Health Committee on March 3rd, 2011

[The Acting Chair, Conservative, Tim Uppal]

I call the meeting to order.

Welcome, everybody, to the Standing Committee on Health. This is meeting number 53; pursuant to Standing Order 108(2), we are doing a study on healthy living.

Our witnesses today are, from Dairy Farmers of Canada, Nathalie Savoie; from the Canadian Medical Association, Jeffrey Turnbull, president, and Maura Ricketts, director; from Option consommateurs, François Décary-Gilardeau, agrifood analyst, and Anu Bose; from NUTRIUM, Nathalie Jobin, dietitian; and from Food and Consumer Products of Canada, Derek Nighbor.

You will have about five minutes for your opening statements.

We will begin with the Dairy Farmers of Canada.

[Nathalie Savoie, Assistant Director, Nutrition, National Programs, Dairy Farmers of Canada]

Mr. Chair, on behalf of Dairy Farmers of Canada, I want to thank the committee for having invited us to speak today.

Dairy Farmers of Canada is the national organization representing Canadian dairy farmers who produce the basic ingredient that is used in the manufacturing of dairy products. Dairy Farmers of Canada does not sell milk products.

The goal of our nutrition department, which I represent today, is to increase the understanding of the nutritional and health benefits of milk products as part of a healthy diet and to encourage Canadians to eat well and consume the number of servings of milk and alternatives recommended by Health Canada.

Milk products provide 16 essential nutrients. Studies show that when the intake of milk products is not adequate, people's diet usually falls short of several of these key nutrients. In addition to the well-established role milk products play in healthy bones, studies show the benefits of them in weight management and in the prevention of hypertension, type 2 diabetes, and colon cancer, and despite their saturated fat content, a growing body of evidence suggests that milk products may be associated with a lower risk of cardiovascular disease.

Unfortunately, most Canadians are not meeting their minimum recommended intake.

In public health messages and government initiatives, an important focus is put on fruits, vegetables, and whole grains, and with good reason. However, the widespread underconsumption of milk products needs to be equally recognized in government efforts in future actions guided by the framework for action to promote healthy weights in children.

As different sectors will be engaged in developing a shared approach to increase the consumption of nutritious foods, we believe that our participation in the discussions is highly relevant, given our expertise in childhood nutrition and education.

My remarks will now address food labelling.

Dairy Farmers of Canada agrees that it's important to guide consumers toward nutritious food choices and more healthful patterns of eating. However, nutrition information on labels needs to be meaningful in order to truly help consumers make informed choices that reflect their individual needs. When strategies to improve eating habits are developed, initiatives need to be effective and not lead to unintended consequences.

It is with this in mind that we would like to raise some concerns regarding the recommendation to develop a nutrient profiling system for defining healthy foods, developing a standardized front-of-pack logo, focusing on nutrients to limit, and highlighting calories on packaged foods and on menus.

The United Kingdom traffic-light system is a good example of the potential pitfalls of such systems. You have an example in your technical brief on page 6 in English and page 7 in French. Foods get a green, yellow, or red light for fat, saturated fat, sugar, and salt, without any consideration of the beneficial nutrients. Therefore, diet soft drinks and unsweetened Jell-O each get four green lights, while nutritious foods, such as 2% milk, salmon, almonds, and olive oil, could all get red or yellow lights for fat, saturated fat, or sugar.

Such systems risk qualifying nutrient-rich foods as unhealthy if they contain disqualifying nutrients. On the other hand, nutrient-poor foods will be perceived as healthy if they are devoid of such negative nutrients.

If we consider only the calories, we face a similar situation. A serving of milk would show more calories than the same serving of a soft drink, and a small serving of almonds would show more than three Oreo cookies.

We also question the feasibility of developing a nutrient profiling system for defining healthy foods because of the complexity of establishing criteria that would be appropriate for all foods and would take into account the requirements of all individuals of various ages and life stages. For example, requirements for fat for young children are very different than they are for adults.

Health Canada has initiated work in this area and published two reports on the subject. They highlight the complexity and controversial nature of nutrient profiling and reveal that there is very little evidence on whether or not these systems have a beneficial impact on health outcomes. Instead of defining healthy foods, they propose to focus on ways of presenting and providing those foods that are more likely to lead to healthy or unhealthy diets. They also highlight the lack of research on how consumers perceive front-of-pack labelling. More work is definitely needed before any conclusions can be made about the best course of action and before effective measures can be developed.

