Food Industry Furious With Health Canada's Front-of-Package Plans

If Health Canada takes Chile's lead, we too might see Frosted Flakes boxes change from looking like those on the left to looking like those on the right.

When industry is furious with a government proposal it's a safe bet that proposal is likely to affect their sales, and so when I learned that the food industry was incensed by Health Canada's front-of-package plan proposals (Aric Sudicky, a final year medical resident who was rotating through our office at the time, watched the recent roundtable style consultation hosted to discuss the implementation of what will be a Canada wide front-of-package program, via teleconference and reported to me that industry was none too pleased), I wanted to learn more.

Now this post isn't going to delve into whether or not those are the best 3 targets for front-of-package symbols, instead I want to focus on the lobbying and machinations of industry.

First though, a tiny bit of background.

In creating a new front-of-package symbol for Canadian consumers, what Health Canada doesn't want is a program that emphasizes so-called positive nutrients as 50 percent of Canadian package fronts already have those (put there by the food industry directly to help sell food), or one that requires a second step of thinking to interpret (eg studying the nutrition facts table) as that has been shown to lead to misunderstanding, or a hodgepodge of programs (as more than 150 front-of-package labeling programs have already been documented in Canada) .

What Health Canada does want is a single, standardized system, that involves a prominent symbol, that's consistently located, that doesn't require nutritional knowledge to understand, to help consumers identify products with high levels of nutrients that Health Canada deems are concerning to public health, that by itself provides the required interpretation for its meaning. Such a system would be consistent with the core recommendations made by the U.S. Institute of Medicine.

Breaking it down further, what Health Canada wants is a system that conveys simple to understand information, rather than one that presents data requiring interpretation.

Further still?

Health Canada wants warnings.

In their recent meeting, Health Canada presented their wants to food industry stakeholders, as well as the evidence they feel supports them, and invited them to submit their thoughts and suggestions for a symbol to fit Health Canada's 4 design principles:

1. Follow the "high-in" approach
2. Focus only on the 3 nutrients of public health concern (sugar, sodium, and saturated fat)
3. Be 1 colour (red) or black and white; and
4. Provide Health Canada attribution

As to what this might look like, here are some mockups put together jointly by the Canadian Cancer Society, Canadian Medical Association, Canadian Public Health Association, Diabetes Canada, Dietitians of Canada, and the Heart and Stroke Foundation.

Given that warning symbols aren't likely to be good for business, I was curious as to industry's response to the ask.

Suffice to say, industry is indeed unhappy.

The Retail Council of Canada wants Health Canada to implement instead an instruction for consumers to turn products around and study their nutrition facts tables, and they don't want Health Canada's name mentioned on the symbol. They are apparently worried that including Health Canada's name on the symbol might be misinterpreted as a government endorsement which in turn would lead consumers to eat more of the products with the warning labels. They're also apparently simultaneously worried that if the symbol utilized is already recognized to be a danger symbol, it could lead consumers to believe there is a food safety risk, and that if used, children, accustomed to seeing these symbols on foods, might lead them to think that cleaning supplies with danger symbols are safe to consume.

The Food Processors of Canada used bold to point out that, "the meeting didn't agree to anything", and that, "Health Canada has lost its way on the obesity issue". They think that what's needed is more public education, not a front-of-package warning program.

The Canadian Beverage Association expressed their, "deep concerns", and that though they were happy to have been included in the meeting, their definition of "deep and meaningful dialogue" with industry should include a process whereby industry participants would all discuss and agree upon what the program would entail.

Food and Consumer Products of Canada also wanted to express their disappointment that they weren't provided the opportunity to be more directly involved in crafting the proposal's criteria and their concerns about "the integrity and transparency of the consultation process". They sent a second note expressing their hope that the criteria still have room to evolve and that their preference is for traffic lights as they believe, "information – good and bad – builds on consumer literacy".

Dairy Farmers of Canada expressed their concern that the proposed warning system lacks the nuance required "to distinguish between nutrient-dense and nutrient poor foods" (sweetened milk will likely be slapped with a high in sugar warning), and that they'd be happy to support, especially, "if coupled with exemptions for nutritious dairy products", those programs that would provide data for consumers to study and interpret (like for instance the Facts Up Front program illustrated below).

There was however, one response from industry that was heartening. It was from Nestlé, whose representative reported being, "a little embarrassed" by how industry presented their views during the roundtable, and, "that Nestlé is not fully aligned to some of the comments that were made by some of our trade associations, and a few of us are feeling very frustrated."

Whatever comes of all of this, one thing's for sure. The food industry's near uniform opposition to Health Canada's proposed front-of-package warning label criteria is strong indirect evidence in support of their utility, as for the food industry, salt, sugar, and fat are the drivers of profitability and palatability, and they'll oppose anything they worry might limit their use.

So kudos to Health Canada for sticking to their guns, and also for honouring their pledge to make this process transparent by sharing with me industry's responses.

(and if you clicked on any of the industry letters to read, this is the post roundtable letter from Health Canada to which they're all referring).

Why Will It Take Health Canada 5-10 Years to Clean Up Nutrition?

Image Source

In case you missed it, last week the Honourable Dr. Jane Philpott, Canada's Minister of Health, announced that changes were afoot to nutrition in Canada.

On the menu?

• A much needed revision for Canada's Food Guide
• A ban on the advertising of food to children
• A front-of-package labeling program designed to help consumers better navigate the grocery store
• A ban on trans-fats (something promised by a former Minister of Health back in 2007)
• A nutrition facts panel that included information on added sugars

None of this is surprising - both from an evidence based perspective, and from a mandate perspective, as in his mandate letter to Dr. Philpott, Prime Minister Justin Trudeau made it clear, these were matters he wanted addressed calling for,

"introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec; bringing in tougher regulations to eliminate trans fats and to reduce salt in processed foods, similar to those in the United States; and improving food labels to give more information on added sugars and artificial dyes in processed foods."

What is surprising though is the announced timeline of 5-10 years to implement.

I can't wrap my head around that.

While clearly change doesn't happen overnight, I can't come up with a plausible explanation for why Canadians will be forced to wait for up to a full decade for these changes as:

• The last Food Guide revision took just over 3 years once the prior Guide's assessment had been completed (where we are now with 2007's Guide).
• Québec has successfully managed an ad ban to kids for the past 36 years.
• Established Front-of-package programs abound and as evidenced by their own marketing campaigns and product reformulations, industry is able to quickly change their packaging to suit their needs (or requirements).
• Health Canada's own trans-fat task force, an industry inclusive task force, provided us with their blueprint for trans-fat's regulated reduction a decade ago.
• The road to added sugar labelling is already well paved by the FDA in the United States.

It's also worth noting that in Canada, a government's mandate's duration is four years and as of this Friday, the first of them is done.

