Proceedings of the Standing Senate Committee on
Social Affairs, Science and Technology
Issue 37 - Evidence - June 10, 2015
OTTAWA, Wednesday, June 10, 2015
The Standing Senate Committee on Social Affairs, Science and Technology met this day at 4:14 p.m., to continue its study on the incidence of obesity in Canada: causes, consequences and the way forward.
Senator Kelvin Kenneth Ogilvie (Chair) in the chair.
[Translation]
The Chair: I would like to welcome you to the Standing Senate Committee on Social Affairs, Science and Technology.
[English]
I'm Kelvin Ogilvie from Nova Scotia, chair of the committee. I will invite my colleagues to introduce themselves, starting on my left.
Senator Eggleton: Art Eggleton from Toronto, deputy chair of the committee.
Senator Cordy: Jane Cordy from Nova Scotia.
Senator Raine: Nancy Greene Raine from B.C.
Senator Stewart Olsen: Carolyn Stewart Olsen from New Brunswick.
Senator Seidman: Judith Seidman from Montreal, Quebec.
Senator Nancy Ruth: Nancy Ruth from Ontario.
The Chair: Thank you, colleagues.
For the benefit of the viewing audience, we are continuing our study to examine and report on the increasing incidence of obesity in Canada: causes, consequences and the way forward.
To give us a bit of why we are here and the way forward, we have, as I said, two really great witnesses before us today. I am very pleased to welcome them. I will identify you in order. Since we didn't discuss it, I will invite you in the order you appear on the agenda, if that is okay with you. Seeing no violent reaction, that is the way we will do it. Both are appearing as individuals. In that context, then, I will invite Dr. Anna Issakoff-Meller to present first.
Dr. Anna Issakoff-Meller, as an individual: Thank you, Mr. Chair and honourable senators. It is a privilege to present to you today. I am thrilled that you are examining the obesity epidemic so thoroughly.
I was pleased to discover I was presenting beside Dr. Yoni Freedhoff, as I gained at least a minute of speaking time by deleting his quotes.
I have a passion to reverse and avoid the ills with this epidemic. I feel society has been misled and robbed of good health due to poor dietary advice from our governments and medical establishments, and by the behaviour of the food and pharmaceutical industries. Health care should serve individuals not industry.
Most cases of obesity are due to metabolic syndrome. The root cause of metabolic syndrome is insulin resistance. If we are successful in treating insulin resistance, then the diseases associated with metabolic syndrome will mostly disappear. These include, but are not limited to: obesity, diabetes and the related kidney failure and eye problems, heart disease, stroke, dementia, depression and at least seven obesity-related cancers.
Although you have heard prior testimony that there is no simple cure, there is a relatively simple biochemical explanation. Please bear with me.
We know sugar is bad for us, but why? Our bodies naturally maintain approximately 1 teaspoon of sugar diluted in our blood stream. When we consume sugar, our blood sugar rises and sugar starts coating our proteins, gumming up our blood stream, stiffening our arteries, causing inflammation and creating large sugar-protein molecules which clog our small vessels. These effects are so harmful that our pancreas quickly reacts by releasing insulin to pull the sugar out of our blood stream and into our cells.
Our cells use some of that sugar for immediate energy, but the majority gets converted to fats to be used later. When we consume a lot of sugar, our cells are bombarded with insulin. After a period of insulin overload through the years, most cells become less sensitive to the insulin message and they become insulin resistant. These cells become insulin resistant at different stages — your liver cells, your muscle cells and your fat cells — and it takes quite some time.
Fat cells are usually the last to become resistant, so they continue to uptake sugar and store it as fat. The irony of insulin is that it helps the blood sugar problem. However, chemically, it blocks our access to our fat stores. The body is storing fat but cannot break it down, so it accumulates. This is the cause of the obesity epidemic. Most who suffer obesity or who are overweight are not undisciplined, unmotivated, nor are they eating more than their neighbour. They have metabolic syndrome and insulin resistance.
Eventually, after a decade or more of having to overproduce insulin to manage the blood sugars, the pancreas can no longer keep up. Sugar levels then start to rise and we are confronted with full-blown diabetes. This usually comes as a shock to us, but we have been chemically malfunctioning and accumulating risk factors for decades. This is so preventable.
It is crucial to understand that all starches and carbohydrates, which are primarily derived from grains, are chemically just chains of sugar molecules. For instance, one cup of pasta is approximately 40 grams of carbohydrates. This is equivalent to 8 to 10 teaspoons of sugar. This raises our blood sugar from 1 teaspoon to 9 teaspoons to 11 teaspoons quite quickly.
