Throughout human history, the leading causes of death have been infection and trauma. Modern medicine has scored significant victories against both, and the major causes of ill health and death are now the chronic degenerative diseases, such as coronary artery disease, arthritis, osteoporosis, Alzheimer’s, macular degeneration, cataract and cancer. These have a long latency period before symptoms appear and a diagnosis is made. It follows that the majority of apparently healthy people are pre-ill.

But are these conditions inevitably degenerative? A truly preventive medicine that focuses on the pre-ill, analyzing the metabolic errors which lead to clinical illness, might be able to correct them before the first symptom. Genetic risk factors are known for all the chronic degenerative diseases, and are important to the individuals who possess them. At the population level, however, migration studies confirm that these illnesses are linked for the most part to lifestyle factors — exercise, smoking and nutrition. Nutrition is the easiest of these to change, and the most versatile tool for affecting the metabolic changes needed to tilt the balance away from disease.

Many national surveys reveal that malnutrition is common in developed countries. This is not the calorie and/or micronutrient deficiency associated with developing nations (type A malnutrition); but multiple micronutrient depletion, usually combined with calorific balance or excess (Type B malnutrition). The incidence and severity of Type B malnutrition will be shown to be worse if newer micronutrient groups such as the essential fatty acids, xanthophylls and flavonoids are included in the surveys. Commonly ingested levels of these micronutrients seem to be far too low in many developed countries.

There is now considerable evidence that Type B malnutrition is a major cause of chronic degenerative diseases. If this is the case, then it is logical to treat such diseases not with drugs but with multiple micronutrient repletion, or 'pharmaco-nutrition’. This can take the form of pills and capsules — ‘nutraceuticals’, or food formats known as ‘functional foods’. This approach has been neglected hitherto because it is relatively unprofitable for drug companies — the products are hard to patent — and it is a strategy which does not sit easily with modem medical interventionism. Over the last 100 years, the drug industry has invested huge sums in developing a range of subtle and powerful drugs to treat the many diseases we are subject to. Medical training is couched in pharmaceutical terms and this approach has provided us with an exceptional range of therapeutic tools in the treatment of disease and in acute medical emergencies. However, the pharmaceutical model has also created an unhealthy dependency culture, in which relatively few of us accept responsibility for maintaining our own health. Instead, we have handed over this responsibility to health professionals who know very little about health maintenance, or disease prevention.

One problem for supporters of this argument is the lack of the right kind of hard evidence. We have a wealth of epidemiological data linking dietary factors to health profiles/disease risks, and a great deal of information on mechanism: how food factors interact with our biochemistry. But almost all intervention studies with micronutrients, with the notable exception of the omega 3 fatty acids, have so far produced conflicting or negative results. In other words, our science appears to have no predictive value. Does this invalidate the science? Or are we simply asking the wrong questions?

Based on pharmaceutical thinking, most intervention studies have attempted to measure the impact of a single micronutrient on the incidence of disease. The classical approach says that if you give a compound formula to test subjects and obtain positive results, you cannot know which ingredient is exerting the benefit, so you must test each ingredient individually. But in the field of nutrition, this does not work. Each intervention on its own will hardly make enough difference to be measured. The best therapeutic response must therefore combine micronutrients to normalise our internal physiology. So do we need to analyse each individual’s nutritional status and then tailor a formula specifically for him or her? While we do not have the resources to analyze millions of individual cases, there is no need to do so. The vast majority of people are consuming suboptimal amounts of most micronutrients, and most of the micronutrients concerned are very safe. Accordingly, a comprehensive and universal program of micronutrient support is probably the most cost-effective and safest way of improving the general health of the nation.