Food Politics

As medical students, having previously studied nutrition and epidemiology,  not only food but also food politics are close to our heart.  We would not want to bore you with our thoughts in our daily posts, but if you are so inclined, read ahead:

September 29, 2015 – 

After years of heart-healthy diet fads focusing on single nutrients, the Heart and Stroke Foundation has come full circle and is now recommending quality of overall diet instead of targeting single components such as saturated fat, cholesterol, and other components. This is interesting as it is beginning to acknowledge that the diseases we see in our society today are not easily caused by nor fixable by single nutrients. Although some conditions require specific dietary modifications, generally it seems like we are finally making a move toward simply recommending a more balanced diet, with fewer refined ingredients. What matters most is the overall diet!

April 3, 2014 – Prescribing bikeshares to fight against obesity in Boston

Today is the first day in 2014 that a cyclist crossed the road I walked along – a fit, elderly man cycled past and I couldn’t help but smile. The sun is out, and it even feels warm – time for me to get my bike out and get moving!

Although this post is not about food exactly, it’s about physical activity, and the lack of it in our daily lives which is a major contributor to the current obesity epidemic. I’m guilty of it too: I spend far too long at my own desk, and many days go by where I am ‘too busy’ to take the time out of my day to work out. One reason I love riding my bike (and I know Catherine would probably agree), is that even on those really busy days, it acts as a workout to take me where I need to go, and it gets me outside, in the fresh air, and lets me explore new roads/paths and places in town.

I think allowing physicians to prescribe a bike share membership is a really interesting way to promote bike use, increase physical activity, and to do so in a way that integrates activity in daily life rather than forcing individuals to make time for exercise. It’s something that addresses several of the social determinants of health, if it is indeed a welcomed tool by the patients who receive this. Of course, long distances still can’t be travelled but for those shorter journeys, in the right conditions, why not take a bike for a spin in the name of your health? After all, physical fitness or capacity for exercise is often one of the most important predictors of health! And it’s fun!

http://www.cbc.ca/newsblogs/yourcommunity/2014/04/doctors-prescribing-bike-share-memberships-to-combat-obesity.html

2 August 2012 – The Epicentre of Canadian Food Politics: Canada’s Food Guide

So honestly, when was the last time you took out your copy of the Canada Food Guide to plan your daily meals with? I must admit that although it’s a useful resource, the only time I’ve ever actually used it has been in class when I was studying Canadian eating habits, and when I was teaching adults and children about healthy eating choices to manage Type-II Diabetes or support healthy growth. I don’t think most of my friends use it much.

Is it really useful? Applicable? Appropriate? Well, it turns out that’s a pretty common question.

Since its origin as a guide published during the Second World War, the Food Guide has gone through many evolutionary steps. Some might argue, however, that it has not changed that much. It was first published in an effort to address widespread malnutrition (undernutrition) as a result of inadequate rations during the war. Nowadays, it’s published in an effort to address widespread malnutrition (often overnutrition) as a result of our current society. It’s published by a panel of experts including healthcare practitioners, dieticians, industry representatives, and government representatives. Since its roots, it has been criticized for siding with industry, instead of fully representing the interests of the consumer.

There are those who argue that because it has industry influences, it is not really created with the consumer’s best interest at heart, and thus that it is not really the tool it was meant to be.

Others argue that in our world collaboration between government, industry and citizens is the only true way to move forward in our day and age, and that since it’s inevitable, it should not be a problem.

I do tend to agree that I’d like the guide to centre around the consumer, and to include dietary recommendations for a healthy diet that are entirely evidence-based. The problem is – is there such a thing as purely evidence-based advice available? Unfortunately, I do  side with idealists when it comes to what I’d like best, but then I find myself stuck when it interacts with reality, where it’s arguably impossible to negate interests.

So I guess the next best thing, which is my main point, is that if we cannot have a purely evidence-based publication, let’s not pretend that it is.

