Dispelling nutrition myths, ranting, and occasionally, raving


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Is it #NutritionMonth2019 or #DairyFarmersofCanadaMonth and #AvocadosofMexicoMonth?

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We need to talk about Nutrition Month. More specifically, we need to talk about Dietitians of Canada’s Nutrition Month recipes. It’s been a long time (back in 2012 to be specific) since I wrote about the issue of sponsorship in regard to DC’s Nutrition Month materials. To be honest, I feel like a bit of a traitor doing it (DC does many great things to advocate for dietitians), but I think that it’s a real issue. Accepting sponsorship for Nutrition Month is undermining DC’s (and by association all Canadian dietitian’s) credibility.

When DC first released their Nutrition Month recipes I was disappointed, but not surprised, to see that they were sponsored by Dairy Farmers of Canada and Avocados from Mexico. Don’t get me wrong, I consume both dairy and avocados. This is not to cast aspersions on either of those foods. However, I think that a dietetic organization accepting sponsorship from the food industry (no matter what the foods are) creates a conflict of interest. I also think that there are additional reasons why featuring these particular foods in DC resources is problematic. I’ll get into that a little later. So, as I said, I wasn’t surprised. This is nothing new for DC. I had a little rant with my RD colleagues (one of whom also happened to point out that the content of the handouts, aside from the recipes was simply duplicated from last year, sigh) and then let it go.

My frustration was reignited last week when fellow RD, Pamela Fergusson voiced her concern about the industry sponsorship of Nutrition Month on Instagram last week. She’s also written an excellent blog post about this issue that you should read.

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That got me curious so I went on the Nutrition Month website and counted how many times dairy and avocados appear in their featured recipes. Out of ten recipes, eight include dairy and four include avocados. There are 12 additional recipes on their handouts, eleven of these include dairy and six include avocados. That’s a lot of dairy and avocados!

While I love avocados, they are freaking expensive. They’re usually about $2 a piece at the grocery store here. Given that food insecurity is an issue across Canada, DC even has position papers on both individual and household and community food insecurity, it struck me as a little inappropriate for them to so prominently feature a food that’s not within the budget for many Canadians. Even for those who don’t struggle with food insecurity, avocados are often more of a luxury item than a staple food. The same goes for many dairy products, particularly cheese, which is featured in many of the DC Nutrition Month recipes. Realistically, who’s making a “crab and remoulade sandwich” for lunch??

In addition to the issue of cost, there’s the lack of alignment with the new Food Guide. Despite what many people would have you believe, milk (and dairy products) have not been removed from the new Food Guide. They’ve simply been incorporated into the new “protein foods” grouping. However, there is a strong emphasis on choosing plant-based sources of protein more often. I realize that DC would have already developed their resources before the new Food Guide came out. Even so, the old Food Guide only recommended two servings of milk (and alternatives) daily for adults. No matter which Food Guide you look at, it doesn’t make sense that DC would feature dairy in the majority of their Nutrition Month recipes.

This takes me to one last issue that I stumbled upon while tallying up the recipes featuring dairy and/or avocados. That issue is the nutrition information for the Turmeric Basil Roasted Turkey Burger. This burger contains 936 calories, 48 grams of fat (9.1 g of which are saturated), and 773 mg of sodium. To put that in perspective, that’s 416 more calories and 20 grams more fat than are in a big mac (177 mg less sodium though). It’s about 3/4 of a day’s recommended maximum intake of fat and over 1/3 of the maximum recommended intake for sodium. That’s just in one burger! I thought for sure this had to be a mistake so I tweeted at DC to ask them about it. This is the reply I received:

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A “hearty” burger indeed! As much as I believe that all foods fit and that having treats is part of a healthy diet, I really don’t think that a recipe like this is appropriate for a dietetic organization to be promoting. When people are looking for recipes from Dietitians of Canada they’re looking for recipes that meet certain nutrition criteria. They’re looking for recipes that are going to provide them with a reasonable number of calories, not too much fat or salt or sugar and plenty of vitamins and minerals. I think it undermines their credibility as an organization when they allow sponsors (such as Avocados of Mexico who developed this recipe) to be put ahead of the public who rely on dietitians for unbiased nutrition information.


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Is milk out?

I’ve been hearing a number of complaints and concerns about the new Food Guide. The one I’ve been hearing the most is that “dairy is out”. I’d like to dispel that. No, dairy is not “out”. Yes, the “milk and alternatives” food group is gone; as is “meat and alternatives” but milk and dairy products still fit within the protein group in the new guide.

The Food Guide now recommends a proportion-based approach to eating, rather than a more prescriptive portion-based approach. Rather than telling you how many servings of each food group to have every day, and how big a serving is, the new guide simply advises you make half your plate vegetables (and fruit), one quarter protein foods, and the other quarter whole grains. It promotes consuming plant-based protein foods “more often”. This is pretty subjective and should – in theory – make it a lot easier for people to adopt. For some people this may mean consuming plant-based protein foods in larger amounts than animal-based proteins. For others, this may mean consuming plant-based sources of protein more often than they usually do. In a country that’s extremely meat-centric this could mean something as simple as adding more beans to a chili and cutting back on the meat slightly.

I’d also like to point out that given that a quarter of your plate should be devoted to protein foods you can easily mix and match to your heart’s content. This might mean that you have lentils and salmon (like I did last night), cheese and bean casserole, tofu and chicken, etc. It might mean that at one meal your protein comes from milk or meat but that at another it comes from legumes or nuts. Snacks can (and generally should) also include a source of protein. If you eat three meals and two snacks a day this means that there are ample opportunities for you to consume protein from a variety of foods, including milk products if you desire.

