Health Committee on Dec. 5th, 2017

[The Chair, Liberal, Bill Casey]

I call the meeting to order.

Welcome to meeting number 83 of the Standing Committee on Health. We are starting our first meeting to study Canada's food guide.

We have some guests with us today to help us through this. From the Department of Health, we have Hasan Hutchinson, director general, office of nutrition policy and promotion, health products and food branch. We have, from Dietitians of Canada, Nathalie Savoie, chief executive officer. By video conference, we also have, from the Canadian Paediatric Society, Dr. Jeff Critch, chair, nutrition and gastroenterology committee.

I guess I just have to ask you: are you related to Mark Critch, Dr. Critch?

[Dr. Jeff Critch, Chair, Nutrition and Gastroenterology Committee, Canadian Paediatric Society]

No. I'm funnier.

[The Chair, Liberal, Bill Casey]

We're going to ask Mr. Hutchinson to start with a 10-minute opening statement. Then we'll go to Ms. Savoie and Dr. Critch.

[Dr. Hasan Hutchinson, Director General, Office of Nutrition Policy and Promotion, Health Products and Food Branch, Department of Health]

Thank you for the opportunity to provide opening remarks on the revision of Canada's Food Guide. I'm very pleased to be here to discuss this important initiative.

Canada's Food Guide has a long tradition of providing Canadians with healthy eating information. Since 1942, the food guide has not wavered from its original purpose of guiding food selection and promoting the nutritional health of Canadians.

The importance of promoting healthy eating and the challenge posed by obesity and nutrition-related chronic diseases have never been greater. Today, more than one in five Canadians live with chronic diseases, and rates are rising every year.

Even more disturbing is that risk conditions like obesity and hypertension are now starting to show up in children, which places them at higher risk for chronic diseases later in life.

The science has established again and again that poor diet is a primary risk factor for these conditions. This is why Health Canada launched the comprehensive healthy eating strategy in October 2016. The healthy eating strategy is made up of complementary, mutually reinforcing initiatives that will make it easier for Canadians to make healthier choices for themselves and their families.

For instance, take the shopping experience. We want to make it easier for Canadians by using a revised food guide for planning, by using tools such as the updated nutrition facts table and the proposed front-of-package labels to select healthier foods, and by having a food supply with lower amounts of sodium and no industrial trans fats.

Therefore the strategy includes important mandate commitments to promote public health by restricting the marketing of unhealthy foods and beverages to children; eliminating trans fat and reducing salt; and improving labelling on packaged foods, including front-of-pack labelling initiatives.

Revising Canada's Food Guide is a fundamental component of the healthy eating strategy.

The food guide is a very important and significant evidence-based policy vehicle. This revision is undertaken with great seriousness by those of us in the department and others across Canada, because Canada's food guide is used to define what healthy eating means, as well as underpinning policies and programs where Canadians live, work, and play.

Canadians and stakeholders have high expectations for the revision of Canada's food guide, and we are up to the challenge. We are committed to ensuring that the food guide remains evidence-based, is linked to public health priorities, and effectively communicates healthy eating guidance to Canadians. These are all elements that were highlighted in the Senate report on obesity.

It was with this in mind that we implemented an evidence review cycle in 2013 to allow for the regular review of the evidence underpinning Canada's food guide and other guidance documents. While we've always reviewed the evidence base, we now have formalized our process.

The review confirmed that Canadians are not consuming enough plant-based foods, like vegetables and fruit, and that they are consuming too many foods and beverages high in salt, sugar, and saturated fat. We also found that the current Canada's food guide is not meeting the communications needs of all users. Some want simplified messages, and others want more information, including the evidence behind the healthy eating recommendations.

There are high levels of integration of the food guide into policies and programs; however, there are challenges in interpreting and applying guidance, especially the serving sizes.

As we revise the food guide, we also need to consider the changing environment, which is increasingly cluttered with competing and often conflicting messages. This erodes public confidence in our healthy eating guidance. Canadians will be reassured that the new food guide is trustworthy if they know and have confidence that Health Canada is reviewing the evidence during the revision process.

Revisions to the food guide will be guided by the best available evidence to support the health of Canadians, including the 2015 “Evidence review for dietary guidance”. We recognize the importance of understanding the totality of the evidence base and continue to monitor the most recent data on healthy eating. We consider relevant evidence such as high-quality, peer-reviewed systematic reviews, and reports from leading scientific organizations and government agencies, including the World Health Organization, World Cancer Research Fund, and the U.S. dietary guidance committees.

