Canada's Food Guide plate view - by Doug Cook RD

Canada’s Food Guide Gets A Makeover

Canada's Food Guide plate view - by Doug Cook RD

By now I’m sure you’ve heard, a refreshed Canada’s Food Guide made its debut.

 

Many have weighed in and given some cursory reviews and opinions on it. There’s the predictable declarations about the virtues of water, the awesomeness of promoting whole grains, and how we’re gonna save the children of the future by the elimination of juice as a fruit serving.

 

It’s true, there’s a couple of significant changes with the new Food Guide. But, on the other hand, some of the messages have just been repackaged and presented in a new way. I’m just surprised by how many dietitians are treating these revamped messages as new or cutting edge.

 

I’m also surprised by how many health professional aren’t even familiar with the history of the Food Guide nor have taken the time to read previous supporting documents for educators and communicators.

 

Many seemingly aren’t aware of the Guide’s purpose as it relates to Health Canada’s role when it comes to nutrition either. Sadly, this lack of effort to detail is the rule and not the exception.

 

Sigh.

 

The history of Canada’s Food Guide

A professor of mine in undergrad told the class that if you want to understand an issue or topic, you need to look at its history. That’s stuck with me to this day and it’s so true.

 

Canada’s first food guide wasn’t a guide but a set of rules. Launched in 1942, the Government of Canada (pre Health Canada) issued guidelines on eating within the context of wartime food rationing.

 

The Government needed to send food overseas to help feed soldiers while striving to prevent nutrient deficiencies here at home. Nutrient deficiencies were common place at the time and the goal of Canada’s Official Food Rules was to improve the health of Canadians.

Canadas Official Food Rules 1942

The first food groups – 1942 to 1944

Before there were conspiracy theories about Canada’s Food Guide, especially when it comes to food groups (dairy anyone?), the Government looked at the foods that made up the Canadian diet at that time. Remember, Europeans were farmers and when they came to Canada, they brought their farming practices with them. They grew crops and raised livestock for food.

 

Canadians were eating milk, cheese, fruits, vegetables, grains and cereals, meats, fish, beans, and eggs. Nothing too crazy about that. Using these foods as a reference, the Government came up with a suggested number of servings of each. A handful of directional statements about how often to include them was also included.

 

The Food Rules outlined the “Health Protective Foods”, a term that I simply love.  In both health care and public health today, we talk about chronic disease risk reduction. Yet, despite our stance on the benefits of communicating positive messages, to me, nothing says positivity more than “health-protective foods”. I might just have to hang on to that one.

 

Food groups

In 1942, there were six food groups and as you can see above, there were some very specific recommendations about serving sizes and frequency. A few observations include:

 

Milk – adults, 1/2 pint (1 cup), children, more than 1 pint (more than 2 cups). Makes sense, why would you not include a readily available nutritious food?

Fruits – of note is the ‘rule’ to have one serving of tomatoes daily, or a citrus fruit, or tomato or citrus juices. No mistaking what they meant, that’s for sure.

 

Tomato juice with tomatoes cucumber slices on a wooden table

 

Cereals and bread – one serving of a whole-grain and 4 to 6 slices of Canada Approved Bread, brown or white.

Vegetables – in addition to potatoes every day, two extra servings of vegetables daily; preferably one leafy green or yellow and frequently raw.

Meat, fish etc – one serving a day of meat, fish or meat substitute (dried beans & peas, nuts). Also, liver, heart or kidney once a week.

Eggs – at least 3 to 4 eggs, weekly.

 

While the promotion of liver, heart and kidney once a week was to stretch the limited amount of meat available in wartime food rationing, the Government inadvertently promoted one of the original superfoods. Organ meats are loaded with essential nutrients often lacking even in today’s modern diet.

 

Lastly, another directional statement about including a source of vitamin D such as fish liver oils since was included since it’s essential for children, and may be advisable for adults. In the 1944 version of the Food Rules, iodized salt was recommended as a way to prevent goiter but the mandatory fortification of table salt with iodine didn’t happen until 1949. Also in 1946, a specific amount of vitamin D was recommended for all growing persons; 400 IU per day.

 

Some time between the 1946 and 1961 versions, vitamin D had been isolated and added to fluid milk eliminating the need for children to choke down their daily teaspoon of cod liver oil. The recommendation for children up to age 11 to have 2 1/2 cups of milk per day would have provided about 250 IU of vitamin D, just over the minimum amount needed to prevent rickets.