Personally, I think that having a food group specifically for milk (and alternatives) was unwarranted and I’m glad to see it go. There are many people who can’t consume milk products (due to lactose intolerance or an allergy) as well as those who choose not to and it is entirely possible to consume a nutritious diet without the inclusion of milk. For those who are concerned about where people will get their vitamin D and calcium from without milk products there are other food sources of these nutrients.

Vitamin D is pretty near impossible to consume enough of through food sources alone anyway, at least during the winter months in Canada and Health Canada recommends all adults over the age of 50 take a supplement of 400 IU/d. I’d also like to point out that milk is fortified with vitamin D as are most plant-based milk alternatives (always check the label to be sure). Other food sources of vitamin D include: egg yolks, salmon and other fatty fish, some meats, and other fortified foods which may include things such as orange juice and cereal.

Non-dairy food sources of calcium include: dark leafy greens (like spinach, collards, and kale), soy beverage, canned fish (eat those bones!), tofu (if prepared with calcium), beans, nuts, seeds, and even blackstrap molasses.

If you are concerned that you may not be meeting your nutrient needs through your diet I recommend keeping a food journal and making an appointment with a registered dietitian.


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Another hot take on Canada’s new food guide

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You all know that I can always find something to bitch about. I’m that girl who’s always the one to find a bug in her freshly picked raspberries or the bone in her piece of fish. My mum will attest to that. It was a running joke in my family that if there was anything weird to be found in the food, I would be the one to find it. So, it should come as no surprise that I have lots to say about the new food guide. But… it may come as a surprise that I don’t actually have anything negative to say about it! In fact, I think it’s pretty fucking great.

In no particular order, here are the changes that I’m most excited about:

  • The addition of food skills (and food literacy). This is literally 85% of my job and it feels really good to have Health Canada supporting it as an important part of healthy eating.
  • The removal of juice as a serving of fruit. It’s going to be so nice not to have to deal with that terrible piece of advice anymore.
  • The removal of serving sizes and recommended number of servings. They confused people and it’s impossible to make recommendations that will work for the entire population. I can’t wait to no longer hear “I can’t eat ALL that” again.
  • I’m glad they got rid of the meat and alternatives and milk and alternatives food groups and lumped them into a proteins group from which they encourage plant-based sources of protein.
  • I appreciate the inclusion of Indigenous foods and ways of eating and the acknowledgement that many people in remote communities and on reserves may struggle to meet the recommendations in the food guide.
  • Following from that, I also appreciate the recognition that external factors, in particular, many social determinants of health, can affect the ability of people to follow a healthy diet.
  • I’m glad that water is recommended as the beverage of choice, again bye bye juice and chocolate milk 👋🏻👋🏻👋🏻
  • I like that the emphasis is on promoting health and only once is weight mentioned. As I’ve ranted about in the past, the food guide is not supposed to be a weight loss diet plan.
  • The photos included in the guide are really appealing. They look way more appetizing to me than the old cartoonish images did. Plus, they’re all about full meals and not just random foods.
  • The overall focus is on a healthy pattern of eating, not just individual nutrients. Much more in-line with how we actually eat. Plus it’s advised that we enjoy (wow!) our food.

My one concern (aside from a couple of very minor things) is that apparently Health Canada does not plan on making the resources for the general public available in print. I think this is a huge mistake. Not everyone has ready Internet access. Also, the old food guide was used in schools and other educational settings (including the food literacy classes I teach) as a teaching tool. I work in public health and we get MANY requests from schools, organizations, and individuals for copies of the food guide. I’m not sure how we’re going to educate people and incorporate the food guide into our programs if we don’t have a print resource available. I hope that Health Canada will reconsider this decision so that everyone has equal opportunity to benefit from the new food guide.


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Do dietitians follow the Food Guide?

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The above inane tweet last week prompted me to post a couple of tweets in which I screamed into the void about a) people not following dietary guidelines anyway and b) weight not being indicative of health. Which then lead to me posting the following poll:

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Obviously, this is a completely unscientific poll but it does show that the majority (83%) of RDs who responded do not generally follow the dietary guidelines for their respective counties. This could be for any number of reasons. Most didn’t respond with a reason. Those who did said that they weren’t big on fruit of dairy or the carbs (that’s the grains food group) are too high. Personally, I suspect that some days I’m low in vegetable and fruit consumption or milk and alternatives. Other days I’m definitely over. And if I’m being completely honest, I have something from that “other” food group (aka sometimes foods) on the daily.

The truth is, the Food Guide is just a guide. It’s not a bible. It’s intended to provide people with all of the nutrients and energy they need to be healthy and active but everybody is different. We all have different needs and preferences. I know that people really like to rag on dietitians and say that all we do is preach the food guide but I’m here to rain on that parade. Dietitians are people too and we enjoy food for more reasons than just as fuel. We are not robots that run on kale and quinoa. I think that most of us think that the food guide could be improved (and fingers crossed it will be whenever they finally come out with the new version) but we also know that it’s just meant to be a tool.

Food Guides are meant to guide people toward nutritious food choices. They encourage a variety of foods from all of the food groups. The overall message that people should be taking from a food guide is that there are healthy choices in all the food groups and eliminating any one food group may result in deficiencies. Also, that eating only one type of food from each food group (e.g. lettuce as your only veg or bread as your only grain) is not going to provide you with all of the nutrients that you need. However, it’s also important to listen to your own body and nourish it accordingly. If you’re not hungry don’t sweat the fact that you’ve only had 5 servings of vegetables or 4 servings of grains. Conversely, if you’re extra hungry one day, don’t feel like you have to limit yourself to the servings recommended in the Food Guide.

Healthy eating really doesn’t have to be complicated or rigid. In fact, if you think that you’re eating healthily and you’re finding that it is complicated or rigid then you diet (or relationship with food) probably isn’t all that healthy after all.


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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.