Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 28 - Evidence - February 25, 2015
OTTAWA, Wednesday, February 25, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day, at 4:16 p.m., to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: Welcome to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I am Kelvin Ogilvie from Nova Scotia, chair of the committee. I invite colleagues to introduce themselves starting on my left.
Senator Eggleton: Art Eggleton from Toronto, deputy chair of the committee.
Senator Merchant: Pana Merchant from Saskatchewan.
Senator Enverga: Tobias Enverga from Ontario.
Senator Seidman: Judith Seidman from Montreal, Quebec.
The Chair: We are continuing our study on the increased incidence of obesity in Canada. Today, we will hear from witnesses in the agreed upon order of presentation, starting with the Canadian Sugar Institute and their President, Sandra Marsden, who has with her Dr. Flora Wang, Manager, Nutrition and Scientific Affairs.
Ms. Marsden will present, please.
Sandra Marsden, President, Canadian Sugar Institute: Thank you, Mr. Chair and senators.
Since 1988, the Canadian Sugar Institute has maintained a scientific Nutrition Information Service that was established to monitor the scientific literature on sugars and health and to collaborate with academia, health professionals and other organizations in the promotion of science-based information. The information service is managed by qualified health professionals, including Dr. Flora Wang and registered dietitians. We are guided by the Scientific Advisory Council. I'm the President of the CSI and a registered dietitian.
Sugar has been a natural and safe part of the human diet for centuries. Sugars are an integral part of our diet and food supply, whether naturally occurring in fruits, vegetables and milk or added to food to contribute sensory properties and functional roles, and to provide food safety in foods such as jams and jellies.
Unfortunately, in recent years there's been an escalation in misinformation and unfounded claims related to sugars in health. You've all read editorials, commentaries and letters to the editor in both the scientific literature and popular media suggesting that we're consuming excessive amounts of sugary foods and beverages. Some have even suggested that sugars are harmful or toxic, requiring strict public health controls. However, available data based on Canadian consumption and the review of high-quality scientific evidence do not support such extreme claims. I'd like to take you through a few of the issues responsible for some of this misinformation that is so popularly held.
First is terminology. There's a great deal of confusion between words such as sugar, added sugar, free sugars and naturally occurring sugars. This has created some misunderstanding around actual consumption levels.
First of all, sugar is sucrose. That's the commodity I represent. It occurs naturally in all fruits and vegetables and is added to foods. It occurs most plentifully in sugar cane and sugar beet. But whether you eat sucrose as sugar in a banana or you add it to your yogurt or cereal, your body metabolizes it in the same way.
The terminology is important because some reports have used the term "sugar'' to talk about all sugars, and we know that sugars naturally occur in fruits and vegetables. There's sugar in milk, and there are other sugars added to food such as maple syrup and honey and high-fructose corn syrup in soft drinks. So it's important to understand the difference. The media often talks about sugar, but they have misused reports that actually quantify total sugars.
In 2011 Statistics Canada reported on sugar consumption in relation to the Canadian Community Health Survey, and they reported total sugars but unfortunately used the term "sugar.'' So the media, not necessarily equipped to dig into the details of that report, used the term "sugar'' to refer to all of the sugars in our diets.
Total sugars consumption in Canada is about 21 per cent of our energy intake, and about half of that is added sugars; so all of the sugars that you add to foods, from sugar, sucrose, high-fructose corn syrup, honey and maple syrup, is about half of the total sugars, and that's about 11 per cent of our energy intake. I have provided the senators with a paper which outlines some of the references for that. So terminology is important.
Statistics are very important as well and quite often misused to characterize consumption as escalating, growing and excessive. Sometimes global food availability data is used, which overestimates consumption because it doesn't account for waste and losses, whether that is at the industrial level or at the consumer level.
To look at trends, it's helpful to look at availability data, but it doesn't reflect actual consumption. If we look at trends in Canada, contrary to popular belief, consumption has been declining. Over the 30 years during which obesity rates have doubled, added sugars and syrups consumption has declined about 20 per cent. Again, if we look at statistics that are available to us from our own department, Statistics Canada, the facts tell a different story than what we read in the media.
This decline in added sugars consumption has been similarly observed in other developed countries, including Australia, the United States and many European countries.
A third problem is the misuse of U.S. data to characterize Canadian consumption. Our consumption of added sugars is lower than in the United States. Our obesity rates are somewhat lower as well. Soft drink consumption in the U.S., for example, is double Canadian consumption. That might sound unbelievable, but that's what our Canadian Community Health Survey reports and that's what our food availability data reports. Total added sugars intake in Canada is about a third less than the U.S. level.
Now when it comes to nutrition, I am a dietitian, so it concerns me when I hear that a calorie is not a calorie or that a sugar calorie is different from another calorie. All calories are created equal. Sugar provides four calories per gram, whether it's naturally occurring or added, and it's the same as all carbohydrates. A number of important systematic reviews have verified this, including a World Health Organization sponsored review. Dr. John Sievenpiper from St. Michael's Hospital, University of Toronto, has also done a number of systematic reviews to demonstrate this.
In both Canada and the U.S., it's been proposed, based on a lot of sugars misinformation, to add "added sugars'' to nutrition facts tables. I've included some information to highlight how consumers may be misled by that information.
I think it's extremely important when making policy decisions that governments and policymakers generally base their decisions on evidence-based studies, not studies that observe or associate sugars with disease without the high- quality examination of systematic analysis of clinical trials. From those studies, the dominant consideration is clearly excess calories, rather than sugars or the type of sugar, for weight gain and other metabolic problems. Current estimates about added sugars in Canada are about 11 per cent of energy, which is very close to that suggested by the World Health Organization of 10 per cent.
So we would strongly recommend that this committee not focus on the popular wisdom, which is to attack single nutrients or single foods, but rather recognize that diets, like obesity generally, are very complex, and single-focused attacks will not solve the problem.
We would strongly urge there to be research funding into more evidence-based analyses to support policy decisions. The Canadian Community Health Survey in 2015, which is under way, is also very important to show us what has changed since the last survey in 2004. It will be another opportunity to look at total sugars consumption, and hopefully the use of the terminology in the Statistics Canada reports will be accurate and not be misused by the media.
Finally, we would hope that nutrition labelling and claims would be closely scrutinized to ensure that they are also based on that evidence base.
Thank you.
The Chair: Thank you very much, Ms. Marsden.
I will now turn to the Canadian Beverage Association and Jim Goetz, who is the chair.
Jim Goetz, Chair, Canadian Beverage Association: Thank you, Mr. Chair. Let me begin by expressing my gratitude for the invitation to appear today. My name is Jim Goetz, and I am President of the Canadian Beverage Association. Given time restraints, here are some key points about the beverage industry in Canada.
We have more than 220 facilities located in every province in the country and directly and indirectly employ over 59,000 Canadians. Beverage industry salaries are on average 26 to 38 per cent higher than the manufacturing sector average. We generate $6.6 billion of added value for the Canadian economy, and we pay over $892 million to governments in taxes each year. Eighty-eight cents of every dollar of GDP generated by the industry is retained in the Canadian economy, which is 10 per cent higher than the overall manufacturing industry average. CBA members also participate in community nutrition, playground builds and environmental programs across the country.
We are proud of these contributions in our role in the Canadian economy, but more important we are proud of the fact that millions of Canadians invite our members' products into their homes each and every day.
We know that many groups and individuals paint our industry as a villain and have told you that by banning or taxing our products you will dramatically impact obesity in Canada. Unfortunately, this isn't true.
When it comes to looking at the causes of obesity, there is no one unique villain, no one food or beverage or socio- economic group or lifestyle to blame, and that is what makes it so hard when looking for a solution. In fact, Statistics Canada published a study in October 2009 that examined the government's own Canadian Community Health Survey data to see whether an association exists between obesity and the relative percentages of fats, carbohydrates, protein and fibre in the diets. The authors concluded that:
. . . it is not what you eat, but rather, how much—the total number of calories consumed—that significantly contributes to obesity.
An excellent example is that since 2002, total sugar-sweetened beverage sales have declined by 13 per cent, yet the number of obese or overweight Canadians age 12 or older has risen by 21.5 per cent. Shouldn't obesity be declining along with sugar-sweetened beverage sales? The answer is that the two are not linked, and unfortunately there is no magic bullet to solving the obesity problem.