Also crucial to understand is that to the body, the source of the sugar molecule is irrelevant. A slice of bread, a Mars bar, a potato or breakfast cereal is all simply sugar to us and will be dealt with by insulin.
In the last 2,000 years, we have increased our sugar intake from 4 pounds to approximately 120 pounds per person per year and most of this increase happened in the last 40 years. This intake mirrors the obesity rates. While correlation is not causation, recent research — and there is plenty — and the biochemistry I just reviewed, connect the dots. We also know that what we have been doing, high carb/low fat diets for 40 years, is certainly not working.
My colleague, Dr. Steven Traplin, and I have been recommending a low-carbohydrate, high-fat diet to our patients for the last seven years with rewarding results. The markers for metabolic syndrome ameliorate, including decreased triglycerides, decreased cholesterol to HDL ratio, increased HDL, lower blood pressure, decreased weight and waist circumference and, in diabetics, decreased fasting blood sugar and hemoglobin A1C, in some to nondiabetic levels.
In addition, we have been able to reduce medications or discontinue them, particularly diuretics, anti-hypertensives, cholesterol-lowering agents like statins and diabetes medications, including insulin. This is particularly rewarding to me.
The ability to educate my patients individually and see their results is extremely rewarding, as I said, but time consuming and inefficient. With the support of the Guelph Family Health Team, with whom I work, I have been working closely with a nurse and a dietitian in our office to educate and support patients. Last year we began giving a seminar program and this year we started monthly support groups. Patients can self-refer to either.
Since with any lifestyle change ongoing support is key to success, we are discussing now with the Guelph Family Health Team how to implement a low-carbohydrate, high-fat clinic under their auspices to reach even more people and provide more frequent support.
I realize this presentation was heavy on biochemistry, but I felt it tremendously important for you to understand in order to help your investigations. That being said, if there were only three salient ideas I hope I have imparted, they are these: Health care is for individuals, not industry; carbohydrates minus fibre equals sugar; metabolic syndrome and obesity are reversible.
Thank you again for your attention to this epidemic. I hope your efforts bear fruit and all Canadians benefit from your work.
The Chair: I will now turn to Dr. Yoni Freedhoff who is also appearing as an individual.
Dr. Yoni Freedhoff, Assistant Professor, Department of Family Medicine, Medical Director, BMI, University of Ottawa, as an individual: Thank you, honourable senators. My name is Yoni Freedhoff. I'm a physician and Assistant Professor of Family Medicine at the University of Ottawa. I have dedicated my professional career to the study and treatment of obesity. I am grateful for the opportunity to chat with you today.
Nine years ago, I had a similar opportunity to speak with the House of Commons' Standing Committee on Health. They were working on a report very much like the one you have been tasked to produce. Their 72-page report's recommendations, though not necessarily describable as bold, did call for action. Now, nearly a decade later, while admirably we are still talking about obesity in Canada, action has remained a rarity.
Some cling to the notion that obesity is a problem of personal responsibility, suggesting that somehow, over the course of the past 60 years, not just Canada, but the world as a whole, has suffered an epidemic loss of willpower. They suggest that, consequent to the fact that on paper obesity can be prevented by the judicious use of forks and feet, governments need not be involved in its prevention. Yet, this flood of diet- and weight-related illnesses is poised to cripple Canada's health care system. To date, in responding to this flood, we have focused on education, on public health messaging campaigns, and on calls to action designed to spur conscious, individual change.
Floods aren't well treated by way of isolated, individual changes. Swimming lessons, no matter how thoughtful, well designed or societally embraced, won't stem rising tides and even the strongest swimmers get tired. That doesn't mean people shouldn't learn how to swim or that we shouldn't encourage them to do so, but when there's a flood it's a government's responsibility to build levees. When it comes to this flood, I'm not sure Canada's bothered to fill even a single sandbag.
It is important to recognize that no single sandbag can stop a flood. That fact is perhaps part of the problem as often that truth cripples action as it allows detractors to rightfully argue "that sandbag won't cure or prevent obesity.'' They're absolutely correct in their criticism. Not only will single sandbags not stop floods, but also the nature of flooding is such that it is impossible to predict which of a levee's sandbags will prove to be the most important ones. But that truth doesn't mean we shouldn't be filling sandbags.
