UK Failing To Meet The Recommended Daily Requirements of Eight Key Nutrients, Potentially Wreaking Havoc On The Nation’s Health And Wellbeing

Should YOU be concerned about your nutrient intake?

New data from the Health & Food Supplements Information Service (HSIS) reveals many people in the UK are lacking in eight key nutrients, with potentially harmful effects on their health.

The HSIS report – BACK TO BASICS: THE NUTRIENTS YOU NEED, SERVED ON A PLATE^[1] – looks at the challenges of meeting recommended nutritional intakes through diet alone. For instance, the HSIS report notes, for an adult female to meet the recommended daily intake of iron (14.8mg for those aged 19-50 years^[2]), they would need toeat 1.057kg (1860kcal) of grilled, lean sirloin steak, 1.973kg (671kcal) of steamed broccoli, or 779g (1005kcal) chickpeas^[3].

Co-authored by HSIS dietitian Dr Carrie Ruxton and GP Dr Nisa Aslam, BACK TO BASICS: THE NUTRIENTS YOU NEED, SERVED ON A PLATE, looks at the role of Vitamin D, folate, calcium, magnesium, selenium, iron, iodine and omega-3. All play a significant role in our overall health and wellbeing and, despite the bombardment of dietary advice we receive daily, these are the nutrients that many of us need more of.

Since the start of 2020, our health has been under the spotlight as never before because of the global pandemic. Dietitian, Dr Carrie Ruxton from HSIS – www.hsis.org – says: “The nutrients we absorb from our food significantly impact our immune status and susceptibility to infection.” Dr Ruxton goes on to say that nine out of 10 women of child-bearing age have low folate levels which fail to meet World Health Organisation recommendations for a healthy growing foetus.

Meanwhile, GP, Dr Nisa Aslam from HSIS notes: “Iron is also lacking in over half of girls aged 11-18 years and more than one quarter of women aged 19-64, which in time could lead to iron deficiency anaemia – a condition that causes tiredness and affects immune function. So, with our nutrition lacking in so many important areas, it’s time to go back to basics with our diet.”

Who is at risk and why?

Teenagers, and teenage girls in particular, adult women; especially those of childbearing age, and the over-65s, are the stand-out groups suffering most from a lack of eight key nutrients for health. In addition, many over-65s are failing to meet the minimum levels for certain nutrients important for optimal health in ageing.

But why these people in particular? Dr Ruxton cites a number of reasons for falling nutritional intakes in these groups, including a rise in faddy diets where whole food groups are avoided, a lack of home cooking, low vegetable and wholegrain intakes, and the rise in biscuits, cakes, confectionery and takeaways eaten during the pandemic. “Over a third of Brits (36%) skip meals because they are too busy^[4], whilst fewer than a third have heard of the Eatwell Guide – the government’s recommended dietary guide,” adds Dr Ruxton.

There’s also been a shift towards plant-based diets, with one in eight people in the UK now vegan or vegetarian, which goes hand in hand with a 16% decline in red meat^[5] consumption.

GP Dr Nisa Aslam notes: “Red meat is a source of several highly bioavailable, key micronutrients including zinc, iron, iodine, vitamin B12 and vitamin D so, if you plan to cut it out of your diet, you need to plan for suitable nutrient-rich alternatives or top up with a multivitamin and multimineral supplement.”

Despite this rise in the number of people following plant-based diets, fewer than a third of adults aged 19-34 manage to hit their recommended number of five 80g portions of fruits and vegetables a day, making it more likely that they miss out on the essential vitamins and minerals provided by these foods.

What can we do to get our health back?

“In an ideal world, we should get all our nutrients from the food on our plates, enjoying a spectrum of colourful fruit and veg, oily fish, dairy foods, lean meats, beans, legumes, nuts, soya foods and red meat. However, busy lifestyles make this hard,” says Dr Nisa Aslam. She recommends a multivitamin and multimineral supplement appropriate to your age group as well as a 10μg daily vitamin D supplement between October and early March. “We get vitamin D via summer sunlight on our skin, but in the UK, during the autumn and winter months, it’s much harder to get enough UVB to meet our vitamin D needs, because we tend to cover more of our skin with clothes and the sun stays lower in the sky. Therefore, we need to rely on foods and supplements.”

