New rules for a fat, idle nation: Once a bible of nutrition, can a single pamphlet possibly satisfy critics and a diverse population?

The Ottawa Citizen - March 5th, 2006

Sunday, March 5, 2006
Section: News Page: A8

Carolyn Bennett, Canada's former minister of state for public health, keeps a laminated copy on the wall of her Toronto medical offices. She uses it as a dart board. Ottawa obesity doctor Yoni Freedhoff calls it "obesogenic" and does not recommend it to his patients who are struggling with their weight.

Yet many Canadians are equally passionate in support of Canada's Food Guide to Healthy Eating. Since the current version was produced in 1992, more than 24 million copies have been distributed to individuals, dietitians, schools, social-service and health organizations across the country, Health Canada is proud to tell you, making it the second most-requested federal government document, topped only by income-tax forms. The bible of nutrition for many Canadians, it hangs on refrigerator doors from coast to coast.

In an age of computer saturation and multi-media everything, it is remarkable that a pamphlet, decorated with illustrations of food reminiscent of vintage home-ec textbooks, can bring Canadian blood to a boil. But that is the case -- especially now, as Canada's Food Guide gets a makeover for the first time in 14 years.

This multi-year process comes at a time when more Canadians are fatter than ever, and suffering the consequences, when fad diets are ubiquitous, when food angst is high and when there is growing concern about the role the food industry plays in what and how much we eat. What is more, research increasingly shows that diet has a direct influence on our health -- diets low in saturated fats, high in whole grains and fruits and vegetables can help people reduce their risk of developing heart disease, cancer and other chronic diseases, according to the Harvard School of Public Health and others.

Not surprisingly, the ongoing consultations over the new food guide, to be released this fall, have been marked by concerns not only about what should go in the guide, but about whether the process is overly influenced by the food industry, and whether the guide is even relevant.

Liberal MP Dr. Bennett, who is a Toronto physician, believes the food guide has outlived its usefulness. She would like to see it replaced with a national, multi-departmental food policy that focuses on overeating and poor nutrition the way governments went after smoking in the past: "The food guide is old-fashioned in its pamphlet approach ... and there is a lack of evidence about whether it changes behaviour," she said. "There are many different ways to teach people to eat better."

Dr. Bennett says her staff laminated the food guide and put it on the wall of her office as a dart board because "they knew it bugged me. We need to listen to people on the ground and truly evaluate what works before we go printing more pamphlets."

The food guide was born in 1942 as Canada's Official Food Rules. Its aim was to help Canadians maximize nutrition in the face of wartime rationing and extensive poverty. The publication identified six food groups -- milk; fruit; vegetables; cereals and breads; meat, poultry, fish; and eggs. Among its recommendations were that Canadians eat liver, heart or kidney once a week. By 1944, the rules were upgraded. The new guide recommended "at least one" serving of potatoes a day and "at least four slices of Canada Approved Vitamin B bread (with butter)" every day.

By 1961, the nutritional recommendations for Canadians were called, for the first time, Canada's Food Guide and presented in colour-coded groupings. The 1961 version, which recommended "bread (with butter or fortified margarine)," featured drawings of milk, fruit, vegetables, bread and cereals, meat and fish with funny faces, arms and legs.

In 1977, the food guide featured a colourful food wheel surrounding the sun. The 1982 version looked similar, but there was a major difference -- for the first time, the food guide was aimed at a population not dealing with too little food, but too much. This, says Health Canada, "signified a major shift in dietary advice."

That message of moderation and energy balance set the tone for future food guides. Still, critics charge that the current guide -- produced in 1992 and featuring a now iconic rainbow with bread and grain products in its largest outer band -- recommended Canadians consume more food at a time when the obesity crisis was in its infancy.

Mary Bush, director general of the office of nutrition policy at Health Canada who has been involved in developing food guides since 1977, says the proposed guide, now in draft form, was specifically designed to address overeating.

"We would never want a food guide to be misinterpreted about the amounts to eat," she said.

The proposed guide, in fact, recommends fewer servings in all food categories -- including, controversially, fruits and vegetables -- than the 1992 food guide did. It also makes specific recommendations based on age and sex to help avoid confusion about how much people should eat. Where the current guide recommends between five and 10 servings of fruits and vegetables every day for everyone, for example, the proposed guide recommends between four and nine servings, depending on age and gender.