There is no shortage of potential sandbags. The rise of obesity has been consequent to dozens, if not hundreds, of changes we have made to our environment such that now the default for the majority of our population is weight gain. People don't choose to gain weight. Weight gain happens consequent to a world that requires each of us, if we want to eat healthfully, to actually go out of our way to do so. It's a world where packages of ultra-processed foods, laden with hyperpalatability's bet-you-can't-eat-just-one's holy trinity of salt, sugar and fat are legally allowed to brag about the fact that they also happen to contain vitamin D, or Omega-3s, or whole grains on the fronts of their packages; where what our children are taught in schools that they shouldn't be regularly eating is regularly provided to them in those same schools' cafeterias and vending machines; where the food industry is allowed to market to children; where our food guide is non-evidence-based and, if followed, might well lead a person to gain weight; and where our nutrition fact panels are so confusing and unwieldy that our government has launched not one but now two campaigns designed to help Canadians understand how to use them; and a world where the standing committee here gets to choose not to have deserts at a meeting at four in the afternoon.
If we want to see change, we need to re-engineer our Willy-Wonkian food environment such that healthful becomes the default choice and that hyper-processed junk foods needs to be actively sought out rather than not only activity avoided but also actively provided. Though there is no consensus as to which sandbags will have the greatest impact or which should be filled first, the ones I believe would be both beneficial and within the purview of the federal government would include: revising Canada's Food Guide and mandating its regular reassessment; joining the rest of the G8 nations in establishing a national school food program that includes the integration of curriculum designed to teach children about nutrition, food and healthful cooking; banning the marketing of all food to children; mandating the provision of contextualized calories on menu boards of chain restaurants, coffee shops, movie theatres, et cetera; effecting nutrition fact panel reform so as to utilize realistic and standardized serving sizes, decrease confusion and ambiguity, identify added sugars and include whole package caloric information; effecting front-of-package health claim reform so as to disallow the use of nutrient-based health claims and promotions; adopting a rigorous, engaging and evidence-based national front-of-package nutrition guidance label; taxing sugar-sweetened beverages; and subsidizing fresh fruits and vegetables.
No one sandbag will stop a flood, but the longer we spend discussing but not filling sandbags, the worse this flood will become and the more havoc it will wreak. While it is always a great time for discussion and debate, we need action as the longer we continue to wait to actually do something, the greater the threat to Canadians' health and to health care as we know it. Thank you for your attention.
The Chair: Thank you very much. Before I open the floor to colleagues for questions, I want to remind us that senators need to be back for a vote. The vote is at 5:30. There will be a bus here at 5:10, so this meeting will end no later than 5:10. The bus will leave here at 5:15.
The meeting, in terms of questions, will be the one question per in multiple rounds, okay?
Without wasting any more of your valuable question time, I will turn to Senator Eggleton.
Senator Eggleton: Thank you for your presentations. They are very helpful and I agree with you: action is needed.
I want to talk about the first sandbag, the food guide. I want to get a sense of how this food guide should be revised.
We have learned a number of things here. For example, the concern about prepackaged, processed and convenience foods is not something that is really covered there; the difference between fresh ingredients and highly processed foods; the question of sugar; and the division between natural sugar and added sugar. Different phrases are used in that regard, but whether the food guide should be attempting to cover that.
We've had conflicting testimony regarding the health effects of fat, but I think we are hearing more and more that carbs are the main problem, not fat.
With that kind of background, could you comment on what changes you think should be made and how the food guide is assembled, what kind of information it should give, and how it should give it to Canadians? Also, is there anything we can borrow from other countries in this regard?
I think Brazil recently did something new, and perhaps European countries have. I don't know if you have much of a handle on that. Both of you have a whack at this question of how we should change Canada's Food Guide.
Dr. Freedhoff: In terms of approaching the change to the food guide, there are two options. One is a complete and total overhaul, which is something that I would certainly encourage. The other is piecemeal changes designed to address the most objectionable aspects to the food guide.
You speak about sugar in the food guide. Certainly one of the easiest ways to improve the food guide's guidance around sugar is to remove the current equivalents of juice to fruit. Doing so would change a number of different things. It would no longer allow juice to prey on parents' good intentions to suggest that a glass of sugar water with a few vitamins is the same as having fruit. It is not the same thing. If we put vitamins in Coca-Cola we wouldn't drink it, yet calorically and from a sugar perspective it is identical drop for drop, and in some cases it's worse.
