What we eat is shaped by food culture, consciously and unconsciously, historically and currently. And food culture in Canada is often shaped by economic forces (see for example Johnston and Cappeliez, 2017). Our relationships with these nutrients of concern is deeply historical, cultural and economic and often unconscious and these realities make it more challenging to reduce their consumption. In some cases, consumption is linked with high levels of domestic production (e.g., canola oil, refined grains). And these forces mean that it's not about individual responsibility for health and reduced consumption. These forces must be mitigated by government intervention (see the Solutions sections).
Our relationship with refined sugar is deeply intertwined with capitalism, slavery and injustice, and hooking the population on sweet food was central to that process. What was originally a luxury item became a necessity, even seen as having healthful properties . Consumption skyrocketed over time, first among elites and then across the entire population, to the financial benefit of those embedded in the sugar trade (see Mintz, 1985).
Now that excess consumption comes back to haunt us. Many foods contain natural sugars, but Canadians consume substantial amounts of free or refined sugars, added in food and beverage processing, in home baking, and at the table (88% of use is in manufacturing and food service, 12% in retail packages, Canadian Sugar Institute). Approximately 20% of the calories in prepackaged foods come from free sugars (Bernstein et al., 2016). The good news is that from 2004-2015, total sugar intake declined slightly, although with more sugars coming from food and less from beverages relative to 2004. The average child was receiving 25% of calories from sugar, substantially above optimal. However, sugary drinks are still the main source of sugar intake (Langlois et al., 2019), of particular concern because the amount of added sugar is not necessarily obvious to the consumer. According to Canada's Food Guide, such drinks may increase risks for obesity, type II diabetes and cavities in children. Jeffery (2019a), working from Global Burden of Disease data, estimates that sugary beverages represent 2% of attributable risks of illness and death.
Unfortunately, Canada has yet to set consumption targets for free sugars in the diet and there is no requirement to label them on the Nutrition Facts panel.
Other refined carbohydrates
It is only relatively recently that processors have been able to mill (and bleach) white flour grains. For most of our milling history, the flour remained course (whole grain flours). However, as with refined sugar, white grains became prized for their "whiteness", associated with status and consumption shifted towards them. The loss of nutrients associated with this level of milling was viewed as acceptable because of the advantages in shelf-life and distribution (for an example, see the story of rice, Visser, 1986).
Canada's Food Guide encourages us to consume whole grains, rather than refined ones. White flour, white rice, and instant oats have all been milled to remove much of the fibre and other constituents that slow the absorption of sugars in the blood stream. These simple carbohydrates are also contributing to obesity and type II diabetes.
There is Daily Value information on fibre on the Nutrition Facts panels, but for many people, the relationship between consumption of refined carbohydrates and low fibre intake is not obvious.
Fat (adapted from TFPC, 1998)
Consumption of healthy fats is certainly essential to good health, but on a population basis, we consume too much fat and the wrong kinds. The design of the food system, and the failure to properly regulate fat, are contributing factors.
The sources of fats and oils in our diet have changed over time. Earlier in this century, consumption of whole foods was a greater percentage of the diet, processing was minimal, and eating out in restaurants was, for most of the population, infrequent. Consequently, consumed fat came from fresh or minimally processed foods. Because people were more involved in growing and raising their own food, or because there was more direct purchase with more flexibility, they had more latitude to control their fat intake according to the needs of the family. For example, carcasses could be trimmed to meet family specifications, or milk skimmed in a variety of different ways. Animals were reared in less intensive production systems, with diets more closely suited to their digestive tracts, and rapid weight gain was not as great a concern as it is today. Consequently, carcasses were generally leaner. Also, animal breeds had not been manipulated to augment the fat content, as happened later with dairying for example. Humans were also generally more active. Physical labour occupied many more in the workforce that it does today.
Oil processing was also very different, and as processing has changed, so have fatty acid molecules. Oils were largely unrefined, produced in cottage industries and distributed and consumed rapidly to avoid rancidity. Starting in the 1920s, industrial heat-producing oil pressing systems replaced cold-pressed small cottage industries. Nutritious, but less stable oils like flaxseed, were replaced by more stable but unnatural oils that fit better into the new industrial processes. Consequently, oils lower in essential fatty acids (and therefore more stable for industrial purposes) became the dominant oils on the market. Hydrogenated and partially hydrogenated oils also came into the market place and have until recently comprised one-third of the edible oil market. These oils have been essential to the evolution of the fast food industry.
They are a major source of problematic trans fatty acids (TFAs or transfats). TFAs result from the high temperatures and hydrogenation process used to convert refined oils into margarines, shortenings, shortening oils and stiffened (partially hydrogenated) vegetable oils. In their natural state fatty acids have a cis configuration, and the hydrogenation process causes the rotation of one or many molecules, in effect, twisting the acid into a new shape. This twist, however, is thought to change substantially the fatty acid's properties, activity in the body, and ultimately negative effects on health, particularly coronary heart disease, immune system function and reproduction.