Having had the pleasure and honour of meeting with Dr. Philpott in the past, I am very comfortable stating my belief that if she were able, these changes would occur far faster than the timeline she's laid out. Which leads me to assert, admittedly without proof, that the food industry lobby in Canada is far more influential than anyone would believe.

[For more on this, definitely have a peek at the award winning journalist Holly Doan's terrific CPAC piece on this government's mandate regarding obesity (disclosure - I'm in it). To watch the video when you get to the link, click the language button below the video to get it rolling as clicking the arrow doesn't do it]

Guest Post: Are Public Funds Being Used to Undermine Canadian Health?

Today's guest post comes from my friend and colleague Dr. Norm Campbell. He's borrowing my soapbox to tell you a bit about a conference on dietary salt that's slated for next week and his concern that it's designed to undermine the health of Canadians.

A prestigious national health and scientific organization uses public funds to undermine the health of Canadians?

The Canadian Academy of Health Sciences (CAHS) - a little known but prestigious organization of top Canadian scientists has decided to weigh on the recommendations for reducing dietary sodium. CAHS indicates it wants assess whether current dietary recommendations are supported by evidence, highlight new evidence and also to provide the spectrum of opinions on dietary salt. However, the meeting seems based on a very few highly vocal scientists who have publically opposed dietary salt reduction, including those that have had long standing relationships with the food and salt industries to address the issue. The only new evidence indicated to be presented is a study based on a very weak assessment of salt intake, questionable assessment of blood pressure and not surprisingly showed a weak association between the two. In fact, many of those opposed to sodium reduction have conducted research that has been highly critiqued as using weak methods that could explain their research findings. Much newly published literature associating high dietary salt to adverse health outcomes is overlooked by the organizers.

The opinions of those opposed to salt reduction and the deliberations of the scientific and health care organizations and experts that support dietary salt reduction has been highly published in scientific journals as well as in lay press. Although highly regarded national and international scientists who support reduction in dietary sodium have been invited, after learning the format of the meeting many have withdrawn or refused to participate.

Very recent research from the American Heart Association has delineated the impact of weak research methods on outcomes of sodium studies. The Cochrane Collaboration and many others have voiced concerns on the impact of conflicts of interest in general on research findings and new merging research indicates very substantive associations of author conflicts of interest on outcomes of diet related research. Cook and Gould commented that systematically appraising the evidence and providing transparent recommendations for practice, guidelines have the potential to improve both bedside decision making and health policy however they also indicated that, to be of optimal quality, such must not be tainted by conflicts of interest, and their authors must employ rigorous methodologies to evaluate the evidence before them. The CAHS symposium however has declined to have a session to address the impact of (weak) research methods on research findings and also declined to have a session on the impact of commercial conflicts of interest. Rather, based on a symposium lasting a few hours and with a foundation of a few dissenting scientists and people with close industry ties, the CAHS proposes to issue public reports clarifying the role of evidence on dietary sodium reductions.

The clinical and public health science of dietary sodium has been repeatedly reviewed by many major national and international scientific and health care professional organizations and over the last 10 years based on best available evidence has had uniform recommendations supporting reducing dietary sodium. The Global Burden of Disease (GBD) study conducted by over 450 of the top public health experts and epidemiologists in the world estimated dietary salt resulted in over 3 million deaths (61 million years of disability) in 2010. The estimate was for over 13,000 deaths and 200,000 years of disability in Canada in 2010. Based on the impact of dietary sodium on health, the World Health Organization and United Nations have made one of 9 global targets to prevent non communicable disease reducing dietary sodium. The World Health Organization calls sodium reduction one of very few ‘best buys’ to improve population health.

In stark contrast to the CAHS approach, careful and thorough reviews of the evidence on dietary salt and health by national and international scientific organizations take 1-2 years of research and deliberation and select a diversity of experts that represent public interest and exclude experts perceived to represent the financial interests of industry. Notably, organized opposition to salt reduction by the food and salt industries to reducing dietary sodium resulted in the formation of a global advocacy group, World Action on Salt and Health with over concerned 500 scientists and health care professional members.

While the CAHS symposium format might be expected to have been created with support from the food or salt industry, it is most startling that the CAHS is supported by a grant of $35 million federal tax dollars to the Council of Canadian Academies. Perhaps even more startling is that the CAHS has indicated it is specifically targeting a multimillion dollar public education program of Health Canada to reduce dietary sodium.

The rational for the CAHS meeting is unclear but one of the organizers Dr S. Yusuf is publicly on record to oppose dietary salt reductions. One of the sponsoring organizations with CAHS has not been able to be identified (World Federation of Cardiology). The other organization (World Heart Federation) that is indicated to be a sponsor is on public record supporting dietary salt reduction.

The bottom line is weak and conflicted research and highly select presentation of a single divergent research study will lead specifically to controversy. The CAHS meeting format seems designed to provide credence to both weak research methods and commercial interests and has an unclear rationale. Further, the CAHS needs to be accountable for spending public funds on this meeting that seems diametrically opposed to the public’s interest. With the United Nations and the World Economic Forum (representing the global corporate sector) declaring chronic non communicable diseases a major threat to global development and indicating reduction in dietary salt one of the primary causes, surely the CAHS, an organization representing Canadians top researchers can make a positive contribution to health of Canadians and the global population.

Norm Campbell MD FRCPC
Professor of Medicine, Physiology and Pharmacology and Community Health Sciences.
HSFC CIHR Chair in Hypertension Prevention and Control
Chair of the Canadian Hypertension Advisory Committee (of national health and scientific organizations to lead the nongovernmental effort to prevent and control hypertension).
President of the World Hypertension League
Co-Chair of the PAHO/WHO Technical Advisory Group on Cardiovascular
Disease Prevention through Dietary Salt Reduction
Co-chair of the Vascular Risk Reduction program of the Alberta Health Services Cardiovascular Health and Stroke Strategic Clinical Network.
Member of the World Health Organization Nutrition Advisory Group, Non Communicable Disease, (NutNCD group 2012-2016).
Member, World Action on Salt and Health

Is Dietary Sodium Just a Marker For A Crappy Diet?

I once referred to salt as a "dietary red herring", whereby I wondered whether or not in modern first world nations the risks extended to high dietary sodium consumption might be indirect whereby high dietary sodium consumption serves as a marker for the consumption of nutritionally awful, highly processed garbage which in turn confers the risk.

A paper published online just 2 days ago in the journal Pediatrics fits that narrative.

In it authors looked at the dietary recall data from 4,283 Australian children between the ages of 2 and 16 (obviously the younger ones' data came from their parents). They explored the relationship between reported dietary sodium consumption and the consumption of sugar sweetened beverages.