Dr Ruxton also suggests an omega-3 supplement containing the fatty acids EPA and DHA if you are not eating at least one 140g portion of oily fish a week, such as sardines, salmon or mackerel. She adds, “For women of reproductive age, a 400μg daily folic acid supplement is essential to reduce the risk of neural tube defects in babies, should they fall pregnant, whilst children aged six months to five years old can benefit from a vitamin A, C and D supplement. In fact, in a large study, those taking full-spectrum multivitamin-multimineral supplements had the lowest risk of any nutrient deficiency^[6].”

So how do we go about ensuring we get the nutritional basics right to maintain good health and prevent disease? The following tips should set you off on the right path.

Dr Carrie Ruxton and Dr Nisa Aslam: 10 HSIS tips – www.hsis.org – to bring your nutrient status back to basics

Bridge dietary gaps: Bridge micronutrient gaps in your diet with a multivitamin and multimineral supplement appropriate to your age group (applies to adults and children).
Love your omega-3s: If you aren’t managing to eat at least one portion (140g) of oily fish a week, ensure your body’s omega-3 needs are being met with an omega-3 supplement containing the fatty acids EPA and DHA appropriate to your age group (applies to adults and children). There are fish-based omega-3 supplements and algae ones for vegetarians and vegans.
Up your Vitamin D: Take a 10μg daily vitamin D supplement between October and early March to top up the limited amounts available from natural food sources (applies to adults and children).
Mums-to-be: All women of reproductive age who may become pregnant should take a 400μg daily folic acid supplement to reduce the risk of neural tube defects in their babies.
Babies, infants and children: It’s a good idea to give children aged 6 months to 5 years a vitamin A, C and D supplement, as recommended by the Chief Medical Officer.
Eatwell: Follow the recommendations from the Eatwell Guide^[7] to help you achieve the recommended intake of protein, fats, fibre, vitamins and minerals.
Veg & Fruit – life’s vitality: Aim to include at least 400g (5 x 80g portions) of vegetables and fruit in your daily diet. This could be through soups, stews or salads, or chucking a handful of frozen peas or sweetcorn into recipes. A daily glass of orange juice, or a handful of berries or raisins sprinkled on your porridge is an easy hack. Or try spinach and mushrooms with scrambled eggs, or a piece of fruit alongside your usual toast.
Plate colour: Try adding a new vegetable or fruit to your basket each week – and remember frozen, fresh, dried and tinned all count. Eating a wide range of colours of fruit and veg is a good way to ensure you’re maximising essential vitamins, minerals and health-giving phytonutrients, such as polyphenols.
Cook from scratch: Aim to cook as much of your own food as possible, as ultra-processed food tends to have lower levels of micronutrients and higher levels of fat, salt and sugar. Batch cooking nutritious dinners and popping them in the freezer is a great way to do this and save time in the evenings.
Label check: Check the label of your regular supplements to make sure you’re not doubling up for any individual nutrients, and you’re following the recommended doses. If you’re on regular medication, it’s wise to let your doctor know that you want to take a dietary supplement.

[1] Back To Basics: The Nutrients You Need, Served On A Plate; Edition 1; HSIS – Autumn 2021

[2] PHE. (2016). Government Dietary Recommendations. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/618167/government_dietary_recommendations.pdf

[3] McCance and Widdowson’s ‘composition of foods integrated dataset’ on the nutrient content of the UK food supply. Available at: https://www.gov.uk/government/publications/composition-of-foods-integrated-dataset-cofid

[4] Perspectus Global; 1000 consumers; Winter 2021

[5] Between 2008 and 2016, red meat consumption fell from 74g/day to 62g/day.

