NHS: Nutritional Health Service.

As of 2014, medical students are no longer required to study nutrition, and this has two concerning implications. The first of these is the welfare of patients, as many medicines and treatments depend on the support of a healthy diet to reach their optimum efficacy. Ineffective medication will leave patients suffering from persistent symptoms, and may even cause  them to develop chronic diseases such as type 2 diabetes and cardiovascular disease (CVD), whereas appropriate nutrition could have prevented this. Secondly, as a result of poor health care, the cost of additional prescriptions, hospital admissions, surgery, and doctors’ appointments could add to the financial pressures currently faced by the NHS, crippling the patients, NHS staff, and tax-payers alike.

Heart disease is the most common cause of death in the UK, accounting for 12.1% of all UK deaths during 2014 (2). Cardiovascular disease, which includes heart disease, is a problem around the globe, and many studies have aimed to address this issue. For example, it has been observed that the Mediterranean diet is capable of reducing the risk of CVD (3), lessening the number of people requiring medical care for this condition. The Mediterranean diet is typically characterised by high  intakes of olive oil, fruit, nuts, vegetables, and cereals, moderate intakes of fish and poultry, and reduced intakes of red and processed meats, dairy produce, and confectionary. Any alcohol usually comes from wine, which is consumed with a meal. This diet is rich in a variety of proteins, vitamins, and minerals, and also provides polyunsaturated fatty acids. These are associated with lower cholesterol levels in the blood, preventing atherosclerosis, a condition where blood vessels are narrowed, and even blocked, leading to heart attacks and strokes. Since it is estimated that strokes cost health and social care services £4.38 billion each year, with 25% of strokes leading to the death of the patient within a year (4), reducing the numbers of cases of stroke  would reduce the amount of money needed to provide carers, equipment, and benefits for those affected.

Another common condition that is associated with nutrition is type 2 diabetes. In 2012, it was estimated that 850,000 people suffered from type 2 diabetes in the UK, and that the cost to the NHS was approximately £8.8 billion a year (5). This incredible sum of money derives from the fact that diabetes leads to a multitude of conditions which are expensive to treat, including visual impairment, kidney failure, CVD, and lower limb amputations. In this case, it may not always be possible to prevent the onset of diabetes using diet alone. However, the disease can be controlled by the diet, and could stop the development of its consequences, again saving the NHS money.  Also, medication to combat diabetes will be ineffective if the patient consumes a diet high in sugar.; for example, some type 2 diabetics are prescribed insulin when this is deemed appropriate, but this cannot help the patient to avoid the adverse consequences if blood glucose remains high following the absorption of excess sugar in the diet. In particular, a high consumption of sugary drinks like coca cola, and even fruit juice, have been associated with an increased risk of diabetes, and also a worsening of symptoms (6). Giving patients the guidance they need on how to obtain an enjoyable diet rich in all the nutrients they need, while reducing the amount of sugar they consume, will optimise the efficacy of the treatments given by doctors.

Cancer is also prevalent in the UK, and it is estimated that 42% of cases are preventable, 5% being due to overweightness and obesity (7). Since diet plays the most significant role in weight control, and weight can be a contributing factor to cancer, helping patients to choose a suitable diet could reduce the incidence of cancer in the near future, also saving the NHS money on doctors’ appointments, prescriptions, and surgery. Some cancers are more sensitive to nutrition thant others, an important example of this being the apparent relationship between low fibre intakes and the development of bowel cancer (8). Bowel cancer is one of the more prevalent cancers in the UK (9), meaning that encouraging the consumption of fibre would likely reducing the number of cases of bowel cancer in the future.

All of the above diseases have some sort of connection with nutrition, and obesity in particular. With 25.6% of the adult population being obese as of 2014 (10), helping these cases return to healthy weights, and preventing new cases from occurring, could have a massive impact upon how much the NHS needs to spend on treating these diseases. Similarly, the influence of nutrition on the above diseases will also save the NHS large quantities of money, perhaps not immediately, but certainly in the future.