Unfortunately that's pretty much all they looked at diet wise. The quality and quantities of macronutrients weren't explored or controlled, nor was where the food was purchased (restaurant vs. home made). This of course makes real conclusions impossible. But that said, they found that kids who consumed more dietary sodium also consumed more sugar sweetened beverages.

The authors postulated that dietary salt intake might be increasing physiologic thirst and that consequently the saltier the food, the more soda they drink.

Yup, possible.

Also possible is that kids who eat the saltiest foods are the ones with the worst overall dietary patterns. More restaurants, more processed foods, and yes, more soda pop.

Whatever the mechanism, when it comes to dietary sodium reduction, and things like regulations and task forces, it may be worth looking beyond the usual debate about blood pressure and also consider whether or not sodium has a unique role in driving hyper-palatable and junk food consumption, or whether or not it really is just a red herring and that folks who are found to consume a great deal of sodium, just have crappy diets.

An Open Letter to Canada's Auditor General Regarding Health Canada

Yoni Freedhoff
Medical Director, Bariatric Medical Institute
Assistant Professor, University of Ottawa
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

July 24th, 2012

Michael Ferguson
Auditor General
Office of the Auditor General of Canada
240 Sparks Street
Ottawa, Ontario
K1A 0G6 Canada

Dear Mr. Ferguson,

My name is Yoni Freedhoff and I'm a physician and public health advocate. I am writing to you today in regard to the actions of Health Canada, and to be very clear, I'm not writing to you to consider their public health decision making, but rather to inform you of willfully mismanaging public funds in their creation of task forces and working groups whose recommendations are summarily rejected nearly the moment they're reported.

The first such example involved our Trans-Fat Task Force. Struck in 2005, the Task Force consisted of 24 members and involved the commissioning of a literature review, 3 full day face to face meetings, 5 teleconferences, 2 public consultations and the writing of a 116 page final report. The Task Force called for a regulatory approach to reducing trans-fats in Canada's food supply. Then Minister of Health Tony Clement elected instead to launch a 2 year trial program of voluntary reductions followed by regulation if voluntary efforts failed.   Unfortunately voluntary reductions did fail, yet rather than implement the regulations promised by Minister Clement, Minister Aglukkaq elected instead to extend the taxpayer funded trans-fat surveillance program.  In April 2010, she herself reported that the program's,

"results indicate that further reductions are needed to fully meet the public health objectives and reduce the risk of coronary heart disease."

However just last week she reported that the surveillance program was,

"a time-limited initiative that ran its course",

and summarily ended it. As a taxpayer I'm quite concerned by all of this. From initially ignoring their own undoubtedly expensive task force's advice, to establishing an undoubtedly expensive surveillance program, to extending that surveillance program rather than follow through with the promise of regulation if it failed, to finally eliminating the program and not enacting a regulatory approach ultimately it means a great deal of public money was wasted.

The next example involves Health Canada's Sodium Working Group. Struck in 2007, the group was tasked with developing a population-health strategy to reduce sodium in the diets of Canadians. Their report was released on July 29th, 2010 and it made two dozen recommendations meant to bring down Canadian salt consumption. 8 months later and Health Canada announced that rather than follow the expert recommendations they themselves commissioned (at a reported cost of $1,000,000), that they would instead seek further guidance from the Food Expert Advisory Committee - a committee with strong ties to the food industry - and that the Working Group was to be disbanded. This led one member of the original working group to state,

"What's the government doing? They got the group of experts and industry people together and spent three years putting together a strategy. Now they're trying to find some other people to give them a different strategy? It just doesn't make any sense."

No it doesn't. And it also costs us a great deal of money.

While I realize it's beyond the purvey of your office to determine the scientific soundness of Health Canada and Minister Aglukkaq's decisions, as a taxpayer I need to ask, why are many millions of taxpayer dollars being spent to fund expensive expert advisory panels and surveillance programs if their recommendations are simply to be wholly and completely ignored?

Respectfully yours,


Yoni Freedhoff, MD
Medical Director, Bariatric Medical Institute
Assistant Professor, University of Ottawa
575 West Hunt Club, Suite 100
Ottawa ON K2G5W5

Breathtaking Heart Health Hypocrisy from Health Minister Leona Aglukkaq

So February is Heart Health Month, and yesterday in a supposed show of support, Canada's Health Minister Leona Aglukkaq released a statement spelling out what Canadians can do to help themselves live a heart-healthy lifestyle.  In it she also brags about what the government's doing to help - primarily she points out they're funding basic research and a hodge podge of feel good, eat less, move more initiatives .

But to me that's not really doing anything, though rest assured, it's not as if Leona Aglukkaq's done nothing for heart friendly public policy.  She's stifled it.

What am I talking about?

As far as Canadian public health initiatives that might have had a positive impact on heart health, here's her legacy:

Leona Aglukkaq disbanded her own office's Sodium Working Group and ignored their recommendations.

Leona Aglukkaq refused to accept a proposed plan for sodium reduction that had been prepared and approved by federal and provinicial health officials.

Leona Aglukkaq without any publicized actual discussion, and despite strong public support, refused to have her office even consider banning junk food ads that target children.

Leona Aglukkaq rather than actually acting on our Standing Committee on Health's recommendations regarding childhood obesity instead launched a useless portal for "dialogue".

And,

Leona Aglukkaq has thus far refused to enact a regulatory approach to trans-fat despite promises from her own office reporting that it would in fact do so if by June 2009 voluntary efforts were to fail, and also despite her own admission on April 21st, 2010 that fail those efforts most certainly had.

Considering Leona Aglukkaq's track record on heart healthy policy, her call to action to Canadians for Heart Health Month is both an embarrassment and a disgrace, and not coincidental to her inactions up above?  "Embarrassment" and "disgrace" are the same two words that leap to mind, when I consider Ms. Aglukkaq's performance to date as Canada's Minister of Health.

Book Review: Hold that Hidden Salt!

[Full disclosure. I was sent this book by the author]

Today's guest post is from my office's Registered Dietitian Mark McGill. Mark's been spending a great deal of time these days in the kitchen, in part because I keep on giving him cookbooks for review. Today's example comes from registered dietitian Maureen Tilley who after coming to one of my talks, asked if I'd like a copy of her books. Reading Mark's review, I'm glad she did:

Maybe it’s because you’ve been diagnosed with high blood pressure, or are at increased risk of stroke or heart disease.

Perhaps you simply want to lead a healthier lifestyle.

Whatever the reason, the question I hear on a regular basis is: How do I lower my sodium intake? Throwing away the salt shaker is a great start, but given the incredible saltiness of most supermarket purchased packaged foods, it’s often not enough.

What’s the solution?

Cooking.

