INTRODUCTION

In 2021, Henry Dimbleby, who is a highly experienced and knowledgeable food writer, was commissioned by the Government to evaluate and make recommendations on the UK’s National Food Programme. This all-encompassing report makes some dire reading, exposing just how poor our diet is and also how poor our food system has become too, making it harder and harder for consumers to eat a regular, well balanced healthy diet. ⁹

He concludes that diet related disease is putting an intolerable strain on our Nation’s health and also our finances, with the UK being cited as the third most obese country within the G7. Dimbleby goes on to state that according to the OECD, the costs related to high BMI in lost workforce productivity and also lost life expectancy, plus NHS spending, is £74 Billion every single year. ⁹

Dimbleby also concludes that the majority of people within the UK are simply not eating a healthy diet. Far from it, which subsequently has a significant impact on our health due to low levels of much needed daily micronutrient intakes such as essential vitamins and minerals, omega 3 fats and fibre, all of which play critical roles in determining our health. Much of this shortfall has been due to the huge rise in the purchase of ultra-processed foods which now represents around 80% of the UK diet according to the report. ⁹

According to a recent report from Access to Nutrition 2019, poor diets accounted for 17% of all deaths in the U.K. in 2017. ²⁸

Poor diets also accounted for a huge proportion of ill health. The risk factors that drive the most death and disability in the UK, and how they have changed between 2007 and 2017, include smoking, dietary risks, high BMI, high blood pressure, high blood sugar, alcohol use and high blood lipids such as LDL cholesterol. ²⁸

Data from the UK National Diet and Nutrition Surveys (NDNS) also conclude worryingly that there have been significant reductions in the intake of some vital micronutrients over the years, including the essential vitamins such as riboflavin, folate, vitamin A, vitamin E and especially vitamin D. Mineral intake, which is equally important as vitamins, has also declined including calcium, magnesium, iodine, selenium and potassium. ⁹  Lack of these key vitamins and minerals have serious consequences to our health.

 

Dietary recommendations: How are We Doing?

In a recent 2022 publication from the Food Standards Agency (FSA), there is further evidence that unhealthy diets contribute to early mortality, with FSA’s estimate being around 13%, slightly less than the estimated 17%, from ‘Access to Nutrition’.²¹  Nevertheless, poor food is now seen as causing significant and serious health issues to large numbers of the UK population. A diet lacking in nutritional quality or overly high in calorie intake can be obesogenic, it can contribute to high blood pressure, high blood cholesterol and high blood sugar too, paving the way to the growing type 2 diabetes epidemic, all of which raises the risk of cardiovascular disease . In  addition, obesity is linked to thirteen different types of cancer,  including post-menopausal breast cancer and bowel cancer.⁷⁹ This is not a good picture! Addressing and improving dietary patterns is crucial to mitigating these health risks and promoting overall well-being.

UK dietary advice is based on recommendations from independent scientific advisory bodies such as the Scientific Advisory Committee on Nutrition (SACN). Within the SACN document is set out a list of dietary targets by nutrition group, such as fibre, protein, sugars and micronutrients, for example . This is then monitored via the various National Diet and Nutrition Surveys in which participants are asked to share food diary data with the technicians and dieticians carrying out the work. This is turn allows the scientists to then analyse the data and work out precisely what nutrients are being consumed.

A recent 2021 report from the British Nutrition Foundation looked at data from the NDNS surveys and concluded that on the whole , UK diets fail to meet dietary guidelines across a number of key nutrient types. ¹⁴¹

It is well recognised that diets high in free sugars are unhealthy and can lead to a host of chronic disease states. Saturated fat is another nutrient type believed to be involved in cholesterol biosynthesis and hence possible cardiovascular disease, though there are now some scientists who are now challenging this science. Salt is well known to exacerbate high blood pressure, while a lack of fibre can increase the risk of many diseases including colon cancer. ¹⁴²

The National Diet and Nutrition Survey (NDNS) concludes that the average UK diet does not nearly match recommendations and compared to these Government targets is still: ¹⁴³

• Too high in sugar
• Too high in salt
• Too high in saturated fat
• Too high in calories
• Too low in fruit and vegetables
• Too low in oily fish
• Too low in fibre
• Too low in some key vitamins and minerals (micronutrients)

In essence, these studies show that virtually all healthful nutrients are lacking in a substantial proportion of the UK population.

According to the NDNS study, under the control of Public Health England, in addition to obesity, the average UK diet is a leading factor in many diseases such as heart disease, stroke, type 2 diabetes and some cancers. ¹⁴³

So, how do we measure up in relation to these dietary goals or targets?

