December 04, 2019 The new food guide and type 2 diabetes

[00:00:02] Welcome, everyone, to Diabetes Canada's 2019 Type 2 webinar series. My name is Jeneni Jude and I will be your host today. We are delighted that you are able to join us today for the webinar entitled The New Canada's Food Guide and How It Aligns with Type 2 Diabetes. To start off, I would like to draw your attention to the survey below the video in order to best serve your needs. We kindly ask that you provide us with your input by completing the short survey towards the end of the presentation. We thank you in advance for your input. Today's presentation will be about 25 to 30 minutes in length. Now I would like to welcome our speaker, Lisa deMolitor, and thank her for joining us today. Before turning it over to Lisa, I'd like to give you a brief introduction. Lisa is a registered dietitian. She completed her undergrad, an internship at Acadia University and her master's of public health at the University of Waterloo. She currently works in a diabetes centre in the Anna Annapolis Valley of Nova Scotia. However, most of her career was based in the Kootenays of British Columbia. She is a self-described foodie and a busy mom of three. So without further ado, I present to you, Lisa deMolitor. 

[00:01:23] OK. 

[00:01:27] Hi there. So thanks, Jen. We're hoping to cover today the new Canada's food guide and how it aligns with type 2 diabetes and the guidelines for type 2 diabetes. So I want start with the new Canada's food guide and what it looks like. And so the new Canada's food guide was released in January of 2019. And it is part of the government of Canada and Health Canada's healthy eating strategy to improve the food environment in Canada. It was developed using a systematic review of current evidence on the links between food, nutrition and health. 

[00:02:07] To create this guide, they completed a stakeholder consultation, which included dietitians and other health care professionals and also consumers. Excluded for the first time were industry commission submissions. And this was to reduce the risk of bias and conflict of interest. 

[00:02:28] This is what it looks like. And so Canada's food guide, we found the previous slide, the plate which will explore a little further. And this is the reverse side of the snapshot. And so the guide has a new look. As we can see, it no longer is a six page fold out with recommended serving sizes. The actual tool, or what we call the snapshot, is a simpler tool and it's much wider in scope. 

[00:02:55] The snapshot is a very small piece of a larger set of offerings. There is also an online suite of resources, including some actionable advice, videos and recipes. The Canada's food guide doesn't just focus on the nutritional value of food as the old one did. But it also includes some recommendations on how we make food choices. So instead of being prescriptive, the guide aims to provide recommendations to help Canadians understand how to incorporate or develop eating patterns that may result in positive health outcomes. And I'll touch on these recommendations in a bit. 

[00:03:35] So we see here the title is there's no one size fits all approach to eating. And I wanted to acknowledge this. No one size fits all in the world of food nutrition, there are quite complex relationships because there are many reasons why we eat besides health. What we eat depends on a great variety of factors, including but not limited to, budget accessibility, health time constraints, individual preference, culture and our environment. These factors are very important when we're navigating the world of food recommendations with sustainability in mind. For example, although vegan dietary patterns have very good evidence behind them, I would never strong arm someone into following it if their preferred protein is fish and wild game. Furthermore, I would never insist that someone eat pricey cuts of meat or fish or expensive out of season vegetables when finances are limited. And so we really have to tailor our nutrition messages to make sure that people are happy with what they're eating and and they're making a choice that's sustainable for them. 

[00:04:49] Diabetes Canada and the American Diabetes Association recognize that there is good evidence behind many different types of dietary patterns or eating patterns. Some of these include the Mediterranean diet, DASH diet, low carbohydrate diet and vegetarian or vegan patterns. I did want to make one little side note about low carbohydrate diets and safety. So for those who are living with diabetes, medical monitoring and management for the initiation of a low carbohydrate diet is so, so important because there are medications that may need to be stopped, adjusted or monitored very closely. And this is something that must be done in collaboration with your provider and health care team. So back to my slide, because there are no one size fits all approach to eating and because many of the dietary patterns have such unique characteristics. It's really difficult to create one food guide for all Canadians. And I don't envy the job that had to be done here to fit this bill. So a brilliant analogy from a fellow dietitians dietitian Stefania Palmeri can help us understand the task of creating a food guide. So her analogy is that diets are like pants. We know that there are many different styles of pants. There is slim fit, skinny jeans, cargo pants and bell bottoms. And Health Canada had to create a design of pants to fit many different patterns, to meet the - to fit the needs of all Canadians. So this is challenging because there's no one size fits all pant. So they had to put out a general format for pants. So they need a waist. They need a zipper and they need two legs and other than that, there's a lot of freedom and movement within within that pattern. They also give us some tips on how to wear the pants and we'll talk about those later. But those are some of those recommendations on how to eat. So how to wear these pants. And we know that not all dietary patterns fit this general format. And low carbohydrate eating patterns are an example of this. 