Other concerns as to the absence of nutrition on the medical syllabus lie in the diagnosis and treatment of vitamin and mineral deficiencies, where many of the symptoms are similar, leading to misdiagnosis, and prescribing the wrong supplements. Also, many deficiencies coincide with one another, complicating treatment. Similarly, diseases like anorexia nervosa and bulimia require careful treatment, not just psychologically, but also in the provision of all the nutrients they need during recovery.

It is undeniable that with the progress of modern medicine, doctors are under ever-increasing pressures to learn and understand a wider variety of subjects. However, with the NHS struggling for funds, looking for ways to reduce the amount of prescriptions and other medical treatments given to patients, without jeopardising their health, is essential. With nutrition playing such a central role in this, doctors need to know the basics, including knowing when a patient needs the additional guidance of a dietician, a specialist in nutrition when applied to medicine. Nutrition is truly essential to medicine.

By Emma Steer, 2nd Year BSc Nutrition.

References:

  1. Iran Daily, 2015, Early deaths from heart disease, stroke to rise [online], date accessed [26/01/2016], URL [http://www.iran-daily.com/News/127987.html]
  2. Office of National Statistics, 2015, What do we die from? [online], date accessed [26/01/2016], URL [http://ons.gov.uk/ons/rel/vsob1/mortality-statistics–deaths-registered-in-england-and-wales–series-dr-/2014/sty-what-do-we-die-from.html]
  3. Estruch R, Ros E, Salas-Salvado J, Covas M.I, Corella D, Aros F, Gomez-Gracia E, Ruiz-Gutierrez V, Fiol M, Lapetra J, Lamuela-Raventos R.M, Serra-Majem L, Pinto X, Basora J, Munoz M.A, Sorli J.V, Martinez J.A, Martinez-Gonzalez M.A, 2013, Primary Prevention of Cardiovascular Disease with a Mediterranean Diet, The New England Journal of Medicine [online], volume 368, pages 1279-1290, date accessed [26/01/2016], URL [http://www.nejm.org/doi/full/10.1056/NEJMoa1200303#t=article]
  4. Stroke Association, 2016, Stroke Statistics [online], date accessed [26/01/2016], URL [https://www.stroke.org.uk/sites/default/files/state_of_the_nation_2016_110116_0.pdf]
  5. National Institute for Health and Care Excellence, 2012, Type 2 diabetes: prevention in people at high risk [online], date accessed [26/01/2016], URL [https://www.nice.org.uk/guidance/ph38/chapter/public-health-need-and-practice]
  6. Malik V.S, Popkin B.M, Bray G.A, Despres J.P, Hu F.B, 2010, Sugar-Sweetened Beverages, Obesity, Type 2 Diabetes Mellitus, and Cardiovascular Disease Risk, Circulation [online], volume 121, pages 1356-1364, date aaccessed [26/01/2016], URL [http://circ.ahajournals.org/content/121/11/1356.full]
  7. Cancer Research UK, 2012, Cancer Statistics for the UK [online], date accessed [26/01/2016], URL [http://www.cancerresearchuk.org/health-professional/cancer-statistics]
  8. Cancer Research UK, 2016, Food Types and Bowel Cancer [online], date accessed [27/01/2016], URL [http://www.cancerresearchuk.org/about-cancer/type/bowel-cancer/about/risks/food-types-and-bowel-cancer]
  9. NHS Choices, 2014, Bowel Cancer [online], date accessed [27/01/2016], URL [http://www.nhs.uk/conditions/Cancer-of-the-colon-rectum-or-bowel/Pages/Introduction.aspx]
  10. Public Health England, 2016, UK and Ireland prevalence and trends [online], date accessed [26/01/2016], URL [https://www.noo.org.uk/NOO_about_obesity/adult_obesity/UK_prevalence_and_trends]

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