Monday, March 28, 2011

A deafening nutritional silence.

4 years ago now, Canada's latest Food Guide landed. As readers here know, I'm not a fan, but what's interesting to me here is that unlike art, opinions on the Food Guide should be objectively defensible, not subjectively spinnable.

Objectively means that strengths and weaknesses can be discussed in the context of evidence, and while it's true that nutritional epidemiology is an inexact science, I would argue that there are many aspects to Canada's Food Guide that are nutritionally indefensible. For instance:

1. The Food Guide recommends you simply "limit" rather than avoid trans-fat. In fact in the section on margarine it states, "Choose soft margarines that are low in saturated and trans fats". Do you know what "low" means? Me neither. And why not, "free of trans-fat" rather than "low"?

2. The Food Guide is fine if half your carbohydrates are highly refined and processed.

3. The Food Guide thinks it'd be just dandy for you to get your protein from processed meats.

4. The Food Guide explicitly advises you to worry about saturated fat.

5. The Food Guide is silent on calories and instead suggests if you "eat healthy", you'll maintain a, "healthy weight".

6. The Food Guide tells the entire country to drink 2 cups of milk daily. 2 cups of milk represents 2 Food Guide servings of dairy. Of course the Food Guide also advises that kids between 2-9 and adults between 19-50 are only supposed to have 2 servings of dairy a day. Guess the only member of my family of 5 that can eat cheese is my 19 month old, but only for 5 more months.

7. The Food Guide tells the entire country to consume 2-3 tablespoons of unsaturated fat in the form of oils daily - including guidance steering Canadians to those soft margarines that are "low" in trans-fat. That's 24-36lbs worth of unsaturated fat oil calories a year.

8. The Food Guide suggests a half a cup of juice is a fruit serving equivalent, and provides zero guidance on maximal daily juice amounts.

There are more areas where I take issue with the Guide, but let's just look at those 8.

Trans-fats - Health Canada's own trans-fat task force has called for its regulation and has stated that it's unsafe, "in any amount".

Refined carbohydrates and their increased consumption due to the decades long low-fat social experiment we've been in are almost certainly contributing to chronic diseases including type 2 diabetes, obesity and heart disease recently leading Frank Hu, one of the world's foremost experts in obesity and diabetes to state,

"The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today"
Processed meats have been tied conclusively enough to risk of cancer for the World Health Organization, while the Canadian Cancer Society and Britain's National Health Service have both specifically called for its reduced consumption.

Calorie wise, there's no doubt that calories are a major determinant of nutritive value and that "healthy" is not synonymous with low-calorie. How much guidance a Food Guide should provide on calories may well be debatable, but that it should be provide some guidance is not.

The milk and unsaturated oil recommendations are untenable with the evidence base. Put very simply, and putting aside the ridiculous incongruence with the Guide's maximal dairy servings allotment, there is no study anywhere that would demonstrate the specific inclusion of 2 glasses of milk or 2-3 tablespoons of oil daily as being beneficial to the prevention of any particular chronic disease. Certainly ensuring one uses healthier oils in their cooking's a good plan, but advising Canadians to ensure they consume 36lbs of unsaturated oil a year? These recommendations at best are blind nutritionism, and at worst reflect the undue influence wielded by Sydney Massey (the then Nutrition Education Manager and Spokesperson for the BC Dairy Foundation whose actual mission statement involves specifically increasing milk consumption) and Sean McPhee (the then leader of a 95,000 person strong industry group representing Canada's oilseed growers) who together sat on the elite 12 member advisory panel to the 2007 Guide's formation. Given their actual jobs were to try to sell milk and oil, can you imagine them advocating for anything but? Should they have been at that table? Would you want Exxon to inform gulf oil drilling policy?

And lastly juice. The American Academy of Pediatrics, and the Canadian Pediatric Society have recommended parents limit their children to a total of half a cup of juice daily with an absolute maximum of 1 cup. With drop per drop the same number of calories and sugar as sugared soda, and with no benefits towards satiety, juice is vitamin-enhanced sugar water. There are no juice trees out there.

None of these issues are nutritionally defensible. They weren't in 2007 and they aren't now. And don't fall into the trap of thinking that the Food Guide doesn't matter, it most certainly does.

Consequently the silence from Canadian health organizations is deafening.

Where are the clarion calls for a revision to the Food Guide? Why the silence? Shouldn't folks like the Dietitians of Canada be breaking down the doors of Health Canada demanding something be done? Or how about the newly formed Canadian Nutrition Society of who their president Leah Gramlich has proudly proclaimed,
"We are Canada’s leading experts in nutrition science, policy, and practice across the entire food – health spectrum."
Where are the Ontario Society of Nutrition Professionals in Public Health, the Canadian Pediatric Society, and the Canadian Medical Association? Where are the Canadian Cardiovascular Society, the College of Family Physicians of Canada, the Canadian Cancer Society, and the Canadian Diabetes Association? How about the Centre for Science in the Public Interest, the Heart and Stroke Foundation and the Canadian Stroke Network?

All of these organizations know our Food Guide is failing Canadians, and their silence means that likely we'll have to wait for another decade before we actually see any revisions.

