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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wavechange

I am still waiting to see evidence that one brand of vitamin or other supplement is better than another. By evidence I am not referring to manufacturers’ or therapists’ claims, but evidence from properly conducted scientific studies.

Recall that in the Which investigation, some therapists advised clients to purchase expensive brands. Ignore whether the supplement is needed and let us consider whether there is any justification for recommendation of specific (and often more expensive) brands.

 
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Simon Rogers

Wait no longer! Consumerlab.com compare brands of supplements, and as you might expect, they vary considerably. Why would you think otherwise?

https://www.consumerlab.com/reviews/vitamin-d-supplements-review/vitamin_d/

[If they've got some kind of vested interested, then by all means let me know. I couldn't dig any out. Quackwatch.com - a sceptic website - recommend them.]

 
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John

Hi, Wavechange…

Take a look at the Jounal – Nutrion and Dietary Journal for Nutrition and Dietary Supplements
Its open access to scientific and medical research…Just sharing, so please dont blast me…..I am not interested in joining in any heated discussion….

 
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wavechange

Simon

My reason for suggesting comparison of the quality of supplements was to bring a little science and objective discussion into this topic. As you have seen, some of the criticism is becoming rather personal. My main interest in this Conversation is because I do not like science being misrepresented and the public being exploited.

I honestly don’t know about differences between the quality of supplements. They have not featured much in my life, though I am aware that products based on fish oils can contain potentially harmful materials. That is common knowledge and the reason why we are recommended to eat oily fish but not more than a couple of times a week.

The US website you mention is a commercial service that provides subscribers with information about a huge number of supplements. Hopefully the FDA makes use of this information.

I am a little suspicious of anything that is not in a peer reviewed journal (maybe that’s a bit sad), so a commercial site with links to selected suppliers immediately rings alarm bells. Like review sites for consumer goods, this sort of website it probably very valuable to alert the reader to potential problems.

Hopefully those who have knowledge in this field may be able to comment on the value of this site.

 
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wavechange

John – Thanks for this. I presume you mean the journal named Nutrition and Dietary Supplements. The fact that it is open access means that everyone can read the articles, a great help on a public discussion forum. Authors pay over £1000 to publish an paper in this peer reviewed. I cannot find information about impact factor or citations, which could give some idea of the the quality of this journal.

Like you, I am not keen to get involved in heated discussion. As I said in my reply to Simon, exploring the quality of supplements is something that could be done without too much personal criticism.

 
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wavechange

Oops, that should read …. over £1000 to publish an paper in this peer reviewed journal.

Perhaps I am being a bit naive to expect proper scientific studies of different brands of supplements but I recall seeing studies on fish oils, covering both the desirable and undesirable compounds present.

 
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Ian

There was a good review for the lay person to read on Statins in Skeptics magazine just over a year ago – might be online?

 
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Alan Henness

Possibly. And if Which? ever look into statins, that might be interesting and relevant.

 
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Barney

Third time lucky, as my last two comments have been deleted by the Which? moderators. I hope people realise just how much they are being manipulated.

[The rest of this comment has been removed by mods]

 

Hi Barney

I’m very sorry if you feel we have let you down on this matter, however I have tried to email you personally to explain our reasons for not publishing your comments and my email has been returned, suggesting that you’re not supplying us with a real email address.

If you’d like to contact us directly, please use our contact us form and we can then email you directly.

Thanks, Hannah

 
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Barney

Aha – this is a new email account and I got the address wrong! Looking forward to hearing your justification for censoring my comments.

 
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chrisb

Alan,
when you say………………………
“If Which? were to write a report into ‘conventional’ (ie generally evidence or science-based medicine), then we could discuss the evils of Big Pharma – and there certainly are some”.

But it’s a very BIG IF, and that is the problem.

I just wanted to highlight that there seems to be a hugely disproportionate amount of mud-raking and unjustified critique of Alternative Medicine, and esp’ of Nutritional Medicine in the media, that can, and probably does turn people away from this into sometimes inferior conventional care. Mass and erroneous publicity against Vitamins for example, sourced from artificially concocted studies, means that Alternatives can all be tarred with the same tainted brush, and where this is the most likely intention.
If Which and the panel of experts are correct in their assessment, then all to the good for this expose and potential harm to those in need, but there should be investigations and exposes within Orthodoxy to counterbalance the misinformed viewpoints of the masses. It’s a case of throw enough mud and it will eventually stick.

It is my (vain) hope that Which and others will at long last turn their attention to the dubious practices within Orthodox Medicine, and expose some of these for what they are: statins being but one example.
Despite what some here may have been led to believe I am not anti-Mainstream, as they tend to excel in areas of Medical care that no other system has achieved, and I am referring here mostly to trauma; diagnostics and surgery. However, Mainstream falls woefully short on the treatment of chronic disease, which for the most part has become “managed illness” for the masses, and therefore a customer is had for life, when there are more effective treatments outside of drug-therapy that most are in ignorance of.

 
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Alan Henness

chrisb said:

“But it’s a very BIG IF, and that is the problem.”

But that is not the problem here! The problem is whether nutritionists give bad advice.

 
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nobbyuk

out of curiosity i have been looking at the article above and the statement from BANT concerning it and there are somethings that do not add up.

“We have looked carefully at the transcripts provided by WHICH?, alleging that a practitioner recommends a client refrain from pursuing cancer treatment for a period of time rather just follow a change in diet. Whilst the information could have been better presented we have found no evidence in the transcripts that the practitioner “directly” made this recommendation, and are thus unable to agree with this finding. The practitioner made it quite clear that the client’s oncologist must be involved and that the client should refer the suggestions to them to seek their opinion and agreement.”

the emphasis on “directly” is mine as it the main point of contention by BANT becasue they themselves accept that suggestions were made and these should have been told to the oncologist to seek their opinion and agreement. So BANT accept this and are just arguing whether these suggestions where “directly” made or not. Considering they told the client to refer the suggestions to the oncologist i cannot see how they can object to the use of the word “directly”. but i guess its all about interpretation but even BANT accept that these suggestions were made.

secondly: “We refute the outcome of cases where supposed ‘dangerous fails’ were deemed to have arisen on the grounds of failure to recommend contact with the client’s GP. The transcripts clearly document that the client stated either they were not willing for their GP to be contacted or that they were disinclined to give details as they were either in the process of changing their GP, or were considering doing so and were not keen for this action to occur.
In these instances, practitioners would still want to provide the best possible advice regardless. If a client refuses to provide GP contact or refuses to allow the practitioner to contact the GP then that should be noted in the case notes and the reason given. In some cases practitioners may refuse to work with a client without that permission.”

This is BANT saying that the client refused the practioner to be able to contact the GP which is not what the article is saying at all.

The article says:”Researchers were advised not to visit their GPs about the problem”. which has nothing to do with the practioner not being allowed to contact the GP.

thanks to the replies about why there is no code of ethics available. i have read the old one and found out why as the old one posted by Alan ages ago clearly states:
“This BANT Code of Ethics and Practice is the property of the BANT member, the content of which is intended to support, benefit, and protect both the member and his clients. Any misuse, printing or
copying of this document is strictly prohibited. Whilst copies of The Code must not be given to nonmembers, a BANT member may show potential and existing clients, or interested medical practitioners, relevant parts of The Code”.

clearly you will get into trouble if you show it to anyone who is not a paying or willing to pay customer, so much for transparency then.

 
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Maria

I think you’re right, nobby.

Which? says “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)”.

When I first skimmed the BANT response I got the impression they were disputing any such advice had been given. Thanks to your post, I’ve now read it more carefully and realise I hadn’t noticed this bit: “The practitioner made it quite clear that the client’s oncologist must be involved and that the client should refer the *suggestions* to them to seek their opinion and agreement.” (my emphasis)

It now seems that BANT are not disputing this advice was given but they are calling it “suggestions” that should be referred to the client’s oncologist for “their opinion and agreement”. (How bizarre. I’m sure they don’t seriously imagine that an oncologist is going to agree to a suggestion from a nutritionist that a cancer patient should delay having conventional treatment, do they?) Assuming it is true that the practitioner made it clear that the oncologist “must be involved”, I don’t see how it mitigates the suggestion that she delay treatment and I certainly don’t see anything wrong with the way Which? reported it.

The second thing you raise I had noticed and assumed everyone else would but, in case everyone hasn’t, it’s worth restating.

The Which? article reports that researchers were advised not to consult their GPs. BANT’s response do not refute this. Instead they seem to be trying to lead us up the garden path by protesting that the researchers refused to allow the nutritionist to contact their GPs.

A complete red herring.

 
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nobbyuk

thanks maria for your reply.

i think the whole notion of the suggestion that was being made is interesting. i have been thinking about what possible suggestions could have been made that BANT would describe as: “Whilst the information could have been better presented”. if it was just a change in diet that BANT would need to use that statement?

So what was it about the suggestions that could have been “better presented” and needed the “opinion and agreement” of their oncologist? combine that with BANT’s argument of the word “directly” and they accept that a suggestion was made. It seems highly plausable that the suggestion of a dely in treatment was correctly reported by by Which and not refuted by BANT as all they are trying to do is argue the way the suggestion was made by the practioner.

 
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david colquhoun

chrisb

Why on earth do you say the large trials that have been conducted on vitamins and other supplements are “artificially concocted”. Have you some criticism of the way that the trials were conducted (I’m presuming you have read them)? Or do you just automatically assume that any observation that disagrees with your prejudices must be a fabricated lie? That would be a very serious allegation indeed.

Any NT should be glad that their ideas have been taken sufficiently seriously that proper tests have been done. I can see that it isn’t good for their business that the tests have mostly shown no benefit, but that is what is seen when you look.

