Thank you for the opportunity to speak to you today about Canada's food guide, and respond to any questions that might assist you in your study.
My name is Joanne Lewis. I am a registered dietitian and the director of nutrition and healthy eating for Diabetes Canada.
Diabetes Canada is a national health charity representing the 11 million Canadians living with diabetes or prediabetes. A number of people at this table are already very well acquainted with the work of our organization and are diabetes champions themselves on the Hill and in their communities back in their constituencies.
On behalf of all Canadians affected by diabetes or prediabetes, I'd like to thank all of you for your hard work and devotion to our cause, and for inviting me to be here today. We are so grateful for your support in helping us achieve our mandate to end diabetes. In particular, we wish to acknowledge the commitment of Sonia Sidhu, who is part of this committee and is also the chair of our all-party diabetes caucus.
About one in three Canadians is living with diabetes or prediabetes. It is an astounding statistic. There is a new diabetes diagnosis being delivered to someone every three minutes. Globally, Canada's diabetes rate is among the highest in OECD countries. Our growing, aging, and ethnically-diverse population, high levels of overweight, and an increase in sedentary living have contributed to an over 50% increase in diabetes prevalence within the last 10 years. Ninety per cent of people with diabetes have type 2. Once a disease of older individuals, type 2 diabetes is now being diagnosed in Canadians at a younger age, impacting people in the prime of life. The rate of diabetes is projected to continue to rise over the next decade. It is estimated that close to 13 million Canadians will have diabetes or prediabetes in 2027, at a direct cost to the health care system of $4.6 billion.
You have all heard of diabetes. It is well known but it is not known well. Few people fully realize the devastating consequences that this progressive illness can have on the health, mind, family, and pocketbook of those afflicted. Diabetes contributes to 30% of strokes, 40% of heart attacks, 50% of kidney failure requiring dialysis, and 70% of non-traumatic limb amputation. It is also the leading cause of vision loss and blindness. Furthermore, people with diabetes are at much greater risk of depression and other mental health challenges compared to the general population. It is a disease that people live with 24 hours a day, seven days a week, 365 days a year, with no breaks. Medication, equipment, devices and supplies required to treat diabetes can cost people thousands of dollars annually. The personal and economic toll is enormous.
Prediabetes is a condition that is equally not known well. Those with prediabetes have abnormally elevated blood sugars that are not sufficiently high to constitute a diagnosis of diabetes. With lifestyle changes and modest weight reduction, half of the people with prediabetes can re-establish normal blood sugar levels and stave off diabetes.
We know that regular physical activity is extremely important for chronic disease prevention and good health. However, to tackle the obesity and diabetes epidemics, we really must address our food and beverage intake and options in a serious way. Now more than ever Canadians need guidance to make healthy choices that will help to reduce the prevalence and burden of chronic disease in this country.
In October 2016, Health Canada launched its healthy eating strategy. As part of this initiative, it undertook to revise Canada's food guide. Leading Canadian and international experts in nutrition, medicine, public health, and policy advised on the proposed new food guide, and developed population-level healthy eating principles that are based on rigorous scientific research. Diabetes Canada applauds Health Canada's efforts in this process. We endorse broad, meaningful stakeholder engagement in policy-making, and feel that consultations on the food guide to date have been extensive and inclusive of professionals, scientists, the private sector, and the Canadian public generally. As powerful a tool as it is, the food guide in isolation is not enough to turn the tide on diabetes and chronic disease in Canada. This is why Diabetes Canada supports the healthy eating strategy, a multi-pronged approach to safeguard the health of Canadians.
More informative front-of-package labelling, an easier to use and understand nutrition facts table on food and beverages, restrictions on the marketing of unhealthy items to children and youth, and the elimination of industrially produced trans fats from the Canadian food supply, alongside the food guide, will help make the healthy choice the easy choice, and will slowly start to change the food environment in our country.
The healthy eating strategy, including the food guide, must be directed to the population to reorient our society toward good health. People will always have the individual freedom to make decisions within the framework of their personal context. To see the bold results we so desperately need when it comes to improving the health of Canadians, change is needed and a population approach is required to facilitate this change.
