Health Committee on Nov. 16th, 2009

[The Chair, Conservative, Joy Smith]

Welcome, everybody, to the committee. It's going to be a really interesting day. We're very much looking forward to hearing your presentations.

Pursuant to Standing Order 108(2), we're going to have a briefing on sodium consumption in the Canadian diet. We've had some previous witnesses who have given us some very insightful and rather shocking information. It certainly alters one's thinking on the issue when one hears from the experts.

From the Canadian Society for Nutritional Sciences, we have Dr. Katherine Gray-Donald, who is an Associate Professor in the School of Dietetics and Human Nutrition at McGill University. From Kellogg Canada Inc., we have Christine Lowry, Vice-President. From Nestlé Canada Inc., we have Catherine O'Brien, who is the Director of Corporate Aaffairs; and Karen Young, Director of Scientific and Regulatory Aaffairs. From the Canadian Institutes of Health Research, we have Dr. Peter Liu, Scientific Director of the Institute of Circulatory and Respiratory Health; and Dr. Philip Sherman, Scientific Director of the Institute of Nutrition, Metabolism and Diabetes. Welcome.

We ask that each association make a five-minute presentation, and we'll start with Dr. Katherine Gray-Donald.

[Dr. Katherine Gray-Donald, Associate Professor, School of Dietetics and Human Nutrition, McGill University, Canadian Society for Nutritional Sciences]

Thank you.

I'm representing the Canadian Society for Nutritional Sciences, which is soon to become the Canadian Nutrition Society. My training is in nutritional epidemiology, and I'm an associate professor at McGill.

Today I'd like to cover two points, from the perspective of a nutritionist and member of the Sodium Working Group. The first is that the health benefits of sodium reduction are very well established, and second, the three prongs to the Sodium Working Group program—education, sodium reduction in the food supply, and research—are all necessary components of a strong sodium reduction strategy.

The evidence that sodium leads to increases in blood pressure, a major cause of cardiovascular disease, is indisputable. Our best sources of data come from two types of studies. One is a dosing study, where different levels of sodium are given to the same person and changes in blood pressure are then monitored. The second type of study is the longer-term clinical trial, in which sodium intake is reduced in one group and not in a control group. Such studies, conducted in both patients with hypertension and in healthy subjects, have shown decreases in blood pressure among those randomized to sodium reduction programs.

However, sodium reduction is by no means the only solution to decreasing blood pressure. Weight loss and sodium reduction appear to be additive in their impact on blood pressure. Overweightness and obesity, present in 53% of Canadian adults, cannot be ignored in our messaging lest Canadians think reducing salt is the magic bullet to improving health. It's an important part of the whole problem.

Reducing sodium will require educating the public, changing the food supply, and research to monitor progress. Educational messages are important to sensitize the population to ways of reducing sodium intake. We could add advice to Canada's Food Guide on reducing sodium intake and inform health professionals and the public through many avenues as well.

Certainly some of this is currently being done. We have sodium content information on the nutrition facts labels on processed foods. However, the target on the label is not the desirable level of salt intake for the day but rather the tolerable upper level of intake. This does not follow the labelling for other nutrients wherein we use the desirable level for health as a target. We can thus mislead the public. For example, if one uses the upper limit of the standard, as is currently done, a cup of mystery cereal has 14% of the tolerable upper level amount, but it has 22% of the healthy target set by the Institute of Medicine.

With the current food supply, it is difficult to help consumers have a desirable intake of sodium without asking people to refrain from eating many of the processed foods they're used to and eating out often. This is not very doable. We need to reduce the sodium content of the commonly eaten foods.

Finally, research to monitor progress is essential, as public health interventions sometimes have unintended consequences. Consumers could start using the salt shaker more if we make certain foods less palatable. The best way to measure progress in sodium reduction is through measuring urinary sodium in a sample of Canadians, as this reflects sodium intake over time. Measuring diet is fraught with the difficulties of measuring salt that is added to foods with a shaker and the changing content of sodium in foods.

In closing, both broad-based education on healthy eating and offering Canadians a wide choice of healthy processed foods is essential to improving their health.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you very much.

We'll now go to Christine Lowry, vice-president of Kellogg Canada.

