Health Canada Fails Science And Canadians By Allowing Any Purported Weight Loss Supplements To Be Sold

The latest of many systematic reviews and meta-analyses of herbal supplements for weight loss plainly makes the case that there is no justification for their sale.

They. Don't. Work.

None of them.

None. Of. Them.

So why does Health Canada license and allow the sale of 1,128 natural products whose listed purported use is for weight management? Or of the 671 products that purport they'll improve sexual enhancement? Or of pretty much any of them?

Maybe the answer lies somewhere in the taxation of the $1.8 billion annual Canadian sales of vitamins and supplements?

Maybe it lies in well-intentioned hope?

Maybe it lies is political contributions and lobbying?

But the one place where it doesn't lie is in science. Shouldn't that be the only place that matters?

Now That Canada's Food Guide Has Markedly Improved, What's Left For Canadian Nutrition And Public Health Advocates To Champion?

Ok. So we have an exciting new food guide here in Canada, but please don't think that means there's nothing left to push for in Canadian nutrition policy.

Back in 2009, I published a piece about the top 10 nutritional hills worth fighting on.

Included on that list were:

• An evidence based food guide
• A national trans fat ban
• Mandatory menu-board calories

So it's nice that at least some progress has been made.

Though far from exhaustive, and in no particular order, here are 6 hills still worth fighting on (adapted from that same original post):

1. We need to get fast food out of our schools. Though pizza days, sub days, shawarma days, and more may well raise a bit of money for our school system, and may give parents a day where they need not pack their kids a lunch (assuming they haven't taught their children to do so - and here I'll say that yes, kids can do so, even kids as young as 8 or 9), I don't think those ends justify the means. And here I don't care if the fast food pizza (or whatever) is formulated in a way to satisfy a nutrition policy document, because it doesn't change the fact that school provided branded fast food weekly just because it's Thursday teaches children, even those who don't order it, that fast food is a normal and healthy part of weekly life. Given that some schools have a different fast food offering every day of the week, consider the message that's teaching our children.
2. We need a national school food program. Canada is one of very few Western nations that does not support a publicly funded national meal program for its students. It has been shown that school food programs markedly improve the mental and physical well being of students who utilize them with some reporting increases in standardized test scores, less illness, better discipline and improved alertness. According to Dr. David Butler-Jones, Canada's former Chief Medical Officer of Health,

   "When children go to school hungry or poorly nourished, their energy levels, memory, problem-solving skills, creativity, concentration and behaviour are all negatively impacted. Studies have shown that 31% of elementary students and 62% of secondary school students do not eat a nutritious breakfast before school. Almost one quarter of Canadian children in Grade 4 do not eat breakfast daily and, by Grade 8, that number jumps to almost half of all girls. The reasons for this vary – from a lack of available food or nutritious options in low-income homes, to poor eating choices made by children and/or their caregivers. As a result of being hungry at school, these children may not reach their full developmental potential – an outcome that can have a health impact throughout their entire lives"

   If interested, sign this formal House of Commons e-petition to the government requesting one.
   
3. We need to ban advertising to children. Plain and simple, young children are not able to discern the difference between truth and advertising and consequently I believe it's entirely unethical to allow marketers to target them. Furthermore food, and specifically unhealthy food, is the number one source of television commercials seen by children. Frankly to me whether or not they impact childhood obesity rates (they do) is beside the point as I think targeting children period is unethical.The somewhat heartening news is that unlike in 2009, there's action now, with Bill S-228 having passed its third reading in Canada's House of Commons, but given it has yet to receive royal assent, it still needs support.
4. We need a soda tax. Nanny state alarmists tend to try to paint soda taxes as a draconian cash grab and an infringement of civil liberties, but really what's generally called for is a nominal tax on beverage manufacturers for each ounce of sugar-sweetened beverages produced which would raise the cost of a can of soda by roughly 12 cents. Hardly a huge amount of money for each individual but likely to generate well over $1 billion annually in Canada which if utilized to fund such things as a National School Food Program, would be an unbelievably beneficial tax (and according to studies would also result in a 10% decrease in national soda consumption). And as far as the tax being regressive, as my friend RD Andy Bellatti has been heard to say, try diabetes, and also have a peek at this piece which expands on this thought in The Lancet.
5. We need to put an end to front-of-package health claims, or at the very least, dramatically rein them in. Sure, the new food guide states, "be aware of food marketing", but why should the onus be on the consumer to turn packages over to ensure that the claims on the front aren't deceitful, or that the product in the package isn't nutritional chaff? There's a great deal of room to improve our reality where Kellogg's can brag about Froot Loops' Vitamin D content and whole grains on the front of its boxes. Personally, I'd prefer a marketplace with no health claims, and though I don't think we're going to necessarily get there, boy does there look nice.
6. We need to treat the supplement industry (and their purveyors) the same way we do pharmaceuticals. Plainly, if a product is being sold to treat a medical condition, the same burden of proof we require of pharmaceuticals (actual evidence of safety and efficacy) should be applied to so-called nutraceuticals. That would mean a huge hit to supplement sales given Canada's Natural Health Product Directorate is comfortable accepting stuff like traditional use claims as a means to receive approval. Doing so costs Canadians in more ways than one in that not only do these products often cost a significant amount of money, but some will certainly forgo actual medical care and evaluation in place of shameless hucksters who prey upon fear, goodwill, and personal misfortune by selling hope in bottles.