I’m sure Which? would welcome suggestions for investigations in other areas. There are actually quite a lot of good investigations into the misbehaviour of some Big Pharma companies, It’s interesting that none of these investigations have been done by nutritional therapists. They have been done by regular scientists and doctors who are angry about the corruption of science by big business. And they have been published in proper medical journals (sadly some of them are behind a paywall, but if you want reprints of any of them I’ll be happy to send them).

You mention chronic illness and that is indeed a major problem. In some cases medicine may enable you to day alive in reasonable comfort for many years. In other cases, there is little that medicine can do. Sometimes I think medicine should be more frank about its failures. And equally so should nutritional therapists who seem unwilling to believe their ideas don’t work even when there is overwhelming evidence to that effect.

You say “there are more effective treatments outside of drug-therapy that most are in ignorance of”. I say, produce the evidence. It really is as simple as that. Nobody is throwing mud. All we are doing is to say that it’s undesirable to believe a proposition when there is no ground whatever for supposing it true.

 
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chrisb

Hello David,
thank you for your reply.
Many trials conducted on vitamins/minerals and other supplements have indeed been concocted to show them in a bad light, and where the majority of conclusions from those trials are that they are worthless or pointless or even dangerous, as you claimed in one of your earlier posts, and which I refuted in one of my replies to you.

It is also fairly obvious from your reply that you have not read any of the the studies that I posted on within this thread, and therefore the essence of your post is of an inquiring nature, rather than someone who has satisfied their curiosity and possible ignorance on the matter.

“Do I automatically assume that any observation that disagrees with my prejudices must be a fabricated lie? That would be a very serious allegation indeed”.

Indeed it would be a serious allegation, but I only disagree with observations that have been distorted away from the truth of the matter. I am not prejudiced either David just a seeker of the truth and the facts on healthcare and health-recovery.

I agree with you on your comment that………..

“Any NT should be glad that their ideas have been taken sufficiently seriously that proper tests have been done. I can see that it isn’t good for their business that the tests have mostly shown no benefit, but that is what is seen when you look”.

I said in a previous post that any expose of any health professional who is offering misleading and potentially harmful health advice should be exposed, and rightly so, but my main argument was that there should be a counterbalance of the sometimes poor and misleading health advice offered by Mainstream and published/investigated as such, and not just that aimed at Alternatives.
A small cross section of Nutritional therapists, who may have offered erroneous advice, does not, and should not, negate or nullify Nutritional Medicine as a whole, and that is my contention with this exercise, as the general impression is, that Nutritional Medicine as a whole is unworthy of consideration for those seeking health advice. Nothing could be further from the truth.
For example: The Peer reviewed Journal of Orthomolecular Medicine
http://www.orthomed.org/jom/jom.html
Scientific Archives……………….
http://orthomolecular.org/resources/omns/index.shtml
Peer reviewed by…..
Editorial Review Board:

Ian Brighthope, M.D. (Australia)
Ralph K. Campbell, M.D. (USA)
Carolyn Dean, M.D., N.D. (Canada)
Damien Downing, M.D. (United Kingdom)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael Gonzalez, D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Steve Hickey, Ph.D. (United Kingdom)
James A. Jackson, Ph.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Thomas Levy, M.D., J.D. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Erik Paterson, M.D. (Canada)
W. Todd Penberthy, Ph.D. (USA)
Gert E. Shuitemaker, Ph.D. (Netherlands)
Robert G. Smith, Ph.D. (USA)
Jagan Nathan Vamanan, M.D. (India)
Andrew W. Saul, Ph.D. (USA),

Your quote David…………………..
“You mention chronic illness and that is indeed a major problem. In some cases medicine may enable you to day alive in reasonable comfort for many years. In other cases, there is little that medicine can do. Sometimes I think medicine should be more frank about its failures. And equally so should nutritional therapists who seem unwilling to believe their ideas don’t work even when there is overwhelming evidence to that effect”

Indeed chronic illness is a major problem, and modern medicine may enable patients to live in reasonable comfort: in other cases there is little that medicine can do, and that is my whole point when these do not have to be the only alternative. Please read the archives links to Orthomolecular Medicine and where the evidence is that you have asked for……………………………..
http://orthomolecular.org/resources/omns/index.shtml

 
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wavechange

David

I have always regarded homeopathy as a harmless exploitation of the placebo effect and if that works it might be better than adding yet another powerful drug to the long list prescribed to many elderly patients. Obviously homeopathy is dangerous if the patient is denied drugs to treat certain conditions. Having said that, homeopathy is big business and a growing proportion of the population seems to think they need to take supplements, usually without any evidence that they are needed. Then we have herbalists whose remedies may or may not be useful. Alternative medicine has a huge following.

It seems to me that we have gone so far that it would be impossible to persuade a lot of people to understand the difference between fact and fiction. It does not help that there is still a lot to learn about many common serious diseases and their management.

Even if we restrict ourselves to nutritional therapy, the subject of this discussion, do you believe that better regulation stands a chance of eliminating the sort of problems that you discovered during the Which? investigation or should the focus be on better education?

 
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david colquhoun

wavechange

They are good questions. I don’t think that anyone wants to ban homeopathy, But it can be very dangerous when homeopaths imagine that they can prevent or treat malaria with their sugar pills (as revealed in a Newsnight programme). Or when they go to Africa to treat AIDS with sugar pills. Or when they got to Haiti to treat cholera with sugar pills. There is a good argument for treating delusions like that as culpable homicide.

You ask whether better regulation or better education would help matters. That’s a question in which I have been very interested. Sadly. I fear that the answer seems to be that neither approach works well.

Regulation in other areas has failed entirely to protect the public. The Complementary and Natural Healthcare Council (CNHC) is meant to be the (voluntary) regulator for Nutritional Therapists, though not many of them seem to have joined it (only 3 of the 14 therapists in this investigation). I can speak with some knowledge of the CNHC because I was a member of its Conduct and Competence Committee for a while (during which time not a single complaint was considered). When complaints were made to the CNHC that reflexologists were making false claims for what they could do, the response of the regulator was bizarre. The CNHC agreed that the claims being made were false, but then said that no action could be taken because they were only saying what they had been taught. The outcome is that nothing whatsoever happened.

The ineffectiveness of the CNHC suggests that the answer lies in education. The problem with that is that, as the CNHC pointed out, it is the “education” that has taught people to make false claims. Because of that, degrees in nutritional therapy have vanished, There are, however, plenty of degrees in nutrition and nutritional science, as well as in dietetics, and these are degrees that, by and large, stick to proper evidence-based teaching about nutrition and diagnostic methods. They are free of nonsense about iridology and hair analysis.

We all agree that nutrition is important, but because there are many good degrees in nutrition and dietetics (at 24 different universities), I don’t see the need for separate degrees in nutritional therapy. We really don’t need two separate subjects that are so closely related.

That still leaves open the problem of what to do about false health claims. I think that they can be dealt with adequately by laws that already exist. The Advertising Standards Authority has recently clamped down quite strongly on claims made by homeopaths, and, I believe, will soon be looking also at claims made by nutritional therapists. The Cancer Act (1939) already makes it illegal to claim to be able to cure cancer. And the Consumer Protection Regulations (2008) make it illegal to make claims that can’t be justified, The enforcement of the CPR is the responsibility of Trading Standards officers, who have, up to now, been strangely reluctant to enforce them, but that situation could change.

It would be an excessive intrusion on personal freedom to try to ban particular beliefs, however bizarre. But it makes perfect sense to prevent the public being defrauded by people who sell medicines that don’t work,. just as they are protected against people who sell washing machines that don’t work. The only problem is that it’s easy to tell when a washing machine works. but much harder to show that a medicine (or diet) works. But is isn’t hard to tell that iridology and hair analysis don’t work. That’s already been shown, and people who sell it are open to prosecution under the CPR, though that has not happened yet,

I made a summary of the relevant laws at http://www.dcscience.net/?p=790 if you are interested in that aspect.

 
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wavechange

Thanks very much David. This is the most thought provoking topic that I have seen on Which? Conversation.

I hope that the Advertising Standards Authority is successful in preventing use of unsubstantiated claims but I feel that this organisation is not doing (or is not able to do) enough to protect the public from dishonesty and misrepresentation, and with the growth of online sales the problem is escalation.

 
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chrisb

Alan,
Yes I know it is not the main problem here, but then you commented on the “IF” and I just expanded on that.
“The problem is whether nutritionists give bad advice”

If you have been reading my posts you would understand that I am concerned that this alleged “bad advice” by a small cross section of Nutritional Therapists, is generally going to be erroneously perceived as being ALL Nutritional advice being bad advice.
I posted to David on the efficacy of Nutritional Medicine as a whole, with scientific references/research, in order that we do not tar all Nutritional therapy with the same tainted brush. Just as sensationalized media headlines, from biased/distorted studies against Vitamins are designed to turn people away from supplementation; the benefits of supplementation are rarely if ever reported, despite scientific evidence in support of it. I wonder why?

 
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colette

I’m signing off now but I just wanted to shed some light on the anti-nutritional therapists on this forum. They are well known in the alternative therapy professions as having tried constantly over the years to scapegoat and target not just NT but ALL alternative therapies, whatever it may be. They peruse all practitioners webwites looking for any error in wording that they can pounce on and report and spend a huge amount of energy and effort trying to put alternative therapies out of business by rubishing them both publicly and to regulatory bodies. They are against all types of alternative medicine and therapies, so personally, I do not believe that even the most rational arguments and scientifically based evidence on vitamin trials or any other benefits of alternative therapies will ever do anything to convince or silence them.
The proof is in the pudding so all that can be done against people like this is to continue practsiing in a responsible and sucessful way and gain a loyal client following who will spread the word further. Just as the first pioneers in any field have come up against heavy opposition and bullying like tactics so now are NT’s, but their work is of huge value in a modern world where medicine and drugs are touted as the only way. Their kind of narrow mindedness will only push NT’s to prove themselves harder.
Goodbye and good luck to all alternative therapists who practise with skill and knowledge and obtain valuable results through this. Keep chins up!

