Had dodgy advice from a nutritional therapist? We have!

by , Senior Food Researcher Consumer Rights 16 January 2012
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Have you ever visited a nutritional therapist? In this month’s Which? magazine we investigated the profession and found some worrying practices, such as therapists advising against going to your GP.

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One therapist advised our researcher, who was posing as a cancer sufferer, against having conventional treatment (a lumpectomy and radiotherapy), saying that she should try for three to six months to rid herself of the cancer through diet (by cutting out sugar).

Nutritional therapy can be big business; therapists charge up to £80 for a consultation and often prescribe expensive supplements on top. So we wanted to investigate whether it was worth the money.

How our investigation worked

We asked five undercover researchers to each visit three therapists. Each researcher was provided with a scenario.

One researcher (in her early 30s) had been trying to conceive unsuccessfully for over a year. Two (in their 50s) had been suffering from severe tiredness for the past three months. And two women (in their 40s) had recently been diagnosed with DCIS (Ductal Carcinoma in Situ), the most common type of non-invasive breast cancer.

A panel of experts (a dietitian, a GP and a Professor of Pharmacology) then assessed recordings of the visits and any other information the therapists provided to the researchers, including prescriptions for supplements.

Are nutritional therapists worth the money?

Our expert panel concluded that visiting a nutritional therapist wasn’t worth the money – and in some cases could have actually endangered the health of the researcher. Six of the fifteen consultations were rated as ‘dangerous fails’.

This could have been down to a number of reasons:

  • The advice given by the therapist could have potentially harmed the researcher.
  • Therapists were diagnosing conditions without relevant testing (even though their Code of Practice says they shouldn’t diagnose).
  • Researchers were advised not to visit their GPs about the problem, recommending unproven testing such as hair mineral analysis, and the case above, advising against cancer treatment.

Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

The experts were also worried by some therapists using non-evidence-based testing to diagnose symptoms. These tests included iridology (studying the patterns, colour and other characteristics of the iris), hair mineral analysis and a researcher being given several liquids to hold in his mouth before being told he had a chromium deficiency.

Are the recommendations right?

Twelve of the therapists prescribed supplements to the researchers, costing up to £70 a month. Researchers were told not to buy them from Boots or other high street chemists as they weren’t ‘pure enough’ and you were effectively ‘flushing your money down the loo’. Instead, they were asked to buy them from the retailers recommended by the therapist.

Of course, there is benefit in following healthy dietary advice, but most of what was provided by the nutritional therapists is freely available on websites such as the NHS site.

Plus, most of the therapists in our investigation recommended quite restrictive diets that excluded several foods (predominantly dairy and wheat) and taking expensive supplements.

If you do have a medical condition that you are concerned about, your first port of call should be your GP. If necessary they can then refer you to a dietitian. We have contacted the British Association of Applied Nutrition and Nutritional Therapy (BANT) with our findings and concerns.

People who have visited nutritional therapists emailed us to say that they found the diets recommended to them difficult to maintain over a long time and eventually gave up.

Have you visited a nutritional therapist? What was your experience like – do any of these findings ring true or did you have a more positive experience?

1951 comments

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tpoots

I must say, I’m utterly shocked and appalled that a therapist recommended a reduction of sugar to rid a researcher of cancer.

A better diet can no doubt improve your quality of life and make you feel better but by god, never advise against seeing a GP.

 
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AfN

There is a real difference between nutritional therapists and Registered Nutritionists (RNutr), who are assessed by the Association for Nutrition (AfN) and can only be on the UK Voluntary Register of Nutritionists if they are qualified and competent in nutritional science and practice and uphold the highest professional and ethical standards through a comprehensive code of conduct.

Registered Nutritionists who consult on an individual basis would only do so under the supervision of a suitably qualified practitioner, such as a GP, if there is a pre-existing medical condition.

There is a response to this investigation on the AfN website, http://www.associationfornutrition.org

 
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Angie

It makes me very sad to read about so called therapists cashing in on what can be a beneficial approach to health when combined intelligently with help and advice from GPs. It gives nutritional medicine…and by that I mean eating healthily and supplementing where absolutely necessary, a bad name. I treated myself for depression and anxiety years ago. Effectively, by altering my diet and taking Passiflora and using relaxing aromatherapy oils. Without the Ativan (subsequently found to be addictive and unhelpful) which I was prescribed by doctors. But such unscrupulous practise labels a good and balanced approach to health as quackery. Shame on them!

 
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Lorna

My Mum visited a naturopath for dietary advice while fighting secondary breast cancer in 2010. On the advice of the naturopath she delayed a chemotherapy treatment which she had been advised to begin by her consultant. This was in order to try and ‘treat’ the cancer through a combination of diet, expensive dietary supplements and self-administered enemas.

The diet restricted her daily routine and failed to help. By the time she began the chemotherapy regime a few months later she was significantly more poorly and suffered an extremely bad reaction to the drugs.

She died in April 2011 and although I don’t put this down to the advice of the naturopath – she
was extremely ill with advanced cancer – I believe that the therapist was negligent in her advice and should not be allowed to treat cancer patients as such.

It is also worth mentioning that the naturopath in question works by signing clients up to a monthy direct debit after asking them to sign a contract which also presuambly acts as a kind of disclaimer.
My Mum continued paying this for months despite being too poorly to use the naturopath’s services.

I was extremely concerned at the time but didn’t want to upset my Mum by intervening. I also discovered there was no regulatory body I could actually raise my concerns with either.

 

Hi Lorna, what a sad story – I’m so sorry to hear what your mum went through, and particularly shocked to hear about the payment methods, which sound very underhand. Thank you for sharing – hopefully stories like these will encourage those reading to research different therapists thoroughly before deciding whether to take their advice or not.

 

Hi Lorna

I am so sorry to hear your story. Unfortunately it shows that the findings of our research are not a one-off.
We have written to Anne Milton, MP with our concerns and to ask the government to address the need for more effective regulation of this industry.

If you know the name of the therapist you could check to see if he/she is registered with BANT and submit a complaint.

 
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HR O.

Hi Lorna, this is very sad and I really feel for you. I too have had close family die of cancer and I know how painful it is to find the right balance between all the different options. I think nutrition has an indisputable role in the management of any disease, but where we fail is to see it as just one more factor, so it’s not just nutrition, or just chemo, or just radiotherapy. Surely every case is different anyway, but what applies to them all is the fact that by covering as many different angles as possible and being integrative and holistic ultimately it is the patient that benefits.

I too would be happy for nutritional therapy to be more regulated but only because it would allow these professionals to work alongside doctors, nurses, consultants, etc, and really help create a National Health System where the patient gets the best care possible.

On a slightly different note, I don’t believe BANT registers naturopaths, as naturopathy is a different discipline.

 
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Louise

May I just say that Naturopathy is a different profession to nutritional therapy and are not regulated by BANT

 
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wavechange

The Code of Practice link in the introduction is not a code but a brief curriculum – details of the content of a taught course.

 

You’re right, Wavechange that isn’t quite the right info. Unfortunately, we can’t actually find the Code of Practice anywhere online so we’ve removed that link – sorry about that.

 
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wavechange

Thanks Hannah. Feel free to delete my message.

 
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JSB

The Nutrirional Therapy Core Curriculum doesn’t appear to be brief as you say – it’s over 40 pages long and appears quite extensive!

