The perfect five-a-day?

This is a follow-up to this post. A study came out on 1st April 2014 (no joke) suggesting that we need to revise the 5-a-day slogan and make it 7-a-day. I had a busy day starting with Nicky Campbell on BBC5 live; Shane on BBC Coventry; Dermot Murnaghan on Sky News and Eddie Mair on PM (16 mins in) and managed to write an 800 word article for The Mirror in between interviews.

My key points were as follows:

1) Five-a-day was invented at a meeting of fruit and veg companies at a meeting in California in 1991. The term has since been trademarked by the American National Cancer Institute. It was not evidence based at the time and for something to be evidence based, it needs to be based on evidence. That means the evidence needs to come before the slogan. A point that seems to escape every person who reiterates this myth as if it is fact. The full monty on five-a-day is here. Here are the findings from the EPIC study in 2010 showing that we couldn’t even establish a clear association, let alone causation, for the condition for which five-a-day is trademarked (cancer) after studying 500,000 people across 23 European locations for 8 years.

2) Fruit and vegetables are not the healthiest foods available. Why are they being singled out as the food items we should be putting such effort into consuming every single day?

3) If only we had put the same effort into promoting evidence based ‘super foods’ – the ones genuinely rich in all the nutrients that humans need to survive and thrive, we could actually have made a difference to human health since five-a-day was first coined.

Combining points 2 and 3, I submit the following tables into evidence. All information is openly available on this site. drawing from the United States Department of Agriculture’s National Nutrient Database for Standard Reference

In the following two tables I have recorded:

– Essential fats (the term “essential” in nutrition means we must consume this substance – our body doesn’t make it);

– Complete protein (any food with a protein score over 100 provides complete protein – including the essential amino acids that we must consume. Any food with a protein score below 100 does not provide complete protein);

– 12 vitamins (the database doesn’t record biotin) and the main macro minerals and trace minerals. (Next to each vitamin and mineral is the US Recommended Dietary Allowance or “AI”, Adequate Intake, where an RDA is not given).

Table 1 has five foods that I would recommend as healthy – based on evidence of nutrient provision. Between them (and not always needing 100g for many nutrients to be acquired) they provide all the nutrients that humans need. Please note the nutrients that are most difficult to obtain. People should ideally consume 200g of oily fish each day to get close to the vitamin D and calcium requirements; the addition of steak to these five foods would be helpful to increase zinc intake.

Table 2 has the same information extracted for a typical five-a-day: apple, banana, orange, carrots and peas.

The yellow highlighter gives you a quick visual check of which food provides the most of each nutrient per 100g of product. This is why I describe liver as the most nutritious food on the planet. Please let me know if you find a food with essential fats and complete protein, which is richer in vitamins and minerals than liver.

 Table 1

(All per 100g of product) Chicken Liver Sardines Eggs Sunflower seeds Kale
Essential Fats – omega 3 (mg) 6 1,480 74 74 180
Essential Fats – omega 6 (mg) 486 3,544 1,148 23,048 138
Protein Quality (100+ = complete protein) 149 148 136 88 92
Vitamins
A Retinol (900 mcg) 3,290 32 139 0 0
A Carotene (assumed retinol equivalent) 6 0 1 3 769
B1 (Thiamin) (1.2 mg) 0.3 0.1 0.1 1.5 0.1
B2 (Riboflavin) (1.3 mg) 1.8 0.2 0.5 0.4 0.1
B3 (Niacin) (16 mg) 9.7 5.2 0.1 8.3 1
B5 (Pantothenic Acid) (5 mg) (AI) 6.2 0.6 1.4 1.1 0.1
B6 (1.7 mg) 0.9 0.2 0.1 1.3 0.3
Folate (400 mcg) 588 12 47 227 29
B12 (2.4 mcg) 16.6 8.9 1.3 0 0
C (90 mg) 17.9 0 0 1.4 120
D (600 IU) (AI) (*) neg 272 35 0 0
E (15 mg) 0.7 2 1 33.2 0
K (120 mcg) (AI) 0 2.6 0.3 0 817
Minerals (M)
Calcium (1,000 mg) (AI) 8 382 53 78 135
Magnesium (420 mg) 19 39 12 325 34
Phosphorus (700 mg) 297 490 191 660 56
Minerals (T)
Copper (0.9 mg) 0.5 0.2 0.1 1.8 0.3
Iron (18 mg) 9.0 2.9 1.8 5.2 1.7
Manganese (2.3 mg) (AI) 0.3 0.1 0.0 1.9 0.8
Selenium (55 mcg) 54.6 52.7 31.7 53.0 0.9
Zinc (11 mg) 2.7 1.3 1.1 5.0 0.4