[00:06:56] So if you have a unique pattern and you need a good fit, it's good to talk to a tailor or a dietician to have the pants altered, to fit your body or to have this pattern to suit your particular needs and in health conditions. So I hope I did that analogy justice and I hope that it made sense. But it's just the analogy that just shows that there are many different eating patterns out there and there's not evidence to prove that one is one is better than others. 

[00:07:28] Now, I wanted to talk about the recommendations on how we eat. So regardless of what pattern or whether or not you choose to follow a specific pattern, Canada's food guide does offer some general principles that are pretty great. The first one is to cook more often. This doesn't mean that you have to labour over a hot stove three times a day. It does, however, get us to think about how and where our food is prepared by cooking our own food. We have more knowledge and control about what goes into our food. The next one is eat with others. And I've heard lots of criticisms on this point because not everybody enjoys eating with others and I choose to think about it in a different way. I choose to think about it as a positive way of saying, don't eat at your desk at work, don't eat in front of a screen at home. Whether you choose to eat with others or quietly by yourself, please take the time to enjoy your food. The third one is be mindful of eating habits. And this ties into the last recommendation. Being mindful of what we are eating can help us feel more satisfied with our food. Mindfulness can also help us listen to our body's hunger cues so that we can tell when we're feeling full. Listening to our hunger cues and stopping when we're full is a much better way of regulating the amount of food that we eat rather than just finishing everything on our plate because it's a habit or because it's what we've always done. The next one is using labels. So reading labels is a very powerful tool that helps us see through the marketing and determine what food really has to offer. Health Canada has some good resources on their website that helps us learn more about reading labels. And you may also like to visit your local grocery store dietitian or attend a grocery store tour to get some hands on experience with label reading. The next one to be aware of food marketing. There are rules about the claims that companies can use to promote their products, but there's still lots of ways that marketing can be deceiving. Some foods may look or sound really healthy, like veggie straws or vegetable coloured pasta, but they are just as processed or high in salts than the product sitting next to it. So the nutrition label will help compare and tease out some of these differences. Next one is choose minimally processed foods. I think that this can be a really complicated idea and I could spend an hour talking about the term minimally processed. But in general, foods that have been highly processed tend to be lacking all the good stuff like vitamins, fibre, minerals, and they're often higher in the stuff that we want to avoid, such as sodium, added sugar and trans fats. 

[00:10:05] The last one is to reduce added sugar. We know that both added sugars and naturally occurring sugars will affect blood glucose. Added sugars, however, do not contain nutrition benefits. So examples of ways to reduce added sugars could be choosing water over pop. Choose unsweetened applesauce over sweetened varieties. Try plain yogurt and add your own flavours with frozen fruit or a drop of vanilla instead of sweetened varieties. Try plain old fashioned oatmeal and sprinkle some cinnamon and cut up apple on it. Or try pumpkin seeds or swirl in some peanut butter in some sliced banana instead of choosing the instant varieties of apple, cinnamon, or peaches and cream. You could experiment with making your own favoured water with an orange slice, some mint or lime instead of getting a sugary coffee latte frappe or something ending with ino. You can upgrade your favoured water by using a tall, chilled glass if you're feeling fancy and want to feel a little bit more satisfied. I want to talk a little bit more about carbohydrate, because this will really help show some of the differences between Canada's food guide and some of our resources for Type 2 diabetes. Carbohydrate is found in many foods, including grains and starches, fruit, some vegetables, legumes, meat. Sorry, not meat, milk and milk alternatives, sugary foods and many prepared foods. Your body breaks down carbohydrate into sugar, which is also called glucose. And this raises your blood sugar or blood glucose levels Meat and alternatives, most vegetables and fat contain very little carbohydrate and moderate servings of these will not have a big effect on blood sugar levels. Since carbohydrates influence blood glucose, you will find that many of the tools that we use in diabetes education are organized according to carbohydrate content. I'm going to, in the next few slides, highlight some of the tools related to Type 2 diabetes that you might be familiar with. I do not intend to promote one tool over another, but these are just a few good visuals that I've gathered to illustrate my point today. 

[00:12:35] Just The Basics is a Diabetes Canada resource. It can be downloaded for free off of their website. It is a brief overview of some basic principles for eating. So on the front, which is pictured on the left here, there are some general tips and on the inside, which is pictured on the right, is the plate. So highlighted here in red. 