[Christine Lowry, Vice-President, Nutrition and Corporate Affairs, Kellogg Canada Inc.]

Thank you, Madam Chair and members of the committee, for this opportunity to appear before you today to discuss this important issue.

By way of background, Kellogg Canada is a wholly owned subsidiary of Kellogg Company. Our head office is in Mississauga, and we have sales offices in Montreal and Calgary. We have two cereal plants: one in London, Ontario, and one in Belleville. Throughout Canada we employ 800 Canadians.

As a leading manufacturer of breakfast cereals in Canada, we know that breakfast cereals contribute significant health benefits to the Canadian diet. Breakfast cereals are a major contributor of B vitamins, iron, and zinc, and in fact, breakfast cereals are the number one source of iron in the Canadian diet for children.

The majority are low in fat, and all Kellogg's breakfast cereals have zero trans fats. Most importantly, many of our cereals are among the largest contributors of fibre in the diet, a nutrient that many Canadian adults and children are deficient in. In addition, there is consistent evidence that people who regularly eat breakfast cereals tend to be slimmer than those who do not.

It is very important to note, in the context of your review of sodium, that breakfast cereals represent 3% of the sodium intake in the Canadian diet, according to Statistics Canada. In fact, as this committee heard at your October 5 meeting, cereals are not among the top 10 foods that contribute sodium to the Canadian diet.

This is not to say that we take this issue lightly. We recognize that sodium is an important issue for Canadians, and we are committed to doing our part to help address it in our products. And we'll be doing our part as an ongoing commitment to our health and wellness.

We were very aggressive in renovating all our food products to ensure that there were zero grams of trans fats per serving. We have already lowered the sugar in a number of our breakfast cereals, and we have lowered sodium levels in a number of our cereal products.

Kellogg Canada is committed to gradually lowering the sodium content of our cereals and to continuing to improve their nutritional profile. For context, I think it's helpful for the committee to understand the range of breakfast cereals we make and their contribution to the sodium intake of Canadians.

Kellogg Canada manufacturers 36 cereal products. About 75% of these products have 230 milligrams of sodium or less per serving. Five of our products have zero milligrams of sodium per serving, 13 have 200 milligrams of sodium or less, and nine have between 200 and 230 milligrams of sodium per serving. However, we do have nine products that have sodium levels of over 230 milligrams per serving. These include Kellogg's All-Bran, which was the subject of some recent media coverage.

At the beginning of 2009, we embarked on a project to gradually reduce the sodium levels in these nine products. I'm pleased to announce to the committee today that we are committed to achieving an initial target of 200 milligrams of sodium per serving for each of these products by early 2011.

All along, our strategy has been to reduce sodium gradually, over time, without compromising taste or quality. Consumers are very sensitive to formulation changes and to drastic changes in the flavour profile of an established brand, especially in the breakfast cereals they know so well. If this is not done properly, consumers may reject the new taste and walk away from the food product. In doing so, they may change to a replacement food that may not have the nutritional benefits of the high-fibre cereal. That's why our plan is to have a phased approach to reduce the sodium.

Although there are many challenges associated with reformulating products to reduce sodium while maintaining consumer acceptance, we remain committed. Progress is being made, and more progress is coming. We're focused on achieving this goal, and we know we will be successful.

Kellogg Canada remains recommitted to continually improving the nutritional contribution of our products for all Canadians. As well, we remain committed to working together with the government, health and professional associations, and members of Parliament from all parties to help Canadians reduce their sodium intake.

To that end, I do appreciate the opportunity to present this information to the committee and I welcome any questions you might have today.

Thank you.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Lowry.

We'll now go to Catherine O'Brien from Nestlé Canada Inc.

[Catherine O'Brien, Director, Corporate Affairs, Nestlé Canada Inc.]

Madam Chair, members of the committee, thank you for inviting me here.

I'm Catherine O'Brien, the Director of Corporate Affairs for Nestlé Canada. I have with me my colleague Dr. Karen Young, who is the director of Regulatory and Scientific Affairs.