Why the silence? Well you'll have to ask them. Certainly it's easier to be silent than to criticize, but at what cost? Propagation of nutritional ignorance and misdirection? Increased morbidity and mortality? More business?

And they could certainly affect change. If they somehow admitted that their mandates necessitated them to advocate for the nutritional health of Canadians, and they joined together in calling for a Food Guide revision, how could the government ignore them?

These organizations should be demanding more from our government. Canadians deserve more. Food Guide apologists should take a moment to stand back and truly ask themselves if the Food Guide reflects what they understand to be the current state of nutritional evidence, and if it doesn't, they should stop apologizing for it and start demanding change. While indeed nutrition isn't black and white, there's no excuse that forgives our national eating guidelines from inaccurately reflecting our current understanding of the evidence.

Also please keep in mind, the silence here isn't just deafening, it's deadly.

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  1. Anonymous7:23 am

    "The food guide kidnapped my brother and killed my mother." ~ Johnny Gr6

    Yoni, if only your anger and self righteousness could do more than sooth your Napoleonic complex.

    Maybe you should list all the people who are involved in making this guide so that we can harass them again?

    Would you mind providing that link again so we can do some more vigilantly justice?

    ...hey, the ends justifies the means - right?

  2. David7:41 am

    Yeah Yoni - how dare you point out evidence based flaws in the Food Guide and suggest that health organizations should care and actually do something about it. Have you lost your mind?

    You're a madman you.

  3. Love your critique of the Canada Food Guide. My 15-year-old son knows the dangers of trans fats and warns us every time he sees it on the labels. I didn't realize how many problems there were with the food guide until now. Thanks for breaking the silence.

  4. CSPI has for many years pushed the simplistic idea that saturated fat causes heart disease. I've been waiting for them to develop a more nuanced view but I haven't seen it yet.

    They are sincere, well-meaning people, and I agree with them on many issues, but after so many years of saying sat fat is evil, it will be hard for them to admit their error.

  5. David7:52 am

    Oh, and one more thing Yoni.

    This standing up for what you believe in crap has got to stop.

    How dare you actually choose to express your opinion and not sit idly by like everyone else?

  6. Anonymous11:37 am

    Do you recommend Willett's pyramid, and that whole approach on the Harvard website. It's so hard to know "what" although, margarine is a no-brainer.

    I have to think wild meat, grass-fed beef and bison in strict moderation would be fine. Our pioneers ate it, and they are the people living to 100. It's the generation in between that's taken the food industry hit.

  7. Anonymous11:43 am

    Really, David, Reeeeeaaaally. Do you think Yoni is telling us something we don't know? And supposing he was, it's very telling that this would irritate you so much.

    Your reaction confirms its importance and veracity.

  8. Yup - I'm a big fan of Dr. Willett's pyramid. We use it in our office regularly.

    While paleo thinking may make intuitive sense, until there's ample evidence, hard to speak definitively.

    Interesting article I saw a few weeks ago - was some paleontologists discussing paleo diet. There responses suggest it's not a given that we had a specific diet.

    You can read it here.

    Oh, and anonymous, I'm pretty sure David's responses were sarcastic, and posted in response to the angry first comment.

  9. Sorry Yoni, I just could not resist.

    Perhaps this calls for a form of civil disobedience … with the creation of the…

    "Interim Canadian Good Food Guide for Weight Reduction and Weight Stability"

    -- A definitive, mathematical possible, logical correct method of loosing weight and maintaining reasonable body weight for the obese and overweight Canadians, based on real evidence and actual science.

    Included is a philosophical framework of diet design and modification for adjustment as will be required over life. Self testing methods are included which allows evaluation of your actual caloric demand, and your tolerance of specific foods in an economical and practical manner. Hunger will be one of the criteria’s that will be evaluated and addressed. A list of the causes of cravings and test methods will be provided for self evaluation.

    The end product diet will be sustainable, and list of psychological or cogitative possibilities will be provided to aid in adherence. You will learn to eat normally in abnormal world of excess.

    It should be written for about a high school graduate, with pictures or drawings to help with maintaining interest, explain complex concepts, and produce a simple mathematical model of the human.

    It must be in short read format as about 2/3 of the population are unable to concentrate long enough to read a novel. Verbosity must be kept to a minimum.

    What a retirement project for a communicator....or a medical professional career suicide project. The expected payback… perhaps 0 to 50 cents per hour, unless it was a web site and exploded, was worked and promoted, but who would fund it.

    but what do I know

  10. Fred,

    Without naming names, one of the groups I mentioned in the post had actually considered doing just that - publishing an alternative to the Food Guide and continuing to publish it until such time as our official one was improved upon.

    Now I personally don't think a Food Guide's sole focus should be weight, but given the impact of weight on chronic disease and health care in Canada, nor should it ignore it.

    Lastly, just an editorial comment of my own. I think your comments would actually pack more of a punch without your closing, "but what do I know" tag. I think sometimes it takes a thoughtful comment or valid question and puts an unnecessarily snarky spin on it which detracts from the comment or question itself (something I struggle with for my posts at times too).