 
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david colquhoun

colette

We are not against alternative medicine. We are just against medicine that doesn’t work, and against people selling products on the basis of claims that can’t be verified. It makes no difference to me whether the people making the claims are GSK or homeopaths (or nutritional therapists).

It really is as simple as that.

 
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wavechange

These discussions have been a real eye opener for me, colette. I knew about the availability of all sorts of supplements but knew nothing about nutritional therapists. I hate the idea of anyone taking any treatment unless needed, whether this is prescription drugs or supplements. If antibiotics had been used more intelligently we might be in a better position to treat disease in the 21st century.

I do urge you to find out about how vitamins work and the amounts present in food, which should give an insight into why supplements are rarely needed, and the need can be established by tests.

I have been concerned about prescription of unnecessary drugs for years, and have seen some problems caused by this. That worries me more than nutritional therapists.

As I have said before, it is evident that Which? has identified a problem that deserves further investigation. It is also evident that BANT, an organisation that regards its code of ethics as a document that should be withheld from the public, could be doing more to keep its members in order. One thing that BANT could do is to ban its members from any involvement with sales of supplements. Drug companies used to encourage GPs to prescribe their products in various ways. I do not know whether this has been completely resolved, but there are rules and GPs are encouraged to prescribe generic versions where these are available.

I strongly believe that if nutritional therapists have a role it should be to support NHS medicine and encourage clients to pursue a healthy lifestyle. If a balance diet is insufficient, clients should be sent to their GPs for testing and the GP or consultant should be prescribing any supplement needed. Unless this is done, nutritional therapists will be seen as the modern day equivalent of snake oil sellers.

 
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Alan Hennsss

colette

Don’t think of it as being anti- alternative therapies. Think of it as being pro- evidence.

Then you might just begin to understand.

 
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chrisb

David,
Your post………………………………………
I’m rather taken by the article by excellent Glasgow GP, Des Spence, in the current BMJ: Bad Medicine: Medical Nutrition. The article ends thus.
“We are being force fed the medicalisation of food and have been distracted from the real problem—that most fundamental of nursing duties—feeding. The huge costs and the rapid increase in the use of supplements should raise concerns about their appropriateness. Cost savings could pay for additional carers and improve budgets for catering throughout the care community. Tasty whole food is the best medicine.”

You fail to mention the exorbitant costs of pharmaceuticals which are way more expensive than supplements, and will probably bankrupt the NHS and the American Medical system before too long. One Primarycare Trust within the UK recently refused to pay for a new cancer drug on this basis, to a cancer patient who requested it under the advice of their Oncologist: the cost? £30,000 per month.
Excuse me?

 
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david colquhoun

chrisb
Some pharmaceuticals. especially generics, are a good deal cheaper than supplements. Others are very expensive, especially some of the new cancer treatments, as you mention.

What really matters, whether you are talking about supplements or regular drugs, is the cost-benefit ratio, and we have an organisation that deals with that pretty well, in most cases.

If a new anticancer drug really cured cancer, the NHS would pay for it, even at £30,000 per month. If, as is only too often the case, they produce only an extra few months of extra (miserable) life, the NICE judges that the price is too high. Whenever it does that, there is a huge public outcry, demanding that everyone should get them. Personally, I think that NICE usually gets such very difficult questions about right.

The NHS would certainly pay for supplements if they had proved their worth. The problem, as I keep saying, is that when they are tested properly they usually fail to live up to your expectations.

 
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jennyp

David
Sorry to hear about your personal situation. Indeed our NHS is wonderful when it comes to cancer treatment. But why stop there? What if there truly is a benefit to long term outcome by integrating nutrition?

You are no doubt aware that cancer has a high recurrence rate. For me the chances were given as 50% (11cm, grade 4, breast). Not great odds when you’re 39 with small kids, so I was somewhat motivated to take every advantage, which meant lifestyle and nutrition as adjunct therapy. I am now fitter, healthier and have more energy than I did 9 years ago. How many people can claim that?

On the subject of reducing sugar in the diet ie: replacing processed carbs with more natural alternatives, you imply it is too stressful to the patient. That may be true for some, but to many of us we just want to play every card. On a practical note I run lifestyle change programmes for people that are overweight. But they also inevitably have low energy, poor digestion, poor concentration etc etc. Guess what? In a few weeks with support, education and coaching, they are able to make simple changes based on managing their blood sugar and all experience vast improvement in ‘symptoms’. Typical quote below.

What if much of chronic disease includes an aspect of nutrient deficiency? This is simple to measure, ask Lucille Leader who works exclusively with Parkinson’s patients. She often speaks at medical conferences about nutrition as adjunct therapy, because all of her patients demonstrate nutrient deficiency (clinically measured).

Not one person in this discussion has supported nutrition as a replacement for medical treatment. If that is truly what was reflected in the Which? consultations then it needs dealing with. But don’t tar us all with the same brush and please, find a fresh way of looking at the problem- we have a nation of people who are eating themselves sick.

Quote from Zest4Life participant “I thought I knew a lot about nutrition and healthy eating and I was wrong! The difference this has made was immediate; it is a way of eating I plan to adopt for life. I feel better than I have for years, so much more energy and I am never hungry”.

 
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david colquhoun

Jennyp
You say “What if there truly is a benefit to long term outcome by integrating nutrition?”

If that were the case, then obviously it would be a good idea to “integrate nutrition”. It is already done. All manner of governmental and non-governmental organisations urge on us advice about good eating. If that is all that nutritional therapists did (as was the case for one of them), there would be no problem (though given the plethora of other organisations that give similar advice free, it’s doubtful if it’s worth their fee).

The question tha you pose is the right one, but the answer has been investigated quite extensively. The results have shown that for anyone on a normal UK diet there is no health benefit from taking the supplements that most of the NTs prescribed (I gave references above).

I’m sorry to keep repeating myself, but you can’t just guess the out come of nutritional interventions. You need hard evidence.

 
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Irina

What a wonderful, wonderful appeal you made, jennyp.
This is what I wanted to bring to the attention of David Colquhoun. I will print it out and give it to read to my grandchildren’s parents and their other granddad, who feeds them chocolate before breakfast, claiming there is no harm. I am sure he will wave with a newspaper in front of me when the report is published. At least now I have an answer for him, tailored to general public’s understanding. Thank you.

 
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Barney

David Colquhoun: “We are not against alternative medicine. We are just against medicine that doesn’t work, and against people selling products on the basis of claims that can’t be verified. It makes no difference to me whether the people making the claims are GSK or homeopaths (or nutritional therapists).

It really is as simple as that.”

Hilarious! [Part of this comment has been removed due to tone and legal reasons]

Your friends on here, who have spent far longer than any Which? staffer responding to the public’s comments, run an organisation called the Nightingale Collaboration that spends its time reporting the websites of practitioners it doesn’t like to the ASA. This childish bullying affects people’s livelihoods, prevents people earning a perfectly legal living and gets in the way of practitioners helping people – people who choose to go to those therapists. You are against patient choice, and yes, you are undoubtedly against alternative healthcare.

And to say that you are only concerned with the ‘evidence’ is complete nonsense. You ignore the 30 years of evidence behind functional medicine, the basis of nutritional therapy. Take a look at the Textbook of Functional Medicine and its thousands of references and tell me it’s not evidence-based! At the same time, you bang on and on about how evidence-based orthodox medicine is, while turning a blind eye to the fact that only 11% of orthodox treatments are of proven benefit – according to the British Medical Journal’s Clinical Evidence project (http://clinicalevidence.bmj.com/ceweb/about/knowledge.jsp).

Another thing you never mention is how many people are harmed or killed by orthodox medicine every year, compared with virtually zero deaths attributed to natural methods according to the American Association of Poison Control Centers (http://www.aapcc.org/dnn/Portals/0/2009%20AR.pdf).

Answer me these questions about the Which? investigation, O noble detractors of nutritional therapy, stout defenders of the orthodox faith:

1) How is an investigation unbiased when the ‘expert panel’ consisted of a GP with very little nutritional knowledge and none at all about the principles of NT, a known ‘skeptic’ and hater of NT, and a dietician – a member of the very profession that is in direct competition with NTs?

2) How is an ‘expert panel’ considered ‘expert’ without any representation from the therapy under investigation?

3) How do you describe, with a straight face, a sample size of 15 NTs as being representative of the UK’s nutritional therapists? How were they chosen? Did you randomise the sample and if so, how?

A final though to finish. If an organisation representing nutritional therapists had performed a similar investigation on dieticians, can you imagine the outcry that would have ensued from all quarters – the medical journals, blogs like David’s, the newspapers etc? Either that, or it would have been completely ignored. The hypocrisy is astounding.

And before you ignore my entire argument in favour of asking whether I think there was no problem with the advice given by the NTs targeted by Which? – I think there may well be questions to answer, yes. But without seeing the transcripts, we can’t know. Clearly, BANT have a very different take on the transcripts to Which? and it will be interesting to see what happens next. But that there are good and bad practitioners in all professions is as obvious as the nose on your face.

 
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Maria

Barney’s remarks about the Nightingale Collaboration would seem to be off-topic, so my thanks are due to Which? moderators for allowing them to remain so that I can respond to them.

Barney wrote that the Nightingale Collaboration, “spends its time reporting the websites of practitioners it doesn’t like to the ASA”.