Targeting one particular food or beverage as a unique cause of obesity sets people up for failure. Think of the low- fat, low-carb, high-protein diets saying that if you stop eating one product you will lose weight. We have all seen that those kind of simplistic solutions do not work.
That said, our industry has been a leader in addressing this issue through product innovation, smaller packaging and industry-specific guidelines and initiatives. It is our belief that education, information and options are key if Canadians are going to make the choices that are best for them and their families.
In fact, nearly 10 years ago, in 2006, the beverage industry voluntarily initiated our Industry Guidelines for Sale of Beverages in Schools. Full implementation was by 2009. These guidelines were created to provide parents with more control over what their children consume throughout the day. Our members voluntarily removed full-calorie soft drinks and provided more low-calorie, nutritious and smaller portion size options in elementary, middle and secondary schools nation-wide.
Our members also developed our Guidelines on Marketing to Children that prevent marketing of beverages, other than 100 per cent fruit juice, milk and water, to children under the age of 12. Many of our members have also committed to similar national and global standards regarding marketing to children.
To date, beverage industry compliance with the guidelines has been very successful. Members that participate in the Canadian Children's Food & Beverage Advertising Initiative are 100 per cent compliant in their commitment.
These results were also supported by research presented at the 2014 CDPAC conference, showing that the beverage industry has reduced their advertising on children's television stations to zero.
In 2011, our members voluntarily gave Canadians more information about our beverages when we launched our Clear on Calories initiative, a front-of-pack caloric labelling program designed to help Canadians understand how many calories are in their beverages. We declare the calories on the front of the bottles or cans. To help reduce confusion, we designated our 591-millilitre bottle as a single serve and now provide caloric and nutrition information based on the full bottle contents. We clearly declare serving sizes and their calories on the front of all of our multi-serve beverage packages.
So what's next? This committee has already heard a great deal of testimony on a variety of solutions. One that has recurred several times is the idea of taxation. First, let's be clear: Soft drinks are already taxed in the provinces through sales taxes.
Second, research shows that taxation doesn't work. In fact, the Manitoba government looked at taxation of sweetened beverages recently and determined that it doesn't accomplish the goal of addressing obesity and would be very hard to administer.
The CBA is now striving to maintain our leadership in helping consumers manage their diet and weight. Just last fall, the American Beverage Association and its partner, the Alliance for a Healthier Generation, launched an initiative to reduce beverage calories in the American diet. Our members in Canada are currently working to adopt a similar initiative in the Canadian market.
The beverage industry's initiatives that I have described here today clearly demonstrate our commitment to being part of the solution. We are aware that, as an industry, we play an important role, and we take this very seriously. However, we must also ensure that any efforts we undertake are based on sound scientific evidence and that any proposed measures will succeed in making a concrete difference for Canadian consumers.
We look forward to working with this committee and continue to work with governments more broadly to ensure this happens.
Thank you very much.
The Chair: Thank you, Mr. Goetz.
I now will call, from the Salt Institute, Vice-president Morton Satin.
Morton Satin, Vice-president, Salt Institute: Thank you for inviting me. I provided a slide presentation as background documentation, but I won't be following that because of the allotted time. It's fully referenced, so you can look at it whenever you do have time. Before we get to the subject of obesity, I would like to provide some background on salt.
Salt, or sodium chloride, is an essential nutrient, and like all other essential nutrients which can't be synthesized, it must be ingested. From the dawn of human existence, salt has been the most ubiquitous food ingredient consumed, aside from water.
Sodium and chloride are the body's predominant positive and negative ions, respectively, and are responsible for a large number of apex physiological functions. When we consume too much salt, whatever is not required is voided. Two normal human kidneys can filter 50,000 millimoles of sodium, which is the equivalent of three kilograms of salt per day.
When we consume insufficient levels of salt, several innate response mechanisms combine to conserve the available salt resources that the body has, and also at the same time stimulate the body to seek out and consume more salt. These inherent feedback mechanisms are not unique to humans but occur throughout the animal kingdom and are particularly active in mammals.
In order to stimulate salt consumption, animals have an inherent salt appetite that signals when to consume more salt. This shouldn't come as a surprise, as it is fully consistent with our physiological understanding of the concept of homeostasis, keeping yourself in balance, often referred to as the wisdom of the body.
This phenomenon is used to commercial advantage in animal feeding, as in the case of cattle. Cutting salt out of animal feed causes the animals to consume more in order to satisfy their salt appetite. They continually eat until they get enough sodium. Once they progress to the expensive finishing feed stage in a feedlot, salt is added to the feed to quickly satisfy their appetite and prevent the over-consumption of high-cost calories. I know it sounds very commercial, but that is the management system that is used in the feed industry.
In humans, while there are well-established examples of higher consumption of low-fat foods, lighter alcohol beers — I was with John Labatt corporation for many years — the question remains whether salt appetite would stimulate greater consumption of low-salt foods in humans, and it's a valid question.
There's a public perception that we consume more salt now than ever before. This "myth-information'' is driven by our misunderstanding of processed foods. Food processing is one of mankind's earliest activities, and no society has ever evolved without the processing required to preserve their foods. It's nothing new. The chief preservative of food throughout history was traditionally salt. However, we consume less salt now than ever — well, at least in recorded history, the last 200 years. This has been confirmed through military records of soldier and prisoner of war rations from the War of 1812 until the end of the Second World War.
In fact, our current salt consumption is about half of what it was up until the end of the Second World War, and that is simply because refrigeration has displaced salt as the main means of food preservation. From 1945 to 1957 — and it varied, depending on the country — as refrigeration and the cold chain took hold, our salt consumption quickly dropped in half, without any public campaigns, without any government recommendations and without any food alarmists. We just naturally gravitated to a fresher, more palatable food supply. But we have remained at the 1957 level ever since. It's a superb example of the wisdom of the body.
The current dietary recommendations for salt consumption are problematic and, in fact, the dietary reference intakes upon which these recommendations are based are currently under review by the Department of Health and Human Services in the U.S. because they have found out — and it's very clear — that they originally were made without following the protocols that were set out to make DRIs.
If you have a look at the slides, one look at the World Health Organization data shows that, in fact, the current recommendation ends up with the lowest longevities or life spans, and the highest levels of, believe it or not, hypertension and diabetes. Those are in the slide shows. The only country in the world that consumes close to the recommendation, but not quite as low, is Kenya, with a life expectancy of 49. No one else consumes anywhere near that.
The available information on salt and obesity is anything but consistent. We know that physiological mechanisms drive food and salt consumption until a salt appetite is satisfied. Foods containing lower salt levels will consequently be consumed in greater amounts. This phenomenon, as I mentioned, is used in animal feeds.
While there have also been publications that epidemiologically — not physiologically but epidemiologically — linked higher beverage consumption to higher salt consumption, other research has dismissed this claim. This evening I'll be passing on a series of recent publications — some saying that they're linked, some saying that they're not linked — related to salt and beverage consumption.
While obesity has grown to epidemic levels in North America during the last 40 years, isolating the root causes has proven extremely difficult. Simplistic solutions, particularly those aimed at the food supply sector, which is routinely maligned as irresponsible to the consumer, have not been as successful. Indeed, some have rushed to judgment on the dietary recommendations, resulting in an overabundance of fat-restricted processed products from a forced interpretation of limited evidence, as being responsible for the current obesity epidemic.
We all know that obesity is not the product of one unique factor or another. There is no single silver bullet to solve it. It is multifactorial, combining elements of diet, energy expenditure, social and economic and technological dimensions.
That is not to say it's too overwhelming a challenge to undertake. On the contrary, it can be undertaken if done so objectively and with a focus on actual scientific evidence rather than resorting to finger pointing. It is in the consumers' and the country's interests. It is equally in the interest of industry to have healthy citizens and employees.
A comprehensive and sensitive analysis of the issues may lead to incentive-driven programs, using available technology, that are better able to balance our integrated lifestyle during this period of enormous change and flux.
Thank you very much.
The Chair: Thank you very much, Mr. Satin.
I will now turn to my colleagues.
