Health Committee on Dec. 12th, 2017

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

As you know, the consequence of eating an unhealthy diet is that fatty deposits known as plaque block the arteries, which leads to heart attacks. We have talked about how healthy eating can reverse the risk of disease. How can healthy eating habits reduce artery blockage? How can the healthy eating strategy help to reduce unhealthy living?

[Manuel Arango]

I won't talk to the actual mechanisms of how plaque is developed in the arteries, but I will say that there is a whole slew of very solid evidence to indicate that unhealthy diets and poor nutrition are related to the development of heart disease and stroke.

[Sonia Sidhu, Liberal, Brampton South, ON]

Is a plant-based diet helpful?

[Manuel Arango]

Plant-based, absolutely. If you look at the Mediterranean diets or other diets that focus on plant-based sources, there is an association with improved heart health. As I mentioned in my testimony, this is not necessarily at the exclusion of some animal proteins. We know you can get nutrients from lean meat, unsweetened milk, and other animal proteins, so it's not their exclusion, but we do support the food guide's overall proposal to focus mostly on plant-based foods.

In our report on ultra-processed foods that was released last week, they looked at 13 different countries in Europe and Latin America, and those countries that had high rates of ultra-processed food consumption also had high rates of chronic disease, obesity, people being overweight. Once again, a major culprit is ultra-processed foods.

[The Chair, Liberal, Bill Casey]

The time is up. Sorry.

That completes our seven-minute round of questions.

Now we're going to five-minute rounds of questions, starting with Mr. Webber.

[Len Webber, Conservative, Calgary Confederation, AB]

Thank you, Mr. Chair.

Thank you, witnesses, for being here today.

I do want to echo Ms. Lewis's comment commending Ms. Sonia Sidhu for her work in diabetes and being an advocate for that. I do commend you as well. Thank you for what you do, Sonia.

I've found these last few days talking about Canada's food guide to be rather depressing, really. Mr. Chair, I like yogourt. I like milk. I like red meats. I like cheese. I like sugar. I like saturated fats, for God's sake. I find that anything I enjoy, I can't eat, according to Canada's food guide. It is depressing, but I guess I should read the revised guide when it does come out.

What I wanted to talk specifically about—and I did bring it up at the last meeting, but I do want to know what your thoughts are on it as well—is with respect to beverages. I'm quite surprised with your comment, Mr. Arango, regarding 100% fruit juice. You say that fruit juice has 33% more sugar than soda pop. Did I hear that correctly?

[Manuel Arango]

Just to clarify, there are certain types of fruit juices, for example, 100% grape juice. There are some products of grape juice that have 33% more sugar than your regular Coca Cola product. Yes, there might be a small amount of minerals and vitamins in that fruit juice, but does it offset that significant increase in sugar? We think not. That's our concern with fruit juice, and we think Canadians should be aware of that. All sugary drinks are basically made equal, effectively.

[Len Webber, Conservative, Calgary Confederation, AB]

That is news to me. Can you tell me the difference between 100% fruit juice and fruit concentrate?

[Manuel Arango]

I will explain. With respect to 100% fruit juice, how is it processed and how is it developed? They get the juice from a fruit; it's squeezed out of it. It's then heated at very high levels to kill bacteria and effectively all the vitamins and minerals are removed when they do this heating or processing. What's left is sugars known as free sugars. Then the juice is later fortified with vitamins and minerals, and that's how you end up with 100% fruit juice.

The issue with this is that it's really no different from fortifying Coke. If you took Coke and you fortified it with vitamins and minerals, it's basically the same process as what's being done with fruit juice. The concern we have, once again, is that it has very high levels of sugars and we know that's associated with dental caries. That's why Health Canada is also quite concerned and trying to propose to remove 100% fruit juice as an alternative to fruits. We should not be recommending to Canadians that they drink fruit juice as an alternative to fruits. Canadians should eat their fruits, not drink them.

[Len Webber, Conservative, Calgary Confederation, AB]

So your beverage of choice—as Ms. Lewis said as well—is water.

[Manuel Arango]

Plain water and milk are what we would advise. We understand that, on rare occasions, Canadians may want to consume a sugary drink. We're not saying if that ever happened it is the end of the world. I think we all know if we were to do that on rare occasions, it's not an issue. But at the population level, we cannot be promoting to Canadians the consumption of these products. The messages we deliver to the public will have an impact on their behaviour. We have to be careful in terms of how we message that.

[Len Webber, Conservative, Calgary Confederation, AB]

Can you support the message of sugar replacements such as artificial sweeteners, aspartame, for example, in fruit beverages or in soda pop? What are your thoughts on that?

[Manuel Arango]

Our message at Heart and Stroke is to consume plain water and plain milk. We do understand that, if diet drinks with artificial sweeteners replaced all sugary drinks, there would be reduced harm to the population. That said, we don't promote diet drinks because we don't want to promote the societal craving for sugary drinks, for sweet-tasting drinks in the population. But we do acknowledge that there's quite a bit of evidence—I know it's emerging and it's changing—to indicate that diet drinks with artificial sweeteners are going to have much reduced harm compared to full-calorie sugary drinks.