 

Child taking cod liver oil from a spoon

The dawn of discovery

The early part of the 20th century was a time of rapid discovery in the sciences. Nutrition was in its infancy but scientists already had a (very) basic understanding of carbohydrate, fat and protein. However the early 1900s belonged to the vitamins and with their discovery, understanding their role in preventing nutrient deficiencies:

  • 1912: vitamin B1 (thiamine) and beri beri
  • 1914: vitamin A and “hypo-vitaminosis A”
  • 1922: vitamin E and fertility
  • 1928: vitamin D and rickets
  • 1929: vitamin K and blood clotting
  • 1932: vitamin C as the preventative compound against scurvy
  • Early 1930s: vitamin B2 (riboflavin) and “a-riboflavinosis”
  • 1931: folate and anemia
  • 1937: vitamin B3: (niacin) and pellagra

Given that nutrient deficiencies were, to steal a phrase, a clear and present danger for the Canadian population, the Government had to act. It needed to prevent and reverse these commonplace threats to public health. The very prescriptive nature of the earlier Food Rules reflects this.

 

Milk provided vitamins A, B1, B2 and B3. Fruit, including tomatoes, citrus or their juices provided much needed vitamin C. Leafy greens provided vitamin C, folate, vitamin K and a small amount of beta carotene which was converted to vitamin A (a fortunate happenstance).

 

Whole grain cereals and Canada Approved Bread provided vitamins B1, B2, B3. Meats, fish, and meat substitutes would have also covered the B vitamins, and vitamin A. Eggs are loaded with vitamins A and folate (and vitamin D but not known at that time). Fish liver oils had vitamin D, and whether or not they knew it, lots of vitamin A.

Canada’s Food Guide 2019 – content selection

Suffice it to say, content that was ultimately included in the 2019 Food Guide was reviewed for its appropriateness via a multi-step, decision-making process. The final content is the result of over 100 systematic reviews of research on the relationship between food and health.

 

Relevance of that research was assessed to the degree that the studies showed “well-established associations with convincing findings”. The evidence also had to demonstrate the potential to shift the risk distribution of chronic disease and health conditions towards the ‘health’ end of the spectrum.

 

In other words, meaningful research that informed Canada’s Food Guide had to be health protective.

 

Fresh salmon and salmon filet on ice

 

It’s also worth noting that the exclusion criteria for any content consideration for the systematic review was, any report or study that was “commissioned by industry or an organization with a business interest” – a.k.a. with this iteration, there wasn’t any agri-food/agri-business or industry influence with this one.

The Food Guide’s purpose

In the end, any content that was ultimately distilled down to the dietary guidelines had to be focused on prevention. The Food Guide and it’s messages is not intended for the management of nutrition-related chronic diseases such as Type 2 diabetes. It also not intended for the management of nutrition-related risk factors such as elevated blood pressure or triglycerides.

 

As a population-based document, Canada’s Food Guide has to be in line with Health Canada’s federal role in nutrition: the promotion of health and well-being of Canadians.  Health Canada IS NOT in the business of medical nutrition therapy. No one should be complaining that it doesn’t apply to disease ‘X’, or health condition ‘Y’.

Key changes

  • No more food groups – well this isn’t exactly true. We arguably still have 3 food groups: vegetables and fruit, whole grains and “proteins”. Some say we now have food groupings instead. It’s true that the language of food groups will fade in favour of the conceptual plate model. For health, the guide states that these foods should be consumed regularly.
  • Proportions not portions – some feel that the old Food Guide causes obesity via it’s old portions. I get it, there was a lot of reasonable confusion as there was discrepancy between Health Canada’s standardized servings sizes and what a food manufacturer called a serving. So this time round, the focus is on proportions: 1/2 the plate vegetables and fruit, 1/4 whole grains and 1/4 “proteins” or protein foods.
  • More than food – healthy eating has always been more than food. It relies on how you eat (being mindful), recognizing when you’re truly hungry and when you’re full, cooking skills,  planning what you’re going to eat and more. This is a welcomed message and focus with the 2019 revision.

 

Young man drinking a glass of water - by Doug Cook RD

Two become one

Two former food groups: Milk and Alternatives and Meats and Alternatives have been collapsed into an all encompassing group called “protein”. Many vegans, vegetarians and ominvores have declared this as a major victory, specifically where dairy is concerned. As long as I can remember, there’s always been grumblings about dairy being its own food group. Many cite influence by the dairy industry for this.

 

But to be clear, dairy foods were always part of the Canadian food supply along with the other categories of foods in the original Food Rules and subsequent Guides. Throughout the history of the Food Guide, all agribusiness had a vested interest in their respective foods (commodities) being promoted and included. To suggest that animal-based food producers are uniquely evil in their involvement is highly biased. The grain, veggie, fruit and legume gang were in there in the thick of it just as much.