I wish! There are plenty of practitioners’ websites that I don’t like but as long as they manage to promote themselves without making any false claims – and a surprisingly large number do – they don’t get complained about.

“This childish bullying affects people’s livelihoods,”

If a car salesman makes a living by advertising dodgy cars as if they were sound, would you care about him losing his livelihood? Would you call a complaint from a member of the public on the grounds that his advert breaches advertising regulations, a piece of “childish bullying”? I’m afraid your bias is showing, Barney.

“…prevents people earning a perfectly legal living…”

The ASA regulations reflect European legislation and continued breach of them could result in a prosecution. If people need to break those regulations to attract customers then the living they are earning is hardly *perfectly* legal.

“…and gets in the way of practitioners helping people…”

That may be the case (but I doubt it, given that plenty of therapists seem to be in business without making false claims); what’s more important is that it gets in the way of practitioners ripping people off. It’s just the same as dodgy car salesmen, dodgy cosmetic surgeons, dodgy plumbers or anyone else. I understand why your sympathy is so wholeheartedly with the practitioner rather than with the consumers who are being ripped off, however.

“– people who choose to go to those therapists”

Are you saying people won’t go to those therapists if they start abiding by the same rules as everyone else? Well, I’m sorry, but that’s not a bad thing. As I said in my other response to you, if people have to make false claims to get business, they should be in a different job.

“You are against patient choice, and yes, you are undoubtedly against alternative healthcare.”

If I may quote directly from the NC website FAQ page,

“But that choice has to be fully informed, particularly about the lack of good evidence for, or implausibility of, a product or therapy. We don’t have a problem with fair and balanced advertising of claims, but in CAM advertising, these seem to be the exception.”

Thanks again for this opportunity to plug the Nightingale Collaboration and I now invite readers to google the name and visit the website. Together we can combat misleading claims in healthcare promotion.

 
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Jamesy

Wavechange

Where is all the money going to come from for all the nutritional testing that she GPs will do? Are you aware that GPs test for very very few nutrients.That is not because research has deemed it unnecessary- that research has not been done. The truth is unless you have had private testing at a specialist lab nobody will not know. Further I believe that nutritional professionals have a greater understanding about supplements than GPs will ever have – unless they were trained in nutrition that is

 
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wavechange

I am not advocating mass testing, only where there is an indication that this may be advisable. I have some knowledge of the tests routinely requested by GPs are recently acted as a university supervisor of a part-time student employed in a hospital biochemistry lab.

By all means have private tests, but I suggest that you avoid using the services of anyone who might make money out of supplements that are deemed necessary. Take the results to your GP or consultant.

 
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ExR&D

Alan says “The problem is whether nutritionists give bad advice.”

In order to know what bad advice is we need to know what good advice is.

In the introduction to this conversation, Which? includes a link to the NHS Choices website where there is information on what the Department of Health (DH) considers healthy eating to be.

DH recommends (and no doubt dieticians too) basing meals on starchy foods, eating at least five portions of fruit and vegetables, eating more fish, cutting down on saturated fat and sugar and eating less salt.

Nuts and seeds that provide many nutrients as well as essential fatty acids are not mentioned.

The Eatwell plate on the NHS Choices website shows the different foods DH says we need to eat (and in what proportions) for a well balanced and healthy diet.

Fruit and vegetables take up one third of the plate and starchy foods take up another third. I estimate the remaining third of the plate is divided up as follows: two fifteenths of the whole plate are devoted to meat, fish, eggs, beans and other non-dairy sources of protein and another two fifteenths to milk and dairy foods. The remaining one fifteenth of the whole plate is given over to foods and drinks high in fat and/or sugar, i.e junk food.

Again, nuts and seeds are not mentioned.

You will see from my description of the Eatwell plate that DH considers we need to eat foods and drinks that are high in fat and/or sugar. Not only that, if you look at the enlarged version of the plate you can see a red cola can, which gives the green light to drinking cola.

Genetically/biologically our physical evolution is still at the Stone Age stage so it would seem reasonable to investigate the Stone Age diet. Leon Chaitow in “Stone Age Diet” lists foods which make up the Stone Age diet: plenty of raw fruit and vegetables, some meat and fish, nuts, a limited number of eggs and some herb teas. He also lists foods not included in the Stone Age diet. These include non-human milk and products made with milk, all cereals and cereal products, sugar in any form, coffee and tea.

If we look again at the Eatwell plate we see that over half of it contains starchy foods, milk and dairy foods and junk food, none of which is part of the Stone Age diet. Starch and dairy foods were introduced into the diet only a few thousand years ago so it makes sense to go easy on them and eat them in moderation only. Junk food cannot be considered part of a healthy diet.

DH recommends a diet that is too acidic for the natural pH of the body’s fluids and tissues. The common view among those who recognise the importance of maintaining the natural pH balance of the body is that a healthy diet should consist roughly of 80% alkaline-forming foods and 20% acid-forming foods. DH advocates a diet that is 67% acid-forming foods and 33% alkaline-forming foods (fruit and vegetables) which encourages over-acidity in the body. No wonder we are such a sick and overweight nation.

Two years ago I was diagnosed with osteoporosis. My GP tried to persuade me to take bisphosphonates. She had been trained merely to treat the symptoms not root out the causes. However, I was clear in my mind I was not going pollute my body with drugs unnecessarily. I would seek treatment outside mainstream medicine. I came across the “saveourbones” website produced by someone diagnosed with osteoporosis who was also a scientist. The essence of the “treatment” is the 80% alkaline-forming foods/20% acid-forming foods way of eating. This is not just for those who want to prevent or reverse osteopaenia and osteoporosis it amounts to a healthy diet for everyone and has its roots in the Stone Age diet.

DH’s advice may help improve the diet of those who eat chips every night and no vegetables but the information is useless for those who seek optimum health. For this I go outside mainstream medicine. It is not inevitable that one contracts heart disease, arthritis or cancer, or dies of something.

There would be no need for nutritional therapists if mainstream medicine embraced the concept of optimum health. Until that happens I shall steer clear of DH, dieticians and universities that teach nutrition and dietetics. I shall also steer clear of nutritional therapists and rely on reading widely and my own intuition. Intuition is not scientific but then just because there is no evidence, that does not mean something is invalid or does not work.

 
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david colquhoun

ExR&D
Mainstream medicine certainly embraces the idea of “optimum health”. The problem is knowing how to deliver it. Guesswork is not a good basis.

You say “I shall also steer clear of nutritional therapists and rely on reading widely and my own intuition”.

The reading is just fine (specially if you look at whether the writer is making money from their ideas). Intuition, on the other hand, is frequently wrong. I would prefer to base my actions on good evidence, whenever it is available. So perhaps you are right to avoid NTs.

 
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wavechange

ExR&D
I don’t understand this ‘natural pH of the body’. The way in which it is regulated within a narrow range is explained in clinical biochemistry textbooks. Can you provide any scientific basis for acidic and alkaline diets? Do they really affect blood pH?

 
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Sophia

Dear Wavechange, your suggestion to take test results to your GP consultant would be fine if they had the time and resources to stay on top of the latest research, but they don’t.
Homocysteine is a good example of a marker that has clinical implications in some people, and detecting a raised level opens the possiblity of a nutritional intervention that may have clinical benefit.

However, when one of my clients with cerebral small vessel disease asked her GP and her neurologist, neither of them had even heard of homocysteine.let alone read the research, some of which is cited below:.

1. L-K Yang et al, Correlations Between Folate, B12, Homocysteine Levels, and Radiological Markers of Neuropathology in Elderly Post-Stroke Patients. Journal of the American College of Nutrition 2007; 26 (3): 272-278.

2. A Hassan et al, Homocysteine is a risk factor for cerebral small vessel disease, acting via endothelial dysfunction. Brain 2004; 127 (1): 212-219.

3. B Pieters et al, Periventricular White Matter Lucencies Relate to Low Vitamin B12 Levels in Patients With Small Vessel Stroke. Stroke 2009; 40:1623-1626.

Furthermore recent work from David Smith’s group at Oxford, wherein patients with early dementia were given either B6 + folate + B12 or a placebo has explored a link between homocysteine and dementia. The intervention groupo were shown on scanning to have 30% less brain atrophy compared with the placebo group, and to have lower homocysteine levels versus baseline.

Smith AD, Smith SM, de Jager CA, Whitbread P, Johnston C, et al. 2010 Homocysteine-Lowering by B Vitamins Slows the Rate of Accelerated Brain Atrophy in Mild Cognitive Impairment: A Randomized Controlled Trial. PLoS ONE 5(9): e12244. doi:10.1371/journal.pone.0012244

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0012244

Progress is made when boundaries are explored and moved, and not always by the established orthodoxy. There are many nutritional therapists who use tests judiciously and skillfully, to support nutritional recommendations that complement ‘conventional’ treatments. Before my NT training I worked for 2 decades in ‘conventional biomedicine’, have a first degree in biochemistry and masters in microbiology, as well as experience in running a research lab, in diagnostics and the medical industry, including research in parenteral nutrition. I have been a chartered biologist for 30 years, am a member of the Nutrition Society and a Fellow of the Royal Society of Medicine. When I was considering a career change I looked at Dietetics, but quite frankly didn’t think it challenging enough, and too constrained by conventional boundaries, I have however, worked with some brilliant specialist dietiticans in parenteral and enteral nutrition, also I did not like the links with the food processing industry, who do nothing for the nation’s health.
Having worked in industry I know just how corporate influence works!

Yes, there are some less than competent nutritional therapists, but there are also very many who do a good job. I noted from a previous comment from DC that only 3 of the practitioners in this survey were registered with the CNHC, which says something about standards.