Senator Eggleton: The first question is on sugar and the second one will be on salt.
According to the Heart and Stroke Foundation, it's estimated that Canadians consume as much as 13 per cent of their total calorie intake from added sugars, not naturally occurring sugars. They state that excess sugar consumption is directly associated with obesity, strokes, heart disease and diabetes. Other scientific evidence that backs this up comes from such organizations as the Centers for Disease Control, the World Health Organization, Harvard University, the National Institutes of Health, Oxford University, the British Medical Journal, and on and on, a number of organizations. The Heart and Stroke Foundation also states — it's a Canadian organization, by the way — that sugar-sweetened beverages are the single largest contributor of sugar to our diets. Harvard University refers to the rising consumption of these drinks as the major contributing factor to the obesity epidemic. Again, numerous studies confirm this.
One, for example, comes from the Union of Concerned Scientists, headed by a professor out of Harvard. In a recent report, they state that the food and beverage companies obscure the science and undermine public health policy on sugar by doing such things as attacking the science, using trade associations to spread misinformation, hijacking scientific language for product promotion, funding research to support their interests and paying academic scientists to influence others about sugar, amongst other things.
I would like your response to all of this scientific evidence, which seems to go counter to what you're telling us here today.
Also, I think Mr. Satin said that there is an epidemic of obesity. Yes, there has been an epidemic of obesity in the last 30 years. If sugar and salt, processed foods and such are not a part of all of that, then what is? What do you think is causing the problem, and what do you think the solutions are to the problem? Just don't tell me that it's complex and that there are tons of other things. If it isn't sugar and isn't salt — I'll start with the sugar though — what is it, and what do you think of these other scientific studies?
Ms. Marsden: What I didn't share with you is the hierarchy of evidence, which is very important in understanding how to interpret the various studies that one might hear about.
At the bottom of the hierarchy are the lower quality studies, such as animal models and observational studies that look at gross changes in population trends — for example, the availability of sugar at one point in time or the availability of any food at one point in time — and that then look at outcomes perhaps 30 years later in terms of an end point. That could be heart disease. It could be death. So looking at someone's diet today and then 30 years from now looking at statistics to see what the outcome was, they're very unreliable.
As you move up the hierarchy, you get to clinical studies, which you can randomize into control groups and study groups, and you have more independent assessment.
At the top of the hierarchy is what is called systematic reviews and meta-analysis. Those are the studies that pool all of this evidence and grade it according to international guidance and criteria.
So in looking at the debate, one really has to go to the top of the hierarchy, and that's where the World Health Organization most recently did their systematic review on obesity. They did not find a unique effect from sugar. They found that when you substituted with other sources of carbohydrates, the same effect occurred. So, absolutely, you can consume too many calories. That is part of the obesity problem. Sugars will be among those calories, but there is nothing unique about sugar. So you may be consuming too much fat, too much sugar, too much protein. All of those things provide energy. It's the overall dietary pattern that is predictive. It's difficult to measure but absolutely essential to evaluate.
Yes, it's complex, but it is important to examine all of those factors. The evidence, when you look very closely, doesn't support a unique effect of sugar on caloric intake.
Mr. Goetz: To follow up on the comments about the collection of studies and how that's analyzed, I won't go down that path too far, but we need to look at a Canadian context on some of these studies as well. I would add to the list that was presented that what wasn't mentioned was the largest Canadian study ever done on the consumption of sugar- sweetened beverages, which was in 2011, by the University of Saskatchewan, and which had absolutely no interference from industry or no sponsorship. The conclusions were:
"Our results show no relationship between Canadian children's consumption of sugar-sweetened beverages and obesity.'' They found one cohort of children — I don't have the age in front of me, but I think it was 11 to 12 — where, the strongest they could link the two, was "may cause obesity.'' But they also made the note that that group of children was significantly inactive.
I don't want to go study by study, but that is the largest, most recent Canadian study on this subject, specific to sugar-sweetened beverages, and that was the conclusion.
Senator Eggleton: They cut the sugar in Coke, I understand, from 10.5 teaspoons down to 9.7 teaspoons. That is still an awful lot. Apparently, that is what it is generally in the world. That's still an awful lot of sugar.
Let me ask about salt. Again, there are a number of organizations — the World Health Organization, Harvard University, the Mayo Clinic, the Heart and Stoke Foundation — that said that excess sodium intake has a negative effect on health. Three long-term scientific studies confirm this: the INTERSALT Study that were started in the 1980s; the two trials of hypertension prevention studies that were conducted throughout the late 1980s and early 1990s; and the dietary approaches to stop hypertension trials that began in 1994. Additionally, another study has recently linked salt intake to soft drink consumption and obesity in adolescence.
I know, Mr. Satin, you'll probably refer to a McMaster study, a university-perspective, urban/rural epidemiology study last year, which however has been countered by the scientific community as being faulty. That would include the American Heart Association and the Libin Cardiovascular Institute of Alberta.
On salt, there seems to be a lot of research and heavy evidence against the position that you are taking here. I would like your comments on that. Also, if we're wrong in tackling salt, then what should we be tackling in terms of the obesity epidemic?
Mr. Satin: It's really a good question. To start countering every one of those studies — and I can, with evidence and with publications — ends up being an argument of "there are these facts'' and "there are those facts.''
As a matter of fact, I've not been in this business for a long time. I only got into it when I started to see how the evidence was being interpreted. I came out of a comfortable retirement to do this business. It is only because I thought that consumers were being misinformed, and I couldn't really understand the reason why. Facts are facts. We should understand and everybody should understand that whatever advice is given, there is somebody at the end of the line that is going to benefit or be harmed by it.
If my record doesn't convince you, at this point in time, salt sales are really not a concern of mine. They have their own salesmen. They are big boys. They can take care of that side of the business. From the time that I started serving in the food industry in Canada back in the late 1960s, my thing was that consumers should be making their decision out of evidence, out of information, not out of a lack of information. Although I have great respect for food advocates, there is a real problem when they're successful, but, unfortunately, their information is wrong.
Over the years, we've had our perspective on food totally skewed. We had less information but a better perspective on food 40 years ago than we have now. Right now, we are stuffed with data and devoid of context, which is a terrible pity because we lose our food culture. In Italy they eat as much sugar and salt as they want and they are still in great shape. They know a little about food, think about food and understand that food has to be in balance.
Over here, the major problem is not only our consumption of food regardless of the food but also that in the past 30 years it has changed, technology has changed and our economy has changed. Thirty years ago was anybody sitting in front of a monitor eating their lunch? We're in a period of incredible flux over here. All of these things are happening, and we're being dragged along. Then all of sudden we get some people saying it's this part of the food industry or this particular aspect, salt for example.
They did it with fat. The alarmists go ahead and say it's fat. Because they are very convincing, there's legislation that agrees with them and we have recommendations to reduce fat.
Industry, generally speaking, doesn't fight this. They're the best friends the industry ever had because they give them all their new product ideas — you want low-fat foods? How low do you want the fat? We'll make it — of course we will. Do you want low-salt foods? We'll even make low-sugar foods.
Instead of getting their marching orders from consumers, and this is so discouraging for me, they are getting their marching orders from the alarmists. There is a disconnect between the industry and the consumer.
When I was with Steinberg, we used to go out and talk to consumers. What do you want? You don't like hot dogs. Tell us what's wrong with hot dogs. If we can't justify them, we're not going to sell them. But that has changed over the years.
Now we're dealing with this great problem of obesity, and it is a major problem. How do we deal with it? Again, it's multifactorial.
We have to deal with the problem of less energy expenditure; no one is riding a bike and no one is exercising. Nobody has time. When I was in Rome at the FAO for 20 years, we took at least a one-hour walk at lunch every day. We worked a little later, but we worked the calories off. That doesn't happen anymore.
We have to look at the idea of how, in this context, we can provide incentives for people to balance what they're taking in versus what they're taking out. The government could come up with a program to say we now have the tools, the Fitbit and whatever else, so why don't you provide tools to the worker so that if they walk so many miles a week, they will get a free lunch, as long as the lunch is a good lunch.
I'm sorry I'm talking so much.