Registered Dietitian and author of Hold That Hidden Salt! Maureen Tilley understands this and has created a cookbook that provides "recipes for delicious alternatives to processed, salt-heavy supermarket favourites".

Canadians average 3400 mg of sodium per day with 75% coming from processed foods. The average adult needs only 1500 mg daily. So why is there so much sodium in our food supply? According to Maureen, it’s to generate profits for salt manufacturers and food companies who use it to cheaply preserve foods and improve their flavour. Food companies argue that without the amount of salt they’re using their products would be tasteless. They’ve even attempted to demonstrate this by providing product samples without salt to show how ‘poor’ they are without it. What they conveniently forget to mention is that if they were required to reduce the amount of sodium they would have to switch to more expensive substitutions which would negatively affect their bottom line, substitutes that they don’t add into the foods with the removed sodium.

If you’re trying to reduce your home’s sodium intake, I highly recommend picking up Maureen’s book. It is well organized, easy to read and if nothing else will get you cooking more foods from scratch – something we should all do more frequently if we want to live healthier lives (and save money!).

The book begins by explaining how to determine the amount of sodium in a food accompanied by a list of which foods are high in sodium. Some are more obvious than others – e.g. frozen meals are a main culprit whereas breads may not come to mind as quickly but are often quite laden with the stuff. Also discussed are daily sodium requirements by age, and easy to follow explanations of high blood pressure and the DASH (Dietary Approaches to Stop Hypertension) dietary guidelines.

Recipes are divided into the following categories: Breakfast Foods and Breads, Snacks and Appetizers, Soups, Salads and Side Dishes, Condiments, Dressings, Sauces and Seasonings and finally, Main Dishes. In each section, Maureen presents a brief commentary on why a type of food (e.g. salsa, chip and veggie dips, meatballs) is high in sodium and an accompanying nutrition facts panel based on a specific example (e.g. Old El Paso Salsa, Ruffles Dip, President’s Choice Blue Menu Lean Italian Beef Meatballs). She then suggests alternative made-from-scratch versions that are lower in sodium. How much lower? The following examples are particularly eye-opening:

Knorr Frozen Shrimp, Asparagus and Penne (1300 mg per 340 g serving) vs. Maureen’s Garlic and Basil Shrimp Medley recipe (141 mg per serving).

Quaker Blueberry Muffin Mix (300 mg per 38 g serving) vs. Maureen’s Blueberry Bran Muffin recipe (87 mg per 54 g serving).

Quaker High Fibre Raisins & Spice Oatmeal (220 mg per 43 g serving) vs. Maureen’s High-Fibre Oatmeal recipe (37 mg per serving)

Heinz Ketchup (140 mg per tbsp) vs. Maureen’s Ketchup recipe (9 mg per tbsp(

I prepared two recipes: curry, lentil and sweet potato burgers (p. 117) and cinnamon garlic sweet potato and turnip fries (p. 74). Both recipes were easy to follow and took less than 45 min (prep and cooking time). The burgers were tasty, filling and high in fibre (7 grams per burger) while the curry paired well with the sweet potato. The fries were certainly different as using cinnamon and garlic together is not something I’ve tried before. I was pleasantly surprised by the combination, though I found the cinnamon over-powered the garlic as I was eating them. I only really noticed the garlic about thirty minutes later. I prepared them for my younger brother (who is a very picky eater) and my mother on two separate occasions. Both enjoyed them and stated that they would have them again. As for the sodium: We saved 378 mg per burger (compared to M&M Angus Beef Burgers) and 283 mg per serving for the fries (compared with McCain Superfries Xtracrispy Straight Cut Fries).

Some may argue that they need to add salt to food to make it taste good. The reality is food tastes good without salt – we’ve just become accustomed to food containing too much of it. It is possible to retrain your taste buds to like foods without added salt, to experience foods as they were meant to be enjoyed. As Maureen correctly points out: “After a couple of weeks of moderate daily amounts of salt, you’ll find that many of the items you used to find ‘normal and ‘tasty’ will seem excessively salty.”

In the end, I can confidently recommend this book to not only those looking to reduce their sodium intake but to anyone who wishes to live healthier by consuming less processed food and more home-cooked meals.

Journalism, salt and ethics.

First, some background.

In early July, the well respected Cochrane Review folks put out a piece on dietary salt reduction and cardiovascular disease. Their review basically had three non-overlapping and somewhat contradictory conclusions. The first (gleaned from their plain language summary) was,

"Cutting down on the amount of salt has no clear benefits in terms of likelihood of dying or experiencing cardiovascular disease"

The second was,

"Our findings are consistent with the belief that salt reduction is beneficial in normotensive and hypertensive people"

While the third was,

"The challenge for clinical and public health practice is to find more effective interventions for reducing salt intake that are both practicable and inexpensive"

The media pretty much only reported on that first bit, with headlines screaming, "It's Time to End the War on Salt", "Review says salt not responsible for heart attacks", "Study Denies Any Link between Sodium Intake and Heart Risk", and "Now salt is safe to eat — Health fascists proved wrong after lecturing us all for years".

I blogged about how it seemed to me, many of the journalists who wrote about the Cochrane Review, must not have bothered reading it, given the message it contained, truly wasn't the message they conveyed. Of course I'm just some doc with a blog, and admittedly, I'm not a statistician, nor am I a hypertension researcher, maybe I misread something?

Well, Drs. Feng J. He and Graham A MacGregor are hypertension researchers (and certainly their likely confirmation bias' are that salt's bad), and they decided to pen a commentary on the Cochrane Review that was published this past week in the Lancet.

Summarizing their commentary - if you exclude the one paper in the Cochrane Review's analysis that was poorly designed (the one on patients with heart failure whose diuretic medications weren't adjusted when patients were placed on low-salt diets (a bad plan) which had negative outcomes for salt reduction), the remaining 6 papers, when combined to increase power, demonstrated a statistically significant reduction in cardiovascular events with salt reduction, and a non-statistically significant reduction in all cause mortality.

It's a very compelling little commentary, as confirmation bias or not, their arguments seem quite rational, and while it received some play in the press, it didn't receive near the same play as what seems to be the preferred new controversial narrative, that salt's no longer a worrisome thing.

So that leads me to my question, one I've posed before, is the ultimate responsibility of the journalist to the public, or to the press?

My idealism has me on the side of the public, but my cynicism (realism?) has me on the side of the press, knowing full well that telling the public what they want to hear will trump evidence more often than not.

Too bad too, think of the immense public health benefits of a unified press corps that preferentially reported science over hype, truth over contrarianism, and thoughtful discussion over grabby headlines.

Do high salt diets impair reading comprehension?

While I'm certainly not one to suggest people shouldn't champion their opinions, I think it's important to champion them based off facts and not headlines.

