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Front-and-centre nutrition alert labels on the way

Health Canada's food labelling proposals should help Canadians deal with an epidemic of obesity and diet-related chronic diseases By Fabio Gomes Contributor EvidenceNetwork.ca Fabio Gomes Supermarkets are crowded with around 40,000 products, yet most shoppers spend fewer than 10 seconds selecting an item. That's certainly not enough time to review current Canadian nutrition labels, which are on the back or side of packages and contain detailed information that's often too complex for many consumers to understand. But nutrition labeling is about to change in Canada. That's good news for our health and for informed consumer decision-making. Health Canada is developing new "high in" nutrition alert labels for the front of food packaging. This is consistent with best practices and evidence of how to provide consumers with quick and easy information about the levels of saturated fats, sugars and/or sodium in food and drink products. How does it work? When a product has more than a specified level of certain nutrients, it must have a prominent black label on the front of the package that says simply, depending on the nutrient in question: "high in sugar," "high in fat" or "high in sodium." There are no numbers or symbols that require further interpretation. Importantly, the simple but powerful words "Health Canada/Santé Canada" should also be on the label to convey that the alert symbol has legitimacy and authority. This is an excellent step forward and will make Canada the first G7 country to mandate such labelsif the plan proposed by Health Canada is approved and implemented. Why did Health Canada choose this option? Research, including work awarded the Nobel Prize, has consistently demonstrated that consumers don't spend a great deal of time and effort in purchasing situations, especially when it comes to repetitive decisions, which is the case when buying food. Current nutrition facts, unfortunately, don't sufficiently influence shoppers' choices towards healthier products. Why is this the case? Because food and drink nutrition labels are frequently difficult to find, hard to read and obscured by competing claims on the packaging. There are often prominent but misleading claims by manufacturers on the front of the packages that may be at odds with the nutrition label on the back. Images of natural foods, such as fresh fruits and cartoon characters, as well as colourful designs, can also distort consumer perceptions about certain foods. A good nutrition label needs to cut through the hype. The key to an effective front-of-package labelling system is that it must be both simple and interpretive. Simple means that it shouldn't require that the consumer have any nutritional knowledge for the label to be understood. Interpretive means that information should be given in the form of guidance to the consumer, rather than simply providing numbers. Consumers invest little time in making a purchasing decision, so the system has to also facilitate quick recognition and processing of the information. Various other promising front-of-package labelling systems have been developed to help consumers make better food choices. Some involve traffic lights - green, yellow and red to indicate low, moderate or high levels of nutrients. Others use numbers and percentages to depict the level of nutrients, and some use stars - the more stars, the healthier. But research has generally found that these systems are not as effective at helping consumers steer away from foods that are "high in" sodium, sugar or saturated fat. And these ingredients are linked to the diseases that are the major causes of death and loss of years of healthy life in Canada, such as cardiovascular diseases, cancer and diabetes. Health Canada was also able to rely on international experience when making its decision. The "high in" labelling approach is used in Chile, and approved for use in Peru and Uruguay. Evaluation of the first year of use in Chile shows that 93 per cent of Chileans reported they understand the labels and 92 per cent found it influenced their purchasing decisions. Manufacturers may also be improving the nutritional content of their products to avoid the negative labels. Food manufacturers in Chile reformulated 18 per cent of their products prior to the implementation of the labelling system in order to avoid having the label on their products. Canada and many other countries face an epidemic of obesity and diet-related chronic diseases with serious and expensive health consequences for individuals and societies. Front-of-pack "high in" nutrition labels will help consumers make healthier and more informed food choices. Dr. Fabio da Silva Gomes is an Advisor in Nutrition and Physical Activity with the Pan American Health Organization/ World Health Organization and a Contributor with EvidenceNetwork.ca based at the University of Winnipeg.

Holiday Peppermint Smoothie

Peppermint can reduce headaches and help you feel rejuvenated. And this smoothie makes a tasty alternative to eggnog. Garnish it with a pretty rim of crushed candy cane.

11/2 cups (375 mL) skim milk
11/2 cups (375 mL) low-fat vanilla yogurt 
11/2 cups (375 mL) ice cubes
5 peppermint leaves, torn
1 Tbsp (15 mL) ground cinnamon 
A few drops peppermint extract (optional)

Blend all ingredients and serve in cups garnished with a pretty rim of crushed candy cane.

Serves four.

Per serving: 114 calories, 8 g protein, 1 g fat (1 g saturated fat), 19 g

Chocolate Almond Smoothie  
http://www.besthealthmag.ca/recipe/chocolate-almond-smoothie

Let's make Canadian hospitals more senior-friendly Hospitals need to identify vulnerable patients with complex needs so they can quickly address and minimize complications (FREE)

By George Heckman
and Paul Hébert
EvidenceNetwork.ca

Canadians are living longer. Unfortunately, our hospitals aren't ready for them.