Senator Seidman: There is no question that your testimony is an indication of all the confusion in the field of nutritional epidemiological. There is an enormous amount of confusion among consumers as the evidence changes over the decades.
Ms. Marsden and Mr. Satin, both of you have talked about the mandate of your respective associations. Ms. Marsden, you said that the CSI has maintained a Nutrition Information Service, established to monitor the scientific literature on sugars and health and to collaborate with academic health professionals and educator groups in the communication of science-based information and programs.
Mr. Satin, you said a similar thing in terms of the Salt Institute's purpose and mission. Indeed, your website says that the Salt Institute analyzes research and public policy and is dedicated to the adherence to sound science as it seeks to improve knowledge of the many ways salt can benefit individuals and the environment. I'm focusing on how you do this. What kind of things do you do to participate with academics or with consumers?
Ms. Marsden: First, we're all either dietitians or researchers, so we're part of the community that we collaborate with. We don't do promotional activity or advertising. We're members of different groups with whom we work and share information. We have a Scientific Advisory Council of academics across the country. We meet with them twice a year and they advise us on our publications. They review them and suggest third party authors, for example for something we call Carbohydrate Nutrition News.
We are all members of Dietitians of Canada so that we can share our views and learn from our broader organization as members of that.
We are also members of the Canadian Nutrition Society, which is principally a group of nutrition researchers. Sometimes we do research in the marketplace. For example, we examine claims on labels and ask health professionals their views or their understanding of those claims. We examine whether claims are in keeping with Canadian guidelines and then do poster presentations and try to publish that information.
We did further analysis of the Statistics Canada Community Health Survey data on sugars because the government didn't have the funding to do it. We took the data and did the statistical analysis to get estimates of added sugars. We were successful in having other researchers collaborate with us and publish that data.
Most of what we do is through collaboration and educational efforts through publications and our website to translate or communicate the evidence-based information that we monitor.
Mr. Satin: We're a very small organization. I'm basically the technical person. We have only four people in our organization. It's funny when we're referred to as "Big Salt.''
Most of our work is based on road salt rather than food salt. Food salt is a small part of the entire salt industry. Only about 5 per cent of the salt volume produced in North America is food salt. In China it's different.
To the extent of our budget, we do studies, most of them in Canada because there is more experience here with road salt than anything else.
We do some studies on water conditioning salt, which is a larger market than food salt. That's usually done through the Battelle Institute. We actually chip in with places like the Water Quality Association.
We also do a few small studies on food salt usually through universities. It's very plain: Here is the money; this is what we are interested in; don't talk to us until the results are published because we can't take a chance on having any influence on the results. Sometimes it's a crapshoot, and we worry about how it will turn out.
There have always been people asking whether kids should put salt on their vegetables. The question is: Will they eat vegetables without salt? We contracted with Ohio State University to do a study with young children to see how much salt they would use. It was interesting because they all took it seriously. They will not benefit from bitter vegetables like broccoli unless there is bitterness mitigator in it, which is a small amount of salt. They don't put a ton of salt in it. It was that sort of study for a master's degree. We're really talking $13,000 here and $15,000 there — very small studies.
We then try to put that information out along with everything else. We try to deal with both sides as there is always a negative publication, not nearly as many in the last five years as there have been on total health outcomes with salt. Those we have had nothing to do with. We read everything that comes out on salt, but medical studies are just too costly for us to even think of getting involved in.
Senator Seidman: Mr. Satin you've explained very well.
I'll go back to Ms. Marsden for a moment to try to understand. You have said in some detail that you even have a nutrition information service. So when you say you collaborate, most of what you do is collaboration; is that correct? Is that with professional associations, academia?
Ms. Marsden: Most of what we do is in the office, so it's reading the papers, which is what Dr. Wang would do. We read all the research papers, critique them, monitor the science so that we have a good understanding. Then we would prepare educational materials to communicate those findings, so that would be in our carbohydrate news publication, for our website.
We are also a very small organization, so we don't have funding to fund research ourselves. We work as part of the World Sugar Research Organisation, which is also a monitoring body. They do fund some research, but in a very minor way.
We essentially communicating the science through our publications and through our website mostly, exhibiting and presenting at conferences. We've presented jointly on media confusion with a scientist who would talk about the science. It's to try and encourage debate and review of the science.
Mr. Goetz: Senator, you mentioned consumers and choice. Our industry is very proud of the fact that between 40 and 46 per cent of our products that are on the market are either low- or no-calorie products. No other industry offers consumers so much choice when it comes to our beverages, which is why our membership moved ahead, as I mentioned earlier, with the Clear on Calories initiative. It puts caloric information on the front in a standardized format for consumers to check and then pick the beverage that best suits their lifestyle.
As far as scientific studies are concerned, our association does not engage in scientific studies, the sponsoring of scientific studies. We rely on the body of evidence that's come forward in Canada. We look at the Canadian environment and the studies that have come out in Canada regarding sugar-sweetened beverage consumption, and I've outlined some of those here today.
Senator Seidman: Thank you. I appreciate that.
Senator Merchant: My first question will be directed to Ms. Marsden and Mr. Goetz.
You're a nutritionist, Ms. Marsden, so I was a little surprised. There's great confusion. Consumers are very confused. I think we need some food literacy for consumers because here you talk to us, for instance, about calories. You say a calorie is a calorie, but there is something that we call empty calories. Telling people just to have 1,200 calories a day, then have two Cokes or five Cokes, or whatever it is, hearing that kind of information doesn't serve the consumer. I have to think that nutrition has something to do with it. And you're a nutritionist, so I take issue with that a little bit.
Mr. Goetz, while I appreciate very much that you're a good corporate citizen, you gave us a great long spiel in the beginning about the taxation, what you pay, but that really is not our concern here. We are studying obesity, so I am more interested in having information about that, not about your sponsorship of events. The cigarette companies did that for years and years, so this is not something new.
Consumers are very confused. Labels are very confusing. We have heard in this committee that some countries colour code the products on the shelves so that consumers can make choices a little more quickly.
What are you doing to help us, the people who have to buy your products, understand nutritional value? I don't know if you are contributing to obesity or not, because you've given us some information and not all information is the same. Different studies say different things. But is it a good thing for people to take all their calories in sugar, whether you're a good corporate citizen or not? What are you doing to help people make better choices?
Ms. Marsden: Certainly I don't take off my dietitian's hat when I go to work. I'm a member of a professional college and I still adhere to those principles, so fundamentally I believe very much in the quality of the diet and promoting good, healthy eating habits.
I'm not here to promote high consumption of sugar, promote consumption of a sugary diet and forget everything else. Of course not. All of the materials that we produce are consistent with advice of Canada's Food Guide, and the food guide is focusing on the four food groups and the nutrients that provides. It is encouraging a high-quality diet within the calories that you're permitted. That doesn't mean you can't have foods that contain sugar. In fact, the vast majority of the added sugars you consume are within those four food groups of the food guide. About 7 per cent of the calories you consume are outside, on average. Now, that doesn't mean some people are maybe consuming more of those foods and should consume less to bring their weight under control. It's all part of a dietary pattern, so all of our materials reflect that.
The reason for my appearance today is to help the committee and consumers understand that a singular focus on an ingredient — the ingredient sugars — won't really help understand the whole diet. It's how much you eat, when you eat, portion sizes, how you serve it, whether you sit down for breakfast. These are all important things, and, yes, focus on those main food groups. You have to limit additional calories, and that will include the foods that contain sugars and fats and other carbohydrate protein sources. Absolutely, the quality of the diet is very important.
Consumers are confused. Scientific papers are out every day and hit the media before we even see them and can evaluate them. Flora gets an email immediately to say, "Please, can you look at this?'' But the story is already done. As you know, you need to look at the systematic reviews of all of those hundreds, thousands of studies to make an informed opinion. I think that's a huge part of the problem.
The Chair: Mr. Goetz, it wasn't a specific question, but do you have any short remark with regard to the issue that Senator Merchant raised?
Mr. Goetz: Yes. For our industry, again, through our voluntary initiatives support, as far as talking about consumer confusion, caloric information is incredibly important. Study after study, specifically the ones sponsored by the Government of Canada, has stated that it's about calories in and calories out. Our industry supports caloric education, and we believe that helps with moderation of the foods and the beverages you're consuming and how many of them you should consume.