Statutory regulation would do much to sort out standards of practice, supported by a robust accreditation process.

 
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david colquhoun

Sophia

Although your references look convincing at first sight, that impression doesn’t last long if you actually read them.

Professor Smith’s 2010 paper which you cite was criticised heavily because it did not measure cognitive ability at all, but just “brain shrinkage”. What you fail to mention is that another paper was published two weeks later which measured what actually matters, cognitive impairment. The result of this was entirely negative. I quote

“Conclusions: The daily supplementation of vitamins B12, B6, and folic acid does not benefit cognitive function in older men, nor does it reduce the risk of cognitive impairment or dementia.”

You can find the papers and details at http://www.dcscience.net/?p=3516

I don’t know whether your failure to cite the more relevant paper was just faulty research or whether you purposely cite only papers that suit your purposes.

It is worth noting that that the same Professor Smith was associated with Patrick Holford on an earlier project, “Food for the Brain”. When that report was also criticised heavily, Prof Smith answered me thus.

““the report is more hypothesis-generating for future research than a rigorous scientific study.
Find us some money and we will do a proper job.
You can quote me for that.”
Professor David Smith (Oxford). Scientific adviser for Food for the Brain.

That, in my view, is fairly damning. More details at http://www.dcscience.net/?p=218

Patrick Holford is, of course the “media nutritionist” whose misuse of science is so controversial the it merits an entire chapter in Goldacre’s bestseller “Bad Science”, as well as a blog that’s devoted to checking his statements, http://holfordwatch.info/

Incidentally, I’d advise you not to boast about being a Fellow of the Royal Society of Medicine. That is not a qualification. All you have to do to get it is pay them money.

 
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wavechange

Sophia

I hope that everyone would agree concerning with what you say in the final paragraph. I do feel sorry for those who are doing their best, keeping up-to-date and are able to distinguish between good practice and quack remedies. Critical evaluation of new research is essential because it is so easy to draw the wrong conclusion when limited information is available.

It is in the interest of competent practitioners of nutritional therapy to gain respect and rid the discipline of those with little or no skill and who are just interested in exploiting the public.

 
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Jamesy

sorry about the double negatives

 
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chrisb

Sophia,
what a good post and so very well said.
Bravo.

 
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david colquhoun

chrisb
Before you congratulate Sophia on the quality of her contribution, perhaps you should read my response to it,, above.

 
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maggie

I too applaud Sophie. I am sorry Mr Colquhoun, but regardless of whay you say, Sophia contribution was was well put. I do think you are a bit rude in saying that about the RSM…I am surpised your comment has not been edited by Which..

I think all that have come on here agree, that the profession does need to be regulated, and that there are good robust degrees that are accredited.

I do think

 
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Maria

Maggie

“regardless of whay you say, Sophia contribution was was well put.”

David didn’t say the contribution wasn’t well put but he did provide some sound information that would seem to contradict that provided by Sophia. Have you nothing to say about that?

“I do think you are a bit rude in saying that about the RSM…I am surpised your comment has not been edited by Which..”

David simply pointed out that being a Fellow of the Royal Society of Medicine is not a qualification but something anyone who is prepared to fork out a few hundred quid can buy. This is not being “a bit rude”. It is being truthful. If you don’t believe it, go to the RSM website where you will see that the prices range from ££207 for Overseas Fellows up to £407 for London Fellows.

 
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maggie

Opps not sure what happened there…I am sure you will come back at me, about something so wait with interest.

 
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chrisb

David
thank you for your reply.
With respect, when you say…..
“The NHS would certainly pay for supplements if they had proved their worth. The problem, as I keep saying, is that when they are tested properly they usually fail to live up to your expectations”.

It is still fairly obvious that you have not read or taken note of the scientific references that I have referred to in previous posts, on the efficacy of Nutrition and nutritional supplements in the prevention of and treatment of disease.
But I understand your mindset and belief systems, because of your training/background and qualifications in pharmaceuticals.
You might like to know that my MEP commented to me on the powerful lobbying influence of the Pharmaceutical Companies within Europe, and the reason why the EFSA are planning to severely limit the maximum upper limits on most all supplements to non-therapeutic levels, as they are seen as competition to their wares. These foods and supplements are to be judged on the pretext of “safety”, but which have been demonstrated to be extremely safe and effective for decades. In comparison, prescription drugs have a dismal safety record, but very little if anything has been done about this.
Just two examples are the prescribed use of gardasil and vioxx.
If you were to dig a little deeper, or at all, then you would discover that the Science behind the therapeutic use of supplements has largely been suppressed in the interests of monopoly and financial gain.
A new study by two York University researchers estimates the U.S. pharmaceutical industry spends almost twice as much on promotion as it does on research and development, contrary to the industry’s claim, and where the study’s findings supports the position that the U.S. pharmaceutical industry is marketing-driven, and challenges the perception of a research-driven, life-saving, pharmaceutical industry……………………………………..
http://www.sciencedaily.com/releases/2008/01/080105140107.htm

 
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Sophia

David if you wish to be insulting then by all means waste your energy, but the research on Hc is not as flimsy as you insinuate, and I didn’t cherry pick intentionally.
The evidence on small vessel disease has a good pedigree:
Hyperhomocysteinemia increases permeability of the blood-brain barrier by NMDA receptor-dependent regulation of adherens and tight junctions.
read on line at: http://bloodjournal.hematologylibrary.org/content/118/7/2007.abstract, which has a number of good references.

It’s interesting to note that you think so little of a professor of pharmacology at Oxford simply because he wants to research brain nutrients!

With regard to the RSM, I didn’t ‘just pay them money’ take a look at their website and you will see that a minimum level of medical-related qualification and experience in a health related field is required. Perhaps you think the rest of my qualifications are bogus as well? Both of my degrees are from your university.

 
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Maria

Sophia

“With regard to the RSM, I didn’t ‘just pay them money’ take a look at their website and you will see that a minimum level of medical-related qualification and experience in a health related field is required.”

With regard to the RSM, I didn’t ‘just pay them money’ take a look at their website and you will see that a minimum level of medical-related qualification and experience in a health related field is required.

Sorry, I don’t think either of us meant to insinuate that membership was open to cleaners. Membership is open to anyone with a medical qualification or those without if they have senior positions in the sector . The point is, it is not a qualification itself – so what is the point of telling people you have it?

 
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Maggie

Well responded Sophia…

 
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chrisb

David,
in defense of sophia re’ your comment of the study she has mentioned………………………….

#Conclusions: The daily supplementation of vitamins B12, B6, and folic acid does not benefit cognitive function in older men, nor does it reduce the risk of cognitive impairment or dementia.

#Classification of evidence: This study provides Class I evidence that vitamin supplementation with daily doses of 400 μg of B12, 2 mg of folic acid, and 25 mg of B6 over 2 years does not improve cognitive function in hypertensive men aged 75 and older.

So there we have it: the classification of evidence that insufficient amounts of B12, Folic acid, and B6 do not have any beneficial effect on cognitive function/impairment or dementia. No surprise there then.

It is well-established within Orthomolecular circles that any nutrient given in isolation is not as effective as when taken in unison. The B Vitamin Complex would act synergistically as a team, and have a far greater therapeutic effect compared to their use in isolation. You cannot expect Arsenal to beat Man’ United with only three players analogy.
It is also well-established that as we get older absorption of foods and nutrients becomes more difficult.

So the study was flawed to begin with, with insufficient amounts of the nutrients used and in isolation. Not a good combination.

 
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Maggie

@Maria

I never suggested he did, I noted that he made a comment to someone else to read his contribution before replying… I did, and still stand by what I said.. I never said anything about a qualification, I said his comment was rude…

I still stand by this…and think that there is nothing wrong with saying who you are a member off…

 
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Sophia

Maria and David, the point of me noting my science qualifications was not to boast about them – but to highlight that there are NT’s with good scientific training and who embrace mainstream medicine. I wouldn’t ‘fork out a few hundred quid’ to the RSM if I didn’t embrace their practices.

 
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Claudine

I am absolutely shocked with your article on nutritional therapists. You seem to have made strong conclusions after visiting only 15 therapists. We do not know how you chose them for one, secondly a dietitian and a pharmacologist seem qualified but have a very different approach to diagnosis. That is why people like myself visit nutritionists and other alternative practitioners.

I have had a number of complaints over the years, which were never dealt with my GP. One was constant ‘cystitis’ for which I was given far too many doses of antibiotics for a lot of years without event a urine test. In fact I had an allergy to oranges. The second was constant indigestion and bowel problems. A nutritionist detected dairy intolerance. No GPs or even gastro enterologists detected it or even thought of it. Thirdly fatigue. I was sent home to rest by my GP. After seeing a nutritionist and taking supplements, I improved rapidly. My liver does not function well but traditional tests certainly do not show it. Forthly stomach acidity. My GP gave me medicines that made it worse, told me to watch what I ate (by myself). I had to wait 16 months for an endoscopy. Meanwhile the nutritionist gave me slippery elm which helped a lot. I suffer from low blood sugar levels. My GP does not know this exists, I also got good diet suggestions from a professional nutritionist.
I have been reading the Which magazine for many years and I find it invaluable. I am afraid this study is very poor. 15 people is not enough to make a good survey. You did not even interview people like me who have had a very positive experience with nutritional therapy. I suggest you go back to the drawing board and do a proper survey.

 
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david colquhoun

[Part of this comment has been removed by mods]

Whatever evidence I produce you ignore it or reject it. Most recently, chrisb says the dose was wrong. Yet you have produced no comparable studies at all with what you consider to be the right doses (merely suggestive things with surrogate endpoints, If you had bothered to check, you would have discovered that the doses in the 2010 study which Sophia cited with such praise were 0.8 mg folic acid, 0.5 mg B12 and 20 mg pyridoxine, not greatly different from the study with the correct endpoint which you reject. With an attitude to evidence like that, it’s hard to take your protestations seriously.