 
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Alan henness

It’s very odd that BANT don’t seem to make the Code of Professional Practice Handbook available on their website. How are the public meant to know how their members are supposed to behave?

The latest issue of their Code seems to be Issue 1.1 March 2011, but an older version from 2005 is available here: http://www.dcscience.net/bant-code_of_ethics.pdf It makes interesting reading.

 
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wavechange

JSB – I was trying to alert Which? to the fact that the linked document was a curriculum and not a code of practice. The curriculum does give information about course content and does not provide details of the depth of coverage. That is not a criticism of the curriculum, but I should not have used the word brief.

 
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aravenscroft

It is important to note that there are people in EVERY profession who do not adhere to the rules that are imposed on their industry.

As a nutritional therapist I would NEVER advise a client to go against the wishes of their doctor and cease conventional treatment. I would NOT diagnose, use unproven testing and suggest that a client spends a large amount of money on expensive supplements. I take my clients’ health and budgets incredibly seriously and would NEVER endanger anyone.

Many of my clients are referred by previous clients who have had very positive results after visiting me for advice.

I would welcome stricter regulations within my profession as I operate to a very high standard.

 
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Elaine

And yet surgeons can remove the wrong organ and not much happens! I visited a nutritional therapist for digestive problems and eczema – which no end of doctors could help me with and it’s the BEST thing Ive ever done. Totally healthy in 3 months! No more drugs, no more pain and suffering.
If anyone else has success stories, which I’m sure there are many you, please write in to which to balance this ‘comprehensive’ survey!

 
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HR O.

I couldn’t agree more with the fact that this piece of research is utterly biased. The medical profession alongside other “mainstream” healthcare providers have historically tried to discredit any therapies that could potentially achieve results by using other methods, whichever these may be. What is really wrong is that the big losers in this battle are those suffering from conditions which could be benefited by a more integrative approach. As a Nutritional Therapist says herself in a previous comment, it would be much better for them to be approved or certified at a higher level so their practices can be assessed and they could bring all their knowledge into the NHS to help many who, like me, need as much help as we can get to feel healthier.

 
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Std

Nutritional counselling and therapy are available on the NHS via a registered Dietitian. By law for a person to call themselves a Dietitian they must be registered on the health professionals council and undergo regular reassessment. This aims to prevent case like this happening whilst still enabling everyone access to this treatment without commercial gain getting in the way of treatments.

 
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HR O.

@Std I lost quite a lot of weight when I had my gallbladder removed after my biliary duct got blocked by gallstones. An NHS dietitian told me to eat crisps, donoughts, cakes and bacon because these are highly calorific foods that would help me “build myself up”. Taking into account that I lost a valuable organ in my body because of my inability to cope with fats, was this safe advice? I assume this lady was an all singing-all dancing-all registered, etc dietitian.

Doesn’t the same argument that’s being used about the inefficiencies of statutory regulation apply to dietitians? If regulation doesn’t provide sufficient guarantee against the bogusness of a profession (quoting Prof. Colquhorn on chiropractors) surely this also applies to dietitians? Do they always offer the right advice? Are doctors never wrong. The bias keeps surfacing with every further comment… You cannot have it all ways. Either it is better to go to a healthcare provider that’s statutorily registered or not. It is nonsense to say that nutritional therapy would continue to be dangerous even if it was statutorily regulated… I may just go and have a bacon buttie now, on the advice of my dietitian!

 
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George Barker

I have written in about good nutrition advice from Sarah Burt.

 
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Clare Daley

It is disappointing that a respected publication such as Which? should publish such a biased piece of research. None of the ‘experts’ chosen are from the profession and at least one is a well-known critic of complemetary therapy and writes a blog on the subject.
Some of the headlines in the article eg ‘Quack Analysis’ are what I would expect from the gutter-press, not Which?.
The article also failed to mention the regulatory body – the CNHC. At the moment registration with this body is voluntary and most nutritional therapists would welcome statutory regulation.
On the other hand, there are clearly issues with the profession if therapists are advising against cancer treatment/visiting GPs. However, having not seen the transcripts it is difficult to know whether comments have been taken out of context. I know of no nutritional therapists that would give this kind of advice. Certainly, our training teaches working alongside conventional healthcare (this may have differed in the past). Modern day nutritional therapy adopts a ‘functional medicine’ approach which is an approach that is gaining acceptance also amongst some conventionally trained doctors etc. In criticising nutritional therapy in such an unbalanced manner, Which? plays into the hands of the almost complete monopoly enjoyed by big pharma who over the last few decades have completely failed to turn around the growing levels of chronic disease in the UK – and yet make huge amounts of money out of increasing levels of sickness.

 
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Andy Lewis

Clare – this is precisely the type of response that Nutritional Therapists should not be making right now.

Which? have clearly shown that 14 out of 15 nutritionists gave bad advice. Some of it very dangerous. They used quack diagnostic tests and prescribed expensive supplements. These are the only thing that needs matter now. It is not relevant if mainstream medicine is failing in some way, or your critics were involved. It only matters that you sort your house out and are seen to be doing that.

The homeopaths went through a similar sting from BBC Newsnight nearly 5 years ago. they failed to address similar issues. They misled and reacted badly. They are now thoroughly discredited and have failed to gain the legislative support they wanted. Nutritional Therapists have the opportunity to do it the right way now. I hope they do.

 
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David Colquhoun

I’m not sure why Elaine and HRO should say the research was biassed. It simply reports what was actually said, That, in many cases, was shocking, and in some cases it was dangerous.

The question of regulation is really quite tricky, simply because regulators usually turn out to be quite ineffective. There can be no better example of that than the General Chiropractic Council. That’s the highest level of statutory regulation, on par with the GMC. Yet it proved totally ineffective. When the British Chiropractic Association tried to sue Simon Singh for defamation, after he described some of their treatments as bogus, the claims made by chiropractors came under close scrutiny and were found to be wanting. Over 600 complaints were sent to the GCC but very few were acted on. Even statutory regulation is no guarantee that a practitioner won’t make false claims. The regulator, in the case of the GCC, itself supported the false claims.

Neither will giving degrees in a subject like nutritional therapy be effective. The course will be taught by nutritional therapists and it will be the source of misinformation, not the cure for it. If you don’t believe that, take a look at the examples of what gets taught on some BSc degrees. at http://www.dcscience.net/?p=259 and at http://www.dcscience.net/?p=260

In fact UCAS no longer offers degrees in Nutritional Therapy, and having seen the nonsense that’s taught on some of them. that seems to me to be a good thing.

The only sort of regulation that is likely to work is for the Advertising Standards people to clamp down on false health claims (a job at which they are quite good) and fro the Office of Fair Trading to ensure that Trading Standards officers prosecute serious cases (a job at which they are abysmally bad).

 
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wavechange

Well said David. I would like to see biochemical or other evidence of deficiency before anyone is prescribed supplements, and not just where nutritional therapists are involved. At least we have stopped blood letting therapy, but the extraction of money from the gullible and desperate continues as it has done for centuries. My diagnosis is a deficiency of regulation of these therapists.

Some people have questioned the existence of certain degrees for many years and I believe UCAS made the correct decision.

