The National Diet and Nutrition Survey (NDNS) is a continuous rolling nationwide programme that collects information on the UK diet, analyses what we eat to determine levels of nutrition, and takes a few blood and urine samples to check average levels of some nutrients. For years it has shown that the UK population are heading towards malnutrition, yet the government has done nothing about it.
What is the NDNS for?
The UK government claims that the NDNS provides the basis for the development of food and nutrition policies in order to support the health of the nation. But does it really?
The primary focus of UK government nutrition policy is on macronutrients – fats, carbohydrates, proteins, and an occasional wave at fibre. Yes, those are important because they provide the fuel for energy and the building blocks for the structures in our bodies. But without sufficient micronutrients (vitamins, minerals, and omega-3 fatty acids) those macronutrients cannot work effectively. And, although we only need them in minute amounts (hence ‘micro’), it is micronutrients that underpin health.
Since it started in 2008, NDNS data shows shortfalls in many micronutrients in the average UK diet. Despite that, the UK government has taken no effective action to increase intake of any micronutrients. Although they acknowledge that certain groups sometimes need extra intake of some substances, there is no public health messaging about it. There is a section on the NHS website that talks about a few micronutrients, but it isn’t publicised. So how would anyone know that the information is there?
What exactly is a ‘varied and balanced diet’?
The UK government says that everyone can get everything they need from a varied and balanced diet. The idea of a varied and balanced diet is set out in the Eatwell Guide, which was put together by civil servants based on evidence provided by the Scientific Advisory Committee on Nutrition (SACN). It is interesting that more than half of SACN members also work for the food industry, including companies like Nestle, Tate & Lyle, Coca-Cola, Mondelez, and Unilever, none of which could be considered to be supporting health with their products. Civil servants took the evidence from SACN and invited the food industry to sit around the table and ‘help’ them put the Guide together. Given the double layers of food industry influence, it is no surprise that the Guide has been criticised as failing to serve public health.
A varied and balanced diet supposedly consists of:
- At least five portions of fruit and vegetables a day.
- NDNS data shows fewer than 1 in 10 children and 1 in 5 adults meet this recommendation.
- Research published in 2018 found most people don’t understand the details of the ‘5-a-day’ message: for example, what is “a portion”?
- Meals should be based on ‘higher fibre starchy foods like potatoes, bread, rice or pasta’.
- Most people peel potatoes (removing the fibre); the most widely eaten bread in the UK is fibre free white; and there is very little fibre in white rice or white pasta (the most commonly eaten varieties in the UK).
- Humans don’t need high carbohydrate diets, particularly when the carbohydrates don’t contain much fibre.
- Have some dairy or dairy alternatives.
- Based on (debunked) research from the 1950s–1970s, the recommendations are for low fat varieties.
- There is substantial evidence that full fat dairy has no negative impact on health, in fact it’s definitely beneficial.
- Eat some beans, pulses, fish, eggs, meat and other protein sources.
- The most recent NDNS data shows most UK adults actually exceed the recommended daily intake of protein.
- The brief reference to beans and pulses doesn’t mention that they are also brilliant sources of fibre.
- Choose unsaturated oils and spreads and eat them in small amounts.
- This policy is based on that debunked research from the 1950s–1970s.
- There’s a whole article about why fat is not the enemy, if you’re interested.
- Drink plenty of fluids (at least 6 to 8 glasses a day).
- There’s no information on what size those glasses should be … Pints? Shots? Tumblers? Champagne flutes?
Recent NDNS data on macronutrients
Average fat intake is lower than the recommended level, with overall fat consumption gradually falling since the survey started in 2008. Although protein intakes are pretty high, like fat, protein consumption has been decreasing over the years. Average overall carbohydrate intakes are slightly lower than the recommended intake levels. But pretty much everyone is consuming around double the recommended intake levels of sugar.
As for fibre, 97.5% of the UK population consumes less than half the recommended intake of 30g a day. Even the 97.5th percentile (that’s 2.5% of the population that eats the most of any particular substance) only just manages 30g/d.
Based on this, it looks like almost nobody eats what would be considered a ‘varied and balanced diet’.
The micronutrient front …
… is where the big health issues sit.
The most recent NDNS shows intake of multiple micronutrients are far below the UK recommended intakes. This has potentially significant negative impacts on population health. Yet despite the current government’s claim that their focus on health is prevention, nothing is being done to increase micronutrient intakes, and there is no government campaigning to try to improve the overall UK diet.
Most people have heard about folic acid (“something to do with pregnancy, yes?”) and vitamin D (“I can get that from fruit and veg, right?”), and intakes of both of these vitamins is far below what is needed. But there are 11 other vitamins and 17 minerals that are considered essential. And the UK government does nothing to promote intake of any of these.
About some of those other micronutrients
Since 2008, intakes of vitamin A have been gradually falling; now pretty much everyone over the age of 11 is at potential risk of deficiency. Vitamin A is a bit of a controversial nutrient because very high intake can cause birth defects. But, among other things, it is essential to the function of the eyes and the immune system, for iron absorption, the regulation of inflammation and glucose metabolism, and in maintaining the structure and function of all epithelial tissues (epithelial tissue is the stuff that forms protective barriers like skin and all tissue on the inside of the body).
The UK has never bothered to set a recommended intake for vitamin E, but based on what other governments have set (the EU and the USA), everyone in the UK, from the age of 11, doesn’t get anything like enough vitamin E. Vitamin E is a potent antioxidant, which protects our cell membranes, helps keep red blood cells and our cardiovascular system healthy, helps to regulate the immune system and is essential for brain development and function.
Iron intakes among all females from the age of 11 have been slowly falling since 2008; now they are at levels that put all women at risk of iron deficiency. Iron binds to protein to form haemoglobin and myoglobin, which transport oxygen around the body. It is part of the complex process of energy generation, is used by the immune system to generate energy and specific types of immune cells, and as a weapon against invaders, and is essential to cognitive development and function.
Since 2008, magnesium consumption for everyone aged 7 and above has been below the recommended intakes. Intakes among females of all ages are even lower than those of males. Magnesium is central to over 300 biochemical processes in the body, ranging from supporting muscle function to regulating blood pressure and blood sugar, maintaining bone health and heart function, powering energy production and DNA synthesis, and keeping our immune system going.
As with many vitamins and minerals, the most recent NDNS data indicates that everyone over the age of 11 is getting far too little selenium from their diet, and, like iron and magnesium, intakes among females are far lower than in males. Selenium is a powerful antioxidant, is involved in the regulation of cell proliferation and glucose metabolism, is essential for thyroid function, helps to regulate the immune system and reduce inflammation, and is essential for reproductive health in both sexes.
Consequences to health
Looking at a recent systematic analysis of 292 causes of death in 204 countries, a significant number of those causes of death come down to diet. Not ‘just’ obesity, but also an insufficiency of micronutrients.
The five micronutrients discussed above support thousands of essential elements of human health and wellbeing. Yet because most of the UK population doesn’t get anything like enough of any of them (or many other micronutrients), every function that those micronutrients support is almost certainly not working to its full potential. The probable negative impact on national health is huge. It is more than time that the UK government woke up to this and started taking effective action on it.
