Dispelling nutrition myths, ranting, and occasionally, raving


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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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Bring on the nanny state

 

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By Marlith (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)%5D, via Wikimedia Commons

I’ve written before about my reluctance to jump on the soda (why are we calling it soda in Canada, anyway? It’s pop, people) tax bandwagon. I just don’t think that it’s addressing the true problem and it’s once again placing the onus on individuals. I’d much rather see high-fructose corn syrup become less artificially inexpensive to produce so that pop would cost more to manufacture and therefore be sold for more. Start paying the farmers more for the corn. Anyway… I found myself in a weird situation when I read the un-authored (what the heck MacLean’s? Where’s the byline?) editorial about the ill-conceived soda pop tax.

According to the author, the problem with the Senate’s new report on obesity is that it lumps all overweight and obese people into one category. Thus, implying that anyone who surpasses the magical BMI cut-off is unhealthy. I don’t disagree with the fact that it’s possible to be healthy at many different weights, shapes, and sizes. I do take some exception to the argument that overweight people are actually healthier than those of “normal” weight. The problem with studies that suggest this is that they’re not taking into consideration changes in weight and the fact that many people lose weight when they’re ill. This may give the false impression that weight is protecting people from illness rather than showing that unintended weight loss is a consequence of illness.”Healthy” weight people may die younger than overweight people because illness may be missed until it’s too late to treat in people who appear to be healthy.These studies also tend to only look at mortality, giving “healthspan” no consideration. Just because you’re living a longer life doesn’t mean that you have good health or a good quality of life during those extra years.

Anyway… I’m a little off-track from the topic I really wanted to address. Essentially, the author is saying that it’s not the government’s job to “tell us what to eat or how much we should weigh”. It’s suggested that the senate report should have focused more on health promotion, which they define as getting kids more physically active. Sigh.

Health promotion is actually providing people with the tools they need to control and improve their own health. It’s more of a population health approach than an individual approach. As such, a pop tax would be a method of health promotion. As essential as physical activity and exercise are to good health it’s fairly well established at this point that diet has a far greater bearing on weight than exercise does. This pop tax is certainly not the approach I would take toward decreasing obesity rates and improving the health of Canadians. However, it’s better than nothing and if it gets people to drink less pop then that’s a positive outcome. If the author truly believes that the government is not already affecting the food choices of Canadians through policies and systems then they’re sorely mistaken.

I’ve read some very good criticisms of the senate’s report. This editorial was not one of them. If you’re interested, check out Dr Sharma’s blog and this piece by Michael Orsini in the Globe and Mail.


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Stephen McNeil gets a failing grade for his response to Nova Scotia’s poor health report card

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Provincial Health Report Card from the Conference Board of Canada

I was driving home from work a couple of weeks ago, listening to the CBC (as per usual), when a segment came on about the recently released provincial health report cards. Nova Scotia did not fare well. We received an overall “D” grade, brought down by our “D” grade for cancer mortality. We also scored poorly on ratings for infant mortality, mortality due to respiratory diseases, and overall life expectancy. Our Premier, Stephen McNeil, made a statement to the effect that while the government does play some role in the health of Nova Scotians, we need to take more ownership of our heath. He said that we should eat better, exercise more, and drink less alcohol. WHAT?! 

I suppose I shouldn’t be all that surprised after the ill-informed op-ed piece by our Minister of Health last year. Really, though, has our Premier never heard of the social determinants of health? How is it possible for someone in such an important governmental role not realise the impact of government on the health of citizens? It’s hard for people to be healthy in our society. In a province where working longer hours is expected, where unhealthy processed foods are more widely available and affordable than nutritious foods, where the weather and poorly cleared sidewalks make even going for a walk difficult, where urban sprawl limits active transportation, where doctors are in short supply and wait times for specialists are outrageous, where many health care plans don’t cover dietitian’s services, where the government profits from the sale of alcohol, where jobs are scare and pay dismally, and so on, the onus should not be placed on the individual to improve population health. It’s the government’s job to make healthier choices more accessible for citizens and to provide us with the services and opportunities we need to be healthy. It’s embarrassing that our Premier would place the blame for our collective poor health on citizens of Nova Scotia when the environment we live in so clearly sets us up for illness.