 
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Sophia

Any practitioner who tries to persuade a client not to seek medical help should be subject to disciplinary action.
Regarding the comments made about sugar and cancer, of course one cannot cure cancer by cutting out sugar, it is worth noting that cancer cells take up sugar faster than normal cells, which is why fluorescently labelled glucose is used for PET scanning to detect cancer tissue during cancer diagnosis.
There is considerable evidence that high blood sugar level and high levels of insulin are associated with a greater incidence and recurrence of breast, endometrial and bowel cancer. Diabetic women have, on average, a higher breast cancer incidence and poorer outcome than women without diabetes. Therefore the appropriate evidence-based advice is that a low glycaemic index/load diet is appropriate for both breast cancer prevention and after diagnosis. Unfortunately this is not the standard dietetic advice to cancer patients, who are usually told that what they eat doesn’t matter.

 
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Lolitaborro

I suffered of repeated miscarriages and the doctors didn’t have a solution to my problem. I resorted to nutritional therapy and was found to have a high level of inflammation in my body that cause my own immune system to ‘reject’ the babies. I was put on the right diet and now I have two beautiful children.

There certainly are lots of ‘rogues’ out there, but a competent nutritional therapist can actually help a lot.

 
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David Colquhoun

Sophia
None of what you say constitutes evidence that a low glycaemic index/load diet will benefit someone with cancer. People in that situation are quite distressed enough without being told that they must eat particular things. It’s really rather cruel to do that.

 
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Sophia

Read the evidence David, then decide if good glycaemic control is of no benefit for someone with cancer. Furthemore the way that advice is delivered is important, of course one wouldn’t wish to frighten a patient, but not giving the whole story is not serving them well either.
I’m sure that you are aware that the mechanisms involved include the action of IGF1, which is raised in hyperglycaemia and hyperinsulinaemia, and that malignant cells switch to glycolysis, but if you have any doubt that avid glucose uptake by cancer cells is relevant for cancer patients, ask why a number of pharmaceutical companies are pursuing glycolysis blocking agents.

Refs for my earlier comments on glycaemic control and cancer risk:

LAJOUS, M., BOUTRON-RUAULT, M.C., FABRE, A., CLAVEL-CHAPELON, F. and ROMIEU, I., 2008. Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women The American Journal of Clinical Nutrition, 87(5), pp. 1384-1391.

LAJOUS, M., WILLETT, W., LAZCANO-PONCE, E., SANCHEZ-ZAMORANO, L.M., HERNANDEZ-AVILA, M. and ROMIEU, I., 2005. Glycemic load, glycemic index, and the risk of breast cancer among Mexican women Cancer causes & control : CCC, 16(10), pp. 1165-1169.

SIERI, S., PALA, V., BRIGHENTI, F., PELLEGRINI, N., MUTI, P., MICHELI, A., EVANGELISTA, A., GRIONI, S., CONTIERO, P., BERRINO, F. and KROGH, V., 2007. Dietary glycemic index, glycemic load, and the risk of breast cancer in an Italian prospective cohort study The American Journal of Clinical Nutrition, 86(4), pp. 1160-1166.

And if you want to see how a group of German oncologists are considering carbohydrate intake:

KLEMENT, R.J. and KAMMERER, U., 2011. Is there a role for carbohydrate restriction in the treatment and prevention of cancer? Nutrition & metabolism, 8(1), pp. 75.

 
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wavechange

The first of the references mentioned by Sophia is available online at:
http://www.ajcn.org/content/87/5/1384.full.pdf

I have not checked to see if the others are available to the public.

 
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taurean

Is it not worse to get someone to take chemical preparations (commonly called medication) that have nasty side effects. That is really cruel, to add to their suffering while telling them it will help. Then it is often the case that other ‘medication is needed to counteract those side effects etc. etc.etc……..
Also, my sister who is diabetic was advised to eat a high carbohydrate diet because of her diabetes, this by an all knowing NHS dietician (same advice from Diabetes UK). Excuse me but science tells us that carbs are converted to glucose in the body which is the last thing a diabetic needs!

 
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david colquhoun

I have now taken a look at the first reference that Sophia provided. The first sentence of the abstract for results says

“Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk.”

Of course I’m not denying that there are interesting relationships between oestrogen levels and diet. That’s standard. All I was saying is that there is no evidence to suggest that withholding sugar from a patient who already has cancer will have the slightest benefit for them, though it may well make them miserable.

 
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Lorna

I entirely agree that a good diet and education about diet should be central to anyone dealing with any sort of illness. One of my daughters has a milk allergy and we have received great support from a nutritionist. It would be fabulous to see more advice being given to people with specific illnesses alongside support from ‘convential’ medical support. I don’t think many people would deny what we consume has a massive effect on our health. In the case of my Mum, she beat the odds with secondary breast cancer, and I would not be surprised at all if it were partly due to the great care she took to eat well.

Obviously there are a lot of credible and well qualified complimentary therapists out there. But there really does need to be a system in place to regulate those who make claims like the naturopath I am talking about. At one point she also advised my Mum to come off beta blockers which were essentially stopping her from having a serious GI bleed! Thankfully my Mum also sought the advice of her GP and remained on her medication.

I have considered contacting her consultant at the hospital even just to make someone aware of this kind of practice in the area. This particular naturopath is seemingly very well established and highly respected otherwise.

 
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Carole

In reply to David Colqhoun, the degree module he illustrates was a small introductory module exploring the naturopathic roots of nutritional therapy. it was worth 10 of the 300 credits needed to achieve the degree. Perhaps to balance the argument the readers would like to look at the course content of a current degree programme
http://courses.uwl.ac.uk/CourseDetails.aspx?CourseInstanceID=30329
If Mr Colqhoun or the authors of the Improbable Science website, have full details of the content of all of the other modules in the degree programme surely he/ they should, in way of fairness, detail those as well … if not, then perhaps it is inappropriate to make a judgement based on such limited information.

 
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David Colquhoun

Well well. I had missed the University of West London course, because it is not listed in UCAS for entry in 2012. Presumably it us a continuation of the course that used to run at Thames Valley University, about which I wrote at http://www.dcscience.net/?p=260

I’d like to point out that it took over three years work to get a judgement from the Information Commissioner that universities must release all such teaching materials (see http://www.dcscience.net/?p=2485 ).. The people who teach the courses have fought tooth and nail to conceal them.

If you are connected with the West London course, I’d be very pleased if you sent me the whole of the course so i can come to a fair judgement. Otherwise I’ll have to send another FOIA request.

All this is slightly beside the point though. This investigation shows that in practice nutritional therapists give bad and sometimes dangerous advice, From what I have seen, that stems from what they have been taught. They aren’t allowed to do diagnosis according to BANT, quite rightly because they aren’t qualified to do so. This leaves them with little to do apart from offering the sort of common sense advice on diet that is coming at us already from every quarter. They only way they can make a living is to prescribe supplements that, in the vast majority of cases, are not necessary.

 
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Jenny Hargreaves

Hopefully these results don’t tar us each with the same brush. We are all trained to 1. Use food first. 2. Back up all recommendations with evidence based research or biochemistry. 3. Never diagnose 4. Refer to a GP for testing 5. If testing, use appropriate laboratory serum/urine/stool analysis 6. If necessary, before supplementing individual supplements – test. 7. Send results to GP 8. Never advise to cease any prescribed treatment. It is a pity not all pracitioners follow these rules. I have found Nutrition Therapy/Functional Medicine very useful in helping my Autistic son with his health issues, which is why I developed an interest and eventually trained in Nutrition Therapy.