People with diabetes or prediabetes and those at high risk have a large stake in the food environment and healthy eating. Diabetes Canada has developed and disseminated clinical practice guidelines for the prevention and management of diabetes in Canada since 1992. This includes nutrition recommendations. The most recent guidelines say:
In general, people with diabetes should follow the healthy diet recommended for the general population in Eating Well with Canada's Food Guide. This involves consuming a variety of foods from the 4 food groups (vegetables and fruits; grain products; milk and alternatives; meat and alternatives), with an emphasis on foods that are low in energy density and high in volume to optimize satiety and discourage overconsumption. This diet may help a person attain and maintain a healthy body weight while ensuring an adequate intake of carbohydrate (CHO), fibre, fat and essential fatty acids, protein, vitamins and minerals.
A balanced diet is good for Canadians and good for people with diabetes. The emphasis in the new food guide on whole foods consumption is one our organization strongly supports. The food guide recommends a regular intake of vegetables, fruits, and whole grains. Many of these foods are good sources of dietary fibre and have a low glycemic index. Studies have shown a diet that includes fibre-rich, low-glycemic index foods can help improve blood sugar control and may decrease cardiovascular risk, which is high among people with diabetes and prediabetes.
The food guide supports intake of legumes and nuts. Regular consumption of these foods is associated with lower fasting blood glucose and hemoglobin A1c in people with and without diabetes, and improvements to blood lipids in those with diabetes. Lean meat, eggs, and dairy products are healthy items that can absolutely be included as part of a balanced diet as per the food guide.
Diabetes Canada supports the recommendation to limit saturated fat and aim to consume unsaturated dietary fats. For people living with diabetes who are two to three times more predisposed to developing coronary artery disease, restricting saturated fat can help to mitigate this risk. Sodium, sugar, and saturated fat are nutrients of public concern. Diabetes Canada is strongly in favour of a reduced consumption of these in the Canadian diet. Eating patterns that feature foods low in sodium, sugar, and saturated fat have been associated with lower blood pressure, fasting blood glucose, weight and waist circumference, and unhealthy blood cholesterol in people with diabetes, compared to other eating patterns. Aiming for whole food, cooking at home more, and limiting intake of processed food will help Canadians to limit nutrients of concern.
Healthy hydration is extremely important to Diabetes Canada. Sugary beverages represent the single greatest contributor of sugar in the Canadian diet and provide little to no nutritional value. Over the next 25 years, sugary drinks in Canada will be responsible for 300,000 cases of obesity, a million cases of diabetes, 300,000 cases of heart disease, 100,000 cases of cancer, 63,000 strokes, and $50 billion in health care costs. Diabetes Canada encourages water as the beverage of choice, and we are very pleased that Health Canada is also promoting this through the food guide.
Diabetes Canada recognizes that enhanced knowledge and skills are needed to navigate the complex food environment. We are pleased the food guide will encourage Canadians to select nutritious food when shopping and eating, plan and prepare healthy meals and snacks, and share meals with family and friends whenever possible.
In order for Canadians to be able to apply the food guide principles in their everyday lives, they require supports, resources, and infrastructure. Diabetes Canada wishes to ensure that there are systems in place to facilitate uptake of the food guide. To this end, we propose the following to the Government of Canada: ensure that the food guide and Agriculture and Agri-Food Canada's food policy for all complement one another; continue to partner with all levels of government to reduce the burden of food insecurity on Canadian households; work with the provinces and municipalities to increase the availability of clean, safe, free drinking water in homes and public spaces across the country.
In conclusion, Diabetes Canada is supportive of the direction Canada's food guide is taking. As part of an integrated strategy, it has real potential to transform our obesogenic, disease-promoting environment and positively impact the eating decisions of Canadians, significantly influencing their heath trajectory. Imagine a Canada with less chronic disease, fewer health care costs, and a more productive society. That is within our reach. Diabetes Canada looks forward to continuing to work with Health Canada to promote healthy eating and improve the health and quality of life for all.
Thank you.