 

ENERGY INTAKE, CALORIES AND OBESITY

In his report, Dimbleby states that he believes that we have in the UK, ‘a predilection for calorie dense foods’, which can mean that certain food companies invest more time and money creating these types of foods. This in turn has led to increased caloric intake, resulting in unhealthy weight gain. ⁹

The evidence is unambiguous: we are consuming excessive amounts of food, particularly energy-dense options, resulting in an overabundance of calories and ultimately contributing to the increasing average body weight of individuals. Many of these foods will contain ‘empty calories’ too, which means that they lack many of the essential and healthful micronutrients. In turn, this leads to poorer health, therefore increasing the risk of many of the chronic disease states outlined earlier in this paper. ⁹

The causes of obesity are complex however. Some people are at higher risk because of their genetic makeup, or perhaps some may have thyroid issues. But the vast majority will gain too much weight simply because of their dietary habits, combined with lack of exercise.  Since obesity is also a risk factor for cardiovascular disease and cancer, measuring the prevalence of obesity in a population gives a useful snapshot of the health impact of what we eat.²¹

Some time ago, the Scientific  Advisory Committee on Nutrition (SACN) set guidelines on the number of calories that each age group and sex should consume on a daily basis, for weight maintenance. These were set as Estimated Average Requirements (EARs) for each of these groups. Clearly eating more calories than the EAR can result in weight gain, whilst reducing caloric intake can result in loss of weight, mostly fat mass, though this will of course also depend on energy output too. ¹⁹

Using just diary data from nutritional surveys, such as the NDNS, remains the best available, but can sometimes result in under-reporting of total energy intake and result in data which is imprecise and is therefore difficult to action. A more accurate methodology is a technique known as ‘doubly labelled water’ (DLW). This is much more precise, but also much more resource demanding, so this technique was performed on a subset of the NDNS population to estimate how much under reporting of energy or caloric intake occurred during the survey. This technique confirmed that on average, that people reported 34% lower amounts of calories than reality. ¹⁹

When corrected, the combination of NDNS and DLW data, and the calculation formulae from SACN, clearly showed that: ¹⁹

• Teenagers consumed on average 70 kcals per day in excess of the recommended target.
• Obese teenagers consumed in excess of on average 380 kcals.
• Adults on average consumed 195 excess kcals per day.
• Obese adults consumed around 250-425 kcals per day.

Proportion of Overweight or Obese Children(4-18 yrs)

 

Proportion of Overweight or Obese Adults(19+ yrs)

 

 Food intake surveys show that adults, on average, consumed 195 excess kcals per day vs targets, while those living with obesity over-consumed around 250-425 kcals each day. ¹⁹

	Target	Actual Measure	Notes
Caloric Intake (adults)	2477 kcals/day	125-246 excess kcals	Excess intake higher with obese adults (250-425 kcals)

This evidence clearly confirms that on average, both children and also adults are overeating based on caloric intake and this overconsumption is enough to account for the continual increase in weight across most age groups. Reduction of portion size, healthier food choices and reducing unhealthy snacking with high sugar/high fat/low micronutrient foods, are some ways in which caloric intake can be reduced. ¹⁹ However, this is easier said than done and despite multiple health messaging, the population is getting fatter and sicker every single year according to the latest statistics from the House of Commons Library. ¹⁴⁴ The preponderance of unhealthy, ultra processed ready meals in supermarkets, combined with numerous takeaways and food delivery convenience, just adds to this melange of unhealthy eating and future chronic disease.

Summarising, in line with data cited above, energy intake exceeds the adult recommendations by on average, 195 kcals and this is even higher in obese populations, where calorie intakes exceed targets by 250-425 kcals each day. Albeit a little over simplified, a calculation will show that eating this average 337 kcals additional each day, has the potential to add an extra kilogram of fat every single month. Of course, physiology is more complex than simply the ‘first law of thermodynamics’ alone, but it does make the point that excessive caloric intake is a real concern based on actual data within the UK and is capable of adding significant weight over time, if unabated.

 

FRUIT AND VEGETABLE CONSUMPTION IS FAR TOO LOW

Public Health England recommend that we eat a minimum of five portions of fruit and vegetables each day, in order to get into our diet, that all important fibre, plus a range of essential micronutrients such as vitamins , minerals, and other healthful phytonutrients. Unfortunately, latest food intake data show that the UK is now at an all-time low in terms of regular intake of fruit and vegetables. ²² Despite ongoing health campaigns designed to try and raise awareness of the value of eating fruit and vegetables, data shows that only 29% of people actually achieve this minimum target, with on average around 2.7 to 4.2 portions eaten daily, of fruit and vegetables. ²²

The NHS also strongly recommends increasing fruit and vegetable consumption as part of a balanced diet, in order to lower risk of heart disease, stroke and various cancers. ¹⁴⁵ Fruit and vegetables are also low in fat and calories too, helping people to maintain a normal weight.

Adding more fruit, dried fruit, vegetables, nuts or seeds to one’s diet will also help to raise the intake of essential micronutrients, such as folate, vitamin C, Vitamin A, magnesium and many others.