Here's hoping that I can cross a few more of these off my list over the coming decade.

BREAKING: Canada's New Food Guide Is Out - And It's A Giant Step Forward #CanadasFoodGuide

Though it would have been wonderful to not have had to wait 12 years for 2007's awful Food Guide's replacement, beyond how long it took, there's not much to complain about the 2019 edition and there's much to praise.

Whether it was consequent to past criticisms, or the insulation of the revision process from the food industry, or a change in leadership, or some combination of those and more factors, the 2019 Food Guide is incredibly different from all of its predecessors. Gone is dairy as its own food group (that doesn't mean the guide is recommending against dairy consumption), gone is wishy-washy language that excused refined grains, gone are explicit recommendations to consume 2 glasses of milk and 2-3 tablespoons of vegetable oils daily, gone is overarching fat-phobia, gone is juice being a fruit and vegetable equivalent, gone is the notion that sugar-sweetened milk is a health food, and gone is an antiquated nutrient-focused approach.

What do we have instead?

The new guide's primary recommendations are easy to summarize:

• Regularly consume vegetables, fruit, whole grains, and "protein foods", where protein foods include everything from legumes, to nuts, to dairy, to meat, and where the guide suggests you consume plant-based proteins more often.
• When you can, consume unsaturated fats instead of saturated fats (with the guide explicitly noting that there's no need to get caught up in the total fat content of your diet)
• Make water your beverage of choice (with the guide explicitly mentioning that 100% fruit juice and sugar-sweetened milk are beverages that should be minimized)
• Limit your consumption of processed foods and beverages that contribute excess sodium, free sugars, and/or saturated fat (the new guide recommends less than 2300mg/day of sodium and less than 10% of total daily energy intake from free sugars and saturated fats respectively)
• Limit your consumption of alcohol
• Plan your meals, cook more often, enjoy your food (here guide is speaking to consideration of culture and food traditions), and eat with others
• Use food labels
• Be aware that food marketing can influence your choices (and here I'd have preferred if they used the word "beware" which is clearly what they're getting at)

Now you may read those recommendations and wonder where the granularity is? How many servings should I have? Which foods precisely should I eat?

The thing is, we don't really have granular evidence of eat this food, not that food beyond the broad recommendations noted above. And servings wise, first off, everyone is different in terms of their needs, but more importantly, prior guides' emphases on servings were a known point of confusion - one that both the public, and health care professionals agreed should go. People don't weigh and measure their foods, and consequently, people tended to underestimate how many servings they were consuming, all the while being spurred on by the food industry to eat at least a certain number. Though it's possible that in some of the ancillary collateral published in the future (there will be a steady trickle of food guide related materials being published over the coming months), there'll be a more specific calculator, not having prescribed numbers of servings in the guide, and instead steering to a more healthful pattern of eating seems both wise and appropriate. It also allows for a much wider variety of diets with differing percentages and types of proteins, carbs, and fats (something those geared up to be furious because it doesn't espouse their particular diet over all others might want to reread).

And of course there's more than just a short document that outlines and supports those aforementioned recommendations, as also released today was the 55 page long Canada's Dietary Guidelines For Health Professionals and Policy Makers and it serves to flesh out the above and provide their rationale and evidence.

No doubt there will be complaints. Dairy champions will clearly be quite unhappy, as will those who are pushing meat and saturated fat as health foods, and my guess is, given there's strength in numbers, people upset about those two issues will likely support one another.

Here I'll simply remind you of the consensus piece on dietary fat published recently in the BMJ that concluded, with prominent low-carb researchers Drs. Ludwig and Volek's approval, that just as the new food guide recommends, "Replacement of saturated fat with naturally occurring unsaturated fats provides health benefits for the general population."

And remember too, science isn't a static set of facts, it's our best interpretation of data, and it can and does change over time. Will we see future research into the impact of saturated fat on health in individuals following low-carb-high-fat diets lead to a specific mention that on those diets it's less of a concern (or not at all)? Maybe. Maybe not. We're just not there yet.

Bottom line?

Our new food guide is a giant step forward and those responsible should be justifiably proud of themselves. Stay tuned the next few days for posts on why the food guide matters even if the majority of Canadians literally never look at it, its policy implications, and where there's room for further reform.

[Oh, and reporters who want to cover the sugar-sweetened milk angle, a reminder that Dominic Cardy, New Brunswick's Minister of Education, is your go to guy to be upset about it as just last month he asserted school based chocolate milk sales provided important calories to children, while helping to combat food insecurity and poverty, which presumably is why his government, the New Brunswick Conservatives, reversed the prior Liberal government's decision to stop its sale and provision in schools - something that clearly this food guide strongly supports]

Once Again I'll Ask, Where The Hell Is Canada's New Food Guide?

