The NEW Canada's Food Guide: Is it Relevant to the way we Eat Today? - Christina Seely RD CDE - St. Joseph's Health ...
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The NEW Canada’s Food Guide: Is it
Relevant to the way we Eat Today?
Christina Seely RD CDE
Clinical dietitian at Parkwood
Mental Health Care
Contributing authors:
Christine Kijak, RD, CDE
Jamie Yermus, RD, MPH
Faculty/Presenter Disclosure
• Presenter: Christina Seely
• Relationships with commercial interests:
– Previous speaker honoraria received from Novo Nordisk
• No other conflict of interest for today’s
presentation
Learning Objectives
⚫ To review the evolution of and evidence behind
Canada’s Food Guide
⚫ To review how the guide and Canada’s Healthy
Eating Strategy compare to current eating habits
and hot nutrition topics
⚫ To provide practical ideas and resources based on
the nutrition recommendations for the general
population
Knowledge is Only One Part of the Picture
Wealth is a Strong Determinant of Health
Canadian Health – the Good News
⚫ Life expectancy has steadily increased in past
decade, and gap between men and women has
been narrowing
⚫ Overall mortality and premature mortality rates,
particularly for CVDs, continues to decrease
⚫ Declining rates for CVDs and COPD are linked to
the major decrease in smoking across all ages
Health Canada report - Health Status of Canadians 2016
Canadian Health –
Areas of Concern
⚫ 11 million live with diabetes or prediabetes in 2019,
costs of care have increased from $14 billion
(2008) to $30 billion (2018) -Diabetes Canada
⚫ Approximately 4 in 5 adults have at least 1
modifiable risk factor for chronic disease
– self-reported tobacco smoking, physical inactivity,
unhealthy diet or harmful use of alcohol
⚫ Inequalities in chronic disease prevalence across
subgroups of Canadians exist
Canadian Eating Habits Health Canada Infographic
Canadian Food Environment
⚫ “In recent decades, highly processed products
are now readily available, competitively priced,
offered in large portion sizes, and heavily
marketed” – Health Canada
⚫ Buying in bulk - Costco is increasing market
share from traditional grocery storesCanadian Food Environment
⚫ Bombarded with marketing - Kellogg’s spent $32
million in 2018 advertising Pop Tarts alone. Coca-
Cola spent $269 million advertising coca-cola
⚫ Exploding options - Between 1975 and 2008, the
number of products in the average supermarket
swelled from an average of 8,948 to almost 47,000
– There are ~ 300 options for yogurt aloneHow Canadians Eat
⚫ Trends include foodie culture vs convenience
⚫ Single-person households have more than
doubled and are now most common type at 28%
⚫ Time cited as biggest barrier to food preparation -
avg < 30 mins / day for food preparation
⚫ Younger generations use more convenience items
related to schedules and lower food and nutrition
skills learned at home / school
Journal of Nutrition and Education Behaviour, 2017How Canadians Eat
⚫ Mobile food delivery apps are estimated at 11
percent of all quick-service restaurant sales
⚫ Apps are reshaping how food is purchased and
consumed, especially amongst millennials
– Millennials >44% of food budget on restaurant food
⚫ UberEats, Just-Eat, Skip the Dishes, and
Foodora, are growing 10-15% a year and have
a $97 billion market globallyHealth Canada Infographic General Social Survey (Canadians at Work and Home), 2016.
Book about the
Food Revolution
⚫ “Food has never been so angrily polarized into
virtues and vices, elixirs and poisons. I worry that
in many cases, our pursuit of the perfect meal has
become the enemy of the good-enough meal.