For instance, there is strong convincing evidence that diets higher in vegetables, fruits, whole grains, legumes, nuts, and fish, and lower in red and processed meats, refined grains, and sugar-sweetened foods and beverages, have been shown to reduce the risk of cardiovascular disease, including risk factors such as high blood pressure and elevated blood lipids.

Sodium, sugars, and saturated fat continue to be nutrients of public health concern. There is strong convincing evidence that higher intakes of sodium have been associated with higher risk of high blood pressure. There is strong convincing evidence that higher intakes of added sugars from foods and/or sugar-sweetened beverages have been associated with higher risk of increased body weight in children and in adults, and type 2 diabetes in adults. Higher intakes of sugar-containing beverages has been associated with higher risk of poor oral health in children as well.

There is strong convincing evidence that lower intakes of saturated fat, when replaced by unsaturated fat, are associated with lower risk of increased LDL cholesterol, triglycerides, as well as a lowered risk of cardiovascular disease.

The new food guide will also take into consideration the context in which food choices are made, including food supply, current patterns of consumption, behaviours associated with food choices, as well as how dietary guidance is used and implemented.

This will result in a new food guide that provides a foundation for healthy eating. This includes encouraging the regular intake of nutritious food and beverages as part of a foundation for healthy eating, describing the types of food and beverages that have the potential to negatively impact health, and acknowledging skills and knowledge as a practical way to support healthy eating.

The revision of Canada's Food Guide is taking into consideration the cultural diversity of Canada and the broader context within which food choices are made. This means that we are considering that the types of food available to Canadians vary across the country and access to nutritious food can be a challenge for some.

Our aim is to revise the food guide to reflect new evidence and communicate our guidance in ways that better meet the needs of different users, including health professionals, policy-makers, and the general public. Therefore, an important part of this work is considering the views of stakeholders, experts, and the general public.

We are consulting a broad range of stakeholders and Canadians to promote the involvement of, and consider the views and perspectives of, a wide variety of participants who are interested in or affected by the revision. This includes provincial and territorial governments, non-government organizations, health professionals, academics, and consumers. Canadians from across the country, from varying backgrounds, areas of expertise and interest have provided input into the revision of Canada's Food Guide.

To maintain public confidence in the revision process, my office—that includes me—is not meeting with representatives from the food and beverage industry during the policy development of the new Canada's food guide. However, all stakeholders and Canadians, including industry, were invited to provide input through online public consultations. In fall 2016 we asked stakeholders and Canadians about their needs and expectations for a revised food guide. In summer 2017 we asked for feedback on our proposed healthy eating recommendations. The level of interest in these consultations speaks to the importance of Canada's food guide to stakeholders and Canadians.

About 20,000 submissions were made to the consultation in fall 2016, with approximately 6,700 contributions to the consultation this past summer. As part of our commitment to openness and transparency, we are making more information available to Canadians and stakeholders. This includes making the results of our consultations publicly available through “what we heard” reports, as well as making stakeholder correspondences and meetings publicly available.

Input from public consultations and experts, along with focus testing with the public, will be considered as we finalize the suite of Canada's food guide tools and resources. The new food guide will look very different from the current six-page version. We are changing the way we communicate our dietary guidance to provide relevant, consistent, and credible dietary guidance to Canadians. New healthy eating recommendations and supporting resources for Canadians will begin to be released starting in 2018. They will include a dietary guidance policy for policy-makers and health professionals and supporting resources for Canadians.

We are confident with the process that we are undertaking to revise Canada's food guide. We are using the best and most relevant recent evidence in our decision-making, and consulting Canadians to ensure that our guidance is useful and relevant. The potential to affect the nutritional health of Canadians is real. Canada's food guide will continue to play a critical role in defining and promoting healthy eating. The new food guide will make an important contribution to the long-term health of Canadians as a fundamental component of the healthy eating strategy. We want to make the healthier choice the easier choice for all Canadians.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Ms. Savoie for 10 minutes.

[Nathalie Savoie, Chief Executive Officer, Dietitians of Canada]

Honourable members of the Standing Committee on Health, thank you for inviting us to appear before you to discuss the revision of Canada's Food Guide.

My name is Nathalie Savoie. I'm the chief executive officer for Dietitians of Canada.