This post was first published back in June. Since then, still no Food Guide, as well as the real possibility that not releasing the Guide influenced the New Brunswick provincial election, and just this past week, an incredible dive into juice, food politics, and our as yet unpublished guide. I really can't wrap my head around why it's not out yet beyond politics. That's not something this country should be proud of.

In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,

"Don't tell Mom, but Chocolate Milk is good for you"

The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,

"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"

And in May 2015 he was quoted by the CMAJ on juice stating,

"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."

I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?

"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."

Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick (unless of course the Conservatives, as they promised prior to their election, repeal the ban).

And here's the most pertinent question. It's been 5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3.5 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

Where The Hell Is Canada's New Food Guide?

In case you missed the news, New Brunswick recently banned the sale of chocolate milk and juice in their schools.

It's a welcome move, and one that will be undoubtedly be adopted nation wide following the long delayed publication of Canada's next Food Guide.

Canada's Food Guide, last published in 2007, inexplicably and explicitly, reports that chocolate milk is a healthy dairy choice (that it also suggests dairy is such a magical food that it requires it's own Food Guide category is a whole other kettle of inexplicability). Or maybe it isn't that inexplicable in that on the then Food Guide's 12 member advisory committee was Sydney Massey, the Nutrition Education Manager and Spokesperson for the BC Dairy Foundation, where their homepage at the time featured the campaign,

"Don't tell Mom, but Chocolate Milk is good for you"

The next one, won't.

I know this in part because back in 2014, Dr. Hasan Hutchinson, the Director General of Health Canada's Office of Nutrition Policy and Promotion (the office in charge of the Food Guide), agreed with me during our then debate, that chocolate milk shouldn't be deemed a health food by our Food Guide,

"One thing we're doing right now is doing a reassessment of all of those things and certainly me personally, I agree with Yoni that it (chocolate milk) should not be there either"

And in May 2015 he was quoted by the CMAJ on juice stating,

"You won’t be seeing that anymore … and there’ll be a fair number of new materials coming out in the next few months."

I also know this because even McDonald's appreciates that chocolate milk, with more calories and sugar drop per drop than Coca-Cola, shouldn't be routinely offered to children.

So here's my first question.

If, in 2007, Canada's Food Guide had explained that chocolate milk is to milk what apple pie is to apples, and that it should be considered a treat rather than a health food, and that no, juice is not the same as fruit, do you think we'd be seeing these actual responses and comments posted on Facebook and on the CBC article in response to the news out of New Brunswick?

"How the hell can juice be bad for you I doubt orange and apple and cranberry juice is bad for your health CFDA would have ban the stuff decades ago"

"It is crazy and stupid. especially since the school officials are comparing the natural sugars found In the cocoa that makes it chocolate to the artificially added high fructose corn syrup used to sweeten coca cola."

"Ugh get a life people! Chocolate milk is some parents only option to get their kids to drink milk. And as far as juices they sell apple and orange at school so are they now telling us apple and OJ juices are bad??"

"I agree, pop and juice fine. Chocolate milk is filled with nutrients."

Because the thing is, though no one shops with Canada's Food Guide in hand, its recommendations do permeate national consciousness. And more to the point of this post, they inform school food policies. Once the new Food Guide is published, and assuming it explicitly recommends limiting sugar sweetened beverages and juice (and it will), all provinces will undoubtedly soon fall in line with New Brunswick.

And here's the most pertinent question. It's been 4.5 years since Dr. Hutchinson agreed chocolate milk should be off the Food Guide's menu, and 3 years since he went on record stating that juice's days are also numbered, so how is it possible that we're still waiting?

If You Need Proof The Food Industry Doesn't Care About You, Look No Further Than Smucker's "No Sugar Added" Jam

So I was shopping the other day.

We were making a dish that included apricot jam in a sauce and I was having a peek at the various offerings on the shelves.

I grabbed Smucker's Apricot Jam and noted that the front of its package highlighted the "fact" that it had "no sugar added".

The label of course told a different story.

It told me that the second ingredient was "white grape juice concentrate", which is likely on the order of 60% sugar by weight.

So yes, sugar was added.

I expressed my indignation on Twitter and Smucker's responded to tell me that they appreciated my feedback, that the concentrated white grape juice was meant to add "fruit flavor" as well as serve as a sweetener, and that according to the letter of the law, it was legal for them to state that their product contained no added sugar.

We appreciate your feedback. White grape juice concentrate provides added fruit flavor, and acts as a sweetener as well. Please know, we follow all CFIA labeling guidelines, including full disclosure of the total grams of sugar in each product, as listed on the Nutrition Facts.

— Smucker's (@smuckers) May 1, 2018

Now the good news is that at least in Canada, the addition of white grape juice concentrate, which of course is just the addition of sugar, will soon preclude Smucker's front-of-package "No Sugar Added" claim.