 
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wavechange

That seems a sensible approach, Jenny. It is a credit to you that you have taken training to help support your son and understand his problems.

 
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david colquhoun

If only the therapist in this study had stuck to the rules outlined by Jenny Hargreaves, then there would not have been much to write about. Sadly, they didn’t.

The only one that i’d quibble with is “Use food first”. If you have already had a diagnosis of breast cancer then it is too late for that approach.

It’s admirable that you say “Back up all recommendations with evidence based research”. The problem there is that the evidence is now quite good that nutritional supplements don’t do you any good (and may even do harm).

 
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HST

I don’t believe you Doc. Show me proof.

 
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John H

I first saw a nutritional therapist in 2008 after getting nowhere with my GP with digestive symptoms and chronic fatigue syndrome. My GP told me I had psychological issues and I was imaginging all my symptoms. This meant I had no option but to seek help elsewhere and pay for it. The nutritional therapist appeared very knowledgeable, professional and well trained. She also listened to me and went through all of my health symptoms. She recommended I ask my GP for a stool test to rule out an infection, unfortunately my GP did not oblige, so at the next session she then recommended a private 3 day stool test. I felt I had no option but to pay for this privately as my GP had been so uncooperative. When the results came back I had a high level of dientamoeba fragilis and H Pylori. The nutritional therapist asked me to consent to her contacting my GP, she wrote a letter to him and sent him my results and asked my GP to prescribe medication. She also helped me make many simple changes to my diet. This really helped my symptoms to improve. My nutritional therapist also helped me with other laboratory tests that helped get to the bottom of my problems. I now know that I have had glandular fever, again my nutritional Therapist notified my GP. Interestingly when my GP received the results he was less than complimentary about the fact that I had seen a nutritional therapist even though it proved my symptoms had physical infective causes. I feel my health was put at risk by the ignorant and archaic views of my GP. Whereas my nutritional therapist was really helpful in identifying the real issues behind my symtoms and ultimately helping me to recover.

 
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JSB

Can you please tell us if the study involved any CNHC registered nutritional therapy practitioners? If the practitioners involved in the study were not CNHC registered, then the study will have been conducted upon practitioners that self regulation is effectively trying to ‘police’ against.

 
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Alan henness

JSB

Although we don’t know whether or not the nutritionists in the study were registered with the CNHC (aka OfQuack), it hardly matters. OfQuack launched themselves with some £900,000 of public money almost exactly three years ago and have consistently shown themselves to be utterly incapable of regulating: http://adventuresinnonsense.blogspot.com/search/label/complementary%20and%20natural%20healthcare%20council

 
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Rachel

I work as a nutritional therapist. I studied at University – a degree in Human Biology followed by a nutrition course at postgraduate level. I would never diagnose and would always suggest a visit to the gp if a client suffered fatigue. My advice is always backed by scientific research. There are unfortunately people working calling themselves nutritional therapists giving wrong advice and giving the rest of us a bad name! I met one who had enrolled on the same post grad course as me – she left without completing an assignment and seemed to think she already knew it all. I would suggest when choosing a nutritional therapist people check on qualifications and if all advice is backed up by research.

 
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Sheila

A very common-sense approach Rachel and one I fully agree with. I am also a fully qualified Nutritional Therapist (following five years study) and have been in practice for a number of years. All my advice is evidence-based and I never diagnose, nor treat. If I feel lab tests are necessary I always recommend clients see if these are obtainable from their GP first. If there are NTs out there who breach the code of practice they’ve signed up to, then they should be removed and named, so that fully qualified Nutritional Therapists can continue to support the health improvement of their clients, working together with other health professionals.

My final point is that I am disappointed, as a subscriber to Which?, to hear that on this occasion the panel of experts used to comment on the consultations did not include an expert representing nutritional therapy. It’s therefore hard to see how an objective conclusion could have been reached by this panel.

 
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wavechange

I agree with what you say Rachel, and it is good to read your input. My only concern is that you suggest that people check that all advice is backed up by research. Some people with health problems put a great deal of effort into understanding their condition and have the critical evaluation skills needed to help decide on what to believe. Most would just turn to websites, where the quality of information on health and disease is arguably poorer than for most topics.

I feel there is a strong case for anyone working in this field to help clients to find reading material that provides a balanced review of the topic. The depth would, of course, have to be matched to what the individual could reasonably be expected to understand.

 
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david colquhoun

Sheila complains that there was not a “nutritional therapist” on the panel. But there was one of the foremost experts on nutrition in the country on the panel, namely Catherine Collins. Since this was meant to be a proper scientific assessment there would be little point in including someone who represented complementary medicine.

 
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dawn

I wish people would wake up and realise that cancer can be prevented and cured naturally!!.People that have cancer should do a hell of a lot of research and then they`d find the real truth that the medical profession are keeping from us.They found out what cancer was 70 years ago by a Dr Otto Warburg that won an nobel prise for,that it is a fungus that lives anaerobic(without oxygen) and that it feeds off sugar(glucose) the cure lies with the fact that you need to make your body as unfriendly for these fungi to live.The fact that someone has cancer means they have been exposed to a lot of toxins, bad diet,heavy metals,parasites etc basically any artificial going into your body including pharmaceutical drugs is going to cause cancer,if you think about it logicaly and sciencifically then it is starring you in the face.It has got nothing to do with genes,its to do with lifestyle!!.The reason why any of this isn`t common knowledge is that the suppession of the facts and the propaganda out there makes it the biggest conspiracy in living history!!

 
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John R

I suffered with arthritis, insomnia and chronic fatigue for a number of years. Since the age of 42 I have been to a number of doctors (I move around for work) and have also seen a couple of dieticians. The pain in my knees would sometimes be so bad that even climbing the stairs would be an ordeal. Lack of sleep would often make me bad tempered and the low energy would leave me seriously debilitated for days on end. My niece took one of these courses at Westminster University and I must admit I thought it was a dressed-up cooking class. She explained the effects the effects of the nightshade group of vegetables on my joint pain and reluctantly I omitted them from my diet. She wrote to my doctor but to put it bluntly he wasn’t interested. I was started on fish oils with a number of other dietary tweaks and supplements such as glucosamine and my pains eased significantly. Following this I let her ‘work on me’ a bit more and now I also sleep much better having increased magnesium rich foods in my diet and I am now able to keep up with the grandchildren on a day trip thanks to my good energy levels. Nutrition hasn’t cured me but I now feel more ‘normal’ again. My doctor is also starting to change his view especially when he measured my vitamin B12 levels and exclaimed they were the best he had seen in a 70 year old in a long time.

 
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Anne

It is worth noting that you can make anyone fail if that is what the intention is…

I am a Nutritional Therapist and get lots of referrals from GPs and nurses at the local practices.

Can we see the transcripts and if not, why not?

 
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Alan Henness

Anne said: “It is worth noting that you can make anyone fail if that is what the intention is…”

I don’t suppose you’ve any evidence that that was Which’s intention as you seem to be implying?

 
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Rosie

As a science journalist and producer I too maintained some very narrow beliefs on the efficacy – never mind the ethics – of nutritional therapy and its related complementary/alternative practices. I ran with the assumption that anyone taking money for a non-medical consultation must be a fraud, a mercenary and quite probably a lunatic.

