Dietary choices made on a regular basis form a person’s pattern of eating. Over time, patterns of eating can lead to better or worse health outcomes. This section focuses on the regular intake of foods that make up patterns of eating associated with positive health outcomes.

Table 2 lists the convincing findings that support Guideline 1.

Vegetables, fruit, whole grains, and protein foods should be consumed regularly. Among protein foods, consume plant-based more often. 

• Protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.

Rationale

Health Canada recommends the regular intake of nutritious foods—vegetables, fruit, whole grains, and protein foods—that are commonly found in patterns of eating linked with beneficial effects on health. Table 2 provides more detail on these patterns, which have been shown to have a protective effect in reducing the risk of cardiovascular disease, including risk factors such as high blood pressure and elevated blood lipids. ^{1 2 3 4 5 6}

Cardiovascular disease is a serious public health concern in Canada. Almost 50% of deaths from cardiovascular disease were attributed to dietary risks in 2017. ⁷  Dietary risks include low intake of nutritious foods, such as vegetables and fruit. In Canada, vegetable and fruit intakes are consistently low. ⁸

While many animal-based foods are nutritious, Guideline 1 emphasizes more plant-based foods. The regular intake of plant-based foods—vegetables, fruit, whole grains, and plant-based proteins— can have positive effects on health. This is because patterns of eating that emphasize plant-based foods typically result in higher intakes of:

• dietary fibre, associated with a lower risk of cardiovascular disease (including well-established risk factors such as LDL-cholesterol ⁹), colon cancer, and type 2 diabetes, ^{3 10 11 12 13}

• vegetables and fruit, associated with a lower risk of cardiovascular disease, ¹⁴
• nuts, associated with decreased LDL-cholesterol, ³ and
• soy protein, associated with decreased LDL-cholesterol. ^3 15 

Shifting intakes towards more plant-based foods could also encourage lower intakes of:

• processed meat (such as hot dogs, sausages, ham, corned beef, and beef jerky), which have been linked to increased risk of colorectal cancer, ^16 17  and
• foods that contain mostly saturated fat. Lowering the intake of foods that contain mostly saturated fat by replacing with foods that contain mostly unsaturated fat decreases total and LDL-cholesterol. ^{1 2 18 19 20 21 22}

Patterns of eating that include animal-based foods should emphasize more plant-based foods, and promote animal-based foods that are lower in saturated fat, such as lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.

The intention is not to reduce total fat in the diet. Rather, it is to help reduce intakes of saturated fat, while encouraging foods that contain mostly unsaturated fat. ^{1 2 18 19 20 21 22}

Foods that contain mostly unsaturated fat should replace foods that contain mostly saturated fat.

Rationale

Health Canada recommends replacing foods that contain mostly saturated fat with foods that contain mostly unsaturated fat to promote cardiovascular health.

The type of fat consumed over time is more important for health than the total amount of fat consumed. There is convincing evidence that lowering the intake of saturated fat by replacing it with unsaturated fat (that is, poly- or mono-unsaturated fat) decreases total and LDL-cholesterol. ^{1 2 18 19 20 21 22} Elevated LDL-cholesterol is a well-established risk factor for cardiovascular disease ⁹ that has affected about 1 in 5 adult Canadians in 2012/2013. ²³

Replacing saturated fat with polyunsaturated fat can also lower the risk of cardiovascular disease. ¹ Further, limiting the intake of foods in which the fat is mostly saturated, while choosing foods in which the fat is mostly unsaturated is a common feature of patterns that have been shown to have beneficial effects on health. ^{1 2 3 4 5 6}

Water should be the beverage of choice.

Rationale

Health Canada recommends water as the beverage of choice to support health and promote hydration without adding calories to the diet. Water is vital for life—in fact it is the largest single component of the human body. It is essential for metabolic and digestive processes. ²⁴ 

Indigenous Peoples who live in remote, isolated, and northern communities may face limited access and availability of safe drinking water.

Drinking Water Advisories (DWAs) are issued to protect the public from drinking water that is potentially unsafe. They are based on the results of water quality tests. DWAs are most notable in communities that are small, remote or isolated.

