Report on Health in Children in Canada

Public Health Agency of Canada publication, published February 24, 2016 – Health Behaviour in School-aged Children in Canada: Focus on Relationships:

Key Finding #11: Healthy Eating

While some concerning dietary habits were reported, there were also some positive findings with respect to healthy eating.

Almost half (46%) of boys and more than one third (37%) of girls reported eating neither vegetables nor fruits once per day or more, while 34% of boys and 42% of girls reported eating both fruits and vegetables once per day or more. Some of these behaviours may be attributable to the food environments that surround young people and the availability and affordability of fruits and vegetables. More positively, reports of soft drink and candy consumption have decreased over time, and reported daily consumption of potato chips, diet soft drinks, and energy drinks was quite low. This lower frequency of consumption was consistent with the Canada Food Guide recommendations on reducing the intake of foods high in fats, sugar, sodium, or calories.

Boys and girls aren’t eating enough fruits or vegetables, but at least they have reduced their consumption of sugary drinks and snacks.

Key Finding #12: Healthy Weights

The epidemic of overweight and obesity is not declining in young Canadians.

Approximately 1 in 3 boys and approximately 1 in 4 girls were classified as overweight or obese by Body Mass Index (BMI; calculated from self-reported height and weight). Up to 25% of girls and 10% of boys were, or thought they should be, on a diet to lose weight. The percentage of young people who perceived that their body was too fat has increased from 28% in 2002 to 32% in 2014. Despite ongoing public health efforts, the prevalence of youth obesity, and the behaviours and feelings surrounding it, remain high and have increased over time.

We need to teach kids about growing food, cooking food and eating food, healthfully.

Sustainability and the Senate report on Obesity in Canada

Good point on sustainability from Food Secure Canada:

Yet what is missing from the Senate’s report is the integration of a key tenet of Brazil’s guidelines – healthy diets are not only about food choices, but also derive from socially and environmentally sustainable food systems. Since our health is intimately linked to the environment, we need to improve the sustainability of food systems and redefine healthy food as going beyond its nutritional qualities alone.

I need to take a look at the new Brazil food guide.

Recommended daily intake of sugars

After reading about the recently released 2015 USDA dietary guidelines (and the controversy surrounding it) I was wondering what the recommended maximum daily intake of sugars was, given those guidelines don’t state a maximum, and neither does the Canada Food Guide. Here’s what I’ve found.

The WHO recommends a daily limit of about 13 teaspoons of added sugars per day

The WHO published guidelines in 2015 on Sugars intake for adults and children, which recommended the following:

  • WHO recommends a reduced intake of free sugars throughout the lifecourse (strong recommendation*)
  • In bnoth adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation*)
  • WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation**)

Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Notes:
* Strong recommendations indicate that "the desirable effects of adherence to the recommendation outweigh the undesirable consequences". This means that "the recommendation can be adopted as policy in most situations.
** Conditional recommendations are made when there is less certainty "about the balance between the benefits and harms or disadvantages of implementing a recommendation". This means that "policy-making will require substantial debate and involvement of various stakeholders" for translating them into action.

Free sugars do not include the sugars already present in whole foods such as fruit and vegetables.

For a 2000 calorie diet, they recommend that 200 calories come from these free sugars. What is 200 calories in terms of, say, granulated sugar? Based on the USDA Nutrient Database, granulated sugar has 387 calories per 100 g of sugar. So 200 calories is 51.7 g of sugar. Put another way, that’s just about 13 teaspoons of sugar per day (at 4 g per teaspoon of sugar).

As stated above, they further propose that the daily limit be reduced to 5% of total energy intake, so going back to our 2000 calorie diet, that’s 100 calories, or 25.8 g, or 6.5 teaspoons per day. The caveat is that there is less certainty about the benefits from recommending an even lower sugar intake amount.

Health Canada’s proposed daily sugar limit

Currently, Canada’s Food guide doesn’t give a limit for sugar. In June 2015, Health Canada published a set of proposed regulations to amend the nutrition labeling of food products (among other labeling changes). In the proposed regulations, a sugar limit is given:

A DV of 100 g is being proposed for sugar, and the declaration of the % DV for sugar in the NFt would be mandated for all foods. Consumers would be able to use the % DV to determine whether a food contains a lot or a little sugar (as indicated by the rule of thumb footnote), and as a result adjust or limit their sugar intake.

