Canadians are a pretty obedient bunch when it comes to eating what the government says we should be eating.
Over the last three decades, we鈥檝e upped our intake of fruits and vegetables while reducing fat and dairy. We鈥檝e increased grains and fish in our diet and reduced red meat, eggs and butter. We鈥檝e even scaled back on sugars (not counting high fructose corn syrup found in processed foods) and soft drinks.
Yet, despite an overall adherence to the sa国际传媒 Food Guide 鈥� held up as the country鈥檚 trustworthy blueprint for what should be a healthy, nutritious diet 鈥� the country is in the grip of an obesity epidemic, with two-thirds of adults considered obese or overweight and obesity rates double that of 1980 figures.
So what gives?
One U.S. science journalist and author say it鈥檚 because the food guide got it all wrong.
鈥淐anadians have, on the whole, followed their food guidelines,鈥� said Nina Teicholz. 鈥淓verything that鈥檚 supposed to be up is up and everything that鈥檚 supposed to be down is down. The evidence shows the public has complied and has got fatter and sicker.鈥�
Among its recommendations, the guide advises adults to eat six to eight servings of grain products a day and to limit saturated fat, which occurs naturally in animal products such as eggs, dairy and meat as well as in some vegetable oils like coconut and palm oils.
It counsels Canadians to trim visible fat from meat, limit butter and cook without or with little added fat. It also advises consuming only two to three tablespoons of unsaturated fat 鈥� often described as the 鈥済ood鈥� fat that is found in plant-based foods and oils 鈥� daily.
It鈥檚 precisely this fixation on carbohydrates at the expense of saturated fat that鈥檚 driving obesity and obesity-related chronic diseases, argues Teicholz in her bestselling book, The Big Fat Surprise.
鈥淭he obesity epidemic in the U.S. and sa国际传媒 really began with our dietary guidelines,鈥� she said. 鈥淭he evidence points in that direction.鈥�
For decades, governments and scientists in the U.S. and sa国际传媒 have warned of the harmful effects of saturated fat on the heart and cardiovascular system, urging consumers to shun butter, eggs and red meat.
The demonizing of saturated fat was based on Ancel Keys鈥檚 landmark Seven Countries Study that found an association between coronary heart disease and total cholesterol levels.
The evidence was weak and preliminary, said Teicholz, but that didn鈥檛 stop the American Heart Association from pushing the idea in 1961 that saturated fat and dietary cholesterol caused heart disease.
鈥淎t the time, the U.S. was in a panic over rising heart disease,鈥� she said. 鈥淭he organization needed to say something. Everyone got on board with this hypothesis and that has become the accepted dogma adopted by leading scientists.鈥�
Since then, more rigorous, billion-dollar, government-funded clinical trials involving tens of thousands of participants have failed to find an association between saturated fat and heart disease.
鈥淎ll those reviews clearly imply that saturated fat has been unfairly condemned,鈥� said Teicholz, one of dozens of witnesses who testified in Ottawa last year at a Senate committee hearing on finding ways to curb sa国际传媒鈥檚 rising obesity rates.
The results of the hearing: A damning report released last month that eviscerated the sa国际传媒 Food Guide as 鈥渄ated鈥� and 鈥渁t best ineffective and at worst enabling鈥� the country鈥檚 obesity crisis.
Witnesses told the committee that fat consumption in the early 1970s made up about 40 per cent of daily calories. Then Canadians heeded the exhortation to reduce fat and reduced their fat intake to 31 per cent by 2004. But during this time, obesity rates spiked, which suggests that dietary fat is not a 鈥減rimary contributing factor鈥� in obesity, said the report.
A higher-fat diet 鈥� one that has more fat than the current diet that limits fat consumption to 25 to 35 per cent of total calories 鈥� is healthier and a better disease-fighter than a low-fat diet, said Teicholz, citing more than a dozen reviews and meta-analyses that concluded saturated fat is not associated with heart disease and has no effect on cardiovascular mortality.
But she said many of these studies are ignored, even stricken off the record, because they go against the government鈥檚 official low-fat dietary advice. Case in point: Teicholz was recently uninvited from a panel at the National Food Policy Conference in Washington, D.C., this week.