In conclusion, we support evidence-based policies and programs that will help people to select healthier eating patterns, reduce chronic diseases, and promote healthy weights, and we certainly welcome the opportunity to be with you today and to work with the government on effective strategies to accomplish that.

Merci beaucoup.

[The Acting Chair, Conservative, Tim Uppal]

Thank you.

Now we have the Canadian Medical Association. You have about five minutes for your opening statements.

[Dr. Jeffrey Turnbull, President, Canadian Medical Association]

Thank you, Mr. Chair.

Thank you for the invitation.

Studies dealing with healthy living habits are very important.

A few weeks ago my colleague Dr. Doig was here to talk about the health consequences of poor nutrition and lack of physical activity and the policies CMA has adopted to promote healthy living. Today I would like to expand on nutritional labelling and health claims on food and on the labelling of food regulated as natural health products.

Nutrition facts tables can be an important source of information, but many Canadians have difficulty interpreting them. A 2009 Health Canada review of research on nutrition labelling indicated that those with little nutritional knowledge had difficulty using the tables and were unable to relate the information they contain to their own dietary needs.

There has been an increase in the use of health claims on the front of packaging, expressed as slogans or logos such as Healthy Choice, as well as in disease reduction and nutrient content claims.

These studies have shown that foods carrying health-related claims are seen by consumers as healthier choices, but the myriad of different claims can be confusing and may draw attention away from less healthy characteristics of food or oversimplify nutritional messages.

Recognizing the concerns that were clearly raised by our colleagues from the dairy farmers, we believe that a standard, consistent, at-a-glance approach to front-of-package food labelling could reduce confusion and help consumers make informed dietary choices. The traffic-light front-of-package label currently in voluntary use in the U.K. is an example. The front-of-package labels on composite processed food use green, amber, and red to indicate low, medium, or high levels of nutrients most strongly associated with diet-related health risks: fat, saturated fat, sugars, and salt. Also included is a calorie count per serving and percentage daily amount information.

Research in the U.K. has shown that consumers generally understand these labels. Shoppers are most likely to use them when buying the product for the first time, to compare different products when shopping for children, when trying to control intake of certain ingredients such as salt or fat for health reasons, or when trying to lose weight. Not surprisingly, research in the U.K. and Canada also shows that those most likely to read nutrition labels are those who are already interested in healthy eating.

For this reason, labelling policy must be embedded in a broader nutritional policy that uses multiple instruments to foster education and interest in healthy eating and helps to ensure that Canadians have healthy food choices by, for example, regulating amounts of salt in processed foods.

In addition, physicians have become quite concerned about the recent tendency toward regulating fortified foods as natural health products.

The Food and Drugs Act effectively prevents products classified as food from being marketed as having medicinal benefits unless there is compelling scientific evidence that the claims are true and the products are safe. The same strong legislation does not apply to natural health products, which are regulated under a different act.

This is a concern, because a trend is emerging whereby manufacturers of products normally sold as food fortify their products with approved natural health products such as vitamins and minerals. Examples of these are energy drinks, vitamin-enhanced juice, power bars, gums, and candies. The manufacturer can then request federal approval to market the product as a health product in food format.

If such requests are approved, food labelling requirements no longer apply and health claims that would not be allowed under the Food and Drugs Act can be made. Without proper nutritional labelling it is difficult, if not impossible, for consumers to make informed food choices. This can be particularly troubling for those with special diets or health concerns. Furthermore, those misled by dubious health claims might be consuming empty calories or high amounts of fat or sodium with no corresponding benefit. The result is that the health of Canadians may then be compromised.

The CMA has called on Health Canada to require compelling evidence for health benefits before changing a product's regulatory status from food to natural health food, and for nutrition labelling for all foods regulated as a natural health product. Faced with an array of products and health claims and a barrage of advertising extolling their benefits, Canadians can find it very challenging to make healthier food choices.

To find our way through to the right choice, we need good nutritional information and the ability to access and understand this information.

Governments and health care providers share a responsibility to help Canadians make choices that will help them achieve and maintain good health.

The physicians of Canada want to work with government and with all Canadians to make a healthier Canada.

