Christina Seely RD CDE

Clinical dietitian at Parkwood

Mental Health Care

Contributing authors:

Christine Kijak, RD, CDE

Jamie Yermus, RD, MPH

The NEW Canada’s Food Guide: Is it Relevant to the way we Eat Today?

Faculty/Presenter Disclosure

• Presenter: Christina Seely

• Relationships with commercial interests:

– Previous speaker honoraria received from Novo Nordisk

• No other conflict of interest for today’s

presentation

Learning Objectives

⚫ To review the evolution of and evidence behind

Canada’s Food Guide

⚫ To review how the guide and Canada’s Healthy

Eating Strategy compare to current eating habits

and hot nutrition topics

⚫ To provide practical ideas and resources based on

the nutrition recommendations for the general

population

Knowledge is Only One Part of the Picture

Wealth is a Strong Determinant of Health

Canadian Health – the Good News

⚫ Life expectancy has steadily increased in past

decade, and gap between men and women has

been narrowing

⚫ Overall mortality and premature mortality rates,

particularly for CVDs, continues to decrease

⚫ Declining rates for CVDs and COPD are linked to

the major decrease in smoking across all ages

Health Canada report - Health Status of Canadians 2016

Canadian Health –Areas of Concern

⚫ 11 million live with diabetes or prediabetes in 2019,

costs of care have increased from $14 billion

(2008) to $30 billion (2018) -Diabetes Canada

⚫ Approximately 4 in 5 adults have at least 1

modifiable risk factor for chronic disease

– self-reported tobacco smoking, physical inactivity,

unhealthy diet or harmful use of alcohol

⚫ Inequalities in chronic disease prevalence across

subgroups of Canadians exist

Canadian Eating Habits

Health Canada Infographic

Canadian Food Environment

⚫ “In recent decades, highly processed products

are now readily available, competitively priced,

offered in large portion sizes, and heavily

marketed” – Health Canada

⚫ Buying in bulk - Costco is increasing market

share from traditional grocery stores

Canadian Food Environment

⚫ Bombarded with marketing - Kellogg’s spent $32

million in 2018 advertising Pop Tarts alone. Coca-

Cola spent $269 million advertising coca-cola

⚫ Exploding options - Between 1975 and 2008, the

number of products in the average supermarket

swelled from an average of 8,948 to almost 47,000

– There are ~ 300 options for yogurt alone

How Canadians Eat

⚫ Trends include foodie culture vs convenience

⚫ Single-person households have more than

doubled and are now most common type at 28%

⚫ Time cited as biggest barrier to food preparation -

avg < 30 mins / day for food preparation

⚫ Younger generations use more convenience items

related to schedules and lower food and nutrition

skills learned at home / school

Journal of Nutrition and Education Behaviour, 2017

How Canadians Eat

⚫ Mobile food delivery apps are estimated at 11

percent of all quick-service restaurant sales

⚫ Apps are reshaping how food is purchased and

consumed, especially amongst millennials

– Millennials >44% of food budget on restaurant food

⚫ UberEats, Just-Eat, Skip the Dishes, and

Foodora, are growing 10-15% a year and have

a $97 billion market globally

Health Canada Infographic General Social Survey (Canadians at Work and Home), 2016.

Book about the Food Revolution

⚫ “Food has never been so angrily polarized into

virtues and vices, elixirs and poisons. I worry that

in many cases, our pursuit of the perfect meal has

become the enemy of the good-enough meal.

While we fixate on this or that wonder ingredient,

the thing that seems to be in short supply is the

unglamorous home cooked dinner”

Canadians Have a Relatively Affordable Food Supply

Compared to countries like Nigeria where 56.4% of

consumer expenditure spent on food

Food Insecurity Still Prevalent

Challenge of Eating Well in Today’s Food Environment

⚫ Healthy behaviour is abnormal behaviour

– Pleasure principle

– Path of least resistance

– Preference for short term gain

– Environment pulls for unhealthy behaviours

⚫ “If you are pressed for time doesn’t picking up

food through a drive-through make perfect

sense?” - Dr. Michael Vallis, leader of the behaviour

change institute

Feeding Families

⚫ The vast array of conflicting information can

create fear and anxiety around feeding children

⚫ “Most parents understand that they should

provide healthy food for their children, but the

reality of work schedules, children’s activities

and different food preferences can make meal

preparation a hectic and frustrating experience”

