Healthy eating advice, then and now

Dietitian Carol Dombrow has seen nutrition ideas come and go. She looks back at key changes — and forward to a healthier future

As a registered dietitian, Carol Dombrow has been contributing her nutrition expertise to Heart and Stroke Foundation information and policies since 1986. She was recently honoured with the Dietitian of the Year award from Dietitians of Canada, Business and Industry Network.

We asked Carol to reflect on the changes she’s seen in nutrition thinking — and the outlook for heart-healthy eating in future.


Canada’s Food Guide comes of age

As we’ve learned more about nutrition, we’ve seen shifts in the guidance provided through Canada’s Food Guide.


Carol Dombrow

In 1982 the focus was a “foundation diet,” which set out minimum amounts of required nutrients and recommended limits on fat, salt and alcohol. 

In 1992 the revamped guide shifted focus to meeting both energy and nutrient requirements. Its aim was to show Canadians how all foods — even those with little nutritional value, such as jam, chocolate and candy — could fit into a healthy diet, if eaten in moderation. But 15 years later, the new food guide reversed that stance, spurred by rising rates of obesity and type 2 diabetes.

The 2007 Food Guide, still in effect today, recommends types and amounts of foods for healthy eating with a focus on reducing chronic diseases. It emphasizes lower intake of fat, sugar and salt and provides specific guidance based on your life stage and sex.

Canada’s Food Guide is not done with changes just yet. As the science of nutrition continues to uncover the relationships between food and health, Health Canada, in consultation with stakeholder organizations such as the Heart and Stroke Foundation, continues to enhance its strategy for promoting healthy eating. Much work is being done to ensure that the next version of the food guide meets the needs of all Canadians. That enhanced strategy is looking very promising and we look forward to the next version of Canada’s Food Guide, hopefully in the not too distant future.


The rise of processed foods

As the 20th century came to a close, consumer research was indicating a shift in food habits: People were increasingly relying on prepared and processed foods, rather than meals prepared at home. I certainly recognized this trend from observing other grocery carts while doing my own shopping.

Clearly, if consumers were shifting away from home-prepared foods, they stood to benefit from authoritative guidance on how to make better choices among processed foods. Here, Heart and Stroke took the lead by creating a “front-of-pack” nutrition program called Health Check. The program involved working closely with food manufacturers and restaurateurs to develop healthier options — which was sometimes controversial. 

With time, more front-of-pack programs hit the market, Heart and Stroke considered this to be a cause of consumer confusion. And, so, after 15 years of assisting Canadians in trying to make healthier processed food choices, the Health Check program closed. Today, Heart and Stroke focuses on emphasizing cooking from scratch and limiting processed foods.


The trans fat debacle

As growing evidence indicated that saturated fats (SFs) created a risk for heart disease, food manufacturers strived to find a healthier substitute. The search culminated in the use of trans fats (TFs), which are derived from partially hydrogenated oils. Subsequently, however, TFs were discovered to actually pose a greater risk for heart disease.

Armed with this new knowledge, Heart and Stroke co-chaired a trans fat task force along with Health Canada and, in 2007, established limits for the amount of partially hydrogenated oils found mostly in margarines, baked goods, snack foods and fried and breaded foods. Though trans fats have been significantly reduced, three per cent of the food supply still doesn’t meet targets. So check ingredient lists carefully when you shop.


The trouble with lower fat

The Food Guide’s recommendation to consume less fat brought an unintended consequence in food production. Simply put, less fat meant less flavour. Manufacturers would have to be restore the flavour somehow.

They began to increase sugar and salt content, as well as thickeners, to make their products taste better to consumers.

The net result for processed foods has been a reduction in fat but without calorie reduction or improvement in nutritional value. Plus, we know that excess sugar and salt are associated with adverse health effects including heart disease, stroke, obesity and more. 

Although we are starting to see some positive changes in processed foods, your best option is to consume a variety of whole and minimally processed foods.


The revitalization of home cooking

It has always been my view that the best approach to helping Canadians eat well is to provide practical advice for preparing delicious foods at home. So, way back in 1988, I was pleased to be involved with bringing the Heart and Stroke Foundation’s first best-selling cookbook, The Lighthearted Cookbook, to market. It sold more than a million copies and led the Foundation to publish several more cookbooks.

While the Foundation is no longer in the cookbook business, today we proudly publish hundreds of heart-healthy recipes on our website. All are carefully reviewed to meet strict criteria, ensuring that they’re lower in sugar, salt and fat and higher in fibre.

Today, it’s great to see a swing towards more home cooking, fortified by influences including TV reality cooking shows, YouTube videos, healthy eating blogs, recipe and food prep websites, farmer’s markets, and expanded produce sections in supermarkets. Plus, I’m finding more of my professional colleagues are promoting at-home food preparation. 

Certainly, these are all very positive changes influencing Canadians to maintain a healthy diet. And, if there is one dietary fact that we should all keep in mind it’s this: Up to 80 per cent of premature heart disease and stroke can be prevented through adopting healthy behaviours, including a healthy diet.

In other words, enlightened at-home food preparation can help you prevent heart disease and stroke.


Looking forward

Consumers question everything, and often the answers are at their fingertips with instant results from a simple Google query. But asking the right questions, finding the most credible resources, locating the most relevant and accurate facts, and interpreting them correctly is complicated, especially as the science of nutrition continues to evolve.

My own philosophy about nutrition is to try to keep things simple:

  • Eat a healthy, balanced diet of mainly whole foods, ensuring lots of variety.
  • That includes eating more vegetables and fruit, choosing whole grains, selecting a variety of protein sources and eating fewer highly processed foods.
  • When thirsty, choose water or plain milk.

This approach is simple but it does involve planning, shopping for and preparing meals while significantly reducing your reliance on most packaged and prepared foods. So, the simple life requires a commitment.

But I assure you: once you start, you will never go back.





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