It would also preclude the ability of selling those fruit gummies and fruit leathers, and the ability to sweeten with fruit juice, which is done constantly. This then allows companies to claim that there is no added sugar because, in the way our guide is created and interpreted, if the sugar once upon a time existed inside a fruit and you put it somewhere else you can still claim that you did not add sugar to the product, that the product has only natural sugars and only what was supposed to be there, so to speak. That leads ridiculously hyper-processed products to get marketed often as fruit equivalents or as healthful.
From a sugar perspective that, along with identifying added sugars on a nutrition fact panel label and providing guidance as to what is a recommended maximal amount would do the sugar trick, and I think that would go a fairly long way in improving some of the dietary choices of Canadians.
The other way to look at it is the total overhaul, and that's what Brazil has done. I encouraged you earlier to consider having Jean-Claude Moubarac come and chat before this committee. He was involved in the creation of the Brazilian food guide and has also been involved in creating the designation of hyper-processed food, a classification system. He has done some research that clearly identifies hyper-processed food as a major risk factor.
What Brazil's food guide has done is, rather than trying to steer people to minutia, to weigh and measure things, and to follow a specific guideline, it goes back to trying to get people into kitchens and not relying on the hyper-processed boxes of foods and to reduce the reliance on restaurants, and to distrust, frankly, the food industry. In their actual food guide, it recommends that people pay keen attention to the messages from the food industry because they might not be truthful.
Personally, I think the Brazilian guide is leading the world in terms of an actual useful guide that would steer, if followed, people to more healthful diets, but I will not hold my breath that we will see that here.
Dr. Issakoff-Meller: Health Canada claims that Canada's Food Guide is the second most downloaded document from the government website, so it's a powerful document. It's promoted at every level: the provincial and municipal governments, the hospitals, the public health units, the schools, and legislated into home day cares. It's hard to go against and really desperately needs to change.
The first step is to absolutely get the industry away from the table. They don't belong there. They have vested interest that is not in keeping with our vested interest of Canadians' health. That's the first thing I would do.
I struggle with, as Dr. Freedhoff does, whether we overhaul the whole thing and go the Brazilian approach, but it won't actually cure the epidemic. I think if we are going to do something that's more detailed, I imagine a food guide that's in two parts. One part is for those of us who don't have metabolic syndrome, and the second is for those of us who do have metabolic syndrome.
If you have a child or someone who is not suffering metabolic syndrome, they needn't restrict their carbohydrates to the same extent that an individual who is struggling with obesity or diabetes or any of the other illnesses associated with it would need to. Those individuals need to get their carbohydrate intake down between 20 and 50 grams a day. It's a very different-looking food guide for them. If we don't have such a thing, it will not make a difference for them and we desperately need to. These are usually the socio-economically challenged in our society. They suffer the most from health care difficulties and they cost our health care system the most. It behooves us to do something for this group.
The Chair: Thank you both.
Senator Seidman: Perhaps we've covered the food guide, which is something I wanted to ask about, so I want to go on to the next potential action.
Thank you very much, both of you, for your presentations. Both of you have criticized the government and said that Canadians have been misled and robbed. Dr. Issakoff-Meller, that's what you said, that Canadians have been misled and robbed of good health by poor dietary advice from government and others.
Dr. Freedhoff, you said that we're still talking about obesity in Canada and that action has remained a rarity.
Obviously the food guide is a big issue, and it's something that one could propose recommendations about. If we move on from the food guide to something else that's actionable and could have an impact, what would you say it should be? You've given us quite a list, Dr. Freedhoff.
Dr. Freedhoff: I don't think it matters, in a sense. Again, this is a sandbag-building effort. Whatever can get done should get done.
I know where I might put my sand first, but that doesn't mean that I would be right. We don't have the luxury of terrific research on this, because this is a very new issue for the world. Sometimes you have to do what feels and seems right, and then watch carefully for unintended consequences.
As far as looking for outcomes goes, the outcome problem is that there really won't be one thing that does much of anything. Singular interventions can't solve a highly complex problem. If the metric of measurement is going to be obesity, I worry. On the other hand, the metric of measurement, for instance, if we were taxing sugar-sweetened beverages — which I think would be a good idea — would be the consumption of sugar-sweetened beverages. Whether or not that leads to changes in obesity rates doesn't really matter; they're not helpful for anybody to consume. It doesn't matter what weight you are.