 

* Data for vitamin D is in IU’s – International Units. The USA has recently revised recommended vitamin D intakes to be 15 mcg per day (from 10 mcg per day). This is equivalent to 600 IU.

 Table 2

(All per 100g of product) Apple Banana Orange Carrots Peas
Essential Fats – omega 3 (mg) 9 27 9 2 35
Essential Fats – omega 6 (mg) 43 46 23 115 152
Protein Quality (100+ = complete protein) 31 62 58 N/A 84
Vitamins
A Retinol (900 mcg) 0 0 0 0 0
A Carotene (assumed retinol equivalent) 3 3 12 835 38
B1 (Thiamin) (1.2 mg) 0.0 0.0 0.1 0.1 0.3
B2 (Riboflavin) (1.3 mg) 0.0 0.1 0.1 0.1 0.1
B3 (Niacin) (16 mg) 0.1 0.7 0.4 1 2.1
B5 (Pantothenic Acid) (5 mg) (AI) 0.1 0.3 0.3 0.3 0.1
B6 (1.7 mg) 0.0 0.4 0.1 0.1 0.2
Folic Acid (Folate) (400 mcg) 3 20 34 19 65
B12 (2.4 mcg) 0.0 0.0 0.0 0.0 0.0
C (90 mg) 4.6 8.7 59.1 5.9 40
D (600 IU) (AI) (*) 0.0 0.0 0.0 0.0 0.0
E (15 mg) 0.2 0.1 0.2 0.7 0.1
K (120 mcg) (AI) 2.2 0.5 0.0 13.2 24.8
Minerals (M)
Calcium (1,000 mg) (AI) 6 5 43 33 25
Magnesium (420 mg) 5 27 11 12 33
Phosphorus (700 mg) 11 22 23 35 108
Minerals (T)
Copper (0.9 mg) 0.0 0.1 0.0 0 0.2
Iron (18 mg) 0.1 0.3 0.1 0.3 1.5
Manganese (2.3 mg) (AI) 0.0 0.3 0.0 0.1 0.4
Selenium (55 mcg) 0.0 1.0 0.0 0.1 1.8
Zinc (11 mg) 0.0 0.2 0.1 0.2 1.2

 

The fruit and veg five-a-day has traces of essential fats; no complete protein; no retinol (the form in which the body needs vitamin A – don’t assume that carotene can be converted); no B12 and no vitamin D (note also that D3 is only available in animal foods – D2 is the plant version). Not one nutrient RDA/AI can be provided by 100g of any of the fruit and veg – not even vitamin C.

We would need to eat 2,100 grams of carrots daily to get vitamin E (taking the best of the 5 sources of vitamin E). We would need to eat 2,300 grams of oranges daily to get enough calcium. We would need to eat 450 grams of peas daily to get our copper requirement – make that 1,200 grams to get our iron need.

One of the other points I made in interviews yesterday was the significant sugar content in fruit and veg. There are 3 grams of sugar in 100 grams of each of the five foods in Table 1. The 3 grams come entirely from the sunflower seeds. There are 41 grams of sugar (10 teaspoons) in 100 grams of each of the five foods in Table 2. In the Sky News Interview Katharine Jenner from Action on Sugar was ‘on the other side’ saying that we should eat more fruit and veg. She tried to discount the sugar issue. As the biochemist said in this programme, “sugar is sugar – the body doesn’t know what it came from.”