But of course if Smucker's actually wanted to do right by its customers it wouldn't be waiting for the Canadian Food Inspection Agency's regulations to change.

But that's not what Smucker's is about. Smucker's, like pretty much all publicly traded food industry players, is about profit, and their "No Sugar Added" jams are great case studies in how we shouldn't wait for the food industry to do the right thing, because unless the right thing aligns with profits, they're not going to do it.

Some Evidence Canada's New Food Guide Will Care About Evidence

Though there's no white smoke signifying the publication of a new Food Guide billowing out of Health Canada's food directorate's chimney, there are some signs that when it's finally published, it may be evidence based.

Take for example this story.

It details the concerns of Conservative agriculture critic John Barlow and it contained some heartening quotes.

Here's my favourite,

"It is very clear…that Health Canada is going in a direction that is detrimental to our agriculture sector, detrimental to our food processors as well as our producers on the ground."

Now while I feel for any sector impacted by the future Guide's recommendations, that Health Canada is not actively capitulating to agricultural interests suggests that perhaps instead, it's sticking with science as its underpinning.

According to Barlow, his office has been flooded with concern from a broad range of agriculture groups who are nervous about Health Canada's new policy of not kowtowing to industry,

"I want to really stress this point. These letters are not only from the livestock industry or the dairy industry, there’s letters in here from grain growers, the horticulture associations — none of them want us as a government, in this food guide document, to be picking winners and losers. They all want to be successful."

While there may well be some disagreement among health professionals as to what truly constitutes a healthy diet, where there likely is no disagreement is the notion that the desires of various agricultural sectors to be "successful" doesn't factor in to dietary health at all.

And just as an odd aside, in the same article is a quote from Agriculture Minister Lawrence MacAulay who was asked to comment about agricultural concerns. His response?

"Without a question, what I want to see is Canadians make sure that they express their view on what’s presented and that’s why things are gazetted. My opinion — really, it’s Canadians opinion that really reflects what takes place on this and anything else that’s gazetted to make sure that is what they do want to have happen."

Here's hoping that's not how policy works in Canada, as while not bashing the public, I'm pretty sure Food Guides shouldn't be built on what Canadians' personal opinions about food happen to be.

So bring on the evidence, and for the matter, bring on the new Food Guide. Remind me again, why are we still waiting?

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).

Canadians, Please Step Away From The Chip Wagons

My office's local chip wagon (for Americans, think of a food truck, but where fries are their dedicated specialty) is a case study as to why trans-fats need to be regulated out of the food supply.

Walking by the truck with Dr. Aric Sudicky we noticed outside of it, were empty fryer oil buckets. The buckets were a perfect size to brine a turkey and so I asked if I could have one. Kindly, the chip wagon folks said, "sure".

When we saw its trans-fat content our jaws dropped.

It contained 1.9g of trans-fat in every 9.2g of deep fryer shortening.

A quick spin online found us an article that reported that 17.1% of the weight of a french fry came from its absorbed frying oil.

A purchase of a large fries, a kitchen scale, and a smidgen of math later and it turns out that there are a staggering 20.5g of trans-fat in a large serving of our chip wagon's fries.

Here's the video we shot to help put all of this in perspective.



Non-naturally occurring trans-fats, according to the head of Health Canada's trans-fat task force (and everyone really), are a toxin unsafe in any amount, and 20.5g? Well that's the equivalent amount found in 11.4 teaspoons of the most trans-fat laden stick margarine we could find in the supermarket, the No Frills No Name All Vegetable Shortening which according to its package packed 3.5g of trans fat into every 2 teaspoons.

Now Health Canada had promised back in 2007 to regulate trans-fat out of the food supply if voluntary measures failed, and despite those measures' epic failure, for inexplicable reasons, regulation never happened.

The good news though is that I have it on good authority that Health Canada will be moving imminently on the trans-fat file. Given people have literally died waiting for them, their announcement can't come too soon.

[Interesting short side note: When looking up the margarine's trans-fat content online (I was looking for better photos than the one that had been shared with me), I found that No Frills' No Name All Vegetable Shortening was reported to only contain 0.1g of trans-fat per 2 teaspoons (as opposed to the actual label's reported 3.5).

Seemed really odd until I also noticed, in a very faint and difficult to read font (that's it in the hard to read light grey at the bottom) the line,

"The values stated are approximate and may not be fully representational of this products (sic) vitamins, minerals, and ingredients"

. Um...WTF?]

[And lastly, huge thanks to Dr. Aric Sudicky who shot and edited the video. Aric is a resident finishing up his last year of training and is spending the month with me. You can follow Aric on Twitter, and he's much more active on Instagram than me (I'm old).]

Could Health Canada's Future Front-of-Package Stoplights Reform Deceptive Claims?

So on Monday I blogged about how there are plenty of foods of dubious nutritional quality with fronts-of-package claims that while legal, are deceptive.