– From a 2017 poll of 1,767 parents who had at least

one child age 4-18 years

Canada’s Healthy Eating Strategy

Changes to labels (must be completed by 2022)

Front of the Package Symbols (roll out pending)

Canada’s NEW Food Guide –released Jan 2019

Canada’s Dietary Guidelines

⚫ 55pg document

expanding on the

information on the guide

⚫ Another health

professionals document

pending later in 2019 with

information about

portions, nutrients etc

Does the Food Guide Matter to Canadians?

⚫ Integrated widely by governments and

stakeholders into nutrition policies, programs and

resources

⚫ Taught in schools and promoted by health

professionals

⚫ Influences foods served in Canada’s public

institutions – day cares, schools, LTC, hospitals

⚫ Second most downloaded document from HC after

income tax form

Food Guides THEN and NOW

⚫ 1942- Canada’s Official Food Rules

⚫ 1944- Canada’s Food Rules

⚫ 1949- Canada’s Food Rules

⚫ 1961- Canada’s Food Guide

⚫ 1977- Canada’s Food Guide

⚫ 1982- Canada’s Food Guide

⚫ 1992- Canada’s Food Guide to Healthy Eating

⚫ 2007- Eating Well with Canada’s Food Guide

⚫ 2019- Canada’s Food Guide (9th edition)

1942- Canada’s Official Food Rules

⚫ 2nd World War origins- address crisis of malnutrition,

focused on rations and fueling solders

⚫ Met 70% of the dietary standard due to limited supplies

⚫ 6 Food Groups – Milk

– Fruit

– Vegetables

– Cereals and Breads

– Meat and Fish

– Eggs

1942- Canada’s Official Food Rules

1961- Canada’s Food Guide

1992- Canada’s Food Guide to Healthy Eating

2007- Eating Well with Canada’s Food Guide

2007- Eating Well with Canada’s Food Guide

Criticisms of the 2007-2018 Version

⚫ Serving sizes difficult to follow

⚫ Too much information on the guide, had all

ages and genders listed

⚫ Protein food group was called “meat and

alternatives” put focus on meat

⚫ Criticism about juice as a fruit serving, and that

having a dairy food group was influenced by

industry

2019 - Canada’s New Food Guide Rainbow → Healthy Plate

½ plate vegetables ¼ plate protein foods

choose water ¼ plate whole grains

A healthy meal is comprised of a variety of foods from these three food

groups:

2019- Canada’s Food Guide

Milk and Alternatives and Meat and Alternatives now in Protein Foods

Basic Principles and Concepts Behind The New Food Guide

✓ Focus on HOW to eat, promotes cooking

✓ Promotes plant based foods, whole foods

✓ Can be individualized to taste, culture, budget

and lifestyle

✓ Limiting the 3 S’s (sugar, saturated fat, sodium)

✓ Emphasis on health risks of alcohol

Resembles Other Countries’ Guides

Korea

USA since 2011

Translations Released June 24, 2019

Feedback from Public and Professionals

⚫ More positive reactions than negative, seen as

an improvement, move to digital resources

⚫ Mixed views from public on social media:

– “Makes a healthy diet look like punishment. Is this

really all we get to eat in a day?”

– “I love it. The photo of the plate is easy to follow”

– “This new guide looks realistic and healthy. I

sincerely hope it will make a positive impact for

people”

Solid Evidence

⚫ Only high-quality scientific reports on food and

health were used including systematic reviews

on over 100 food-related topics

⚫ Over 400 convincing conclusions summarized

in the Evidence Review for Dietary Guidance

2015 and the Food, Nutrients and Health:

Interim Evidence Update 2018

⚫ Industry-commissioned reports were excluded

to reduce potential conflict of interest

Is the new CFG appropriate for People living with Diabetes?