Adequate water intake is based on the total amount of water required to prevent the effects of dehydration. In addition to beverages, it would include water from foods like fruit, vegetables, and soups. Some foods and beverages contribute to water intake but can also contribute sodium, free sugars, or saturated fat to the diet. Section 2 provides guidance on foods and beverages high in these nutrients.

Most people consume enough total water to meet their hydration needs. ²⁴  However, factors such as physical activity and exposure to hot climates can increase total water requirements. Those most at risk of becoming dehydrated are young children and older adults.

Considerations

Nutritious foods to encourage

Nutritious foods to consume regularly can be fresh, frozen, canned, or dried.

Vegetables, fruit, whole grains and protein foods are nutritious foods to encourage. Frozen, canned, or dried foods (such as legumes) are always convenient options, especially when fresh food is out of season, costly, unavailable, or takes too long to prepare. Nutritious foods to encourage should have little to no added sodium and saturated fat, and little to no free sugars.

Cultural preferences and food traditions

Nutritious foods can reflect cultural preferences and food traditions.

Part of the enjoyment of eating is choosing nutritious foods that reflect the cultures and traditions we come from. The cultural make-up of Canada is rich, with over 250 different ethnic origins identified on the Canadian Census. ²⁵  Canada’s rich diversity is represented in a variety of traditions, cultures and lifestyles. Canadians can expand their repertoire of nutritious foods as they explore recipes and cooking methods from their own cultural backgrounds and the cultural backgrounds of others.

Eating with others can bring enjoyment to healthy eating and can foster connections between generations and cultures.

Healthy eating is about more than just eating certain types and amounts of food. In all cultures, food is an integral part of social interactions and celebrations. Eating together can help to reinforce positive eating habits. This is especially true for children, who learn from behaviour modelled by parents and caregivers. Eating together may also encourage children and adolescents to take part in cooking and food preparation. ^26 27 Preparing and eating food in the company of others is an opportunity for people of all ages to learn about food and share food cultures.

Traditional food improves diet quality among Indigenous Peoples.

The intake of traditional food among Indigenous Peoples, even in limited amounts, has been shown to improve diet quality. ^{28 29 30 31 32 33 34} These foods may be trapped, fished, hunted, harvested, or cultivated. Traditional food—and the way they are obtained—are intrinsically linked to culture, identity, way of life, and thus overall health. ^28 29 35 Traditional food varies across the country because Indigenous Peoples historically consumed what was available locally. Some traditional foods are commonly consumed across a number of regions. Some examples are: ^{28 29 30 31 32 33 36 37}

• large and small land mammals (moose, deer, elk, hare/rabbit, and caribou),
• sea mammals (seal and whale),
• fish (coastline fish such as salmon, cod and arctic char; lake fish such as trout, walleye, whitefish and northern pike),
• shellfish along the coastlines,
• birds (ducks, geese, and to a lesser extent grouse),
• berries (blueberry, strawberry, raspberry, Saskatoon berry and many others),
• vegetables (corn, squash, fiddleheads, and mushrooms),
• beans,
• nuts (hazelnut), and
• other wild plants (wild rice and Labrador tea).

Research has generally found that traditional food is safe to eat, though regional environmental risks should be considered. ^{28 29 30 31 32 33} Through research and monitoring, the Northern Contaminants Program works to reduce—and, wherever possible, eliminate—contaminants in traditionally harvested foods, while providing information to make informed decisions about local food use. Refer to local, provincial or territorial governments for up-to-date information, including consumption advisories about locally harvested food. The First Nations Food, Nutrition and Environment Study provides additional data on traditional food consumption and contaminants.

Energy balance

Energy needs are individual and depend on a number of factors, including levels of physical activity.

Energy needs depend on individual factors such as genetics, age, sex, body size, body composition, and level of physical activity. ³⁸ Each person needs to eat enough nutritious food to support nutritional health, growth, and development, while avoiding overconsumption and maintaining a healthy weight.

