Tuesday, November 13, 2007

I'm Scary?

So on Sunday I had the pleasure of joining Dr. Barry Dworkin at CFRA's studios for his syndicated radio show Sunday House Call to talk about the Heart and Stroke Foundation's Health Check program.

When I arrived I was excited to learn that his producers had contacted both Mr. Stephen Samis (the Director of Health Policy at the Heart and Stroke Foundation) and Mr. Terry Dean (the General Manager of Health Check) and that they had agreed to come on the show. Barry's producers had made no secret that I was to be in attendance and at the onset of the show Barry had asked if Stephen and Terry would be willing to hang around for a round table discussion following a very brief interview with me and what ended up being a fairly lengthy interview with them.

I was excited because frankly I can't fathom how the Heart and Stroke Foundation can endorse the consumption of foods that increase Canadians risks of cancer, increase their risks of diabetes, increase their risks of obesity and increase their risks of heart attacks and strokes. I also can't fathom how the Heart and Stroke Foundation can lend its good name to the virtually universally maligned industry practice of marketing nutrient poor foods to children utilizing popular cartoon characters.

While Sally Brown (the CEO of the Heart and Stroke Foundation) had responded to my letter outlining these and other concerns, in her response she certainly left those questions unanswered and instead fell on Canada's Food Guide to defend Health Check.

So the show started off with a very brief interview with me during which I basically stated that while I greatly respect the Heart and Stroke Foundation, I felt their Health Check program not only fails to uniformly steer Canadians to nutritious foods that in fact it steers Canadians to non-nutritious ones.

Then Barry chatted primarily with Mr. Dean whose points I'll try to summarize below:

  1. The Heart and Stroke Foundation likes to rely on large meta-analyses to help them with their recommendations. They especially like the work of the World Health Organization
  2. The Heart and Stroke Foundation believes that a food is healthy so long as it provides specific nutrients
  3. The Heart and Stroke Foundation thinks that drinking juice is a good idea as it will help busy people consume more fruit
  4. The Heart and Stroke Foundation thinks that their products are better than some of the other products out there
  5. The Heart and Stroke Foundation thinks Slush Puppies Plus is a "great" product
  6. The Heart and Stroke Foundation thinks that products packaged with Disney characters on them don't target children
  7. The Heart and Stroke Foundation based their Health Check criteria on the 1992 Food Guide
So after hearing all these points, I was very excited to chat with the Heart and Stroke folks about them.

In point form I wanted to discuss how:
  1. The World Health Organization, an organization whose reports Mr. Dean specifically mentioned were integral and useful's technical report #916, Diet, Nutrition and the Prevention of Chronic Diseases cautioned against targeting nutrients. To quote the report,
    "Seldom is there a single "best value" for such a goal. Instead, consistent with the concept of a safe range of population averages that would be consistent with the maintenance of health .... Sometimes there is no lower limit, this implies that there is no evidence that the nutrient is required in the diet and hence low intake should not give rise to concern."
    On the other hand, with regards to whole foods, Technical Report #916 has a lot to say, as does reams of research into the effects of foods and their role in chronic disease prevention. To be consistent with our best evidence the WHO report would suggest unambiguously encouraging Canadians to preferentially consume (in no particular order)fruits, vegetables, whole grains, legumes, fish and nuts, while minimizing the consumption of free sugars (white rice, white flour, white sugar, potatoes), red meat, salt and hydrogenated oils.
  2. People eat foods, not nutrients and just because a food may contain a few nutrients does not mean it's a healthy food. Putting vitamins in Coca Cola would not make Coca Cola a healthy choice and by that token, nor should the vitamins that God put in grape juice make it a healthy choice
  3. Childhood obesity experts around the globe have called on explicit limits to be placed on juice consumption. Why? One glass of Welch's grape juice has double the calories and double the sugar of Coca Cola. It is a glass of water with 10.5 teaspoons of sugar and some vitamins thrown in. It has the caloric equivalent of consuming 50 grapes. In a country where childhood obesity rates rise annually, where the World Health Organization predicts by 2025 1 in 9 adults will have type II diabetes, it is exceedingly unwise to equate drinking juice with eating fruit.
  4. Being less bad than the product beside you on a shelf does not by definition make you a healthy or nutritious choice. Light cigarettes are not better than regular ones.
  5. There are no words to describe the look of wonder on my or Barry's faces hearing the General Manager of Health Check describe Slush Puppies as a "great" product. Drinking concentrated apple juice with artificial flavouring sprinkled over some crushed ice is not a healthy drink. The fact that the Slush Puppie website brags it gives "2 servings" per day means the serving size is at least 250mls and therefore exceeds the recommended daily limits on juice recommended by both the American Academy of Pediatrics and the Canadian Pediatric Society for 1-6 year olds and maxes out every kid over 7.
  6. The child's eye level giant posters of Mickey Mouse from a sorcerer's apprentice pointing at the foods in bins, that in turn have Mickey Mouse, Donald Duck, Buzz Lightyear, Winnie the Pooh and others absolutely target children. That these foods contain red meat, refined flour, added sugar, and tons of sodium only adds insult to injury.
  7. Unfortunately from an evidence based perspective, falling on the Food Guide is like falling on a sword - it'll cut you as the Food Guide unfortunately suffers from many of Health Check's same failings and lacks the evidence-based underpinning that would have allowed for a rigorous defense.
So as you might imagine I was quite saddened when in a flurry of activity at the producers desk, Barry and I were told that the communications director of the Heart and Stroke Foundation had called and that they were not at all happy. Initially I was told that Mr. Dean and Mr. Samis were unhappy to be talking with me about things but then it became clear that the Heart and Stroke Foundation was no longer willing to stay on the line. Dr. Dworkin very kindly gave them a face-saving out by stating that they had other engagements.

So why wouldn't they want to talk with me? The word from the control booth was that they were "wary" to do so. Why? I'm not slinging mud or name calling and frankly I have absolutely no vested interest in the recommendations made by Health Check other than those of a physician who cares about nutrition. All I'm doing is asking questions about whether or not the Heart and Stroke Foundation's Health Check recommendations are reflective of our current evidence-based understanding of the effects of diet on chronic disease prevention.

I also know that it's not the individuals involved. I've met Mr. Samis before and we've had very nice conversations about some of the issues facing society and obesity and I have found him in the past to be a very sincere and caring individual whose intentions and commitment to helping improve the health and welfare of Canadians I do not doubt for a second, nor do I doubt the intentions of the Health Check program itself.

That I don't doubt the Heart and Stroke Foundation's intentions is what makes this all the more upsetting to me. It's not like we're talking here about PepsiCo's Smart Spot which is an industry generated Health Check like device from which I would expect the worst - we're talking here about the Heart and Stroke Foundation - an organization that certainly should be held to a much higher degree of accountability and I would have hoped an organization that would have possessed an eager willingness to in fact utilize the best available evidence in formulating their recommendations.

(Tapes of the interviews will be forthcoming and obviously I'll post them when available)

Stay tuned tomorrow to hear why this all might matter even more than I had originally thought.