Letter

As a group of concerned physicians and healthcare workers, we have watched with increasing frustration as our healthcare system is overloaded with diseases such as obesity (which has quadrupled since 1990) [l ], diabetes, and coronary heart disease which are the result of an unhealthy diet and lifestyle.

Our profession is poorly equipped to address these factors and it is essential that government get involved by advocating a healthy diet and lifestyle since this has been shown to be highly effective in decreasing the incidence and reversing these diseases. This was clearly shown in Finland which was able to reduce their rates of mortality from cardiovascular disease by 80% as well as their overall mortality by 62% and their cancer mortality rate by 65% with public health interventions [n ].

The next set of Canadian dietary guideline need to be based on the best scientific data and evidence-based data for change. This is the only way to reduce our growing burden of chronic disease with its associated suffering and healthcare costs.

The following points are clearly based on the peer-reviewed scientific literature and are endorsed by us as health care professionals:

The Canadian Dietary Guidelines should:

1. Strongly support the role of a plant-based diet as the best option for obesity and diabetes prevention/treatment since studies show:
   1. A plant-based diet is better than the American Diabetes Association diet in a 74 week randomised controlled trial [c ]. These results were confirmed in multiple other studies [d].
   2. In a large prospective cohort study (e), high animal protein intake was associated with a 49% higher rate of type 2 diabetes; conversely, a high plant protein intake was associated with a 9% lower rate of diabetes.
   3. A meta-analysis of 7 studies (124,706 participants) from around the world showed statistically significant reductions in ischemic heart disease mortality (29%) and cancer incidence (18%) and non-significant reductions in all cause mortality (9%), circulatory disease mortality (16%), and cerebrovascular disease mortality (12%)[f].
2. Strongly support the role of a plant-based diet as the best option for cardiovascular disease prevention and treatment since studies show:
   1. A randomised controlled study showed the angiographic reversal of coronary artery disease with a low fat plant-based diet [h, i].
   2. A plant-based diet improves multiple cardiovascular risk factors [g].
   3. The DASH diet which is high in fruits and vegetables is highly effective in treating hypertension [ ]
   4. There is a clear and significant dose-response relationship between intake of fruits and vegetables and mortality from coronary heart disease (16% reduction), stroke (8% reduction), and cancer (10% reduction). Similar associations were observed for fruits and vegetables separately. Dose-related reductions in risk were observed in all outcomes up to 600 g/day [j].
   5. Separate studies have shown that approximately 45% of cardio-metabolic deaths are due to deficiencies in diet including high sodium, high processed and red meats, high sugar-sweetened beverages, and low in fruits and vegetables [k]
   6. Real world data shows that a plant-based diet is effective in reducing multiple cardiac risk factors
3. Advise lower saturated fat intake as cited in the recent American Heart Association Presidential Advisory on Dietary Fats and Cardiovascular Disease [a ]
4. Encourage a shift to a diet which is lower in fat and refined carbohydrates and sugars since:
   1. A plant-based low fat diet is the ONLY diet which has been shown to reverse coronary artery disease in the majority of patients [ ] on angiography in randomised controlled trials [b ].
   2. A single high fat meal impairs vascular endothelial function while this is not the case with a low fat meal [k]
   3. Substituting fat with processed carbohydrates and sugars does not decrease heart disease [b]
   4. High sugar-sweetened beverage intake is a major cause of cardiometabolic and diabetic mortality [m]
5. Advise the avoidance of processed and ultra-processed foods since
   1. Added sugar intake is strongly associated with cardiovascular mortality [p]
   2. The intake of processed and ultra-processed foods is clearly and strongly linked to energy intake from added sugars (o).

Thank you for your consideration of this submission. We sincerely hope that Canada takes this opportunity to develop a food guide which will best serve the health of our country and serve as a leader throughout the world.

Signed,