Dietitians of Canada is the national professional association for registered dieticians. We aim to advance health through food and nutrition and to provide leadership in shaping food and nutrition policy. Dietitians are passionate about food. There are more than 10,000 dieticians in Canada. We all share a deep appreciation of food and a curiosity to understand the science behind it. Like all regulated health professionals, we undergo comprehensive and rigorous training both on the job and in university. You can find dietitians working everywhere, including in health care, education, government, media, the food industry, business, and many other sectors.

Dietitians of Canada and our members are pleased to see many advances in food and nutrition policy within the mandate of this government. We fully support Health Canada's healthy eating strategy, which aims to create food environments in Canada that make the healthier choice the easier choice for all Canadians. We've provided input to consultations on marketing to children, front-of-package labelling, prohibiting partially hydrogenated oils, and sodium reduction. We also support “A Food Policy for Canada” led by Agriculture and Agri-Food Canada, which is designed to set “a long-term vision for the health, environmental, social, and economic goals related to food”. We applaud the broad interdepartmental collaboration.

The dietary guidance policy document and suite of public education tools will be the foundation to guide food selection and promote the nutritional health of Canadians. Dietitians of Canada and our members have provided input to part one and part two of the dietary guidance consultations, incorporating input from more than 800 members from all areas of practice.

Our members have a high level of agreement with the scope and accuracy of Health Canada's evidence review, as we indicated in our response to part one of the consultation. The evidence review cycle for dietary guidance is Health Canada's systematic approach to gathering and analyzing scientific and population data relevant to dietary guidance. Dr. Hutchinson talked a bit about that. In that review, the most convincing evidence is related to healthy dietary patterns—the combination of higher consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood, and the lower consumption of red and processed meats, refined grains, and sugar-sweetened foods and beverages. We concur with this conclusion.

In part two of the consultation, Dietitians of Canada members were in general agreement with the evidence-based guiding principles and considerations, understanding this dietary guidance as a health driver contributing to food policy in Canada. As health practitioners and knowledge translation experts, dietitians had many recommendations for Health Canada. The interpretation section under each guiding principle—explaining what this means for Canadians, for instance—we found excellent, but we recommended an additional interpretation around what this will mean for food policy in Canada in order to position health as a driver in the interdepartmental work on a food policy.

We need system-level policy to improve food environments, with stores and food services consistently offering healthier choices so that it's easier and more accessible for all Canadians to choose the healthy foods recommended. We have a lot of food choice in Canada, but it's not all healthy.

Now I will share some examples of what dieticians specifically said to Health Canada in response to the guiding principles and considerations described in the consultation, part two. The first guiding principle was about what to eat:

A variety of nutritious foods and beverages are the foundation for healthy eating.

More specifically, it called for:

Regular intake of vegetables, fruit, whole grains, and protein-rich foods—especially plant-based sources of protein

Inclusion of foods that contain mostly unsaturated fat, instead of foods that contain mostly...saturated fat

Regular intake of water

We recommended that Health Canada have more clarity in their message about “especially plant-based” protein in order to ensure consistent messaging in the future and avoid misunderstanding.

We asked also for food-based directional statements, if “protein-rich foods” was to be the language in public education tools. We felt that the public would need direction to make sure they get adequate intake of calcium, vitamin D, vitamin B12, and iron in that group.

We also asked for more clarity about “replacement of saturated fat by polyunsaturated fat”. What does it look like in terms of food choices? We felt that the elimination of artificial trans fats, mandatory by the end of next summer, will already improve the profile of fat intake in Canada.

We also recommended including a reference to policy for drinkable water in all communities across Canada as a mandatory standard. Again, we recommended integration of environmental considerations to preserve water resources and reduce dependence on bottled water. With respect to population-specific guidance that our members work with daily, we recommended more age-specific guidance, such as that for children and for adults over 70, and we acknowledged that changes are needed in the indigenous food guide, emphasizing that Health Canada must consult directly with indigenous educators and traditional knowledge keepers to identify what tools are needed.

Guiding principle two described what to limit or avoid to maximize benefits to health, and it talked about processed or prepared foods and beverages high in sodium, sugars, or saturated fats. With this particular guiding principle, we recommended including a clear definition of what prepared or processed food means. For example, frozen vegetables or frozen fruits are industry-processed, but they contain no added sugar and no added salt.