However. Like a growing number of people who are dissatisfied with the diagnosis and/or treatment of their medical problems I eventually had to swallow a significant amount of pride and consult a nutritional therapist. Two hours into my first appointment, my entire medical history made sense. Chronic pain and other problems – some of which significantly degraded the quality of my life – and ALL of which doctors had given up on – were explained and a course of therapy suggested.

(Note the key word here: suggested. At no point have I ever been forced to buy anything. Nor have I been ‘told’ to make a follow-up appointment. It’s always been my choice.)

Anyway, the therapy that was suggested to me on that first consultation consisted of several dietary changes and natural (not homeopathic) medicine. While unconvinced I felt I had no option but to at least try this path and was astonished to feel my body and health transform. Yes, it’s not easy to stick to a healthy diet in an age where we are addicted to refined carbohydrate and processed convenience food but again, it is my choice. The benefits of this way of eating have been explained to me and it’s up to me what I do next. I choose not to eat problem foods, because if – for example – I decide to eat dairy I begin to suffer all manner of unpleasant problems within only a few hours. I don’t need a Dietician to tell me I need milk for calcium. I know I need calcium. I get it elsewhere. It’s not hard.

During the months following my first consultation I began to read more about nutritional therapy and its related practices and discovered that, rather than being populated by a world of flower-patterned sarong-wearers and bushy-eyebrowed meat haters, I had discovered a world of rigorous learning, research and excellence. It is now an important part of my life and I have become impervious to the sneerings of my colleagues. If allopathic medicine works for them; great. It hasn’t worked for me. Recently I was hospitalised while abroad and flown home for urgent medical attention. The hospital doctors that I saw told me I was fine. I was not fine. I could barely walk.

My nutritional therapist had me back in full health within six weeks.

I am advised regularly by my nutritional therapist to consult my GP about certain matters. I am never recommended any supplements that have not been fully explained to me. And they certainly haven’t cost any less than that which I might buy at a chemist; the difference is only that the State does not subsidise them so I pay full price.

I too would like to see the transcripts of this investigation. I would like to know exactly what was said. Similarly, I do not understand why a doctor and dietician were called in to ‘judge’ the performance of a naturopath. Is that not like asking a butcher to assess the performance of a weaver? The two professions are distinct. Naturopaths are not trying to put Doctors out of business. They are not claiming to know more. They practice a different form of healthcare. It’s complementary.

I am bored by the venom of the witch hunters out there. I do not need a randomised controlled experiment to prove to me that western medicine has repeatedly failed me while natural medicine has transformed my life. It feels like a shame that doctors and scientists lack the humility to entertain the possibility of there being alternative methods of diagnosis and treatment – but really, I just wish they’d leave us to it. I would venture to suggest that the vast majority of people seeking alternative therapy are intelligent, informed and shrewd. We just want to get better. We are aware that we have a choice, and that there are alternative avenues which we are free to pursue at any time.

 
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Catherine Collins RD

@ Rosie

“Similarly, I do not understand why a doctor and dietician were called in to ‘judge’ the performance of a naturopath. Is that not like asking a butcher to assess the performance of a weaver”
- or a science media individual to comment on the quality of a self-professed nutritional therapist?

If a naturopath/ nutritional therapist/ enthusiastic amateur offers a therapeutic nutrition service to a client, it is unethical, nay immoral for that individual to

a) offer reasons for their advice that defy biological plausibility (eg – your bowel looks leathery, i can see it is so by looking at your eyes)
b) offer advice that is at best benign, at worst potentially harmful to a client WHILST exploiting their ‘professional’:client relationship to advise against proven medical management which is based on nothing more than personal prejudice.
c) recommend exclusions of entire food groups whilst stating to a client that there was no real reason for doing so but it may prove useful.To do so fosters ambivalence long term.

I agree- as the RD involved in the article I wouldn’t for example comment on naturopathy, just as I wouldn’t presume to know more than my friendly mechanic when he looks at my car. But stray into the area of clinical nutrition with clients reporting medical complaints and hoping for dietary treatment and yes, I do have a perfect right and suitable knowledge to comment on the appalling quality of the information offered.

 
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Irina

Bravo!

 
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Irina

Bravo, Rosie.

 
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Alan Henness

The anecdotes are coming thick and fast.

 
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taurean

I think people’s personal experience counts for much more than sceptic’s unfounded comments!

 
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Alan Henness

taurean

What unfounded comments?

 
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Stefan

For the individual experiencing the healing, their anecdote is all that matters.

 
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Caro

I’m not disputing the results of this study, I know such practitioners are out there. But I don’t think that that means you can tarnish us all with the same brush.

I’m not a nutritional therapist to make money – god knows I would have stuck to corporate life if that was my aim! I never diagnose anything and I always make sure my clients have either already talked to a GP or do so after our appointment. I never recommend clients don’t take prescribed medications or treatments such as chemotherapy.

I also do not use expensive supplements – my aim is to help people be as healthy as possible in a way that suits there lifestyle and budget. I make recommendations and make sure the client knows that I am not affiliated with any of the products I recommend – it is up to them if they go ahead or if they source an alternative. I work with diet changes where possible to provide needed nutrients, rather than have clients dependent on supplements.

I would consider myself to be ethical, knowledgeable and bloody good at helping people to improve their health. So don’t judge us all by the standards of certain people you chose for your investigation.

 
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Carole

Mr Colquhoun
Thank you for your response but I am not connected with the course and am unable to help you with materials. My only connection was that I studied Nutritional Therapy at the University and could not ignore what I believe to be an unbalanced perception and description of the course put forward on the link you gave. Later modules on the course covered the study of nutritional science and its application to health, anatomy and physiology, biochemistry modules, pathophysiology and an understanding of named diseases, amongst others. The University placed much emphasis on evidence based learning and I continue to research and seek out best available research to inform my work.
Nutritional Therapists would not take it upon themselves to try and diagnose a named disease as you say, but we are taught to have a thorough understanding of nutritional and biochemical imbalances and their possible implication in less than optimum health and of how such imbalances/ deficiencies might be rectified safely and effectively. I am a person of integrity Mr Colquhoun, I and would not subscribe to or promote a programme/ therapy if I were not utterly convinced both from the available research and from my own experiences that it was of value. I also work hard to ensure the advice I give is informed and responsible and would always advise a Client to inform his/her GP of the nutritional programme put forward.

 
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david colquhoun

I have submitted a request under the Freedom of Information Act to see the teaching materials so we’ll be able to judge. My experience so far suggests that such courses usually have a mixture of real elementary physiology and pure make believe. Since these two sets of lectures often contradict each other, I fear students must be left quite confused.

 
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Jane Reed, London

The debate on this page revolves around transcripts to which we have no access.

Just as a matter of interest, I strongly doubt that such a study would be approved by a university ethics committee as such underhanded methods, specifically non-consensual, of obtaining information is frowned upon. While the purpose of the study may not be entirely divulged, the fact that a study is being conducted MUST be divulged.

I am shocked at the tactics of a magazine to which we once subscribed for many years but I do wonder now how unbiased and fair your assessment has been of goods and services conducted in the past. Perhaps the magazine is subject to extraordinary editorial influence by large unnamed companies?
Jane, London

 
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Alan Hennsss

OMG! It’s all a big conspiracy!!!

Jane Reed: undercover reporting is sometimes necessary to find out what would happen to a member of the public. It was not a scientific, clinical study: it was an exercise to see what Joe Public are being told by self-styled nutritionists. And thank goodness Which? did it. We now have some data that show there is a problem with the information being given by some nutritionists.

