Learn more about the risks of poor diet, and how changes in nutrition policy could better support the health of all Canadians. In this webinar Dr. Norman R.C. Campbell, MD, will review some of the issues Canadians face when trying to eat healthy food and what types of food policies are required to improve the food environment in Canada. Watch the full webinar recording at https://explore.ucalgary.ca/let-food-be-thy-medicine-diet-and-disease

1. Let food be thy medicine:
Diet and disease
Dr. Norm Campbell, MD
Professor, Cumming School of Medicine
January 11, 2019

2. • Professor of medicine, community
health sciences and physiology and
pharmacology
• Member, O’Brien Institute for Public
Health and Libin Cardiovascular
Institute of Alberta
• Seeks to improve hypertension
control, and diet
• Known around the world for his
work in sodium reduction and blood
pressure control
Dr. Norman R.C. Campbell, MD
2

3. • Major health risks from eating current diets
• Some of the challenges individuals face in eating a
healthy diet
• Recommended public policies to create healthy
eating environments
Agenda
3

5. Hypertension is common
5
• 1 in 4 Canadian adults have been diagnosed
with hypertension
• 1 in 3 Canadians aged 55-65 have
hypertension
• What happens to the 2 in 3 Canadians aged
55-65 that don’t have hypertension?

6. Lifetime risk of hypertension in women
and men aged 55-65 years
6
Risk of Hypertension %
0 2 4 6 8 10 1
2
1
4
1
6
1
8
2
0
Years to Follow-up
Women
Risk of Hypertension %
Years to Follow-up
0 2 4 6 8 10 1
2
1
4
1
6
1
8
2
0
Men
JAMA 2002: Framingham data.
80
60
40
20
0
100
80
60
40
20
0
100

7. Hypertension and risk of stroke mortality
7Lancet 2002;360: 1903-13

8. Figure obtained by cropping a downloaded figure from http://www.healthdata.org 2018
GLOBAL DEATHS > 10 million/year
HYPERTENSION
GLOBAL 2016
DIET
TOBACCO
AIR POLUTION

9. Societies most at risk of developing
hypertension
9
Meneton et al, 2005

10. Lifestyle risk factors leading to
hypertension
10
Risk factor Approximate attributable
risk for hypertension
Increased salt in diet 32%
Decreased potassium in
diet
17%
Overweight 32%
Sedentary lifestyle 17%
Excess alcohol 3%

11. The burden of hypertension:
Cost estimates of increased blood pressure
11
• Direct health care costs
• In Canada, approximately 10% of overall health
costs and are estimated to be $20 billion in 2020
• Indirect costs
• Estimated to be 4.5% to 15% of GDP in high
income countries
• In Canada, almost 1 in 2 people over than age
60 are taking antihypertensive medication
Heidenreich PA et al Circulation 2011;123:933-944
Gaziano TA et al, J Hyperten 2009;27:1472;-77

12. • Reducing systolic blood
pressure by a small
amount (salt
reduction/better diet) can
reduce:
• death rates from stroke by
1 in 7
• heart disease by 1 in 11
• premature death by 1 in
14
A small change can make a big difference
12

13. Canadians and diet
13
• Statistics Canada surveys find very few Canadians
have healthy diets
• National surveys confirm most understand that
Canadians eat unhealthy diets
• However, most claim they personally eat
healthy diets
• If you regularly eat processed foods it is very,
very, very unlikely you have a healthy diet
• The vast majority of Canadians indicate they are
trying to improve their diets

14. Health risks of current diets
• About 36% of deaths attributed to diet
• About 1 in 4 cancers attributed to diet
• The main diseases caused by diet are heart disease,
stroke, chronic kidney disease and diabetes
• Mental illness (depression, anxiety, ADD)
• Reduced school performance

15. Canadian diets
Excess of Lack of
Calories Fruit
Sodium Nuts and seeds
Free sugars Vegetables
Saturated fats Fibre
Trans fatty acids Potassium
Calcium
Vitamin D

16. Canadian dietary risks 2017
Sodium
Trans fat
Sugary drinks
2017 CANADIAN DEATHS
FROM DIET >60,000/year
FROM SODIUM >12,000 /year

17. Canadian leading risks for death due to
lifestyle
1990 2017
Rank Risk Risk
1 Smoking Smoking
2 Diet Diet
3 High blood pressure High blood pressure
4 High plasma glucose High plasma glucose
5 High cholesterol High body mass index
6 High body mass index High cholesterol

18. Why might Canadians think they eat
healthy, but don’t?
Food awareness and labeling
• Decades long extensive social marketing
campaigns have normalized unhealthy eating
patterns and foods
• Widespread inability to accurately interpret the
Nutrition Facts Panels (NFPs)
• Unclear if the NFP information is accurate or not

19. Food awareness and labeling
• Front of package ‘health claims’ can/do mislead
consumers
• Reduced in ‘______’ claims may still be very high in
‘______’ and contain other ingredients in vast excesses
or deficiencies
• Over 30 front of package labels, many relating to
health, but most could mislead a consumer
whether the food is healthy or not

