daily recommended sodium intake. If we take the current 2300mg recommendation that would mean that they, including the Heart and Stroke Foundation, would want us to avoid foods containing more than 230mg of sodium per serving.

Regarding sugar, as noted before the World Health Organization's expert consensus was to limit consumption to reflect less than 10% of total daily Calorie consumption.

So what would a person consume if they ONLY chose Health Check'ed items?

Well in the test diet I created using only Health Check'ed items, it led to the consumption of an astronomical 4,065mg of sodium and a mind-numbing 190.5g of sugar - that's 47 teaspoons of sugar - almost a full cup in one day, with sugar accounting for 30% of the day's total Calories.

Now before you conclude that I chose only those items highest in sugar and sodium, I'll tell you that I did nothing of the sort. To view my test diets, click here.

Oh, and by the way, doing the same type of test diet for children yielded 2,285mg of sodium and 40 teaspoons of sugar (also reflective of 30% of their total daily Caloric intake).

Another new development came from one of the world's most indefatigable advocates of healthy eating and evidence-based nutrition, Dr. Marion Nestle from NYU, (I link to her blog on my sidebar) who weighed in on the debate on the Canadian Medical Association Journal's website. Her response, along with a letter from me and a couple from folks "defending" Health Check are available in their entirety on the CMAJ's online response section however here's her first paragraph,
"I view front-of-package labeling programs as a slippery slope. They make it all too easy for food companies to reformulate products to make them conform to criterion cut-points. The fewer the criteria, the greater the potential for such manipulation. As I understand it, the Heart and Stroke Foundation's Health Check program currently relies on few criteria, a method that permits the Foundation to endorse foods containing amounts of sodium and sugar than would be excluded by more comprehensive criteria, and lesser amounts of health-promoting ingredients."
So keep on asking your questions to the Heart and Stroke folks and perhaps eventually they may come to recognize that Health Check is broken and that they can either roll it up or fix it.

Whether you've done so already or not, if you find all this the least bit concerning, I would urge you to voice your concerns with the folks responsible for Health Check and in positions of authority at the Heart and Stroke Foundation.

Click here to send Health Check an email, and included on the email will be Sally Brown (CEO of the Heart and Stroke Foundation), Stephen Samis (Scientific Director of the Heart and Stroke Foundation), and Terry Dean (General Manager of Health Check) as well as the members of the Technical Advisory Committee responsible for overseeing Health Check's inclusion criteria.

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  1. Dr. Freedhoff –

    I would like to point out that the term “free sugars” according to the WHO’s expert panel refers to “all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices”.

    However, the value listed on the Nutrition Facts tables in Canada do not report only “free sugars”, they report total sugars from ALL sources, including those naturally present in fruit, vegetables and milk which are not part of the WHO’s definition.

    Some of the sugar-containing foods that you have used as part of your Heath Checked Diet may be composed only partially of free sugars OR in fact may contain no free sugars (i.e the V-8 juice or the Sun-Rype fruit source which is just fruit). 30% is a correct value for TOTAL sugars, but it cannot be compared to the 10% standard recommended by WHO. I know your position is that all sugars act the same way in the body, which is true, but the WHO report specifically refers to free sugars and therefore, if you wish to compare products to THEIR standard, you will have to do the same.

    Unfortunately, you will not be able to do that from simply checking the Nutrition Facts Table since it does not distinguish between “free sugars”, “natural sugars” and “added sugars” – it simply lists total sugars.

    Essentially, you are counting the sugars naturally present in vegetables, for example, as part of the total sugar value for your test diet! No wonder the percentage is 30%! If you were to only calculate free sugars, the percentage would be lower (however, certainly not as low as 10%).

    As examples, here are some products used in your diet that contain no free sugars or only partial free sugars:
    Sun-Rype Fruit Source (natural fruit sugars)
    V8 V-Plus (natural vegetable sugars)
    Compliments Sicilian Chicken Farfalle (sugar is listed very far down on the ingredient list, so likely not a huge amount of added sugar)
    Campbell’s Santa Fe Sweet Corn with Chipotle Soup (natural vegetable sugars)
    Chocolate milk (lactose contributes to total sugar)
    Compliments 5-fruit Muesli muffins (some fruit sugars are present)

  2. Hi k.,

    Thanks for the thoughtful comment.

    The Sun-Rype you point to of course has juice concentrate as the 3rd, 4th, 5th and 6th ingredients so indeed that would meet the WHO definition.

    The V8 doesn't actually list ingredients (at least not from the source I found so I can't comment on those sugars)

    12 grams of the chocolate milk's sugars come from lactose, but indeed you're correct, I'm definitely a sugar is sugar kind of guy.

    But for the sake of argument, you can have the 12 grams of lactose from the chocolate milk, I'll give you half the sugar from the chicken (3.5g), I won't give you much on the muffins 'cause you and I both know there isn't much in the way of real fruit in a muffin so how about you take a third or 6g and you can also have all 5g from the soup.

    That leaves 164g of WHO defined added sugar and that 41 teaspoons of added sugar reflects 26% of the total day's calories.

    So really k, clearly you've got a background in nutrition - do you think you can really call a program that guides you to consume double your daily sodium requirements along with 41 teaspoons of added sugar a healthy choice program?

    I think you're just splitting hairs.