I now await with interest to see if any of the nutritionists’ trade bodies or ‘regulators’ (BANT, CNHC, etc) follow this up – as they must if they are to have any credibility. Are they there to regulate to protect the public or are they self-serving organisations, there only to promote the commercial interests of their members?

They have been shown there is a problem – they must now investigate and either convince us (with credible evidence) these were isolated instances or ensure that none of their charges give out any further misleading and potentially dangerous advice.

Wouldn’t that be a lot more beneficial than throwing around unfounded accusations and a lot of hand waving?

 
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Monika

David – I think there is a lot of furious agreement on this issue. Of course there is a need to regulate the practice and this is being done, which is why it is important that WHICH and similar surveys must ensure they look carefully at who they are testing before blanket bombing a profession on the basis of such a small sample size. It is in the interests of all to ensure that the practice of Nutrition as a health science is correctly monitored. While you may see it as unnecessary quackery, there are many out here who, having studied the science, see your disparaging remarks aimed at discrediting the profession per se as frankly, grossly uninformed. Although you say that common sense advice on diet comes at us from all quarters, sadly health statistics prove that this advice is not being acted on. Diabetes type 2, for example is usually related to poor diet and drains NHS resources by a million pounds an hour according to Diabetes UK. Incorporating nutritionists into GP practices could go some way to alleviating this. Some people need support to help understand why certain foods are contributing to their health problems and what they can do about it. Knowing the underlying mechanisms can be of much greater benefit than simply taking prescribed medication that may contribute to other illnesses after long term use (e.g. statins). Some people do have mineral deficiencies that can be rectified by dietary changes or nutritional supplementation. Conventional dietary advice is often outdated and in some cases lags behind current scientific research by many years. Recent acknowledgement (finally) of the importance of Vitamin D is a case in point. While I commend your interest in public health, I would ask you to consider that many of us studying this profession also share your interest and wish to contribute in a practical and professional manner. I am still waiting to hear your response to Sophie.

 
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Alan Hennsss

Monika

While I agree entirely that there are many nutritionists that give good, evidence-based nutritional advice, some seem to have ideas that are not based on science – like the ones highlighted in the report. So I think it’s necessary to be clear which group we’re talking about. There may well be a case for statutory regulation of the former (I’ve yet to be convinced), but it’s difficult to see who would benefit from regulation of the latter group. You can’t regulate nonsense – all that will happen is that they will gain false and unearned credibility in the eyes of the public.

If you only regulate the science/evidence-based nutritionists (perhaps by specifying what courses are acceptable), that still leaves the problem of those giving unsound and dangerous advice.

 
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Karen Shields

I was very disappointed to read the Which report as I have spent the last five years of my life studying a BSc in Nutritional Medicine. This has cost me a great deal of money and time. I am about to launch myself into this industry and this sort of press does not fill me with confidence in starting a new business. The NHS seems to favour dietician’s and not NT’s so other job prospects outside of private practice are nil.
The university that I trained with has been through a thorough accreditation process which is monitored every year. The detail of the teaching is changed every year in line with new research that has come to light. As you may be aware, new research brings to light new findings every month so this in itself is a challenge for universities.
The professional body of BANT, in my experience is certainly far more stringent on code of conduct and ethics than most other complementary therapies.
I believe that the new wave of students leaving with a qualification in NT are far better trained than ever before and post university they are monitored and guided in self regulation by BANT. As an NT I would welcome regulation as this would give us the opportunity to stand up and be taken seriously. Any NT who does not join BANT is running the risk of not keeping up with changes to the industry. As students we are encouraged to join BANT and the CNHC. You can only join CNHC if you are a member of BANT first. At uni we were trained to refer patients to the GP if any “Red Flag” symptoms are revealed in the consultation.
We are also trained to refer any clients who display symptoms mirroring life threatening conditions to their GP. We were trained to look at the “whole” of the patient including financial constraints as in these circumstances you can only suggest dietary recommendations.
BANT has been saying for months now that we have to check the wording on our website. We cannot “diagnose” or “treat” symptoms but “support” certain conditions. This is so that patients know that we are not GP’s and that if they are worried about serous conditions the first port of call is the GP. Any NT that doesn’t follow this is nuts!! We are not all bogus and quacks!
With the current obesity crisis occuring in Britain today I feel the NHS could certainly look at recognising the NT world and utilising them (after vetting them stringently first) to support the GP’s with this increasing problem.
Healthy eating isn’t rocket science to an NT but it can be to certain members of the general public and giving advice on healthy eating can only be a good thing. It is a shame, as many of the general public do not know the difference between dietician, nutritionists and nutritional therapists so this article can only bring shame on all three.

 
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Alan Henness

Karen Shields said:

“The NHS seems to favour dietician’s and not NT’s”

Is that because Dietitians have a far better and science and evidence-based education? From the nonsense that Which? exposed (although we cannot generalise from their sample to all BANT-type nutritionists), it does seem like there are questions that those teaching these nutritionists need to answer urgently. I note that the BANT press release didn’t address these issues.

“The detail of the teaching is changed every year in line with new research that has come to light. As you may be aware, new research brings to light new findings every month so this in itself is a challenge for universities.”

That’s no different to any other university course, is it?

“The professional body of BANT, in my experience is certainly far more stringent on code of conduct and ethics than most other complementary therapies.”

It’s a pity that BANT don’t actually publish this Code on their website so the public can see what standards their members are supposed to meet, isn’t it? The latest one appears to be ‘Code of Professional Practice Handbook – Issue 1.1 March 2011′. Do you have a copy?

“As an NT I would welcome regulation as this would give us the opportunity to stand up and be taken seriously.”

Therein lies the problem – you need to have the credibility first and then seek regulation, not the other way round.

“You can only join CNHC if you are a member of BANT first.”

If that’s what they are telling you, then – as I understand it – you are being misled. If you look as the CNHC’s guidance on registering as a nutritional therapist, it makes no mention of being a BANT member: http://www.cnhc.org.uk/assets/2-092.pdf

Besides, if you think your course was based on science and good evidence, why would you want to join the CNHC and be lumped in with reiki, reflexology and craniosacral therapists?

 
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Catherine Collins RD

@ Karen

“The professional body of BANT, in my experience is certainly far more stringent on code of conduct and ethics than most other complementary therapies.”

I’m not sure I share your trust in how BANT operate.The Which? article maintained the anonymity of therapists randomly sampled to become part of this review. However, in my opinion those who advised dangerous recommendations to their clients should be complained about to their professional body BANT. I understand that BANT had the transcripts some time ago so already have independent verification of the appalling practice neatly transcribed by an independent secretarial agency. I wonder if BANT will conduct their own internal review of the poor practice of their members – or will they wait for a third party to make the complaint?
Incidentally, as dietitian is a title protected by law, we aren’t tarred with the same brush as nutritional therapists.

 
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wavechange

I cannot understand the British obsession with vitamins, minerals and other food supplements. At best they are a waste of money for most people and at worst, some of them could be harmful.

Yes there are some people who could benefit from supplements but those who have an understanding of the subject should be doing more to help the public make an informed choice. If nothing else it could save many people a lot of money.