The “% DV” is the daily value amount, based on the recommended daily intake chart (near the bottom of the page).

The proposed 100 g of sugar recommended here is about double the recommendation from the WHO; however, that’s total daily intake, from added and natural sugars. The WHO recommendations only dictate limits on added sugars to foods.

Proposed sugar limit and % DV

I advocate for a 50 g daily intake limit for added sugars. The nutrition labeling should also reflect this 50 g limit and corresponding % DV for sugar. Added sugars are more of a concern than naturally occurring sugars in vegetables and fruit, and nutrition labeling is generally on processed foods – where the added sugars are. However, it should be clear in the guidance documentation that overall limit is 100 g of sugar per day.

Canadian Senate report on obesity – first thoughts

The Canadian Senate report – Obesity in Canada – A While-of-Society Approach for a Healthier Canada was released last week:

There is an obesity crisis in this country. Canadians are paying for it with their wallets — and with their lives.

Harsh and sobering. The infographic is good.

Among the more controversial recommendations:

  • Consider a tax on sugar- and artificially-sweetened drinks
  • Ban the advertising of food and beverages to children
  • Immediately update the food guide without industry influence

Sugar Tax?

The Canadian Taxpayer Federation and the Canadian Beverage Association both denounce the recommended sugar tax, claiming that it doesn’t work. Three comments:

  1. The discussion and promotion of such a tax is very helpful and brings some awareness to the issue of high sugar consumption, whether the tax is implemented or not.
  2. We need to look at the sugar content of all processed foods and see if such a tax should be expanded to cover foods with added sugars/sweeteners, natural or artificial. Even foods such as fruit juices, which give us the liquid without any of the fibre of the fruit, need to be reviewed for inclusion.
  3. As with salt, we need guidelines on the recommended maximum daily intake of added sugars, and the report suggests this in the text.

The CBC hosted a short forum discussion on the sugar tax last week.

Restricting food advertising to children

As for advertising, currently the Quebec Consumer Protections Act protects children (under the age of 13) from any commercial advertising:

248. Subject to what is provided in the regulations, no person may make use of commercial advertising directed at persons under thirteen years of age.

1978, c. 9, s. 248.

249. To determine whether or not an advertisement is directed at persons under thirteen years of age, account must be taken of the context of its presentation, and in particular of

(a) the nature and intended purpose of the goods advertised;
(b) the manner of presenting such advertisement;

(c) the time and place it is shown.

The fact that such advertisement may be contained in printed matter intended for persons thirteen years of age and over or intended both for persons under thirteen years of age and for persons thirteen years of age and over, or that it may be broadcast during air time intended for persons thirteen years of age and over or intended both for persons under thirteen years of age and for persons thirteen years of age and over does not create a presumption that it is not directed at persons under thirteen years of age.
1978, c. 9, s. 249.
The Senate report calls for a study on the effects of this restriction in Quebec, and for implementation of a similar restriction for all of Canada.

Updating the food guide

The call for updating the food without industry influence is fantastic. I’m not sure how realistic this could be, since many non-industry researchers in academia are funded by industry, so does this mean they can’t be involved? The removal of politics from the food guide is one of the questions I’ve always had, in light of the huge ‘push’ for milk/dairy products as our main recommended calcium intake method.

On contradictory food studies

Paul Taylor at the Globe and Mail – Why do researchers churn out so many contradictory food studies?:

Food studies frustrate me. One week a study says one thing. The next week another study says the opposite. Why do researchers churn out so many contradictory studies – and why does the news media keep covering them?

Taylor covers the various research methods well, but doesn’t discuss the media’s culpability in promoting findings that aren’t really there.

Dr. Donald Redelmeier gives good advice:

For that reason, Redelmeier says the best thing to do is focus on having a lot of variety in your diet – “everything in moderation” – and don’t get distracted by contradictory studies and the latest food fads.

