Playing It Safe

Ask a dozen people, “What’s the key to healthy eating?” and you’ll probably get a dozen different answers. Ask Mary Bush at Health Canada, and she’ll direct you to Canada’s revised Food Guide to be released this fall.

Since its last update in 1992, a lot has changed–food trends, modern lifestyles, and yes, the typical waistline. The much-needed revisions began in mid-2002 and involved input from everyone–trade groups, certainly, but also the average consumer. Still, some critics suggest the revised Food Guide won’t go far enough in disease prevention and the fight against obesity.

What’s New

You’ll recognize the four food groups–grain products, vegetables and fruit, milk products, and meat and alternatives—but the recommended daily servings are new.

“In the past,” says Bush, Director General of the Office of Nutrition Policy and Promotion, “we had wide ranges. People said, ‘I don’t know where I fit.’ The revised guide is age and gender specific. We tried to focus on the appropriate amount of food, so nobody thinks they need to eat more than necessary.”

Take grain products. The previous five to twelve recommended daily servings now shifts to between three and eight–three for two- or three-year olds of both sexes, and to eight for 19- to 50-year-old men. Females 19 to 30 are urged to eat the most grains, at seven servings daily.

For fruits and vegetables, the old “five to ten” guideline will range from four to nine daily servings, with a five-to-eight intake in most sex and age categories.

The recommended daily intake of milk products has remained at two to four servings, but the Food Guide encourages us, “Drink lower-fat milk or fortified plant-based beverages most of the time.”

Then there’s the meat and alternatives category, which has increased from the across-the-board two to three servings per day, to four servings in males 14 and older.

Don’t Forget the Small Print

The updated Food Guide (as pitched last spring in its draft version) also features additional advice on eating, shopping tips, and label reading, expanding its original two pages into an eight-page foldout.

A “Tips on Vegetables and Fruit” section, for example, urges us to eat dark green and orange vegetables, at least one of each per day; to choose veggies and fruit more often than juice; and to go for steamed or stir-fried rather than fried.

It’s no secret Canadians don’t eat enough fruits and veggies. In fact, only 43 percent of respondents to a 2005 survey by Campbell’s Company said they get their recommended five to ten servings. Another 2005 survey by the Canadian Produce Marketing Association found only 25 percent of people eat enough fruits and vegetables, even though 87 percent of us darned well know that this food group helps prevent disease. So here’s a question: Will the small print make a difference?

“It’s good because people know they need to eat more variety,” says Kitty Yung, a registered dietitian in Vancouver. She’s also enthusiastic about the bigger emphasis on whole grains and the dairy section’s inclusion of soy products.

Dial-a-Dietitian, where Yung works, is a nutrition hotline where staff frequently respond to Food Guide-related questions. “We use it as a resource to counsel people,” she says. (Twenty-four million copies of the 1992 version were distributed nationwide and it’s Health Canada’s most popular website.)

Convention Versus Innovation

But Jonathan Prousky, ND, chief naturopathic medical officer and associate professor of clinical nutrition of the Canadian College of Naturopathic Medicine, had a few criticisms when he emailed Health Canada during their period of public input.

“In general, they’re fine recommendations,” he says, “but the problem is they aren’t innovative. They could actually increase health by being less conventional.”

One of his critiques concerns beneficial fats, or essential fatty acids. “There’s very little in the new guidelines. Omega-3s from fish can reduce cardiovascular mortality and morbidity, as well as being good for the brain. They’re even good against depression, mood disorders,
schizophrenia, and bipolar disorder. The guide should recommend 1,000 to 2,000 milligrams of fish oils a day.”

Dr. Prousky also disagrees with reducing the suggested daily servings of fruits and vegetables, from five to ten, to five to nine. “That’s a big mistake. Since 1992, more research has come out showing fruits and vegetables can have very strong effects in the prevention of disease, including heart disease and cancer.”

Our Daily Dose?

“All adult Canadians should take a good multivitamin and multimineral just to provide assurance, because nobody is going to eat a perfect diet,” Dr. Prousky adds. “You can’t get all the nutrients you need from our diet.”

Vitamin deficiency, especially in the elderly is common, and it is a risk factor for chronic disease, reports a 2002 Journal of the American Medical Association study. “Most people do not consume an optimal amount of all vitamins by diet alone,” the authors wrote.

But Mary Bush from Health Canada disagrees. “Following the pattern of eating in this guide, you will meet your nutrient needs.” Bush says they recommend supplements for some people, like vitamin D for adults over 50, but they aren’t saying everyone needs to be consuming a multivitamin. “The revised Food Guide is a very evidence-based initiative. Great care is being taken that it’s sound scientifically, in its communication, in that people understand what’s being said.”

“My recommendations are completely evidence based as well,” counters Dr. Prousky. “These aren’t extreme measures. I’m just requesting that the Food Guide raise the bar.”

Weighing in on Obesity

A dietary discussion wouldn’t be complete without addressing obesity–arguably the biggest problem affecting health and health care today. Only 39 percent of Canadians are at a healthy weight, leaving the majority at risk for weight-related diseases such as heart disease, stroke, and diabetes. The revised Food Guide, Bush says, counters overeating with specific serving sizes for each age and sex category.

Not good enough, according to obesity expert, Dr. Yoni Freedhoff, medical director of the Bariatric Medical Institute in Ottawa. He called the proposed version “obesogenic” in the Canadian Medical Association Journal last January.

“By Health Canada’s own reckoning, following the Food Guide perfectly will lead to the consumption of 1,800 to 3,200 calories daily. But unfortunately, the calories don’t stop there. Not included in Canada’s Food Guide is the ‘other’ category of food,” he added in an e-editorial letter shortly thereafter.

“Other” foods–those fatty, sugary, processed products–make up 25 percent of the energy and fat intake of most Canadians. By eating according to the Food Guide and then adding our usual amounts of other foods, reasons Dr. Freedhoff, we’ll be getting between 2,250 and 4,000 calories a day. “That also assumes that patients …actually take the time to learn about portion sizes and weigh and measure their dietary choices.”

The suggestion that the revised Food Guide will cause obesity is off the mark, defends Bush. “We can say with assurance that if you were to follow our pattern, it would help you maintain a healthy weight or get to a healthy weight.”

More on Carbs

Dr. Freedhoff also believes the Food Guide should do a better job of minimizing refined carbohydrates. Echoing his concern is Dr. Quinn Rivet, Chair of Nutrition at Boucher Institute of Naturopathic Medicine and adjunct professor at the Canadian College of Naturopathic Medicine and Bastyr University.

“Say you have white rice or white bread,” Dr. Rivet says. “For people who are prediabetic and don’t know, they’re eating all these high-starch, high-glycemic foods that increase their blood sugar.”

He points out the Food Guide doesn’t differentiate between high- and low-glycemic foods, which are especially significant given more than two million Canadians have diabetes (expected to rise to three million by 2010). Type 2 diabetes can be prevented or delayed through diet and lifestyle.

When you go for grain products, Dr. Rivet suggests skipping white bagels, which often contain hidden sugar; instead choose whole grains and wheat alternatives such as spelt, kamut, barley, millet, oats, amaranth, and quinoa. Brown rice is better, too. “Even though brown rice is still high on the glycemic index, it’s better than white rice because it has more vitamins and minerals and protein. With white rice, you may as well eat a couple teaspoons of sugar.”

A Step in the Right Direction

Despite the nutrition debate, everyone agrees that exercise is also important for a healthy lifestyle; that the revised Food Guide has admirable intentions; and that everyone should be consuming more of–yes, it’s worth mentioning again–those fruits and vegetables.