These past few weeks have seen a flurry of activity in the pro-salt camp that suggests we've been barking up the wrong tree.

A great many folks have linked to a recent article published in Scientific American. The article, It's Time to End the War on Salt, appears to be explicitly written in response to a newly published meta-analysis on salt reduction.

The meta-analysis, Reduced Dietary Salt for the Prevention of Cardiovascular Disease is reported by Scientific American as finding,

"no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure"

Scientific American then goes on to report on another study from May that found an association between dietary salt reduction and increased mortality in folks with congestive heart disease, to make it's case that, "it's time to end the war on salt".

So what's my beef? Certainly if the data suggests we've been barking up the wrong tree, we really ought to change our tune, after all, that's what evidence-based medicine's all about.

While that's true, it's also important to look critically at the actual data.

So let's look at those two studies that Scientific American uses to conclude that it's time to end the war on salt.

The Harvard School of Public Health explains that the increased mortality study cited by Scientific American, used only a single day of sodium excretion upon which to base all of their findings; that they didn't control for even basic confounding variables such as height, physical activity and total calories; and that there was a great deal of missing data from participants.

Unfortunately those are enormous problems, and certainly calls into question, if not outright negates, the utility of the paper's findings to draw any firm, actionable, opinions.

And what of the Cochrane Review?

Why don't I just quote directly from the opening line of the Review's Author Conclusion's section,

"Our findings are consistent with the belief that salt reduction is beneficial in normotensive and hypertensive people"

They then go on with their call to action,

"The challenge for clinical and public health practice is to find more effective interventions for reducing salt intake that are both practicable and inexpensive."

That sure doesn't sound like ending a war, it sounds like an RFP for new weapons.

So while I think healthy debate is in fact healthy, I would have thought that magazines like Scientific American, and many of the intelligent commentators on this and other blogs, would in fact do their due diligence to read and critically appraise studies, before getting on any particular bandwagon.

To put this another way, while it's wonderful to question, make sure your questions are based on sound science, not on sound bites, and while you might think salt's harmless, basing your conclusion on these recent papers and media reports isn't a reasoned decision.

Reminds me of a wonderful Yiddish proverb, "What you don't see with your eyes, don't invent with your mouth".

[And for other takes on some of this salt spin, have a read of the Globe and Mail's Carly Weeks' discussion on some of the conflicts of interest inherent to the spin, and Science Based Medicine's Scott Gavura who relates salt's recent reporting to confirmation bias]

Campbell's only re-salting American soups

So a few days ago I blogged about the re-salting of Campbell's soups in response to lagging sales.

Andrea Dunn, Campbell's "Nutrition Strategy Manager" read the post and emailed me with a clarification,

"Good Evening Dr. Freedhoff,

In light of recent media coverage and today's update on Weighty Matters, I wanted to personally assure you that Campbell Canada remains committed to sodium reduction over time and clarify our Canadian approach.

In Canada, there are currently no plans to add salt back to our existing sodium-reduced varieties. It’s also important to note that the Select Harvest soups as well as four of Campbell’s condensed varieties that will be re-introduced in the US market are not available in Canada.

Campbell Canada has been a leader in sodium reduction since 2003. To date, we’ve removed the equivalent of more than 46 million teaspoons of salt from more than 100 of our recipes. Our approach remains to adjust Canadians palates to the taste of healthier sodium levels by gradual and consistent reduction over time. As an example, we’ve reduced Campbell’s Condensed Tomato soup by nearly 50 percent over the years and it now has five tomatoes per can.

Please let me know if you have any questions."

I only had one question, and I emailed that to Andrea a few days ago, but haven't heard back.

I asked if she would care to comment on her American cousin's plans. While certainly there's public debate on the role of sodium reduction, it would seem from Andrea's email that Campbell Canada believes it to be quite important.

Should Andrea respond, I'll be happy to post the response for you readers.

Campbell's soup resalting belies true corporate responsiblity - profit.

To be fair, and to be clear, at the end of the day, nothing can matter more to corporations than profit, as without profit, there'd be no corporations.

Oh sure, corporations need to ensure they sell safe products, and they need to treat their employees fairly and such, but as far as "corporate social responsibility" goes, there's really no such thing.

That's not to say there can't be corporations who provide incredible contributions to worthy causes, it's just to say that it's their choice to do so, and not their "responsibility", and that at the end of the day, their responsibility, especially when discussing publicly traded companies, is for profit. Simply and fairly put, if a corporation's socially responsible moves impact negatively on their bottom line, you can rest assured, they'll move to eliminate them.

Campbell's recent soup re-salting is a perfect example.

The Campbell Soup Company's original de-salting was a move trumpeted both by Campbell and by many public health organizations, as a shining example of so-called corporate social responsibility.

The Campbell Company milked it for all it was worth, producing at least two television spots congratulating themselves (email subscribers, videos are on the blog). The first involved Hilton, a Campbell employee who, "questioned all the salt". They then filmed Hilton standing in a room where the salt the Campbell Company had removed reached his waist. The second involved Michael, another Campbell employee, who admitted that he didn't feel comfortable feeding Campbell soups to his children, "he didn't always feel right serving them at home". They then filmed him eating with his family with the then sodium reduced soup he could presumably feel good about.

Public health organizations and health care professionals bought into it hook, line and sinker.

Blood Pressure Canada even awarded Campbell's a "Certificate of Excellence" to commend Campbell for "the company’s continuing sodium reduction efforts and industry leadership".

Their fawning over Campbell's was certainly understandable given the powerful statements the corporation kept making. For example, Philip Donne, President of Campbell Company of Canada, in a press release from just one short year ago, referencing last year's Sodium Working Group call to reduce sodium consumption, stated that he believed the call to action was an urgent one, "We are pleased to see that many of our peer food companies are joining us in efforts to advance their sodium reduction programs. And for those who don't sense the urgency, the Sodium Working Group's recommendations may be just the motivation they need".

Or how about that of Andrea Dunn's, the Campbell Company's so-called, "Nutrition Strategy Manager" who in that same year old press release explained, "Campbell Canada's approach of gradual and consistent sodium reduction is helping to adjust our consumers' palates to the taste of healthier sodium levels".

So what do you think the Campbell Soup Company will tell Hilton and Michael now that the sales of their less salty broths faltered, and in response out came their corporate shakers? Will Blood Pressure Canada rescind their award, and will Campbell's stop bragging about it? Will Andrea Dunn quit in protest, and will Philip Donne, who when awarded Blood Pressure Canada's award stated, "We know there is still more work to be done and we are hopeful our leadership will inspire industry changes", ponder on his leadership inspiring industry change for increased sodium?

Not a chance.

And what of the public who were led to believe that health steadied the hands of Campbell's?