No one argues that the over-consumption of certain products may contribute to obesity, but if you balance those calories and have the education to eat a balanced diet, you're going to run into a lot less trouble with obesity.
Mr. Satin: On the issue of labelling, the most confusing thing in the world is current labelling, and it's very unfortunate because in 1973 the Universal Product Code was introduced by Steinberg in Montreal, not anybody else in the world. It was not by an American. At that time they wanted to have an entirely open system where you could scan a product and have every bit of information on it, because you couldn't put everything on a label.
A colour-coded label is the worst possible thing because it doesn't give you a choice. It gives you directions. If it's green, choose the green. That's not giving you a choice. Celery is green. You can't live on celery.
It makes it so simplistic, and it also takes away the confidence that somebody had in their own knowledge of what balanced food should be, because you can balance something green with something red with something orange. You can do that, but to be told if it's green or it's orange makes it so simplistic. And if you ate celery, whatever else you ate, by the way, including any protein, would go through you like it went through a goose because celery is mostly fibre.
The point is it's a little bit more complicated. Although it seems like we're doing the consumer a favour, we really aren't. We've taken the most important thing away from the consumer, and that is this basic innate and knowledge of what balance is all about.
Senator Merchant: I'm asking all of you: Do you think it's a good idea for Health Canada to come forward with a recommendation as to the amount? We have the Canada Food Guide, and that tells us to have nine fruits and four proteins; it's a guide.
Do you favour Health Canada, because they have all these scientific papers and they can review all of these things, coming up with a recommendation as to the amount of salt or sugar, in this case, because you're from these two organizations?
Ms. Marsden: In Canada we utilize the Canada-U.S. dietary reference intakes, so some of those nutrients are undergoing review. Perhaps at some time sugars will undergo review, but that's the evidence that Health Canada relies on; so in that report they did not find an association between sugars and obesity, and they did not find sufficient evidence to set an upper level. They made a suggested maximum of 25 per cent.
Now that doesn't suggest that we should consume 25 per cent. It's a suggested maximum because when levels get to very extreme levels, and that's very high, they found that micronutrient intakes — that's your vitamin and mineral intakes — could be compromised at high levels. Equally, at very low levels, below 5 per cent, your micronutrient intakes can be compromised.
Fundamentally sugars were not a good predictor of the quality of the diet. They didn't find sufficient evidence to give a number to sugars intake.
Mr. Satin: Senator, my answer is not going to be a happy one.
Senator Merchant: I didn't have an answer in mind.
Mr. Satin: If there was any way that we could promote the concept of balance in your entire lifestyle, if we sat down and had a committee that really understood how people thought, and just get that idea across, without anything specific, even that would give me some confidence that people are thinking about food and that they're not just consuming whatever's available.
I've had the fortune of living in many places around the world, in places that do have a food culture. They don't have the problems that we do. They consume, in some cases, enormous amounts of calories, but they work them off; they know the whole idea of balancing.
So if there's any way that we can get the concept of balance back to the consumer — not just a word, because "balance'' is such a general word and it's boring — the whole idea of it being for your own health and the health of your family and your children, to think about what you're doing, if that message could be successfully conveyed to consumers, if somebody could do that, that's where we have to start, not with all these epidemiological studies.
As I said, for every study there's a counter-study, and for the studies that were considered terrific 40 years ago all of a sudden we're finding out that they're not. In fact, they were a little illegitimate when they were started. This is something that most people around the table don't understand.
Senator Merchant: Thank you.
The Chair: Back to the original question: Should Health Canada develop it?
Mr. Goetz: I don't have a lot to add that Ms. Marsden hasn't already, other than the daily reference intake, which is the basis of the Canadian dietary guidance. It recommends that your sugar intake from added sugar be 25 per cent. It's estimated that Canadians are at 11 per cent, so we are below that. Some of that guidance information is already out there.
Senator Enverga: Thank you for the presentation. I have seen a lot of statistics here, and I notice that most of them show that obesity is on the decline through the years. I want to question the statistics. Do they consider the age group? Do they consider the sex of the obese individual or the ethnicity of the person who is supposed to be obese? How do they classify all of these obesity statistics? Could it be that we're getting the wrong statistics, the wrong presentation here? Maybe a further study of obesity in general will give us better information?
The Chair: Senator, I think you meant to say that statistics show that obesity has been on the rise.
Senator Enverga: No, according to them, compared to them giving us statistics on sugar and saying that obesity is going down.
The Chair: Look, we need to know what statistics we're talking about because over the last 30 years the obesity rate has gone up significantly. So what decline are you talking about?
Senator Enverga: It's more like there's correlation between the obesity and the —
The Chair: Right. These are not experts in the health area, but they might be able to comment on the issue of whether they think the proper studies are being done, or something of that nature.
Your question is a good one, but you may want to hold the fundamental issue for some other witnesses. But on the issue of are the right studies being done, what they think.
Senator Enverga: You can answer that.
Ms. Marsden: There's very good data on obesity statistics, both self-reported and measured. There are more statistics on self-reported data. There's also some measured data, but the trend is the same, that obesity rates are going up.
There's less information on children, so certainly there's more room — as you say, I'm not an expert on obesity statistics, but we do monitor that.
In terms of sugars, or sugar, we have good trend data from Statistics Canada on waste-adjusted availability which shows a downward trend, and that's consistent with the other observations of declining soft drink sales and lower sugar sales.
The Community Health Survey in 2015 will be the first time we will have comparative data on a dietary basis. We only have the 2004 data right now, so we can't look at changes from the two dietary surveys. We look forward to when the 2015 data is released to see what the changes are in caloric intake, sugars, fats, dietary patterns. That will be very helpful.
Senator Enverga: You say that there has been a decline in sugar intake. However, could it have been affected by the fact that fewer adults are eating sugars now and a lot more children are eating sugar? It's going to be lower in adults like senior citizens or the elderly. However, there's an increase there from children. So it's sort of gone into the median there; that's where we get the real statistics.
Ms. Marsden: We don't have data in Canada to evaluate that because we only have the one dietary survey; so there is variability in the population, absolutely, but there are dietary surveys in other countries. We'd be happy to follow up and provide information on what the trends are between age groups in those countries.
The Chair: Thank you. We'll ask you to provide information through the clerk.
Ms. Marsden: Absolutely.
Senator Enverga: Mr. Satin, you mentioned that when we eat a lot of salt, we just filter it right away. You say that a body can clean up three kilograms of salt really fast. How does it work for children or the elderly?
Mr. Satin: Those are the published figures for the normal adult kidney. Nobody would ever eat that much. It's more than the amount that's toxic, by the way. I think one kilogram per day is toxic. Again, it's usually done for adults. That is the normal way that we remove salt.
By the way, every study that has been done on the relationship of salt consumption to whatever condition has now been declared defunct because just two weeks ago in New Orleans it was found that we store salt and use it as needed. So the urinary salt figures that have been used for every study in the past 40 years are meaningless now. They do a 24- hour "urinary salt'' test. It turns out that the salt they collect in your urine after that 24-hour urinary collection is not the salt that you ate yesterday. It could have been the salt that you ate a week ago.
That's the difference between epidemiological and physiological studies. Salt is stored in the skin, which is our largest organ, and mobilized as we need it, in some cases when there's inflammation and infections. So our figures on 24-hour urinary salt related to anything else, any other health conditions, are false.
We used to think that the dietary recall was false and that the gold standard was 24-hour urine. Well, it will be published in Cell Metabolism in about two or three weeks, showing that salt is stored.
The point is that we can void much more than we would ever eat. There's no way anybody could possibly eat anything like that.
The Chair: Thank you.
Mr. Goetz?
Mr. Goetz: Just a comment on the data available. I can't comment on the obesity studies. Obviously, obesity is a problem. I don't think anyone is denying that.
Just to reiterate, the information that we will all receive in 2015 from the updated consumption data will be very helpful. Having to rely on 2004 data, it is difficult to make predictions about where things are going.
I will comment that we are looking forward to that data because, as I mentioned before, full-calorie, sugar- sweetened beverages, we have seen declines in sales. That's because more and new and different products are hitting the market, while obesity rates have continued to climb.