Looking ahead, there is the chance that Health Canada will be implementing a national front-of-package food labeling program which in turn would highlight products' higher than desired nutrient contents (perhaps by way of stoplights for instance).

So here's my straightforward suggestion.

Regardless of the system implemented, if a product's ingredients score it a front-of-package warning from Health Canada, that product's packaging should be legally prohibited from including any front-of-package health claims or inferences (where inferences for example would be a package of Froot Loops shouting out to its inclusion of whole grains or Vitamin D, but without an actual functional health claim).

Though imperfect, this simple step might help tilt the playing field ever so slightly away from the food industry's current unfair advantage.

The Canadian Food Inspection Agency Asks For Examples of Deceptive Food Labels

Saw this tweet from the CFIA and so I decided to take a supermarket field trip and found plenty of what I would describe as deceptive food labels.

5 teaspoons of sugar per bar along with 210 calories 

31% more sugar cup per cup than Froot Loops

By weight, this product is 48% sugar

Cookie for cookie more than double the sugar of an Oreo

Drop for drop more sugar and calories than Coca-Cola

With 2.75tsp of sugar per "Twist", contains the sugar of 2.3 actual Twizzlers

Each popsicle contains the sodium found in 93/100ths of one single grain of table salt (along with 2 teaspoons of sugar)

But here's the problem, none of the products' labels above break any Canadian packaging laws, and if the labelling laws themselves explicitly permit deceptive labels, consumers don't stand a chance.

Why have a system where the onus is on the consumer to study the products' nutrition fact panels to determine if their healthy front of package claims are supported?

Guest Post: A Lawyer Weighs In On Canada's Proposed Kid Ad Ban

Early last week there was a surprising piece in Blacklock's Reporter that suggested that Canada may be reconsidering its plans to ban the advertising of junk food to children (an election piece of Prime Minister Trudeau's and part of Health Minister Philpott's mandate letter). After seeing it, I contacted Canadian public health lawyer Jacob Shelley and asked him if he'd be so kind as to share his legal thoughts. He kindly agreed.

Restricting food and beverage marketing to children has long been identified as a necessary public health strategy to reduce diet-related chronic diseases, including obesity. It is a strategy endorsed by the World Health Organization and has been the focus of the Stop Marketing to Kids Coalition in Canada over the past few years (the Coalition has called for the implementation of its Ottawa Principles, which bans food advertising to youth and children under 16). Not surprisingly, there was considerable excitement in the public health community when Prime Minister Justin Trudeau identified “introducing new restrictions on the commercial marketing of unhealthy food and beverages to children, similar to those now in place in Quebec” as a top priority for protecting public health in his Minister of Health Mandate Letter.

Québec’s Consumer Protection Act prohibits, with some exceptions, all commercial advertising to children under thirteen years of age (s. 248). In 1989 the Supreme Court of Canada upheld the Québec ban as a constitutionally valid limitation on the freedom of expression, protected by section 2(b) of the Charter of Rights and Freedoms in the seminal case of Irwin Toy v Québec.

In Canada, expression is considered a “fundamental freedom”, and because of its importance, the courts have consistently held that section 2(b) requires a large and liberal interpretation. Commercial speech, which includes advertising, is among the types of expression that the Charter seeks to protect. The courts have held that commercial expression serves an important public interest, one that goes beyond its economic value, because it allows consumers to make informed choices. Even so, the government can impose restrictions on expression. A limitation on the freedom of expression can be justified if the government is able to demonstrate that it is reasonable, an assessment based on the Oakes test.

This is what occurred in Irwin Toy, where a majority of the Supreme Court found that the Québec ban was justified, even though it infringed on the freedom of expression. The Court was particularly concerned about the vulnerability of children to advertising. It held: “the evidence sustains the reasonableness of the legislature's conclusion that a ban on commercial advertising directed to children was the minimal impairment of free expression consistent with the pressing and substantial goal of protecting children against manipulation through such advertising.”

Since Irwin Toy, the Supreme Court has upheld other bans on commercial speech, most notably, commercial speech related to tobacco products. In Canada v JTI-MacDonald, the Court unanimously held that the restrictions placed on tobacco advertising and marketing were justified restrictions on the freedom of speech. Of particular note, the Court held, “when commercial expression is used for the purpose of inducing people to engage in harmful and addictive behaviour, its value becomes tenuous” (para 47).

Through Irwin Toy and JTI-MacDonald, the Canadian jurisprudence clearly establishes that (i) children are vulnerable and need to be protected from manipulative advertising and (ii) commercial expression that induces harmful behaviour(s) has tenuous value. It would seem apparent, then, that restricting advertising to unhealthy food products to children – the strategy the government appears to have adopted – is relatively low-hanging fruit. After all, the government could do more, as Irwin Toy involved restricting all advertising directed to children. While there may be some details to iron out – such as what age should the ban use and determining what constitutes unhealthy foods – the overall strategy seems to be in accordance with Canadian law.