We also recommended including direction about limiting red meat and avoiding processed meats—it's in the evidence review but it's not there in the dietary guidance—and also including facts about alcohol and Canada's low-risk alcohol drinking guidelines in public education tools. We advocated again for nutrition facts table information to be mandatory for all standardized industrially processed foods, such as deli foods in grocery stores and foods in chain restaurants, and we suggested that more discussion is needed about policies that will encourage industry reformulation to reduce added sugars, especially in foods and beverages that also contain natural or intrinsic sugars, such as, for example, flavoured milk, or flavoured soy beverages, or canned fruit.

Guiding principle three was about the knowledge and skills that are needed to navigate the complex food environment and support healthy eating. This would be a new addition to Canada's food guide. Our feedback to Health Canada was very supportive. It addresses both how to eat, which is important, and the need for food literacy and food skills. Dietitians are uniquely qualified and positioned to help Canadians navigate the food environment to achieve healthier outcomes. It's our specialty. We collaborate with our patients, our clients, the industry, government leaders, and communities to deliver reliable life-changing advice.

In closing, we commend Health Canada on taking a broader approach to eating; providing evidence-based guidance on food and beverage choices; acknowledging the importance of eating habits, food environments, and food literacy; and adding a layer of considerations that include the determinants of health, cultural diversity, and environmental sustainability.

Dietitians are passionate about the potential of food to enhance lives and improve health. We applaud the government's commitment to advancing food and nutrition policy in Canada. As leaders in advancing health through food, Dietitians of Canada and our members look forward to our continued collaboration with the government to shape the future of eating and healthy living for all Canadians.

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Dr. Critch, by video conference, from St. John's.

[Dr. Jeff Critch]

Thank you.

Honourable members and invited guests, thank you for this opportunity to reflect on revisions to Canada's food guide.

Canada's food guide, which was first released in 1942 as Canada's official food rules, has been a pivotal document for both individual counselling and policy. As a representative of the Canadian Paediatric Society, the CPS, I wish to acknowledge our support of the government's commitment to review and enhance food policy in Canada, including ongoing assessments and revisions of Canada's food guide.

The CPS is a voluntary professional association representing more than 3,000 pediatricians, subspecialists, residents, and others who care for children and youth. The CPS is committed to advancing the health of children and youth by nurturing excellence in health care, advocacy, education, research, and support of its members. Our current strategic framework is guided by the principles of nurturing every child's promise, ensuring access to care, and achieving equity.

As professionals dedicated to improving the health of children and youth, we are acutely aware of the importance of healthy nutrition in optimizing children's health and development. We are also cognizant of the important influence that families and the food environment play in the quality and quantity of foods consumed.

Daily, we are confronted with the effects of poor nutrition on our children and youth. Non-communicable, nutrition-related chronic diseases place a staggering burden on Canadians and Canadian society. This is reflected by increased morbidity, increased health care utilization, decreased quality of life, premature mortality, and reduced economic productivity. Most important, these diseases are largely preventable and often begin in childhood.

It is through this perspective of maximizing beneficial impacts on the health of children and youth that I will focus many of my comments today.

The CPS has been following the current process for revisions to Canada's food guide. We are aware of Canada's healthy eating strategy, initiatives to reduce sugar consumption, and the nutrition north Canada program. The CPS has a history of working closely with Health Canada and other associations.

The CPS has been encouraged by Health Canada's process in revising Canada's food guide. Enabling significant public consultation and restricting the potential adverse influence of industry are positive components. Health Canada's proposed guiding principles are succinct, evidence-based, and comprehensive. The recognition of the importance of providing guidance in the Canadian context with the integration of the concepts of the socio-economic determinants of health, cultural diversity, and environmental sustainability is vital.

Specifically, we are supportive of the advice provided in the proposed guiding principles of encouraging water consumption, the regular intake of a diversity of fruits and vegetables, and increasing plant-based sources of protein. We are supportive of limiting the intake of processed and prepared foods high in sodium, salts, and saturated fats, as well as the avoidance of beverages high in sugars. We agree with recognizing the essential importance of food literacy and skills in selection and preparation. On an associated topic, we strongly support Health Canada's decision to prohibit the use of partially hydrogenated oils in foods.

It is our hope and expectation that the proposed guiding principles will be adequately reflected in the advice and tools developed by Health Canada in the revised Canada food guide.

There are, however, a few issues to highlight for specific attention. It is important that Canada's food guide continue to be framed as just one component of a national food strategy. Canada's food guide and associated tools must be evidence-based, address cultural variability, and allow practicality of use. It must remain a tool for policy development that can be leveraged to optimize food environments.