	Target	Actual Measure	Notes
Fruit and Vegetables	5 portions (400g)/day	8-31% achieve 5 a day	<8% children achieve. -11% fall in intake over 10 years

 

 

CONSUMPTION OF OILY FISH CONTINUES AT ALL TIME LOW

Oily fish, such as mackerel, salmon and sardines, not only contain a high-quality source of protein, but also a collection of vitamins and minerals, including vitamin D, vitamins B12 and B6 and selenium. These fish also comprise significant amounts of essential omega 3 fatty acids. These are called essential as the body cannot make these endogenously, so must obtain these from the diet.

Oily fish in particular, contain two quite special omega 3 fatty acids, namely DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid) that have proven health benefits for the heart, the brain and also the retina. These long chain omega 3 fats are present at high levels in the heart, the brain and especially the macula and therefore need constant replenishment. ³¹

Current guidance for adults suggests two portions of fish per week, of which one portion should be oily fish, a portion of which is around 140 grams. ¹⁴⁶ According to NDNS data, the average consumption of oily fish is a dire 56 grams, meaning that very few of the UK population will achieve this goal of consuming enough healthy omega 3 fats. This in turn will have a negative health effect on their heart, brain and retina over time. ¹⁴⁷

	Target	Actual Measure	Notes
Oily Fish	140g(1 serving/wk)	56g/wk	No increase in intake over last 10 years

 

FATS AND SATURATED FAT INTAKE NOW LESS PROBLEMATIC

Since the 1950s and the extensive work of Ancel Keys, fat had been demonised as a direct cause of heart disease.⁶⁹ Manufacturers have in turn over the last two decades, made a huge effort to lower fat across many food types, but unfortunately replace this with sugar, now regarded as by some scientists substantially worse for our health than fat itself, though both in excess will not be healthy. ¹⁴⁸ The discussion around dietary fat has continued to evolve with advancing scientific research and more comprehensive data analysis. Recent studies have indicated that the vilification of fat in the past may not have been entirely justified. The emergence of diets like the ‘ketogenic diet’ underlines this shift in perspective for example. The ketogenic diet emphasises a high intake of dietary fat, often exceeding 70% of total daily caloric intake.¹⁴⁹

Researchers and proponents of the ketogenic diet argue that consuming higher proportions of healthy fats and drastically reducing carbohydrate intake, can lead to a metabolic state called ketosis. In ketosis, the body primarily burns fat for fuel instead of carbohydrates.⁶⁸

The scientific literature is now more sophisticated than previous, evaluating across many long-term epidemiological cohorts, intakes of saturated fats and its possible link with cardiovascular issues, as it has been proven in many trials, that elevated levels of dietary saturated fats can increase LDL cholesterol (the so called ‘bad’ cholesterol). LDL cholesterol is in turn associated with atherosclerosis, which is a precursor to cardiovascular disease, though causality has still not been proven with certainty. Despite this ambiguity, many quite eminent scientists within the world of lipid research, believe that saturated fats are perfectly heart safe. ⁷⁰ It is not within the scope of this paper to present this debate but suffice it to say that an excessive intake of saturated fats seems counterintuitive to long term good health.

Therefore, the ongoing discourse on fat continues, and certain scientists now assert that fat may have limited relevance to actual cardiovascular outcomes as measured as so called, 'CVD events'. ¹⁵⁰ This is at odds with dietary policies across the world, but the biochemistry and eventual CVD outcomes due to high dietary fat intake is certainly not clear cut. However, it now seems that sugar is the current food demon and many now believe that it is excess sugar that is responsible for the growing type 2 diabetes epidemic we are now witnessing, together with a range of other related metabolic diseases. ¹⁵¹

Against the government recommendation of 11% of total energy from saturated fat, actual intakes have been measured at around 12%, and this figure has not changed for many years and is unlikely to, going forward.

	Target	Actual Measure	Notes
Saturated Fat	11% total energy	12% total energy	Unchanged over many years

 

FREE SUGARS - STILL A WORRY

In a recent ‘carbohydrates and health’ report from SACN, the recommended average intake of free sugars should not exceed 5% of total dietary energy, where free sugars are defined as ‘any sugar added to food or drinks’. ⁷¹ It also includes ‘natural sugars found in honey, syrups and unsweetened fruit juices’.  SACN also recommended that the consumption of sugar sweetened drinks be minimised by both adults, but especially by children. ²¹

Unfortunately, the intake of free sugars remains far too high, as it has been for the last two decades. A recent NDNS survey shows that the highest average intake of sugar sweetened beverages was in children (11-18 yrs), where they consumed over 12% of total energy intake, well in excess of the government target of less than 5%. ²¹

Reducing the consumption of free sugars offers advantages such as minimising tooth decay in children. Additionally, it helps limit overall caloric intake, addressing the risk of related chronic conditions like obesity, type 2 diabetes, and cardiovascular diseases. Sugar has also been associated with other chronic diseases including various cancers, so sugar reduction is imperative to continued good health. Though the exact mechanism is not fully understood, it is evident that cancer cells, once formed, do require large quantities of sugar in order to replicate and grow. This is known as the ‘Warburg effect’. According to Professor Johan Thevelei at the Leuven Centre for Cancer Biology, the latest scientific studies confirm that the over consumption of sugar can contribute to the onset and progression of cancer. ¹⁵²

In fact, obesity and also type 2 diabetes are estimated to be responsible for 800,000 cases of cancer each year.²³

	Target	Actual Measure	Notes
Free Sugars	<5% total energy	10-12%	Only 2-16% met the <5% target.