I’m afraid that chrisb rather gives his game away by referring approvingly to orthomolecular medicine. This is a form of fringe medicine so utterly bizarre that it isn’t even mentioned by the National Center for Complementary and Alternative Medicine (NCCAM). The Wikipedia entry is a fair description http://en.wikipedia.org/wiki/Orthomolecular_medicine,

He also objects to the fact that “EFSA are planning to severely limit the maximum upper limits on most all supplements”. That is because high doses of some vitamins have been been shown to be harmful to your health. I have already given references for that, but you don’t bother to read them. It seems you prefer to harm people rather than read the evidence and change your views. Needless to say, the EFSA are being lobbied strongly by the supplements industry to drop these sensible precautions. It is important to realise that you are dealing with a big business. According to an industry site, the supplement business is worth $61 billion in the USA alone: http://www.nutraingredients-usa.com/Industry/Supplements-industry-worth-61bn-to-US-economy

There is a 2009 article in the Guardian that sums it up nicely: http://www.guardian.co.uk/business/2009/feb/08/vitamins-healthcare-industry

Unlike the defenders of the industry lobby that are so evident here, I’m on record as being highly critical of the bad behavior of Big Pharma.

[Part of this comment has been removed by mods]

 

Hi David, you’ll notice that we’ve removed parts of your comments above. We’re very glad to see you so involved in this discussion and taking time to post some thought-provoking replies, however please keep your tone professional – some of the passages we have removed do little more than bait nutritional therapists, which is not what this site is about. I’ve also posted below about getting personal about qualifications. Thanks, Hannah

 
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chrisb

David,
[Part of this comment has been removed by mods]

Apparently you are well known for your stance against Alternative Medicine, and where this has been revealed in your posts within this thread. That reminds me of a quote and whose source escapes me for the moment……………………….
“No medical man during his student days is taught to think. He is expected to assimilate the thoughts of others and to bow to authority. Throughout the whole of his medical career he must accept the current medical fashions of the day or suffer the loss of prestige and place. No public appointments, no coveted preferment’s are open to the medical man who declines to parrot the popular shibboleths of his profession”.

You go on to say: “Whatever evidence I produce you ignore it or reject it”. Well the same can be said for you as well, in that you have also ignored the scientific evidence for Nutrition and the use of Nutritional supplements that I have presented within my own posts.

As with the use of drugs, the use of nutrients in combating disease are “dose dependent” and address the nutritional imbalances within the patient, so for example……………..
http://orthomolecular.org/library/jom/2001/pdf/2001-v16n01-p052.pdf
http://orthomolecular.org/library/jom/1979/pdf/1979-v08n04-p227.pdf
http://orthomolecular.org/library/jom/2008/pdf/2008-v23n03.pdf

Orthomolecular Medicine and their Journal is peer reviewed that is excluded from medline on the basis of bias and censorship. I listed the qualified editorial review board in an earlier post.
If you rely on Wikipedia for accurate advice contributed to by amateurs, then that is your prerogative but does not mean it is reliable information.

You also mention: “high doses of some vitamins have been been shown to be harmful to your health”. That is true for Vitamin A and Iron, but rarely to other high nutrient doses that are used to optimize the nutritional status of any individual suffering from disease. Did you know that the RDI for Vitamin D is 800ius for men, when the wealth of evidence states it should be 6000 to 10,000ius depending on the blood levels determined by a 25 OHD test which should reach between 50ng/l and 70ng/l…………………..
The scientific references are at the bottom of this page………………….
http://www.vrp.com/bone-and-joint/vitamin-d3-higher-doses-reduce-risk-of-common-health-concerns
It may be news for you David, but the influence of the supplement industry on any political agenda pales into insignificance in comparison to the pharmaceutical agenda………….
http://www.iwatchnews.org/2005/07/07/5786/drug-lobby-second-none

Also, compare the difference between the supplement industries worth of $61 Billion in the United States with the Pharmaceutical income in the United States back in 2007 of $315 Billion…………………………
http://www.reuters.com/article/2009/05/13/idUS140811+13-May-2009+BW20090513

I think further discussion/debate will be just a futile exercise, as it seems your dogma and belief system in healthcare is extremely limited.

 
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Tig

Interesting that all the NT supporters are expressing shock the Which? produced a report on 15 NT’s and throwing around claims of bias and unfairness and saying they will review their subscriptions*.

Wonder if they say the same thing when Which? reviews fridges and doesn’t invite Bosch or Beko onto the expert panel of reviewers of the result, or demand all the results to be published. Seems it is only biased when it contradicts their *own* biases.

That said, if I had invested money and time in training be be an NT or receiving treatment, i guess cognitive dissonance would guarantee I would have to vociferously defend any perceived attack, as otherwise I would have to accept I might have been misled and wasted my time / money / health on quackery. Or just observed basic (conventional) nutritional advice.

Also, lots of nice “oh but these other people are so bad” strawman arguments. Drrrr, the question is about the bad (and dangerous) advice Nutritional Therapists are giving the general public. Not any other group of businesses.

As a consumer, I applaud the Which? report, and will likely be checking out my local NT’s for false and misleading claims on their websites and in literature that need to be reported to the ASA and/ or Trading Standards. Having seen alt med claims for cure of serious illnesses inc cancer by Alt Med practitioners, my expectations of their ability to give accurate health advice is very low. Even if they think (to judge by the responses here) they are being open minded and scientific.

*(if indeed those saying they are reviewing their subscriptions actually subscribe at all.)

 
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wavechange

I have never even considered alternative medicine, though I have read about the chemicals present in plants used for herbal treatments. Excuse the pun but my eyes have been opened to iridology. I initially assumed that medical conditions could conceivably affect the iris, but when I discovered that these nice charts dividing the iris into nearly 100 sections representing different parts of the body I realised that iridology should be exposed for what it really is. I am prepared to accept that some practitioners actually believe in iridology.

Hopefully the good nutritional therapists who support conventional healthcare and do not recommend supplements unless there is reasonable evidence for need will find some way of gaining respectability and excluding the rogue element.

This will be my last contribution to this topic. I realise that some of the things I have said are a bit naive and impractical, and I am very glad that David has had the patience to put me and many others right on so many issues.

At one stage I feared that Which? could risk damaging their reputation by venturing into such a controversial area, but I’m glad they did and hope that some people will think twice before spending money on supplements and engaging the services of those hell bent on making a profit or even discouraging people from getting proper treatment. I might take an interest when Which? reports that progress has been made.

The only NT of interest to me is the National Trust. :-)

 
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david colquhoun

Well said,Tig and wavechange.
It’s been a pleasure, if somewhat exhausting, to try to explain the evidence to the best of my ability. Thanks for your contributions.

 
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Alan Henness

Claudine said:

“You seem to have made strong conclusions after visiting only 15 therapists.”

They made strong conclusions about 15 therapists after visiting them and listening to them giving misleading and dangerous advice.

“We do not know how you chose them for one”

No. We’ve been told they were selected at random by Which?.

“a dietitian and a pharmacologist seem qualified but have a very different approach to diagnosis.”

If you mean they don’t believe in disproven diagnostic tests such as iridology and hair mineral analysis, then I should think so too.

“I am afraid this study is very poor. 15 people is not enough to make a good survey.”

Wrong. David Colquhoun has already given the confidence limits for this survey. They are wide – and a larger sample would give tighter limits – but even taking these limits at their most generous, there is still a great cause for concern.

“You did not even interview people like me who have had a very positive experience with nutritional therapy.”

You do not seem to understand the problem of bias in scientific trials and why anecdotes are of little or no value. In proper studies, extreme care is taken to ensure that personal bias (intentional or otherwise) does not affect the results. If you want to find out whether people visiting a nutritionist thought they had a positive experience, then you might interview them and ask them as you suggest. If you want to find out whether a diagnostic test actually gives reliable and repeatable results, you test it independently. If you want to find out whether nutritionists are giving good advice, you do what Which? did.

“I suggest you go back to the drawing board and do a proper survey.”

See my last answer to find out why that would not answer the question Which? asked.

But we’re still left with the one big question. Now that Which? have exposed some nutritionists (who were mainly BANT members) giving misleading and even dangerous advice, what happens next?

The onus is now on BANT to conduct an independent study into what proportion of their members are using disproven diagnostic tests and giving misleading and dangerous advice. But they will need to make sure that any such study is conducted to rigorous, open and transparent standards to ensure absolute independence and confidence in the results. If they conduct it as a PR exercise, it will be transparent to all.

The other questions that need answered are:

1. When are BANT going to publish their Code of Practice so the public know how they are protected and how well they are protected?

2. What is BANT going to do to ensure that their members do not give dangerous or misleading advice and use only proven, reliable and repeatable diagnostic tests?

3. What are the CNHC doing about all this, particularly since they are supposed to be regulating some nutritionists and ensuring their charges are complying with their Code of Conduct, Performance and Ethics (http://www.cnhc.org.uk/assets/6-063.pdf)?

How these organisations (and other nutritionists’ organisations) now deal with the situation will be judged against how they protect the public, rather than protecting their members’ interests.

 
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Barney

As is very very clear to everyone except you and your prejudiced mates in the tiny but vociferous skeptic ‘movement’, the Which? study was designed to fail. Which? hasn’t explained how their tiny sample was selected or randomised, so simply repeating that “Which? has told us it was random” means nothing at all.