When it comes to calorie intake, what is interesting — and I can circulate this information if you want — the 2004 consumption data it showed that Canadians were getting 2.5 per cent of their daily calories from soft drinks and 2.1 per cent from salad dressing. So it was almost in the exact same ballpark. We talk about what products and calories are being consumed as far as causes of obesity, and I think that's a pretty interesting statistic. Again, that was from 2004, so we're looking forward to the data from 2015.
Senator Raine: Thank you very much. This is very interesting. I have a lot of questions.
First up, Mr. Goetz, could you just clarify something? You said that sugar should be at a 25 per cent level, and I didn't quite understand. I thought that was the upper level, not the recommended level.
Mr. Goetz: Yes, and I think Sandra mentioned that as well, that 25 per cent is the upper level. It's been estimated that Canadians' intake of added sugar is at approximately 11 per cent.
Senator Raine: And that's 11 per cent of the calories?
Mr. Goetz: Yes.
Senator Raine: I'm just looking at the World Health Organization's guidelines from 2002 that they're recommending to be changed. The old guideline was 10 per cent of the total calories per day, and the new guideline they're recommending is 5 per cent of the total calories per day. Could you comment on that?
Mr. Goetz: I'm just referencing the dietary reference intakes which form the basis of the Canadian dietary guidance. We have to remember that Canada is quite different from other parts of the world, which is where the World Health Organization has to also make their recommendations for.
The World Health Organization recommends — which have not been published yet, by the way. They've been put out for consultation. They have not been formalized. They do quote the 10 per cent and the 5 per cent, but the 5 per cent has a lot to do with dental issues in other parts of the world, which are not prevalent problems here in Canada.
I'm just referring to the Canadian dietary guidance. We have different consumption patterns here in Canada than the rest of the world. We have significantly different consumption patterns from the United States, for example.
Ms. Marsden: The World Health Organization's 10 per cent and 5 per cent guidelines are both based on tooth decay, not obesity. Again, there's great confusion, because the draft guidance that came out was released to the media without the full report. However, we did provide scientific input, a comment. Dr. Wang did review the full report and all of the evidence that went into it, and both of those targets were set in relation to dental caries.
The 5 per cent was a conditional guideline based on very low-quality evidence, as evaluated by the WHO itself. In fact, it was three studies in post-World War II Japan, amongst three schools, in relation to availability of sugar in the country. So it's not likely to be a reasonable target for the global population but nonetheless was in relation to dental caries, not obesity.
As I mentioned earlier, the systematic review did not find a quantitative relationship between sugars and obesity.
Senator Raine: I guess it just points out that there are a lot of different studies out there and there are a lot of organizations, like the World Health Organization, which seems to have a huge amount of credibility, but in this case it doesn't.
The second question I wanted to ask, and both of you could probably comment on it, is when you talk about sugar being sucrose, and then there is high-fructose corn syrup, could you explain to us the metabolic difference in terms of how those two forms of sweetener impact the body? You're saying that added sugars typically include all the different kinds of sugars. Do you think they should be limited or defined differently than as sugars?
Ms. Marsden: There are many different sugars. Sucrose is made up of glucose and fructose. High-fructose corn syrup is produced from cornstarch with a somewhat larger amount of fructose, but probably metabolically not substantially different than other sugars.
Flora is an expert on metabolism. She could comment more specifically on the metabolic aspect. I can't recall the second part of your question.
Senator Raine: Personally, when I look at sugars, I try to avoid high-fructose corn syrup. Everything I've read about it says that's not really good for you, and so I would rather drink water. I would like you to explain, because the public out there doesn't differentiate between all these different kinds of sugars. Should they be differentiating?
Flora Wang, Manager, Nutrition and Scientific Affairs, Canadian Sugar Institute: Thanks for clarifying the differences or the lack of differences metabolically between sucrose and high-fructose corn syrup. For sucrose, it's a 1:1 ratio of glucose to fructose. For high-fructose corn syrup, as Ms. Marsden just addressed, the difference in the proportion is negligible. When it comes to the consumption level, it can be ignored, so it can still be regarded as close to the 1:1 ratio. The body metabolizes sugars the same way, regardless of whether it's from sucrose or high-fructose corn syrup.
A lot of concerns about high-fructose corn syrup were actually related to the misconception or the confusion regarding fructose metabolism. There were a lot of animal studies using high doses of fructose. There are consequences related to the extremely high doses, which are not relevant to the human consumption level.
There have been well-controlled human studies using the normal ranges of fructose consumption. When you consume a normal dose, it does not convert to fat. It fuels glucose synthesis. It can be directly used for energy or converted to lactate. However, a minimum amount of that fructose is converted to fat or, as indicated, stored as fat, which is the main difference between the animal and human data. For humans, our body does not differentiate or metabolize sugars differently.
Senator Raine: That's clear as mud.
Mr. Goetz, you talked about how 40 to 46 per cent of beverages in Canada now are low-cal or no-calorie beverages. How do you decide what kind of artificial sweeteners to use?
Mr. Goetz: The individual companies make those decisions. We don't make that decision. We track the product line and what products are available to the consumer. We just received some data yesterday. Very close to 46 per cent of the products on the market now are either low- or no-cal.
A variety of low-calorie sweeteners are used in our members' products. Again, it's up to the member companies to decide, through their formulation process, which are right for them.
Senator Raine: Mr. Satin, there are a lot of different kinds of salt, as you know, and salt is quite a fad product out there now. You can get your salt from the Himalayas or the desert in Utah. Is there any real difference in these salts?
Mr. Satin: No. Salt is sodium chloride. It's as simple as that. The rest is marketing.
I like the idea that people eat all these different things only for one reason: It shows an interest in food. It titillates people, and that's okay. As long as people are interested in food, I'm happy, because they are thinking about what they are doing.
But salt is salt. I've heard of Himalayan sea salt, but the last time the Himalayas were close to the sea was some time ago.
The Chair: You might admit that some of them have more impurities than others.
Mr. Satin: If you want to be brutal about it, the only difference between sea salt and regular salt is all the detritus you will find in sea salt — dead whales, et cetera.
The Chair: We get the picture.
Mr. Satin: The only reason I say this is because it bothers me that people really believe — it's enough just to have something good. You do not have to think that it's doing all these things for you, because it's really not.
There is one danger in that sea salt does not have sufficient iodine to protect against iodine deficiency diseases, but a lot of people think it has.
The Chair: You're absolutely 100 per cent correct. Under any basis, even if you want to go to a spiritual basis other than scientific fact: Sodium chloride is sodium chloride. The different products have other things in them that are actually impurities, and that's the issue. There are differences in the products, as you indicated, but it's not because the sodium chloride is different.
Mr. Satin: I apologize for the detail.
The Chair: You made the picture clear.
Senator Stewart Olsen: I just want to ask you if in the manufacturing of sugar or salt there has been a significant change in the actual product. In other words, did sugar have the same number of calories100 years ago? Was it produced in the same way? I'd like to know about the process and the product that you produce.
Ms. Marsden: Sugar refining is a bad term because it implies that you have done something to the sugar, but it's a purification process. It is more sophisticated in a refinery and more efficient today, but fundamentally you wash the sugar crystals, melt them and remove the molasses and other impurities. Granulated sugar has very few impurities and is very low in colour, which comes from the molasses. Fundamentally the process is the same. Just like sodium chloride, you don't change the sucrose molecule in refining. It's exactly the same.
Senator Stewart Olsen: There would be no way of doing that. The only thing that you can wonder is why people are using more sugar when they process foods. Are they putting more in and is that reflected in the value that I would read on the label? I know about soft drinks and that you are taking it down. Something's odd and we're trying to figure out what that oddness is.
You may remember the tobacco debacle when they found that there were additives in tobacco — there was a change. They even changed the formula of Coca-Cola. I don't mean to get into conspiracy theories, but you have to wonder why people today want more. With regard to salt, people have been educated that using less salt is better. Sugar, I'm not so sure about.
Ms. Marsden: Food is not tobacco. Sugar is an ingredient in a wide variety of foods and it occurs naturally. Sucrose, as I mentioned before, is in all fruits and vegetables. It's extracted from sugar cane and sugar beet. The sucrose is exactly the same. Your body treats it exactly the same. That's the first point.