It is vital that implementation of the advice provided in Canada's food guide is inclusive of vulnerable populations, including those at risk because of age, literacy, finances, and/or culture. Tools need to be developed specifically to ensure vulnerable populations are reached. For children and youth, this may include formats designed for social media, web- and phone-based applications, and/or the school curriculum. These formats need to be multimodal and attractive for the users. Other groups that will need to be targeted include those consuming alternative diets, such as vegetarian, vegan, and/or gluten free.

Canada's food guide and the associated tools should enable individual users to understand nutrition quality and energy balance.

Youth will need to learn the skills to understand nutrition labelling. Portion size will be a key component to address. This is a complex issue and will vary based on age, gender, and food type. Related to this is the importance of ensuring that appropriate-sized portions are served in restaurants and other venues.

Stringent definitions of what constitutes healthy and unhealthy foods and beverages are vital to consumers and regulators. Specific advice around ways to increase fruit and vegetable intake is needed. This should include education around the benefits of fresh, frozen, and canned food choices when fresh foods are unavailable or more expensive.

Specific education and tools highlighting the beneficial role of adequate fibre in the Canadian diet should be developed.

Effective educational tools and messaging emphasizing the negative impact on health of processed foods high in sugar, salt, and saturated fats is important. Specific attention needs to be directed towards reducing sugar-sweetened beverages.

Consideration would need to be given to how best to present dietary advice in Canada's food guide. Central to this is the decision regarding whether to categorize based on food type, such as fruits and vegetables, grains, milk and alternatives, or in a manner similar to that utilized in the Brazilian dietary guidelines, in which categorization is based on the level of processing. While there are pros and cons to each approach, a hybrid system incorporating categorization by level of processing within each food type may be a useful model.

As outlined in section D of the proposed guiding principles, recognition of the impacts that food production, distribution, and consumption have on the environment is an important consideration. In addition to supporting health, food policies should promote sustainability of the food supply and minimization of the environmental footprint.

The CPS recognizes that industry plays an important role in shaping our food environment and economy. This role can at times be in alignment with favourable nutritional policy and at other times be contradictory to it. Nevertheless, to protect and promote optimal food environments, effective policies would need to be developed to promote optimal actions from industry.

Associated with this is the importance of protecting children from unfavourable influence from industry. To this end, the CPS supports measures to ban marketing of unhealthy foods to children, the use of taxation policy to discourage consumption of unhealthy foods, and the use of subsidies to encourage consumption of healthy foods.

Policies should also be designed to reduce and eradicate poverty, as this is tightly related to food consumption.

The CPS recognizes that many of these issues are being explored by the present government, such as through Bill S-228.

Policies and tools should encourage and facilitate communities and industries to embrace changes designed to improve the food environment. These would include banning unhealthy foods near and in schools, redesigning grocery and corner stores to present fruits and vegetables in a more attractive setting, supporting the proliferation of local farmers' markets, and increasing access to community centres and fitness facilities. It is hoped that such policies will foster a collegial atmosphere in which all stakeholders, including consumers, policy-makers, and industry, are committed to optimizing and strengthening the living environment for Canadians, that being a healthy population with a high quality of life, living in clean environments, and working in robust economies.

Government must leverage policy and, when needed, legislate mandatory and enforceable regulations on industry to effect the desired changes. We believe such activity can be achieved while enabling a strong Canadian economy. Importantly, Health Canada would need to maintain and enhance its commitment to monitoring the effects of implemented interventions to ensure that the desired changes to food consumption and food environment were achieved. To this end, sufficient funding and even expansion of the Canadian health measures survey on chronic disease and nutrition quality will be needed.

In summary, one of our biggest challenges will be using the knowledge and guidance provided by a revised Canada's food guide to effect the individual and societal changes necessary to maximize health benefits for all Canadians. Considerable thought will need to be invested in developing policy, legislation, tools, and messaging that effectively communicate key information on topics such as nutrient quality, portion size, and healthy, active living. Reaching vulnerable populations, including those separated by education, poverty, language, and/or culture, will need to be a high priority. Education, increased nutritional literacy, development of basic cooking skills, and improved food environments will be needed.

