Health Committee on Dec. 12th, 2017

[The Chair, Liberal, Bill Casey]

We'll call our meeting to order. Welcome, everybody, to meeting number 85 of the Standing Committee on Health.

Today we're going to continue our study on Canada's food guide.

We welcome all our witnesses, both those who are present and those who are here by video conference.

Today our witnesses include, from the Heart and Stroke Foundation of Canada, Mr. Manuel Arango, director, health policy and advocacy; from Diabetes Canada, Joanne Lewis, director, nutrition and healthy eating; and, as an individual, Dr. Benoît Lamarche, chairholder of the chair in nutrition at Université Laval, by video conference from Quebec.

Welcome, all of you. We'll go in the order mentioned, and we'll start with the Heart and Stroke Foundation. We like to have 10-minute opening statements at a maximum.

If you'd like to start, you're on.

[Manuel Arango, Director, Health Policy and Advocacy, Heart and Stroke Foundation of Canada]

Thanks for the opportunity to testify today.

In my role as the director of health policy and advocacy at Heart and Stroke, my team and I have had the pleasure of engaging with many of you at this committee one-on-one on the subject of Canada's healthy eating strategy. We appreciate the ongoing commitment to enhance Canada's food environment.

We also applaud Health Canada's recent step to eliminate industrial trans fats in our food supply. Heart and Stroke is proud to have co-chaired the trans fat task force and to have worked with government and other partners to make this health policy a reality. This was an important step because trans fat levels are still high among certain vulnerable populations, including our children, in the food they consume. In foods such as processed baked goods and restaurant foods, levels are still high.

On the study of Canada's food guide, the committee is hearing from some of our partners on this subject. Our common agreement is that the healthy eating strategy and particularly the soon to be revised Canada food guide provide an unprecedented opportunity to make meaningful changes to our food environment and to support Canadians to make healthy choices.

In building on the comments made by my colleagues, my testimony today will focus on the following key components: the nutrition status of Canadians and the relationship between nutrition and chronic diseases; the importance of robust revisions to Canada's food guide; and, as well, Heart and Stroke's specific recommendations for the food guide.

Nutrition is a key impetus for our work at Heart and Stroke. We know that up to 80% of heart disease and stroke can be prevented by adopting healthy behaviours, including a healthy diet. While the causes are numerous, poor diet, excess caloric intake, and inadequate access to important nutrients are leading factors driving chronic disease and obesity.

The situation is not ideal in Canada. Currently, more than 60% of adult Canadians and more than 30% of children and youth are overweight or obese. Approximately 70% of Canadians age 18 years and above and youth 12 to 17 years of age did not eat the recommended servings of vegetables and fruits in 2016.

Also very worrisome, ultra-processed food consumption is on the rise. Almost 50% of Canadians' energy intake comes from ultra-processed foods. It's even higher, 60%, for kids nine to 13 years of age. This was highlighted in a report that the Heart and Stroke commissioned through the University of Montreal just last week.

What concerns Heart and Stroke in the context of today's discussion is that this could be the first generation of kids to have a shorter lifespan than that of their parents as a result of premature death related to chronic disease, including obesity.

The annual cost of diet-related disease is $26 billion annually, and unhealthy diets are the number one risk for death in Canada in 2016. Without public policy intervention, the situation will only get worse.

Whether you or your caucuses agree or disagree with how the food guide should be revised, we can all agree that in the last 10 years since the release of the last food guide, social behaviours and consumption habits have changed, technology and information access have evolved, and scientific evidence related to nutrition has also progressed, all of which necessitate a re-examination and revision of how Health Canada is advising Canadians to consume foods and beverages.

Canada's food guide was once a central resource for Heart and Stroke, both for the development of policy papers and for the creation of consumer resources. However, in the last few years, we have increasingly moved away from utilizing and referencing the food guide due to inconsistencies between the food guide and Heart and Stroke's messages on healthy eating. We hope that will be resolved with the revision of the food guide.

Heart and Stroke is supportive of and in agreement with many of the key principles proposed by Health Canada during the consultation phases for the food guide. Broadly speaking, we support the consumption of whole real foods, mostly plant-based foods, but certainly not at the exclusion of a moderate amount of some animal proteins, which can certainly be part of a healthy diet. Here, we're talking about fish, eggs, lean meat, low-fat milk, unsweetened milk, etc. We also support the proposals to limit or avoid highly processed and ready-made foods and beverages high in sodium, sugars or saturated fat, and to avoid all sugary drinks, because these are certainly not part of a healthy diet. Let me elaborate on some of the specifics.