I welcome your questions.

Thank you.

[The Acting Chair, Conservative, Tim Uppal]

Thank you.

We'll now move on to Option consommateurs.

[Dr. Anu Bose, Head, Ottawa Office, Option consommateurs]

Mr. Chairman, members of the Standing Committee on Health, Madam Clerk, and colleagues, bonjour and good afternoon. I want to thank you for giving us the opportunity to appear before you once again.

My name is Anu Bose. I am the head of the Ottawa office of Option consommateurs. With me is François Décary-Gilardeau, the food and agribusiness analyst at our Montreal office.

We are no strangers to this committee. We were here late last year, speaking to you very strongly on Bill C-36--now, thanks be to God, the Consumer Product Safety Act.

We are a moderate outfit. We are 30 persons--lawyers, economists, and energy and agricultural scientists--but we have locked horns with the likes of Maple Leaf Foods and lived to tell about it. We also sit on several government committees and working groups, such as the advisory committee on food regulation for Health Canada and the consumer associations round table for CFIA.

Healthy living is a very vast and very complex subject. We've chosen to restrict ourselves to the labelling of food, not only because we are what we eat but because we have seen one too many claims that are economical with the truth about the products they are pushing.

We do realize that it is not very easy to eat healthily in today's world because of the siren song of fast foods and convenience foods. We also believe that the tide must turn, and that given the appropriate incentives, Canadian consumers could make healthier choices for themselves and their families.

We base our remarks on the UN guidelines on consumer protection, which state that consumers should be protected against risks to their health and safety and that consumers have the right to have access to adequate information to make an informed choice. It reinforces the concept of the duty of care that every government, including our own, owes its citizens.

Option consommateurs maintains that all information provided to consumers by manufacturers should be credible, should be verifiable, and, above all, should be appropriate. Information must also be easily understood--that is, be jargon-free--since not everyone in Canada has full command of one or the other of the official languages.

Mr. Chair, with your permission, I'll ask my colleague, the real expert on labelling and health claims, to continue.

Thank you.

[François Décary-Gilardeau, Agrifood Analyst, Representation and Research Department, Option consommateurs]

Thank you, Dr. Bose.

Good afternoon, Mr. Chair, ladies and gentlemen.

Canadians are concerned about their health and that of their families. They know that healthy lifestyle and eating habits are key to good physical and mental health.

To help Canadians eat well and make the best choices possible, whether at a grocery store or in a restaurant, several strategies can be put in place. We will address two consumption issues: health claims and logos, and access to healthy foods.

We will start with health claims and logos. In recent years, we have witnessed a host of new health logos and claims appearing on the front of food packaging. While the nutrition facts table and list of ingredients enable a large segment of the population to be better informed of the nutritional content, logos also satisfy another need: having quick access to easily understood information.

Regardless of their income, Canadians have difficulty reading labels. In fact, only 45% of adult Canadians have sufficient numeracy skills to understand the nutrition fact table, and just 52% of Canadians are literate enough to understand complex wording, such as the list of ingredients. For these consumers, health claims and logos can play a significant role in their food choices. To achieve that, logos must meet certain criteria: for example they must be credible enough to communicate relevant information. Putting a healthy choice logo on Oreo cookies on the basis that they contain no trans fat, as Kraft did, is not appropriate, because Oreo cookies are very high in fat and sugar.

Health information and claims must also be truthful and not misleading for consumers. For example, indicating that a bag of chips is “cholesterol free” is accurate, but it may lead consumers to believe that that brand of chips is better for their health than a competitor's brand is, which is not necessarily the case.

Last year, we criticized a series of logos placed on products that contained very little nutritional value. I have brought some examples.

The second issue we want to address is access to healthy foods. It is inconceivable that, in Canada today, people are going hungry. Did you know that 48% of school children in Montreal are from underprivileged families? “A hungry stomach has no ears”, as Jean de La Fontaine said. The situation is worrisome. Today, because of the price of food and the low income levels of many consumers, we are starting to see a two-tier system: food for the rich and food for the poor. All too often, making healthy choices is costly.

