The UK has a malnutrition crisis hiding in plain sight, and almost nobody in government seems to be taking any notice of it. The Times published a story based on data obtained by the Times Health Commission through a freedom of information request to the NHS. Malnutrition in the UK is on the rise. No other newspaper covered the story. Instead the focus of all other news outlets on that day was something seemingly intended to destroy the career of a BBC newsreader, manufactured by the right-wing press. Because who cares about the health of the nation, right? It is clearly far more satisfying to pruriently pry into the private life of a prominent individual.
It is concerning that no news outlet has picked up on the story since. Nor has anyone in government – or what passes for government – made any public statement about it.
What is malnutrition?
The article highlighted the number of people hospitalised with malnutrition, scurvy, or rickets in the last year.
The NHS defines “malnutrition” as a range of conditions all relating to a lack of proteins, fats, and carbohydrates. Numbers for scurvy (vitamin C deficiency) have more than doubled since 2007. Although the number of hospital admissions for rickets (vitamin D deficiency) has stayed broadly stable, it remains concerning as, in 2016 the UK government put out advice about taking vitamin D supplements.
Malnutrition is a lot broader than children with spindly legs and arms and a bloated belly. What the NHS considers malnutrition, as well as rickets and scurvy, are the tip of a scary iceberg. Malnutrition is not just outright deficiency, or even not getting enough calories. It is about getting the balance wrong between macronutrients (proteins, fats, carbohydrates, fibre and water) and micronutrients (vitamins, minerals, omega-3 fatty acids and phytonutrients). It can be about getting too much, just as much as not getting enough. Obesity is malnutrition. Diabetes is a disease of malnutrition. But so is not getting enough vitamin A, or iodine, or a lot of other micronutrients which are worryingly low in the UK diet.
The UK government runs a rolling survey programme which collects detailed information about food and nutrient intake, and nutritional status across the UK. It’s called the National Diet and Nutrition Survey (the NDNS) and it is supposed to enable UK government public health policy makers to identify nutritional issues and put solutions in place for them. If only it worked that way…
NDNS data shows a long-term pattern of excessive intake of foods which contain high fat, salt and or sugar, known as HFSS foods. HFSS foods are known to contribute to obesity, and a policy was developed to try to tackle over-consumption of them. It was supposed to be brought into law last year. It was blocked by then Secretary of State for Health, Thérèse Coffey (hardly a poster girl for a healthy lifestyle). Then it was supposed to come into effect in June of this year, but the “government” once again kicked it into the long grass. So, no government action on a key cause of obesity (and therefore ill health).
At the moment, obesity is costing the NHS around £6 billion a year. But consumers are spending around £12.3 billion on HFSS foods. You have to wonder who is winning in this particular scenario.
Vitamins and minerals – if you don’t get enough, your health will suffer. And so will the NHS. There are 13 vitamins, 17 minerals and some other nutrients that are essential to health, which can only be obtained through the diet. And an awful lot of them are in short supply in the UK diet.
Here are just a few.
Iron – more than anaemia
Most people know that if you aren’t getting enough iron in your diet you can end up with anaemia. But not many people know that if you don’t get enough vitamin A and or vitamin C in your diet (that’s lots of people in the UK), you can’t absorb the iron your food may contain. So you can end up with anaemia. And if you don’t get enough folic acid or vitamin B12 (again, lots of people in the UK), you can also end up with anaemia because those vitamins are needed to make the red blood cells that carry iron around the body.
In 2017–18 the cost to the NHS of dealing with iron deficiency anaemia alone (not the anaemia caused by a lack of folic acid or vitamin B12) came to £179.6 million. Those costs will almost certainly have increased since then.
But not getting enough iron causes more problems than “just” anaemia. It reduces the operating efficiency of your immune system, so you are more likely to get infections. And iron is absolutely essential for foetal brain development, and brain function throughout life. Over 40% of women, including teenage girls, have iron intakes that are far too low, and that puts the next generation at risk of a lifetime of lower IQ and poor mental health..
Thinking about the next generation, most people know that folic acid “is good for the baby”, although they don’t necessarily know how or why. One of the many things that folic acid, which is part of the B vitamin group, does is protect the growing foetus from neural tube defects (NTDs). These include spina bifida and hydrocephalus which both lead to a lifetime of disability, and anencephaly which is 100% fatal.
NDNS data shows that 90% of women of childbearing age in the UK (i.e. any woman who could have a baby) have such low levels of folate, that any children they may have would not be protected. NTDs affect around one in 1,000 pregnancies in the UK, but they can only be detected at the 20-week scan. So at five months pregnant, hundreds of parents every year are faced with an impossible decision: to go ahead with the pregnancy, or to terminate.
It is estimated that the lifetime cost of neural tube defects to the NHS could be as high as £500,000 per person. Meanwhile the government does nothing. No public health messaging (it’s not complicated, they just don’t want to spend the money). Last year the government finally agreed to fortify white flour with folic acid (arguments about this have been rumbling on for decades), but so far, no action has been taken.
Intake levels of several other B vitamins, particularly vitamins B2 and B12 are also low. Together with folic acid and vitamin B6 these vitamins are central to keeping levels of a substance called homocysteine at manageable levels. This is important because high homocysteine is a key risk factor in a lot of pretty serious medical conditions including heart disease, stroke, depression, dementia, osteoporosis and hip fractures. Although NDNS data does not show problems with intakes of vitamin B6, a significant proportion of the UK population don’t get enough of the other three (B2, B12 and folic acid).
The costs to the UK for all the diseases that high homocysteine is linked to is staggering. In 2019 it was estimated that heart disease alone cost at the NHS least £7.4 billion. Based on 2014/15 costs, stroke costs the NHS and social care £26 billion a year. According to the Mental Health Foundation, mental health problems cost the UK economy a minimum of £117.9 billion a year. A 2019 report from the Alzheimer’s Society estimated costs to the UK economy of £34.7 billion. And evidence submitted to the All Party Parliamentary Group on Osteoporosis, by the Royal Osteoporosis Society in 2022 estimated that the cost of osteoporotic fractures to the NHS was £4.6 billion a year.
Add all those up and it comes to £190.6 billion from homocysteine related conditions alone! Think of the savings that could be made if only the UK government viewed nutrition as a valid preventative measure to protect health, wellbeing and the economy.
It is interesting that sufficient vitamin D could also either prevent or reduce the risk of developing every single one of the conditions linked to homocysteine. But that is a subject for another article….
Nutrition policy in the UK is a disaster. It needs serious revision by individuals who embrace the most up-to-date science and who are prepared to accept that they have been getting it badly wrong for the last few decades!
T C Callis’ articles are very well researched, and always come with a wealth of references. If you are interested in following up anything in the article, don’t hesitate to contact us at Kent & Surrey Bylines for more information.