Thus it was surprising to read that Health Canada may be backing away from meaningful restrictions on food advertising to children out of fear of industry lawsuits (note: this has not been confirmed or reported elsewhere).

UPDATE: Health Canada was kind enough to tweet a response after this article was posted.

Have no fear: HC is committed to restricting marketing to kids and is taking action. See https://t.co/0qIZDHG1Of

— Health Canada (@HealthCanada) July 24, 2017

What is there to be afraid of, exactly? Certainly industry lawsuits were expected the moment PM Trudeau penned his mandate letter. It would be unrealistic to expect the food industry to accept any governmental oversight of advertising to children – kids are big business, after all, and restricting food advertising to children will have a discernable impact on the industry’s bottom line. The industry is not interested in any regulation.

To avoid regulatory interference, the industry has created its own self-regulatory framework that it frequently touts. It includes the Broadcast Code for Advertising to Children and the Canadian Children’s Food & Beverage Advertising Initiative (this is in addition to individual corporate promises). Such frameworks are often considered to be largely ineffective, lacking transparency and accountability. Recent research suggests that advertising of unhealthy foods to children has increased in recent years. Self-regulation, simply put, isn’t working.

If the industry does initiate a lawsuit, we can be sure that it will cloak its claim in Charter language, but this should not be mistaken as interest in protecting Canadian’s freedom of expression. Rather, it seeks an unbridled free market, one that allows it to continue to target vulnerable children in order to increase profits.

When PM Trudeau announced Canada would impose restrictions on the marketing of unhealthy foods and beverages to children, the world noticed. Canada now has the opportunity to become a global leader when it comes to restricting marketing to kids. It would be a shame if the fear of industry push-back impeded current efforts, especially when the courts have already made it abundantly clear that children are more important than commercial expression.

Have your say: Health Canada is currently seeking feedback on its approach to restricting marketing unhealthy food and beverages to children, and you can do so by visiting here.

Jacob Shelley is an Assistant Professor with the Faculty of Law and the School of Health Studies in the Faculty of Health Sciences at Western University. His primary area of research is the role of law in promoting public health and preventing chronic disease, with a focus on diet-related chronic diseases. Follow him on Twitter here.

The Coca-Cola Company Supports Stricter Sugar Guidelines Than Health Canada

By Romain Behar

Last week Coca-Cola announced that they supported the World Health Organization's recommendation to limit added sugars to 10% of total daily calories.

Putting aside that it's difficult to limit that which you can't see or count, Health Canada recently announced that rather than recommend limits and listings to added sugars on food labels, they are going to do so only for total sugars.

Their rationale has been explained to me and others as being in part reflective of the fact that as a percentage of Canadians' total sugar consumption (the other was a regulatory concern that they couldn't identify added vs. intrinsic sugar by way of testing), added sugars make up roughly half of those, and therefore with Health Canada's proposed 100g limit to total sugars, and using simulated diets, they expect 50g of those to be free or added. Working off a 2,000 calorie diet (which itself may not be all that wise, but is the convention everywhere), that reflects the WHO's 10% recommended daily added sugar limit. Of course that's only if you follow Canada's Food Guide. And given that soda, candy, and what were once known as "other" foods, aren't part of the Guide, suggesting a total sugar value will serve as a useful surrogate will fail the vast majority of the population given studies have suggested  that 25% of the average Canadian's calories come from "other" foods.

Even if you put dietary reality aside for a moment, there's a big problem with the plan as more recent research calls Canadians' presumptive added sugar consumption into question. The research, spearheaded by PhD candidate Jodi Bernstein and working out of Dr. Mary L'Abbé's lab notes that prior guesstimates were based off data generated in part from the limited Canadian Nutrient File (CNF) - a database that according to Bernstein et al. lacks, "scheduled, systematic and comprehensive updating", and does not contain any brand specific data.

In the CNF's stead, Bernstein et al created their own database, the Food Label Information Program (FLIP) database, which they update every 3 years. The data was collected by way of boots on the ground in Toronto, Ottawa, and Calgary grocery stores representing 75% of the market share. There, researchers used a smartphone to scan and categorize every single item with a Nutrition Facts table (NFt). Next, an algorithm was utilized to calculate the products' free and added sugars.

Among their FLIP derived conclusions is that rather than the 50% derived from the CNF, 62% of consumed sugar in Canada is from free and added sources.

In turn that means that Health Canada's arguments in support of their much criticized plan to list simply total sugar on future NFts, are weak, and may underestimate added sugar consumption, and that if you consume 100g of total sugar, you'll be exceeding the WHO's recommended daily added sugar maximum by 24%.

It also means that The Coca-Cola Company may now be supporting stricter added sugar limits than Health Canada.

[I should note though, both the 50% and the 62% are best guess estimates. In turn I'd say that speaks to why we'd be far better off with an added rather than total sugar listing on our NFts.]

Is Health Canada About To Allow Wonder Bread To Market Itself As A Health Food?

Last month Health Canada announced their finalized version of the changes Canadians can expect to see, 5 years from now, on our nutrition fact panels.