While we fixate on this or that wonder ingredient,
the thing that seems to be in short supply is the
unglamorous home cooked dinner”Canadians Have a Relatively Affordable Food Supply Compared to countries like Nigeria where 56.4% of consumer expenditure spent on food
Food Insecurity Still Prevalent
Challenge of Eating Well in Today’s
Food Environment
⚫ Healthy behaviour is abnormal behaviour
– Pleasure principle
– Path of least resistance
– Preference for short term gain
– Environment pulls for unhealthy behaviours
⚫ “If you are pressed for time doesn’t picking up
food through a drive-through make perfect
sense?” - Dr. Michael Vallis, leader of the behaviour
change instituteFeeding Families
⚫ The vast array of conflicting information can
create fear and anxiety around feeding children
⚫ “Most parents understand that they should
provide healthy food for their children, but the
reality of work schedules, children’s activities
and different food preferences can make meal
preparation a hectic and frustrating experience”
– From a 2017 poll of 1,767 parents who had at least
one child age 4-18 yearsCanada’s Healthy Eating Strategy
Changes to labels (must be completed by 2022)
Front of the Package Symbols (roll out pending)
Canada’s NEW Food Guide – released Jan 2019
Canada’s Dietary Guidelines
⚫ 55pg document
expanding on the
information on the guide
⚫ Another health
professionals document
pending later in 2019 with
information about
portions, nutrients etcDoes the Food Guide Matter to
Canadians?
⚫ Integrated widely by governments and
stakeholders into nutrition policies, programs and
resources
⚫ Taught in schools and promoted by health
professionals
⚫ Influences foods served in Canada’s public
institutions – day cares, schools, LTC, hospitals
⚫ Second most downloaded document from HC after
income tax formFood Guides THEN and NOW ⚫ 1942- Canada’s Official Food Rules ⚫ 1944- Canada’s Food Rules ⚫ 1949- Canada’s Food Rules ⚫ 1961- Canada’s Food Guide ⚫ 1977- Canada’s Food Guide ⚫ 1982- Canada’s Food Guide ⚫ 1992- Canada’s Food Guide to Healthy Eating ⚫ 2007- Eating Well with Canada’s Food Guide ⚫ 2019- Canada’s Food Guide (9th edition)
1942- Canada’s Official Food Rules
⚫ 2nd World War origins- address crisis of malnutrition,
focused on rations and fueling solders
⚫ Met 70% of the dietary standard due to limited supplies
⚫ 6 Food Groups
– Milk
– Fruit
– Vegetables
– Cereals and Breads
– Meat and Fish
– Eggs1942- Canada’s Official Food Rules
1961- Canada’s Food Guide
1992- Canada’s Food Guide to Healthy Eating
2007- Eating Well with Canada’s Food Guide
2007- Eating Well with Canada’s Food Guide
Criticisms of the 2007-2018 Version
⚫ Serving sizes difficult to follow
⚫ Too much information on the guide, had all
ages and genders listed
⚫ Protein food group was called “meat and
alternatives” put focus on meat
⚫ Criticism about juice as a fruit serving, and that
having a dairy food group was influenced by
industry2019 - Canada’s New Food Guide Rainbow → Healthy Plate A healthy meal is comprised of a variety of foods from these three food groups: ½ plate vegetables ¼ plate protein foods choose water ¼ plate whole grains
2019- Canada’s Food Guide
Milk and Alternatives and Meat and Alternatives now in Protein Foods
Basic Principles and Concepts
Behind The New Food Guide
✓ Focus on HOW to eat, promotes cooking
✓ Promotes plant based foods, whole foods
✓ Can be individualized to taste, culture, budget
and lifestyle
✓ Limiting the 3 S’s (sugar, saturated fat, sodium)
✓ Emphasis on health risks of alcoholResembles Other Countries’ Guides
USA since 2011
KoreaTranslations Released June 24, 2019
Feedback from Public and
Professionals
⚫ More positive reactions than negative, seen as
an improvement, move to digital resources
⚫ Mixed views from public on social media:
– “Makes a healthy diet look like punishment. Is this
really all we get to eat in a day?”