With respect to dairy, Heart and Stroke recommends that the food guide should contain a statement about including lower fat unsweetened milk, milk alternatives, and yogourt as part of your diet. We see value in ensuring that dairy products be identified for their efficient delivery of calcium and vitamin D. For example, we think whole milk should be encouraged for children one to two years of age who are not being breastfed. Furthermore, we recommend the continued monitoring of emerging evidence on the impact of high-fat dairy products on cardiovascular health.

With respect to saturated fat, Heart and Stroke agrees that the government should promote the consumption of foods that contain mostly unsaturated fat, instead of foods that contain mostly saturated fat. Research clearly indicates that saturated fats raise the risk of heart disease and stroke, whereas the replacement of these saturated fats with other types of healthy fats decreases the risk of these conditions. Our advice to Canadians is that the best way to avoid unhealthy saturated fats is to avoid consuming highly processed foods. There is emerging evidence that it's not just the fat itself but the type of food that the fat is found in that can affect heart health. If Canadians are eating a balanced amount of whole real foods, cooking from scratch, and avoiding highly processed food, then they will likely have managed any risk posed by saturated fats.

With respect to beverages, Heart and Stroke agrees with satisfying our thirst with water and plain milk. Safe, clean water should be readily available to all Canadians. Heart and Stroke firmly believes that sugary drinks of any sort, including 100% fruit juice, should not be included in dietary recommendations to Canadians. They should not be considered alternatives to fruit. Sugary drinks have little to no health benefits but many health risks. The 100% fruit juice is metabolized in virtually the same way other sugary drinks are, and juice can have the same amount of or up to 33% more sugar than soda pop does. Canadians should eat their fruit, not drink it. We know that excess sugar consumption is associated with adverse health effects.

With respect to food preparation and ultra-processed foods, Heart and Stroke agrees that Canadians should be advised to limit their intake of highly processed or ready-made prepared foods. Ultra-processed foods are a major source of saturated fat, and are also high in calories, sodium, sugar, and sometimes trans fats. These all raise the risk for heart disease and stroke. Therefore, Heart and Stroke believes, it's important to have a clear definition of “processed foods”, since many foundational foods are minimally processed, such as frozen and canned unsweetened and unsalted fruits and vegetables. We need to advise Canadians that these are good foods to eat. It's important for the consumer to clearly understand which foods to limit.

With respect to food knowledge, Canadians need support and education on planning and preparing healthy meals and snacks, and we hope that the revised food guide will do this. Additionally, having the food literacy skills to make healthy selections requires a good understanding of how to read and understand nutrition facts tables. We also support the federal government's efforts to institute front-of-package labelling that provides interpretive, simple, highly visible, and easy-to-understand information about the risks of products high in sodium, sugar, and saturated fat. Evidence from other jurisdictions indicates that front-of-package labelling is a necessary step toward making it easier for Canadians to eat healthy food.

Finally, with respect to determinants of health, cultural diversity, and the environment, Heart and Stroke believes it is essential that any new or revised directive on eating habits in Canada take into account access to and availability of nutrition and food in a culturally appropriate manner. This includes acknowledging the importance of food sovereignty and reflecting cultural preferences and food traditions. As Health Canada works to develop the indigenous food guide, which, it is our understanding, will be tailored to include traditional and country foods, and will be translated into a host of indigenous languages, we strongly urge that the department work towards releasing both food guides simultaneously if possible. We also recommend that this committee hear from indigenous-led organizations about the progress of that document. Furthermore, in terms of the overall process, we also encourage Health Canada to publicly articulate their proposed schedule for releasing the various components of the revised food guide, and to ensure that the tools for Canadian consumers and the direction for health professionals be released concurrently.

To conclude, consistent with our participation in the consultative process, Heart and Stroke supports the healthy eating strategy, including a robust updated food guide, front-of-package nutrition labelling, trans fat regulations, and restrictions on the marketing of unhealthy foods and beverages to kids in Canada. This strategy will help to reduce the number of heart attacks and strokes in Canada.

Thank you very much for taking the time to listen to our input today. I welcome your questions.

[The Chair, Liberal, Bill Casey]

Thank you.

I just had a question. What's an ultra-processed food?