At one end of the spectrum, overconsuming calorie-containing foods or beverages can lead to excess energy intake. Over time, that can lead to unhealthy weights. In addition to following physical activity guidelines, other approaches such as reducing portion sizes can help promote energy balance among adults. ¹⁸ At the other end of the spectrum, restricting intakes of nutritious foods can be a reason for concern. This is because inadequate energy and nutrient intake can have significant and lasting impacts on health. Monitoring of weight status by a health professional can be used as a way to assess unhealthy weights.

Some fad diets can be restrictive and pose nutritional risks.

Canadians are exposed to the promotion of diets that are often commercially driven and promise a quick fix for weight loss or the management of a chronic disease. These diets are often referred to as ‘fad diets’. Sometimes these diets evolve from a medically indicated eating plan, and other times they are based on anecdotal observations and have little or no scientific basis. These diets are often used to promote or sell dietary products such as pre-portioned meals and cook books. Fad diets can be restrictive and pose nutritional risks, particularly when many nutritious foods are eliminated from the diet without appropriate planning for nutritional replacements. Nutrient inadequacies can have a significant and lasting impact on health. A healthy diet should provide sufficient energy to promote a healthy body weight, while minimizing the risk of having too much or too little of any particular nutrient. It should also allow for personal food preferences, which can reinforce the enjoyment of healthy eating.

Environmental impact

Food choices can have an impact on the environment.

Assessing and measuring the environmental impact of food choices can be complex and challenging. This is because all food production requires land, water, and energy. Further, the environmental impact of any food can vary greatly based on factors such as where the food comes from, the packaging, and how it is produced, processed, and transported.

While health is the primary focus of Canada’s Dietary Guidelines, there are potential environmental benefits to improving current patterns of eating as outlined in this report. For example, there is evidence supporting a lesser environmental impact of patterns of eating higher in plant-based foods and lower in animal-based foods. ^1 42 43 The potential benefits include helping to conserve soil, water and air.

The way our food is produced, processed, distributed, and consumed—including food loss and food waste—can also have environmental implications ^1 44 Food waste is a contributor to landfill greenhouse gas emissions in Canada. ⁴⁵  Reducing food waste—by households, food manufactures and processors, farmers, and food retailers—can help make better use of natural resources and lower greenhouse gas emissions. ⁴⁴ Raising awareness about the importance of reduced food waste is a necessary first step. ⁴⁶ This is further discussed in Section 3.

Conserving natural resources and reducing food waste can help to ensure that Canadians have a long-term, reliable, and abundant food supply. ⁴⁴

 