[6] National Health and Nutrition Examination Survey (NHANES)

[7] The Eatwell Guide. (2016). Available at: https://www.gov.uk/government/publications/the-eatwell-guide

µg	Microgram a measurement of weight equal to one millionth of a gram (or one thousandth of a milligram). Microgram (µg or mcg) is used for a number of nutrients found in food supplements.
Amino Acid	The building blocks of protein, there are eight essential amino acids which cannot be synthesised within the body and therefore must come from the diet. These are: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine. In addition arginine and histidine are amino acids required by infants and young children which supports their rapid growth.
Antioxidant	A substance or nutrient which helps to protect our cells from damage caused by free radicals, damaging molecules which are found in pollution and tobacco smoke. Our bodies also produce free radicals as part of the normal biochemistry of living.
Deficiency	A lack of essential macronutrients or micronutrients which results in malnutrition and or disease. This may be the result of inadequate intakes or absorption issues associated with gastrointestinal disease. There are a number of recognised deficiency diseases including (but not exclusively): scurvy (vitamin C deficiency); rickets (vitamin D deficiency); anaemia (iron deficiency, but also deficiencies in B12 and folic acid) and Kwashiorkor (protein deficiency).
DH	The Department of Health is a UK Government department. It has responsibility for nutrition legislation and sets health policy for nutrition.
DHA	Docosahexaenoic acid; one of the key omega-3 fats that provides health benefits
Dietitian	An individual qualified in nutrition and dietetics who can assess, diagnose and treat health issues associated with nutrition and diet. Dietitians are governed by law with a statutory code of practice; they often work within the health service although increasing numbers are also working in a freelance capacity.
EFA	Essential fatty acids (omega 3 and omega 6) cannot be synthesised by the body and must be derived from the diet. EFAs do not provide fuel for energy production and are required for vital biological processes which support growth, development and health.
EFSA	European Food Safety Authority; the European Union food risk management agency which scientifically evaluates safety across all areas of food.
EPA	Eicosapentaenoic acid; one of the key omega-3 fats that provides health benefits.
Fat soluble vitamin	The fat soluble vitamins are vitamins A, D, E and K. Because they are fat soluble these substances can accumulate in the body, often being stored in fat cells, or in the liver. This can create health issues, particularly if intakes have been high for a prolonged period of time. For example, long term high intakes of vitamin D may lead to the laying down of calcium in tissues such as liver and kidneys which can cause nausea and vomiting.
Food supplement	A food supplement is a concentrated source of vitamins, minerals or other substances with a nutritional or physiological effect which is sold in small, measured unit doses.
FSA	The Food Standards Agency is a non-ministerial UK Government department responsible for food safety and food hygiene.
GLA	Gamma-linoleic acid is an omega-6 fatty acid (an essential fatty acid considered to be necessary for human health which must be derived from the diet). GLA is most commonly found in evening primrose oil (EPO), borage or starflower oil and blackcurrant seed oil.
Health claim	A health claim is any claim which states, or implies, that consumption of a specific food will have a beneficial effect on health. Claims may be written, verbal or pictorial.
Herbal medicine (herbal remedy)	A product is considered to be a herbal medicine if the main active ingredient/s are only herbal substances or preparations. Not all herbal products are medicines, some may be food supplements and some may be cosmetics. What determines if a product is, or is not a medicine is complex but generally rests with how the product is presented (i.e. does it make medicinal claims to treat, prevent or cure any disease) and what it does (i.e. does it have a physiological impact on, or alter, any body functions).
Macronutrient	Dietary constituents which are needed in significant amounts, generally protein, fat, carbohydrate, fibre and water.
Malnutrition	Malnutrition is a state in which the deficiency of nutrients such as energy, protein, vitamins or minerals results in measurable adverse effects on the body. Malnutrition may refer to insufficient intake of protein, carbohydrate and fats (macronutrients) which can result in overly low BMI. It may also be insufficient intake of vitamins, minerals and other micronutrients, which can impact on overall health and could include obese individuals with poor diets.
Mg	Milligram is a measurement of weight equal to one thousandth of a gram. Mg is used for a number of nutrients found in food supplements.
Micronutrient	A substance derived from food which is needed in extremely small amounts for the normal growth and development of living beings. Micronutrients are vitamins, minerals and essential fatty acids (omega-3 fats)