There are no additives in sugar purification.
Senator Stewart Olsen: And no manufacturing differences.
Ms. Marsden: The only difference is the crystal size and the amount of molasses that is retained. You can buy a dark brown sugar, organic sugar, sugar in the raw, and that's for flavour. The associated micronutrients would be so small; and you don't want to be eating cups of sugar.
The other common misperception is that manufacturers are told to remove fat and so they stuff sugar into products. That's simply not true. We know sugar consumption is going down or use in the food supply. Sugar has different functional properties than fat, so you don't just replace fat with sugar. They are in different foods.
We also know that many manufacturers are producing no-added-sugar and reduced-sugar foods also using more alternative sweeteners. There is a bigger variety of foods. There is not an increased availability of sugar in the food supply. There are some common misperceptions you hear over and over in movies and documentaries but they're simply not true.
Mr. Goetz: I will just add for the record that all our members' products are regulated by Health Canada as foods, by the FDA as foods and by the European Food Safety Authority as foods, so parallels to tobacco products are really not appropriate.
Senator Stewart Olsen: You mistook my meaning.
The Chair: She was trying to ask whether there are any additives put in deliberately.
Senator Stewart Olsen: I was trying to give an example, but it was a bad one. I was trying to figure out whether in the processing of the basic product there have been changes over the last 100 years such that one gram of sugar today is ten times what you got 100 years ago. That's where I was trying to go.
Ms. Marsden: Two of our refineries in Canada were built in the 1800s, so the process is the same. It's a purification process.
The Chair: That may be scarier than the question that was asked. I don't think we want to go down that one any further.
Senator Frum: Mr. Satin, I picked up that you're skeptical about the negative health effects of salt in general. On the specific topic of obesity, I'm interested in salt as an appetite accelerant. I don't think you addressed that or you alluded to it briefly when you referred to working for John Labatt Limited. People who love salty peanuts or chips drink more beer and end up consuming far more calories. Who hasn't gone to a movie and been astonished that they ate an entire bucket of popcorn when they weren't even hungry? It was so salty they wanted to eat it all. Isn't that a factor?
Mr. Satin: It's intuitive you would think of it that way, but in fact the higher the salt content of the food, the more quickly you're satisfied when you get your sodium as per the animal studies used commercially today. The more salt you put into the feed, the less feed the animal will eat. If you want them to eat more, you take the salt out of it. It's counterintuitive, but that's what is used commercially. That is a million dollar business.
In terms of taste, it's rather interesting because you're saying that the tastier the food is, the more people will eat it, and I agree with you. I don't know in terms of volume what that would translate to. The idea is to make something tasty. You do the same thing at home, obviously. The Italians consume far more salt than we ever will — about 40 per cent more. The big secret of the Mediterranean diet that no one talks about is the high salt content. We live with these stereotypes.
The problem with the stereotypes is that they don't give you really good direction about where to go with this. Our salt consumption hasn't increased since 1960. It hasn't increased. We presumed it has, but it hasn't. The way we used to process foods in the past, there were far saltier foods and salt-preserved foods than we have now.
I'm not really sure exactly what to the say. What I am worried about is that they will go ahead and try to fool the senses because, as I said, the food industry is always willing to do something to respond to the latest criticism. When I gave a lecture at Nestlé in Switzerland, they all told me, "We know there's nothing wrong with salt, but the marketing department wants us to act.'' The problem is that we can end up having a cocktail of synthetic chemicals to replace something that we have consumed for thousands of years without any real evidence indicating that it's negative. There certainly is not any strong indication that it's related to obesity.
I will provide publications on both sides of that question, but it's all epidemiological data, which is certainly not cause and effect.
Senator Frum: I think the most surprising thing that I've learned today is your suggestion that in fact low salt is the appetite accelerant. So it makes me want to ask you: As we have seen with the low-fat movement, there's now a growing awareness that, when foods are low fat, people will eat more of them because they think —
Mr. Satin: When we took nicotine out of cigarettes, people smoked more. When we made lite beers, they drank more beer. When we made low-fat foods, they ate more foods.
There are two things associated with it. There's the guilt aspect. I haven't seen any studies measuring the guilt aspect, so it's something that I think about but don't have any data on. I don't know if there has been any data published. There is certainly clear evidence that when you start to single out particular nutrients in foods, that is not going to not stop anybody from consuming them. In some cases, they consume more. Those are the facts of life.
By the way, we do in some cases self-prescribe salt — maybe that's the best way to put it — women more than men, because the more salt we eat, the lower the level of circulating cortisol. Women self-prescribe salt. When they're depressed, women will eat more salt. We have studies on that, which I didn't bring, but we do have a lot of publications on that. Men do so to a lesser extent because they are already eating more salt than women. So you get self-prescription of salt in certain cases, when women are under stress.
When kids are growing, they will eat more salt, by the way. Again, we have the studies, all from the NHANES database, indicating that kids who consume salt grow faster and at a better growth rate. I can't comment if a faster growth rate is good or not, to be honest, but that's what it is.
When I was doing studies in the 1970s on high-protein foods, if you looked at the studies at the far end, the animals that grew the fastest didn't live the longest. There's only so much that you can tell from it, but those are the facts that we have, that salt is sometimes self-prescribed by people in order to take care of a condition. When you have a drink and a salty snack at the end of the day, I'm no longer sure whether it's the drink you're after or the salt in the snack. I'm quite serious. I really don't know. But, again, it's conjecture on my part. There is no data on it.
Senator Frum: To be clear on the drink or the salt at the end of the day, you're saying that the body craving the salt at the end of the day is related to cortisol levels. The salt will do what for your cortisol level?
Mr. Satin: The more salt you consume, the lower your cortisol level. Your stress level will go down. When we had economic problems of four or five years ago, sales of salty snacks boomed. It was the highest period of sales of salty snacks according to Mintel, a very big British marketing company. These are just things that we observe. It really doesn't tell us very much about the overall impact of salt in the diet.
Senator Eggleton: We're hearing a lot of defence of salt and sugar, and we still haven't gotten to the bottom of what has caused this obesity epidemic. I did hear, though, a couple of suggestions. One was over-consumption, and the other was the imbalance between calories in and calories out.
You may have read a book that I have read, Michael Moss's book on salt, sugar and fat. It gets close to conspiracies here. He talks about what the industry does to try to create the bliss point, to get to that point of using the sugar, fat, salt or whatever combination of it to make their product irresistible: You can't just have the one chip; you have to have another one and another one. That means more sales.
What that amounts to is exploiting people's vulnerabilities. It starts at an early age apparently. It's alleged that the food industry particularly has an interest in targeting children because repeated exposure to highly processed foods and sweetened drinks, even during infancy, builds the taste preferences and ultimately leads to brand loyalty and to higher profits. All of this is alleged.
One of the suggestions in terms of starting at an early age has been to ban advertising directed towards children. Quebec has an advertising broadcasting ban, but of course there are other platforms, other means of getting advertising to children. What do you think of the banning of advertising to children and building up loyalty and the bliss point factor?
Mr. Goetz: Our industry has voluntary initiatives, through our association, regarding advertising to children. As well, several of our member companies, who are some of the larger players in the beverage industry in Canada, participate in the Canadian Children's Food & Beverage Advertising Initiative. As I mentioned earlier and as was confirmed at the Chronic Disease Prevention Alliance of Canada, the beverage industry in Canada has reduced their advertising to children, for example, on television stations, to zero.
We do have a voluntary code, which can be found at our website, canadianbeverage.ca, where our members have committed to standards of advertising for children, not just on television. The CDPAC reference made specific reference to children, but to other media as well — print advertising, online, et cetera. That is our industry and what we're doing.
Ms. Marsden: I won't comment on advertising. We don't advertise as an industry and it's certainly not our area of study.
I would comment that I have seen no scientific evidence of a bliss point with respect to the sugar consumption. Michael Moss's book is certainly an interesting read, but not really evidence-based.