I'm not in the habit, usually, of giving thanks or kudos to the food and beverage industry, but we do think that the movement toward more bottled water and diet drinks is going to, at the population level, reduce harm for Canadians.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Ms. Sidhu, welcome back.

[Sonia Sidhu, Liberal, Brampton South, ON]

I have read that for children, 10% of their daily calories come from sugar-sweetened drinks. This surely is contributing to the rate of childhood obesity. The obesity rate is growing very high. Do you think it will give more pace to growing diabetes, the sugary drinks, or, as Mr. Arango said, the 100% juice?

[Joanne Lewis]

I'm sorry, Sonia. Could you repeat the last part of your question?

[Sonia Sidhu, Liberal, Brampton South, ON]

Do you think these sugar-sweetened...? How can we educate our kids to avoid those sugary drinks? I know that Bill S-228 is coming, and I'm speaking on that, too. Besides that, how can we give the correct message to our youth or other people to avoid that 100% sugar juice and to eat more food?

[Joanne Lewis]

At the risk of sounding redundant or repetitive, I think it's going to take a multipronged approach. My understanding is that the largest consumers of sugar-sweetened beverages are teenage youth, and the major purchaser of sugar-sweetened beverages to bring them in the home is the parents. It's going to take a combination of education modalities to reach the various target groups with respect to sugar-sweetened beverages, reducing the intake of that and increasing the intake of healthier foods.

One thing I've learned in my practice is that everybody is motivated by something different, so there won't be a one-size-fits-all. People don't change behaviour all based on the exact same information or reason to change behaviour. I think it's up to the school system, the parents, the communities, or the Internet, wherever the various populations are, to get those messages out there.

I have to give kudos to the SodaStream company. They have a commercial—you've probably seen it—where they're standing outside drinking sugar-sweetened soda as though it's the smoke break and everybody's outside smoking, and then they have to go in. One woman says, “I've been trying to kick the habit”, and the habit she's been trying to kick is drinking sugar-sweetened beverages. I really think that for that message to be strong enough, we almost have to treat it like smoking. To be caught with soda in your grocery cart.... You almost want to cover it with your other groceries so people don't know you're buying soda.

I'm always amazed.... I'll tell you this secretly. I take secret pictures of people's shopping carts when soda is on sale, and the stacks of soda cans in a cart.... It's still very acceptable to buy it in large quantities, especially if it's on sale. The message isn't out there yet; this is still happening. I think the only way we're going to get that message out is to treat sugar-sweetened beverages, especially the regularly sweetened sodas, as though it's smoking, something you would be embarrassed to be doing.

[Manuel Arango]

I would just add a few comments.

I agree with my colleague. A multipronged approach is very important. With respect to public education and public awareness, I know that Health Canada is intent on developing a public awareness campaign. From what I understand, it will focus on parents of teenagers, advising them not to keep soda in the house. Not buying it and not having it in the house would help reduce consumption. That's a very interesting public awareness campaign.

The other point I would add is with respect to a levy on sugary drinks. One interesting unintended positive outcome of a levy is that it will actually raise awareness in the population about the dangers of sugary drink consumption. If they know that a levy is being put on a sugary drink because it is not healthy, that would help increase the awareness. That's another way a levy would have a positive impact on health.

[Sonia Sidhu, Liberal, Brampton South, ON]

Thank you.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we go to Mr. Van Kesteren.

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

Thank you, Mr. Chair.

Thank you all for being here.

I'm going to go to you, Dr. Lamarche, and change channels a little. You're the doctor. I'm reading about how foods are broken down in our stomachs, the enzymes. It's just amazing how the body has been created. How important is what comes with the food? We've probably all seen or heard about the french fries—and I won't mention where they come from—that sit in the fridge for three months. They just don't deteriorate. They don't go mouldy. How important is it that the foods we eat have the bacteria to...? Is that part of the breakdown in our body as well? Is that something we need to look at as well?

[Dr. Benoît Lamarche]

The bacteria?

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

Well, whatever it is that breaks down the food. It's the bacteria that causes the moulds and all that. The processed foods apparently don't have any of these enzymes or whatever. Is there a coalition between our bodies and the food that's going in as well?

[Dr. Benoît Lamarche]

Yes, there is. Of course, as much as we have diversity in our genes, we also have diversity in our gut capacity to digest and process food. This is of course the filter that will influence or modify the impact of a food on your health.

At the end of the day, what we see from the literature is that if you consume a Mediterranean diet.... And that takes away the effect of the gut completely. If you consume that diet, irrespective of the genes you have in your gut, or the bacteria, you're going to have some benefits. There is a filter, but it's just a filter, and what we're seeing is the end product of that filter. At the end of the day, it's the whole diet that counts. There is an interaction between foods and how we process foods in the gut, but it's the whole diet that will count. This is just a filter.