There are three major kinds of fat: saturated, monounsaturated, and polyunsaturated. Saturated fats tend to raise low-density lipoprotein (LDL) blood cholesterol, the other two tend to lower it, so we are generally advised to favour the latter two. Many foods contain many of all three categories of fat, but saturated fats come mostly from animal products, palm and coconut oil. Monounsaturates predominate in avocados, cashews, olives and olive oil, peanuts, peanut butter, and peanut oil. Major sources of polyunsaturates include almonds, corn oil, cottonseed oil, soybean oil, sunflower oil, walnuts, flaxseed oil and canola oil.
Jeffery (2019a), working from Global Burden of Disease data produced prior to Canadian government restrictions on hydrogenation, estimates that diets low in polyunsaturated fats (and consequently higher transfats and saturated fats) represent 5% of attributable risks of illness and death.
After a period of labelling TFAs, Canada has now placed partially hydrogenated oils on the List of Contaminants and other Adulterating Substances in Foods. As a result, TFAs no longer need to be labelled because their levels in the diet should now be quite low. Of the three main categories of fats, polyunsaturate labeling is still not required on the Nutrition Facts panel.
Salts at certain levels are important for cellular function. Many foods contain different salts and many cultures survived for millenia without adding salts to foods. But the use of mined and dehydrated salt (primarily NaCl) has been part of the human story for centuries. It has played historically an important role in food safety, especially before refrigeration, canning and vacuum packing became possible. Its use facilitated mobility of people carrying with them their salt preserved food stores, and then trade, both salt itself and the foods preserved with it. It played a role in colonialism (eg. India's independence from Britain). It also shifted people's taste profile, as a key component of seasoning (for a history, see Visser, 1986).
But it also became a way to hide low quality ingredients in industrially produced goods. It's role as a flavour enhancer became increasingly significant as manufacturers and restaurants attempted to enhance the flavour profile of their foods. Now, much of the population is hooked on salty foods, finding unsalted foods and meals to be bland. Food manufacturers and chefs are often reluctant to reduce salt levels for fear of the cost implications (having to use more flavourful ingredients) and loss of customers. Industrial salt manufacturing processes made it cheap for people to buy. So, the challenge is having sufficient salt to fulfill food safety requirements, but not so much as to facilitate use of low quality ingredients.
Canadian salt consumption averages around 3400 mg/day. The Health Canada upper limit is 2300 mg/day. The Institute of Medicine of the U.S. National Academies’ (IOM) recommendation is 1500 mg per day for persons aged 9 to 50 years, and less for those younger and older (Sodium Working Group, 2010). We have a significant over-consumption problem, with some 80% of Canadians including 93% of children aged 4-8 consuming too much. Jeffery (2019a), working from Global Burden of Disease data, estimates that diets high in sodium represent 12% of attributable risks of illness and death.
The challenges of change
It's important to acknowledge that widespread reformulation of the food supply so that Canadians consume substantially less of these nutrients is a challenge. Very strong economic, scientific, cultural and taste-related forces have created the current situation. These nutrients of concern play multiple roles in product recipes - some very important - and in the economy of food manufacturers. Food scientists have conducted tremendous volumes of research on how to use these ingredients for food safety purposes, to create bulk, texture and other properties, lengthen shelf life, create flavour, produce uniformity in taste and presentation, and reduce manufacturing costs. Often this research has been conducted without much attention to the population health implications and has contributed to the explosion of ultra processed pseudo foods (see Winson, 2013).
Changing recipes, rejigging manufacturing processes, and changing product labels are not cheap undertakings, especially if customers reject the new product. Educating eaters and voluntary reformulation by manufacturers has so far only generate modest levels of change. State intervention to change the underlying rules of food manufacturing is required, but must be rolled out carefully given the forces in favour of the status quo. Equally significant, the product reformulations, if not well conceived, may not solve some of the dietary problems, again suggesting the need for substantial interventions that go beyond minor ingredient substitutions. Problematic artificial sweeteners and fat substitutes, increases in total product calories, and reduced quality of fats and oils have all resulted from earlier efforts to change ingredients (for an analysis related to free sugars, see Bernstein et al., 2016).
Another challenge relates to government authority to intervene in the food market place. Legislative authority is derived primary from the criminal law power (fraud prevention), expressed in the Food and Drugs Act, the Safe Food for Canadians Act. As a result, governments have tended to use information instruments (e.g., Healthy Eating Guidelines, Canada Food Guide) and regulatory measures (rules on nutrition information for packaged foods, e.g., nutrition facts table, ingredients list, and possibly front-of-pack labels). More recently, ingredient bans have been employed (also regulatory instruments).
Advocates for change also face difficulties related to these private and public sector realities. A common advocacy trajectory that can take 10-40 years has the following elements, resource and time commitments (and not necessarily in this linear sequence):
- Scientific articles start outlining emerging evidence (and it continues to build); conferences begin
- Expert health panels are created, sometimes called by government, sometimes by NGOs
- Burden of disease reports are produced, with economic implications for the economy and health care sector
- Health advocacy groups call for specific regulatory actions, often linked with information campaigns that are not yet supported by government
- Responding to the mounting pressure, government consults with industry; industry has numerous objections that delay implementation
- Governments set consumption targets,then information campaigns, then labels, then sometimes bans on specific ingredients.
The rest of this section focuses on solutions specific to nutrients of concern. However, numerous other parts of this site address some of the wider strategies to create a food supply that has health as an overarching goal.