Canadians over 65 years old use more than 40 per cent of hospital services, a demand that continues to rise.

But as they age, Canadians hope to stay at home as long as possible.

George Heckman

If hospitalization is required, they should expect to go home quickly and safely afterwards. Yet many spend weeks to months in a hospital bed, acquiring new health problems and disabilities, only to find themselves among the more than 300,000 Canadians living in nursing homes.

If hospitals are meant for getting well, why does this happen?

Our health-care system was designed in the 1950s and focused on hospitals. Back then, it was about unexpected emergencies, like pneumonia or injuries. Conditions like heart attacks had few beneficial treatments, so most patients didn't survive very long.

Today, advances in medical science and public health mean that more people survive with conditions that would have killed their grandparents. Conditions that can be treated but not cured are called chronic diseases. The biggest risk factor for chronic diseases is aging. As Canadians get older, they usually acquire not just one but many chronic diseases.

Many older Canadians also develop other age-related problems such as dementia, making simple everyday tasks more difficult. Many lose muscle strength, becoming less active and more disabled.

Over time, the burden of these problems grows and affected persons become increasingly vulnerable. Simple health challenges like influenza, nothing more than a nuisance to young people, will incapacitate or kill a vulnerable older person. This vulnerability is called frailty.

Paul Hebert

The problem is that hospitals remain better suited to care for healthy surgical patients and acute illnesses like pneumonia. Most aren't geared to helping frail seniors cope with acute illnesses or flare-ups of chronic conditions. Frailty is why so many do poorly in senior-unfriendly hospital environments, often becoming more confused and disabled, often irreversibly.

What can be done?

First, hospitals need to identify vulnerable patients with complex needs so they can quickly address and minimize complications. Detection requires that the right information be collected efficiently and reliably at the right time.

Ideally, information about complex needs and frailty should be identified early, in all health-care settings, using a common approach. That would mean that important information can be gathered and acted upon even before a hospitalization. Most of the pieces for this approach are in place in Canada but not in hospitals. Existing hospital documentation systems are bloated and inefficient, collecting some information repetitively but missing other important data.

Yet knowing who's at risk ensures that patients with mobility issues don't stay bedridden a minute longer than needed. It means that patients with dementia are regularly oriented to place and time, and maintained on a stable daily routine. It means aggressive de-prescribing programs to get rid of harmful or useless medications. It also means a more efficient health-care system.

An international not-for-profit group of researchers called interRAI has carefully designed and studied instruments for just this purpose. Its assessment tools are already used in home care, nursing homes and mental health settings across Canada. Unfortunately, they aren't used yet in primary care and hospitals, where measuring frailty is typically an afterthought, if done at all.

Along with colleagues, we recently studied the interRAI Hospital Suite used in 10 Canadian hospitals on over 5,000 older adults, supported by the Canadian Frailty Network. The instruments were easy to use and reliably predicted, within 24 hours of hospitalization, which older patients would develop complications in hospital, which were at risk of a long hospital stay and which were at risk of ending up in a nursing home.

Efforts are already under way to make our hospitals senior friendly, but the lack of systematic assessment in the system overall leaves us all vulnerable as we age. By the time frail patients need hospital care, it's often too late to address their complex needs.

Reliable information is a fundamental requirement to make our health-care system and especially our hospitals senior friendly, allowing better targeting of programs to respond to needs along the entire trajectory of life.

Dr. George Heckman is the Schlegel Research Chair in Geriatric Medicine and an associate professor at the University of Waterloo, and an assistant clinical professor of Medicine at McMaster University. He is an interRAI Fellow, a researcher with Canadian Frailty Network, and a contributor with EvidenceNetwork.ca. Dr. Paul Hébert is a senior scientist at the Centre de recherche du Centre hospitalier de l'Université de Montreal (CRCHUM), and a full professor in the Department of Medicine of the Université de Montréal. He is also a researcher with Canadian Frailty Network and a contributor with EvidenceNetwork.ca.

© Troy Media

Trooper Black Eyeliner Obsession

 A limited-edition vault which features five of Kat Von D's long-wear, high-pigment liquid eyeliners. 

- Available at Sephora, $110.00 CAD

Butternut Squash + Sweet Potato Soup

Butternut squash, pear, and sweet potato blend well together and make a filling low-calorie soup you'll savor.