At the end of the day people need to remember that corporations don't do things out of the goodness off their hearts, they do them out of the goodness of their balance sheets. Sure, if corporations can make money and do good, they will, and good for them, but please don't ever kid yourself about true corporate responsibilities, as by definition they boil right down to plain old dollars and cents.

Is sodium a dietary red herring for the effects of processed foods?

You may have read or heard about a research paper that came out a few weeks ago in JAMA. The study followed 3,681 Europeans and looked for relationships between sodium excretion (the gold standard means of determining sodium intake), and cardiovascular disease and death.

The study's findings were in contrast with what most would have expected. Though higher sodium excretion did in fact correlate with higher blood pressures, surprisingly, it also correlated with decreased mortality.

So what's going on here?

Well here are two obvious possibilities:

1. We've been barking up the wrong tree sodium wise, and sodium's not something the general public should be worrying too much about (unless they suffer from congestive heart disease or hypertension).

2. We're right, sodium's bad, and this study, due to methodological limitations, shouldn't be one that influences us on not lowering our sodium intake.

I think there's at least one more possibility:

3. Sodium's isn't a causal agent of disease but instead given that processed foods are phenomenally high in sodium, is a useful biomarker for the degree of processed foods a person's consuming, and that it's the huge volumes of sugar and pulverized flour (that's more often than not packaged with gobs of sodium) that's actually causal for cardiovascular disease and death.

This study, where data was amassed from European countries from in some cases as far back as 26 years ago, may be looking at a days gone by Europe where processed foods and meals out were anything but the norm, and where a high sodium consumption reflected some other, in this case protective, dietary pattern. I wonder if the study were repeated here and now in North America, if the findings wouldn't stand in stark contrast, with sodium excretion here likely reflecting a highly processed lifestyle which in turn would correlate dramatically with cardiovascular disease?

Of course if option #3's viable it would mean that sodium reduction will likely only benefit those who rely on a return to actual cooking to reduce their dietary sodium, and not to those who eat large volumes of sodium reduced processed foods.

The great news is that science marches ever forward, and while it may take some time, eventually we'll have solid answers. Until then, and before I'd worry about absolute sodium intake, I'd recommend we all work on markedly reducing our consumption of processed and restaurant foods.

No doubt in my mind, sodium be damned or not, if we could all just re-discover our kitchens, the world would rapidly become a much healthier place.

Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, Jin Y, Olszanecka A, Malyutina S, Casiglia E, Filipovský J, Kawecka-Jaszcz K, Nikitin Y, Staessen JA, & European Project on Genes in Hypertension (EPOGH) Investigators (2011). Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA : the journal of the American Medical Association, 305 (17), 1777-85 PMID: 21540421

Should the Auditor General be investigating Health Canada?

So let me get this straight Health Canada.

4 years ago you commissioned an industry inclusive National Sodium Working Group who finally, after years of back and forth negotiations, managed to come up with an agreed upon series of recommendations which they published now nearly 7 months ago in their comprehensive document Sodium Reduction Strategy for Canada.

And what's your response Health Canada?

To disband the Working Group itself and transfer their power over to the Food Regulatory Advisory Committee - a group with deep industry ties, and to hold more "Stakeholder" consultations with a survey and a call for input from industry ?

Um, wasn't industry part of the actual Working Group?

Given Health Canada's complete and utter disregard for the National Trans-fat Taskforce's industry inclusive recommendation that we regulate trans-fat in our food supply, a recommendation that's now nearly 4 years old, I guess I shouldn't be too surprised.

But here's the thing. My money and yours go to funding these Task Forces and Working Groups, and given the years of work involved in both, along with the time and expertise in researching writing and publishing their reports, I can't help but figure that the cost for the groups must be into the many millions. But those direct costs aren't the only ones taxpayers should consider and also worth considering are the costs of the increased morbidity and mortality associated with not following through with these groups' recommendations.

Personally I'd love to see an investigation into the whys and wherefores of these official governmental groups being ignored by the very government that's commissioning them - both from a political perspective in terms of pressure being brought to bear by special interest groups and in terms of money being wasted.

I also wonder whether or not there's a case now for a spouse or loved one has a case for a wrongful death lawsuit where their recently deceased partner had been eating trans-fats in restaurants Health Canada themselves have monitored and shown to be non-compliant with their call for voluntary trans-fat reduction? The case to my non-lawyer brain seems fairly straightforward. Health Canada and their Task Force have admitted that trans-fat in any amount is a risk to health, the government has demonstrated non-compliance with the voluntary call for reduction and they've failed to act both on the recommendations of the task force and their own promise of regulations were voluntary trans-fat reduction to fail.

At the very least, I sure wish they'd stop wasting my money on feel good working groups and task forces that they're clearly not planning to listen to anyhow.

Health Check's rotten tomato

Further to yesterday's post on the Heart and Stroke Foundation announcement that they finally figured out that chocolate milk and french fries aren't healthy choices comes an across the Health Check board reduction in their program's allowable levels of sodium.

Truly, the reductions are significant with some criteria and product categories now actually representing sodium levels that would in fact be considered low.

But not tomato juice.

According to these newer, more stringent criteria, tomato juice (and all vegetable juices and all soups), are still allowed to contain 480mg of sodium per serving.

480mg is in fact still quite a lot. One glass of Heart and Stroke Foundation endorsed tomato juice will now provide you with 32% of their own recommended daily maximum of 1,500mg and as any dietitian (and the Heart and Stroke Foundation themselves) will tell you, you should try to aim for foods that contain no more than 10% of your total daily recommended maximums.

Now one might argue that you can't expect people to tolerate a rapid reduction in sodium and so it's being reduced in a stepwise fashion with this reduction representing a 26% decrease in sodium from the prior Health Check allowance of 650mg. Only problem with that argument is that there are many categories in this most recent revision, where Health Check has reduced their sodium allowances by 50% and some where they've reduced it by 70%.

So what is so magical about tomato juice?

Looking at Medline records since 1950 there have been a grand total of 216 articles that included "tomato juice" as a keyword.

Looking at all of their abstracts, there were 3 that were worth noting:

The first, out of Finland, detailed a very small, very short study that looked at a 3 week low tomato product diet vs. a 3 week high tomato product diet on the LDL concentrations of 21 healthy individuals. The high tomato folks were given 400mL of tomato juice and 2 tablespoons of ketchup daily so results certainly can't be isolated to the juice. This short, small study found a decrease in LDL concentration in the high tomato diet of 12%.

The second, out of Connecticut, was a rat study whereby rats were force fed tomato juice for 3 weeks and then had their hearts extracted from their bodies and subjected to 30 minutes of no blood flow followed by 2 hours of restoration of blood flow. Those rats who had been force fed tomato juice's hearts had smaller areas of infarction than those who hadn't.