– “I love it. The photo of the plate is easy to follow”
– “This new guide looks realistic and healthy. I
sincerely hope it will make a positive impact for
people”Solid Evidence
⚫ Only high-quality scientific reports on food and
health were used including systematic reviews
on over 100 food-related topics
⚫ Over 400 convincing conclusions summarized
in the Evidence Review for Dietary Guidance
2015 and the Food, Nutrients and Health:
Interim Evidence Update 2018
⚫ Industry-commissioned reports were excluded
to reduce potential conflict of interestIs the new CFG appropriate for
People living with Diabetes?
⚫ “Starting point of nutrition therapy is to follow the healthy
diet based on Eating Well With Canada's Food Guide.
Choose the dietary pattern that best aligns with values,
preferences and treatment goals for long-term
adherence” – Diabetes Canada 2018 Guidelines
⚫ Plate model can provide as low as 25% carb
⚫ Starchy veg can be considered for the 25%
starch/grain portion instead of the veg portion
⚫ Further adaptation needed for medical dx such as
renal impairment, IBS, woundsPlant-Based Diet Movement
⚫ Does not apply only to vegetarians
⚫ Refers to eating plant based foods more often
⚫ “Flexitarian” has become more popular – meat
or fish ~3X / weekPlant Based Foods ✓Plant based proteins: Beans, nuts, lentils, peas, nut butters, soy beans, soy nuts, tofu, chickpeas, etc. ✓Plant based beverages: soy milk, almond milk, etc. ✓Fruits and vegetables: apple, broccoli, carrots, spinach, tomatoes, berries, etc. ✓Whole grains: Quinoa, barley, oats, wild/brown rice, whole grain pasta, whole grain bread, buckwheat, farro, amaranth, etc.
Q: Is Soy Safe to Eat?
⚫ “Results of recent population studies suggest
that soy has either a beneficial or neutral effect
on various health conditions. Soy is a nutrient-
dense source of protein that can safely be
consumed several times a week, and is likely
to provide health benefits—especially when
eaten as an alternative to red and processed
meat”
Harvard School of Public HealthLentils
⚫ High in fibre and protein. They are a good
source of folate, potassium and iron
⚫ Delicious, low-cost substitute for meat
⚫ Cook quickly, versatile in different dishes
⚫ French/Indian/Lebanon cuisine includes lentil
dishes
⚫ Can be mixed in ground meat dishesBeans
⚫ Beans are good sources of protein, potassium,
excellent sources of fiber, and naturally fat-
free, sodium-free, and cholesterol-free
⚫ Can add chickpeas, navy/black/kidney beans
in any salad, pasta, or rice dishNot Just Plants
⚫ Although the Food Guide emphasizes plant-based
foods, it still includes nutritious foods such as:
✓ fish
✓ eggs
✓ poultry
✓ lean red meat
✓ lower-fat milk, lower-fat yogurts, and cheeses lower in
fat and sodiumLimiting the 3 S’s Limiting highly processed foods: ✓ Sodium • i.e. processed foods and beverages (deli meat, canned foods, chips, cereals) ✓ Sugar • i.e. sugar sweetened foods and beverages, confectionaries, sugars, syrups, preserves, desserts, bakery products ✓ Saturated fat • i.e. red and processed meats, high fat dairy products, pastries
Limiting the 3 S’s Some processed foods do not have added salt, sugar and saturated fat and can be part of a healthy dietary lifestyle: ✓ Canned Foods ✓ Dried Foods ✓ Frozen Foods
Study of Dietary Risks in 195
Countries from 1990-2017
⚫ “Suboptimal diet is an important preventable risk
factor for non-communicable disease. Improvement
of diet could potentially prevent 1 in every 5 deaths
globally”
⚫ “High intake of sodium, low intake of whole
grains, and low intake of fruits were the leading
dietary risk factors for deaths and disability-adjusted
life years”
The Lancet Health effects of dietary risks in 195 countries. Pub
April 3, 2019Whole Grains / Fibre
⚫ Avg fibre intake is 14 g per day intake (25g women,
38g men recommended) 30-50g per day for DM
⚫ Comprehensive review suggested high-fibre eaters
have a 15- to 30-per-cent lower risk of heart attack,
stroke, type 2 diabetes, colorectal cancer and
cardiovascular-related death compared to low fibre
⚫ Consuming 25 - 29 grams of fibre a day was
protective
The Lancet Carbohydrate quality and human health 2019Study on Recommended
Carbohydrate Intake
⚫ A large population study reported 50–55% of diet from
carbohydrate associated with the lowest risk of mortality
⚫ Both lower carb consumption (70%) conferred greater mortality risk
⚫ Mortality increased when carbohydrates were
exchanged for animal fats or protein, and mortality
decreased when the substitutions were plant-based
(vegetables, nuts, and whole-grains)
Dietary carbohydrate intake and mortality: a prospective
cohort study and meta-analysis 2018 The LancetFruit vs Vegetables?