[Manuel Arango]

Ultra-processed foods are foods that really don't resemble their original state anymore. For example, if you take a piece of chicken, add additives, process it, add emulsifiers, etc., you end up with chicken nuggets. Chicken nuggets are ultra-processed foods. They contain really not that much of the original chicken anymore.

That's one example of ultra-processed foods. It also includes sugary drinks, other ready-made or frozen meals, burgers, some sandwiches, etc.

[The Chair, Liberal, Bill Casey]

Thanks very much.

Now we will go to Joanne Lewis from Diabetes Canada.

[Joanne Lewis, Director, Nutrition and Health Eating, Diabetes Canada]

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.

[The Chair, Liberal, Bill Casey]

Thank you very much.

Now we'll go to Dr. Lamarche by video conference.

You have 10 minutes.

[Dr. Benoît Lamarche, Chair in nutrition, Université Laval, As an Individual]

Thank you very much. I would like to thank the Standing Committee on Health for this truly great opportunity to provide my perspective on the healthy eating strategy. I think this is a very significant step towards a better food system, and perhaps better health in the long term for Canada as well.

I'm chair in nutrition at the Université Laval. I've been researching diet and health for 20 years. My main focus is on nutrition and heart disease, and obesity and diabetes. I do research from an epidemiological, big cohort perspective, clinical as well as mechanistic perspectives. I've studied all types of fat, as well as whole diets such as the Mediterranean diet, for example.

I think it's important for transparency to disclose that I've been funded by industry in the past, by the dairy industry and the Canola Council of Canada, both as part of the Agriculture and Agri-Food Canada clusters. However, I want to also emphasize that I have no particular agenda regarding food and health. I'm not a vegetarian. I don't like milk particularly. I'm allergic to fish and seafood. These are my disclosures, I guess.

I believe that my role as a researcher is to advance knowledge and to make sure the data are interpreted as they should be. For me, the revision process undertaken by Health Canada, which is based on the totality of evidence, is key. Again, as a researcher my role is to make sure we provide the best evidence possible for efforts like this to make the best decisions possible.

Finally, before I go to my perspective on the healthy eating strategy and the food guide in general, I'll note that I was fortunate to be involved in the evidence review cycle undertaken by Health Canada in 2015, and I provided my perspective on the evidence on which these decisions are based.

I commend Health Canada for undertaking this extensive review of the healthy eating strategy. This is not an easy task. There are high expectations. There are a lot of controversies in many of these areas. I'm sure that as consumers you're all aware of these controversies. This is not an easy task, and I think Health Canada.... It's been mentioned by the two previous speakers that the process—the transparency and the level of consultation—has been really amazing.

What I want to do in the next few minutes is take the guiding principles and provide some perspective on each of them.

The first relates to consuming a variety of nutritious foods and beverages as the foundation of healthy eating. There's a strong tendency around the world now to focus on food patterns, thereby promoting food patterns to the population. There are, of course, many different food patterns that can be healthy. I think this is well acknowledged. However, I don't understand how we can connect this strategy, which I think is great, to the focus that is given on each nutrient. We're going to hear a lot about food patterns—vegan patterns, the DASH type of diet, the Mediterranean diet—yet there will be a lot of focus on nutrients. We are going to have a front-of-pack strategy for nutrients, labelling the saturated fats, the sugars, the sodium. For me, this is not a direct connection with a food-based or a food pattern approach; we're still focusing on nutrients, thereby perhaps contributing to confusion among the public.

This is not easy, because over the last 20 to 30 years we have programmed the population to focus on nutrients. We have provided information on nutrients on the food labels. In the consultations with the public by Health Canada over the last couple of years, the population, the consumers, have been saying they want information about proteins, carbohydrates, lipids, and energy. This is really difficult, because we want to emphasize a whole diet approach, a whole food approach, yet we're going to still provide information on nutrients. This is a disconnect for me. I want to understand why we're going this way, because these two approaches are clearly different.

There is, of course, in the U.S. and in Canada this recommendation for a substitution of saturated fat versus unsaturated fat. I think we have a lot of evidence to support this recommendation, but again, it's a highly nutrient-based recommendation. I would hope Health Canada, through the revised guidelines, will not emphasize this. It's putting too much emphasis on the nutrients, whereas we want them to focus on foods. We want people to focus on food substitution.