Mineral	Inorganic micronutrient essential to health and wellbeing. Minerals are absorbed from soil by plants which are in turn eaten by animals or humans. Minerals may be split into minerals which are needed in relatively high amounts (calcium, phosphorus, magnesium, sodium, chloride and potassium) and trace elements (iron, zinc, cobalt, copper, chromium, fluoride, iodine, manganese, molybdenum, boron and selenium) which are needed in very small quantities.
Multivitamin	A product which contains more than one vitamin, often multivitamins will contain all 13 vitamins although some may contain only the eight B vitamins, or a combination of some of the vitamins and some additional minerals.
NDNS	The UK National Diet and Nutrition Survey is a continuous rolling survey of the dietary habits and nutritional status of adults and children in the UK. The results are used to assess whether intakes of food and nutrients are adequate across different ages and population groups.
NRV	Nutrient Reference Value is the amount set by the European Food Safety Authority (EFSA), primarily to support food labelling, which the majority of the population requires to maintain health. Previously known as RDA
Nutrient	A substance derived from food which provides nourishment to the body and is essential for the maintenance of life and for growth and development.
Nutritionist	Nutritionists generally work for public bodies or governments, although some do work with private clients. They tend to look at large populations to determine risk factors and make dietary recommendations that are applied at population levels. For example, evidence on the incidence of type II Diabetes led public health nutritionists to determine that some populations are more at risk of developing this disease, and to make recommendations for dietary changes to either reduce the risk or manage the disease. However, public health nutritionists do not practice with individual patients.
Omega-3 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-3 fats are oily fish and fish oil supplements with some also coming from enriched eggs and fortified foods. There are a number of scientifically proven health benefits for omega-3 fats including supporting the health of the eyes, brain and heart, maintaining an appropriate balance of triglycerides in the blood and reducing blood pressure.
Omega-6 fats	Essential fatty acids which cannot be synthesised by the body and must be derived from the diet. Primary sources for omega-6 are vegetable oils such as sunflower and corn oils as well as nuts and seeds. There are a number of health benefits associated with omega-6 fatty acids; they are thought to be beneficial in the management of premenstrual syndrome and in some skin conditions including eczema and psoriasis.
PAGB	Proprietary Association of Great Britain (PAGB) is the UK trade association which represents the manufacturers of branded over-the-counter medicines, self care medical devices and food supplements.
Prebiotics	Foods which promote the growth of probiotics, the beneficial bacteria that inhabit our gut. Prebiotics are generally fibres such as inulin, which our bodies cannot digest and absorb but which provide a food source for probiotics.
Probiotics	Live bacteria (and some yeasts) which inhabit the digestive tract which are viewed as being beneficial to human health. There are thousands of different bacterial strains; some are resident in specific areas of the digestive tract whilst others are transient, simply passing through.
Public Health England (PHE)	Public Health England is an agency of the Department of Health responsible for improving public health. They work with local government, the NHS and non-governmental organisations as well as communicating public health messages to the general public.
PUFA	Polyunsaturated fatty acids (PUFA) are found in nuts, seeds, fish (and fish oil), krill and some algae, small amounts are also found in leafy greens. The omega-3 and omega 6 fats are PUFAs, which are generally associated with health.
RDA	Recommended Daily Amount; previously used terminology for the amount set, primarily to support food labelling, which the majority of the population require to maintain health. Now described using nutrient reference value (NRV)
SUL	Safe Upper Levels of vitamins and minerals were established by the Expert Group on Vitamins and Minerals who published a report in 2003 (https://cot.food.gov.uk/sites/default/files/cot/vitmin2003.pdf). The UK food supplements industry works to the levels set in this report.
Vitamin	Organic micronutrient essential to health and wellbeing. Vitamins cannot be synthesised in sufficient amounts by the animal or human body and must therefore be obtained from the diet. Plants manufacture vitamins which move up the food chain as the plants are consumed by animals or humans. Vitamins can be divided into fat soluble (vitamins A, D, E and K) and water soluble (vitamins B1, B2, B3, B5, B6, B12, biotin, folic acid and vitamin C).
Water soluble vitamin	The B vitamins and vitamin C are water soluble. They are not stored in any significant quantities within the body and are generally either utilised or excreted in the urine. As they are not stored in the body, they tend to have low toxicity and are needed on a daily basis.