⚫ Higher fruit and veg intake associated with slower
cognitive decline, healthy bp, lower risk of heart
disease, stroke and certain types of cancer
⚫ Some vegetables are the best sources of nutrients
– leafy green veg for certain carotenoids associated
with healthy brain aging and immune function
– cruciferous veg (broccoli/cauliflower) only source of
glucosinolates (anti-cancer phytochemicals)
https://www.theglobeandmail.com/life/health-and-fitness/article-is-
fruit-just-as-healthy-as-vegetables-on-your-plate/#commentsRecommendations Around Sugar ⚫ “Limit free sugar to
Make Water your Drink of Choice
⚫ In 2015, sugary drinks were the main sources
of total sugars in the diets of Canadians, with
children and adolescents (9 to 18 years of age)
having the highest average daily intake
⚫ Water, unsweetened milk or fortified soy
beverage, and fruit are recommended
⚫ Average total fluid requirement is 2.2L / day for
women and 3L/ day for menCanadian Beverage Intake
Q: How to get enough calcium without a dairy food group? Age in Years Aim for Intake of (mg/day) Men and women 19-50 1000 Women 51-70 1200 Men 51-70 1000 Men and Women 71 and older 1200 Food Item Mg calcium 3.3% homo, 2%, 1%, skim milk 250ml (1 C) 291-322 Cheese 50g (1.5 oz) 252-386 Yogurt, fruit bottom 175g (¾ C) 221-291
Other Calcium Sources Food Item Mg Calcium Spinach, cooked 125 mL (½ C) 129 Salmon canned, with bones 75 g (2 ½ oz) 179-208 Tofu, set with calcium 150 g (¾ C) 234-347 Soy beverage 250ml (1 C) 321-324 Almonds, dry roasted 60 mL (¼ C) 93 Beans (white, navy), canned or cooked 175 mL (¾ C) 93-141 Broccoli 125ml (½ C) 35 Calcium bioavailability from dairy - 30% absorbed. Bioavailability from plant foods varies considerably. Oxalates and phytates in vegetables reduce calcium absorption https://www.dairynutrition.ca/nutrients-in-milk-products/calcium/calcium-and-bioavailability
Sample Day Menu Based on Guide
⚫ Vegetable stuffed omelet with slice whole grain
toast or fruit
⚫ Whole grain tuna wrap with raw veggies or
vegetable soup, and a fruit or yogurt
⚫ Bean burger with salad“Healthy Eating is More than the Foods you Eat” Additional messages from health professionals resource
Shift from what to eat→ how to eat ✓ Mindful eating - Be present in the eating experience without judgement - Take time to eat - Listen to hunger and fullness cues - Enjoy your food and being mindful of the eating experience - Avoid distractions while eating
Mindful Eating can be Incorporated
into Diabetes Care
⚫ Not currently in CDA guidelines but promising research
is ongoing
⚫ “Mindful Eating for Diabetes is a practical mind-body
approach that shifts focus from strict nutrition rules and
exercise regimens to learning to listen to and
understand your “inner expert”, putting you in charge
of your eating and health decisions.”