It's important, when moving forward with the sandbags, that obesity is not the only measure with which they are evaluated because frankly, especially in the early days, they may be disappointing in regard to obesity.
Dr. Issakoff-Meller: I agree. I'm a big believer in exercise, but for this epidemic I don't really think that is where we need to spend a lot of effort. I think it is more dietary and financial. Those sorts of things will have a bigger impact.
Senator Enverga: Thank you for your presentations. I've been hearing a lot about low-carb and high-fat diet. The thought that you will be eating a lot of fat or oil sometimes doesn't feel good.
Could you explain that again in simple terms? The low-carb and high-fat diet, especially the high-fat part, those are things we'd like to understand a bit more.
Dr. Issakoff-Meller: In detail, nuts have a lot of fat and cheese has a lot of fat. We've been having pork that's leaner and leaner every year, so it's as tough as the sole of a shoe. We need to just incorporate natural fats back into our diet. Saturated fats, too, I don't see from the latest research to be a problem whatsoever. Whole milk as opposed to advising children to have 2 per cent milk, or people drinking skim milk; high-fat dairy products and olive oil.
There are easy ways to get fat back into our diet that are palatable. In fact, fat makes food more palatable. It's tastier. It gives us a good feeling of satiety. It allows you to eat less because there are more calories per gram of fat, so it's quite advantageous in many ways.
Dr. Freedhoff: I've been working in obesity for a long time and have read a lot of the literature, and I'm not as married to one approach. People lose weight successfully and maintain their weight successfully with all sorts of different diets. I'm not opposed to low-carb, high-fat, by any means. There are people who flourish living with that style of diet. But I also don't think it needs to be that style of diet. We have people losing weight every which way there is.
Again, I think that we, as a society, jumped the gun on saying this is the right way to go with the low-fat approach to eating, and people replaced low-fat potentially with more hyper-processed foods.
I also think it's really important to consider livability. That's something I talk about a lot. Whatever you do to lose the weight, if you stop doing it, you regain the weight you lost that way. So, even if low-carb, high-fat is a terrifically useful tool for people to lose weight, unless they happen to want to live that way forever more, the outcomes and benefits they might receive from that style of dieting may not last.
I'm not opposed to low-carb, high-fat diets, by any means, but I'm not sure we should have a food guide that steers to one right way, because I think there are a lot of people on the planet with a lot of different cultural backgrounds and there are a lot of different ways to go.
Personally, I would prefer that overarching let's deal with the biggest problem, which is our incredible reliance on hyper-processed foods and restaurants. Lowering those foods' consumption will certainly lower carbohydrates and free sugars and likely improve health.
It's like we have a population where the average grade is, let's say, a D for the standard Canadian diet. Trying to get people to be an A-plus may not be the first step. Maybe the first step is to get everybody to a B and then worry about trying to tweak and fine-tune, but that's my opinion on that.
Senator Raine: Thank you very much. It's great to have your expertise at the table.
I've been cooking for a long time and seen things come and go in terms of what's in and what's the right thing to do. My big question is this: Obviously the low-fat diet didn't work. I remember seeing an article in The New York Times saying: What if fat doesn't make you fat? It opened my eyes. That was quite a while ago, but people are still thinking we should have low fat.
Now you're saying fat; low-carb, high-fat. What about protein? Is protein fat? We hear about high protein, but now we're hearing high fat. Can you describe the difference? I go back to what my mother used to say: Eat everything on your plate. But we only ate three times a day. There was no snacking. Could you comment on that?
Dr. Issakoff-Meller: In most of these diets, protein stays pretty much the same. Also, through different cultures and through the existence of Homo sapiens, it seems to be a relatively stable amount. What changes more so is the carbohydrate and the fats. A low-carb, high-fat diet would certainly not encourage high protein. Protein is a very inefficient source of energy and we tend to make sugar from the excess protein.
Dr. Freedhoff: The importance of protein, as far as weight management goes, is that it seems to be quite sating, especially the distribution of protein. Having a big steak at dinner and then having lots of simple carbs all day long, that's not a pattern of eating that's likely to lead to a lot of fullness or satiety. Having protein throughout the day with all meals and snacks is a useful way to improve satiety. I think there's actually quite a lot of utility in protein. We don't need to go overboard on it, but if there's a message to be had about protein, it's inclusion with all meals and snacks, not trying to get one huge wallop of it.