鈥淭here鈥檚 a lot at stake here,鈥� she said. 鈥淚f the people who invested in these guidelines are wrong, that鈥檚 a bad story.鈥�
Teicholz鈥檚 findings are controversial but have been bolstered by other studies and reports.
A 2013 paper published in the British Medical Journal called the link between saturated fats and heart problems a 鈥渕yth,鈥� while a 2014 study funded by the U.S. National Institutes of Health and published in Annals of Internal Medicine found that people who ate fewer carbs and more fats, including the saturated type, lost more body fat and reduced their risk of developing heart disease.
Last fall the Canadian Heart and Stroke Foundation issued a position paper overturning the usual warnings about saturated fat and focusing instead on a 鈥渨hole diet approach鈥� and the dangers of highly processed food. It noted that, in hindsight, dietary recommendations that encouraged people to cut back on fat and boost carbs may have played a role in increasing calorie consumption and rates of obesity and metabolic syndrome.
Teicholz said she is not advocating people start gorging themselves on eggs, cheese and fatty meats 鈥� only that saturated fat does not deserve its villainous casting and should be 鈥渓et out of jail.鈥�
She does not suggest an ideal fat consumption level, arguing only that government remove limits on fat. Asked whether there should be a cap on carb intake, Teicholz pointed out that before the existing dietary guidelines were in place, Americans ate less than 40 per cent of their daily calories in carbs. Today, that number is 50-60 per cent.
鈥淪imply reversing that back to 40 per cent would be a common-sense kind of recommendation for a healthy population,鈥� said Teicholz, a 鈥渘ear vegetarian鈥� in her younger years who now estimates her diet to be about 50 per cent fat, with moderate protein and low carbs.
sa国际传媒 obesity expert Michael Lyon said the assumption all saturated fat is evil is a mistake, but cautioned against 鈥渂andwagon diets.鈥�
鈥淚t鈥檚 like a pendulum that swings from one extreme to another,鈥� said Lyon. 鈥淚 don鈥檛 want to throw the baby out with the bathwater when it comes to recommendations about fat.鈥�
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听Dr. Michael Lyon runs the Medical Weight Management Centre in Coquitlam, the only multidisciplinary obesity management program in sa国际传媒 covered by MSP.
Not all saturated fats are created equal, said Lyon. Some, such as hydrogenated fats, should go. But rather than promoting 鈥渢he extreme end鈥� and bulking up our diet with meat, fat and cheese, Lyon recommends a more measured route: 鈥淚t would be more sensible to consider becoming more moderate in our consumption of carbs and choosing our carbs more wisely.鈥�
The Senate report noted there was no consensus regarding how much fat, dairy, starch and sugar comprises the optimal diet. All witnesses, however, agreed that whole foods are best and highly processed foods should be avoided. And all of them recommended an immediate review of the sa国际传媒 Food Guide to better reflect current scientific evidence.
The report also prompted a petition by Ottawa resident Mike Sheridan urging Health sa国际传媒 to revamp the food guide. The petition has garnered more than 21,800 signatures in less than a week.
In an emailed statement, Health sa国际传媒 said it is conducting a review of the evidence to determine if there is a need to revise the current guide.
鈥淭he current evidence review process will help to identify whether there are needs to revise current guidance or develop new guidance,鈥� said spokesman Andre Gagnon.
The results will be announced publicly later this year.
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Why the sa国际传媒 Food Guide is difficult to digest
The sa国际传媒 Food Guide is one of the government鈥檚 most popular documents, downloaded more than 230,000 times with more than 1.7 million print copies. It shapes countless school lunches and hospital menus, and remains the go-to guide for many doctors, dietitians and institutions.
But the food guide is also widely criticized as outdated, confusing, soft on ultra-processed foods and unduly influenced by food industry groups.
And its classification system, which equates fruit juice with real fruit, deli meat with chicken breast, and whole grains with sugary cereal? Nonsensical, say some experts.