20. Food awareness and labeling
• No current label clearly indicates relevant
excesses and deficiencies and indicates the
health issue.
• i.e. This product is high in sodium. Diets high
in sodium can cause hypertension and are
associated with gastric cancer and other
health risks
• Restaurant food (fast or slow, cheap or
expensive) is largely unhealthy and is rarely
labeled

21. Undermining science
21
Low
quality
research.
Conflicted
and dissident
scientists
Unreliable
results
Controversy
Paradoxically
more
publicity,
citations and
publication in
higher impact
journals and
presentations
at meetings

22. The business model for undermining of
public health
22
>4
trillion
USD/yr.
food
industry
Extensive
social
marketing
Undermining
confidence in
healthy public
policyConflicted
and
dissident
scientists
Low quality
research

23. Reducing your risk of hypertension
• Dietary change can lower blood pressure and can prevent or
control hypertension
• If you eat a diet with a variety of fresh (or minimally
processed) fruit, vegetables and whole grains with some nuts,
seeds, legumes, some low fat dairy and some fresh (or
minimally processed) meat, poultry or fish then you likely eat
a healthy diet
• However, if you add too much sugar, salt or saturated fats,
you can make healthy food unhealthy

24. Reducing your risk of hypertension
• Dietary Approach to Stopping Hypertension (DASH)
trial was highly effective (provided food)
• Extensive nutritional advice and support are effective
but diminish with time
• Brief clinician advice is effective for other
interventions but the vast majority fail to change

25. Future risk if we continue to eat
unhealthy diets
Based solely on societal trends in caloric
consumption and obesity, the next generation
is predicted to live a shorter life.

26. How can we change the future?
• The relative lack of effectiveness of education and
clinical approaches indicate a need for policy --
environmental interventions
• We need to stop blaming all Canadians for making
poor choices in an environment that makes it very
difficult to make a healthy choice

27. What can I do to champion change?
• Advocacy as an individual
• Be a role model
• Teach the importance of healthy and
unhealthy eating to friends, family and
colleagues
• Join efforts to support dietary policy change
• Advocate to politicians; help create the
political will

28. What could the wider Community do to
improve healthy eating?
• Advocacy as an organization
• Policies
• i.e. healthy food procurement
• Publications
• Presentations
• Politicians

29. Is the public supportive?
The majority of Canadians want government to introduce
policies and or regulations to make food healthier
• 8 in 10 want warning labels on high sodium foods
– 2 in 3 want it to be mandatory and
– 7 in 10 view it as extremely or very important
• 7 in 10 want a regulatory approach to how much sodium
can be added to foods by food processors- in contrast a far
lower % vote for any political party

30. Zoos have better food policies

31. So why isn’t something being done?
Governments claim health is a top priority and that they are
taking appropriate actions but largely are doing the same
ineffectual interventions over and over again.
Current governmental policy interventions remains focused
- at the level of the individual and the responsibility on
individual behavior change
- on industry volunteerism
Both have been shown over and over and over again to fail

32. So why isn’t something being done?
The bulk of external advice on the health policy
relating to foods received by Health Canada in the
past came directly from the food industry and
individuals with financial ties to the food industry
Many global best practices are not being
implemented - all require substantive Federal and
or Provincial and or Municipal government
oversight and or regulation

33. Some policy interventions
• Setting targets and timelines for sodium,
saturated and trans fatty acids, and free sugars
content of all processed foods with close
government monitoring and oversight
• Implementing healthy food procurement policies
• Implementing clear transparent conflict of interest
guidelines to ensure public health food policies
reflects public health interests and are free of
commercial bias
• Banning advertising (of unhealthy foods) to
children

34. Some policy interventions
• Mandated clear easy to understand food package
labeling with health implications
• Taxing foods that have added sodium, saturated
and trans fatty acids, and free sugars to
recuperate health and other societal costs
• Reducing the cost and increasing the availability
of healthy food
• Defining ‘unhealthy’ foods
• Monitoring and evaluation of the health of our
food environment

35. What is being done
• Development of new Canada Food Guide and
strategy
• Development of Calgary Statement and petition

36. You are not alone
• Top priority for hypertension prevention and
control
• Hypertension Advisory Committee ( Canadian
Association of Cardiovascular Prevention and
Rehabilitation, Canadian Cardiovascular Society,
Canadian Council Of Cardiovascular Nurses, Canadian
Diabetes Association, Canadian Medical Association,
Canadian Nurses Association, Canadian Pharmacists
Association, Canadian Society of Internal Medicine,
Canadian Society of Nephrology, Canadian Stroke
Network, College of Family Physicians of Canada,
Heart and Stroke Foundation of Canada,
Hypertension Canada, Public Health Physicians of
Canada)

37. In summary
• Society’s (government’s) responsibility
• To make healthy choices the easy choice
• easily accessible, low cost
• To make unhealthy choices the difficult choice.
• less accessible, and more costly
• To ensure the public are aware of the consequences of
their choices
• The Individual’s responsibility
• to select their choices based on their values with an
understanding that there are consequences associated
with their selection.

38. Thank you