/ Health

Had dodgy advice from a nutritional therapist? We have!

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.

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?

Comments
Rosie says:
16 January 2012

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

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

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

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

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

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

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

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

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

Catherine Collins RD says:
17 January 2012

@ Rosie

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

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

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

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

Irina says:
28 January 2012

Bravo!

Irina says:
28 January 2012

Bravo, Rosie.

Alan Henness says:
16 January 2012

The anecdotes are coming thick and fast.

taurean says:
17 January 2012

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

Alan Henness says:
17 January 2012

taurean

What unfounded comments?

Stefan says:
19 January 2012

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

Caro says:
16 January 2012

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

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

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

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

Carole says:
17 January 2012

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

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

Jane Reed, London says:
17 January 2012

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

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

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

Alan Hennsss says:
17 January 2012

OMG! It’s all a big conspiracy!!!

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

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

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

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

Monika says:
17 January 2012

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

Alan Hennsss says:
17 January 2012

Monika

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

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

Karen Shields says:
17 January 2012

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

Alan Henness says:
17 January 2012

Karen Shields said:

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

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

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

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

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

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

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

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

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

If that’s what they are telling you, then – as I understand it – you are being misled. If you look as the CNHC’s guidance on registering as a nutritional therapist, it makes no mention of being a BANT member

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

Catherine Collins RD says:
17 January 2012

@ Karen

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

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

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

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

Monika says:
17 January 2012

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

Maria says:
17 January 2012

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

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

Alan Henness says:
17 January 2012

Monika said:

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

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

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

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

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

Sheila says:
17 January 2012

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

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

Maria says:
17 January 2012

Sheila

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

eleanor says:
17 January 2012

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

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

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

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

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

Always look on the bright side ….

Catherine Collins RD says:
18 January 2012

@ Guy

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

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

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

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

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

Alan Henness says:
17 January 2012

eleanor said:

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

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

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

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

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

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

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

Karen Shields says:
17 January 2012

In response to Alan Henness:

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

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

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

There are several routes through which you can join the CNHC, however, our university suggested to join BANT first as this was the easier administrational route as BANT recognise my university degree as credible and CNHC recognises BANT as a credible Professional Body.

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

Chris James says:
17 January 2012

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

Alan Henness says:
17 January 2012

Chris James

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

Chris James

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

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

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

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

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

Chris James says:
17 January 2012

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

Alan Henness says:
17 January 2012

Chris James said:

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

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

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

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

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

Monika says:
17 January 2012

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

Alan Henness says:
17 January 2012

Monika said:

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

Are you referring to CNHC regulation/accreditation?

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

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

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

Personally think he ate too much spicy and fried
foods.

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

Nish says:
17 January 2012

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