Dispelling nutrition myths, ranting, and occasionally, raving


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Canada’s not-so-innovative strategy to achieve healthy weights

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A few weeks ago, to little fanfare, the government of Canada announced an “Innovation Strategy” to achieve healthy weights in Canada. My coworker alerted me to it and got me going out on a rant on a Friday afternoon. Don’t get me wrong, there’s some good stuff in here: promoting active neighbourhoods to increase access to green spaces and encourage active transportation, promoting traditional foods, and early childhood interventions for priority populations. However, for the most part I was hugely underwhelmed by the strategy.

Most of the initiatives involved some form or other of food charity, such as expanding the community food centre model. While I appreciate the CFCs efforts to improve on the traditional food bank through the addition of cooking programs, gardens, and social inclusion, when it comes down to it, they’re still a charitable organization doing the work that our government should be doing. These programs also still put the onus on the individual to seek out and access the available services, rather than implementing programs that would be universally available. Also, I understand the desire to target people living on low incomes and experiencing food insecurity but I don’t believe that obesity and unhealthy lifestyles are something that only affect that population.

I know that it would be more complicated than throwing some money at some existing programs but I think that there are many things that the government could have chosen to do that would have a much greater impact on the health of Canadians. How about a national school lunch program? This would reach every child in school without stigma and would ensure that children had the nutrition needed to learn and grow. How about bringing back mandatory home economics or teaching food literacy in schools and supporting school gardens? Yes, I realize that the curriculum is under provincial jurisdiction but there must be some way to get this back in schools. That would ensure that all children learned food skills rather than just those attending limited classes. As we know, food skills are lacking across all income levels in Canada and are not just an issue for those living in poverty. How about subsidizing fresh vegetables and fruit making it easier for Canadians to afford these nutritious foods? I know that this one is working its way through government right now, but how about putting a ban on marketing to children? And not just “junk” food but all food as we know that children (and even teens, and let’s face it, adults) are ill-equipped to contend with the marketing abilities of the food industry (possibly more on this next week). How about increasing access to registered dietitians so that people who want to speak with a RD can do so? How about collaborating with doctors, farmers markets, and grocery stores to enable all physicians to “prescribe” vegetables and fruit? These initiatives would have far greater reach and impact than the ones selected by the government. It really makes me wonder who’s informing these decisions there and it enrages me that our governments continue to throw our money at piecemeal initiatives that are unlikely to make any significant long-term change in our health.

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Is a spoonful of sugar the way to get the vegetables to go down?

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When I saw this article: “Sugar, salt or sweeteners may be key to getting children to eat greens” last week in the Nutrition Resource Centre “News in Brief” email I knew that I had to read more. I mean, were the authors really suggesting that we should add sugar to veggies to get infants and toddlers to eat them? Or was this just a case of a misleading or misinterpreted press release? I found a copy of the full article: Mary Poppins was right: Adding small amounts of sugar or salt reduces the bitterness of vegetables and set about reading.

One thing that struck me right away was that this study was done with adults, no infants or toddlers, or children of any age were involved in the research. Adult participants were provided with puréed vegetables (broccoli, kale, and spinach) with varying concentrations of added sugar. They were asked to rate them on various attributes, and most importantly, they were asked to indicate whether or not they liked or disliked each sample. I was surprised that the conclusion would be drawn that adding sugar to green vegetables is a reasonable means to encourage infants to eat them (I’m saying infants because these were puréed veggies and as such are really only suitable for babies just starting to eat solid foods) based on ratings by adults. After all, adults have very different palates than infants and have very different relationships with food that have been shaped over decades. To me it seems inappropriate to conclude that because adults preferred sugar sweetened veggies that infants will as well. The authors themselves also state that, “It should be noted that infants and toddlers are also not merely small adults”. However, they also use the analogy of adults beginning coffee consumption with added sugar and gradually weaning off the sugar as justification for proposing adding sugar to vegetables when the World Health Organization, among many other bodies, is currently encouraging reduced consumption of added sugars.

