Health Committee on Dec. 12th, 2017

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Maybe I'm not being clear but I guess I'm asking if there is a contribution from the food as well? The gut has the enzymes that the pancreas creates in the liver, and all the others. Do the foods also introduce a necessary bacteria or enzyme, or something, to break down the foods?

[Dr. Benoît Lamarche]

Yes. For example, in some of the yogourts, you have a high bacteria count. Long term, this is going to influence your own flora of bacteria in your gut. The fibre that you consume might also influence your capacity to digest different foods. So, yes, the foods have an effect, but it depends on the content of that food. Some fats are better for the gut than others. The fibres are better. Some bacteria may be present in some foods. To answer, it's yes.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Is that part of the problem with our processed foods, that they're, in essence, dead foods? They have nothing in them other than the starch contents.

I was leading to another question. This is a personal curiosity.

I love tomatoes. There are tomatoes that produce.... Again, I won't pinpoint where they come from. They're my absolute favourite, but they've been engineered genetically. At one point I noticed that they would sit on the shelf for weeks. Being a tomato lover, I know that tomatoes don't do that. Then I went to the location where this plant was first engineered. They told me that they took out the enzyme that breaks it down. Apparently they do this with apples too.

Is this something we should possibly look at as well?

[Dr. Benoît Lamarche]

This is something that we can do now. I have some colleagues here who did the same thing with strawberries. They actually crossed different types of strawberries, and they ended up with a strawberry that can stay on the shelf 20% or 25% longer without rotting.

From a public health perspective, I don't think that's how we're going to solve the nutrition and health issue. This is—

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Sorry, I don't want to interrupt, but what I'm suggesting is that we're introducing foods into our bodies that aren't helping the body break it down. Are these foods possibly causing or triggering some reactions in our bodies? Has it been studied?

[Dr. Benoît Lamarche]

I would say that we don't have any idea about this. The research is very thin on GMOs and on food modification. I would say that we don't know.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

You don't know at this point.

[Dr. Benoît Lamarche]

We have to learn about this.

[The Chair, Liberal, Bill Casey]

Time is up.

[Dave Van Kesteren, Conservative, Chatham-Kent—Leamington, ON]

Thank you, Chair.

[The Chair, Liberal, Bill Casey]

We will move to Mr. McKinnon.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thanks, Chair.

Ms. Lewis, I believe you spoke earlier about the importance of food with a low glycemic index. Are you saying that we should focus on those kinds of foods, that kind of diet? To me, that is consistent with the common theme I'm hearing about reducing sugar and reducing refined carbohydrates.

I'd like all of you to comment on that.

In particular, Dr. Lamarche, I wonder if you can comment on any research out there that would support this.

Please go ahead.

[Joanne Lewis]

Thank you for mentioning glycemic index.

Diabetes Canada has been a supporter and proponent of the glycemic index for a number of years. The reason for that is when people consume a diet with a lower glycemic index.... For those of you who may not be aware, glycemic index measures or ranks foods according to how high blood sugar is raised after consuming those foods or beverages. Foods with a low glycemic index take a much longer time to raise blood sugar. Foods with a high glycemic index raise blood sugar levels immediately, so that would be the difference between having lentils, which are low glycemic index, versus pure sugar or glucose, which has a high glycemic index.

The impact of consuming a more low glycemic index diet is that the outcomes of studies have shown that people have a much quicker sense of satiety, so they tend to eat less. It contributes to lower incidence of cardiovascular disease, and it can help people to lose weight. Much to our benefit at Diabetes Canada, it can help to prevent diabetes.

We would love Canadians to have more foods with a low glycemic index. Right now, it's very difficult for Canadians to identify foods that are low glycemic index, because it's not written anywhere on the package, and it's very hard to find a list of which foods are low glycemic index.

In a culture where we are demonizing carbohydrates, and people are talking about no carbs and low carbs, and “I don't eat carbs after 4 p.m.”, we need to look for alternatives that are what we call healthy carbs or quality carbs, because they are a great source of energy as well as fibre. Having more of the right carbs is really the direction we should be going in as opposed to telling people to eat no carbs or fewer carbs.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Thank you.

Mr. Arango, do you want to comment on this?

[Manuel Arango]

I would just concur with my colleague that promoting the right carbs is definitely something we have to do.