 

Calcium and milk/dairy allergy

A few more thoughts on yesterday’s post on calcium:

  • While I admit that dairy seems to be some of the most calcium-rich foods, why is dairy pushed so much in the dietary guidelines?
  • Is it a political issue? (i.e., through industry lobbying, economic issues, or something else?)
  • Many people are lactose intolerant (especially many people with non-european backgrounds) so why is milk/dairy listed in such a large amount of foods in many countries’ food guides?
  • While the vitamin D/calcium relationship is well known, does the type of calcium-rich food also matter? Is the calcium from dairy better or worse than from other foods?

Nutrition with food allergies and sensitivities – Calcium

See previous… Nutrition with food allergies and sensitivities

(Update: please also see my further thoughts on this issue here.)

Calcium intake in our diet is a major concern of ours since most of the dietary guidelines push a form of dairy as the primary source of calcium. However, the dietary guidelines do not provide a sufficient variety of foods for those of us with food allergies. Witness Appendix 11 of the recently updated USDA dietary guidelines, published late last year, on the Food Sources of Calcium. I’ve highlighted in pink the foods that we cannot consume.

Appendix 11. Food Sources of Calcium - 2015-2020 Dietary Guidelines - health.gov cropped highlighted
(Click on the picture to enlarge)

That leaves us with the following 5 items from the list, with my comments following each item:

  • Fortified ready-to-eat cereals – many of which we cannot eat due to our wheat, peanut and treenut, and dairy allergies
  • Orange juice, calcium fortified – we would have to purchase this, as whole oranges are not at the top of this list
  • Sardines, canned in oil, drained – okay; though some are packed in soy oil, and so we tend to stay away from these products
  • Mustard spinach (tendergreen), raw – I don’t see this in our grocery stores
  • Rice drink – this is suitable; however, many rice drink producers also manufacture almond and/or soy drinks on the same production line, and so we tend to stay away from these products

There are some good resources out there that list calcium-rich foods to incorporate into your diet:

National Institute of Health – Calcium in Diet
National Osteoporosis Foundation – A Guide to Calcium-Rich Food
Dietitians of Canada –Food Sources of Calcium

Also, the USDA provides a great food-nutrient database from which you can search based on nutrient, categories of food, and even through some popular processed foods (Click on Nutrients List in the header).

Here’s a search based on Fruits, legumes and vegetables. (A lot of it is soy-based, which we can’t have, but we can’t remove soy from the search results.)

Nutrition with food allergies and sensitivities

While our son has the majority of the allergies and food sensitivities, we are still nursing him and thus his mother also has to stay away from the many of the same foods. I have no food restrictions, but we plan and cook our meals as a family and we want the food at our table to be all-inclusive. Thus in the interest of creating a safe food space for our son, we’ve decided to restrict our foods within the home such that all (or almost all) of the food we eat is safe and healthy for everyone to eat.

With the food restrictions, we have constantly been concerned with nutrition – how do we ensure that we are all getting a nutritious diet? One guidance document is Canada’s Food Guide published by Health Canada.

Overall the guide seems to be quite reasonable – focus on vegetables, fruit and grain products, some milk and alternatives, and some meat. Limit your oils and fats. However, looking at the page on serving size examples, a lot of it is restricted for us. What I see is illustrated below.

GFAF Canada Food Guide Suggested Foods Serving Restricted

I know that this figure is an example of serving size, and not an example of the foods that are possible in that category. But when I look at that, I see limitations and not possibilities, and it’s very disheartening. What I want to find are possibilities for new or different recipes and foods that we may enjoy, and be healthful.

For example, Dairy and Alternatives is a category unto itself in Canada’s Food Guide; however, with our restriction on soy and milk, what can we do? I think calcium and vitamin D are the main nutrients being promoted with dairy, but how can we get that otherwise? What about grain? Our diet is mainly rice since bulgur and quinoa is difficult to source without contamination.

Over the next few weeks, I hope to explore this more and try to answer some questions we have about nutrition and health in light of our food restrictions. I will also look into food guides around the world to see what they have to say about it.

On the updated 2015 US dietary guidelines

Marion Nestle:

In the 2015 Dietary Guidelines,

  • Saturated fat is a euphemism for meat.
  • Added sugars is a euphemism for sodas and other sugar-sweetened beverages.
  • Sodium is a euphemism for processed foods and junk foods.

If the Guidelines really focused on dietary patterns, they wouldn’t pussyfoot.

Why don’t they?  Politics, of course.