At Nestlé Canada we're committed to supporting the health and wellness goals of Canadians by providing high-quality, great-tasting, and nutritious products. Our focus is on offering science-based solutions to Canadian consumers to help make their journey towards a healthy lifestyle easier and more enjoyable.

We share the concerns of the Standing Committee on Health with respect to sodium reduction. We are committed to reducing sodium in our products, educating our consumers about sodium reduction, and partnering with the experts.

As with most nutrition issues, reducing sodium in our diets is a complex effort and there is no one-size-fits-all solution. We must balance the push of science against the pull of the market. Consumers will simply not compromise on taste; therefore, it must be a priority, alongside improved health. We must also ensure that the functional qualities of sodium, such as safety, are also considered.

We're here today to share a glimpse of our commitment to sodium reduction, what we've accomplished, and our future plans.

This is an ongoing process, and while we've made great strides, we know that it is a journey and that we certainly have opportunities for improvement. We've established a policy to reduce sodium in our products worldwide, and in Canada especially we have made significant progress in reducing sodium levels in many of our most popular products. I want to offer a few examples today.

Stouffer's meat lasagna is our number one selling Stouffer's product. The sodium levels have been reduced in most of the Stouffer's products in a phased approach that began in 2005. To date, we've been able to reduce the amount of sodium in Stouffer's meat lasagna by 26%. Not only does the sodium level meet the Health Check criteria, Stouffer's meat lasagna is also preferred on taste versus our competitors' products. We've been able to reduce the sodium and maintain the taste for consumers.

Stouffer's meat loaf is another example. Again, this is a product with very high sales. In a similar fashion, we've been working to reduce the sodium level in meat loaf since 2005 and have reduced the sodium by 22%. Meat loaf is another success story among Canadian consumers, as it also was recently preferred on taste versus that of our competitors. It also carries the Health Check symbol.

Another example from the Nestlé portfolio is Lean Cuisine. Every Lean Cuisine recipe we have has a sodium level of 700 milligrams or less, offering consumers a variety of nutritious offerings made with whole grains, without preservatives, and with two servings of vegetables.

Skillet Sensations is yet another example of a nutritious and convenient choice for families. Many of these Skillet Sensations recipes meet the Health Check criteria, with sodium levels of 720 milligrams per serving or less. We've been working to reduce the sodium levels of the Skillet Sensations recipes, with an average reduction of 25% since 2005.

Nestlé is also a food service provider. Our Nestlé professional business has reduced sodium significantly in many of our own branded products as well as our custom products.

As you can see, product renovation is ongoing, but at the same time, we know it's not the only piece of the solution. Communicating with our consumers is extremely important, and we regularly answer questions, offer advice, receive suggestions, and dialogue with our consumers.

One particularly relevant example is a booklet on sodium that we created and distributed through Reader's Digest to over 140,000 homes and through 1,800 pharmacies across the country. The booklet contains information about sodium, its role in our diet, and how to understand levels in foods. We know this is only a start and that further education is essential.

We're also working with the Heart and Stroke Foundation and participate in their Health Check program. The majority of our Stouffer's products carry the Health Check symbol, which means the meals were evaluated by the foundation's registered dietitians and found to be a healthy choice, with the appropriate levels of fat, protein, and sodium. We also support the efforts of the multi-stakeholder working group on sodium reduction, led by Health Canada, of which our industry association, Food and Consumer Products of Canada, is a member.

The reduction of sodium in our diets is definitely a journey, but a journey on which we have made great strides. We will continue to make progress, to look at opportunities to improve all of our products, and to dialogue with consumers. We know that industry, government, health experts, and our fellow food manufacturers all play a role, and we look forward to continuing to collaborate to address this important issue.

Thank you for listening.

We are now ready to take your questions.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. O'Brien.

Do you have copies of that booklet you were referring to?

[Catherine O'Brien]

I do, yes.

[The Chair, Conservative, Joy Smith]

Are they in both languages?

[Catherine O'Brien]

Yes. I don't have a copy for each person, but I have samples.

[The Chair, Conservative, Joy Smith]

If you would be so kind as to make sure that each of the committee members does have a copy of that, I think it would be very helpful.

[Catherine O'Brien]

Sure, yes.