Ms. Bush says the new recommendations represent a significant shift in the amount of food energy Health Canada thinks people require to remain healthy. For the first time, the proposed guidelines are based on the assumption that Canadians are sedentary, something Ms. Bush says Health Canada officials grappled with.

"While we encourage Canadians to be physically active," Ms. Bush said, the fact is that many Canadians are not and that comes at a time when food is more readily available than ever. "We are just all faced with an awful lot of food."

Canadian food consumption, in fact, has gone up by about 15 per cent in the past 15 years, according to Statistics Canada.

But she says people who blame the food guide for increasing obesity are misguided.

"This is a tool in one country to try and help people understand what healthy eating is. To either give it the credit or blame for a global epidemic is just not to understand how it is used, and what it is."

Still, Bill Jeffery, Ottawa co-ordinator of the U.S.-based Center for Science in the Public Interest, believes Health Canada should take some responsibility for encouraging Canadians to eat too much of the wrong things.

"It is a credible conclusion that Health Canada's advice about diet may have at least partially contributed to the rise in obesity rates," he said.

He also says he is baffled by recommendations in the proposed guide that Canadians eat fewer fruits and vegetables than the 1992 guide recommended. "I just don't know how that can be justified."

Since fruits and vegetables are, in most cases, the lowest calorie, healthiest foods people can eat, Mr. Jeffery says encouraging people to eat fewer of them means they probably will eat more of the things they shouldn't -- especially foods high in fat and sugars.

Mr. Jeffery also notes that the proposed guide appears to recommend Canadians eat more meat and alternatives than the previous guide did, which is counter to almost all advice about limiting saturated fats.

Health Canada says its meat recommendations in the proposed guide (four servings a day for men versus two to three servings in the current guide) involve smaller portions than the 1992 recommendations did, so they actually add up to less meat than recommended in the 1992 guidelines. But Mr. Jeffery fears most Canadians will miss the fine print and take the diagram as a recommendation to eat more meat.

Mr. Jeffery says the food guide needs to be more blunt about what Canadians should and should not eat.

"When we have a fairly clear understanding about the relationship between diet and disease, the government has a responsibility to Canadians to make sure it translates that advice in action -- not just fuzzy statements that don't offend the food industry."

The food industry's role in the formation of national nutritional guidelines is a particular bone of contention with Mr. Jeffrey and others who say the guide is lacking credibility at a time when Canadians badly need credible advice.

Mr. Jeffery notes that the 12-member advisory committee working on the newest food guide includes people who have or have had ties to the British Columbia Dairy Foundation, the Vegetable Oil Industry of Canada and the Food and Consumer Products Manufacturers of Canada, which represents 180 different companies, including Coca-Cola, Heinz and Frito-Lay.

"A few members of the advisory committee had pretty obvious conflicts of interest," said Mr. Jeffery. "It set up a dynamic that wasn't destined to produce good independent advice."

Dr. Freedhoff, medical director of the Bariatric Medical Institute in Ottawa, who says the proposed guide will promote obesity, agrees that people with links to the food industry should not be so closely involved with formation of the guide.

"There are huge pressures put to bear at all levels of (development of) the food guide by the inclusion of the food industry. The food industry does not have my health in mind."

Dr. Freedhoff added that: "Having (companies such as) Frito-Lay invited to the table is just bizarre. It doesn't make any sense. They are stakeholders. It will affect them. But it doesn't mean they should have a say."

The role of the powerful food industry lobby in formation of the U.S. Food Pyramid -- the American version of the food guide -- was documented by author Marion Nestle in her 2002 book Food Politics: How the Food Industry Influences Nutrition and Health. Ms. Nestle, the chair of New York University's Department of Nutrition and Food Studies, who managed production of the Surgeon General's Report on Nutrition and Health in 1988, wrote:

"My first day on the job, I was given the rules: No matter what the research indicated, the report could not recommend 'eat less meat' as a way to reduce intake of saturated fat ... The producers of food that might be affected by such advice would complain to their beneficiaries in Congress, and the report would never be published."

The U.S. Department of Agriculture, which produces the American Food Pyramid (a revised version of which was released last year), is responsible for overseeing both the success of American agriculture and providing food advice to the American public, an obvious conflict, notes Ms. Nestle.