⚫ “Starting point of nutrition therapy is to follow the healthy

diet based on Eating Well With Canada's Food Guide.

Choose the dietary pattern that best aligns with values,

preferences and treatment goals for long-term

adherence” – Diabetes Canada 2018 Guidelines

⚫ Plate model can provide as low as 25% carb

⚫ Starchy veg can be considered for the 25%

starch/grain portion instead of the veg portion

⚫ Further adaptation needed for medical dx such as

renal impairment, IBS, wounds

Plant-Based Diet Movement

⚫ Does not apply only to vegetarians

⚫ Refers to eating plant based foods more often

⚫ “Flexitarian” has become more popular – meat

or fish ~3X / week

Plant Based Foods

✓Plant based proteins: Beans, nuts, lentils, peas, nut

butters, soy beans, soy nuts, tofu, chickpeas, etc.

✓Plant based beverages: soy milk, almond milk, etc.

✓Fruits and vegetables: apple, broccoli, carrots,

spinach, tomatoes, berries, etc.

✓Whole grains: Quinoa, barley, oats, wild/brown rice,

whole grain pasta, whole grain bread, buckwheat,

farro, amaranth, etc.

Q: Is Soy Safe to Eat?

⚫ “Results of recent population studies suggest

that soy has either a beneficial or neutral effect

on various health conditions. Soy is a nutrient-

dense source of protein that can safely be

consumed several times a week, and is likely

to provide health benefits—especially when

eaten as an alternative to red and processed

meat”

Harvard School of Public Health

Lentils

⚫ High in fibre and protein. They are a good

source of folate, potassium and iron

⚫ Delicious, low-cost substitute for meat

⚫ Cook quickly, versatile in different dishes

⚫ French/Indian/Lebanon cuisine includes lentil

dishes

⚫ Can be mixed in ground meat dishes

Beans

⚫ Beans are good sources of protein, potassium,

excellent sources of fiber, and naturally fat-

free, sodium-free, and cholesterol-free

⚫ Can add chickpeas, navy/black/kidney beans

in any salad, pasta, or rice dish

Not Just Plants

⚫ Although the Food Guide emphasizes plant-based

foods, it still includes nutritious foods such as:

✓ fish

✓ eggs

✓ poultry

✓ lean red meat

✓ lower-fat milk, lower-fat yogurts, and cheeses lower in

fat and sodium

Limiting the 3 S’s

Limiting highly processed foods:

✓ Sodium• i.e. processed foods and beverages (deli meat, canned foods,

chips, cereals)

✓ Sugar• i.e. sugar sweetened foods and beverages, confectionaries,

sugars, syrups, preserves, desserts, bakery products

✓ Saturated fat• i.e. red and processed meats, high fat dairy products, pastries

Limiting the 3 S’s

Some processed foods do not have added salt, sugar and saturated fat and can be part of a healthy dietary lifestyle:

✓ Canned Foods

✓Dried Foods

✓ Frozen Foods

Study of Dietary Risks in 195 Countries from 1990-2017

⚫ “Suboptimal diet is an important preventable risk

factor for non-communicable disease. Improvement

of diet could potentially prevent 1 in every 5 deaths

globally”

⚫ “High intake of sodium, low intake of whole

grains, and low intake of fruits were the leading

dietary risk factors for deaths and disability-adjusted

life years”

The Lancet Health effects of dietary risks in 195 countries. Pub

April 3, 2019

Whole Grains / Fibre

⚫ Avg fibre intake is 14 g per day intake (25g women,

38g men recommended) 30-50g per day for DM

⚫ Comprehensive review suggested high-fibre eaters

have a 15- to 30-per-cent lower risk of heart attack,

stroke, type 2 diabetes, colorectal cancer and

cardiovascular-related death compared to low fibre

⚫ Consuming 25 - 29 grams of fibre a day was

protective

The Lancet Carbohydrate quality and human health 2019

Study on Recommended Carbohydrate Intake

⚫ A large population study reported 50–55% of diet from

carbohydrate associated with the lowest risk of mortality

⚫ Both lower carb consumption (<40%) and higher carb

consumption (>70%) conferred greater mortality risk

⚫ Mortality increased when carbohydrates were

exchanged for animal fats or protein, and mortality

decreased when the substitutions were plant-based

(vegetables, nuts, and whole-grains)

Dietary carbohydrate intake and mortality: a prospective

cohort study and meta-analysis 2018 The Lancet

Fruit vs Vegetables?