[The Chair, Conservative, Joy Smith]

If you have a couple, I can take one of them up here as well.

Can we now go to Dr. Peter Liu from the Canadian Institutes of Health Research? I understand that Dr. Philip Sherman will be sharing his time, so you have five minutes. Thank you.

[Dr. Philip M. Sherman, Scientific Director, Institute of Nutrition, Metabolism and Diabetes, Canadian Institutes of Health Research]

I'll take the liberty of going first, since that's how we've made the arrangements.

Thank you for inviting us. I'm a practising pediatric gastroenterologist at the Hospital for Sick Children, University of Toronto. My colleague Dr. Liu is an adult cardiologist at the University Health Network, University of Toronto. We are co-leading, together with multiple institutes of the Canadian Institutes of Health Research, a research agenda to support sodium reduction in Canada, which includes a workshop.

You all have the slides with you, so I'll just go through them.

We are holding a low-sodium workshop to look at this initiative during the third week in January in Toronto, to identify strengths, gaps, and opportunities in research capacity in Canada related to sodium reduction in the thematic areas of health, food science, knowledge to action, and evaluation and monitoring of any policy change in sodium content in foods.

We are identifying a research agenda for sodium reduction to support Health Canada's working group on sodium reduction, and we are identifying opportunities for international and global collaborations in this context, as well as engaging potential research funders to support this research agenda on sodium reduction.

The next slide shows a list of partners we've already engaged, including Health Canada, the Public Health Agency of Canada, Blood Pressure Canada, the Heart and Stroke Foundation of Canada, the Canadian Hypertension Education Program, the Kidney Foundation of Canada, and two national centres of excellence, including the Canadian Stroke Network and the Advanced Food and Materials Network.

As you know, there is a Sodium Working Group that is tasked with developing and implementing a program of lowering sodium content, with a three-pronged approach of education, voluntary reduction in sodium levels, and research. It's in the research aspect that Peter and I are involved.

As you know, and the next slide reinforces what you've already heard, most of the salt in Canadians' diet is actually in processed foods. The next slide shows factors associated with increased salt sensitivity, and these are populations of vulnerability. The next slide shows adverse effects of excess sodium intake, including heart disease, blood pressure, effects on bones, and an increased risk of cancer.

The next slide, which is titled “Excess salt stored in the skin stimulates, via macrophages, neolymphatics”, is to show to all of you that there are new advances in the control of sodium intake. Understanding basic biologic principles will have a major impact on the sodium in one's diet and on its impact on health, including blood pressure and cardiovascular disease. This fundamental advance was actually published in a medical journal in May 2009. So we know lots about sodium, but not everything that needs to be known.

On the next slide, it's important to note that sodium is involved in a variety of conditions, including stomach cancer, and there's strong mechanistic evidence that salt is a probable cause of stomach cancer.

I'm going to turn it over now to my colleague Dr. Liu.

[Dr. Peter Liu, Scientific Director, Institute of Circulatory and Respiratory Health, Canadian Institutes of Health Research]

I will continue to the next slide, which is on global perspectives. It indicates that the actions we take today come from research knowledge to date. In regard to reducing salt intake in populations, there is strong evidence that salt consumption is linked with several chronic diseases—obviously hypertension and heart disease, as we heard earlier. Any intervention to reduce population-wide salt intake can actually be highly cost-effective, as illustrated in other countries. There's an urgency to implement the sodium reduction strategies here in Canada, and we need to look for opportunities to be innovative in this type of setting.

If we go to the next slide, in terms of international perspectives, I think this group already heard that the U.K. has aggressively pursued sodium reduction by setting targets through their publication and also setting up an agency to reduce sodium in the population. In 2008, the Institute of Medicine from the U.S. convened a committee on strategies to reduce sodium intake involving various partners, including food manufacturers, the government, and public health professionals. Most impressively, over the past 30 years in Finland, a one-third reduction in average salt intake was accompanied by a greater than 10-millimetre fall in terms of blood pressure in the population and a 75% decrease in stroke and heart mortality.