[00:12:59] You will see on other Diabetes Canada resources that they have this similar plate as well. And I'll describe the plate in more detail later. But you can see here that it is part of a complete meal that may or may not include milk and/or fruit. 

[00:13:19] This is a poster called Beyond the Basics. And this is the next step up. It is not a tool that everyone needs in their toolbox, but it is handy if you want to dive a little deeper into carbohydrate counting. Beyond the Basics was developed by Diabetes Canada and it's a copyrighted tool that must be purchased. So it's not freely downloaded and if you're interested in finding out more, please ask your health care team. You may be able to see, and you may not, depending on how big your screen is, that each page is divided into food groups. So the left hand side of the poster displays foods that contain a notable amount of carbs. On the left hand side, you can see the group's grains and starches, fruit, milk and alternative, and other choices. The right hand side of the poster displays foods that do not contain a significant amount of carb. So the food groups that we see here are vegetables, meat and alternatives and fat. We can also see the plate image again at the top right there that we saw on the previous tool, Just the Basics. And that's highlighted in red. 

[00:14:34] This is another example of a resource used for carbohydrate education. This two page handout is full of pictures and it is called the Diabetes Food Guide and it was developed by the Community Diabetes Education Program of Ottawa. It, too, is a copyrighted tool that must be purchased. You can see from this snapshot that it too is organized into different food groups. Six  food groups, to be exact. From left to right, these food groups are titled vegetables, grains and starches, fruit, milk & alternatives and meat & alternatives and fats & oils. Similar to the poster that we just saw, Beyond the Basics, you can see that the purple banner at the bottom identifies the groups that are considered carbohydrate foods. So like Beyond the Basics, these are foods that contain a notable amount of carbohydrate. So we can see from this brief overview some of these tools that maintain a bit of a diabetes focus, that they maintain a focus on carbohydrate content of foods. I call this the carbohydrate lens and it's with this lens that you will start to see some of the differences between diabetes focussed resources and the Canada's food guide. On the left is a rotated image of Canada's food guide plate. On the right is the plate from Diabetes Canada Resources. We see that the candidate's food guide plate is separated into three sections. The largest section takes up half the plate and it contains vegetables and fruit. The remaining plate is divided into a quarter plate of wholegrain food and a quarter plate of protein foods. You will notice that the Canada Food Guide classifies potatoes and sweet potatoes as vegetables. And you can kind of see those kind of on the top, right? The Diabetes Canada plate classifies all potatoes, so sweet potatoes and white potatoes, as a green or a starch. Corn isn't pictured on the new kind of food guide. But in the old version, it, too, is classified as a vegetable whereas Diabetes Canada classifies corn as a grain or starch. Food items such as potatoes, sweet potato and corn do contain starch or carbohydrate and this does influence blood sugar. For this reason, with our carbohydrate lens, we think about them as a grain or a starch. And this is one of the big differences between the two resources. 

[00:17:09] So if we go further into some of the more detailed resources on carbohydrate, on the left here, we see that Beyond the Basics. And we see the little red squares on the top left here showing potatoes, sweet potatoes and corn as classified in the grains and starches category. And on the right hand side, you can see the diabetes food guide. And it also classifies potato, sweet potatoes, and corn into grain and starches. So if we go back to our two plates, another little difference here. When we look at the new Canada's food guide, a lot of people wondered when it came out.: Where did the milk go? And the answer to that is that the milk is now classified in the protein category in the bottom right of the plate. And so it used to have its very own category. But now we see that yogurt, cheese and milk are classified in the protein category. And so I want to talk about cheese for a moment. So cheese is made of milk and many of us would put it in the same category as milk and yogurt as is done in many versions of the Canada's food guide. However, because of how cheese is made, it contains very little carbohydrate and comparably more protein. So for this reason, with our diabetes lens, we would classify cheese into a different category than we would classify milk and yogurt. And I'll talk about those differences in a moment. 

[00:18:57] So we'll turn again to our more detailed tools to take a closer look. So we see here that in the milk and alternatives, we have milk and yogurt. And when we look at the diabetes food guide, we see that in the blue arch, we see milk and yogurt. And in the red arch, we see cottage cheese and regular hard cheese. And these some of the differences because cheese is high in protein and lower in carb and, whereas milk does contain carbohydrate. 

[00:19:37] For individuals living with diabetes, healthy eating recommendations cannot always be communicated to one page handout. There are many complex conditions that require more individualization and tailoring of nutrition messages. Some of these include kidney disease, inflammatory bowel disease, absorption and digestion issues, high risk wounds, swallowing impairment and many others and these require conversation and input from the individual. And as medical needs change, so too will nutrition messages need to change and further adjustments are needed. In these circumstances, it becomes very important to consult a registered dietitian and your health care team. 