⚫ Higher fruit and veg intake associated with slower

cognitive decline, healthy bp, lower risk of heart

disease, stroke and certain types of cancer

⚫ Some vegetables are the best sources of nutrients

– leafy green veg for certain carotenoids associated

with healthy brain aging and immune function

– cruciferous veg (broccoli/cauliflower) only source of

glucosinolates (anti-cancer phytochemicals)

https://www.theglobeandmail.com/life/health-and-fitness/article-is-

fruit-just-as-healthy-as-vegetables-on-your-plate/#comments

Recommendations Around Sugar

⚫ “Limit free sugar to <10% of total energy intake”

⚫ Free sugars are any sugars added to food

– Includes honey, syrups, fruit juice concentrates

⚫ For 2000 kcal this is 200kcal / 50 g sugar (12.5 tsp)

⚫ Examples of sugar content:

– Can of pop 39g

– Greek yogurt 10g

– Kashi granola bar 8g

– Package of maple instant oatmeal 13g

Make Water your Drink of Choice

⚫ In 2015, sugary drinks were the main sources

of total sugars in the diets of Canadians, with

children and adolescents (9 to 18 years of age)

having the highest average daily intake

⚫ Water, unsweetened milk or fortified soy

beverage, and fruit are recommended

⚫ Average total fluid requirement is 2.2L / day for

women and 3L/ day for men

Canadian Beverage Intake

Q: How to get enough calcium without a dairy food group?

Age in Years Aim for Intake of (mg/day)

Men and women 19-50 1000

Women 51-70 1200

Men 51-70 1000

Men and Women 71 and older 1200

Food Item Mg calcium

3.3% homo, 2%, 1%, skim milk 250ml (1 C) 291-322

Cheese 50g (1.5 oz) 252-386

Yogurt, fruit bottom 175g (¾ C) 221-291

Other Calcium Sources

Food Item Mg Calcium

Spinach, cooked 125 mL (½ C) 129

Salmon canned, with bones 75 g (2 ½ oz) 179-208

Tofu, set with calcium 150 g (¾ C) 234-347

Soy beverage 250ml (1 C) 321-324

Almonds, dry roasted 60 mL (¼ C) 93

Beans (white, navy), canned or cooked 175 mL (¾ C) 93-141

Broccoli 125ml (½ C) 35

Calcium bioavailability from dairy - 30% absorbed.

Bioavailability from plant foods varies considerably. Oxalates

and phytates in vegetables reduce calcium absorptionhttps://www.dairynutrition.ca/nutrients-in-milk-products/calcium/calcium-and-bioavailability

Sample Day Menu Based on Guide

⚫ Vegetable stuffed omelet with slice whole grain

toast or fruit

⚫ Whole grain tuna wrap with raw veggies or

vegetable soup, and a fruit or yogurt

⚫ Bean burger with salad

“Healthy Eating is More than the Foods you Eat”

Additional messages from health professionals resource

Shift from what to eat→ how to eat

✓ Mindful eating

- Be present in the eating experience without judgement

- Take time to eat

- Listen to hunger and fullness cues

- Enjoy your food and being mindful

of the eating experience

- Avoid distractions while eating

Mindful Eating can be Incorporated into Diabetes Care

⚫ Not currently in CDA guidelines but promising research

is ongoing

⚫ “Mindful Eating for Diabetes is a practical mind-body

approach that shifts focus from strict nutrition rules and

exercise regimens to learning to listen to and

understand your “inner expert”, putting you in charge

of your eating and health decisions.”