While we applaud the industry's efforts to reduce the amount of trans fat, salt and sugar that is added to certain products, we believe there is a need for a comprehensive approach that applies to all products, not just niche products. We deplore the fact that, in 2011, efforts to provide people with quality foods are benefiting a minority only. We must not forget that household income is the most significant determinant of health. With the rising cost of living and food prices, this trend may become more widespread. That is why we have some recommendations for you.

First, Option consommateurs recommends that the Government of Canada tighten up the use of health claims and logos on processed food packages. That would help consumers make more informed choices. I think that the UK's traffic light labelling system was mentioned in a previous brief, but Doctor Katz and the NuVal system are other examples that we are following closely.

Option consommateurs also recommends that the government fast track the implementation of recommendations from the trans fat and sodium working groups, specifically the goals of reducing these products.

Finally, Option consommateurs recommends that the government encourage companies to further reduce quantities of trans fat, salt and sugar in all of their processed foods and not only in their niche products.

Thank you very much.

[The Acting Chair, Conservative, Tim Uppal]

Thank you.

We'll now hear from NUTRIUM.

[Nathalie Jobin, Dietitian, Extenso, Nutrition reference centre of Université de Montréal, NUTRIUM]

Thank you, Mr. Chair, for allowing me to speak at this hearing.

As a nutrition professional, I am very aware that it is not easy to encourage people to eat well. Food choices are influenced by a series of complex interactions between individual factors and social, cultural, economic and environmental determinants.

Early intervention, which targets everyone and is designed to help people maintain or improve their health before it is compromised, has a great deal of positive influence over health. In fact, the earlier the intervention, the better the potential gains. Nutrition labelling and claims are part of the environmental strategies designed to improve public health. However, at present, nutritional labelling is lacking in a number of areas. The current system must be improved if we are to get consumers used to reading, interpreting and using nutritional information effectively in order to make healthy food choices.

I want to address five aspects of labelling: the nutrition facts table, health claims, logos, food labelled as natural health food products, and restaurant menus.

We have three recommendations for you on the nutrition facts table in order to meet the nutrition labelling objectives that will truly assist consumers to make informed choices. Firstly, serving sizes of similar foods must be standardized as much as possible. Requirements for the nutrition facts table were established as a labelling tool to enable consumers to easily compare food value and to make informed purchases. However, when the serving sizes of similar products are not exactly or approximately the same, it becomes difficult for consumers to compare products and make good choices.

We also recommend updating the basis for establishing the daily value (DV) on the nutrition facts table using DRIs for 2011. As a former member of the Sodium Working Group, I believe we should also replace the daily value of sodium on the nutrition facts table. Reducing it from 2,400 mg to 1,500 mg would reflect adequate amounts of sodium.

The third and final recommendation is to emphasize, on the nutrition facts table, certain less desirable nutrients present in large quantities in a food as a way of alerting consumers to that fact. Values on the nutrition facts table that exceed 15% of the daily value could be in red. Nutrients that should be emphasized, for example, are total amounts of fat, saturated fat, trans fat, sodium and sugar.

We also have several concerns about health and nutrition claims. Using health and nutrition claims on food packaging is often seen as a marketing tool that companies can use to attract consumers by highlighting certain nutritional aspects of a food. However, these claims are frequently used to showcase the positive aspects of a food, while sometimes ignoring the negative aspects. This approach can encourage consumers to use a food product because of one of its characteristics, without taking the others into account.

To prevent this from occurring, it may be necessary to incorporate ineligibility criteria for the use of all types of health and nutritional claims. That would ensure that consumers are not misled by positive claims on foods containing less desirable elements.

I will now move on to the presence of the many commercial logos on food products, which has already been raised today. In 2006, the Canadian Council of Food and Nutrition reported that 80% of Canadians wanted labels or packaging to clearly indicate the presence of healthy foods. The solution for determining whether or not a food is healthy is not just reading the label but also understanding it. The nutrition facts table is reliable, but it is not the first thing a consumer sees, as it is on the back of the package. Several symbols are now found on the front of the packaging. Of those Canadians who read labels, about half of them look for that type of symbol to guide them in their choices. However, the use of these commercial logos is open to criticism in a number of ways.

These numerous logos greatly confuse consumers because there is no standardization in the manufacturers' criteria. Manufacturers use these logos mainly for marketing purposes. It raises the question of how compatible these logos are with the overall approach to nutrition. Finally, we find it unfortunate that there is no independent authority to evaluate these criteria. As my colleague François Décary-Gilardeau said, it should also be mentioned that a product with a logo may not necessarily be the best choice in its category, and that is confusing to consumers.