– Eat What You Love, Love What You Eat with Diabetes by
Michelle May, MD and Megrette Fletcher, MEd, RD, CDE
https://wn4dcsymposium.com/wp-content/uploads/Why-A-Weight-Neutral-
Approach-Is-Essential-In-Diabetes-Care-Ebook-June-2019-final.pdfEnjoy your Food
⚫ The benefits of enjoying your food include:
– tasting the flavours
– being open to trying new foods
– developing a healthy attitude about food
⚫ A healthy diet should allow for personal food
preferences, which can reinforce the
enjoyment of healthy eatingCook More Often
⚫ Compared to those with “basic or limited”
mechanical food preparations skills, those who
reported having “very good skills” were more
likely to also report:
– Higher frequency of vegetables and fruit
consumption
– Better self-perceived eating habits
– Higher levels of perceived health.
Dietitians of Canada + Health Canada StudyIs the New Guide More Expensive?
⚫ If a family of 4 decided to change the type and
proportions of food they ate from
recommendations in the 2007 Food Guide to
those of the 2019 Food Guide, it would cost on
average, 6.8% lessEat Meals with Others
⚫ Meals may be the only time of day for families
to reconnect, relax, recharge, laugh, tell stories
and catch up on the day’s ups and downs
⚫ Benefits start at two family meals together a
week with five or more recommended
⚫ All meal times count including breakfasts or
weekend lunchesBenefits of Family Meals ⚫ Better academic performance ⚫ Higher self-esteem ⚫ Greater sense of resilience ⚫ Lower risk of substance abuse ⚫ Lower risk of teen pregnancy ⚫ Lower risk of depression ⚫ Lower rates of eating disorders https://thefamilydinnerproject.org/uncategorized/family-dinner- references/
Some Fad Diets can be Restrictive
and Pose Nutritional Risks
⚫ “Canadians are exposed to the promotion of diets
that are often commercially driven and promise a
quick fix for weight loss or the management of a
chronic disease”
⚫ “Fad diets can be restrictive and pose nutritional
risks, particularly without appropriate planning for
nutritional balance” – Health Canada
⚫ 1-5% will stay on a diet long-termPopular Diets Searched on Google
Why Diets Remain Popular
⚫ Whole 30, ketogenic diet etc promote eliminating
foods and following (often strict) guidelines
⚫ Reduces decision fatigue, clear rules, removes
craved foods
⚫ Provide on-line community of support and many
examples of weight loss stories (few at 5yr+ mark)
⚫ Appeal lies in providing new and straightforward
solutions (ie. change macronutrient content of diet)
to a complex area influenced by many factorsDieting is a Risk Factor for Weight
Gain
⚫ “..obesity prevalence keeps increasing, in a similar
speed as diet attempts. As many as 45 million
Americans are always in the on-and-off process of
diets. This apparent paradoxical correlation is based
on the deluding assumption that dieting automatically
means weight loss. For most, diets will bring further
over-compensatory weight gain”*
⚫ Possible resource: Weight Neutral 4 Diabetes Care
– https://wn4dc.com/
*http://www.digitaljournal.com/pr/4335262Popular Diet –
Ketogenic Diet
⚫ Avg Western diet 55% carb, 15% pro, 30% fat
⚫ Keto diet 5-10% carb, 20% pro, 70% fat
⚫ Keto diet associated with significant
improvements in blood sugar control, similar
weight loss to other diets at 12-24 mos. Long-
term data lacking in adult population
⚫ Demonstrates improved HDL and triglycerides,
but also increases LDLKeto Diet Risks
⚫ ‘Keto flu’
– Nausea, vomiting, headaches, fatigue, dizziness, insomnia,
constipation, exercise intolerance
– Resolves in a few days to a few weeks
⚫ Constipation
⚫ Heartburn
⚫ Hypoglycemia – need to adjust diabetes medications
⚫ Vitamin and mineral deficiencies (B vitamins, folate, K, Mg)
⚫ Potentially negative impact on gut microbiome
⚫ May not be efficacious for everyone – mixed resultsCaution for use of Keto Diet in..