This is why I get seriously pissed off with five-a-day. It isn’t evidence based, never was and we are telling people to eat foods that can never compete with genuinely nutritious foods. To add insult to injury – the most nutritious foods are the ones that we demonise. I think that justifies the words pissed off!

 

 

 

 

 

 

 

 

 

 

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30 comments on “The perfect five-a-day?
  1. avatar Arno says:

    So essential means that your body can not produce it, like dioxin ? I thought essential means without it you’re pretty miserable like in dead. Where is the evidence for the essentiality of polyunsaturated fatty acids, what is the associated pathology of essential fatty acid deficiency ? Can you eat yourself into an essential fatty acid deficiency with a SAD diet ? Do we need to increase consumption of polyunsaturated fatty acids? Sugar and starch is bad and green veggies are the best carbohydrate, really ? Why does your list ignores potassium which is massive in fruit and is important for the uptake of glucose into the cell, which most grains are deficient of. Eat 200g of oily fish and 2,5kg of oranges to cover your needs of calcium? Have you ever heard of dairy ? Need enough E from fruit ? Try a few kiwis, Miss Nutrition ! You just proved that without nutritionists our health would be just fine. Get a real job !

  2. avatar Vicente says:

    Thank you Zoë for this fantastic analysis.

    I have being following a low-carb diet for over a year and I was a little worried about eating not much fruit. Your three articles tell me exactly what I needed to know.

  3. avatar Matthew Mitchell says:

    Five a day is fine… if it’s kale. :-)

    What about the argument about phytonutrients and the such? Apparently there are a lot of antioxidants in some fruits like berries. But I’d rather stick with vegetables except fruit as occasional treat.

    Also sunflower seeds contain a lot of omega-6 and don’t you want to keep that balanced with omega-3? I would not eat sunflower seeds.

  4. avatar Graham Jones says:

    “There are 41 grams of sugar (10 teaspoons) in 100 grams of each of the five foods in Table 2.”

    Apples – 23 gms, Banana – 17 gms, Orange – 23 gms, Carrots – 4.7 gms, Peas – 6 gms. Source – Google. Perhaps I’ve misread something, quite possible. I’m never sure how many sources to check and I’d be the first one to say that the problem with the internet in general is that not everything is accurate.

    • avatar Zoë Harcombe says:

      Hi Graham – the sources are linked through to in the article (click on apple/banana etc). The source is as the article says – the United States Department of Agriculture’s National Nutrient Database for Standard Reference. Click through and you’ll see 100g of apple has 10g sugar, 100g banana has 12g of sugar, 100g orange has 8g sugar, 100g carrots has 5g sugar and 100g peas has 6g = 41g.

      Best wishes – Zoe

  5. avatar Gwen says:

    Just found your blog, and very glad that I did. Excellent work!

  6. avatar George C says:

    This article was eye opening. I have always been a massive advocate of animal produce and have always held the opinion that they are a great source of a lot of essential things we need including fat and vit/mins. and it peeves me off when people try to avoid a steak etc. for fear of it’s “saturated fat” and how it offers the body nothing more than protein… but I wasn’t aware just how VOID fruit and veg. actually are of these!
    You hear it all the time, “fruit and veg are key to your vitamins and minerals” but this has blown it right out of the water. It is so ingrained into us that fruit & veg. are amazing that is almost seems wrong to disagree with that even in the face of hard evidence!

    However my question is (and it may sound silly), given that they do offer a lot less nutrition than we are led to believe, is there a big place for them in the diet? I always go for veg. over fruit really, obviously due to the sugar content totting up quite quickly when you eat a lot of fruit. So do you think the 5 a day or more recently “7 a day” is complete nonsense or do you still see the benefits to getting in 6 or 7 pieces of veg a day?