Colquhoun’s confidence limits are similarly meaningless. A sample size of 15 is tiny and would be laughed out of the room if this study had been performed by anyone working in the CAM field. Whether the NTs ‘passed’ or ‘failed’ was determined entirely by the panel’s judgement on the advice given by the NTs, which comes from a different paradigm – functional medicine – that orthodox medicine rejects. Therefore, a high failure rate was ensured from the start, especially with a dietician (NTs’ direct competition) and Colquhoun (known hater of NT) on the panel. Oh yes, and no representation by the NT profession itself. So any confidence intervals calculated around these meaningless and falsified results are themselves meaningless. Plus, the CIs were rather wide, implying a definite lack of precision in the results. Lack of precision + tiny sample size + biased rate of failure = a load of rubbish.

Doubtless BANT will look into this matter and tighten up their procedures. Hopefully, they will also defend themselves robustly against this attack by Which? and the skeptic crew – an attack that is infinitely more “transparent” than the results of any study BANT may or may not perform.

By the way, since you’re such a great fan of dietetics and its unimpeachable evidence base, can you point me to a definitive scientific study that shows where the ’5 a day’ recommendation comes from?

 
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david colquhoun

Barney
Evidently your education has not included an understanding of statistics and uncertainty.

I note, though, that you suggest that BANT should “tighten up their procedures”, so you do seem to admit, after all that something is wrong.

I would be very happy if BANT does that, though it has not got a strong track record in doing that. It can hardly condemn totally batty diagnostic methods like iridology when the chair of BANT herself uses it.

Let’s come back in a year to discover exactly how much BANT has done to improve the situation.

 
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Maggie

Any comments to make over this re Vitamin D… Not yet looked at the background…

http://www.bbc.co.uk/news/health-16700833

 
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david colquhoun

Yes there may indeed be some people with vitamin D deficiency. There is a good summary in the British Medical Journal http://www.bmj.com/content/340/bmj.b5664.full

In order to tell if someone is deficient you need to have a proper test for the amount of a vitamin D derivative in the blood.

If you are deficient then you’ll be prescribed the right thing, free of cost, thanks to our wonderful NHS.

It is hard to see a role for nutritional therapists in this because they frequently don’t do the right tests and they charge you a lot of money.

 
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ExR&D

This is a far bigger problem than it may appear. See article including reader comment. Do we have something to learn from Canada and France?
http://www.magazine.utoronto.ca/leading-edge/reinhold-vieth-interview-vitamin-d-cancer-prevention/

 
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Chrisb

Maggie,
there is now a large consensus of professional opinion that there is now a widespread deficiency of Vitamin D, and esp’ in northern climes where sunlight is not in abundance during the winter months. Darker skinned people have more of a problem with converting sunlight exposure into Vitamin D as well and who are more likely to be deficient.

Supplementation is seen as a necessity by many, but you also have to be careful as to which Vitamin D you use for this.
In fact Vitamin D is not a Vitamin at all but a steroid hormone precursor.
Vitamin D3 (cholcalciferol) is preferable to Vitamin D2 ( ergocalciferol )
http://www.medscape.com/viewarticle/589256_4

Deficiency can have serious consequences to your health in a the prevention of a multitude of diseases……………………………….
http://www.physorg.com/news201791554.html

 
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frozenwarnings

Doesn’t take much to become a Fellow of the RSM. Just invent your own “healthcare profession”

http://deevybee.blogspot.com/2011/07/what-does-it-take-to-become-fellow-of.html

 
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Andrea

Just checked web in random and found out that most of Nutritional therapists are academically trained. Some of them with Foundation degree in Science, most of them with BSc and and many with Masters. Storm in a teacup. Lobbying!

 

Hi all, as ever we’re doing our best to keep as many of your comments published and in full. However, I’d like to step in on the issue of qualifications. While debating the differing general qualifications of the relevant professions to this Conversation has a place, picking individuals’ qualifications apart – and getting personal about their origins – does not. For that reason, we’ve decided not to allow some more recent comments of this nature, and we’ll continue to remove any similar comments posted in future, so please resist from turning an interesting debate into a personal attack on individuals.

 
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Alan Henness

Hannah

I assume your intervention is because of my last comment (although you mention comments in the plural).

The qualification of no individual was the subject of any discussion, nor could any individual be identified in any way whatsoever.

Andrea talked about random websites she looked at and the fact she found some to have science degrees and assumed this conferred some legitimacy. It is clear that this is a key issue in this debate.

I informed her that there certainly are those with legitimate science qualifications, but that there are some ‘science’ courses that are not based in science and linked to an article that demonstrated this.

What I said cannot be construed as a personal attack on anyone.

You seem to be accusing me of “picking individuals’ qualifications apart – and getting personal about their origins”.

I refute that entirely and ask that you look again at what I said and reconsider.

 
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Alan Henness

Hannah

If I’ve jumped to the wrong conclusion about your moderation of my comment, please accept my apologies. My comment had one link in it, so it may just have been held in the queue.

 
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Ellie

Maggie

Thank you for directing us to the latest report on Vitamin D via the BBC website. It centres around the reemergence of rickets in young children and babies, and the situation of health professionals being unaware of the recommendations for pregnant, breast feeding mothers and children under the age of 5 to take Vitamin D supplements. This is a concerning report as one young couple were wrongly accused of child abuse because their 4 month old baby had a damaged skull and broken bones and sadly died as a direct result of a deficiency in this essential nutrient. At the end of the report an Orthopeadic surgeon commented that ‘Health care professionals do not know enough about Vitamin D’ and also suggested that advice commonly given that ‘if your diet is good you don’t need supplements’ is fundamentally wrong as clearly shown by the disturbing statistics cited in this coverage of the topic i.e. that 1:3 babies may be deficient in Vitamin D.

Low income families are entitled to free supplements but there is only 2% take up according to this report.

There is another link within the report to a genetic link between Vitamin D deficiency and Multiple Sclerosis which also provides intersting reading.

I do feel something is missing in this debate. For example a basic understanding of anatomy and physiology can also be seen as evidence. All clients whether visiting an orthodox or complementary practitioner should feel free to ask:

‘Please can you explain to me how this works?’ and if the answer does not fill them with confidence or displays a basic lack of understanding of anatomy and physiology then they should feel able to go away and think about it, look it up, seek alternative advice, or go elswhere’

Good healthcare is about choice and enpowerment of the individual.

 
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Maria

@Barney

I can’t help but notice that all your contributions to this conversation so far have been censored yet you still begin with a gratuitous insult. Why? Is it really so hard to act like an adult and engage with people you disagree with in a civil manner? The first line of your comment posted at at 11:45 am today clearly breaches the guidance here. I hate to think what you’ve said that hasn’t been allowed through.

“Which? hasn’t explained how their tiny sample was selected or randomised, so simply repeating that “Which? has told us it was random” means nothing at all.”

I agree. On the second page of this thread, David Colqhhoun said,

“I understand that Which? staff selected the therapists in a way that mimicked what a present day consumer might do. They used google and online directories, and chose the therapists that were at the top of the search results.”

It would be useful if Which? could confirm this or tell us how they did it. Otherwise those with a vested interest in defending NT regardless of how appallingly practitioners behave will continue to make an issue out of it to divert attention from this behaviour and its implications for consumers.

 
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Barney

I don’t see what’s insulting about calling skeptics like yourself prejudiced. I think you’re quite proud to be prejudiced against something you disagree with so strongly. You also have a very thin skin for someone who spends their time writing complaints to the ASA about people you’ve never met, thereby making it difficult for them to earn a living. (Wo)man up – this is a robust debate.

Thanks for pointing me to DC’s explanation. Interesting that the sample was not only vanishingly small, but also not representative nor randomised in any way! Practitioners at the top of a Google search could be those who know how to manipulate search results, or who have appeared in the local press – for reasons good or bad – more often than others. Not representative of the UK-wide NT population, in other words, and certainly not randomised.

So, we have so far established that the Which? study was intrinsically biased against NTs and that the NT sample was tiny, unrepresentative and non-randomised. Unless Which? refutes what DC says and reveals a decent sampling protocol. Hmmm.

Nice try to divert the argument by slyly inferring I have a ‘vested interest in defending NT regardless of how appallingly practitioners behave’, but it won’t wash. It is Which? and those who spend days and days defending Which? that have to defend accusations of vested interests, which you repeatedly fail to do. I ask again:

1) How is an investigation unbiased when the ‘expert panel’ consisted of a GP with very little nutritional knowledge and none at all about the principles of NT, a known ‘skeptic’ and hater of NT, and a dietician – a member of the very profession that is in direct competition with NTs?

2) How is an ‘expert panel’ considered ‘expert’ without any representation from the therapy under investigation?

3) How do you describe, with a straight face, a sample size of 15 NTs as being representative of the UK’s nutritional therapists – especially when poorly sampled and non-randomised?

And finally, can you point me in the direction of studies that back up the ’5 a day’ recommendation so beloved of dieticians, please?

 

Hi Maria

I can confirm the nutritional therapists were chosen as David says. We tried to replicate how a member of the public would find a nutritional therapist. We used online search engines and directories of nutritional therapists and chose those that appeared at the top of the search results.

 
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Maria

@Barney

“I don’t see what’s insulting about calling skeptics like yourself prejudiced. I think you’re quite proud to be prejudiced against something you disagree with so strongly.”

So it was intended as a compliment? Well, in that case, thank you and sorry for the misunderstanding. :-)

“You also have a very thin skin…”

If asking people to be civil and focus on the issues is having a thin skin, I have to wonder how you would describe someone whose posts are continually censored because they just can’t restrain themselves from attacking the character and motives of people simply because he disagrees with them.