With regard to low-fat diets, we don't have many people on ultra-low-fat diets. We have people on anything, but there are folks out there who have had remarkable results with low-fat, but that's because they are not switching from high-fat foods to low-fat foods that are chock full of sugar and refined carbohydrates. It was not about switching from high fatty foods to SnackWell's cookies, but that's what the world did — and that, I think, is a bigger problem.
I know I'm beating this to death, but if there were ways to improve the use of kitchens of Canadians to transform fresh, whole ingredients into meals and have those meals eaten together around a table, almost regardless of what they made, it would be an improvement on what's going on right now.
Working with parents of children whose weights are of concern, which I do, I'm regularly amazed that it is more common for me to meet a family eating out three or four times a week than it is for me to meet a family who eats out less than once or twice a month. We're ensuring kids leave home knowing how to play hockey and soccer, which is wonderful, but not knowing how to cook anything.
There are big, macro problems that I would love to see dealt with before worrying as much about this much nutrients of this and this much nutrients of that. Ultimately those things may be helpful, but I think they are the next step down the road, if we ever get down the road.
Senator Frum: I also want to thank you for two very interesting presentations. You both made reference to the fact that our food guide is not evidence-based. Is it not more accurate to say that it maybe is based on flawed evidence or outdated evidence? That's my one question.
My next question is this: I think you both recommend a tax on sugar-sweetened beverages, and we have heard that from a number of witnesses. But seeing as you both have put such a strong emphasis on the danger of sugar — and that seems to be without any contradiction; I don't think anyone has made a case in favour of sugar here — why just beverages? Why don't we have a more aggressive attack on sugar the way we do on tobacco?
The Chair: I'll have you answer the first question.
I'll deal with the tax, since you only get one question. You weren't here when we discussed how we would proceed. We will get the taxation question.
Dr. Issakoff-Meller: The first question was: Is the food guide based on flawed or old evidence?
Senator Frum: Or disproven. It was evidence at one point, wasn't it?
Dr. Issakoff-Meller: Yes. You may have heard in prior testimony, but it was based on research out of the 1940s, 1950s and 1960s, starting with Dr. Ancel Keys. I think you have heard about that, so we won't repeat that.
Dr. Freedhoff: I would say flawed evidence. There is no evidence that suggests that every Canadian in the country should be drinking two or three glasses of milk a day. There has never been any study in the history of time that says that that will confer specific health benefits. We don't know why that recommendation was made, but certainly there was the nutrition manager for the BC Dairy Foundation who was sitting on the 12-member advisory panel of the food guide at the time of this current food guide's creation. Maybe she got a raise afterwards; I don't know.
The bottom line is the messaging in that guide hearkens to the nutrient approach to health, which is we believe that you need this much zinc, magnesium and copper. What the committee did, or what the food guide did, was they designed a guide to ensure that all those nutrient requirements were met.
But we don't have nutrition drilled down like that into nutrients. We understand nutrition much less specifically than the world believes. We understand about patterns of eating and swaths of food, and even then the data is questionable because they are all with these recall data that we know are flawed to begin. I would absolutely say it is non-evidence-based in many cases and evidence-based in some. Based on this flawed notion of nutrients, this leads to rather ridiculous products like Froot Loops that say it has vitamin D and whole grains in it.
Senator Cordy: Thank you. These were fascinating discussions and presentations that you made.
What I'm looking at is messaging to Canadians for good eating. You and others have referenced it already. Things are pretty confusing out there. Your parents are going to shop for snacks for their kids and they look at fruit juices that have added whatever. You look at products that have oat bran, wheat bran, or whatever the current flavour of the day is.
What is the simple messaging for Canadians? If they can't tune out after 30 seconds, which is probably long, then what is the messaging?
You talked about contextualized calories on menu boards. I think that's a great idea, although I don't know what a contextualized calorie is. Maybe you could tell me what that is? Canadians are being bombarded with information. So how do we keep it simple and effective?
Dr. Freedhoff: Contextualized means having an anchoring statement of how many calories a person might be aiming for. I think having this 2,000 for everybody is a bit silly. The reason it's important is because in studies where there wasn't an anchoring statement, when people consumed calorie-guided meals that were in fact lesser in calories consequent to the ticker on their menus, they ate more when they went home. It was almost like they earned that extra candy bar at night or whatever it was. But that changed when they added context and they talked about sort of what you're aiming for. That phenomenon disappeared. Again, these are early days.