 

HEALTHY FIBRE INTAKE IS DIRE AND WORSENING

Within the gut, or our colon, there exists a huge diverse number of bacteria, viruses and fungi, known collectively as the microbiome. In fact, there are many more bacterial cells within the gut compared to the number of human cells we have, making us strangely more bacterial than human. This makes the gut a particularly important metabolic factory, helping to digest and utilise fibre via fermentation, helping to control the immune system and even affecting many aspects of the central nervous function which control the    brain. ¹⁵³

However, from time to time, the balance between ‘good’ and ‘bad’ or pathogenic bacteria can alter, leading to a host of conditions including IBS and IBD (irritable bowel syndrome and disease), immuno-senescence (a weakened immune system), weight gain and can even influence various aspects of cardiovascular disease, much of which can be the result of low fibre intakes. A lack of fibre therefore will have consequences on health, spanning a variety of health areas. Furthermore, there is strong epidemiological evidence that diets high in fibre are associated with lower risks of heart disease, type 2 diabetes and also bowel cancer. ¹⁴⁵

Unfortunately, the diet and nutrition data show that on average, we are just eating around 19 grams of fibre a day, falling significantly short of the target of 30 grams per day. Neglecting our fruit and vegetable intake will clearly result in a lower overall fibre intake. ²²

The current level of fibre intake is already far too low for optimum health, but examining trends over time, the data paints a concerning picture, with fibre intakes continuing to decline further over time, making the thirty-gram target increasingly elusive and highlighting a worrisome trajectory. ²²

	Target	Actual Measure	Notes
Fibre	30 g / day	19 g / day (average)	Fibre intake has also fallen by 3%, in 10 years

 

SALT TARGETS STILL BEING EXCEEDED BY FORTY PERCENT

In 2003, SACN published their first report on the need to reduce salt in the diet, in order to reduce the risk of high blood pressure, which is a known major risk factor for cardiovascular disease, including stroke. A maximum of six grams of salt per day was set as a maximum target and has not been changed for many years. SACN also make it clear that this target is an achievable and realistic target, but is not an optimal salt intake, indicating that even lower salt consumption will be beneficial. ¹⁵⁴

It has been estimated that just a gram per day salt reduction could prevent over four thousand premature deaths annually.

In a recent 2019 NDNS survey, salt intake was measured in urine sample across 596 adults in the UK. The findings showed that salt intakes were on average 8.4g per day, representing an intake level some 40% higher than the government recommendation. ¹⁵⁴ This excessive consumption of salt has remained relatively stable over many years and therefore continues to remain as an ongoing health concern. That being said, an ongoing discussion persists regarding the impact of salt on blood pressure.

	Target	Actual Measure	Notes
Salt	<6g /day	8.4g /day	Little change of the years Target is not optimal.

 

MAJORITY ARE INSUFFICIENT ACROSS MANY ESSENTIAL MICRONUTRIENTS

Across social media and within the popular press, it tends to be the macronutrients like fats, sugars and carbohydrates that dominate discussion, debate and overall exposure when discussing health and disease. These macronutrients are necessary in larger quantities compared to micronutrients such as vitamins and minerals, which are needed in much smaller quantities, ranging from just a few grams to a few micrograms each day. Micronutrients play an essential role helping and activating many of our enzymes to carry out the various processes of metabolism, without which they would simply not function. Though these micronutrients are needed in small quantities, they play a crucial role in our overall health and are essential to a well-rounded and healthy metabolism. Each micronutrient plays many of these essential roles in our overall metabolism, with insufficient micronutrient dietary intakes contributing to a range of chronic ailments and even disease states. ¹⁵⁵

All such micronutrients have been set a recommended daily allowance (RDA or RNI) or Nutritional Reference Value (NRV) as it is now known, by both the European Food Safety Authority (EFSA) and the UK arm, the Food Standards Agency (FSA). This RDA/RNI is defined as the level of intake of that essential micronutrient as adequate to meet the needs of 97.5% of the population. ¹⁵⁶

Some see this RDA as the minimum needed to avoid disease, while some scientists believe that these RDA’s do not represent ‘optimal doses’ ,where health benefits can be improved further at higher, but not excessive intakes. ¹⁵⁷

Due to the decline in the overall quality of food and the proliferation of ready meals, fast food, and a variety of unhealthy ultra processed options, essential micronutrient levels, in a similar manner to fibre and oily fish, often fall below the recommended intake levels. ²² Moreover, a recent report by HSIS (Health and Food Supplements Information Service) has assessed micronutrient intake levels over the past two decades and has revealed significant decreases in many of these essential micronutrients, some of which have dropped quite substantially. The report from HSIS further reveals that over the last 20 years, there has been significant declines in the consumption of a number of these essential vitamins and minerals, thereby increasing the likelihood of chronic ailments and even disease. ²²

Analysis of the nutritional quality of peoples’ diets shows that the majority of people are failing to consume the recommended targets across many essential vitamins and minerals.²⁵

Below are listed some of the most important essential vitamins and minerals, some of which have been shown in UK diet studies to be lacking in many peoples’ diets.