-Sitelle

24 July 2012 – A lesson on food insecurity in a West African marketplace

Hunger hurts, we all know that. I learned that in some cultures, people don’t eat in public as they don’t want to make people uncomfortable who do not have enough access to food. Does the fact that we live in a culture where we promote eating in public (e.g. many of us love the Drive-Thru in North America) mean we are more food secure? Does it mean we care less about others’ access to food? I doubt either of these are true, but I did find it interesting to experience, and somewhat hard to break the habit of eating in public while I was there.

6 October – Canada and Caffeine Regulation: they may ask for advice, but don’t listen

An article published today entitled Energy Drink Labels to Contain Warnings discusses a recent move by Canada to change how energy drinks are regulated. They’re no longer going to be regulated as a ‘natural health product’ but instead a ‘food’.

The important thing to consider is what, exactly, is a regulatory change going to mean, for the average consumer (a 17-year-old probably)? It means they might know that there’s now a maximum amount of caffeine allowable per beverage (180mg caffeine), and they’ll now have a nutrition label printed on their can.

An 8-member expert panel was convened to make recommendations to Health Canada on how they should regulate energy drinks. They recommended restricting sale to certain ages, and to certain locations, among others. Restricting advertising to certain age groups was also suggested.

In light of these recommendations, what does the government do? They opted for the paperwork – changing the category under which this product is regulated – from natural health product to food. What will this do? What of all the other recommendations? What about all the other ‘expert’ advice they ignored?

In my opinion, this change will not mean much. The caffeine limits the government is imposing are a good plan. A good start. Providing nutritional labels on these products is also a good idea. In fact, I can’t believe the requirement did not exist before. We’re making progress, but at the pace of a slug, and at a high potential cost.

Quite frankly, I think the bigger questions need to be re-iterated. Who is most vulnerable to these drinks? Exactly those people to whom they are advertised.

On their website, (which still has not been up-dated after this announcement),  Health Canada states:

• Carefully read the labels of all health products you consume, including energy drinks, and follow label instructions…
• Energy drinks should be consumed in moderation. Energy drinks should not be taken on an empty stomach and should not replace foods.
• Do not mix energy drinks with alcohol.
• …

My first thought is who, aside from a few people who are actually interested in this or at stake, actually take the time to read this information available on the website before consuming their first energy drink? Next, who actually follows these recommendations? Third, mixing energy drinks and alcohol is common. It’s not difficult to see, and happens nightly in many bars. So, then, how effective is the recommendation not to mix alcohol and energy drinks anyways? I’ll let you judge that one.

Most importantly, I think that the current regulatory changes are not protecting children and young teens any more than they did before. Once again, on their own website, Health Canada compiles a list of general toxic effects of caffeine:

• general toxicity (e.g. muscle tremors, nausea, irritability)
• cardiovascular effects (e.g. heart rate, cholesterol, blood pressure)
• effects on calcium balance and bone health (e.g. bone density, risk of fractures)
• behavioural effects in both adults and children (e.g. anxiety, mood changes, attentiveness)
• potential links to cancer
• effects on reproduction (e.g. male and female fertility, birth weight)

While adults are generally safe beneath 400mg caffeine/day, children between the ages of 10-12 should not exceed 85mg caffeine/day… roughly equal to two cans of cola. There is no mention of recommendations for those beyond 12 but not yet adults, meaning there’s an information gap. One can of energy drink is allowed to contain up to 180mg… which is more than twice the allowable amount for someone 12 and under. What will stop them from drinking more than 1/3 of a can after getting their hands on it?

I guess what I am trying to say is that I don’t think this move is going to protect the most vulnerable to this type of product any more than it did before, and if it doesn’t protect them, what good does it really do?

26 September – What does renaming do to a problem?

Naming issues in a society can create divides which may facilitate discussion, help in addressing the situation, but which may also contribute to stigmatization. Today I read an article by the CBC which raises the point that some parents would prefer if physicians not to call their children “fat” or “overweight”, instead replacing these highly loaded (but potentially important for other reasons?) terms with the more general and currently less loaded term “unhealthy weight”. I want to raise the issue of why these terms were created in the first place (obesity is certainly different from overweight), and what does replacing these terms do to the conditions these terms referred to?

