Co-authors: Dr. Barbra Allen Bradshaw, Anatomical Pathologist (Abbotsford, BC), and Dr. Carol Loffelmann, Anesthesiologist (Toronto, ON).
Nutrition is an emotionally charged topic. Low carbohydrate and ketogenic diets have been in the news lately, and are stirring up controversy. Why should Canadians pay attention to them, and what does this have to do with our own dietary guidelines? We will address these questions. First, though, we must discuss the nutritional health crisis facing our nation.
Our nutritional crisis
Forty years ago, our government told us to eat less fat and more carbohydrates. Tragically, we have seen an explosion in type-2 diabetes, obesity and other nutritional diseases, and alarmingly, these diseases are now being diagnosed in our children. Worldwide obesity has tripled since 1975, and childhood obesity has increased 10-fold. In today's food environment, five in 10 children will develop type-2 diabetes in their lifetime. Even more shocking is that 80 per cent of First Nations children in Canada will develop type-2 diabetes.
Problems with the Food Guide
When we took fat out of our food, we replaced it with sugar and refined carbohydrates to make it taste better. We displaced traditional foods with processed food, and ultra-processed food now makes up 48.3 per cent of our daily calories.
Our traditional methods to combat this disease burden haven't worked, so we formed a network of Canadian health professionals who went "back to school" to stop this crisis. We learned there was never good evidence supporting the advice to eat less fat and more carbohydrates. Our dietary guidelines are heavily based on the Dietary Guidelines for Americans, but the National Academies raised serious concerns about the scientific rigour of these guidelines.
Others have noted the lack of scientific rigour, describing political influence by powerful individuals and big food manufacturers. The sugar industry, for example, sponsored and influenced scientific research in the 1960s.
Our nutritional health crisis is fixable
We have experienced devastating unintended consequences of making dietary policy with faulty information. Now that we understand that sugar, not fat, is implicated in most chronic nutritional diseases, we can actually help our patients. If these people reduce their intake of sugar and refined carbohydrates that helped cause the disease, they may be able to reduce or eliminate many of their medications. This is no more restrictive than needing to avoid gluten if you have celiac disease, or animal products if you choose to be vegan or vegetarian. Insulin resistant people are simply intolerant to carbohydrates.
Our grandparents had it right by cooking with whole, unprocessed food. A low carbohydrate, healthy fat (LCHF) way of eating flies in the face of current guidelines, but this world-wide food revolution is making people well, and can save our healthcare system.
We are advocating for dietary policy change
Health Canada is revising the Food Guide, and we are advocating for guidelines based on rigorous, updated science. We submitted a letter to Health Canada asking for whole food guidelines, which reflect the current state of evidence on issues like saturated fat, animal products and salt intake. This letter was signed by 717 of our colleagues, some considered world experts in therapeutic nutrition and research.
If experts disagree, we cannot make recommendations, and the guidelines must remain silent.
Health Canada published a set of guiding principles regarding the new Food Guide, with many positive changes. However, there was still a notable focus on reducing saturated fat, animal-based protein and salt, which is not supported by current evidence. We submitted a rebuttal letter, and were disappointed to receive a standard reply from the Health Minister. We felt they essentially ignored our concerns.
The only time we should be making recommendations to change our food or macro-nutrient intake is when we have incontrovertible evidence of its benefit or harm. The evidence surrounding saturated fat is still in a state of flux. If experts disagree, we cannot make recommendations, and the guidelines must remain silent.
Rather than advise a reduction in saturated fat, we should follow the lead of the Canadian Heart and Stroke Foundation. In 2015, they reviewed the same evidence as Health Canada, and they judged a percentile cap on saturated fat was not warranted.
What this means for the general Canadian population
If low carbohydrate nutrition is so successful in metabolic disease, does this mean everyone should eat this way? This personalized, low carbohydrate approach works best for diseases of insulin resistance; authors suggest a carbohydrate-restricted diet should be first line therapy in type-2 diabetes.
For the rest of us, the evidence, especially the recent, Canadian led epidemiological PURE study, suggests we should consume less refined carbohydrates and more natural fats than is currently recommended. Focus on whole food and ditch more of the processed, refined products.
Why bother changing the Food Guide?
There are many populations who cannot ignore the Food Guide. Hospitalized patients with diabetes are given foods like juice, toast and sugary low-fat yogurt. Kids are given juice in school because the Food Guide says it is a serving of fruit. Schools must choose low saturated fat dairy products, but we have studies showing benefits of full fat dairy.
So not everyone gets to ignore the guidelines.
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A grass-roots food movement can be incredibly powerful, but change ultimately must come from the top. We must ask our schools to reduce sugar, and our hospitals to remove sugar-sweetened beverages, and serve more whole, nutritious food. We expect unbiased dietary advice from our diabetes and obesity organizations, but we must challenge why they receive financial support from food companies that create products implicated in causing these diseases. Finally, we must help our healthcare colleagues learn the power of eating real, whole food with respect to disease prevention and reversal.
We must act now. Help us tell Health Canada by signing our public petition. Do research. Question your health providers and policy makers. Knowledge is power; we have the knowledge, now is the time to start using it.
You can find the public petition as well as our letters to Health Canada on our website at www.changethefoodguide.ca. If you are a Canadian health provider and wish to collaborate, contact us through the above website.
If you want to learn about using low carbohydrate nutrition, the Diet Doctor website provides simple explanations, recipes and meal plans, and is the reference most often given to patients by healthcare professionals across Canada.
CORRECTION: An earlier version of this blog indicated that coronary heart disease rates are on the rise. In fact, the rate of coronary heart disease is actually dropping.
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