 

Vitamin A

Vitamin A is a fat-soluble vitamin which is essential for supporting our vision. It is also required for optimum immune function, cell specialisation, skin health, vision quality and also supports the health of mucous membranes.

Over the past two decades, the level of Vitamin A intake has fallen by 21 % and according to the NDNS survey, intakes were below the LRNI (lower recommended nutrient intake), signifying a serious deficiency, in 13% of adults and 21% of teenagers, highlighting a genuine vitamin A deficiency problem within these groups.

Further data from the 2016 NDNS show that 72% of adults (22-65yrs) and 64% of over 55s failed to reach even the RDA for vitamin A.²⁵

Vitamin A is such a key nutrient of concern, that the NHS recommend that all children aged 6 months to 5 years, are given vitamin supplements containing vitamins A, C and D daily. However, babies who are on formula do not need this level of supplementation ,as formula is already fortified with these key vitamins.¹⁵⁸

Folate

Folate is a water-soluble vitamin, which is associated with the prevention of neural tube defects in the developing foetus. However, this vitamin is also required for making essential new blood cells, for healthy division of cells throughout the body, for synthesising key amino acids, needed for protein and enzymes, and also for supporting the all-important immune system. In addition, folate is one of the few vitamins that helps to maintain lower levels of the unhealthy amino acid, homocysteine, in the blood, elevated levels of which are associated with cardiovascular diseases and other vascular problems affecting the brain. ¹⁵⁹

The medical profession now fully accepts that women should take a folic acid supplement before and during pregnancy in order to avoid the possibility of neural tube defects. But data from a recent publication in the scientific journal, ‘PloS one’ showed that two thirds of women are still failing to take a folic acid supplement, thereby increasing risk of spina bifida and anencephaly defects.²²

Additionally worrying is the sheer number of people in the UK who are failing to reach even the RDA. Data from the NDNS survey shows that 47% of people across all ages are not meeting this folate intake target.²⁵

Vitamin D

Though all micronutrients are essential, vitamin D is a real ‘nutrient of concern’. Most people are aware that this vitamin is required for the health of both bones and teeth, performing this important function by helping the absorption of calcium and phosphorus, both of which are key minerals needed for optimum bone strength. But vitamin D is also needed for a healthy immune system and for optimum muscle function too, both of which are especially important for older adults who tend to lose muscle function and exhibit a weaker immune function. Vitamin D has also been associated with the reduction of cancer risk in more recent studies, though more research is needed to unequivocally confirm this. ¹⁶⁰

Recent data from the NDNS shows that around 84% of all adults are failing to get enough of this key vitamin in their diet alone. Of course, vitamin D is also synthesised in the skin from sunlight, but this is not available every day, all year round, especially within the UK, meaning that many will become vitamin D deficient over time. In addition, the rate of vitamin D synthesis in the skin falls significantly with age. ¹⁶¹

Though many seem to be failing to meet the agreed recommended daily target for vitamin D, especially older adults, there is little evidence to suggest that exceeding the RDA is beneficial.

According to the HSIS report, vitamin D intake has seen a significant decline of 22% over the past two decades. Low vitamin D status is now prevalent across the UK, with data from the rolling plan NDNS showing that 29% of adults and 37% of children were found to be vitamin D deficient, with measured blood serum levels below 25 nmol/litre. ²²

Vitamin E

All our cells are under a constant daily attack by damaging free radicals, a natural byproduct of our energy producing biochemistry. This in turn causes what scientists refer to as ‘oxidative stress’ and can cause considerable cellular damage, leading ultimately to ongoing chronic inflammation. This inflammation can in turn then lead to a number of disease states if not controlled. Vitamin E is known to be a potent ‘antioxidant’ and has been proven to help protect these cells against this ongoing oxidative attack. ³¹

NDNS dietary data in the UK shows that between 72-80% of adults are not reaching the recommended intake for Vitamin E and this insufficiency has hardly changed over the past two decades.

Vitamin E continues to be a nutrient of concern due to its important protective function and its low level found in today’s diet.