The third, out of Harvard, examined the intake of lycopenes and tomato based foods, including juice, and the risk of cardiovascular disease in 39,876 middle aged women over a 7.2 year period. Of all of the tomato based products examined, only tomato sauce and pizza were seen to have potential cardiovascular disease lowering effects.

Those sure don't sound like good reasons to continue to explicitly encourage Canadians to consume 32% of their total recommended daily sodium intake from one glass of the stuff.

Similarly there's soups where again, Health Check allows for 480mg per serving where a serving is in fact a single cup (despite the fact that in the real world people drink bowls (2 cups)).

So what's so special about soups and vegetable juices that they are allowed to contain 25% more sodium than each and every one of the 58 other single product categories in the Health Check universe?

The cynic in me says that what's so special about them is that among the denizens of the Health Check brand there is perhaps no company that has more products with Health Checks than the Campbell Soup Company who also happen to own V8. Therefore unlike some of Health Check's other corporate partners, a major change to soup and vegetable juice criteria would be decidedly bad for business and corporate relations for Health Check.

What do the folks from Health Check have to say about it?

Well once upon a time Terry Dean, the General Manager of Health Check was paraphrased by the Toronto Star as stating that,

"while some Health Check products may have a sugar or sodium content that is higher than optimal, the product must have redeeming nutritional value, such as calcium or fibre"

He himself stated further,

"In every case, there are two or three nutrients it has to have"

Ahhhhh, magic nutrients.

So Terry please tell me, what redeeming, magic, "two or three nutrients", does tomato juice and soup have that make them worthy of 32% of your total daily sodium allotment and a criteria limit 25% higher than virtually everything else you Check?

[Thanks to Twitter's @girldownthelane for the new and improved headline]

Why the food industry's thrilled with Canada's Sodium Working Group

With the release of Canada's Sodium Working Group's recommendations last week I imagine champagne corks were flying in Canada's food industry's boardrooms.

Why?

1. There's no call for regulation. There's no call even for the most conservative recommendations like for instance limiting the amount of sodium per serving in toddler foods. With no call for regulation, there's no cause for urgency. With no cause for urgency, there's no cause for change. With no cause for change, there's no cause for spending any money reformulating and repackaging products.

2. The call to post nutritional information on menu boards includes both calories and sodium. You might think industry would be upset by this. I'd guess you'd be wrong. I'd guess you'd be wrong because by coupling the call to action with a call to post both calories and sodium, the call is far less likely to be heeded. It simply adds a degree of difficulty to any push for menuboard reform and that of course in turn makes it far easier to fight.

3. With the call to adopt the recommendations of the US' Institute of Medicine report on front-of-pack food labeling the food industry is likely hopeful that their recommendations will be more lenient than ours - a likely case scenario given that front-of-package health claims are far easier to make in the States than in Canada and so even with reform, they're still likely to allow the Canadian food industry to enjoy a robust expansion in their front-of-package labeling allowances.

All said and done, the Sodium Working Group's recommendations, while broad reaching in theory, aren't particularly likely to be broad reaching in practice and demonstrate quite clearly why the inclusion of the food industry at the decision making table is a completely irresponsible practice.

While the food industry is certainly a "stakeholder" in federal dietary recommendations and reforms, their role should be relegated to that of a consultancy whereby they're asked and encouraged to provide as much input as they'd like to a committee free of industry influence. That committee would in turn take the food industry's concerns into account when creating a series of recommendations whose primary goal is to improve the health of Canadians, not protect the wealth of Big Food.

[Tellingly, when I was asked by Health Canada a few weeks ago to participate in a post-hoc survey on the implementation and design of Canada's 2007 Food Guide there was a question as to whether or not there were "stakeholders" who should have been consulted or whose concerns may have fallen by the wayside. I of course suggested that the question should also have asked whether or not there were stakeholders who should not have been consulted or whose concerns were overly represented in our awful Food Guide.]

The good, the bad and the ugly of Canada's recent sodium working group.

Last week saw the release of the recommendations of Health Canada's Sodium Working Group (SWG) - a "multi-stakeholder" group with representation from public health folks, health related NGOs, the government and the food industry.

The group was established in October 2007 and it's taken them nearly 3 years to come up with a series of recommendations meant to tackle the problem of sodium intake in Canada.

Overall, I was pleasantly surprised by the recommendations themselves, though not by their lack of regulatory backing, and in fact I think some are more important than the media's given them credit.

So first the good.

Shockingly good in fact.

The SWG's recommendations that Canada's Food Guide be revised to provide guidance on calories (and sodium) and updated far more frequently are exceedingly important. They're important because they're the first official admission that the 2007 Canada's Food Guide leaves much to be desired. So much so apparently, that a "multi-stakeholder" working group on sodium decided to make it a point to point it out.

I was also pleased to see a call to action for nutritional fact panel reform so that there would no longer be such things as serving sizes that suggest they're a third of a cookie and that the percent daily value of sodium be calculated using the goal of 1,500mg rather than 2,300mg.

Next, the bad.

Unsurprisingly bad.

The working group's recommendations are completely toothless. They couldn't even get the food industry to agree to a regulatory approach to the reduction of sodium in toddler foods. Of course that's not particularly surprising given the food industry was effectively given veto power at the table which is I suspect also why it's taken nearly 3 years for the SWG to come up with their recommendations.

Finally, the ugly.

Hideously, hideously ugly.

By creating a, "multi-stakeholder" working group, Health Canada has continued its maddening and reckless practice of including the food industry at tables whose discussions and recommendations are meant to serve public health.

As one SWG member said to me on Friday afternoon,

"Effectively Health Canada has asked the food industry to help guide public health policy"

because as this person described it to me, industry made the process exceedingly challenging whereby even the smallest victories necessitated industry catering compromises.

Anyone else out there think it's horrifying that Health Canada most assuredly believes the food industry's interests are as important a consideration in the creation of public policy as is our health?

Stay tuned tomorrow for a, "what's in it for the food industry post" regarding the SWG.

Breaking News: Canada's Sodium Working Group's Recommendations

It's not often I'm thrilled with something the government's had a hand in but today I'm thrilled with the recommendations that have come from Canada's Sodium Working Group.

CSPI posts the highlight reel which includes:

Reducing the Nutrition Facts table’s “daily value” for sodium from 2,400 mg to 1,500 mg, mandate standardized serving sizes as the basis for reporting nutrition information, and retrofit labels to facilitate improved consumer understanding after the US Institute of Medicine’s report on front-of-pack food labelling is published in 2011

Mandate prominent placement of sodium and calorie information at chain restaurants serving standardized fare;

Ensure regulatory standards for products using protected names like cheese and pickles to permit the use of low-sodium salt substitutes;

Include sensible sodium limits in government food-service policies and procurement contracts (e.g., for schools, hospitals, and the military);

Retrofit advice in Canada’s Food Guide on caloric intake and sodium.