Health Canada has no such obvious conflict. Still, the food guide has a powerful influence on what Canadians eat. Every inclusion and exclusion in the food guide can potentially mean big money to parts of the multibillion-dollar food industry.

People behind the scenes have described the exercise of revising the food guide as politically charged -- a world in which every fruit and vegetable sketched on the diagram is examined and analysed, where every recommendation has potential ramifications.

"It is no surprise" says Mr. Jeffery. "The implications of this advice are considerable.

" Still, Mary Bush says suggestions by some critics that the food industry plays too large a role in formation of Canada's Food Guide are unfounded.

"When we put together a food guide and other kinds of advisory groups, we purposely try and make them multi-sectoral. We want to hear the issues first-hand. We want to hear it from different perspectives ... I don't look at it as being anything other than understanding any different point of view."

The powerful Canadian dairy industry is among those with complaints about what it has seen in the proposed guide. Although milk consumption has declined in Canada in recent years, the proposed food guide represents the first time since the official food rules were published in 1942 that milk may have some competition in its own category. A container of soy milk stands next to milk, yogurt and cheese in the milk products category of the proposed guide.

Therese Beaulieu, director of communications of the Dairy Farmers of Canada, says her group has met with Health Canada to express its displeasure with the placement of soy milk in the milk products category.

"We're not against soy products, we just don't think they fit in the milk category," she said. Ms. Beaulieu also said dairy farmers believe the recommended daily servings of milk and milk products are too low in the proposed guide. Her organization believes adults need three servings of milk products daily rather than the two which would be recommended for adults under 50.

But, for some, milk remains a controversial part of the food guide, even with the inclusion of soy milk as a possible alternative.

Dr. Tom Barnard, a Leamington family doctor and adjunct professor at the universities of Guelph and Western Ontario, believes milk does not deserve a place as a major food group.

 "The truth is dairy is not an essential food for human beings." Dr. Barnard says its prominence in the Canadian diet has historically been as much about marketing the dairy industry as about nutrition.

"That is part of why we look at dairy as an essential food group for human beings -- which it might be for baby cows. Dairy is not some kind of sent-down-from-Moses nutritional supplement."

Dr. Barnard, who says he is not "categorically opposed" to anyone drinking milk or eating dairy products, says society should not ignore the fact that there are probably better and safer sources of calcium for many people.

Increasing numbers of Canadians are lactose intolerant and Dr. Barnard says milk consumption has also been linked to diabetes and multiple sclerosis. Health Canada says the inclusion of soy milk as one alternative source of calcium recognizes that many Canadians are not culturally or physically disposed to drinking milk. When revision of the guide was announced by the Paul Martin government, a need to make dietary advice more culturally diverse was cited as a key factor in the new guide.

Many critics of Canada's Food Guide say Health Canada should look to Harvard University professor Dr. Walter Willett's alternative food pyramid (www.hsph.harvard.edu/nutritionsource/pyramids.html) for the best way to provide nutritional advice. Dr. Willett's pyramid recommends whole grain foods at most meals, healthy oils frequently, an "abundance" of vegetables, fish, poultry, eggs and dairy up to two times a day and, significantly red meat, butter, white rice, bread, pasta, potatoes, pop and sweets "sparingly." It also recommends multiple vitamins, which Dr. Willett calls insurance.

Neither Canada's Food Guide or the American Food Pyramid makes such strong negative statements about foods, particularly white flour, potatoes and rice.

"I don't follow the food guide, I follow Walter Willett's food pyramid," says Dr. Yoni Freedhoff.

Can an eight-page pamphlet really influence the way Canadians eat in a world where food is everywhere and people are less active than ever? While some critics say no, others say the new food guide is a chance to make a difference at a time when every bit helps. But it is up to Health Canada to make sure that the appearance of food industry influence does not water down what is potentially an important public health tool.

"There are some who think the food guide is a document of little consequence and we shouldn't worry about it," says the Center for Science in the Public Interest's Bill Jeffery. "I think that is wrongheaded. It drives nutrition policy and it is widely disseminated. But if it reflects policies plainly not in accord with scientific evidence, it will be treated as such, and one of Health Canada's primary education tools will lose credibility."

Elizabeth Payne is editor of the Citizen's senior writers.

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