Table 2: Convincing findings* supporting Guideline 1

Finding	Source of evidence
Patterns of eating
Association between the Dietary Approaches to Stop Hypertension (DASH) eating plan and lowered cardiovascular risk factors	Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture
	American College of Cardiology/American Heart Association 2013: Guideline on lifestyle management to reduce cardiovascular risk: a report of the ACC/AHA task force on practice guidelines
Association between Mediterranean-style diets and decreased cardiovascular disease risk	Canadian Cardiovascular Society 2016: Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult
Association between eating patterns characterized by higher consumption of vegetables, fruits, whole grains, low-fat dairy, and seafood; and lower consumption of red and processed meats, refined grains, and sugar-sweetened foods and beverages and decreased cardiovascular disease risk	Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture
Increased intake of plant-based foods
Association between increased intakes of vegetables and fruit and decreased cardiovascular disease risk	Health Canada 2016: Summary of Health Canada’s assessment of a health claim about vegetables and fruit and heart disease
Association between diets high in nuts and lowered cardiovascular risk factors	Canadian Cardiovascular Society 2016: Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult
Association between diets high in soy protein and lowered cardiovascular risk factors	Canadian Cardiovascular Society 2016: Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult
	Health Canada 2015: Summary of Health Canada’s assessment of a health claim about soy protein and cholesterol lowering
Association between diets high in viscous soluble fibre such as oats and lowered cardiovascular risk factors	Canadian Cardiovascular Society 2016: Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult
Association between increased intakes of total dietary fibre and decreased risk of cardiovascular disease, colon cancer, and type 2 diabetes	Scientific Advisory Committee on Nutrition 2015: Carbohydrates and health report
Association between single grains (beta-glucan oat fibre, barley grain products) and flaxseed and lowered cardiovascular risk factors	Health Canada 2014: Summary of Health Canada’s assessment of a health claim about ground whole flaxseed and blood cholesterol lowering
	Health Canada 2012: Summary of Health Canada’s assessment of a health claim about barley products and blood cholesterol lowering
	Health Canada 2010: Summary of assessment of a health claim about oat products and cholesterol lowering
	Scientific Advisory Committee on Nutrition 2015: Carbohydrates and health report
Saturated fat replacement
Association between replacement of saturated fat with monounsaturated fat and lowered cardiovascular risk factors	World Health Organization 2017: Health effects of saturated and trans-fatty acid intake in children and adolescents: systematic review and meta-analysis
	World Health Organization 2016: Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis
	Food and Agriculture Organization of the United Nations 2010: Fats and fatty acids in human nutrition – Report of an expert consultation
Association between replacement of saturated fat with polyunsaturated fat and lowered cardiovascular risk factors	World Health Organization 2017: Health effects of saturated and trans-fatty acid intake in children and adolescents: systematic review and meta-analysis
	World Health Organization 2016: Effects of saturated fatty acids on serum lipids and lipoproteins: a systematic review and regression analysis
	Food and Agriculture Organization of the United Nations 2010: Fats and fatty acids in human nutrition – Report of an expert consultation
Association between replacement of saturated fat with polyunsaturated fat and decreased cardiovascular disease risk	Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture
Association between replacement of saturated fat with unsaturated fat (especially polyunsaturated fat) and lowered cardiovascular risk factors	Dietary Guidelines Advisory Committee 2015: Scientific report of the DGAC: advisory report to the Secretary of Health and Human Services and the Secretary of Agriculture
	American College of Cardiology/American Heart Association 2013: Guideline on lifestyle management to reduce cardiovascular risk: a report of the ACC/AHA task force on practice guidelines
Association between replacement of saturated fat with unsaturated fat (type not specified) and lowered cardiovascular risk factors	Health Canada 2012: Summary of Health Canada’s assessment of a health claim about the replacement of saturated fat with mono- and polyunsaturated fat and blood cholesterol lowering
Association between replacement of saturated fat with monounsaturated fat and lowered cardiovascular risk factors and type 2 diabetes risk	Dietary Guidelines Advisory Committee 2010: Report of the DGAC on the Dietary Guidelines for Americans
Processed meat
Association between increased intakes of processed meat and increased risk of cancer	International Agency for Research on Cancer 2018: IARC Monographs on the Evaluation of Carcinogenic Risks to Humans – Red Meat and Processed Meat
Association between increased intakes of processed meat (per 50 grams/ day) and increased risk of colorectal cancer	World Cancer Research Fund International/American Institute for Cancer Research 2018: CUP report: colorectal cancer
* Convincing findings are findings graded ‘High’ by the American College of Cardiology/American Heart Association, the Canadian Cardiovascular Society, and the World Health Organization; findings graded ‘Strong’ by the Dietary Guidelines Advisory Committee; findings graded ‘Sufficient’ by Health Canada; findings graded ‘Group 1: Carcinogenic’ by the International Agency for Research on Cancer; findings graded ‘Adequate’ by the Scientific Advisory Committee on Nutrition; and findings graded ‘Convincing’ by the Food and Agricultural Organization, and the World Cancer Research Fund/American Institute of Cancer Research.

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References

Footnote 1

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Footnote 2

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Footnote 3

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Footnote 4

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Footnote 5

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Footnote 6

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Footnote 10

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Footnote 11

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Footnote 12

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Footnote 13

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Footnote 14

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Footnote 15

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Footnote 16

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Footnote 19

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Footnote 20

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Footnote 21

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Footnote 22

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Footnote 23

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Footnote 28

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Footnote 29

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Footnote 30

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Footnote 31

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Footnote 32

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Footnote 33

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Footnote 34

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Footnote 35

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Footnote 36

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Footnote 38

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Footnote 42

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