And while some of the changes are laudable, the changes to how our labels report sugar appear confusing.

Rather than highlight the distinction between total sugars and added sugars, a distinction that the World Health Organization, Canada's Heart and Stroke Foundation, the American Heart Association, the American Academy of Pediatrics, the Institute of Medicine, and many other public health authorities believe to be the crucial distinction as would pertain to the impact of sugar on our development of chronic diet related diseases, Health Canada instead declined to add a line expressly highlighting a food's added sugar content. Instead, Health Canada elected to provide a line for total sugars, and to it attribute a %DV (percent daily value) measure derived from a recommendation of a total maximal daily limit of 100 grams of sugar (or 20% of total daily energy for a diet of 2,000 calories).

In a consultation that I participated in at Health Canada, they explained to us that their rationale for not having an "added" or "free" sugar line was regulatory in nature. They reported that it would be impossible for Health Canada to include a line on added sugars because if there were a regulatory challenge, a laboratory would be unable to differentiate between a product's sugar source and would only be able to report total sugar and not the percentage of sugar added to said product.

This strikes me as something of a cop out as not only do we currently have other labeling features that aren't testable in laboratory settings (Halal, Kosher, etc), but it is far from impossible to compare a product's total sugar and subtract that which would be expected to be intrinsic to a product's ingredients. It's also clearly not impossible as evidenced by the fact that America's Food and Drug Administration has announced that a line for added sugars will be rolled out to their nutrition fact panels (and required to be adopted in 2 years, rather than Health Canada's 5).

As to why this matters, beyond stepping away from the recommendations of other jurisdictions and public health authorities, it's deceptive.

For instance, if you were considering a 12oz can of Coca-Cola, if an added sugars %DV was set at 10% of total daily calories (as per pretty much everyone's recommendations), the can's label would tell you that it contained 78% of your recommended total daily value, but with Health Canada's new label, it'll tell you it contains a far less awful sounding 39% of your total daily sugar.

But there's more. And it's worse. There's a far more worrisome sugar labeling initiative being considered by Health Canada. In what will undoubtedly make matters worse for consumers, a "low in sugars" claim is being considered whereby the food industry will be allowed to market their products as healthful if they

"have no more than 5 grams sugars (a) per reference amount and per serving, (b) per 50 grams if the reference amount is small (i.e., 30 grams or 30 millilitres or less), or (c) per 100 grams if the food is a prepackaged meal."

On that basis Wonder Bread would be allowed to promote itself as "low in sugars", and so too will scads of other ultra-processed foods.

All this leaves me scratching my head and wondering whose interests are best served by these changes - the public, or industry?

New Brunswick Says Slush Puppies Provide "Maximum Nutritional Value"

Need proof that 5-10 years is too long to wait for improved nutrition guidelines from Health Canada?

That photo up above is from New Brunswick's George Street Middle School's cafeteria's Facebook page. They're highlighting the fact that they've recently installed this Slush Puppie machine for their students.

Slush Puppies, for those who aren't clear, are non-carbonated, vitamin fortified, juice concentrates, poured over ice.

Each glass of Slush Puppie Plus contains 7 teaspoons of free sugars - more than the World Health Organization and Canada's Heart and Stroke Foundation recommends as a total daily limit for kids.

This led one concerned parent to write to George Street Middle School's cafeteria to express her concern.

The response she received in reply?

It spelled out that the vitamin fortified liquid candy machine that the school installed was not only not cause for concern, but rather was a drink that was defined by New Brunswick's Healthier Foods and Nutrition in Public Schools Policy 711 as being of Maximum Nutritional Value which

"indicates foods that are a good or excellent source of important nutrients and are low in fat, sugar and/or salt. These foods are considered nutrient dense relative to the energy they provide. These foods should be offered on a daily basis and comprise the majority of foods/beverages served in schools."

And it's not just a New Brunswick inanity by the way. When writing this blog post I noticed that Slush Puppie Plus is making the rounds in US schools as well where it is reported to meet the “Alliance for a Healthier Generation” Guidelines for 100% Juice in Elementary, Middle and High Schools.

And no, just in case you were wondering, this isn't The Onion.

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]

If Health Canada Won't List Free Sugars, These Frustrated Researchers Will

Today's guest post comes from PhD candidate and RD Jodi Bernstein. The post covers her, and her supervisor Dr. Mary L'Abbe, the University of Toronto's Earle W. McHenry Professor and Chair Department of Nutritional Sciences', continued push for Health Canada to require free sugars to be included on Canada's nutrition fact panels.

The World Health Organization recommends that we limit free sugar intakes to a maximum 10% of calories a day. But there are many factors that hinder our ability to abide by these guidelines, far more than support it. First of all, it’s pretty difficult to picture what 10% of calories looks like. Sure I can tell you that for the average adult it’s about 50g or 12 teaspoons, but would that really help you all that much? Most of the free sugar we eat is coming from inside candies and sweets, cereal, beverages, and baked goods, so we can’t easily see how much free sugar is in the food. To abide by the World Health Organization’s recommendations, free sugar needs it to be included on the nutrition facts table.