[00:20:26] Food security is a really important issue and one that is worth noting. So food insecurity is when somebody is without reliable access to a sufficient quantity of quality and affordable, nutritious food. So being food insecure negatively impacts physical health, mental health and social health. Adults living in a food secure environment or situations are at higher risk of developing chronic diseases such as type 2 diabetes, with the risk increasing as the severity of food insecurity increases. Food security is a very important factor in any food conversation. And so my hope is that conversations about food and nutrition messages that should always have that consideration of whether or not somebody has access or finances for food. A common criticism of the new Canada Food Guide is that it is not affordable because it suggests that half of our food intake come from vegetables and fruit. And some have argued that with the focus on these plant based proteins, such as beans and legumes, it kind of averages out because the plant based proteins can often be cheaper and more economical to store. And so the argument is that with plant based proteins, the average family of four would actually save six point eight percent or about a dollar and 90 cents a day on their food costs. But this also has the expectation that people know how to cook and prepare these plant based proteins. So it's just a note that healthy food is not accessible to all and we need to be mindful of that. So the new kind of food guide does include some tips, such as following a budget and suggestions on how to use frozen, canned and dried foods as more economical choices. And this isn't always enough. So this is where, again, speaking with your health care team or a dietitian can be helpful to help tailor those nutrition messages to those needs. In the vein of economics and and eating on a budget. Statistics shows that more than a thousand dollars of our household food dollar ends up in the garbage every year. So this equates to about 140 kilograms of household food waste per year, which is astounding to me. These statistics and graphics that you see here are from a Canadian website called Love Food, Hate Waste. And it has some interesting information that might be helpful. As we all try to stretch our food dollar and make healthful choices. And so it shows here that 30 percent of food waste is from vegetables. And so I know that a lot of us have really good intentions when we go to the grocery store and we buy up all these vegetables that look so good and then they end up going bad in the fridge. And so trying to find strategies to be strategic with how we use these and being realistic on on the amount of time that we have to prepare these is is good and important. And the graphic on the right shows that 63 percent of our household food waste is food that could have been eaten and is avoidable. So in this same line of food waste. The graphic that you see here shows a little infographic that was created Which Food Should I Eat First? And so if you go to the market, you buy a whole bunch of food on Saturday, which foods will kind of turn for the worst the soonest? And so this is one little strategy that you can use, just knowing which foods will go bad first. But if you check out their website, Love Food, Hate Waste, They have lots of different resources and discussions on how to plan out your meals, strategies on how to use up leftovers and different ways to store your food on how to keep it fresh because we know that most of the food loss and food waste can be caused by preparation mistakes, lack of proper storage, different storage practices, trimming for consistency, mishap and products, spillage during handling, poor portion control, contamination, overproduction and food safety concerns. And so this is a kind of a neat way to pick up some tips and resources on how to reduce your food waste. 

[00:25:11] So this is my last slide and kind of just what you need to know. And the first thing that you need to know is that there is no one size fits all approach to eating. We all have different values and preferences and we need to consider these when we're thinking about what foods we're going to eat. And know that the major difference between general resources, such as Canada's Food Guide and diabetes focused resources, like the ones that we showed today, is the carbohydrate lens. The consideration of whether or not a food will be affecting blood glucose or not. And then finally, I encourage you to use whichever resource or approach that works for you for your own wishes and needs. Because we're all different and so if using a very basic resource such as the plate method works for you, you know, just making sure that you have a half a plate of veggies if that works for you, then that's great. If going into a bit more detail and counting and looking at a few resources to be able to quantify carbohydrates is important, then then use that and you have to do it with what works for you. And I say thank you very much. 

[00:26:29] This may be quite small print, but these are some of the references that I've used today and some of the links to the website are right in here. So please feel free to peruse and take a look or if you wanted any more detail on some of the other topics that I've discussed today. And finally, I want to say thank you for listening to this recording, and I hope that it was helpful in understanding some of the differences between Canada's food guide and some of the diabetes recommendations for individuals with Type 2 diabetes. Thank you. 

[00:27:07] And that concludes our webinar for today. I'd like to sincerely thank Lisa for speaking on behalf of Diabetes Canada. It has been a great learning experience. And for those of you looking for more support and resources for living well with diabetes. Feel free to call our toll free line at 1 800 Banting. That's 1 800-226-8464. If you have any questions about today's presentation, please send us an email at webinars@diabetes.ca and we will get back to you as soon as possible. Thank you for joining us today. We hope you've enjoyed learning with Diabetes Canada and look forward to your participation in the future.