The second thing I wondered about was precisely how much sugar was added to each serving of vegetables. The news article, and much of the journal article, references 1% and 2% concentrations but what did that translate to in teaspoons or grams? It sounds pretty innocuous, right? 1% or 2% is hardly anything. Well, in actuality the 1% was equivalent to the addition of 1/2 teaspoon per serving and the 2% was equivalent to 1 teaspoon per serving. Not an insignificant amount when you’re talking about toddlers who are generally only consuming a tablespoon or two of a food in a serving. Interestingly, the researchers asked parents how comfortable they would be offering their babies vegetables with added sugar in amounts of 8 calories, 16 calories, 1/2 teaspoon, or 1 teaspoon. The 8 calories = 1/2 teaspoon = 1% concentration. The 16 calories = 1 teaspoon = 2% concentration. Essentially asking: how can we frame this added sugar to make it more palatable to parents who are trying to feed their children healthy diets?

Despite the general conclusion that adding sugar to vegetables may encourage young children to eat them, even the ratings by adults were not overwhelmingly improved by the added sugar. For broccoli and kale purées both 1% and 2% sugar increased overall liking. For spinach the 2% sugar (but not the 1%) increased overall liking. For broccoli and spinach the sugar increased the ratings of liking from disliked to liked. However, for kale, even at the highest sugar level ratings never rose above the midpoint (i.e. neither like nor dislike). So, these adults did not like any of the green vegetables to begin with (at least not in puréed form) but after adding higher quantities of sugar they liked the spinach, and even with the smaller quantity of added sugar they liked the broccoli. But neither amount of sugar was enough to get them to like the kale. Would babies have different initial reactions to these vegetables? Would the addition of sugar cause them to change these reactions? I don’t know and I don’t think anyone can say based on the results of this study alone.

Just for fun, I took a look at the funding sources for the study after I finished reading it. Can you guess what one of the funding organizations was? If you guess the Sugar Association you’d be correct. I think this explains a lot because honestly I was a bit baffled as to why anyone would be looking into adding sugar to get babies to eat vegetables and why such tenuous conclusions would be drawn and publicized based on the actual findings. But who other than the Sugar Association would think that we need to encourage babies to eat more sugar?

I think a better analogy than the sugar sweetened coffee for this research would be the argument that chocolate milk is a good way to get kids to drink milk or that baking apples into a pie is a good way to encourage fruit consumption. In some ways it’s even worse because infants are at the mercy of their caregivers when it comes to what foods are offered to them and encouraging a preference for only sweet foods at such a young impressionable age could have long lasting implications for their food choices and health throughout their lives.

 


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The Food Guide needs to rise above dietary dogma

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A while ago I remember reading an article by some doctors about how the updated Canada’s Food Guide should be promoting a low-carb, high-fat (LCHF) diet. Then last week there was another article about a “prominent Ontario doctor” who asserts that the new Food Guide is being based on “very bad science”. And I’m just so frustrated that doctors, who we all know receive minimal nutrition education, are getting so much press for their self-serving misinformed opinions.

First of all, these doctors all serve to benefit if their particular dietary dogma is promoted. The doctors pushing the LCHF agenda make a living by putting people on this diet. The doctor who said the new Food Guide is based on “very bad science” and should instead contain specific diet recommendations (e.g. low-fat, DASH, LCHF) has received money from the Dairy Farmers of Canada in the past (and as we know, they are highly opposed to the potential shift from the current Food Guide food groupings).

Secondly, they seem to have a poor grasp of population health and the purpose of a national food guide. When we’re talking about population health we’re talking about improving the health of the entire population. We are not trying to address specific medical concerns of illnesses. We’re also not trying to put the entire country on a weight loss diet, which seems to be the perspective that these physicians are taking. Similar to the daily recommended intakes for vitamins and minerals, which are based on the average amount that a healthy person requires each day, the food guide is intended to promote a healthy dietary pattern for most healthy Canadians. Obviously we are all different and our needs and optimal diets will vary, hence the fact that this is called a guide. It’s not a prescriptive diet, it’s one size fits most with some personal tweaking, not one size fits all straight off the rack. It’s not meant to address every, or actually any, disease states. That’s why we have dietitians and doctors and primary healthcare to help individuals with specific health concerns. It’s meant to promote a healthy pattern of eating among as much of the population as possible. It’s not at all, “picking a specific dietary plan for all Canadians is the wrong approach and that, like all clinical processes, treatment should be considered based on individual patient needs” as the doctor in the second article said. It’s providing general guidance on healthy food choices for those who aren’t in need of clinical treatment.