Further, there is actually some controversy about this recommendation for substitution of saturated fat for PUFA; not from a cholesterol effect or health effect, but from a food-based effect, this is really hard to do. For example, if we say you have to substitute saturated fat for polyunsaturated fat, the bad fat for the good fat, how do you do that if you're consuming yogourt? You don't have yogourt high in unsaturated fat. Yogourt is going to be containing saturated fat as part of dairy fat. It's the same thing for cheese. This substitution is very difficult for the population to understand. Maybe we can address that in the question period. It's not as easy as it seems, and I think this is important to keep in mind.

Of course, all guidelines right now around the world are trying to address this issue by using the totality of the scientific evidence. I'm just curious, and I don't understand why everybody is looking at the same evidence and not coming to the same conclusion. We're talking about a low saturated fat, high polyunsaturated fat paradigm, because in Canada and in the U.S. we say that's what the science says. Yet the Dutch health agency is saying they don't have the evidence to support that, and we're all looking at the same evidence. For example, in the Netherlands, they don't have the recommendations to consume lower-fat dairy products because they're saying they don't have the evidence for that. Personally, I've done a lot of research on this and I can't find evidence, for example, showing that consuming a low-fat yogourt is better for health than consuming a high-fat yogourt. This is a leap of faith mostly based on the fact that high-fat dairy contains more saturated fat. But there is evidence that the food matrix may modify the effect of the food on health. It's quite interesting, as a scientist, to look at this evolving work around the recommendations. We're all looking at the same evidence and we're not coming to similar conclusions.

The whole issue on processed and prepared food I think is a great idea. Again, there is the risk of putting too much emphasis on some of these nutrients, and sugar is one of those. Just for your information, for sure, over-consumption of sugar is problematic; no one will argue against that, but I think we're putting a lot of weight on sugar. In some analyses around the world looking at nutrition factors contributing to the burden of disease, sugar, among all nutritional factors, comes in 10th place. It's just after fruit, nuts, sodium, processed meat, vegetables, trans fat, omega-3 fats, whole grains, and fibres—10th place for sugar. We are putting a lot of pressure on sugar. Maybe it's going to have an effect, but there are a lot of other areas in nutrition that could have a lot of effect on health.

On the front-of-pack approach to sugar—and we've discussed that among our colleagues here in Quebec at our research institute—using the total sugar of the food is problematic. I'll give you some examples. Several products, cereals, for example, which are high in sugar, are below the cut-off for the front-of-pack label for sugar. Mini-Wheats, Honeycomb—you can name a lot of them—are just below the 15 grams per serving size, so they won't have a label for high-sugar content, but they may be just at 14 grams. That's a pretty high sugar content. The added sugar versus the total sugar for us is a key issue. There is a lot of challenge in looking at added sugar, of course, but from a public health perspective, I think this is something we need to consider as well.

I'll say a word on juice. Of course, over-consumption of juice, over-consumption of sugary beverages, is not good for health, not good for obesity, and not good for cardiovascular disease. We feel, and I have discussed this with my colleague, again, avoiding wording related to juice intake is pretty strong. For me, I don't think we have evidence that zero millilitres of juice is any better than a little bit of juice. We have evidence that too much juice is not good, but there are nuances there, and from a public health messaging perspective, again from my scientist's perspective, we're lacking some evidence there.

[The Chair, Liberal, Bill Casey]

Doctor, could you come to a conclusion. We're out of time for your 10 minutes.

[Dr. Benoît Lamarche]

Yes. I have nine minutes on my clock, so I'm finishing.

I really appreciate the healthy eating strategy related to children. The banning of trans fats was a great initiative, and I'll speak more to that during the questions.

I'll stop, and maybe I'll add more comments during the questions.

[The Chair, Liberal, Bill Casey]

Okay, thanks very much.

We'll go to our seven-minute round of questions starting with Mr. Oliver.

[John Oliver, Liberal, Oakville, ON]

Thank you very much for your presentations today and for being here. I have to say it's tough studying this topic right before our holiday season. My office and house are full of candy and baked goods, and it's just a tough time to be talking about it, but thank you for being here.

The first question is for Diabetes Canada and the Heart and Stroke Foundation.

I was looking through the dietary approaches to stop hypertension, your DASH approach. Is what you presented today basically consistent with DASH, and is that consistent, as you understand it so far, with the guiding principles document?

[Joanne Lewis]

There are many overlapping recommendations between DASH, the Mediterranean, and some of the recommendations of the new Canada food guide.