    Of course you're the boss and as I know you're aware, I welcome dissenting opinions here, but just thought I'd give you my two cents.

  11. Anonymous12:15 am

    Thanks for the link. Love reading about this stuff while I try not to think of bread.

    Don't you think there must have been biodiversity among humans? The original Canadians ate meat and fish, almost no plants. It's only the last couple waves of immigration that have introduced people who do not have a culture of meat eating, so much.

    I'm not a follower of Dr. Wortman (Big Fat Diet) but some of what he says is interesting. Thought provoking.

  12. Anonymous12:17 am

    Mea Culpa David. I meant to address my reaaaaaaally comment to the angry poster. Perhaps he too is trying not to think of bread.

  13. The Canada Food Guide has always been full of crap. The reason for this is because they ask dieticians to contribute. If you want real nutritional advice, you need to ask a nutritionist. In the eighties I was a vegetarian at the time and I was hospitalized. The dietician who came to see me, said they would make adjustments for this; they took the meat away and gave me more potatoes and white bread. I mentioned this years latter to my medical doctor (not the same M.D. at the time). He told me that a study was done on the nutritional well being of long term patients in hospitals and they found out that these patients were malnourished. This is because dieticians follow and contribute to the Canada Food Guide which dictates how you are fed in the hospitals. Kind of scary!

  14. Anonymous9:21 pm

    Cheryl, I am a registered dietitian and I have long held the view that Canada's Food Guide to Healthy Eating is highly flawed. I don't refer to it when counseling patients. BTW nutritionist is not a protected title in Canada. You too Cheryl can become a "nutritionist" with an online course
    of your choosing.

  15. Anonymous1:47 pm

    Yoni, I am a dietitian and I do agree with most of your comments on the food guide. There are a few of your criticisms that I'm not really on board with though: 1) I don't see any promotion or inclusion of processed meat on the food guide anywhere. 2) despite the problems you have noted, I believe the milk recommendation was there to get people to have adequate vitamin D intakes as per the old DRI recommendations (which were recently increased, so this food guide reommendation no longer makes sense) 3) I don' think there's anything wrong with telling people it's ok to have a small amount of unsaturated oils each day... it lets them know that it's ok to cook with a Tbsp or two of oil and to use some salad dressing without feeling guilty. There are many modifications that could/should be made, but I don't think everyone will ever agree on a perfect food guide. Unfortunately, this means that many of us will resort to just not using the food guide at all.

  16. Hi Anonymous RD,

    There is no caution whatsoever in the Food Guide regarding the consumption of processed meat.

    Getting vitamin D from milk isn't going to come close to providing enough D and in turn will provide a great many non-satiating calories.

    Having healthy oil is indeed a good idea, steering Canadians explicitly to ensure they're consuming 2-3TBSP a day is not.

    In terms of pleasing everyone, that's not what Food Guides are for. They shouldn't be designed to "please" anyone, they should be designed to reflect best available evidence.

    I don't think ours does (and it doesn't sound like you do either) and I don't think there's any excuse for that.

    Thanks for taking the time to comment,

  17. Hilary9:16 am

    Okay. I haven't read all the other comments left, but I disagree with your overall blog post. But I will outrightly agree with you in saying that the guide is flawed.

    Firstly, it's called the Canadian Food "Guide" because it is explicitly that: a guide. It is not meant to dictate exactly what each and every Canadian should consume in a day. And sometimes this guiding can be a little too vague- like the 5-10 servings of fruits and vegetables for example. That is a HUGE range!

    Secondly, from my own experience in educating about healthy living (I represent a group at my University- yes, I am a student), healthy living should be a positive endeavor and nothing dampens happiness than being told what you CAN'T do. Thus, the Canadian Food Guide does not want to tell Canadians what they should NOT eat, hence the 'limitations' on trans fats rather than 'elimination'.

    Your observation that they accept processed meats is good- you're right, it's totally bogus and processed meats are one of the worst foods you can be eating. And it isn't like Canadians aren't getting enough protein in their diet in general and are grasping for sources.

    Your comment about fat and oils, however, was the grounds for me to leave this comment to begin with. 2-3 tablespoons of oil/fat is reasonable- you cannot present this information as unacceptable because you collect it all into a one year equivalent. That's just silly. Fats are a necessary (read: NECESSARY) part of our diet and all those fat-free diets that come and go gave fat a bad rep. Don't get me wrong: too much of anything is bad for you. But fat is something you need in your diet- and if you aren't getting the required calories from fat, you're getting it elsewhere (either in carbohydrates or protein) which will actually pack on the pounds because your body has no use for it. Ingesting fat does not equal body fat!

    Here's a book I recommend you read: "An Apple A Day" by Dr. Schwartz. This book is from the readings for my Chemistry of Foods class (he is one of my professors) and it is absolutely fabulous. You should also read his book "Eat Food. Not too Much. Mostly Plants". Both books are well written, sometimes humorous, and very educative. Seriously, they give you the facts (he's a chemistry professor- he only knows facts) and although he doesn't address the Canadian Food Guide directly, I think these two books might help you or anyone else have a better understanding about the food obsession/confusion/misguidance that is occurring in our current culture and society.

    Good luck!