The article raises the issue about the findings in the paper that suggest (although it is only hypothetical) that certain terms are more motivating for children to improve their weight circumstances than others. While this is interesting, I think it should be examined in a real context rather than a “if your child was obese, what would you…?” sort of context.

Does renaming the problem help at all? It would certainly be beneficial if it could reduce stigmatization attached to weight issues. It would also be beneficial to use certain terminology over other if it was clearly more motivating to change existing habits. The truth is, though, that changing the wording will probably not change body image ideals which our society holds (which I believe is at the bottom of all this). Changing terminology, therefore, may not actually be helping the situation much. Furthermore, I am afraid that it might do a disservice by lumping two different situations under one umbrella, and if a physician doesn’t name a certain condition in one way certainly won’t change how this is perceived at school, for example.

On the other hand, it is possible that image ideals are what are wrong, and that instead we may need to begin adopting a slightly heavier standard as our normal simply because of how our society has now evolved. Although I am skeptical about this, I think it is still an important issue to discuss.

18 September – MacLeans needs to fact check

An article from MacLeans Magazine this week suggests that a high-salt diet is better for humans than a low-salt diet.  With such mixed messaging, its no wonder that health conscious members of our society are often confused about dietary choices.  With all the fad diets out there, it is not always easy to sift the old wives tales from strong scientific evidence.

And for the record, MacLeans has it wrong this time around.  The research they cite to support the claim that high-salt diets are better for people is funded by the Salt Institute (the USA’s largest salt lobby group).  Funny coincidence, eh?

Next time MAcLeans, stick to the systematic reviews on the topic.

http://www2.macleans.ca/2011/09/15/a-pinch-of-reality/

15 September – Harvard’s response to MyPlate

Harvard joins the crowd critiquing USDA’s newly released MyPlate.  They have released their own healthy eating plate, mirrowing MyPlate.  The big differences?  They promote water, tea and coffee over milk as the beverage of choice and insist that all grains should be whole instead of refined.  Sounds like the food industry didn’t influence Harvard as much as it did USDA…

http://www.hsph.harvard.edu/nutritionsource/

23 June – The evils of Potato Chips

I am the first to admit how much I love munching on potato chips. Between the crispiness and saltiness, they make the perfect snack (and can be at times nearly impossible to stop munching on!). So it comes to no surpirse that a new article in the New England Journal of Medicine is reporting that eating potato chips (along with sugar-sweetened beverages such as pop and fruit drinks) is associated with upwards of 1 pound of weight gained per year.

http://www.cbc.ca/news/health/story/2011/06/23/diet-weight-gain-potato-chips.html?ref=rss

Now if only there was something equally as delicious (with half the calories/fat/salt) as a plate of nachos for a midnight snack…

26 May – Is fruit sabotaging your weight loss?

I was reading the Globe and Mail this evening, when I came across this article entitled “Is fruit sabotaging your weight loss”.  The article’s premise is that most popular diets such Atkins or the Dukan diet that the Middleton sisters famously went on recommends that individuals trying to lose weight avoid fruit.  This argument is founded on the high sugar content of fruit.  But not all sugars are created equal – and those in a banana or berries (not to mention all the other micronutrients and antioxidants) are far superior to anything you would ever find in vitamin water.

So to me, the trouble here is that this article was featured in the Globe and Mail – Canada’s most widespread newspaper – and founded on very little concrete scientific evidence.  It makes you understand why and how the general public no longer knows what to believe when it comes to nutrition – contradictory messages are coming from trusted sources.

http://www.theglobeandmail.com/life/health/new-health/health-nutrition/nutrition-features/is-fruit-sabotaging-your-weight-loss/article2030287/

14 March – Does obesity ever become negligence?

I was chatting with a  colleague, a health care practioner who regularly practices up North.  He was telling me how just last week, he saw a 13-year old boy in the clinic who weighed over 300 pounds — giving him a BMI of 52.  BMI is often used a proxy for body fat.  A BMI under 18 is considered underweight, 18-25 normal, 25-29 overweight, 30-39 obese, and 40+ clinically obese.  This child is literally off the radar.