Despite these current issues, Canada sits in a relatively enviable position moving forward. We have some understanding of the magnitude of the problem facing us. We have some understanding of the root causes. We have a fair idea of where we want to be. We have evidence to guide us in making the needed interventions to effect those changes, but it won't be easy. For any complex problem, altering human behaviour and environments can be challenging. There can be inertia to change. There can be opposition to change. Interventions will need to be varied, multi-focal, and integrated. Interventions need to be effective, evidence-based, and inclusive.

Disenfranchised and vulnerable populations need to be specifically targeted. Fortunately, Canada is a country rich in financial, intellectual, and human resources. We have shown a willingness and we have a capacity to effect favourable change for all Canadians. We have a responsibility to do so. Health Canada has been engaged in this process and their continuing leadership is vital.

Thank you.

[The Chair, Liberal, Bill Casey]

Thank you to all of you for the presentations. You put a lot of work into them, and we appreciate them very much.

We're going to go to our first round of questions. These are seven-minute questions and answers, and we will begin with Ms. Sidhu.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you, Chair.

Thank you all for being here today.

I held a consultation this summer on the healthy eating strategy. I heard from many people that the Canada food guide did not work for them. Some had dietary restrictions and had to follow a low-sodium diet or a low-glycemic diet. As you said, one in five Canadians lives with chronic disease.

Also, for those who follow diets that are vegetarian, vegan, or gluten free, how will the changes in Canada's food guide address those populations?

[Dr. Hasan Hutchinson]

Some of the things you've mentioned of course relate back to the nutrients of public health concern. When one has diabetes, one wants to look at the sugars coming in. Hypertension is very strongly linked to salt intake, and of course saturated fats are linked to cardiovascular diseases as well.

In our guiding principles, this is really what we're focusing on as well. We really want to get people to make sure they are consuming foods that have lower amounts of these nutrients of public health concern. That goes partway towards really dealing with that. You've actually seen that emphasis but not just in the food guide. In the whole healthy eating strategy, whether we're talking about the front-of-pack proposal that we have out there or whether with the proposal on marketing to kids that we're looking at right now, those nutrients of public health concern come through. That consideration will be reflected in the types of guides we come forward with. It will be reflected in the policies we're developing. These policies, of course, get picked up by the provinces and the territories and are incorporated into their programs. It will also be picked up by the health professionals like my colleague Nathalie Savoie here and make it easier for them to move forward with that.

Then of course there's the whole side with respect to education, communicating that message out there. We're trying to take a very different approach there as well. We know that it's sometimes quite difficult to get the information on our website. We're taking a very deep dive into creating a new mobile-friendly web portal that should make it a lot easier whether on your phone, your tablet, or your computer. It just makes it a lot easier to get that information. We're trying to develop it in such a way that it is really readily accessible as well. As part of that, of course, we hope that we will be able to develop more focused sorts of messages for different sorts of folks.

We talk about different types of diseases, chronic diseases. We have been working very closely over the last 18 months with the Canadian Diabetes Association, with Heart and Stroke, with the cancer folks, as well as with a whole series of health professionals as well. We're trying to make sure we develop policies and messages that can really be used by all so that we get away from this sort of confusion in the different types of messages that you get together.

Tomorrow, we're actually meeting with Ms. Savoie's folks for, I think, the fifth time in this process to go through and say, “This is what you said to us, and this is how we've incorporated it into our work going forward”. The idea is that by working closely with these different disease-specific groups or health professionals, we actually construct policy and we construct messages that are really applicable for all, and then they get a reinforcement. We reinforce each other instead of giving conflicting messages.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

Next, for an ordinary person like me, sometimes there are a lot of names for sugar. I think there are more than 15, such as fructose, sucrose, and maltose. There are so many names. Corn syrup is another. No one knows that these are names for sugar. They just look at the simple name for sugar. It's the same thing with salt. Is it kosher salt or sea salt? Salt is salt.

How we can address this? As Ms. Savoie said, we need to improve consumer literacy. How are we addressing these issues?

[Dr. Hasan Hutchinson]

There are some regulatory things that we have done recently. Last year, we updated and had the final regulations with respect to the updates on the nutrition facts table. One thing we changed was the ingredient list. What you see out there right now, actually, in terms of an ingredient list on the packaged foods is that you can see “sugar”, but all the individual sugars can be spread throughout the ingredient list. In terms of what we will have in the regulations now, when they do become enforced—I believe in 2021—you will have to group all of those sugars. This deals with part of what you're talking about, which is that people don't realize that those are sugars; it will reduce that.

