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.