It’s hard to imagine how a 13-year old could weigh so much.  You have to wonder what he is fed, how sedentary is his lifestyle, could he even be neglected? But then again, you can imagine how he probably is from a very poor family, and up North, where a bag of chips are cheaper than a banana and Coca Cola is cheaper than milk, he is unlikely to be fed nutriously.  Up North, where for a few months of the year there is over 20 hours of darness and it is below – 30 degrees, how is a child supposed to play outside?  There have been a few cases in the USA and the UK where a child is removed from his or her parents due to concerns of negligence in allowing their child to become morbidly obese.  But up North, where you have some of the already highest levels of foster care in Canada, and poor parents struggling to make ends meet with circumstances more often than not beyond their control, can a child’s weight become criminal?

It is certainly food for fodder.

– Catherine

28 February – My first experience of indoor cooking fires without chimneys.

There is increasing evidence that indoor air pollution from open cooking fires in homes has a negative effect on health, increasing the risk of asthma, and other diseases.  The problem is, improving this situation is not as simple as handing out new stoves.  For one, stoves are often integral parts of the culture within which they are used, and so people are reluctant to change because this changes the preparation and taste of food.  Also, these alternative stoves that pollute less often require a fuel that must be purchased and distributed, instead of being foraged or harvested.  This makes tackling the indoor air problem even more challenging – not to mention that the thatched roofs on these homes often last longer where an open cooking fire is used inside.

I just spent 4 nights in Laguna, a Maya village in the Toledo district of Belize, where this problem was clearly evident (a welcome change from simply reading about this).  Each home I visited (approximately 6) had a gas stove (that is conveniently used as a storage shelf and counter), and a cooking fire and hearth that is always kept lit and is used to prepare all meals except when wood is too wet to use in the midst of the rainy season.

I could not help but think about what this all means in terms of health prospects, the importance of culture, and development.  The question is, how can we move forward with this while remaining sensitive to all the different facets of the issue?

-Sitelle

9 February 2011 – Junk food may lower IQ of Kids (http://bit.ly/dV2iPI)

The Journal of Community Health and Epidemiology recently published a study Monday that suggests an association between processed food consumption as a child andIQ 8.5 years later  (for the evidence diehards, here’s the abstract – http://jech.bmj.com/content/early/2011/01/21/jech.2010.111955.abstract).

Despite the substantial loss to  follow-up, the authors did a fairly decent job adjusting for all sorts of confounders (family income, maternal education, home environment, etc.  Their proposed mechanism is that processed food lacks the nutrients found in healthier diets, potentially hindering cerebral development.

It makes you wonder if the government is ever going to stop subsidizing junk food industry (corn is hugely subsidized, which brings down the costs of  items such as soft drinks dependent on high fructose corn syrup) and start subsidizing produce?

– Catherine

4 February 2011 – Sodium Working Group Disbanded (http://bit.ly/gdpAdd)

Excessive salt consumption is the largest preventable risk factor for cardiovascular disease, Canada’s leading cause of death.  The average salt intake is 3,300 mg, over twice the daily limit recommended by nutritionists.  Over 70% of our salt comes from processed food – canned food, frozen food, and bread products.  Reduction of salt is safe and, if done incrementally, unnoticeable to the taste buds of consumer.

The canadian government has been slow to take action with respect to restricting salt levels in manufactured foods (if you think about it, Canada’s first export was dried cod, absolutely dependent on salt). Recently, some progress had been made by the Sodium Working Group, composed of governmental, public health, NGO and industry representatives.  Health Canada has disbanded this group, in favour of the Food Regulatory Advisory Committee, at the beck and call of industry.

Makes you doubt where Canadian priorities lie.  I mean, who really needs health and wellbeing when industry can feast off our illness?

– Catherine