The United States is planning to include the amount of added sugar (similar to free sugar) on their food label. But here in Canada, the latest proposal to change the nutrition label did not include free sugar on the label. In fact, we discussed the importance of including added sugar on Canada’s nutrition label in a previous blog post on Weighty Matters.

But in the meantime, we weren’t about to just sit around and wait. In light of this difficult predicament we took it upon ourselves to calculate the free sugar content of over 15,000 Canadian packaged foods and beverages, published it for open-access use, and found some interesting results along the way. Using the University of Toronto’s Food Label database, which has nutritional and ingredient information, we calculated the amount of free sugar in each product using a 6-step algorithm tailored for just this purpose. Here’s what we found:

1. A lot of foods have free sugar in them. Sixty-five percent to be exact. That means its probably harder to find a packaged food that doesn’t contain free sugars, although the proportion was a lot lower in certain food groups like vegetables, nuts and seeds, dairy products and cereals and grains and highest in desserts, sugars and sweets, and bakery products.
2. Free sugar accounts for 62% of total sugar. Although this was much higher for sweets, bakery products, desserts, and beverages and much lower for fruits and vegetables.
3. There is a wide range of free sugar in a food category. This means two things: 1) when choosing a product, there may be a similar one that has less free sugar available; and 2) successful reformulation is possible. Having similar items, some with less free sugar, acts as proof showing that, yes, this food can be made with less free sugar and consumers will still buy it!
4. There are 152 ways to say “free sugar” in the Ingredient List. It’s no wonder free sugar is considered a “hidden” source of calories. For instance, ‘table sugar’ was listed 40+ ways including all dehydrated, dried, granulated, concentrated, refined, coarse, evaporated, solid, powdered, and liquid variants of cane juice, sugar, and sucrose.
5. 1/5 of total calories come from free sugar. Of course this ranged between food groups, with the highest at 70% of calories coming from free sugar in beverages. Consuming foods that have more than 10% of calories from free sugar increases the likelihood of exceeding dietary recommendations.

We are hopeful that these results will support of interventions and policies (including labelling free sugar on the nutrition label!) to limit excess free sugar consumption. The detailed information we provided in this study can be used as a benchmark to monitor changes in free sugar contents overtime, identify areas and targets to focus reformulation efforts, direct educational messages, and can be linked to national nutrition surveys to evaluate free sugar consumption and monitor associated health outcomes.

Jodi Bernstein is a Registered Dietitian and has a Master’s in Public Health, specializing in community nutrition. She is currently a PhD Candidate in the Department of Nutritional Sciences at the University of Toronto. Her thesis focuses on sugars in the Canadian food environment.

Most recently, Jodi has developed an algorithm to estimate the free sugars contents of Canadian food and beverages. Results have since been used to populate One Sweet App, a mobile app that allows users to track their free sugars intakes and compare this to guidelines from the World Health Organization.

Dr. Mary L’Abbé is the Earle W. McHenry Professor and Chair of the Department of Nutritional Sciences, Faculty of Medicine, at the University of Toronto, where she leads a research group on Food and Nutrition Policy for Population Health. Dr. L’Abbé is an expert in public health nutrition, nutrition policy, and food and nutrition regulations, with a long career in in mineral nutrition research. Her research examines the nutritional quality of the Canadian food supply, food intake patterns, and consumer research on food choices related to obesity and chronic disease.

Dr. L’Abbé a member of several committees of the WHO including the Nutrition Guidance Expert Advisory Group on Diet and Health and the Global Coordinating Mechanism for NCDs; the former which recently released the WHO Guidelines on Sugars. Dr. L’Abbé was co-chair of the Canadian Trans Fat Task Force, led the Trans Fat Monitoring Program and served as Chair and vice-Chair of the Canadian Sodium Working Group. Before joining the University of Toronto, Dr. L’Abbe was Director, Bureau of Nutritional Sciences at Health Canada. Dr. L’Abbé holds a PhD in nutrition from McGill University and has authored over 180 peer-reviewed scientific publications, book chapters and government reports.

Why Does @HealthCanada Allow Chocolate Syrup To Be Enriched With Iron?

I took this photo at my local supermarket a few weeks ago.

It's a rather mind boggling product.

As is evidenced by the photo up above (and by common sense) this "iron enriched" Nesquik is meant to be added to a glass of milk.

So what's my issue?

Firstly a glass of milk, by way of both its casein and its 300 or so mg of calcium impairs iron absorption so what's added isn't the iron your body will be getting by a long shot.

Second it's vitamin fortified chocolate syrup with a front-of-package designed to infer good-for-you-ness.

That Health Canada allows a product designed to be added to milk to be enriched with iron is bizarre.

That Health Canada allows the enrichment of candy with vitamins, and then allows that vitamin enriched candy to be marketed as healthy, is just plain wrong.