    Also, I have my own nutrition and exercise blog mainly based around dispelling myths, you wouldn’t mind if I posted the link to this particular post would you please obviously fully credited with your name etc? Feel free to say no!

    Thanks!

    • avatar Zoë Harcombe says:

      Hi George – many thanks for this. I was surprised too when I first started getting the facts. Surprised enough to end 20 years of being veggie!

      I do think veg is a good thing to consume. Some people are so carb sensitive that they aim to stay around 20g of carb a day (Atkins kind of levels). This would be super miserable in my view and thankfully such people are rare. My one public health message would be “Eat real food” – no 5 of this, 8 of that, not more than 14 units of this – it’s not evidence based. So I would never say have X portions of veg – it’s a real food so eat it! Non starchy veg is best – the green leafy things are the most nutritious and the least fattening. (Back in 1869 Tanner said “Farinaceous and vegetable foods are fattening, and saccharine matters are especially so” – interesting…)

      This is what food plates should look like in my view – here (http://theharcombediet.com/2013/11/the-eatwell-plate-harcombe-diet-style/) and here (http://theharcombediet.com/2013/11/the-eatwell-plate-harcombe-diet-style-veggie-option/) When you remove starchy rubbish from plates there’s more room for the nutritious stuff – meat/fish/eggs/veg!

      Please feel free to link to the post – always welcome :-)
      Very best wishes – Zoe

  7. avatar Michael B says:

    Zoe, Thanks. I should have known and searched first.

    By the way, your first link i incorrect. Should be: http://www.zoeharcombe.com/2014/04/seven-a-day-fruit-and-veg/

  8. avatar PC says:

    @Marie-France: “Everything in moderation…even moderation”, so says ancient Chinese wisdom!

  9. avatar Michael B says:

    Zoe, I’d like to get your reaction to this study:

    New evidence linking fruit and vegetable consumption with lower mortality
    http://www.sciencedaily.com/releases/2014/03/140331194030.htm

    “Eating seven or more portions of fruit and vegetables a day reduces your risk of death at any point in time by 42 percent compared to eating less than one portion, reports a new study. This is the first study to link fruit and vegetable consumption with all-cause, cancer and heart disease deaths in a nationally-representative population, the first to quantify health benefits per-portion, and the first to identify the types of fruit and vegetable with the most benefit.”

    “Researchers used the Health Survey for England to study the eating habits of 65,226 people representative of the English population between 2001 and 2013, and found that the more fruit and vegetables they ate, the less likely they were to die at any age. Eating seven or more portions reduces the specific risks of death by cancer and heart disease by 25% and 31% respectively. The research also showed that vegetables have significantly higher health benefits than fruit.”

  10. avatar Marie-France says:

    Thanks Zoe,
    1) Yes absolutely but if I don’t smoke, eat the least amount of sugar as possible, can’t escape pollution… but I get your point eat 5 veggies per day should not be the FIRST thing they should count on on their way to healthy eating. Here in Canada, it’s the same thing. In fact in Quebec there is the 5-30 Challenge where people are encouraged to eat those 5 portions of fruits/veggies per day…

    2) mmm something new – the ORAC scale. Will be checking that out – coffee check, 80% dark chocolate check, red wine check, pecans check…. I like that list

    3) In terms of ingesting the pesticide – wouldn’t washing and ?cooking? get rid of these? Even if, that doesn’t address the impact on air quality of that much pesticide usage!

    4) “But our brains need sugar” and “everything in moderation” I find are the two most difficult assertions to debunk! Moderation is highly overrated!

  11. avatar Michael B says:

    Hmm, I eat nutrient-dense foods. Does that make me a nutrient-densetarian? Maybe we need a catchy way to describe the type of diet that’s best for us?