I would just point to an unfortunate situation from many, many years ago. Back in the late 1960s or 1970s, a researcher from Harvard University who received funding from the U.S. Sugar Association basically indicated that a lot of the sugar research that was out there was not credible, etc. He focused instead on saturated fats. That was something the U.S. Sugar Association wanted. The result of that was that we then had an ensuing focus on low-fat diets, and in these low-fat diets, the lower fat was replaced with higher levels of unhealthy carbs, refined sugars, etc. It is quite likely that this change in dietary patterns in the 1970s and 1980s was responsible for our overweight and obesity epidemic that we experience today.

Just to the issue, yes, we want to eat the right carbs, but high carb consumption and low fat consumption is a problem. I know that Dr. Lamarche has also done some work in this particular area as well.

[Ron McKinnon, Liberal, Coquitlam—Port Coquitlam, BC]

Okay, over to you, Dr. Lamarche, and you can bring it home with the science.

[Dr. Benoît Lamarche]

Yes, the glycemic index was invented in Canada, so we have to be proud of the Canadian researchers who invented it, David Jenkins and his team, and Tom Wolever.

I think the issue in the field with the glycemic index, as good as it may be, is an issue of using it. As mentioned, this is hard, because we don't have this information. At the end of the day, if you consume whole-grain products, you're leaning towards low glycemic index products. If you consume vegetables, you're leaning towards low glycemic index products. If you look at the Mediterranean diet and at the DASH diet, they generally have a low glycemic index, so it's another way to look at a healthy diet.

It's extremely useful, I think, for the management of type 2 diabetes, but from a practical perspective, since we don't have this information, it's really hard for the public to use it if we don't have the information on a product.

We could argue whether it's a good strategy from a public health perspective. We understand a lot about food because of this discovery, but from a public health perspective, are we ready to change the whole landscape of labelling and so on to provide information on this? For me, that's a big question.

[The Chair, Liberal, Bill Casey]

Thanks very much. Time is up.

Now we go to Mr. Davies for a three-minute round.

[Don Davies, NDP, Vancouver Kingsway, BC]

Ms. Lewis, to what extent is diabetes linked to poverty?

[Joanne Lewis]

I guess the question is, to what extent is poverty linked to diabetes? We do see that there are a disproportionate number of people with diabetes who are in a lower socio-economic category. That could be for many reasons, and access to healthy food could be one of them. Knowledge and education levels could be another one, and there are various other social determinants of health of course. So, yes, that is something we know very well.

[Don Davies, NDP, Vancouver Kingsway, BC]

Mr. Arango, you commented on meal planning. The statistic I have in front of me is that about 37% of Canadians currently plan their meals in advance. That actually strikes me as high, but let's assume that's the case. In your view, would a meal planning app based on the new food guide be a useful tool for Canadians?

[Manuel Arango]

It would be one tool for sure. If Health Canada did contemplate that, it would be useful. There is certainly growth in nutrition-related eating apps. We have to be innovative in our approaches to addressing unhealthy diets and unhealthy lifestyles, so consideration of digital apps is certainly something that holds a lot of promise.

[Don Davies, NDP, Vancouver Kingsway, BC]

Dr. Lamarche, I'll end with you.

If there is one bit of advice you could give this committee about the food guide and what we should do with it, how it could be improved, and how it could be more effective, what would that be?

[Dr. Benoît Lamarche]

Before I answer, there is another example where the science is not seen the same way by different groups. The group from Harvard, which is the mecca of research and nutrition, with regard to their drinking pyramid, say that it's okay to drink one small glass of juice every day. They look at the same evidence we do, and that's what they say. There you go. If it's small, it's okay.

The main advice and the main concern I would have, and I've discussed this with many of my colleagues, has to do with all around communication. We have here an effort towards a whole food, whole dietary pattern approach, which I think is great, and yet we're focusing and several of the strategies are focused on nutrients. This is going to be very confusing to the population, because we're focusing on nutrients but we're telling them to worry about their whole diet.

For me, this is really a communication issue, and the guide will have little effect if we create more confusion. I've listened to the previous meetings you've had, and judging just by the questions you have, everybody's confused. We have to find a way to reduce that confusion, to provide less information but key information, and to focus not too much on small details. That would be my recommendation.

[The Chair, Liberal, Bill Casey]

That's a great way to end.

I want to thank all of our witnesses for great presentations and great information in language we can understand. We really do appreciate it.

Dr. Lamarche, I think that by video conference it must be especially difficult to be there by yourself and to participate. Thank you very much.

Thanks to our other witnesses as well.

On committee business, I understand that our pharmacare study will be available to us on December 21, and we're planning to have our first meeting to look at the draft study on pharmacare on January 29.

Mr. Oliver, you indicated that you wanted to make a motion.