Food policy embraces all those policies affecting food, food economy, supply and demand. Food policy is concerned with the global market, international laws and regulations governing the selling of food (Caraher 2000). As Lang & Heasman (2004) note, there is no one food policy or one food policy-maker, but that food policy-making is a social process as well as being highly politicized and contentious.

In the UK in the 1960s and 1970s, food policy was aimed at food security, ensuring that everybody had enough to eat – a legacy from the 1939–1945 world war when governments had struggled to ensure there was sufficient food for everyone to have their essential nutritional needs met. This was achieved by imposing a system of rationing essential foodstuffs, such as meat, eggs, butter, sugar and tea. By contrast, a world food crisis between 1972 and 1974 highlighted the global availability of, and access to, food. Maxwell & Slater (2004, p 3) argued that concern about food security is not sufficient and we need to extend attention to food policy. The lack of a coordinated approach to food reflects the causes of the changes in the food system and food policy. These are driven by urbanization, technical change, income growth, lifestyle changes, mass media and advertising and also fluctuating changes in relative food prices (Maxwell & Slater 2004, p 30). Such shifts are bound to lead to battles of interests, knowledge and beliefs (Caraher 2000, p 429; see also Lang & Heasman 2004). Successive governments in the 1980s and 1990s were in favour of self-regulating markets and food industry. As Caraher (2000) points out, cheap food was produced at the expense of quality and that led to food safety being compromised. Examples of this are the bovine spongiform encephalopathy (BSE) crisis, foot and mouth outbreaks in cattle, swine fever and more recently avian influenza. Despite unsound practices, such as condemned meat being resold, such practices have continued during subsequent governments (Caraher 2000). These examples highlight the difficulties of monitoring food production and the level of scrutiny required to ensure that only food that is fit for human consumption is sold.

Baggott (2000, p 193) noted that pressure for changes in regulations governing food safety and nutrition and calls for better health education resulted in demands for greater regulation of commercial activities, with improvement in standards. Despite this, there are ‘powerful counter-pressures’ that inhibit more-informative food labelling and allow the continued use of food additives. These commercial interests also favour international free-trade agreements (Baggott 2000, p 194).

In the UK, the government’s food policy is based on advice from the Food Standards Agency (FSA), which was established in 2000 following the bovine spongiform encephalopathy (BSE) epidemic. The FSA is the only body that deals with the quality of our food, which was previously the responsibility of MAFF (Ministry of Agriculture, Fisheries and Food 2002), which is also concerned with farm incomes. The FSA is answerable to the Department of Health, although its (quite generous) budget comes from MAFF (MAFF 2002).

The functions of the FSA include:

The FSA works at three levels: at a national and international level to influence food regulations; at a community level to influence people’s food choices to become more health orientated (see Figure 8.1); through health education campaigns.

Labelling of foodstuffs is not compulsory, unless specific claims are being made (e.g. ‘low fat’ or ‘high fibre’). However, many food firms recognize that labelling their products increases public confidence. Legislation requires that information about nutrients must be provided in one of two ways as outlined in Box 8.1.

Lists of ingredient might not be comprehensive; for example, ‘raising agents’ or ‘flavourings’ need not be fully listed. This is a particular concern for vegans/vegetarians and for allergy sufferers as the ingredients they wish to exclude may be omitted from the list. (The FSA would like to address this issue.) Many of the terms used in packaging have no meaning (e.g. ‘fresh’ or ‘traditional’).

Where foodstuffs are being sold for a particular nutritional use (known as PARNUT foods), the labelling regulations are more strict, although these are sometimes open to controversy as they could mislead people into believing they are eating food that is recommended for their condition. An example could be diabetic jams, when it is probably healthier for the diabetic person not to eat products with a high glycaemic index (see the Food Standards Agency 2004).

The FSA would like to make labels less confusing. For instance, ‘90% fat-free’ can be interpreted in several ways and a more accurate form of labelling, such as 10% fat content, would be safer for consumers. Similarly, labelling a product as ‘fat-free’ or ‘low fat’ should have a specific recommended meaning such that low fat would mean 3 grams per 100 grams and fat-free would mean less than 0.15 gram per 100 grams.

The FSA would also like information to be provided regarding the presence of potential allergens and to clarify labelling on genetically modified (GM) foods as well as improved strategies to detect such substances.

Marketing terms such as ‘fresh’ and ‘traditional’, which actually mean nothing, are also descriptions on which the FSA would like more clarity and restriction. There is no restriction on how food companies can name their product, or promote its image or promote a food as being ‘healthy’.