We are born with a liking for the sweet taste, believed to protective against bitter tastes that might be poisonous, so there is some logic to that. There are lots of studies looking at the variability in taste preferences in relation to sugars and fats. Adam Drewnowski has a lot of good research in that area, and I'd be happy to point you in the direction of that. But there is no evidence that I've seen that you can actually force people to eat more sugar and more food.
Senator Eggleton: Thank you.
I'm going to talk about labelling very quickly. We heard from Dr. Lustig, from California here. You may know him. He thinks that the components of sweeteners should be all listed on labelling, not just that you're using the sweetener, but what's in the sweetener. There have also been front-of-package labelling ideas like Health Check, created by the Heart and Stroke Foundation. Commercially, Loblaws' President's Choice Blue Menu attempts to use front-of- package labelling. Can you comment on that and whether you see some usefulness?
Finally, there is this whole question of simplifying the label, the sign post concept they used in U.K. Mr. Satin, I thought you gave convincing remarks about the simplistic nature of the red, green and orange light concept, but is there something else we can do to simplify these labels? You may not agree with this, but if the amount of sodium intake should be no more than 2,300 milligrams, how can anybody figure out how much they are taking when you look at the processed foods? It's all labelling. Comments on labelling?
The Chair: Focused answers, please. We are getting towards the end and this could go on and be very lengthy.
Mr. Satin, I will start with you and I will be firm.
Mr. Satin: In labelling, we are actually coming to a point where we will have — there is no doubt that the original concept back when the UPC was invented in 1973 of scanning the product and getting all the information is coming to pass. You now have it on smartphones. That will be the ultimate answer. You will not only know if your tuna comes from seal-free waters because you're talking about a limitless source on the Internet, whereas the label is limited in size, in real estate. That has always been the problem. That's why labelling has never been and never will be successful, because it takes the product out of context of the whole meal, the whole diet and the whole lifestyle.
Senator Eggleton: You go to the store and you hold this up to it.
Mr. Satin: You just scan it. I presented on this back in 1993 when they started with the Internet.
Ms. Marsden: We can't expect too much of a food label, there's not enough room, especially in Canada. We have two official languages.
As for adding more marks, a lot of manufacturers are doing that, but the problem is it's not on every food. Should we put a traffic light system on every food? It's difficult to profile individual foods. It's not something I've supported throughout my career because we eat diets, not just foods. It's challenging.
I think the nutrition label is a very important part of our label's real estate. We have to get that right if we're making changes and not to expect too much. It's a tool and will not do everything for us. Let's follow international standards like Codex, and let's try to harmonize as much as possible with the U.S., given our international trade, but recognize we need good public health education. There are dietitians in grocery stores, lots of great examples of things to help educate.
Mr. Goetz: Our industry supports scientific and science-based labelling, which is why a lot of folks take issue with the traffic light concept. It simply labels something as good or bad. A piece of cheesecake has far more sugar in it than a full-calorie soft drink and would receive a red on traffic light labelling.
I'm a little disappointed, senator. I've mentioned it three times. You mentioned a couple of other voluntary labelling systems, and, again, if you go down your average beverage aisle in a Loblaws or grocery store of any kind, you will see our front-of-pack caloric labelling program, which is on all our major members' products. It gives consumers caloric information at their fingertips, which is most important when you look at the research concerning obesity.
The Chair: Senator Greene Raine.
Senator Raine: My questions have been answered.
The Chair: I'm not going to ask extensive questions. A lot that has been said here and there are a lot of interesting aspects.
Ms. Marsden, there is one thing I want to clarify. I thought when you gave your answer with regard to Senator Seidman's question on publishing information that you said you hire academics to write articles.
Ms. Marsden: No. We might invite an academic to contribute an article. We don't hire them and pay them. We might have an invited author to author one of our publications.
The Chair: You invite authors to write papers on certain topics.
Ms. Marsden: We have a newsletter that goes out to dietitians once a year.
The Chair: These are not articles to be published in journals.
Ms. Marsden: No, if we publish, it's all done on a voluntary basis.
The Chair: I've got it. You can understand the basis of the question. I wanted to clarify that because it went across and it will be in the record.
Ms. Marsden: I totally support scientific independence.
The Chair: Thank you very much.
Mr. Satin, you talked about the overall issue of balance. Have you been looking at what they have been doing in Brazil with regard to dietary issues? If not, please don't answer.
Mr. Satin: No.
The Chair: We'll bring this up with the committee later. It's interesting and deals with the issue of balance.
I was interested in your answer to Senator Frum with regard to her question about picking up a big box of popcorn in a theatre, all of a sudden it's gone and you can't imagine how that happened. Salt is a contributor to that consumption. You said you weren't certain that adding salt caused people to have an increased appetite for the food, and yet if I heard you correctly earlier, you said one of the things to do to get people to eat vegetables is to sprinkle salt on them.
Mr. Satin: That's because almost all dark green vegetables have healthy but bitter phytonutrients. If somebody is presented with a bucket full of popcorn that's not high salt, we don't know whether they will eat that as well. It's hard for me to comment on something like that; I don't know.
The Chair: I'm not expecting you to give an absolute answer. I wanted to clarify what appeared to be a different context.
Mr. Satin: I have no problem with supporting any study that would find that out. We have to find out what happens to people.
The Chair: I wanted to clarify what appeared to be a difference in your response.
Mr. Satin, I think you gave us a very good suggestion. We had been looking at this issue of how people can quickly discern the nutritional and overall dietary value of a food product in general. One of the issues that there has been a great deal of discussion on, which has come up here several times and that you have all indicated is not a great idea, is the simplistic labelling of colour codes. The issue is that if the average consumer has to deal with the information that is provided, there will have to be a simple way for them to do that quickly as they're going through a food distribution store.
Mr. Goetz, I certainly appreciate that you talked about the degree of labelling on your industry's products, but in actual fact the next step is how they use that. Do they use it appropriately and can they use it appropriately?
On this idea of a smartphone with an appropriate app, we know that in the U.S. at least, and maybe some places here in Canada, you can take your smartphone and go into the hardware store, hold it up to a given product, and it will tell you what that same package product goes for, in terms of price, right now in several competing outlets. It's that smart. That's the kind of answer a consumer is looking for in that case, which is price comparison.
It seems to me that taking the smartphone concept and being able to hold it up to a product label — Mr. Goetz describes his industry's products, and there are many other industries that provide detailed nutritional and content labels on the back — with the appropriate app software, it should be able to instantly tell the consumer certain things. That includes the percentage of daily recommended consumption of certain items in that category, in that particular size of package, and a number of other things. In other words, there is a possibility that electronically you could interpret the data on an item on the shelf and get an interpretation that tells the harried consumer an answer that is reliable and quick.
I thought in your comment there might very well be the basis, because it's no light-year step to go from being able to analyze a given hardware product and where it's available in that city and several other cities and all the different suppliers for a cost effect, and you also get what other certain consumer evaluators tell you about its quality relative to certain other products that are in that area. So that might very well cover the issue, and you, again, identified for us the concerns.
On one end, you have the consumer who needs to be able to deal quickly with this information. I will tell you, frankly, I am not going to go through the store and look at — I have done this just to see, and turned the boxes and cans over and looked at what's on there. I'm not going to do that. Hopefully my instinct gives me a chance to evaluate what I'm looking for. People are not going to do that and get that overall comparison.
I think it's absolutely critical. I think the things Mr. Goetz said his industry is doing are terrific. It has to be there, but there now has to be a way of interpreting it into some useful manner for a consumer.
I thought that was an excellent suggestion. I liked it because it gets away from the idea of the so-called simplistic view, that it's too simplistic. It doesn't tell people really what they need to do, and yet it doesn't require the individual to do that detailed analysis in their head and compare it to everything else they've already got in the shopping cart.
I prolonged that a little bit, but one of the issues that we have been advised of and we know from the literature that we've read coming into the study, is that giving consumers some way to get appropriate evaluation of the items they consume would go a long way to meeting the objective that most consumers say they have, and that is to eat healthy and be able to determine quickly what the foods will be. I'm not going to go into whether that's an accurate interpretation of what consumers will really do, but at least the theoretical part deals with that.
I want to thank you all for your initial comments and your responses here today. I think it's been a very good session and a lot of things have come out. I want to thank my colleagues for their questions.
(The committee adjourned.)