Indeed, the data to date on the next slide suggest that the relationship between sodium intake and blood pressure is a progressive and continuous one without an apparent threshold. The next slide shows the long-term effect of reducing sodium intake on cardiovascular disease, but I think this committee is familiar with some of this data, and that reducing sodium in the various contexts has been consistently able to reduce blood pressure. Indeed, each millimetre of blood pressure reduction translates into a 2% reduction in the death rate. This is very impressive.

In terms of supporting the effort in the sodium reduction policy working group, we also proposed in our workshop to monitor the effectiveness of sodium reduction as it is taking place. And the parameters that will need to be monitored included the effectiveness of public education programs in samples of the population, and in terms of a sodium content reduction in the various food categories over time, and also sampling of the total sodium intake in the population, and also sampling of urinary sodium excretion in samples, as we heard earlier.

With that, I'd like to thank the committee for the opportunity to present our research agenda to support sodium reduction efforts.

[The Chair, Conservative, Joy Smith]

I want to thank all the presenters for their insightful preliminary comments, and I want to remind you that at five o'clock we're going into a half-hour of business. We have some motions and some things to deal with.

For the next hour, we will go into seven-minute questions and answers.

We'll begin round one with Dr. Bennett.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Thank you very much.

This is maybe for the researchers. Would you consider that reducing sodium in the diets of Canadians is an urgent problem?

[Dr. Peter Liu]

Certainly the data to date suggest that the ability to reduce sodium would have translated into blood pressure reduction, which would have an impact on stroke and on various cardiovascular outcomes. There are data from other countries to suggest that when we are able to do this, it will be important in terms of health consequences.

I would say that this is a thoughtful type of process in which you can achieve this successfully, and it will translate into health benefits.

[Carolyn Bennett, Liberal, St. Paul's, ON]

The Sodium Working Group was formed on October 25, 2007. I think a lot of us felt at the last hearing that there doesn't seem to be a lot to show for this in the last two years for something that seems to be an urgent problem. I think we heard there weren't enough resources, that they don't meet often enough. They seem to be waiting to launch a public awareness campaign even though it's quite clear in the mandate, in the terms of reference, that the recommendations of the Institute of Medicine would be a reasonable target, that we don't need a separate target for Canada.

What I'm asking is this. Given what has happened in Finland and around the world, do you believe that for this committee to have their terms of reference be voluntary reductions of sodium levels in processed foods and foods sold in food service establishments is adequate and broad enough to be able to get the job done?

[Dr. Philip M. Sherman]

I will try to answer that.

One of the points is that when you do make a change in the salt content of foods, it's very important to measure the outcomes—the anticipated as well as the unanticipated outcomes.

The Institute of Medicine report—I see the book there, if you want to look at it—in 2001 actually identified a bunch of gaps in knowledge that really do need to be identified, whether it's a voluntary or mandated change in salt. For example, if you lower salt content in diet, what's the impact on children and their later life—not just the immediate impact, but many years later—and on pregnant women and other vulnerable populations? If there is a change in salt in the diet, our job is to monitor what happens to make sure there is documented benefit, but also to monitor to make sure there is no adverse outcome. We have been working since the beginning of this year to put together the workshop and evaluate if there is a policy change.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Do you think there is any reason for the government to wait to do a public awareness campaign? It has now been two years. If it weren't for The Globe and Mail series, there wouldn't be any real awareness out there, not thanks to this government, since it has established the working group.

[Dr. Philip M. Sherman]

Our plans for monitoring and evaluation of a change had been under way in advance of The Globe and Mail articles. But you're absolutely right; it certainly did raise awareness.

Again, I would say that if there is any change in salt in the diet, we need to monitor its outcome and evaluate that it's a positive benefit.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Dr. Liu, you are interested in cardiovascular health as well. Do you think the failure to make trans fats reductions compulsory or regulated has been working?

[Dr. Peter Liu]

I will say that currently there is some enthusiasm in looking at the U.K. model, because they have actually started on this. And indeed, the thought is to start out with a voluntary reduction strategy, but with the possibility of regulation as a potential incentive, as a strategy to move forward as a possible—

[Carolyn Bennett, Liberal, St. Paul's, ON]

As a working group, do you feel confined that the terms of reference only allow you to look at voluntary reductions and don't allow you to look at a regulatory framework for this?