The narrow focus on clinical care and treatment in the realm of healthcare does a disservice to us all. As does the medicalization of eating. In order to promote health and wellness in our communities and country we need to move back upstream and start preventing the need for many doctor visits, hospital stays, and medications. That sort of thing is achieved through population-based measures that address the social determinants of health and general guidelines such as Canada’s Food Guide.


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Why we need to stop with the meat and alternatives

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Ever since the new Food Guide consultations began the dairy and beef industries have been pushing back hard. They’re afraid that if the traditional food groups are dismantled, and if the food guide encourages people to consume more plant-based sources of protein, as has been put forward in the consultation, that there will be decreased consumption of dairy and beef. It’s understandable that they would want to protect their interests. After all, going from being featured prominently in the current (and previous versions) of the Food Guide with food groups named: Milk and alternatives and Meat and alternatives, to receiving little-to-no mention is a bitter pill to swallow. On the other hand, it’s a hugely positive step for the health and wellness of Canadians.

You see, words matter. “Alternative” is generally different than the norm. According to the dictionary, the definition of alternative is, “one of two or more available possibilities.” By naming food groups “Meat and Alternatives” and “Milk and Alternatives” we’ve positioned animal products as the norm and plant-based sources of similar nutrients as differing from the norm or abnormal. This positioning makes it sound like meat and milk are the front-runners and the “alternatives” runners up. This does a disservice to the health and budgets of many Canadians, particularly those living on low incomes, as meat is positioned as something to aspire to and the “alternatives” (which are often more affordable options such as beans, lentils, and tofu) as inferior.

I think that the standard Canadian home-cooked meal is often some variation on meat and potatoes. Having taught cooking classes for people living on low incomes for the past few years I have found that even if participants are open to trying new foods and recipes they are often unable to sell their family members on beans and lentils and other more affordable sources of protein. One of the few negative pieces of feedback we receive is that participants would like more meat in the meals we prepare. For many reasons we emphasize vegetables and “alternative” sources of protein in our classes. Among those reasons are: nutrition, food safety, variety, and affordability. Meat is generally one of the more expensive foods at the grocery store. By creating the impression that meals centred around meat are something to aspire to we’ve really done a disservice to Canadians. The majority of us don’t consume even the minimum recommended servings of vegetables and fruit each day and don’t consume enough fibre.

Milk is widely encouraged as a beverage with meals, on cereal, with snacks, and for sports recovery. It’s been positioned as the beverage for growing children and for seniors for bone health. While not quite as costly as meat, serving for serving, it’s still a pricey beverage in comparison to water and many other drinks. Setting aside vitamin D, which milk is fortified with, there are many other sources of the nutrients we commonly consume milk to obtain. Calcium is found in many leafy green vegetables, tofu, beans, nuts, and seeds. Protein is found in beans, lentils, eggs, nuts, seeds, and tofu.

All this to say, that despite the push-back, I think that (if Canadians pay attention to the new Food Guide when it’s released) ditching the current configuration of food groups, or even just the current naming of food groups, will be beneficial to the health and pocketbooks of most of us. If we stop seeing plant-based sources of protein as “alternative” and start recognizing them for their delicious value then maybe we can get out of that meat and potatoes mentality and start enjoying a wider variety of nutritious meals.


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Naturopaths are jumping onboard #NutritionMonth and this boat ain’t big enough for all of us

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As you probably know, March is Nutrition Month. Traditionally this is the month in which dietitians come out in full force on social media, and in news articles, with nutrition tips, recipes, etc. This year I noticed a change. Yes, dietitians are still out there telling everyone to eat more vegetables, promoting the profession, and encouraging people to “unlock the potential of food”. Interspersed throughout those posts and articles though are ones from a new voice, naturopaths.

On March 15th the Institute for Natural Medicine put out a news release titled “Naturopathic Doctors Complete 155 Hours of Nutrition Education in Medical School: March is Nutrition Month“. In the linked FAQ: “What advanced nutrition education do naturopathic doctors receive?” the INM states that, “Naturopathic doctors provide individualized nutrition assessment and guidance utilizing evidence based nutritional recommendations” (emphasis mine). On addition, one of the “areas of concentration” is “collaboration with Registered Dietitians, as needed”. While part of me is glad to see Nutrition Month catching on, rather than being an echo chamber of RDs, another part of me is frustrated to see it being co-opted by a pseudoscientific profession.