But please folks, don't hold your breath until these get done. Not to be a killjoy but I can't help but think of the wonderful recommendations that came out of Canada's 2006 Trans-fat Task Force which have yet to be acted upon.

Why Health Check's serving sizes are inexcusable.

Headlines this past weekend read that the FDA is about to crack down on food labels' unrealistic serving sizes.

Serving sizes matter so much because as far as the nutrition facts panels go, the breakdown of contents is described in terms of the reported serving sizes. Unrealistically small serving sizes lead to more favourable sounding breakdowns of calories, sodium etc.

For Big Food - it's not really their fault. They're just getting away with what labeling laws have to date allowed them to get away with. Of course the same cannot be said to be true about the Heart and Stroke Foundation's self-administered Health Check program. Simply put, Health Check's nutritional criteria certainly need not be based or built off of patently unrealistic serving sizes - yet they are.

To illustrate what I'm talking about let's take a look at two of the more popular categories - soups and canned beans.

First up is Campbell's Butternut Squash Gardennay Soup. The Heart and Stroke Foundation happily gives it a Health Check because it has 650mg of sodium per nutrition facts panel serving (close to 1/2 of the Heart and Stroke's total daily maximal sodium recommendation) and soups clearly help pay the bills at Health Check. But what's a serving? The panel says a serving is 250mL. 250mL is a cup. Ask any restaurateur and they'll tell you, cups and bowls aren't the same. Most folks sitting down for soup at home are going to eat a bowl.

The New York Times article linked up above also doesn't think a cup's a reasonable, real-life serving of soup and had this to say,

"Many of the soups are billed as “Heart Healthy” and claim to have a reasonable amount of salt per serving. But a shopper has to examine the label closely to understand that the salt claim refers to half a bowl. A full bowl may contain close to half the daily salt allowance recommended for people with high blood pressure."

That picture up top? That's one of my home bowls with a single "serving" of soup in it. Now my bowls aren't particularly large bowls and certainly that single cup in one of my bowls sure doesn't look very satisfying. No question, when we eat soup in our home (and I imagine in your homes too) it's 2 cups per bowl.

So now back to that Health Check'ed soup - my real life serving would therefore give me 1,300mg of sodium. That's 200mg shy of the Heart and Stroke Foundation's total daily maximum.

Think it's just me, that somehow I've either got gigantic bowls, a huge appetite or simply have it in for Health Check? Let's switch to beans.

This past weekend I read an article in the Ottawa Citizen. It was entitled, "Decoding a can of beans" and it looked at the food label of the Health Check'ed Heinz Chili Style Pinto & Red Kidney Beans. The published serving size on the beans is 1/2 a cup. According to the Citizen,

"The sodium content is very high: if you ate a full cup of these beans, a reasonable quantity, you would consume 840 milligrams of sodium",

leading dietitian Rachelle Charlebois to comment,

"If it wasn't for the sodium, canned beans would be such a healthy alternative to lunch meats"

And these are the beans with the Health Check and that photo up above includes what 1/2 a cup of 'em look like.

Health Check'ed soup and beans for dinner? Even if you eat Heart and Stroke sized portions you'd get 1,070mg of sodium (a huge and shameful to be approved by the Heart and Stroke Foundation amount in and of itself). If you eat real life portions because you a) Want a substantial meal and b) Trust the Heart and Stroke Foundation enough not to weigh and measure your food, they'll hand you a heart stopping 2,140mg of sodium. 30% more sodium than the Heart and Stroke Foundation's own total daily recommended maximum!

Now toss in a glass of tomato juice (480mg sodium per glass of the stuff is ok by Health Check) and you're at 2,620mg of sodium in a single Health Check'ed meal and rapidly closing in on two days worth of maximal Heart and Stroke Foundation sodium.

The Heart and Stroke Foundation has no excuses. Remember with Health Check there's an independent body in charge of setting up shop. Unlike nutrition facts panels which are are mandated from on high, Health Check can set any old levels they want and yet they've chosen to set levels that in the majority of Health Check'ed cases are downright bad for you.

So unbelievably sad, pathetic and shameful to abuse the public's trust that way.

(And don't try to talk to me about Health Check's new so-called stricter criteria - the soup'll drop to 960mg per real life serving, the beans to 720mg while the tomato juice is already "stricter" at 480mg per glass)

Gerber Graduates wins the dubious 2010 Salt Lick Award!

Ah Gerber baby foods, now a Nestlé company where,

"Together, Nestlé & Gerber have made an unwavering commitment to a healthier generation, one baby at a time. It’s our pledge to support the healthy growth and development of babies around the world. And, you’ll see this commitment in everything we do - bringing you and baby innovative and trusted feeding solutions from birth through preschool, and everything in between"

So together what have Gerber and Nestlé brought?

Salt. Lots and lots of salt.

This morning the Canadian Stroke Network and the Advanced Foods and Materials Network announced that the Gerber Graduates toddler food product line won the 2010 Salt Lick Award.

So how much salt we talking?

Looking at Gerber Graduates Chicken and Pasta Wheel Pickups we're talking 550mg of sodium, more than half a toddler needs in a daytime and the equivalent amount of sodium found in 2 orders of medium fries at McDonald's.

Guess they're trying to graduate them to full blown heart disease.

Great job Gerber and Nestlé, your caring for kids is truly blogworthy.

CBC Marketplace Bashes Health Check (Again)

I know most of my readers know that I'm far from fond of the Heart and Stroke Foundation's misinformation program "Health Check", and in my discussions with allied health professionals involved in nutrition and chronic disease prevention I can tell you my sentiments are widely shared.

CBC Marketplace, Canada's award winning investigative consumer affairs show has also rightly targeted Health Check as being deceptive and a program that may well be misleading consumers into buying less healthy choices. Last year they did a feature on Health Check (where I made a few brief appearances) and last Friday they hit them again in their "Busted" segment.

This time they were looking at the sodium content in restaurant foods such as the ones I've made fun of in the past at Boston Pizza.

To be honest at this point I really can't fathom what's going on inside the heads of the Health Check folks. Their program is maligned by anyone who bothers to take the time to really look at it (even Chatelaine magazine bashed it), the food industry itself has proposed a more rigorous front-of-package labeling program, and I have to imagine the controversy has affected donations. Why they persist in hanging onto it is beyond me. Isn't it time to hang up the gloves? Either completely revamp the program (or better yet, license Nuval) or just let it go. It's not helping Canadians and it's hurting the increasingly fragile integrity of the Heart and Stroke Foundation.

The segment's brief (5 mins) but well worth a look.

Check it out for yourselves by clicking here.