Vitamin B12

This essential vitamin is only found in animal products, meaning that vegans will need B12 supplementation if they are to avoid deficiency. ¹⁶² Vitamin B12 also requires the acidity of the stomach for effective absorption, hence common medicines such as antacids and PPI inhibitors (which reduce acid production) can cause malabsorption of this key vitamin.¹⁶³ Older adults too can frequently suffer from low acid levels leading to serious deficiencies, which can manifest as not only chronic fatigue but also a decline in cognition.

Vitamin B12 carries out a number of important metabolic functions including various processes associated with the brain, the nervous system and overall psychological function. It is also required for red blood cell formation and energy production, hence tiredness and weakness become obvious symptoms at low intake levels. Like folate, it is one of the key B vitamins which also helps to manage normal levels of toxic homocysteine, which must be controlled to lessen the risk of  cardiovascular disease. ³¹

Potassium

Potassium is a key electrolyte required in all cells and works in harmony with sodium to control cell function. It is also vital for maintaining a healthy blood pressure and also overall muscle function, including the heart muscle. ³¹

Data shows that around 24% of adults are failing to achieve the RDA for potassium, with 17% of adults even falling below the LRNI, thereby demonstrating a serious deficiency.²² This in turn may increase the risk of high blood pressure, which is associated with the risk of stroke. In fact, some studies show that potassium may play an even more important role than sodium in influencing blood pressure. The American Heart Association actively recommends plant-based foods that are high in potassium to help control high blood pressure. ⁹³

Calcium

Adults have around 1.2 kilograms of calcium within their body, making it the most abundant mineral in the body. Calcium’s major role is bone integrity, with 99% of all calcium existing in the skeleton and teeth. Low levels of calcium will lead to low bone density over time and can even lead to osteoporosis. As calcium is also essential for effective muscle contraction and nerve transmission, its deficiency can also lead to severe muscle weakness. ¹⁶⁴

Calcium intake has become a real concern recently, while dietary levels have dropped around 10% over the last twenty years. Furthermore, adult data from the NDNS shows that over half of adults are failing to reach the RDA for calcium, putting them at risk of osteoporosis and other musculoskeletal issues, especially during the menopause, where calcium levels are key to protection against an acceleration of bone loss. ²⁵ Having said this, supplementation with excessive calcium has been shown to possibly promote cardiovascular plaque formation, so following the advice from the Royal Osteoporosis Society is recommended. ⁹⁴

Iron

A healthy person will typically contain around 3-4 grams of iron within their body, most of which exists within haemoglobin in red blood cells, responsible for transporting oxygen from the lungs to the various tissues. Iron is also used in a muscle protein called myoglobin, where it is used to store oxygen within muscle. Iron is required for maintaining a healthy and effective immune system and a healthy brain function. A lack of iron will initially be felt as fatigue in most people and can also result in a higher risk of infection. ¹⁶⁵

According to a 2016 NDNS survey, over 80% of adults do not reach the target RDA for daily iron intake.²⁵ Furthermore, more than half of teenage girls report intakes of less than the LRNI, showing a concerning iron deficiency, which clearly needs addressing by their doctor. This deficiency is even seen in more than a quarter of women too, demonstrating that iron is a real mineral of concern. Part of this problem may be related to the fall in red meat intake, as red meat contains a highly absorbable form of haem iron.

Zinc

This essential mineral acts as a prosthetic group or a co-factor in many enzymatic biochemical reactions throughout the body. Zinc is required for DNA synthesis, for efficient cognitive function, for immune function and energy production. It is also needed for the metabolism of macronutrients, for the synthesis of protein, and for the maintenance of bone strength. Zinc even plays a role in beauty, with its requirement for healthy looking hair, skin and nails too. Finally, and importantly, zinc is required for fertility and also the production of the male hormone, testosterone. ³¹

What is worrying however, is that data indicates that nearly 80% of adults fail to consume enough zinc in their diet to reach the recommended target (RDA). Amongst teenage girls, over a quarter consume less than  the LRNI, demonstrating a significant deficiency problem. ^{25, 22}

Data indicates that nearly 80% of adults fail to consume enough zinc in their diet to reach the recommended target

Magnesium

Like zinc, magnesium deficiency is yet another cause for concern, with approximately 90% of people failing to reach the RDA for this particularly important mineral. Data indicates that the average magnesium intake is 27% below the RDA set for magnesium. In addition, 13-16% of adults even fail to reach the LRNI, thereby demonstrating a magnesium deficiency with these people. ^{22, 25}

Given that magnesium is involved as a cofactor in over 300 biochemical reactions, ensuring sufficient dietary magnesium is crucial, due to its requirement across a wide spectrum of health areas. These include energy production, bone strength and protein synthesis, DNA and cell replication, electrolyte balance and even the overall nervous system. ³¹ 

Copper

Copper is often the forgotten micronutrient, but it is essential for several key processes. Being a key co-factor involved in the activation of many enzymes, copper is a mineral that is required for energy production, the operation of the immune system and also the protection of cells, due to its anti-oxidative nature. It is also needed for an effective nervous system, and also plays a role in maintaining the health and integrity of many of the connective tissues throughout the body such as collagen in the skin and also collagen fibres within the outer elastic layer of the blood vessels. ³¹