The use of the term “evidence based” concerns me. What evidence might that be? Those of us working in dietetics and medicine often talk about the need for treatments, interventions, and programs to be evidence-based. However, these interventions are only as good as the evidence on which they’re based. Ideally, you want high level evidence like guidelines and and summaries which draw on a larger body of research demonstrating consistent results (check out the 6S Pyramid from the National Collaborating Centre for Methods and Tools for more details). At the bottom of the pyramid, are single studies. The single studies aren’t necessarily poor (they’re the foundation for the higher levels of the pyramid) but if there aren’t many and they aren’t in agreement it becomes difficult to make solid evidence-based recommendations. Also, it can be easy to cherry pick single studies to support nearly any position and proclaim your stance to be “evidence-based”. Without attending naturopath school, I can’t say how credible the evidence-base they’re drawing on is with certainty. However, based on what I see on the websites, social media feeds, and have heard from many people who’ve seen naturopaths, I think it’s wise to question the quality of the nutrition education they’re receiving.

I also question the statement about collaborating with RDs. I’m sure that someone will tell me I’m wrong in the comments but in my experience, I have never heard of a naturopath referring a client to a dietitian. Considering their 155 hours of nutrition education and their alleged nutritional knowledge I’m not sure why they would see a benefit to referring a client on to one of us.

Now, I’ll be the first to tell you that the plural of anecdote is not evidence and I’m sure that seeking responses from twitter is likely to have skewed toward my own bias, but I was curious what sort of nutrition advice people are receiving from naturopaths. I received a number of responses ranging from negative to positive. I assured everyone anonymity so names have been changed – thank you to everyone who was willing to share their experience(s) with me. Here you have it:

The good:

Emma told me that they started seeing a naturopath to improve her diet, energy, and overall health. She found the naturopath to be very down-to-earth with realistic expectations and advice in-line with current research. She said, “She’s always been incredibly supportive; always learning; always approaching everybody as an individual and very willing to make adjustments depending upon someone’s reactions to process.” This naturopath also provided affordable recipes and shopping plans.

Ava went to a naturopath for IBS and was told to try a FODMAP elimination diet.

The bad:

Emma’s naturopath promoted organic products as best and advised her to avoid GMOs.

Ava was also told to eliminate gluten (despite having expressed no issue with gluten and not having celiac disease). She was also not provided with sufficient support to feel like she could adhere to the low-FODMAP diet and quickly abandoned it.

Liam was diagnosed with hypercholesterolemia and prescribed medication by his doctor. He didn’t tolerate it well so he went to a naturopath who sold him a special drink and put him on an alkaline diet.

Sophia went to a naturopath to help her control her severe asthma. The naturopath advised her to eliminate gluten and follow a vegan diet with the explanation that, animal products increase inflammation in the body and were worsening her asthma. As she had previously eliminated gluten and experienced no benefit she followed a vegan diet for about 6 months. She experienced no decrease in symptoms during this time so she reintroduced animal products to her diet.

The ugly:

Liver cleanse supplements were part of the plan provided by Emma’s naturopath.

Olivia went to see a naturopath and was told to cut out dairy, given a stack of photocopied book chapters and opinion pieces, and $800 worth of liver detox tablets, supplements, and powders. To be fair, this was pre-Internet times so photocopies were not so odd, and the profession may have grown since then. But, that also makes the cost of supplements even more exorbitant than it sounds today.

Isabella told me, “I got “nutrition advice” from a naturopath. I walked in, he fat-shamed me, and gave me a whole sheaf of paper basically outlining how I already eat.”

Mia was advised to consume raw milk, and to give the same to her three year old child.

Amelia has both celiac disease and multiple sclerosis. Despite following a gluten-free and dairy-free diet, taking recommended supplements and medications, she still experienced digestive issues. She went to see a naturopath who advised her to get IgG allergy testing. Due to the nature of this not recommended form of allergy testing the naturopath told her she could no longer consume the foods that she was consuming the most of leaving her with very little that she could still eat.

Harper went to see a naturopath after being diagnosed with breast cancer. After spending over $15, 000 on a “natural” treatment overseas she ended up having a double mastectomy but sadly died within a year.

If this is the sort of nutrition advice that naturopaths are providing I’d rather have Nutrition Month remain the echo chamber of dietitians promoting truly evidence-based nutrition recommendations.