I get around
I get around
For our 'I get around' series, every month, mostly younger Association members tell stories of where they are, what they are doing, who they have met, and why they believe or hope they are doing valuable work. This month for his second story, Jean-Claude Moubarac returns to his home city of Montréal.
Montréal and now São Paulo. Yes, I am recently back in Brazil where I now work, after a trip to my home country of Canada. I presented some of the work my collaborators and I at the University of São Paulo have done this year on ultra-processed products, to Canadian colleagues. This story is also about good food.
It's great to return to the parental home and to savour the food we grew up with. My mother and father migrated to Canada from Egypt nearly 40 years ago. Our food heritage is a mix of Lebanese, Syrian and Egyptian cuisine. My wife and I shared many meals with my parents, my sister, her husband and their four daughters, and my brother. My mother prepared wonderful meals. I adore the famous Molokheyyah, one of the national dishes of Egypt. This is a soup prepared the chopped leaves of Molokhia, a leafy vegetable a little like spinach but much more juicy, with garlic, coriander, and chicken, served with rice.
Here is what I came back to Canada to savour, as prepared by my mother: her Egyptian Molokheyyah soup (left) and then stuffed vine leaves (right)
The Molokheyyah is known for its nutritional richness, because the leaves contain a lot of beta-carotene, vitamin C, iron, calcium, and a multitude of other vitamins, minerals and trace elements. The plant has a potent antioxidant activity with significant amounts of alpha-tocopherol. The gummy fibre of its mucilage is a natural laxative, and can be used to treat a lot of digestive problems. Molokheyyah also tastes wonderful and can be eaten in various ways, with for example with rabbit or shrimp rather than chicken. My way of eating Molokheyyah follows my father: first a bowl of soup without rice, and then a second helping with rice plus vinegar and hot and crusty pitta bread. I recently told my wife that we must learn how to prepare it. It's not complicated, but like any good thing in life it takes some time.
Canada in the fall
Fall is gorgeous in Canada. On the left, a view of the St Lawrence river in Montréal, and on the right, a corn field in the countryside outside Montréal
September and October are a special time to visit Canada because in autumn the colours of the leaves of our maple trees change. It's a perfect time to go apple picking, a great outdoor activity that combines fresh air, exercise, and the eating and storing of fresh apples. There are plenty of apple fields surrounding the island of Montréal. People walk in the fields and pick as many apples they wish, and pay by the bag. Picking is done by rolling or twisting the apple away from the fruit spur. There are many varieties of apples including the Macintosh, the Red Delicious, the Spartan or the Honey Crisp. Harvested apples should be kept cold, just above freezing point, for retention of flavour and quality. Apples can be used in pies, to make apple cider, wines and juices, and of course we can also simply enjoy eating fresh apples!
Here are my nieces Zaya and Loula, enjoying the healthy fun of going into the countryside fields near Montréal in the fall to pick, enjoy and to store apples
Pizza with a difference
Back in the city, one of my friends introduced us to an interesting restaurant located in St-Viateur Street. This night we were enjoying a couple of beers and looking for an evening snack. As in São Paulo, pizza is a famous product in Montréal. There are outlets at every corner. Most of them offer the standard pepperoni and cheese, the Quebecoise (with olives, bacon and mushroom), or the vegetarian (that's green pepper, olives, and some tomato). I don't usually go for pizza, but I decided to make an exception. We walked one block and found a small pizza restaurant. To our surprise, this was not the usual fast food joint.
The restaurant is owned by two Algerians. It offers many special features. There were no soft drinks in sight. Instead, on the tables there were glasses and jugs of water. Inside, the soft drinks were not on display but were hidden nearby the cashier in a discreet compartment and not offered by the waiter. And as shown in Box 1 below, the pizzas came with an entrée of salad made of lettuce, radish, carrots, and olives. Even more unusual, there were no French fries (chips) or poutine (French fries with gravy and cheese curd) in this restaurant.
Also, there were a wide variety of pizzas on the menu with several containing a lot of fresh vegetables. My wife, her sister, my cousin and I shared a pizza containing fresh cut tomatoes, roquette (rocket, a salad leaf), home-made tomatoes, and of course cheese. Fourth, both the sauce and the pasta were home-made every day from fresh ingredients bought at the Marché Jean-Talon, a nearby local food market. This pizza was quite different from the typical pizza made with cheese, pepperoni and pre-prepared tomato sauce.
