Largely due to tobacco use, lack of physical activity and unhealthy eating, Canada and the world are facing an epidemic of chronic noncommunicable disease (mostly cancers and cardiovascular diseases).
As a result it is predicted the next generation will live a shorter life span; if this occurs it will be the first decline in life span since industrialization. In response, the United Nations has devoted a summit to address the increasing threat of premature death and disability both to the health of the world’s population and the global economy. Notwithstanding the questionable sustainability of health care in developed countries, it is expected that the economies of developing countries will not be able to cope with the expected increase in disability in their work forces or rising disease management costs and resource use stemming from chronic disease.
An estimated 40% of premature death is related to our diets. For example, increased blood pressure is estimated to be the leading risk factor for premature death in the world. It is estimated that hypertension is up to 32% attributed to high dietary sodium, 28% to the “westernized diet,” 17 % to lack of potassium in the diet, and up to 28% to obesity. Our current diets are also related to the development of diabetes, obesity, dyslipidemia, and some cancers in a similar fashion.
Do we know what we eat?
Although links between poor diet and premature death and disability in our society are well established, we have not developed nomenclature that appropriately reflects the level of risk associated with current food consumption patterns. In fact, foods high in sugars, saturated fats, and sodium, now a common and large part of everyday diets, are implicated in declining diet quality because of their ubiquity in western society. Such foods have historically been “treats” and either used as rewards for good behaviour or distributed in celebration of holidays such as Halloween, Christmas, and Easter. However, what was once perhaps appropriately named a “treat” is now available 24/7 in the markets, vending machines, and drive-throughs of the nation. Food manufacturers promote the idea of “treat” in advertising. In Canada, every hour of the day within the safety of their own homes, children are exposed to advertisements for foods of poor nutritional quality up to 6 times per hour, 1 of the highest rates of food advertising in the world. This situation reflects attributes of the broader food environment. For example, globally, changes to the production and trade of agricultural goods, foreign direct investment in food processing and retailing, as well as global food advertising and promotion, have led to highly processed foods being increasingly inexpensive. Closer to home, a Canadian governance structure characterized by active and passive encouragement of market forces, and a “hands-off” approach to regulation of industry, even if such regulation is essential for population health, is part of the changing food environment.
Recognizing that the foods high in sugars, saturated fats, and sodium have limited nutritional value in a balanced diet, such foods are now commonly referred to as “junk foods.” While such a label appropriately implies that such foods are not required and could be thrown away without loss of value in our diets, the term “junk” food does not reflect the serious risk to health and premature death posed by diets made up of these foods. The term “junk” also connotes a certain ease in removing them from the diet, and implies that people are readily able to discard them through willpower despite being regularly encouraged to “give in” and indulge while living in an environment where such foods are readily available and purposefully promoted.
We propose a new nomenclature, “pathogenic diets and foods,” to describe diets and foods that are high in calories, sodium, saturated and trans fats, and simple sugars with deficiencies in fibre, potassium, and other minerals. Further, we propose that sodium, saturated and trans fats, and simple sugars be called “pathogens” when they are in foods in excess of physiologic needs. Labelling diets, foods, and components of diets as pathogenic could be based on deviation from the recommended nutrient intakes for those constituents that are closely associated with major health issues. The specifics of what represents a pathogen should likely change over time with changes in scientific understanding of the relationship between dietary constituents and disease or with changes in intakes of foods/nutrients that ultimately cause disease. The specifics of how to label foods to include clear health implications based on nutrient excesses are the subject of discussions that are currently ongoing in the United States. Notwithstanding the details that would need to be worked out to define “excess,” we assert that nomenclature that directly links our current diet and the implicated nutrients to disease could bolster action to improve our diets and prevent predicted increases in death and disability. The birth of public health is closely associated to uncovering the link between unsafe foods and water and disease (http://en.wikipedia.org/wiki/Public_health). The discovery that the bacteria, virus, and toxin content of food and water were the cause of much disease led to close surveillance and regulation in most developed countries. The public and media are now quick to respond to outbreaks of bacteria in food or water and especially to any resulting death and disease. Governments have reacted quickly to small numbers of deaths or people with disease with increased scrutiny and regulation. Such responses appear to have been effective as disease and death due to food and water-borne bacterial or viral pathogens and toxins in developed countries have been limited. This is in contrast to the government reluctance to respond meaningfully to the deaths and disability of tens of thousands of Canadians each year that can be attributed to our “junk food” diets full of “treats.” We intend the pathogenic nomenclature to draw attention to the fact that currently although on one hand advising healthy eating, governments condone and support pathogenic diets by using public dollars to buy and also sell implicated foods in government buildings and elsewhere, allowing overt commercial advertising of pathogenic foods to all Canadians including our children, and regulating nutrient labels that do not provide clear warnings or that allow a consumer to determine the food being purchased is likely to contribute to illness and premature death. Further, the government should consider a system recouping health costs by taxing pathogenic food (like tobacco) and providing incentives for foods that prevent disease. Given the difficulty people have in understanding the current nutrition labels, clear, easy to understand front of package food labelling with health implications is attracting substantive interest in the United States as a potential mechanism to inform the public about the health implications of the foods they purchase. Regulating pathogens is a government responsibility. Limiting junk or treats is a personal responsibility. By implementing legislative action, the government would acknowledge the difficulty the public has in eating a healthy diet in a “toxic” food environment which places few or no restrictions on food industry for producing, processing, and promoting pathogenic foods.
A clear understanding by the food sector, public, and policy makers of the role of foods in disease—in part through the use of an appropriate terminology—might help change policies and behaviours. A greater awareness of diet’s role in the non-communicable disease epidemic will also potentially result in increased research on nutrition and health. Currently a lack of high quality and impartial publicly-funded nutrition research is also a major concern. Nevertheless with current knowledge, food processors and those preparing foods can develop foods consistent with good health. Governments could ensure Canadians can easily identify pathogenic foods with clear warnings, prevent the coercive marketing of these foods to our children, only purchase and sell healthy food choices, and ensure all Canadians have healthy foods accessible to them.
Originally Published in Canadian Journal of Cardiology (2012):
A Call for Changing Nomenclature to Fit the Risk of Today’s Diets
Norm R.C. Campbell, MD,a Kim D. Raine, PhD, RD,b and Lindsay McLaren, PhDc
Received for publication October 18, 2011. Accepted November 29, 2011.
Corresponding author: Dr Norm R.C. Campbell, Departments of Medicine, Physiology and Pharmacology, and of Community Health Sciences, The University of Calgary, Libin Cardiovascular Institute of Alberta, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada.
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