⚫ People with type 1 diabetes or type 2 diabetes on insulin,
sulfonylurea or SGLT2 inhibitor
⚫ History of eating disorder or disordered eating
⚫ Mood disorders
⚫ GI disturbances
⚫ Alcohol abuse
⚫ High cholesterol >10mmol/L or LDL >6.5mmol/L
⚫ Risk of or current malnutrition
⚫ Children, teens, breastfeeding
Source Andrea Langley, RD, MSc, CDESample Day Keto Diet
⚫ BREAKFAST: 2 eggs in butter + spinach, onions + ½
avocado + “Bulletproof coffee”
⚫ LUNCH: 3.5 oz. salmon on mixed greens salad with
mixed veggies + walnuts, olive oil + balsamic
vinaigrette ¼ cup blueberries
⚫ DINNER: 3.5 oz. roast chicken w/ skin on Pancetta-
wrapped asparagus, cooked in olive oil + creamed
cauliflower
⚫ SNACKS: Cheese, celery & cucumber, olives, cashews
Menu from Jen Sygo RDCanada’s Food Guide 2019 Areas for improvement
Areas for Improvement • Cultural sensitivity – Few cultural foods appear on guide – no roti, dumplings, dragon fruit etc. Translated versions do not include different food examples.
Areas for Improvement • Indigenous population – previous guide is still on website but is being revised
Idealism vs Realism
⚫ Does not include the concept of moderation
⚫ Can promote black and white thinking about
good or bad foods
⚫ Does not review how convenience foods can fit
other than canned/frozen produceAreas for Improvement
⚫ Higher percentage of protein are typically
recommended for older adults
⚫ Website does not yet contain in-depth content
to be more helpful to a well-educated populace
⚫ Recipe section could be greatly expanded,
currently about 75 recipes
⚫ Pending document for release in 2019 should
provide more comprehensive guidanceResources
⚫ Employers may have dietitian services
available through employee assistance
programs
⚫ Telehealth Ontario now has dietitians available
for free information over the phoneResources
⚫ Unlock Food – Resources and Recipes by RDs
– http://www.unlockfood.ca/en/default.aspx
⚫ Family Dinner Project – recipes and strategies
– https://thefamilydinnerproject.org/
⚫ My Plate Resources – recipes, handouts, ideas
– https://www.choosemyplate.gov/
⚫ www.halfyourplate.ca/Plant-Based Protein / Mindful
Eating Resources
⚫ http://ontariobeans.on.ca/consumer-
resources/download/
⚫ http://www.pulsecanada.com/resources/
⚫ https://www.lentils.org/recipes-cooking/
⚫ https://www.meatlessmonday.com/
⚫ https://www.thecenterformindfuleating.org/
⚫ Dr. Michelle May - Eat Mindfully Live Vibrantly
– https://amihungry.com/Other Recipes
⚫ Leslie Beck RD recipes
– https://lesliebeck.com/cooking-eating/healthy-recipes
⚫ Guelph Family Health Study – 4 e-cookbooks
– https://guelphfamilyhealthstudy.com/cookbooks/
⚫ Real Mom Nutrition Recipes
– https://www.realmomnutrition.com/recipes/
⚫ Heart and Stroke Recipes
– https://www.heartandstroke.ca/get-healthy/recipesSubscribe for Food Guide Updates
⚫ https://www.canada.ca/en/health-
canada/services/canada-food-
guide/subscribe.html?hq_e=el&hq_m=1782962
&hq_l=4&hq_v=74fb0c9e7bConclusion
⚫ Canada’s new Food Guide is a source of credible general
information about nutrition. Customization at an
individual level is most relevant.
⚫ Canadians have access to a huge array of food choices
and nutrition information. Access to professional
guidance remains important.
⚫ Much more is needed to help address equal food access,
food security, and the challenges of eating well in today’s
food environment/busy lifestyles.
⚫ Development of food skills and promoting enjoyment as
well as health in eating habits can be common goals.Thank you!
Questions?
E-mail anytime Christina.Seely@sjhc.london.on.caYou can also read
