Is five-a-day really enough?

By: 

Alex Gazzola BSc, Health and nutrition writer

Issue: 
Spring
Year of publication: 
2009

It was the World Health Organization (WHO) in 1991 that first advised an adult daily consumption of 400g fruit and vegetables per day, equating to about five portions of 80g each, yet it wasn’t until 10 years later in 2001 that the Department of Health translated this recommendation into the 5 A DAY plan most of us have become familiar with.

The 5 A DAY programme has a number of strands, including the national School Fruit and Vegetable Scheme, whereby Local Education Authority-maintained primary schools provide a piece of fruit to all pupils aged between four and seven. There are other national and local initiatives and communication programmes, while the designated website – www.5aday.nhs.uk – carries the slogan ‘Just Eat More (fruit & veg)’ and offers tips on tricking stubborn vegephobes, such as hiding chopped vegetables in a pasta sauce. For those puzzled on the matter of what a portion might be, there are plenty of precise examples – seven strawberries, six lychees, eight cauliflower florets, two broccoli spears, and a two-inch piece of cucumber.

IMPORTANT MESSAGES

In 2002, the Government introduced a logo showing five ascending squares changing in colour from green through to yellow, with the 5 A DAY message beneath, for use on products where a serving provides a contributing portion. Food manufacturers can apply for a licence to use the logo, which will be granted providing they meet stringent criteria. At present, it can only be used on fresh, chilled, canned, frozen, dried or 100 per cent juiced fruit and vegetables with no added salt, sugar or fat – however, nutritional criteria for fruit and vegetable products that contain added fats, sugars or salt are being considered.

According to WHO, 2.7 million deaths would be avoided annually worldwide if everybody ate 400g of fruit and vegetables a day. A year ago, an inquiry by the Prime Minister’s Strategy Unit stated that lower than recommended intake of fruit and vegetables was to blame for 42,200 premature deaths annually in the UK, and poor nutrition has cost the NHS £6bn in treatment and care.

We know, of course, that fruit and vegetables are good for us in a whole host of ways and can reduce the risk of ill health, being rich in antioxidants, vitamins and minerals, but not all varieties are created equal. “Evidence suggests not all fruit and vegetables are equally effective at reducing disease,” says Dr Carrie Ruxton of Nutrition Communications. “Polyphenols in apples and berries are good for cancer prevention, as are green leafy vegetables, but for the bowel you might want garlic and onion for prebiotics to stimulate gut bacteria. “That’s why we need to emphasise that you should eat a variety of foods,” she adds.“In essence, the five-a-day message is a dumbing down and a compromise. Giving specific messages about particular antioxidants and foods to the public would be confusing to them. The Government would perceive it as too complex for them to digest.

THE MAGIC NUMBER
Keeping the message simple is one thing, but is five the right number? There is no specific research on the number of portions to maintain optimum health, but many believe that five is not enough, pointing to other nations who recommend more, including Denmark, which advises six portions, France, which advocates 10 portions a day, and Japan, which suggests a staggering 17 – made up of four portions of fruit, and up to 13 of vegetables (although admittedly their portion sizes are smaller than ours, at 50g).

In the absence of clear studies specific to numbers, is it possible to identify the ‘magic number’ or are the recommendations all just arbitrary numbers? “Five has always been intended as a minimum,” says Ruxton. “We cannot know or define a precise amount, because it depends on an individual’s genetics, gender, age, risk of disease and lifestyle factors such as smoking and exercise – and it also depends on the kind of illness you are aiming to prevent.

” Whether too modest or not, the sad fact is that the five-a-day message isn’t working anyway, with many of us fooling ourselves into thinking we’re getting enough. According to the Food Standards Agency, in 2000, 43 per cent of consumers said that they understood the five-a-day message, with 26 per cent claiming to be putting it into practice; by last year, those figures had risen to 74 per cent and 58 per cent, respectively.

On face value, the figures appear promising. But they are disputed by the latest independent survey by TNS, Health of Britain – Perspectives on Nutrition, released in August 2008, which paints a depressing picture. It found that 88 per cent of us are failing to meet five-a-day targets, with 12 per cent not even managing to eat one portion daily. The average consumption is 2.7 and 2.4 portions for women and men, respectively, a rise from three years ago so minute that it would take 25 years for us to average five-a-day at this rate of increase. Low-income groups fared worse, and young men worst of all, averaging a shocking 1.9 portions a day. “The current levels of consumption are very worrying and should be a wake-up call to government and industry alike,” commented Giles Quick, the managing director at TNS Worldpanel. “There are some serious underlying issues that need to be addressed if fruit and vegetable consumption is to increase across the population.

APPORTIONING BLAME
Dr Martin Caraher of the Centre for Food Policy at City University partly blames too much emphasis on advertising of junk foods over healthier foods, the lack of offers in supermarkets on fresh produce, and the gradual loss of the culture of sit-down family meals. “With children we’ve seen an improvement in fruit intake, but there’s been a loss in vegetable intake, and that’s down to busy lifestyles and sacrificing regular meal patterns,” he says. “We know that, in a school setting, a child’s vegetable intake rises – but they need to sit down. The problem is we live on the go.”

There has also been criticism of the information provided by the Department of Health. “There’s no limit to how much [fruit and vegetables] you can consume, so the more you eat, the better,” states the Government’s 5 A DAY website. “This makes no sense from what we know about the way people consume calories,”says Caraher. “We do need to eat more fruit and vegetables, yes, but we need to cut down on other foods. There is a lot of evidence to suggest that many people interpret eating initiatives as additional – rather than substitute – calories, and they ‘reward’ themselves for eating a piece of fruit with a piece of chocolate. Telling consumers to consume unlimited amounts of fruit is a dangerous message.”

There remains confusion too over what counts as a portion. For instance, the Department of Health insists that only one portion a day can come from juice and smoothies, due to the high quantity of sugar released from the fruit and, in the case of juice, the lack of fibre. However, smoothie manufacturers do sometimes claim a serving of their products contributes more than one portion, and there is no legislation forbidding this. Carrie Ruxton supports a change in the smoothie ‘allowance’. “Why is it that if I liquidise a banana and berries with some fruit juice it counts as two portions, but if I buy it in the shops it’s only one?” she asks. “The Food Standards Agency is concerned with sugar, acid production in the mouth and dental erosion, but a study from Leeds University comparing fruit juice, mashed fruit and whole fruit proved there was no difference in oral acid production. It is not worse for your teeth.”

The key problem, says vegan dietitian Sandra Hood, author of Feeding Your Vegan Infant with Confidence and an advocate of five, seven and nine portions daily for children, women and men, respectively, is that we remain ignorant about vegetables.“Most people have heard the message, but getting them to action it is another matter,” she says. “We need to give practical advice, ideas and education. People have no clue how to incorporate vegetables into their diets. These days, there’s too much reliance on fast foods. ” When the whole five-a-day message becomes too complex to the public, there may even be an argument for abandoning the number adding altogether. “Lots of my patients can’t get a sense of what 80g is, or have the time to weigh and count portions, and find it all confusing anyway,” says Hood. “Quite often when I talk to them, I tell them to make sure half their meal plates are filled with vegetables, and that’ll ensure they meet their requirements. That’s really the way we should be doing it.

 

Keywords: 
FOOD, Fruit, Vegetables, Campaigns, Portions, Guidelines
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