Health CommitteeWritten evidence from the British Association for Applied Nutrition and Nutritional Therapy (ETWP 28)

Summary Points

Tackling obesity and diet-related disease is a major priority.

One-size-fits-all dietary guidelines are not supported by post-genome science.

The nutrition workforce needs to be competent and up-to-date to prevent/combat diet-related disease.

1. Obesity and diet-related disease represent a major public health challenge which Foresight have predicted will cost society £49.9 billion per year by 2050 if not effectively tackled.1 A competent, up-to-date and effective nutrition workforce has an important role to play in shifting trends and relieving the economic burden posed by poor lifestyle choices.

2. Up until the last decade it was widely accepted that the primary role of diet was to provide sufficient nutrients to meet the metabolic requirements of an individual and to give a feeling of satisfaction. Evidence now shows that by modulating specific targets diet can have beneficial physiological and psychological effects beyond the previously accepted nutritional effects. It can not only promote optimal health and development but also play an important role in reducing the risk of disease, particularly the chronic diseases of ageing. The EU PASSCLAIM project which ran from 2001–05 surveyed the impact of nutrition on health in the following domains: cardiovascular disease; bone health and osteoporosis; physical performance and fitness; body weight regulation, insulin sensitivity and diabetes risk; diet-related cancer; mental state and performance; and gut health and immunity.2

3. Prior to October 2010 the Food Standards Agency was responsible for nutrition and diet. It funded seven nutrition research programmes at approximately £6.5 million per annum, including some of the largest, well-powered intervention trials investigating the type of fat and carbohydrate (N02031), whole grains and fruit and vegetables on various CVD risk factors. In June 2009 an expert panel met to review nutrition research carried out by the Food Standards Agency. The panel recognised that “the publication of these appropriately powered studies is going to overturn some widely accepted relationships between diet and cardiovascular risk and help establish some new ones”.3 Commenting on projects N02029 and N02030 the five-a-day campaign: “different types of fruit and vegetable have different effects on CVD risk and that the dietary target may need focusing on specific types of fruit and vegetables.” The final reports of projects N02038 and N02039 have yet to be published by the Agency on their research website www.foodbase.org.uk

4. On 11 May 20104 the Agency published the final report (dated January 2007) of Project T01022 on diet and colorectal adenomas which ran from October 2001 to December 2006. This project investigated the influence of dietary factors on susceptibility to colorectal adenomas and the factors that predispose certain adenomas to become colorectal cancers. The results showed that outcomes were dependent on individual genotype. This research was classified as “Food Safety” and therefore did not get considered in the June 2009 review which looked only at studies classified under “Diet and Colonic Health”.

5. Nutritional therapists represent a significant resource to tackle diet-related disease and promote optimal health in individuals and society. Nutritional therapy comprises individualised dietary, nutraceutical and lifestyle advice within a functional medicine5 framework to promote optimal physical and mental well-being. National Occupational Standards were published by Skills for Health in 2003 and updated in 2009. The Complementary and Natural Healthcare Council regulates nutritional therapy, reflecting that NT represents a nutritional paradigm different from that which has hitherto underpinned dietetic and public health nutrition practice. In 2004 the Nutrition Society published a Department of Health funded report “Understanding the Differences between Nutrition Health Professionals” which anticipated merging of nutrition professions: “In the longer term, the research indicates a need to consider the possibility of having just one, regulated professional group speaking for nutrition. One possibility suggested was through the Health Professions Council, by expanding the Dietetics to encompass Dietetics and Nutrition, and including anyone (including nutrition therapists) who meet the HPC criteria.” (Section 14)6

6. Nutritional therapists use plant, fungal and algal (ie herbal) products in their practice and are therefore concerned at the developments in the implementation of EU Traditional Herbal Medicines Directive and the perverse results of EU scientific substantiation of health claims, eg that “drinking water does not reduce the risk of dehydration”—as understood by the average EU consumer. As the European Commission and Member States have rejected the use of qualified health claims, the situation looks to become more confusing in the short-term.

December 2011

1 Tackling obesity: future choices, Foresight and BIS (2007)/

2 www.ilsi.org/Europe/Pages/PASSCLAIM_Pubs.aspx

3 www.food.gov.uk/multimedia/pdfs/nutresrev180310.pdf

4 www.foodbase.org.uk/results.php?f_report_id=494

5 www.functionalmedicine.org

6 www.bant.org.uk/pdf/Understanding the Differences Nutrition Professionals.pdf

Prepared 22nd May 2012