As well, on the ingredient list, it will bring the positioning of sugars up closer to the top of the ingredient list, because the listing is based on the volume of that ingredient in there. Instead of having a whole whack of different types of sugars that you don't understand distributed throughout the ingredient list, it will combine them. It will be “sugars” and then in brackets all the different types. That's one aspect.

On the other side, of course, we are responsible for health promotion as well, and for health promotion campaigns. We are certainly preparing for those sorts of campaigns as well. Certainly, those are areas that we focus on. A number of years ago, we did a whole set of campaigns around sodium reduction, including sodium reduction in the home, when you're shopping, and when you're out in restaurants as well. Those are things that we will have to circle back on again. Similarly, with respect to sugar—sugar-sweetened beverages, sugary drinks—those are things that we envision being looked at going forward.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

My next question is for the dietician.

Healthy food is expensive—this is a myth. We need to go back to the basics. How can we teach our children about the healthy stuff? How can we shop for healthy food and nutritious food together? Can you address that?

[Nathalie Savoie]

I think one way to do that is certainly to improve the food skills of children. We know that prepared food is more expensive than basic ingredients. When you cook at home, you can select ingredients that may not be that expensive. You can feed yourself quite well, with good nutrition, on a low budget.

Many of our member dieticians are involved in communities where they support groups with tools and classes in terms of healthy eating on a low budget. That's what I would recommend.

[The Chair, Liberal, Bill Casey]

Your time is up. I'm sorry.

Ms. Gladu, you have seven minutes.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Thank you, Mr. Chair, and thank you to our witnesses for appearing.

I have questions for each of you. I'll start with Dr. Critch.

I'm interested in this from the point of view of children and their development. You've read the consultation document. Is there anything in there that you don't agree with or that gives you concern in terms of promoting healthy growth for children?

[Dr. Jeff Critch]

I assume you're referring to the guiding principles. Is that what you meant by “consultation document”?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Yes.

[Dr. Jeff Critch]

As I said in my opening statement, we see that the guiding principles are a pretty good reflection of the knowledge base that exists right now to guide food-eating practices. What remains to be seen is how that gets translated into consumer tools and messaging that can translate that knowledge into benefits for all Canadians and, from the CPS perspective, for children and youth.

Certainly, on the knowledge base, I think people are hearing the message. I think we understand the evidence. Health Canada understands the evidence. The challenge now, I think, is to take that evidence, because that evidence, I think, will benefit children.... It will help children's development and growth if we can take those environments and that nutritional advice and translate that into Canadian society moving forward .

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Very good.

I have a question for you, Ms. Savoie. I'm a bit concerned when I see in some of the consultations a de-emphasis on meat proteins in favour of plant proteins. I think it doesn't reflect the fact that meat proteins have a broader range of the amino acids you need, as well as some of the nutrients you talked about, such as iron and selenium and all of these different things. Can you comment about the consultation that's come forward and whether you think it's balanced?

[Nathalie Savoie]

Thank you for the question. Really, our members also asked Health Canada to be more precise with regard to that message, because we felt there was a potential for misunderstanding.

I talked earlier about healthy dietary patterns, and those with the most evidence are the ones with a higher intake of fruits, vegetables, whole grains, low-fat dairy, and seafood, but also a lower consumption of meat. When we say “lower”, it always depends on where you start from. The data is quite solid that too much meat can be detrimental to health. I guess that's where Health Canada will need to go to be more precise with that.

The current food guide is already promoting plant-based protein sources. There's a directional statement saying that you should have legumes, pulses, and tofu more often, so that message was already there.

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Okay. I just want to make sure that people are aware that sometimes they will have to consume more plant protein. I had the example that you have to consume 270 more calories from chickpeas to get the same amount of protein that you would from a 75-gram pork portion. I'm not sure that is well understood when people are talking about changing those things.

The other thing I was interested in is that there's been this controversy over time about milk and the high-fat sour cream and going to a lower-fat sour cream. At one point in time, it was said that artificial oils definitely are bad for you, but also that all these high-fat products are bad for you, which kills me, because I'm a cheese fan.

Then we see in the medical research—I was looking at a bunch of things from The American Journal of Clinical Nutrition and the American National Library of Medicine and stuff—that there's a bit of controversy out there. Can you weigh in on these higher-fat milk products?

[Nathalie Savoie]

Me again?

[Marilyn Gladu, Conservative, Sarnia—Lambton, ON]

Everyone, please.