Though copper can be found in many foods, amounts may not be enough to reach the RDA on a daily basis. This is evidenced by findings from NDNS surveys in which approximately half of adults failed to reach recommended  levels from their diet. ²⁵

Manganese

Manganese serves a critical function by activating specific enzymes like superoxide dismutase, which is vital in antioxidative defence, safeguarding cells against damage. Apart from its antioxidative role, manganese also plays a role in preserving connective tissues like collagen, abundant in tendons, ligaments, skin, and also the elastic layer around blood vessels. Furthermore, it is essential for energy production and maintaining optimal bone strength.

According to a recent NDNS survey, approximately 23-28% of adults do not meet the recommended dietary allowance (RDA) for manganese, highlighting a significant gap in manganese intake compared to the desired target.²⁵

Selenium

This essential mineral plays a vital role in the so called ‘selenoproteins’ that play critically important roles in cellular protection, due to their powerful antioxidant properties. Selenium is also recognised for its support in thyroid performance, the body’s immune function and also spermatogenesis. ³¹

Selenium levels in UK soil are quite poor compared to some regions across the world, such as the USA, thereby contributing to inadequate dietary selenium levels. Dietary recall data shows that selenium is a mineral of concern, with nearly 80% of adults failing to reach the target RDA. Furthermore, 36% of adults exhibit a real deficiency, falling below the LRNI, thereby raising the risk of thyroid problems, compromised immunity and fatigue. ²⁵ A recent 2021 editorial on selenium and health show across a wide range of scientific reviews, that a number of chronic diseases are influenced by low selenium intake. ⁹⁵

 

WHY ARE DIETS SO POOR

In addition to consuming food for sustenance, we also indulge in eating for enjoyment, whether it's in the comfort of our homes or while socialising with friends. Unfortunately, however, the nutritional quality of the food we eat has declined over recent decades.

Poor diet is now the biggest risk factor for preventable ill health within the UK, just ahead of smoking.

Poor diet is now the biggest risk factor for preventable ill health within the UK, just ahead of smoking. Type 2 diabetes continues to rise, as does obesity, with more than a quarter of people now technically obese, with a third of primary school leavers either overweight or obese. ⁹

The consequences of a poor diet are staggering, affecting both wellbeing and financial resources. The government allocates an estimated £18 billion annually, constituting 8% of total healthcare expenditure, to address conditions associated with high BMI. This figure does not even encompass diseases linked to diet that are unrelated to weight. In the 2019/20 period, there were slightly over one million hospital admissions citing obesity as a primary or secondary diagnosis, reflecting a 17% rise from the previous year. If we fail to manage diet-related diseases, there is a genuine risk of overwhelming the NHS or having to make cuts in other public services to cover these growing expenses. ⁹

In contrast to the past, our current environment is saturated with a plethora of food options, often dominated by unhealthy ultra processed food (UPFs) or simply junk food choices. Some of these foods can potentially contribute to a detrimental combination of an unhealthy diet and the onset of chronic diseases. Adding to this concerning situation, we are now further afforded the convenience of staying totally sedentary, as we can simply pick up the phone, place an order, and have our meals delivered to our doorstep without exerting any physical effort.
In the United Kingdom, according to the 'ZOE PREDICT' study, approximately 95% of individuals engage in regular snacking, and 76% indulge in snacks twice or more each day. ¹⁶⁶  The caloric contribution from snacks accounts for almost a quarter of the total daily energy intake, primarily sourced from highly processed snacks with limited nutritional value. Substituting even a portion of these snacks with nuts, seeds, or dried fruits could significantly enhance dietary quality.

The real issue is that of implementation, not lack of knowledge.

According to The Health Foundation, good, nutritious food is now three times more expensive per calorie, than high fat, high carb, high salt, junk food. To compound this issue, it is also harder to purchase healthy foods in the more deprived areas of the UK. Furthermore, deprived neighbourhoods tend to contain a much higher density of fast-food outlets than less deprived areas. ⁹

A key driver of caloric intake of course is appetite itself, primarily regulated and influenced by groups of hormones such as leptin, ghrelin, insulin, glucagon and others, with each being influenced by the levels of sugar in our circulation and also by the fat content of our cells. ¹⁶⁷ Studies show that most people are aware of what constitutes a healthy diet, emphasising the need to limit the intake of sugar, fat, salt and calories in general. But the real issue is that of implementation, not lack of knowledge. As a species, we continue to struggle to resist the allure of sugary, fatty foods with high caloric value, suggesting that much of this desire for such foods may be genetically ingrained. ⁹