 

I do find it curious that we are calling two of the food groups by what they are, fruits and vegetables, and whole grains, and the third group by the macronutrient that’s being emphasized – protein. This is just going to reinforce something I’ve hated for a while; when patients and clients say ‘I need more protein’ which is code for meat, fish, poultry, eggs etc.

What about protein?

Protein experts suggest that our protein requirements should be increased. Why? Because current recommendations (0.8 g/kg body weight) are based on (outdated) nitrogen balance studies. Studies that served us well before better, more accurate methods for determining requirements were developed. Using the highly quantifiable method of “Indicator Amino Acid Oxidation” or IAAO, minimum requirements are more likely 1.2 g/kg of body weight; 50% greater than we once thought.

 

To put it into perspective, using my weight of 72 kg, 1.2 g/kg = 86 g protein per day versus the older estimate of 58 g; a 28 g difference.

 

It’s true, all life forms have protein. So yes, there’s protein in vegetables, fruit and whole grain products and “protein” doesn’t just mean meat. The new Food Guide’s protein group does include foods with the most concentrated amount of protein per serving but we know that not all protein-containing foods are created equal.

 

When about 70% of the calories come from carb, legumes are more a carb than they are protein. Legumes impact blood sugar like a carb. Likewise, when 80% or more of the calories come from fat, nuts and seeds are really a fat and are digested and metabolized more like a fat than protein.

What about protein quality?

Given that our true protein requirements are higher than what we once thought they were, only time will tell if the new Food Guide protein concept will ensure Canadians are getting both enough total protein and enough high quality protein. And when it comes to protein, the timing of when you eat protein can’t be ignored either.

Vitamin D supplement

Getting enough high quality protein at the right time is key to ensuring your muscles are getting adequate amounts of amino acids for optimal muscle protein synthesis. There is a lot of protein in milk and dairy foods which is why people have expressed concern about it being blended with the new protein group.

 

We know undoubtedly that not all protein-rich foods are created equal. Vegetable sources, save a few, don’t have all 8 essential amino acids (9 if you count histidine for children). With the new protein group, people will be lead to believe that any food from that group will provide the amino acids they need. Many may just choose nuts or seeds or legumes.

 

Studies have shown that when plant proteins are complemented/combined (like we emphasized in the 70s), they perform better when it comes to stimulating muscle protein synthesis. This is because complemented vegetable proteins (beans & rice), or complete proteins like fish, meat, eggs, cheese etc, contain the ideal amount of leucine.

What about milk and calcium?

Before anyone jumps all over me, to be clear, I couldn’t care less if anyone consumes dairy (milk, cheese, yogurt, kefir, ice cream). You don’t have to include dairy to have a healthy diet but dairy can be part of a healthy diet. Personally, I don’t go out of my way to include it, nor do I go out of my way to avoid it.

 

When it comes to calcium (the easy default argument to include dairy foods), recommendations vary. The WHO and the UK only recommend 500-700 mg/day. In Canada & the US, we push a hefty 1000-1200 mg per day. Thing is, to replace the 200 mg that’s lost every day, we need to absorb that much from our diet and supplements. When blood levels of vitamin D are low, you need to consume a lot more calcium to get that 200 mg in. When vitamin D levels are optimal (100 nmol/L), you can get by consuming with less total calcium because your body will be optimized for calcium absorption.

What about juice?

If I was a good little dietitian, and I’m not, I’d toe the party line and be doing cartwheels down the halls and in the meadows with the removal of juice as a serving of fruit.

 

Cuz, don’t you know? There’s an “ugly truth about fruit juice”? Juice doesn’t have any fiber so your blood sugar will ‘spike and crash’. The sugar in juices makes it no better than cola and juice is one of the major contributors of overweight and obesity. Guess that explains my obvious weight problem [BMI 22.3].

 

You see, I grew up with juice.

Here’s rub though…

1 medium orange 125 ml (4 oz) juice
Calories 62 kcal 56 kcal
Sugar 12 g 11 g
Fiber 3 g 0.5 g
Vitamin C 70 mg 62 mg
Glycemic Index 42 (low) 52 (low)

(P.S., if I have to explain the obvious in this table, then you have no business saying juice is the devil. For those who worship at the Church of the Glycemic Index..I’ve included that too).

 

For anyone who might be too young to recognize the image below. It’s a juice glass. You might only find this in an antique store nowadays. Believe it or not, this is the former (and scary) 4 oz (125 ml) Canada’s Food Guide fruit serving size.

Small juice glass that's empty - by Doug Cook RD

Sure, the way juice is sold today in 500 ml bottles could be a problem. Or, if you’re a Costco kind of family and buy your juice in a gallon-sized bottle and ‘free pour’ your juice, I’ll give the juice fear-mongers the win for that one, you could be over-consuming liquid calories.