In closing, the fact that there are so many commercial logos and the lack of standardized criteria lead to confusion among consumers when they are buying food. To remedy this situation, we need a third-party agency that would clarify nutritional criteria that allow a logo to be used on a given food. This third party would be entirely at arm's length and would be the only agency authorizing the use of a logo on food.

Finally, we note that there is also some concern as to a differentiation between foods and natural health products. An increasing number of food products, most of which are enriched, make it to grocery store shelves as natural health products rather than under the Food and Drugs Act. There needs to be a clear differentiation between natural health products and foods in order to protect the health of Canadians.

In closing, with respect to restaurant menus, we should if possible demand that...

[The Acting Chair, Conservative, Tim Uppal]

Thank you, Madam Jobin.

I'm sorry; I did allow you some extra time because our clock actually stopped, but thank you. You may have some more time when questions are asked.

Next we have the Food and Consumer Products of Canada, please.

[Derek Nighbor, Senior Vice-President, Public and Regulatory Affairs, Public Policy, Food and Consumer Products of Canada]

Thank you, Mr. Chair, clerk, and committee members.

It is my pleasure to be here on behalf of Food and Consumer Products of Canada. We are the largest national industry association representing companies that manufacture and distribute food and consumer products in this country.

To capture a little bit about who we are, the members we represent today are companies that manufacture, I would imagine, about 75% to 80% of what you see in your neighbourhood grocery store. It is important to know that we are now the largest employer in the manufacturing sector in Canada as well, with some 300,000 jobs in both rural and urban Canada. I look around the table. There are probably about 1,000 jobs in your ridings collectively that are fueled by this industry.

I want to be clear that our companies take nutrition and health and wellness issues very seriously. The kits that were provided to you today show that we just launched in the last few days our health and wellness report, which is a report that we haven't done for a few years. It captures all of the reformulation efforts and initiatives that are going on in our communities and in our workplaces in terms of contributing to healthier products and healthy living.

We support Canada's Food Guide, and we promote it. We've been active partners working with Health Canada. I'm proud of what we've done in the areas of trans fat elimination, the work we are doing with the sodium working group with NGOs and government on sodium reduction, and what we have done recently on allergen labelling. I'm proud to say that our industry did not come knocking on the doors of government for an exemption on allergen labelling. We took our responsibility very seriously, we understood it was the right thing to do, and we supported the recent regulation.

Most recently we've been involved with Health Canada in a program. You might have seen commercials on TV and other information around the nutrition facts education campaign, which is really a campaign focused on trying to help Canadians to better understand how to read per cent daily value and use the nutrition facts table to make informed food choices.

This is a regulated table. It's a trusted source of information for Canadians, but admittedly, as many of the speakers have said, there is confusion around how to use it. There is an opportunity for us to work together in educating Canadians on how to use this tool, which has been in the market in Canada for about 9 or 10 years.

This table is on every packaged food product. As my colleague from the Dairy Farmers of Canada said, it allows Canadians to make the right decisions for themselves and their families. My mother is looking for more calcium. My father is looking for less fat. That makes the cheese purchase challenging in my parents' home. When we are looking for different things, we need to be very careful about simplistic labelling and drawing general conclusions.

The campaign we launched was back in November, as I mentioned. We have 33 participating member companies on board. We have the support of the Heart and Stroke Foundation, Dietitians of Canada, the Canadian Diabetes Association, and the Canadian Obesity Network. They are helping us promote this campaign to Canadians through their networks.

We heard a bit of talk today and at previous committee sessions around traffic-light labelling. In the kit I provided there are a few examples, the cheese example being one of them, which make a very simplistic conclusion from a very complex set of information. As was said by the Canadian Medical Association, it displays the levels of sugar, fat, saturated fat, and sodium, ranging from red to amber to green. It is problematic. The European Parliament recently voted against it. Australia has had some very active discussions and has decided not to go that route. In a lot of cases they have seen a customer see a red light on the front of a package and the person will think that the product should be avoided, and that is not necessarily the case. If we look to that traffic-light model as the panacea, as the alternative, as the magic bullet, we are all sadly mistaken.