It鈥檚 not an easy task to come up with a document in an easy-to-understand, eye-catching format that captures the essence of what we should be eating, considering Canadians鈥� various health needs, special diets and demographics.
Since the guide falls short, we ask experts: How should we be eating?
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Jean-Claude Moubarac
A researcher in public health nutrition at the University of Montreal, Jean-Claude Moubarac said the guide does not do enough to counter the immense role that ultra-processed, ready-to-eat snack food plays in the modern diet.
The consumption of ultra-processed food increased more than any other food group since the 1980s, said a Canadian Senate report released last month. These foods now account for up to a quarter of calories Canadians consume every day, yet they fall under the鈥渙ther foods鈥� category听 in the guide, said Moubarac.
鈥淚f you have a typology that doesn鈥檛 allow you to qualify a quarter of what people are eating, then your system needs to be updated.鈥�
Moubarac is a proponent of the Brazilian food guide, which he helped develop as part of a team from the University of Sao Paulo tasked by the ministry of health to revise the old guidelines.
The Brazilian guide, released in 2014, is often held up as a shining example of what a food guide ought to be in the modern food landscape.
It鈥檚 based on the notion 鈥� and sound scientific evidence 鈥� that a diet based on home-cooked foods and minimally processed food is going to be healthy. 鈥淚f you base your diet on (home) cooked food and minimally processed food 鈥� it doesn鈥檛 matter if you鈥檙e eating beans or meat or apples or mangoes 鈥� they鈥檙e all food,鈥� said Moubarac.
The Brazilian guide also moves beyond food to provide lifestyle advice: cook at home as much as possible, eat with friends and family, and be wary of food marketing.
Desiree Nielsen
Vancouver dietitian Desiree Nielsen had to dust off her copy of the sa国际传媒 Food Guide in preparation for this interview. She doesn鈥檛 use it for clients because it鈥檚 too confusing.
鈥淭here is so much emphasis on knowing numbers and counting and measuring what is a serving,鈥� said Nielsen, author of Un-Junk Your Diet. She encourages people to make good meal choices, rather than focus on nutrient intake.
Her advice: Eat as many vegetables as possible. 鈥淢ake half your plate fruits and vegetables,鈥� she said. 鈥淭hat鈥檚 an easy thing to eyeball.鈥�
Replace highly processed food with whole foods. 鈥淭he less human involvement in altering it, the better.鈥�
Nielsen said the guide needs to come out stronger against ultra-processed food. At the back of the guide, in fine print, is a sentence recommending people avoid foods and beverages high in calories, fat, sugar or salt, she noted.
鈥淚f that鈥檚 not the No. 1 message, then our Food Guide is doing Canadians a disservice.鈥�
Dr. Michael Lyon
Any revision of the sa国际传媒 Food Guide should be made without involvement from corporate interests, says Dr. Michael Lyon听 鈥� something last month鈥檚 Senate report also recommends. 鈥淲e know we live in an obesegenic society,鈥� Lyon said. 鈥淭he last thing we need is the food industry to be a major influencer in what we are teaching the general public.鈥�
Lyon, who runs sa国际传媒鈥檚 only MSP-covered weight management clinic in Coquitlam, likes using the Harvard School of Public Health鈥檚 Healthy Eating Plate with his clients.
It uses plate imagery similar to that of the U.S. government鈥檚 MyPlate, which replaced the old pyramid-shaped food guide in 2011. But it is also markedly different. It explicitly tells users to avoid sugary drinks and trans-fat and displays a glass of water beside the plate, compared to the government鈥檚 version, which depicts a serving of dairy.
Unlike the U.S. government鈥檚 version, noted Lyon, the Harvard version was not influenced by food lobby groups.
Lyon said the best diet is one you can stick with. He counsels eating more plants and more simple foods made from scratch. 鈥淓at whole foods. Eat more plants. That鈥檚 all I have to say. End of lecture.鈥�
Unique guidance
The Swedish food guide is unique in the world. Announced in 2015, Sweden鈥檚 revised dietary guidelines take into account the health of the planet and the impact of the human diet on the environment. It counsels its citizens not only to eat healthy, but in season and sustainably.
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