The owners of the restaurant agreed that some of their business decisions at first glance were questionable, for example not having a display for soft drinks means selling fewer drinks. But their aim is to attract customers concerned about health, and that are looking for a gastronomic experience, not a fast food quickie. I believe this restaurant is going in the right direction. Best of all, after eating this pizza I didn't felt weird in my stomach as I do when I eat a fast-food pizza plus fries and a soft drink.
Unhealthy and healthier pizza
Here we are enjoying a home-made style pizza filled with vegetables, in a new
restaurant in Montreal where fries are off the menu, and the salads are fresh
Pizza is a famous product in Canada. Today, there are more than 7,500 Canadian pizzas outlets. That's not much more than the 6,000 pizza establishments in the one city of São Paulo! Canadians on average consume about a million pizzas a day, compared to almost one and a half million in Sao Paulo. As seen below, most pizzas offered by fast-food outlets in Montréal are in a same format – pepperoni and cheese, with a hot-dog, soft drink, and fries, and often the famous poutine.
We however discovered a restaurant on St-Viateur Sreet that offers a healthy way to eat pizza. There is no display of soft drinks or juices. Many pizzas on the menu were topped with fresh vegetables, like the bruschetta pizza seen in the picture above. Pizzas also came with a nice bowl of salad as the entrée. Of course, this would not be a regular meal for me, but if I am eating out, I would rather enjoy a meal made from fresh ingredients, not prepared manufactured junk.
A typical fast food meal in Canada; pepperoni and cheese pizza, a soft drink, a hot dog, and also the too-famous poutine made with fries, cheese and gravy sauce
Nutrition label babel
During my stay in Canada I came across a new nutrition labelling system. This is now used by Loblaws, the Canadian supermarket chain. It's called 'Guiding Stars' – and see http://guidingstars.ca/loblaw-introduces-an-innovative-program-to-help-shoppers-make-healthier-choices/. This system rates food products – mostly ultra-processed – using 0 to 3 stars. Products are 'credited' with stars for containing more vitamins, minerals, dietary fibre, whole grains, and omega-3 fats; and are 'debited' for containing saturated fat, trans fat, added sodium, or added sugars. The ratings are displayed on easily identifiable shelf tags. The system is meant to provide customers with a faster, easier way to make healthier food choices when shopping for groceries for their family.
Sounds great? I think not. For a start, unprocessed and minimally processed foods, such as fresh vegetables, fruits and meat, which should be the basis for all diets, are not included in this system, which pushes customers merely to make somewhat less bad choices. Also it is promoting the notion that nutrition is all about making fast and easy choices, like of ready-to-eat or ready-to-heat products that are fast and easy alternatives to real foods. Third, more and more supermarket chains in North America are devising their own labelling systems as a way to induce loyalty to their brand: customers who want to shop at different supermarket chains have to learn more and more systems. Label babel!
As you see, I refer to 'ultra-processed products' in this piece. These are not highly processed foods. Here is the account specified by 'The Food System' team at the University of São Paulo, of which I am a member.
Ultra-processed products are made mostly or entirely from processed industrial ingredients, and mostly contain little or no whole foods.
The purpose of the formulations is to devise products that are durable, and highly or ultra-palatable by themselves and in combination. These products are not recognisable as foods, except that ultra-processing includes techniques designed to imitate the appearance of food. They are designed to be consumed by themselves or in combination mostly as snacks or drinks, although some may be consumed wholly or partly as meals or dishes.
Their formulation includes industrial versions of ingredients derived from foods, such as oils and fats, flours and starches, sugars and syrups, and proteins. Alternatively these industrial ingredients are substances intensely processed from constituents of foods, such as hydrogenated oils (some of which generate toxic trans-fats), hydrolysed protein, modified starch. They also include preservatives, stabilisers, emulsifiers, solvents, binders, bulkers, sweeteners, sensory enhancers, flavors, colors, and other classes of chemical and other additive. Bulk may come from air or water. Synthetic micronutrients may be added.
Some techniques used to make ultra-processed products are originally ancient or old, and so can be used artisanally or domestically, though this is now not common. Almost all ultra-processed products now are developments or inventions of increasingly sophisticated food science and technology, with industrialization, and then in recent decades. Newer versions of these products are usually initially formulated in industrial laboratories.
Methods include wholly industrial processes such as hydrogenation and hydrolysis; techniques designed to make ingredients appear to be foods or to invent novelty products, such as extruding, moulding, reshaping; and industrial versions of cooking such as pre-processing by frying and baking. These methods simulate domestic cooking but are typically very different, involving a number of or many processes and processing aids.
Now for some work!