  12. avatar Hannah says:

    Love the blogs Zoe. I did a Public Health Nutrition degree which obviously teaches all the NHS advice but have totally moved away from that way of thinking. Real food all the way and if my clients like liver then they eat it (lots don’t). It’s interesting you also point out lifestyle, too many people focus on just one part of it rather than the whole lifestyle.

  13. avatar Marie-France says:

    Nice piece – I like this list of which I eat only one – the eggs. mmmmm certainly makes me think…..
    Do have a question: from a cancer perspective is it possible that the recommendation of 5 fruits/veggies per day recommendation is based on increasing antioxydant consumption rather than based on nutirent content??

    • avatar Zoë Harcombe says:

      Hi Marie-France
      Four thoughts back:
      1) Surely we should be managing oxidants (smoking, sugar, pollution etc) rather than trying to mitigate with antioxidants?

      2) The ORAC scale is the measure for antioxidants – check out oracvalues.com. An apple has an ORAC score of 3,049 vs coffee in excess of 15,000 and cocoa powder scores over 55,000. Search the database from richest antioxidants downwards and see how many pages you go through before you find a fruit. If fruit is being promoted for antioxidants, it would be another example of promoting poorer providers with a lack of evidence base.

      3) Has anyone factored in the cancer impact of 5.6 billion pounds of pesticides on fruit and veg? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2946087/
      It’s never been mentioned in any 5-a-day nonsense I’ve seen; and

      4) As Otto Warburg said “But for cancer there is one prime cause – the oxidization of sugar…” Fruit is sugar, veg is not void of sugar. Has the sugar impact on cancer been taken into account?

      Very best wishes – Zoe

  14. avatar Ash Simmonds says:

    @Nathanneil

    I’ve compiled a BUTTLOAD of stuff to do with fiber and how it’s not the friend we’ve been duped to believe:

    http://highsteaks.com/forum/health-nutrition-and-science/fiber-end-fantasy-myths-and-realities-an-indigestible-nutrient-198.0.html

  15. avatar Nathanneil says:

    What about Fibre – don’t we need fibre to support the functioning of our bottoms (and associated inner tubes) and the like innit?

  16. avatar Ash Simmonds says:

    Chuck oysters up there I reckon.

  17. avatar SpittinChips says:

    It baffles me how fruitarians have any time for posting youtube videos. Surely they spend all day eating.

  18. avatar Marty says:

    I’m wondering how the protein score is calculated. Thanks.

    • avatar Zoë Harcombe says:

      Hi Marty – it’s a tool used by the Nutrition Data site. If you look up any food and then look at the protein quality diagram/score, there’s a button you can click on to find out more about how they award the score. It takes the 9 essential amino acids (the ones we need to consume – the body can make other amino acids) and assesses whether or not a food provides them and if so how well.
      Hope this helps
      Very best wishes – Zoe

  19. avatar Catherine says:

    I am in total agreement with you, Zoe. Much as I enjoy fruit and vegetables, they never make me feel as full and satisfied as meat, fish or eggs. On Daybreak yesterday, Ranvir was with an “expert”, alongside two plates, one showing five portions of fruit and vegetables, the other with seven portions, although I nearly swore badly when I saw that one of these was a bowl of baked beans! No mention of the piles of sugar in those. My husband and myself enjoyed a huge plateful of liver, onions and bacon for our Sunday dinner this past weekend – yum! No other vegetables necessary.

    • avatar Constantine says:

      I’m amazed by how people consider animal foods healthy. All the major diseases skyrocketed in the last century proportionally with our consumption of animal food. These are not our natural food, certainly not in the quantity people consume them. Also we slowly kill our planet by deforestation for future meat.

  20. avatar sarah hill wheeler (@hill_wheeler) says:

    Interesting post, as I suspected, more complex than a slogan could ever do justice to.

  21. avatar TemporaryID says:

    Sorry – antepenultimate sentence.

  22. avatar TemporaryID says:

    Terrific article. There seems to be a word missing from the middle of the penultimate sentence (before “foods”). Will you tweet the Mirror piece? I can’t see it.

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