Other new additions

  • Grains and grain products – whole grains are now emphasized where the old guide read “make at least half your grain products whole grain each day”. Historically this was to allow for the inclusion of foods made with refined wheat flour and enriched white pasta, both of which are fortified with folic acid.
  • Water is encouraged – “make water your beverage of choice” but to be fair, the old guide promoted water consumption too. But please, do not interpret this to mean you have to guzzle water all day long. Please free yourself from the myth of needing to drink 8 to 10 glasses of water per day.
  • A statement about alcohol – “there are health risks associated with alcohol consumption”. True enough.

Waiting to hear

A supporting document for health professionals is coming out later this year. I’m curious to see if there will be any directional statements to address some significant public health concerns that were covered in previous Food Guides.

 

Vitamin D3 – normally I don’t write “D3” but given the plethora of plant-based milk alternatives, I now do. Vitamin D3 was added to milk to replace the use of cod liver oil. Health Canada recognizes that fluid milk is THE main source of vitamin D3 in the Canadian diet. Vitamin D2, used in plant-based alternatives is added in the same amount, 100 IU per 250 ml serving but D2 is only 1/3 as potent as D3.

 

Supplements – previously, women who could become pregnant, are pregnant or breastfeeding were advised to include a multivitamin with extra folic acid, and iron. Prenatal supps also had extra D3 and iodine. All important public health measures as it relates to preventing anemia and birth defects and supporting cognitive development. Also, those over 50 years of age were also advised to get extra vitamin D3 and B12.

 

Fish – under the previous Meat & alternatives group, a directional statement to get 2 servings of fish per week was included to help address the fact that most Canadians are not meeting the minimum recommended intake of 250 mg of omega-3 fats (EPA, DPA & DHA) per day. While there’s concerns about the sustainability of eating fish and seafood, there are lots of sustainable ways to get these badly need fats. Time will tell how this will be addressed by Health Canada.

 

Canada's Food Guide 2007 - by Doug Cook RD

Plant based protein (and diets)

A thorn in my side. I hate the expression “plant based” (or plant-focused or plant-centric) as much as I do “foodie”. Plant based is a term that has come to convey distinction or ‘of the tribe’, different from the rest. I find it devise; a term that smacks of superiority – let’s be honest. An expression that’s been coopted by vegans and vegetarians.

 

The new Food Guide doesn’t help matters much either. It supposedly recommends a plant-focused diet but not to the exclusion of animal products with an emphasis on plant based protein. The former Food Guide and the 2019 revision both contain essentially the same directional statement about plant based protein (those high-carb, high-fat ones) save one word:

 

  • 2007: “have meat substitutes such as beans, lentils & tofu often”
  • 2019: “among protein foods, consume plant-based ones more often”

 

The assumption I assume (hope?) is that people will include more legumes, nuts, seeds and prepare meals with these. Maybe even include some vegetarian protein powders such as hemp, pea or brown rice. The reality I think will be different.

 

Not unlike so-called “high school” or “university” vegetarians where animal foods are avoided without planning, many will turn to highly-processed, soy-based, food-like products for their plant based protein. Soy-derived ‘wieners, deli meats, cheese, ground round, burgers’ and more will fill the void.

 

The first Food Rules in 1942 recommended ‘meat substitutes’. By 1944 it was recommending ‘meat alternatives’ such as dried peas, beans and nuts. With soy beverage and tofu slowly becoming more common in the 70s and 80s, both the 1992 and 2007 versions of the Food Guide provided ample opportunity to include plant alternatives for the now defunct milk/meat and alternative food groups with soy beverage, legumes, tofu, nuts or seeds.

 

In short, when the majority of servings, serving sizes and calories come from plant foods, the Food Guide(s) have always been “plant-based”.

 

I personally think we should do away with plant based and just focus on healthy diets, healthy eating and health protective foods.

 

Bottom line

I like the new Food Guide.

 

It’s about food, it recognizes the food environment’s influence on what we eat and how much we eat. It supports the idea that healthy eating is a shared responsibility.

 

It also talks about food skills, cooking skills and food literacy while acknowledging the real concern of food insecurity.

 

It’s also important to remember that it’s in line with Health Canada’s role in promoting the health and well-being of Canadians and is ultimately a starting point for a conversation about healthy eating; conceptually, like all Food Guides before it, underscores the health protective foods; both animal and plant-based.

 

Doug Cook RDN is a Toronto based integrative and functional nutritionist and dietitian with a focus on digestive, gut, mental health.  Follow me on FacebookInstagram and Twitter.

 

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