 
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Monika

Alan – I’m not clear as to why you are “yet to be convinced” that nutritionists who give good, evidence, based nutritional advice should be regulated? Is that an inherent bias (of the Colquhoun variety) or is it based on fact. Why should other health professionals be regulated but not them? Do you think there will be less danger to public health if they are not regulated?
I agree that regulation can only work so far, but it is surely a step in the right direction. Health care professionals who are regulated give bad advice too but that doesn’t make regulation pointless. Rather it makes it easier to safeguard public health.

 
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Maria

Monika – Do you think there is a need for two separately regulated professions to give advice on diet and nutrition or would it be better if they merged? What is the difference between “nutritionists who give good, evidence-based nutritional advice” and dieticians and what prevents the nutritioniasts from becoming dieticians if they want to be regulated properly and achieve mainstream respectability?

If nutritionists want to be taken seriously they need to sort themselves out. Attacking a long-established and respectable consumer magazine for reporting what it found doesn’t help them one iota.

 
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Alan Henness

Monika said:

“Why should other health professionals be regulated but not them? Do you think there will be less danger to public health if they are not regulated?”

There has to be a balance and the overall public good considered. As I said, statutory regulation can give false imprimatur to those regulated. Just look at chiropractors. They achieved statutory regulation nearly two decades ago, but many of them still believe in non-evidence-based pre-scientific ideas such as the vertebral subluxation complex (VSC); an idea for which there is no good scientific evidence and is medically implausible. Their regulator has pronounced that the VSC is just ‘an historical concept’, yet many of their charges still push it and gain customers on the basis that undiagnosed VSCs can be the cause of untold health problems. The General Chiropractic Council is a perfect example of statutory regulation trying (and failing) to regulate nonsense and the public certainly do not benefit – nor are protected – by this.

As I said, regulating science and evidence-based nutritionists might be a good idea – but we already have statutory-regulated dietitians, so I’m not sure we need a different group and regulation for science/evidence-based nutritionists. It is clear to me that the non-evidence/science-based nutritionists should not be regulated, because, in order to protect the public from misleading claims and information, they would need to abandon all the nonsense they have been taught, leaving…what?

 
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david colquhoun

Needless to say, I deny strongly to having any “inherent bias”. I was asked to read the transcripts and report on the quality of the advice that was offered, and that is what I did. If you wish to defend that advice then please say why.

I suppose it is true to say that, having seen some of the things that are taught on nutritional therapy degrees, I wasn’t very surprised by the poor quality of the advice. Nonetheless I’d have been quite happy if I’d discovered that, despite the quality of what they were taught, the therapists in this study had given good advice. Sadly that was, by and large, not the case. It won’t help to shoot the messenger.

 
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Sheila

I am a fully qualified Nutritional Therapist (following five years study) and have been in practice for a number of years. All my advice is evidence-based and I never diagnose, nor treat. If I feel lab tests are necessary I always recommend clients see if these are obtainable from their GP first. I work with my clients’ GPs and if on any medication, I always send a copy of my recommendations to their GP, with their permission. If there are NTs out there who breach the code of practice they’ve signed up to, then they should be removed and named, so that fully qualified Nutritional Therapists can continue to support the health improvement of their clients, working together with other health professionals.

My final point is that I am disappointed, as a subscriber to Which?, to hear that on this occasion the panel of experts used to comment on the consultations did not include an expert representing nutritional therapy. It’s therefore hard to see how an objective conclusion could have been reached by this panel.

 
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Maria

Sheila

I’d be interested in your response to my questions to Monika above if you have a moment.

 
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eleanor

what a shame the investigative journalists or editors involved in this exercise for ‘Which?’ magazine didn’t see fit to offer a balanced piece of investigation. Of course poor, dangerous practice should be exposed. But equally, good practice should be applauded and celebrated. In saying 14 out of 15 therapists gave bad advice, infers 85% of therapists in this field are similarly bad. Another journalist could just as easily find 14 out 15 registered with BANT and CNHC, practising within the regulatory code and providing a valuable service. Anyone with a brain can work out that people struggling with health issues seek help beyond the remit of their G.P., because of the limitations and constraints of an imperfect ‘one size fits all’ model. But that is not the fault of G.P.’s and the NHS, most of whom recognise the invaluable complementary support a good NT can provide especially in the management of chronic, lifestyle related diseases. This hue and cry could have been avoided with the sort of proper investigation that ‘Which?’ used to conduct – when did they join the ranks of the gutter press?

 
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Guy

After suffering from multiple allergies for many years and having only received symptom management from GPs, I visited a nutritional therapist who advised several dietary changes (no long term supplements) which resulted in a huge reduction in my sensitivities. I can confirm that all the advice I was given was scientific (I am a research scientist with 25 years experience) and that the changes were significant (i.e. well above any placebo effect).
The Which? article and the discussions seem to make a big point about the difference between dieticians and nutritional therapists. This reminds me of the vicious arguments between the ‘Judean Peoples Front’ and the ‘Peoples Front of Judea’ (in Monty Python) which were of course stupid since both groups were insignificant compared to the Romans (which in this analogy would be the symptom management (pharmaceutical) industry). The main (100% scientific) point is that ‘We are what we eat’ which both Dieticians and Nutritional Therapists can agree on. The issue about regulation is 1) Very British (we are obsessed with procedures) and 2) wrong, since Nutritional therapists are regulated through the CNHC. I am disappointed and surprised that Which? did not mention the CNHC registration process or the CNHC status of the 15 therapists involved in the study. I would also be interested in how the 15 were selected and whether the study originally included a much larger number which were whittled down by the ‘unbiased experts’. I guess we will never know the truth. This article is sure to worry any patient seeking advise from any complimentory therapist and so will leave us all at the mercy of the Romans.

 
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wavechange

As an allergy sufferer myself, I feel that your GP should have referred you to a consultant at an early stage.

Diet is undoubtedly important in health but individuals differ. ‘You are what you eat’ is a good way of justifying the need for a balanced diet, but don’t push it too far. Some have food intolerances and allergies, for example, so it is not sensible to treat everyone in the same way.

I trust Which? to carry out this study and report that there appears to be a problem that needs investigation. It is for others to look into the matter in more detail.

Always look on the bright side ….

 
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Catherine Collins RD

@ Guy

1. There was a random selection of therapists by Which? which means less bias.

2. As an RD I am bound by the HPC Code of Conduct to ensure that the advice or recommendations I give in my professional capacity are evidence based, impartial and objective. Review of therapists for this article was no different.Your suggestion that I do otherwise based on preconceived perceptions about how Nut Therapists work is offensive. Pleaes do not assign attributes you may find in your field of work to my practice.

3. When nutritionists of any creed purport to be able to give 1:1 nutritional advice to prevent or treat a clinical condition they are advising in an area that is part of common practice for dietitians then it is relevant that a RD assesses their practice.

4. CNHC (or OfQuack to give it its more familiar term) is a voluntary register of therapists. As such it carries no weight in regulating practicing Nut Therapists out there.

5. The HPC – my regulatory body – refuses membership to those not qualified in the subject of nutrition, and ensures the protected title of ‘Dietitian’ or ‘RD’ is awarded only to those proficient in the subject. 100% of dietitians must be registered with the HPC, unlike the paltry few therapists registered with the CNHC.

 
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Alan Henness

eleanor said:

“what a shame the investigative journalists or editors involved in this exercise for ‘Which?’ magazine didn’t see fit to offer a balanced piece of investigation.”

What balance do you think would have mitigated the shocking discoveries by Which?