If you ask me, I think we allow information to be provided by the wrong people. Right now, we are letting food industry provide information on the fronts of packages of stuff that I wouldn't feed my family. You look at the front of the package and it looks phenomenal. Right now, the onus is on Canadians to turn a box around, read a panel that is admittedly confusing because we clearly can't understand it and we need to have campaigns to teach people how to use it, to determine if the front of the package was telling the truth.
We should stop allowing claims based off of the nutrients on the front of packages — claims period. I would love to see a claim-free aisle, where people weren't duped into buying nonsense. Actual food doesn't need health claims because it doesn't have packages.
Dr. Issakoff-Meller: I agree with Yoni. In addition, I would educate the population about the dangers. First, fat is not bad for you and so eat fat. Second, carbs eaten in excess are going to get the insulin going and result in fat production. So people should be aware of sugar in food — added sugar, natural sugar and that grains are chains of sugar molecules. Just increase their awareness. The third is processed foods, absolutely. I would say those three things: don't worry about fat; become knowledgeable about carbs; and avoid processed foods.
Dr. Freedhoff: I also mentioned that there are front of package programs that provide an engaging and quick point of reference that could be utilized. Existing programs are the U.K.'s traffic light system, and there is a program called NuVal. People will have disagreements about each program. You're never going to find one that everybody agrees on, but something that is overseen by a power that is not the food industry; that is on every single product; and that can identify, at a glance, what is risky according to the government, may be useful, so long as what the government considers risky is in fact risky.
The Chair: I'm going to ask a question on taxation. It's actually being used in some jurisdictions as an attempt in this area. It has been widely discussed with regard to impacting this area and specifically with regard to sugar consumption.
There is another issue that is emerging fairly quickly, which is the impact of artificial sweeteners as a health issue. I'm going to ask both of you to comment on the idea of taxation of added sugar-containing products in the marketplace and whether you see that the taxation should include deliberately sweetened foods or beverages, as opposed to just the sugar content.
Dr. Issakoff-Meller: For added sugar, absolutely, I would agree, but the total amount of natural sugar, which you could also call carbohydrate, is vitally important. With the total carbohydrates, you have to remove the fibre from the equation because we are unable to digest it. So that obviously has to be taken into account. Yes, I would tax it. I think, as Yoni mentioned, I would then maybe subsidize whole foods. I would subsidize farmers to grow broccoli and cauliflower again. All we see are fields of wheat and corn.
Dr. Freedhoff: I don't have shares in Splenda, but I think that a lot of the studies that suggest harm to artificial sweetens are all-comer studies. That means that they are polling everybody, not a specific population of people, which also means that there is a real possibility that the people being captured are the folks who might be more frequently utilizing hyper-processed food — as in, I will have the Big Mac combo with the Diet Coke. That's not really the same thing.
If you look at the studies specifically addressing weight and people who are substituting caloric beverages with artificially sweetened beverages, it helps with weight loss and improves weight maintenance. I think that in an ideal world, we would have less sweet from all sources because our palates do in fact prefer sweet and the more sweet we have, the more sweet we want. We don't live in a perfect, idealized world and if we're talking about lesser evils, of the two, artificial sweeteners to me is definitely a lesser evil. The taxation on sugar-sweetened beverages is just more logical because there is virtually no argument to suggest that there is a benefit to them.
Once you range into other products that have sugar in them, then you're going to have a whole rigamarole of arguments about why there is some nutrition and benefit. It's easier to tackle the single largest contributor of calories to North American teens. That would be the first and largest raindrop in the flood.
Senator Eggleton: Let me fill another sandbag here with you. You've already made a quick reference to the nutrition labelling on products, which I think we all agree is very complicated and people would have a very difficult time sorting out what they should do by reading the label. You've suggested simpler like the U.K.'s stoplight system.
What do you think would be the best way to be able to communicate nutrition on packaging that would be meaningful and understandable to the public?
Dr. Issakoff-Meller: I personally don't like the stoplight approach because I think it's too simplistic and doesn't help the people in the population that do have metabolic syndrome. I think it's great for prevention.
I actually like the Nutri-Facts. I just think it should be more detailed and also the ingredient lists on products needs to be much clearer. I think it was Dr. Lustig, who mentioned to you there are 56 different names for sugar and they are not added up and listed as a total at the top of the ingredient list. That absolutely has to happen.
Do you follow what I mean?
Senator Eggleton: I'm getting your drift.