Most people have at least some opinion as to how food should be prepared, served and eaten. They also have a view about what foods are appropriate on different occasions. Some have a religious significance and some religions have strict dietary rules (see Box 8.2), in some cases originally designed to protect people from food poisoning.

As a nursing student, you will need to ask your patients/clients (or their family) about their beliefs and preferences, and be guided by this. Most people know that eating is essential to life, and for many people eating in the correct way is just as important. It may be useful to consider the point that, although the rules may be important for various reasons, including safe eating, it is not always clear if they are practised for religious reasons or whether they are culturally constructed.

Many people choose to reduce or omit animal products from their diet. Such people are often referred to as vegetarians or vegans. The rationale for vegetarianism is varied and will influence the exact type of vegetarian diet chosen. For example, some people are concerned about animal welfare, but may perhaps eat meat if they are satisfied about the standards of animal husbandry (Royal Society for the Prevention of Cruelty to Animals 2004).

The Royal Society for the Prevention of Cruelty to Animals has started the ‘freedom foods’ scheme, which identifies meat derived from animals in cases where the farmer has met certain criteria. Others feel that the costs of raising an animal to eat makes it morally wrong when so many people cannot get enough to eat; these people may accept meat that has been raised in areas, such as high hill land, that are unsuitable for arable purposes. Still others believe that fruits and vegetables are particularly healthy and choose to eat vegetarian or vegan food, although some may accept meat as an occasional treat or as a courtesy. Many devout religious people believe it is wrong to kill any sentient being and observe a strict vegan or vegetarian diet, whilst others who find it difficult to obtain meat that has been treated according to religious laws, or who are unsure about how the meat has been prepared, choose a vegetarian diet.

Energy is the ability (or potential ability) of the body to function effectively and to enable it to carry out our daily activities. Most of this body work is conducted within the millions of cells that make up our bodies. Within each cell there are special structures called ‘mitochondria’ (singular: ‘mitochondrion’), often known as the power house of the cell because of their essential role in undertaking the activity of metabolism (Figure 8.3). In order for a cell to carry out its metabolic work, it usually requires energy. The mitochondria use a particular compound that facilitates this energy production; this compound is called adenosine triphosphate (ATP). The mitochondria can manufacture ATP by using oxygen that has been delivered via the red blood cells to the tissue cells, along with another product of nutrition, glucose. (Sometimes the mitochondria produce energy using different products, but this normally only happens as an emergency if there is a shortage of oxygen and glucose.) In the process of manufacturing ATP, the mitochondria also produce several waste products, one of which is energy in the form of heat, another is carbon dioxide and another is water. The water helps transport the carbon dioxide out of the mitochondria and the cell into the capillary blood from where it is transported via the veins, through the right side of the heart and then on to the alveolar capillaries in the lungs to be excreted in the breath.

The process of ATP manufacture is called a metabolic pathway; Figure 8.4 summarizes this process. Energy production is carried out in the mitochondria of all cells, except red blood cells (because red blood cells only have minimal energy requirements).

Humans are described as being in energy balance if the energy they are taking in through their diet is about the same as the amount of energy being used. So sports people prepare themselves before a sporting event by taking large quantities of high-energy foods. As a result of an evolutionary response to times of hunger, the body has the ability to store energy reserves during times of plenty, usually in the form of adipose tissue (fat) deposited under the skin, or in the buttocks, or over the abdominal organs. If inadequate energy-providing foods are taken, for example during periods of famine or food shortages, or starvation (such as in hospitals), then the body has the ability to maintain its cellular function, and thus life for a period of time, by drawing upon its reserves until they are exhausted, when death will take place.

Carbohydrates all contain carbon, hydrogen and oxygen. There is a wide range of foodstuffs that are high in carbohydrate and they are the most plentiful. The main purpose of carbohydrates is to provide the necessary substances for energy production and they are the simplest form of nutrient to transform into energy. Carbohydrates are subclassified, according to the size of the molecules, into monosaccharides, disaccharides and oligosaccharides. These all taste sweet and are present in almost all sweet-tasting foods, including cakes, sweets and fruit (Table 8.1).

Polysaccharides are large complex molecules composed of many monosaccharides. They do not taste sweet. The chief examples are amylose and amylosepectin, which together constitute starch (found in plants) and glycogen (found mainly in animals). In the Western diet the most important sources of polysaccharides are potatoes, rice and wheat products such as bread and pasta.