” In saying 14 out of 15 therapists gave bad advice, infers 85% [sic] of therapists in this field are similarly bad.”

I don’t think anyone is saying any such thing. What Which? have highlighted is that there seems to be a significant problem with advice given by some nutritionists. What BANT and similar trade bodies/regulators must do now is explain how such dangerous can possibly be given, what steps they are taking to see if it is widespread and what they are doing to make sure no such advice is given in the future. I await with bated breath.

“Another journalist could just as easily find 14 out 15 registered with BANT and CNHC, practising within the regulatory code”

It is, of course, available to anyone to do further research into the advice given by BANT members and I would certainly like to see those results.

As for ‘practising within the regulatory code’, do you know what that code is? I can’t find it on BANT’s website.

 
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Karen Shields

In response to Alan Henness:

I do not know whether Dieticians have a far better science and evidence based education as I have never sought to becoming a Dietician, although since reading this Which report I now wish I had. The qualifications that I needed for the BSc in Nutritional Therapy were the same for a Dietetics degree. What I do know is the BSc in NT that I did was taught using Science & Evidence based research, unlike some other courses I had looked at which seemed to be sub standard. I could have left after completing just a Diploma, however, this would not have enabled me to go into Clinical Practice which is why I continued into the degree.

BANT is the only organisation to choose from with regards to being part of a Professional Body in the Nutrition Industry that recognises NT and we were encouraged as students to join them whilst still at university. The Code of Conduct Handbook you mention was sent to me when I joined last year.

You mention credibility, well, this is why I choose to study a degree in NT rather than just study a diploma. Also, knowing that the university I choose regularly updates their accreditation this seems to me to offer the credibility I was looking for. Credibility as a practising NT comes with joining a Professional Body, or so I thought, which for NT we only have one in the UK, BANT.

There are several routes through which you can join the CNHC, however, our university suggested to join BANT first as this was the easier administrational route as BANT recognise my university degree as credible and CNHC recognises BANT as a credible Professional Body. See the routes of entry at http://www.cnhc.org.uk/pages/index.cfm?page_id=68

I have not yet joined CNHC for the same reasons you highlighted, however, there are no other credible organisations that are available to my profession.

 
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Chris James

I’m rather puzzled as to the sample size of 15 therapists, from a population of around 2000. Perhaps Which? could confirm just what the confidence limits and error% is for such a small sample size? Is this study actually ‘scientific’? From a quick read of it, I got a few doubts. Chris.

 
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Alan Henness

Chris James

I don’t think there is any doubt that this was a small sample survey designed to gauge the extent of any problems. I don’t think Which? have claimed that it was intended to be ‘scientific’. The next step, now some problems have been highlighted, is for those responsible for representing or regulating this industry to conduct a thorough investigation to see whether the kind of advice received by the Which investigators is widespread and then devise a plan of action to tackle it before any member of the public is harmed by dangerous advice.

 
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david colquhoun

Chris James

It is easy enough to calculate limits yourself -you don’t even need to be able to do the maths -there are web calculators that do it for you, e.g. http://www.causascientia.org/math_stat/ProportionCI.html

14/15 = 93% failed. 95% confidence limits for this are 69.8% to 98.4%
6/15 = 40% gave dangerous advice 95% confidence limits 19.7% to 64.6%

So despite the small sample size we can say that it’s likely that at least 70% (and possibly 98%) of nutritional therapists fail/

And it is likely that at least 20% (and possibly 65%) of nutritional therapists give dangerous advice.

These results give real cause for concern, despite the small sample size,.

 
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Chris James

In reply to Alan and David:
There’s no doubt the study highlights problems; but got to be very sure they are reliably representative of the population before demanding action from government. It can become difficult to criticise those practitioners who have scant regard for evidence, on the basis of a study that is not scientific itself. Bit of a contradiction, it seems to me. All we can really say is ‘more studies are needed’, surely?
David – thanks for the maths. Imho should really have stated your final (safe!) 20% in the report. Would have avoided some of the accusations of bias that are around the place.

 
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Alan Henness

Chris James said:

“All we can really say is ‘more studies are needed’, surely?”

I await to see the various trainers, trade bodies and regulators take up the challenge and weed out the bad apples that give unevidenced, unscientific and unethical advice.

 
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david colquhoun

I night add, for anyone with an interest in statistics, that the calculation of the confidence limits above used these limits a Bayesian method with a uniform prior. Very much the same result is given by the standard analysis which is explained in section 7.7 of my textbook Lectures on Biostatistics (which you can download, free, from http://www.dcscience.net/)

 
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david colquhoun

Chris James
You say that we should have given the safe lower limit of 20% in the report, but I must point out tha the upper limit of 65% is equally safe. Uncertainty works both ways. The problem might be smaller than 40% suggests, but equally it might be bigger.

In a scientific journal, one would have stated both limits 40% (CL P=0.95, 20% to 65%), but this would have been a bit heavy for a magazine like Which? Since any number in the range would be a cause for concern, it perhaps doesn’t matter too much.

 
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Monika

Maria / Alan – I agree – there IS a need to “sort themselves out” which is what is being done through accreditation of courses and attempts to regulate the industry. So it is currently happening and I applaud it. It may be interesting to know why some people choose to study Nutrition Therapy instead of Dietetics, despite the controversy and mud-slinging that must be endured. I personally felt that I didn’t want to work in a hospital setting and was more interested in aetiology and supporting those with chronic disease than prescribing hospital diets and learning about post-operative specialised enteral nutrition. I would prefer to work alongside a GP practice than in a hospital. Both are necessary in our health service. I felt nutrition provided the skills I was interested in and gave me the option of specialising in research as well. So far I have been pleased with my choice – but it is frustrating, as a few practising NTs above have mentioned, when the profession as a whole is demonised on the basis of a small survey. I know both dietitians and nutrition therapists. We work well together when we do, despite our different training – and yes, sometimes we debate on the best approach based on scientific evidence. I know some dietitians who wished they’d studied NT and vice versa becasue of the subtle but real differences in what the work involves. As for regulating by whom and for whom, I don’t think most of us care about the politics of it. We’re not all at each other’s throats – and we’re not all money grubbing charlatans – most of us are just trying to get some much-needed work done.

 
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Alan Henness

Monika said:

” I agree – there IS a need to “sort themselves out” which is what is being done through accreditation of courses and attempts to regulate the industry.”

Are you referring to CNHC regulation/accreditation?

“I personally felt that I didn’t want to work in a hospital setting”

Surely a Dietitian isn’t forced to work in a hospital setting – they could easily set themselves up in private practice or work for a GP practice, couldn’t they?

 
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ArgonautoftheSeas

Talking of eczema that has been alluded to, I
took a guy to see a Chinese doc practising
TCM which shop you see on almost every high
street .

Personally think he ate too much spicy and fried
foods.

That was quite some years ago, he paid £45 which
course of treatment and outcome he seemed entirely
happy; he’d eschewed the NHS.

 
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Nish

My child was diagnosed with a liver disease when he was a baby. As a consequence he could not put on weight and was uncomfortable day and night. we seeked advice from a nutritionist when he was 6 months old and within a couple of days we saw a drastic IMPROVEMENT!
After his transplant we were advised by the dieticians in the hospital to feed him chocolate, add butter to everything to fatten him up! Un the other hand a nutritionist advised a protein rich diet.
Which do you think is better for the health of a child???

 

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