– Eat What You Love, Love What You Eat with Diabetes by

Michelle May, MD and Megrette Fletcher, MEd, RD, CDE

https://wn4dcsymposium.com/wp-content/uploads/Why-A-Weight-Neutral-

Approach-Is-Essential-In-Diabetes-Care-Ebook-June-2019-final.pdf

Enjoy your Food

⚫ The benefits of enjoying your food include:

– tasting the flavours

– being open to trying new foods

– developing a healthy attitude about food

⚫ A healthy diet should allow for personal food

preferences, which can reinforce the

enjoyment of healthy eating

Cook More Often

⚫ Compared to those with “basic or limited”

mechanical food preparations skills, those who

reported having “very good skills” were more

likely to also report:

– Higher frequency of vegetables and fruit

consumption

– Better self-perceived eating habits

– Higher levels of perceived health.

Dietitians of Canada + Health Canada Study

Is the New Guide More Expensive?

⚫ If a family of 4 decided to change the type and

proportions of food they ate from

recommendations in the 2007 Food Guide to

those of the 2019 Food Guide, it would cost on

average, 6.8% less

Eat Meals with Others

⚫ Meals may be the only time of day for families

to reconnect, relax, recharge, laugh, tell stories

and catch up on the day’s ups and downs

⚫ Benefits start at two family meals together a

week with five or more recommended

⚫ All meal times count including breakfasts or

weekend lunches

Benefits of Family Meals

⚫ Better academic performance

⚫ Higher self-esteem

⚫ Greater sense of resilience

⚫ Lower risk of substance abuse

⚫ Lower risk of teen pregnancy

⚫ Lower risk of depression

⚫ Lower rates of eating disorders

https://thefamilydinnerproject.org/uncategorized/family-dinner-

references/

Some Fad Diets can be Restrictive and Pose Nutritional Risks

⚫ “Canadians are exposed to the promotion of diets

that are often commercially driven and promise a

quick fix for weight loss or the management of a

chronic disease”

⚫ “Fad diets can be restrictive and pose nutritional

risks, particularly without appropriate planning for

nutritional balance” – Health Canada

⚫ 1-5% will stay on a diet long-term

Popular Diets Searched on Google

Why Diets Remain Popular

⚫ Whole 30, ketogenic diet etc promote eliminating

foods and following (often strict) guidelines

⚫ Reduces decision fatigue, clear rules, removes

craved foods

⚫ Provide on-line community of support and many

examples of weight loss stories (few at 5yr+ mark)

⚫ Appeal lies in providing new and straightforward

solutions (ie. change macronutrient content of diet)

to a complex area influenced by many factors

Dieting is a Risk Factor for Weight Gain

⚫ “..obesity prevalence keeps increasing, in a similar

speed as diet attempts. As many as 45 million

Americans are always in the on-and-off process of

diets. This apparent paradoxical correlation is based

on the deluding assumption that dieting automatically

means weight loss. For most, diets will bring further

over-compensatory weight gain”*

⚫ Possible resource: Weight Neutral 4 Diabetes Care

– https://wn4dc.com/

*http://www.digitaljournal.com/pr/4335262

Popular Diet –Ketogenic Diet

⚫ Avg Western diet 55% carb, 15% pro, 30% fat

⚫ Keto diet 5-10% carb, 20% pro, 70% fat

⚫ Keto diet associated with significant

improvements in blood sugar control, similar

weight loss to other diets at 12-24 mos. Long-

term data lacking in adult population

⚫ Demonstrates improved HDL and triglycerides,

but also increases LDL

Keto Diet Risks

⚫ ‘Keto flu’

– Nausea, vomiting, headaches, fatigue, dizziness, insomnia,

constipation, exercise intolerance

– Resolves in a few days to a few weeks

⚫ Constipation

⚫ Heartburn

⚫ Hypoglycemia – need to adjust diabetes medications

⚫ Vitamin and mineral deficiencies (B vitamins, folate, K, Mg)

⚫ Potentially negative impact on gut microbiome

⚫ May not be efficacious for everyone – mixed results

Caution for use of Keto Diet in..