Dr. Freedhoff: As a pragmatic individual — and whether I'm right or wrong, I don't know — but I don't think many people are going to study the backs of packages when they shop. I think people are busy and harried; they have two little kids in tow and are worried about taking care of their mom at home or paying the rent. As much as I think it is important and we should have improved labels, for sure, for those folks who do turn them around, there needs to be something on the front. Whatever it is; it has to be something. Right now the only things on the front are actually programs designed literally by the food industry. They have their own healthy-food listings. People don't realize that. Certainly the people in this room might, but I don't think the average person necessarily knows that Sensible Solution is an industry program and not something that's there to help them.
The removal of all front-of-package claims aside, a sort of guidance, whether it is stoplights, a score from 0-100, something, because I don't think — as much as it would be wonderful — that we will have people spending the time studying the labels as much as would benefit them to do.
Senator Raine: I was interested if you could expand a bit on the "hyper-processed foods'' definition by Jean-Claude Moubarac. Is this a definition that is evidence-based and accepted around the world?
Dr. Freedhoff: It is new. Nothing that is new is accepted around the world.
It is fascinating. What he and his group have done, including for, I believe, the Canadian data, is they have three gradations of processing. There is minimally processed, processed and hyper-processed. Minimally processed would be stuff like butter, which is processed. There is processing involved. You can't go and collect butter off of the floor, so there is some processing involved. It is the same with flour. You go up a level in processing to finally reach the hyper-processed foods. He does have a classification and a definition scheme for it.
What is fascinating about his work is when he then looks at dietary patterns and hyper-processed foods and health and obesity, the correlation is striking. What is also striking is that we eat a lot of these products. About 60 per cent of the Brazilian diet — and close to that for the Canadian diet — comes from these hyper-processed products.
I think he would be a wonderful guy to have come down and chat. That would be a big-picture thing to focus on rather than specific diets, just trying to reduce the consumption of these products. Maybe the labelling would be on the degree of processing, and the campaign would be to teach people that hyper-processed foods are the ones to worry about.
Senator Frum: Dr. Freedhoff, you've made this point already a few times, but just to reiterate, when we see packages that say "25 per cent less fat'' — which maybe isn't even in and of itself a good thing, perhaps — or any other claim, these are completely self-regulated by the producer. Is that what you are saying?
Dr. Freedhoff: No. There are guidelines for claims. The guidelines are weak and they provide far more leeway to the industry than to the consumer. Kellogg's is allowed to claim on the front of the Froot Loops package that it has vitamin D and whole grains and all of that stuff because they do. Products that are 25 per cent less in fat than their prior product — but they might be 25 per cent more in carbs — are allowed to say they are less.
All of those messages are speaking to one thing, which is health washing. It is convincing the hurried person that the box is good for them, that they can get away with not cooking, that that effort isn't required and that this will be a smart choice.
I think all of these messages, especially since they're focused on this nutrient concept, which really is flawed, mislead consumers rather than help them.
The Chair: This is, unfortunately, one of the problems of this time of year in the Senate with regard to our requirements for votes and things of that nature, but it has been absolutely great to have you. I am sure we could go on longer.
Both of you, and particularly Dr. Issakoff-Meller, you are aware of the molecular basis of some of the issues we are talking about, and you summarized it in your presentation.
I think, Dr. Freedhoff, one of the things that is different from back in the Keysian era is we now know a lot about the metabolic processes from the chemical point of view. We know the structures and the biochemistry of these things, and it is possible now to draw some conclusions in terms of the impacts of particular things we consume and the quantities we consume them in in terms of our overall health. Hopefully, these will come together and help us to perhaps be a bit more precise down the road.
I must say that I know there are those who disagree with you and with me on the business of the label on the back of processed foods, but I have seen it in action and I know how difficult it is for a person in a hurry while shopping to turn that product around and attempt to compare two things in terms of the issue.
I think one of the things, Dr. Issakoff-Meller, you have added to, in terms of other presentations we have had, is the idea that most people do not understand that carbohydrates are really sugars and that there are two types. There are those that break down in our bodies and turn to sugar, and there are those that are fibre that don't break down in our body. The irony is that glucose is in some of the best fibres. Cellulose, for example, is a remarkable fibre. We don't break it down, but glucose is a part of sugar. The only difference is the way the molecules are linked together. Unfortunately, so many of the carbohydrates we consume do break down and turn into sugars in the body. You have emphasized this as we go along.
You both have been great here today. I want to thank you very much for appearing, and my colleagues for their questions. With that, I declare the meeting adjourned.
(The committee adjourned.)