Five-a-day? Ten? Lucky thirteen?

It is generally accepted that:

• eating a 200g (gram) mix of vegetables and fruit (V&F) a day (two and a half 80g portions) reduces one's risk of:
  
  • developing heart disease by 16%
    
  • having a stroke by 18%
    
  • developing cardiovascular disease by 13%
    
  • developing cancer by 4% and
    
  • succumbing to premature death by any cause by 15%
    
• eating a 400g mix of V&F a day (the UK Department of Health's Five 80g Servings of Vegetables and Fruit A Day' recommendation) reduces the risks of developing these diseases significantly more, and ...
  

In February 2017 a very large review and meta-analysis conducted by Dagfinn Aune and colleagues (which pooled and re-analysed the findings of 95 studies covering around two million people)¹ concluded that:

• eating 800g of F&V a day appeared to have reduced the risks by even more, viz:
  
  • of developing heart disease by 24%
    
  • of having a stroke by 33%
    
  • of developing cardiovascular disease by 28%
    
  • of developing cancer by 13%
    
  • of dying prematurely by 31%, and ...
    
• eating even more V&F brought additional benefit - up to 800g a day of vegetables and 500g a day of fruit, above which there was no evidence of further benefit
  

The economic benefits of 'Ten a day'
Following a different analysis of the data they had amassed the researchers stated that, if the associations they had observed had been causal (i.e. the diets had largely influenced the likelihood of developing the illnesses) diets containing below 800g of vegetables and 500g of fruit a day could have caused between 5.6 and 8.5 million premature deaths just in 2013.
We have been unable to ascertain

• (i) what the UK's share of that 5.6 - 8.5 million toll would have been, or
  
• (ii) what it would have cost the UK, but we can tell you that the National Health Service apportioned £5.8 billion of its 2006/2007 £43 billion spend to treating poor diet-related ill health.²"
  

Editorial
(i) Dagfinn also made the following comments:

• "Fruit and vegetables have also been shown to (i) reduce blood cholesterol levels and blood pressures and (ii) boost the health of our blood vessels and immune system. This may be due to the complex network of nutrients they hold"
  

"One example are compounds called the glucosinolates in cruciferous vegetables (e.g. broccoli) which activate enzymes that may help to prevent cancer"

• "Vegetables and fruit may also have a beneficial effect on the naturally-occurring bacteria in our gut"
  

He urged people to eat lots and lots of vegetables and fruit rather than waste their money on dietary supplements: "It will not be possible to bottle the effects of vegetables and fruit or put them in a pill. Most likely it is the whole cocktail of beneficial (phyto) nutrients you obtain by eating fruits and vegetables that is crucial to health"
"Forget the dietary supplements!"

• Dagfinn added: "Some fruits and vegetables bring greater benefits than others. For instance, apples, pears (although low in vitamins and minerals), citrus fruits, salads and green leafy vegetables such as spinach, lettuce and chicory and cruciferous vegetables, such as broccoli, cabbage and cauliflower were found to be best at preventing heart disease and stroke"
  

For those worried about reducing the nutritional value of food through cooking, he stressed that there was no evidence that eating the foods raw had reduced the risks more than eating the foods cooked.
(ii) If you are minded to try and eat 800g or, even better, 1,300g of V&F a day, bear in mind that:

• eating a wider variety of V&F is likely to deliver broader nutritional benefit than eating the same volume of a lower variety
  
• there is nothing magic about the serving size of 80g. It simply helps keep the serving size relatively small, making it easier for people unaccustomed to eating V&F to eat it
  
• if you eat more V&F you will also increase your intake of chemical fertiliser and pesticide residues. Maximise your consumption of organic V&F, which also contain higher levels of phytonutrients
  

There is another reason why we should eat more V&F. Most of us who try to do so are likely to eat fewer portions of meat, fish and dairy - all significantly linked with high levels of environmental pollution, climate change gases and human illnesses - as a consequence.
What is the likelihood that the UK Department of Health will note the health and economic benefits of the 'ten 80gram portions of V&F a day' diet highlighted by Dagfinn and colleagues and recommend it to the nation? The Environment-Health Trust is not optimistic. The Meat, Fish and Dairy Industries are (i) important sources of tax revenue for the Government and (ii) major sources of employment for the people (also generating more tax revenue).

References
¹ Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality - a systematic review and dose response meta-analysis of prospective studies. Aune,D et al. International Journal of Epidemiology 2017 Feb 22 doi: 10.1093/ije/dyw319
² https://academic.oup.com/jpubhealth/article/33/4/527/1568587/The-economic-burden-of-ill-health-due-to-diet

(17431)  Nick Anderson. Green Health Watch Magazine 52   (2.8.2017)