⚫ People with type 1 diabetes or type 2 diabetes on insulin,

sulfonylurea or SGLT2 inhibitor

⚫ History of eating disorder or disordered eating

⚫ Mood disorders

⚫ GI disturbances

⚫ Alcohol abuse

⚫ High cholesterol >10mmol/L or LDL >6.5mmol/L

⚫ Risk of or current malnutrition

⚫ Children, teens, breastfeeding

Source Andrea Langley, RD, MSc, CDE

Sample Day Keto Diet

⚫ BREAKFAST: 2 eggs in butter + spinach, onions + ½

avocado + “Bulletproof coffee”

⚫ LUNCH: 3.5 oz. salmon on mixed greens salad with

mixed veggies + walnuts, olive oil + balsamic

vinaigrette ¼ cup blueberries

⚫ DINNER: 3.5 oz. roast chicken w/ skin on Pancetta-

wrapped asparagus, cooked in olive oil + creamed

cauliflower

⚫ SNACKS: Cheese, celery & cucumber, olives, cashews

Menu from Jen Sygo RD

Canada’s Food Guide 2019Areas for improvement

Areas for Improvement

• Cultural sensitivity – Few cultural foods appear on guide – no roti, dumplings, dragon fruit etc. Translated versions do not include different food examples.

Areas for Improvement

• Indigenous population –previous guide is still on website but is being revised

Idealism vs Realism

⚫ Does not include the concept of moderation

⚫ Can promote black and white thinking about

good or bad foods

⚫ Does not review how convenience foods can fit

other than canned/frozen produce

Areas for Improvement

⚫ Higher percentage of protein are typically

recommended for older adults

⚫ Website does not yet contain in-depth content

to be more helpful to a well-educated populace

⚫ Recipe section could be greatly expanded,

currently about 75 recipes

⚫ Pending document for release in 2019 should

provide more comprehensive guidance

Resources

⚫ Employers may have dietitian services

available through employee assistance

programs

⚫ Telehealth Ontario now has dietitians available

for free information over the phone

Resources

⚫ Unlock Food – Resources and Recipes by RDs

– http://www.unlockfood.ca/en/default.aspx

⚫ Family Dinner Project – recipes and strategies

– https://thefamilydinnerproject.org/

⚫ My Plate Resources – recipes, handouts, ideas

– https://www.choosemyplate.gov/

⚫ www.halfyourplate.ca/

Plant-Based Protein / Mindful Eating Resources

⚫ http://ontariobeans.on.ca/consumer-

resources/download/

⚫ http://www.pulsecanada.com/resources/

⚫ https://www.lentils.org/recipes-cooking/

⚫ https://www.meatlessmonday.com/

⚫ https://www.thecenterformindfuleating.org/

⚫ Dr. Michelle May - Eat Mindfully Live Vibrantly

– https://amihungry.com/

Other Recipes

⚫ Leslie Beck RD recipes

– https://lesliebeck.com/cooking-eating/healthy-recipes

⚫ Guelph Family Health Study – 4 e-cookbooks

– https://guelphfamilyhealthstudy.com/cookbooks/

⚫ Real Mom Nutrition Recipes

– https://www.realmomnutrition.com/recipes/

⚫ Heart and Stroke Recipes

– https://www.heartandstroke.ca/get-healthy/recipes

Subscribe for Food Guide Updates

⚫ https://www.canada.ca/en/health-

canada/services/canada-food-

guide/subscribe.html?hq_e=el&hq_m=1782962

&hq_l=4&hq_v=74fb0c9e7b

Conclusion

⚫ Canada’s new Food Guide is a source of credible general

information about nutrition. Customization at an

individual level is most relevant.

⚫ Canadians have access to a huge array of food choices

and nutrition information. Access to professional

guidance remains important.

⚫ Much more is needed to help address equal food access,

food security, and the challenges of eating well in today’s

food environment/busy lifestyles.

⚫ Development of food skills and promoting enjoyment as

well as health in eating habits can be common goals.

Thank you!

Questions?

E-mail anytime Christina.Seely@sjhc.london.on.ca