“for someone who spends their time writing complaints to the ASA about people you’ve never met,”

That’s unfair. I write complaints about people I have met as well. You should see the complaint I submitted about the cowboys who replaced my boiler. You see, Barney, I don’t like being ripped off, I don’t like seeing my friends and family getting ripped off and I have sufficient human empathy to even care about people I don’t know getting ripped off. Anyone making unsupportable claims in advertising is fair game. If they can’t make a living without telling lies, they should find a different job. I’m surprised you should feel any differently.

“(Wo)man up”

That sounds like good advice – if a tad ironic coming from someone who avoided a straight question about why chose to begin their comment with an insult by claiming it wasn’t an insult. :-)

“- this is a robust debate.”

Good grief! This is what you call a “robust debate”? That would explain why you appear to find participating without being insulting, so difficult.

“Thanks for pointing me to DC’s explanation.”

Thanks for confirming that you don’t actually read all comments of people you insult. That was in one of his earliest posts. By the way, the first three questions you pose have been answered in this thread and more than once. You may not like the answers but if you disagree with them then please say why. Don’t just repeat the questions as if you haven’t read the answers already given. Unless, of course,….

You stated in no uncertain terms that you consider me and various others here as ‘prejudiced’ . Given that you apparently missed so much of what’s been said already, I would venture that you are unable to read anything we write with an unjaundiced eye yourself, if you read it at all. Just one of those little ironies that tend to crop up whenever people disagree on emotive topics.

“Nice try to divert the argument”

I should bill you for a new irony meter.

“by slyly inferring I have a ‘vested interest in defending NT regardless of how appallingly practitioners behave’, but it won’t wash.”

There was nothing sly about it. What else are we to think when you focus so obsessively not on the findings of the report but on the motives of people who conduct it and defend it?

“It is Which? and those who spend days and days defending Which? that have to defend accusations of vested interests, which you repeatedly fail to do.”

Actually, I haven’t – until now – been directly accused of having vested interests (at least not in any comment that has been allowed through ;-) ). But I did infer it from one poster’s repeatedly asking me to reveal my identity. To that poster, I said,

“If your question is whether I have any kind of financial interest in anything to do with this topic, the answer is no.”

Was this another comment that you omitted to read or are you accusing me of lying? If the latter, please state exactly how you think I am benefitting financially from participating in this discussion. Put up or shut up, as they say.

“And finally, can you point me in the direction of studies that back up the ’5 a day’ recommendation so beloved of dieticians, please?”

No. What’s your point?

 
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Jamesy

I have to comment here re vitamin D. .Up until very recently GPs have actually not had anything to prescribe except for calcichew (which is calcium and a low level of vitamin D – too low for many according to most research) or a much much higher preparation which was not always available or clinically suitable and if the GP decided it was unsuitable the GP would say go to the high street and find a vitamin D supplement. This was happening alot. GPs were sometimes even refusing to test for vitamin D because they did not understand the implications of deficiency and also there wasn’t a ‘product/remedy’ to prescribe and patients who were deficient were missing out on diagnosis and treatment. Things have improved due to awareness campaigns but it has to be said that it one group of health professionals, nutritional therapists, who practice evidence based NT who for several years now have been recommending blood tests at reputable laboratories and prescribing appropriate amounts of vitamin D based on the literature. On nutritional matters, progress is often slow in conventional medicine – I suspect becasue there is so much less interest in it than in drugs.
Anyone who wants to follow the vitamin D story closely should attend the Royal National orthaepedic Hospital 2nd vitamin D conference in Stanmore on 19 March 2012.. I went to the first.

 
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Ellie

DC
Appreciate your comments – and the statement about Vitamin D supplements being free on the NHS. Would just like to say that my understanding is that Vitamin D supplements are not free to everyone only the group mentioned i.e. pregnant and nursing mothers and children under 5 years on a low income, and only 2% are taking advantage of the free supplement allowance because they are not being advised that there is a need.

Technically the NHS is not a free service either as we all pay via national insurance contributions and If GP’s are not aware of the importance of Vitamin D are they likely to recommend a test?

What happens then if you go to your GP and say “I am worried that I may be deficient in Vitamin D do you think I might be tested?”

and the reply is “no need to worry, I really don’t think you need one”.

What if that same patient then goes to see a nutritonal therapist, or any other practitioner whether orthodox or complimentary, – and they advice where a good quality test can be obtained.

Results come back: Deficiency. Where does that patient then go? Back to the GP who has said the test was unecessary in the first place?

Please can you understand the point that is being made here: Everyone is entitiled to take advice from whoever they wish. In such a case I would put my confidence in the practitioner who listened to my concerns and acted on them.

 
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frozenwarnings

[What happens then if you go to your GP and say “I am worried that I may be deficient in Vitamin D do you think I might be tested?”

and the reply is “no need to worry, I really don’t think you need one”.]

The reply should always be “Why do you think you need one, what are your symptoms?”

[What if that same patient then goes to see a nutritonal therapist, or any other practitioner whether orthodox or complimentary, – and they advice where a good quality test can be obtained.

Results come back: Deficiency. Where does that patient then go? Back to the GP who has said the test was unecessary in the first place?]

Trouble with alternative practitioners is that they will almost always sell you an often dodgy test and give you a diagnosis that requires expensive supplements. This is NOT a good thing.

Even if the test were real, altmed practitioners cannot and should not diagnose anything. Only the medically trained can do that. There may be multiple and complicated reasons for a deficiency that a self proclaimed nutritional therapist will not be able to spot. Having a degree is not evidence of expertise. Until recently you could also get a degree in homeopathy. Yep, a degree in giving people water.

Yes, people are fully entitled to spend their money on whatever they choose. That choice though, must be made with the full facts, not just the advertising blurb.

 
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david colquhoun

Ellie
If you check the British National Formulary, you’ll find q
uite a large selection of Vitamin D products are available -see http://bnf.org/bnf/bnf/current/5130.htm#_5130 (free registration needed).

The NICE guidelines suggest that

“The plasma concentration of 25 hydroxyvitamin D is widely used to indicate an individual’s vitamin D status. A level below 25 nanomoles/litre (nmol/l) indicates risk of vitamin D deficiency.”

If you are below that level, I’m sure that Vitamin D would be available free on the NHS.

I think that if I had any suspicion that I might be deficient in Vitamin D I’d prefer to go to a doctor who could check properly, and give free treatment if it was needed, rather than to a nutritional therapist who, in many cases, would not check properly, and would be likely to suggest a multivitamin blunderbus that would cost a lot of money.

 
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Guy

Many comments (including from frozenwarnings) are critising nutritional therapists for only being in business to supply expensive supplements. In the interests of remaining scientific with our comments, it is worth noting that the NHS budget each year is £106B which works out at £1700 per year for each person in the UK. This is money that we spend whether we like it or not. I suspect that there are no examples where a NT patient would be expected to pay more than this for supplements and also (since NT follows a functional medicine approach) it is unlikely that suppliments would continue to be required for any more than a few months.
Also are there any examples of NT practioners who earn more than £110K ? ( the current average GP salery, see http://www.telegraph.co.uk/news/uknews/1567887/Average-salary-for-a-GP-leaps-to-110000.html ). I would be suprised if there were. However I am sure that if all practioners were paid on results (that is curing conditions NOT managing symtoms) then the gap between NT and GP salaries would be considerably narrowed.

 
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david colquhoun

Guy
I don’t see the point of your comparison at all. NTs don’t do expensive procedures like hip replacement. They don’t do 5 hours of neurosurgery that saved my wife’s life after a subarachnoid haemorrhage while pregnant -see http://www.dcscience.net/?p=2073
Of course real medicine costs more.

You then say
“I am sure that if all practioners were paid on results (that is curing conditions NOT managing symtoms) then the gap between NT and GP salaries would be considerably narrowed”

I fear this is sheer invention. I challenge you to produce the evidence for this statement.

On thing that intrigues me is what NTs do when they get a real serious illness. My bet is that if they get malaria, pneumonia, sepsis most quickly forget “functional medicine” and rush to be saved by the NHS.

 
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Clare

Guy – NT practitioners would not make any claim to cure any condition, which is inferred in your last reply. Also not all NT practitioners make money out of supplements. It is true we receive trade discounts for supplements – some practitioners choose to pass on either a proportion or all of the trade discount they receive to their clients. We would also make customers aware if we are benefitting financially from recommending supplements. Unfortunately although £50-80 for a consultation sounds a lot of money the preparation before the consultation and follow-up time afterwards is considerable and what we charge for consultations does not really reflect the time many spend. So for some, supplements may provide additional income. However, all the practitioners I know operate to a high standard of integrity and make recommendations based on need, NOT on likely gain. That is also stated in our Code of practice. We are not supplement salesmen.

 
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david colquhoun

Claire
You make a good point about claiming cures. But others have pointed out that your Code of Practice seems to have vanished from the BANT site. Could you perhaps email a copy to me?

 
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Maria

Claire wrote, “NT practitioners would not make any claim to cure any condition,”

I should hope not but if you google “what can nutritional therapy treat” you may be surprised to find what some of them do claim. For example, the top unpaid hit for me claims that, “Nutritional therapy is wholistic because it is designed to treat the body as a whole – *curing* the causes of problems, not just the symptoms as is too often the case in conventional medicine”. (My emphasis.)

From the consumer’s perspective, a claim that nutritional therapy “has been found to help” any named health condition can amount to the same thing. Take, for example, the claim that “nutritional therapy has been found to help infertility”, which appears on a number of practitioners websites including some of those who state they are members of BANT and registered with the CNHC. This claim seems to be designed to lead the person desperate to conceive that, whatever else they do, they should book an appointment with an NT. If it is true that nutritional advice has had a demonstrable effect on infertility, that’s wonderful news, of course – but why not post links to the supporting evidence alongside the claims, so that people can see it for themselves before paying out?

 

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