I also had the opportunity during our stay in Montreal to share the work my colleagues and I have been doing over the last year in Brazil on ultra-processed products to my Canadian peers. I gave two seminars at the departments of nutrition in the University of Ottawa and the University of Montreal.
I presented our paper that will be soon published in Public Health Nutrition in which we describe the consumption patterns of ultra-processed products in Canada (2001) diet and evaluate the impact on the quality of the diet. I also presented data on time trends in the consumption of ultra-processed products in Canada from 1938 to 2001.
Box 3 below shows that in the first half of the 20th century, most of the Canadian household food budget was spent on unprocessed and minimally processed food, and on processed culinary ingredients, used to prepare and cook dishes and meals. In 1938, these foods and ingredients accounted for three-quarters (75.8 per cent) of the household energy availability. But by 1953, the share of these foods and ingredients was not more than a half (56 per cent) and in 2001 was less than two-fifths (38.3 per cent). So correspondingly, in the same 1938-2001 period, the share of ultra-processed products rose from a quarter to three fifths (24.2 to 61.7 per cent) of total calories.
Canada: ultra-processed product consumption
This slide shows the displacement of minimally processed foods and processed culinary ingredients by ultra-processed products throughout the 20th century
While in Canada I presented the work my collaborators and I at the University of São Paulo have undertaken this year on ultra-processed products. I presented results of our second Canadian study in which we analysed food expenditure surveys from 1938 to 2001. The above slide shows the dramatic displacement of minimally processed foods and processed culinary ingredients by ultra-processed products.
A similar scenario is evident in the metropolitan areas of Brazil where the proportion of ultra-processed products in the diet increased from under one-fifth (19.2 per cent) in 1987-88 to almost three-tenths (28.0 per cent) in 2002-03. This is a warning for countries of the global South. The diet profile of those countries could reach that of Canada in the next decades unless governments and other independent partners act to check and reverse the trend.
The trends in the Canadian diet reflect a fundamental change in food practices characterized by less and less time and effort given to the preparation and cooking of dishes and meals at home, and the corresponding increased snacking. This is a linked social, cultural and economic phenomenon.
Does it merely reflect what people really want? I think not. First, people are not yet fully aware of just how unhealthy are diets based on ultra-processed products, though ballooning obesity in Canada should make this clear. Second, the change has been driven by aggressive advertising and marketing. Work done by historian Caroline Durand at Trent University in Ontario shows that in the 1930s and 1940s, marketing strategies heavily stressed the message that ultra-processed products would allow women to cook faster and would give them more time for leisure, while enabling them still to ensure that their families ate well.
Today, ultra-processed products are still advertised with mixed messages of sex appeal, family tradition, convenience and glamour. While in Montréal, we saw such an advertisement (below) promoting a ready-to-eat dish made from chicken nuggets, fries and juice. The slogan is 'Pas le temps de ponder unrepas?' meaning 'No time to make a meal?
This hoarding is promoting a ready-to-eat dish made from chicken nuggets, fries and juice from a fast snack chain. It says: 'No time to make a meal?'
The end of airline food
On our long flight back to Brazil, we found that for folks like us in standard economy class, even though we have nine hours to enjoy good food while watching 9 hours of movies, the meal is dead. Our 'dinner' aboard American Airlines was a bag of potato chips (crisps), a chocolate bar, grilled cheese with Mortadella and a stack of butter, and a 'fruit salad' in heavy syrup. Disgusting. Take your own food on board, is my advice – as many now do, stinking out the cabin with the smells of fat and syrup.
Now I am back in Brazil for my second year as a post-doctoral research fellow at the Center for Epidemiological Studies in Health and Nutrition (NUPENS) at the School of Public Health at University of São Paulo. On return, I gave a seminar to share the work I did as part of my PhD thesis. I plan to use this for a new study this year in Brazil, to describe and analyze the contexts of ultra-processed product consumption. This includes examination of how people feel and think about what they are consuming. I hope this work will inform rational policies and effective actions.
Will you be at the XVI Congreso Latinoamericano de Nutricion (SLAN) in Cuba, on 11-17 November 11-17? If you are please let's meet. The USP team including me, will be presenting on 'The Food System' and ultra-processing as a main driver of obesity at 13.30 on Wednesday 14 November in room 7. Carlos Monteiro is presenting a full conference at 17.00 on Monday 11 November in room 4. This is a good time for research, networking, partnerships, the knowledge-policy-action mantra of the Rio2012 congress, and to amplify the importance of food processing in public health. Good times ahead…