Epidemiology Unit,and analysis of CPI index from ONS 2012-22, Source: MRC

Around 85% of this food is so unhealthy, it is deemed unsuitable for children

Within this so-called ‘Junk Food Cycle’, we humans tend to have a predilection for calorie dense foods, which in turn means that many Companies will invest within these areas, formulating foods which are irresistible, yet are unhealthy. According to a 2019 report from Access to Nutrition, around 85% of this food is so unhealthy, it is deemed unsuitable for children, based on analysis using the WHO Euro nutrient profile modelling. ²⁸

From a marketing point of view, only around 1% of food advertising budgets are spent on vegetable-based foods, while 22% is spent on cakes, confectionery, biscuits and ice cream. This disproportionate allocation of funds further perpetuates the consumption of unhealthy, calorie-dense options and contributes to the challenges of addressing public health issues related to diet and nutrition. ⁹

The communication of healthy food information to the general public, coupled with populist health reporting in the media ,has also been problematic, with oversimplified health and food messaging, which has only led to confusion. Fat has been the dietary villain for decades, but the narrative has now shifted, placing more emphasis on sugar in the ongoing health debate. Even food labelling can still be confusing to many shoppers, despite numerous iterations to enhance clarity of information on the back of pack. For example, a 2009 study designed to evaluate whether the UK traffic light labelling system had any effect on buying behaviour, concluded that this labelling had no discernible effect on purchasing decision.⁸⁰

In addition, there is the ongoing temptation and accessibility of conveniently prepared or semi-prepared ultra processed ‘ready meals’, which offer quick and simple microwave solutions. In addition, many of these ultra processed foods tend to be high in fat, high in hidden sugars and full of a myriad of processing aids and artificial additives, making these types of meals less nutritious overall, with low levels of essential and healthful micronutrients, such as vitamins and minerals, let alone fibre. ¹²

Also with children, only 25% of state schools in England meet the appropriate healthy nutritional requirements as agreed for this age group.

According to the Broken Plate study from The Food Foundation, the poorest quintile of households would need to spend 43% of their income on food to meet the price of the Government recommended healthy diet, as opposed to just 10% for the richest quintile. This fact, combined with the fact that most healthy foods are three times the cost of junk food, illustrates the hurdles that need to be overcome. Also with children, only 25% of state schools in England meet the appropriate healthy nutritional requirements as agreed for this age group.²⁹

People are understandably inclined to consume food that is convenient and easily accessible. Many items commonly found on supermarket shelves, restaurant menus, cafes, and takeaways tend to be high in fat, salt, and/or sugar, while lacking in fruits, vegetables, fibre and essential vitamins, minerals, and omega 3 fats. Although measures like calorie and nutrition labelling can be somewhat useful, they often place the burden on individuals to determine the healthiness of their choices, and frequently, only a minority of available options are genuinely healthy. Instead, if manufacturers reformulated their products and businesses offered more nutritious choices, it would increase the accessibility of healthier foods for people. To gauge progress in the right direction, businesses should openly disclose the health and sustainability aspects of their offerings.

Schools play a vital role in guaranteeing that children attain the necessary nourishment for their overall well-being, academic success, and in reaching their maximum potential. Furthermore, schools offer an excellent environment for imparting knowledge about health and the consequences of inadequate nutrition to children. Considering the pivotal function that schools can fulfil, it is crucial that the food provided within educational institutions promotes good health. ²⁹

 

Summary

• Both children and adults are consuming an excessive number of calories from their daily diet. This is resulting in weight gain over time and if not controlled, will lead to an unhealthy and high BMI, together with a string of metabolic disorders.

• Only between 8-31% of the UK population are eating their 5-a-day of fruit and vegetables, despite constant health messaging.

• The goal of achieving 30 grams of fibre per day remains distant, as the current average intake is a dire 19 grams per day. Fibre consumption has also declined over the last 10 years.

• Oily fish, with its content of essential omega 3 fatty acids also continues to be a food type which does not appeal to the majority of people. On average, against a weekly target of 140 grams, only a meagre 54 grams is consumed, meaning that the majority of people will be deficient in the two most important omega 3 fatty acids, namely DHA and EPA.

• Guidelines indicate that the intake of saturated fats should be around 10% of total energy intake, with current levels measured at 12%. Saturated fats continue to be demonised, but the latest science tells us that excess fats may not pose as high a risk to cardiovascular disease as originally thought.

• Free sugars continue to be a dietary challenge, as intake levels are more than double government guidelines, thereby increasing the risk of many associated chronic diseases.

• The latest NDNS survey shows that salt intake is a worrying 40% more than target. This combined with low potassium intakes, means that risk of high blood pressure and associated diseases such as stroke, will be increased in a sizeable proportion of the population.

• Data from various diet and nutrition studies continue to show that large numbers of the population fail to reach the recommended daily targets (RDA) for many of the essential vitamins and minerals, thereby raising health risks across a number of areas. Furthermore, the intake of some essential micronutrients has even dropped further over the last 20 years, mostly due to poor food choices and food that is generally low in key micronutrients.