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More on fat tax

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Recent research showed that a combination of factors was best at discouraging purchasing of “junk” foods. It also showed that, on their own, cheaper healthy options, anti-obesity advertising, and healthy food advertising were ineffective at dissuading “customers” from purchasing the junk food. However, increasing the price of the “junk” by 20% was persuasion enough for customers to select the healthier options.

While an interesting result, there are a number of problems with applying these findings in the real world. The research was done with participants in a laboratory. Thus, their economical means and purchasing behaviours may not have been representative of how they would act in “reality”. Also, were participants representative of the population? I worry the most about the impact of jacking up prices on “junk” food on those who are experiencing food insecurity. Increasing the cost of these foods may cause more harm than good.

In addition, as mentioned in the article we’ve already seen the failure of the “fat tax” in Denmark. Why would we think that increasing the price of “junk” food would be any more effective in North America? And who will decide what foods are healthy and what foods are unhealthy and deserving of taxation. I’ve seen granola bars that were not permitted under school nutrition policies that (in my opinion) were healthier than those that were permitted. The ones that were permitted contained chocolate chips. The ones that weren’t contained almonds, causing the fat content to be too high to meet criteria! Research is always evolving and even within the dietetic world there isn’t consensus on some matters. Some dietitians would rule out butter in favour of margarine. Some would be okay with added sugars, while others would eschew them. Most would say that all foods are okay, with some being everyday foods and others being occasional foods.

Also, what would happen with the increased revenue from “junk” foods? Would it go to the food industry? Would it go to the government? Or would it go to subsidise vegetables and fruits or create community food initiatives?

Yes, this research provides some insight into human behaviour. However, I’m not sure that it’s all that useful of a weapon in the war against obesity.


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Don’t fear the fluoride

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My dad suggested that I read an article in The Coast last month and, slacker that I am, I just got around to reading it. It was written by the founder of “Safe Water Halifax”, an organization opposed to the addition of fluoride to our municipal water supply. Honestly, I find it appalling that an article could be written by a homeopath and student of holistic nutrition, claim to be supportive of science, and yet contain zero links to scientific research. This is not an opinion piece. This is not a personal blog. This is a newspaper article which makes claims regarding the safety of fluoridation yet cites no research to support the claims. The argument? Fluoride is poison and the government has no right to added things to our water.

If fluoride in our water is poisoning us then why is there absolutely no mention in the article of the ailments it’s inflicting upon us? I did blog last year about a report claiming that fluoride in drinking water lowered IQs in children, and was pretty much responsible for every imaginable illness (but wait!… I thought that was wheat…). A statement by the Institute for Science in Medicine provides some background on the history of municipal water fluoridation. It states that at levels between 0.6 and 1.1 ppm there is a wide margin of safety while providing the benefit of increased tooth and bone strength and decreased cavities in children by 20-40%. Only at concentrations greater than 4.0 ppm does it become a risk. And that risk is more cosmetic (i.e. stained teeth) than anything. In Halifax, the average level of fluoride in the water supply is 0.72 ppm. Well within safe limits.

I think that it’s great for people to question the decisions of government and to do research to look out for our own best interests. However, when the crux of your argument is that you distrust anything the government is adding to your food it’s not exactly a solid argument. Without the addition of iron and folic acid to white flour many more people would be suffering from iron-deficiency anemia and many more children would be born with neural tube defects. Iron, like fluoride, is a mineral. Iron, like fluoride (and nearly everything) can be toxic in excessive amounts. Yet, it would be physically impossible to overdose on iron by eating bread. The same can be said for drinking fluoridated tap water. You would die from hyponatremia before you would perish from fluoride toxicity. The fortification of flour with folic acid has been the most effective measure in reducing neural tube defects, such as spina bifida. The addition of iodine to table salt reduced the incidence of goiters and mental deficiency significantly in North America. However, iodine deficiency is becoming a public health concern again as we increasingly use un-iodized salts such as sea salt and rely on un-fortified processed foods. I could go on and on… What about vitamin D added to milk? Calcium and vitamin D enriched milk alternatives?

My point is that the addition of vitamins and minerals to foods and beverages is done to benefit the population. There is no more reason to fear the fluoride in our water than there is to fear all of the other examples above.