3 slices center-cut bacon, chopped
3 leeks, white and light green parts only, chopped, 2 cups
2 pounds butternut squash, peeled, seeded, and chopped
1 pound sweet potatoes, peeled and chopped
2 pears, peeled, cored, and chopped
2 carrots, chopped, ½ cup
1 teaspoon chopped fresh thyme
⅛ teaspoon ground nutmeg
4 cups lower-sodium, fat-free chicken broth
½ cup light cream
¼ teaspoon salt
⅛ teaspoon ground black pepper

1. Heat a large saucepan over medium-high heat. Add the bacon and cook until crisp, 5 to 6 minutes. Stir in the leeks and cook until they start to soften, 2 to 3 minutes. Add the squash, sweet potatoes, half of the pears, the carrots, and thyme; cook, stirring occasionally, until the vegetables are slightly softened, about 9 to 10 minutes. Stir in the nutmeg and cook for 30 seconds. Pour in the broth; bring to a boil, reduce the heat to medium-low, cover, and simmer until the vegetables are tender, about 30 minutes. Remove the saucepan from the stove and cool for 10 minutes.

2. Transfer the soup, in batches, to a blender and puree. Return the soup to the saucepan over medium heat. Stir in the cream, salt, and pepper and heat until hot, 1 to 2 minutes. Divide the soup among 8 bowls and garnish each with some of the remaining pear.

Common surgical knee procedure doesn't provide much benefit

A growing body of research shows that most older adults will get the same long-term outcomes from less invasive treatment By Eric Bohm and Ivan Wong EvidenceNetwork.ca Nearly half of Canadians aged 65 and over experience osteoarthritis in their knees. Osteoarthritis is the most common form of arthritis and occurs when the protective cartilage on the ends of bones wears down over time leading to pain, stiffness and decreased mobility. It frequently occurs in the hips and knees - and can be quite painful. To help improve mobility and treat joint pain, it has been common for older adults with osteoarthritis of the knee to be referred to an orthopedic surgeon, like us, for a knee arthroscopy. Eric Bohm As orthopedic surgeons, we want to ensure that our surgical procedures provide high-value care to patients and do more good than harm. Unfortunately, this is often not the case for knee arthroscopy in older adults with arthritis. Arthroscopy of the knee for arthritis involves making several small cuts to insert a small camera and instruments to view the joint and trim loose cartilage and wash the joint out. Now there is a growing body of research showing that this procedure may not be necessary for most older adults since it usually has the same long-term outcomes as non-operative and less invasive treatment. Alternative treatments can include weight loss, physiotherapy, exercise, over-the-counter pain medicines such as Tylenol, anti-inflammatories and pain-relieving joint injections. Knee arthroscopy, on the other hand, is a surgical procedure that typically requires spinal or general anesthetic; there's always a risk of infections or structural damage to the joint. Does this mean that all arthroscopy shouldn't be performed? No. Rather, arthroscopy needs to be done for the right conditions and on the right patients. For example, meniscus repair surgery for a younger person with a knee injury can help improve function, treat pain and increase mobility. What's at stake? Ivan Wong Unnecessary surgeries mean that our time as surgeons, as well as health-care system resources such as operating rooms and staff, are tied up doing surgeries that don't add much value to Canadian patients. These resources could be directed towards other orthopedic procedures that provide pain relief and improved function yet have long waiting lists, such as spine surgery and hip and knee replacements. For older patients with osteoarthritis in the knee, arthroscopy is more often than not the wrong choice. As surgeons, we advise our patients on alternatives to surgery and reflect on our own practice habits. We're also championing the Choosing Wisely Canada campaign to our colleagues and patients far and wide. Recently, the Canadian Orthopaedic Association, the Canadian Arthroplasty Society and the Arthroscopy Association of Canada joined to release a set of recommendations on best practices. The first recommendation is against arthroscopy for initial treatment and management of osteoarthritis in the knee. It's well established that physicians tend to overestimate the benefits of our procedures and often underestimate harms. Recent research shows that the same misconceptions about harms and benefits of common procedures are held by patients. A culture shift is needed for surgeons, patients and the public on treatment expectations for knee osteoarthritis. Saying no to arthroscopic surgery, and instead undertaking non-operative management, is a challenge for clinicians and patients alike. Thoughtful, evidence-based utilization of our health-care resources will help to improve appropriate care for all Canadians. Dr. Eric Bohm is a professor at the University of Manitoba and an orthopedic surgeon with the Concordia Joint Replacement Group in Winnipeg. He is also a contributor with EvidenceNetwork.ca, which is based at the University of Winnipeg. Dr. Ivan Wong is an associate professor at Dalhousie University and an orthopedic surgeon at the QEII Health Sciences Centre in Halifax. He is also the president of the Arthroscopy Association of Canada.

© Troy Media

Perfect Cranberry Sauce Recipe | Food Network Kitchen | Food Network Food Network

Empty a 12-ounce bag of fresh or frozen cranberriesinto a saucepan and transfer 1/2 cup to a small bowl. 

Add 1 cup sugar, 1 strip orange or lemon zest and 2 tablespoons water to the pan and cook over low heat, stirring occasionally, until the sugar dissolves and thecranberries are soft, about 10 minutes.

Biocell breast implants at centre of ‘biggest controversy in plastic surgery’