I will defer to our third speaker, who might know a little more with respect to the smaller nuances of the diets. But with respect to increased intake of fruits and vegetables, reduced intake of red meats, and so on, the DASH diet, because it was specifically formulated for hypertension, does look at specific nutrients such as magnesium and potassium, so dairy products play a big part of the DASH diet.

I'll defer to the other speaker, if he has further comments.

Thank you.

[Manuel Arango]

I'll just add one comment, and I will defer to Dr. Lamarche, as well, if he wants to speak to the nuances of the DASH diet.

For sure, we certainly have evidence through the U.S. National Academy of Medicine and many other international—

[John Oliver, Liberal, Oakville, ON]

I have only a minute, so if you're going to defer to the doctor, then—

[Manuel Arango]

No problem, it's just that other international organizations have definitely recommended.... There is a relationship between low sodium consumption and health.

[John Oliver, Liberal, Oakville, ON]

Absolutely. Thank you.

Dr. Lamarche.

[Dr. Benoît Lamarche]

No, I don't think I have any other significant things to add. This is one pattern that is healthy for both diabetes and heart disease.

[John Oliver, Liberal, Oakville, ON]

Definitely I'm hearing messages around reducing sugar, reducing salt, swapping fats, and a swapping in the carbohydrate area for healthy carbs versus....

Other countries have moved towards whether the distinction between saturated and unsaturated fats is really important versus lowering the carb intake. As I understand it, we're still recommending 300 grams of carbs in a 2,000 calorie diet. Some of the Scandinavian and Nordic countries—and there was a McMaster study—along with scientists from about eight other countries looked at 100,000-plus people, and their conclusion was that we need to start reducing our carb intake, and maybe allow some relaxing on the fat side.

Dr. Lamarche, do you have any views on that? Your whole food, whole diet analysis, was capturing my attention.

[Dr. Benoît Lamarche]

It's really hard to separate the effects of each of these nutrients, because they have to be interpreted in the context of each population. You're referring to The Lancet paper that I think was published in the summer. This was a multi-country study, and the context of carb consumption is very different among these countries, so we have to be careful how we interpret the data.

For example, the Mediterranean diet is not a low-fat diet, but it's a healthy fat diet. According to that paradigm, we could shift towards a higher fat diet if you consume the higher quality types of fat. However, the risk with the higher fat diet is to accept the higher saturated fat diet from transformed products, which are not to be recommended. You have the Atkins diet that has been promoted quite a lot. This is a high saturated fat diet that had some effect on cholesterol, but we don't have any long-term study to support that.

I don't think we need a recommendation on the amount of carbohydrates we should consume. This is variable from country to country, from population to population, even within Canada, but I think if you consume the right types of fat, then it's okay to consume a higher fat diet.

[John Oliver, Liberal, Oakville, ON]

Thank you.

On processed and highly processed and refined foods, I know in my community there are lots of working families—both parents are working—and the kids have a thousand and one activities after school and on weekends. As far as the opportunity to cook from scratch and the cost for some families of cooking those diets are concerned—they have cost and time factors—are there reasonable substitutes?

Some families I know in my neighbourhood are using those high-nutrition protein shakes, like Ensure and things like that, just to make sure something gets into their kids, because they don't always have time to put together a properly home-cooked meal, and some can't afford it.

Are there products like that out there that should be considered in this, or is it just a straight no, you cook from scratch, you cook basic foods?

[Manuel Arango]

If I could take the first crack at that question, certainly we would encourage innovation in the food manufacturing sector to try to reduce the harm from some of their products. Research in that respect, and more responsibility from the food and beverage industry as well, would be helpful to reduce that harm.

However, it is definitely possible, with a bit of advance planning, to cook from scratch and plan your week ahead. It is very true that in this modern-day age of convenience—families are driving the kids to sports activities after work; you have two-parent families, both working, rushing home—it's more complicated. There is no doubt about it, and we're living in an age of convenience.

[John Oliver, Liberal, Oakville, ON]

What about single-parent families?

[Manuel Arango]

Yes.

We're living in an age of convenience, but with a little bit of planning and, as well, support from the government in terms of promoting a positive food environment, it can make it easier for these parents who are leading these hectic lifestyles to eat a little healthier.

I would definitely underscore that advanced planning in terms of cooking from scratch before the start of the workweek could help.

[John Oliver, Liberal, Oakville, ON]

Are there any other answers? Do you both agree with that?

Are products like Ensure—I don't want to name a brand—but those kinds of products, a substitute for a meal made from scratch, or are they all pretty unhealthy because they're processed and refined foods?