Most carbohydrates are at least partially broken down in the gastrointestinal tract to mono- and disaccharides. However, the rate at which this takes places varies and this is very important for human health. Some carbohydrates are very quickly and easily broken down to mono- and disaccharides, whereas others take much longer. The speed at which dietary carbohydrate appears as blood glucose is referred to as the glycaemic index. Foods with a high glycaemic index are quickly broken down and lead to a rapid rise in blood sugar, which provides an energy burst, followed by a rapid drop in blood sugar, leaving the person hungry. Those foodstuffs that take longer to be digested by the gastrointestinal system are identified as having a low glycaemic index. They are absorbed into the bloodstream more slowly and so lead to a slower but more sustained rise in blood sugar. Normally it is better to choose foods with a low glycaemic index, as they provide energy over a longer period of time. Foods with a high glycaemic index can cause wide swings in blood sugar, which might lead to long-term health problems. A simple guide to high or low glycaemic foodstuffs is the size of the molecules. Most foodstuffs with large molecules have a low glycaemic index, but there are important exceptions to this. Note, for instance, that baked and roast (but not boiled) potatoes have a high glycaemic index, and so would lead to a rapid increase in blood sugar, whereas milk and yoghurt have a low glycaemic index, leading to a slower and more sustained rise in blood sugar (see Table 8.2). Try Activity 8.4 and calculate what your typical daily glycaemic index intake might be.

Fibre includes any foods that cannot be absorbed or broken down by enzymes in the human digestive tract and are usually complex carbohydrates (e.g. some forms of starch). Fibre is therefore not a true nutrient. Foods rich in fibre include most fruit and vegetables, and wholemeal foods such as brown rice and wholemeal bread. However, fibre does play an important role in regulating gastrointestinal function, and a lack of fibre can lead to constipation and other difficulties.

Proteins are an important component of a healthy diet. They are found in a range of foodstuffs, but particularly in animal products and some pulses and cereals. High-protein foods include meat, fish, dairy products and eggs. Proteins are normally used primarily for tissue development; however, in times of shortage of carbohydrate foods, the body can convert proteins into energy. This is one of the principles of some diets.

Some people choose to take vitamin supplements, often in large quantity. If the vitamin concerned is water-soluble, this is probably harmless and may be helpful, as any excess vitamin is lost in the urine. For instance, many people take generous supplements of vitamin C, believing that it will help ward off infections, including the common cold (New Scientist 2005). There is indeed evidence that supplements may assist in reducing the length of the incidence but not reducing its occurrence.

However, taking large quantities of lipid-soluble vitamins is not recommended, as these can accumulate in the liver, and be potentially toxic.

See Table 8.3 for a brief summary of the chief sources and action of some of the vitamins discussed in the sections below.

One of the best ways to ensure that the required micronutrients are received is to eat plenty of fruit and vegetables. Studies consistently show that people who eat five or more portions of fruit and vegetables are healthier than those who do not (outlined in Vines 1996). The effect is quite strong, and not fully understood. Certainly fruit and vegetables tend to be rich in vitamins and minerals and low in fat, but high in fibre. However, there are probably other compounds that we are only just learning about that are present in fruit and vegetables and that are very beneficial to health.

It has been shown that quite limited intervention encouraging greater consumption of fruit and vegetables can have impressive outcomes in terms of blood cholesterol and other indicators of health (Steptoe et al 2003). The evidence is now so convincing that ‘five a day’ is government policy, and there are many initiatives designed to increase the intake of fruit and vegetables (Department of Health 1998). For instance, all schoolchildren between the ages of 4 and 6 years should receive one piece of fruit on each school day. Some people regard the ‘five a day’ target as unreasonably high. These people should have it explained to them about the wide range of foods that ‘count’ as fruit and vegetables; the food can be in any form, including tinned, frozen then cooked, dried or pureed. However, potatoes, in any form, do not count; they form a very useful part of the diet, but have a different role. People are often surprised to learn that tinned baked beans, dried fruit and fruit juices all contribute to a healthy diet.

Minerals are also micronutrients that are required by the body in small quantities. Minerals are of inorganic origin (i.e. they are found in rocks and soil). Of course, unlike animals, humans do not normally lick rocks to obtain these nutrients; instead, they get them from water, or from plants and animals that have ingested them. One of the most important minerals in the body is iron, as it is essential for the formation of haemoglobin and thus the transport of oxygen around the body.

Calcium and magnesium are important for bone development and muscle contraction.

Table 8.4 lists some of the more important minerals, their sources in food and their action.