In closing, I wanted to put that on the table and to restate our organization's commitment for even more education. We made a financial and a time commitment on this education campaign around the nutrition facts table. I will tell you that the CEOs on my board have said they were only investing in this if it was the first phase of a multiple-phase campaign that we could continue to build on going forward. Our commitment from industry is to work together with our partners in all different segments to continue to ensure that Canadians are making the best choices they can when they're shopping for groceries.

I will leave it there, and I'm happy to take any questions when we get to that portion of the discussion.

Thank you.

[The Acting Chair, Conservative, Tim Uppal]

Thank you very much. That is where we are. We'll open it to our members to have some time for questions.

We will start with Mr. Dosanjh from the Liberals. This is a seven-minute round, please.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

Thank you.

If I stop short of using my time, my colleagues can take over.

I am somewhat confused. I want to thank you all for making excellent presentations, but I have a question about the FCPC presentation.

Sir, you don't support the light system and you are in a project with Health Canada and others that clearly implies that Health Canada is on board for the nutritional fact charts. Then we heard from Ms. Savoie, and she said both of those can be problematic, both the red light and the yellow light and the other one. You have said that they could be confusing.

Am I correct in my interpretation of what you said?

[Nathalie Savoie]

They can be confusing.

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

You mean both of them.

[Nathalie Savoie]

Yes, both of them. While they're trying to--

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

I'm trying to get my head around it.

Dr. Turnbull, I think you opted to support the lighting system, if I got that correctly. You felt that the other was fine, but that it didn't go far enough. It wasn't easy enough for people to understand.

We have an obligation at the end of the day in this committee to come to a conclusion on these kinds of issues and make recommendations. If you were sitting in my place, all three of you, what would you recommend to the government? All three of you differ.

[Derek Nighbor]

I'm happy to start. Let's rally around two common points, confusion and the need for more education and awareness. It was Minister Anne McLellan who launched the nutrition facts table back around 2002. There was a bit of noise--

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

It was before my time.

[Derek Nighbor]

If it was before your time, we'll blame Anne for the problems.

[Some hon. members]

Oh, oh!

[Derek Nighbor]

It was launched in 2002. There was some education and some money spent by government in terms of developing some awareness around that. There was another attempt by Health Canada, not the most resourced campaign, around 2005 or 2006. We really haven't done a lot.

It's inherently a complex tool because nutrition and eating well are complex. There's a lot of information out there. I think there are about 13 to 16 nutrients highlighted on the nutrition facts table, and everybody's looking for different things. People with hypertension and people with diabetes are looking for different things on the label. That's the warehouse of all information that's needed.

The position that we've taken in supporting that table is to ask how we can work together to make sure people use the tool that we know Canadians know is on the package. Research that we did a couple of years ago, which pretty much mirrored the research Health Canada came out with, showed that 93% of Canadians actually know the table's there. About a third of them actually use it to influence their decisions. We might debate over five or ten points on either side of that, but it is something that Canadians defer to.

How do we empower them to use it better? In some jurisdictions you're seeing people go to front-of-pack labelling, and I know our colleagues in the U.S. are looking at doing that, but I say to them that they're putting on the front of the pack what's already on the back of the pack. You're really just transferring the information from one part of the product to another. Maybe the font's a bit bigger; is that going to empower people to better use that to make informed food choices?

[Ujjal Dosanjh, Liberal, Vancouver South, BC]

A bigger font would help people my age.

[Voices]

Oh, oh!

[Dr. Jeffrey Turnbull]

Thank you very much.

I think there are some areas of commonality. First, what we're doing is confusing. I think those of us who have used and looked at these products recognize that we have a very short period of time to make a decision, and the variables that they've put there are confusing, even for us, even without taking into consideration other people who probably don't have the same educational background or literacy, so I think we can all agree that what we've got is not sufficient.

Second, I don't think there will be a perfect way, and we have to continue to work. Simplicity and education, I've heard around the table, are essential, so we supported a process--albeit not perfect--that is simple and quick. It recognizes the challenges that we all have when we go to a grocery store to choose something. Front-of-package labelling, simple standard labelling that everybody can get used to, is not perfect, and I do agree that we should include some of the nutritional value as well as the harmful effect of some of the medications, but I would say that at this moment, it's probably the best of a group of options.