/ 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
Guest
Ellie says:
22 February 2012

I think I have changed my stance a bit since participating in this blog. It has made me feel that Statutary regulation of Nutritional Therapists may well be a good thing, and probably sooner, rather than later in order to protect the well qualified NT’s who are practising responsibly.

Guest

Just called back to say that CNHC now has a descriptor for nutritional therapy:

http://www.cnhc.org.uk/assets/Nutritional-Therapy-4-009.pdf

Guest

Ellie, I think you are absolutely right, the whole alternative field seems fair game for accusations of all sorts and to be able to feel confident in the qualifications and professionalism of a Therapist is vital. Both the Therapist and the Patient would benefit especially if the Regulating Body could also monitor and gather evidence of good practice and benefits to patients.
I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies delivered by dedicated and well trained Practitioners. Sadly jumping through some ‘orthodox hoops’ might make the work of delivering these valuable Therapies more successful and effective. The biggest question is who will foot the bill?

Guest
Alan Henness says:
22 February 2012

Liz said:

“the whole alternative field seems fair game for accusations of all sorts and to be able to feel confident in the qualifications and professionalism of a Therapist is vital. Both the Therapist and the Patient would benefit especially if the Regulating Body could also monitor and gather evidence of good practice and benefits to patients.”

Cart and horse here. First show that a therapy has a worthwhile, repeatable, beneficial effect; find out the parameters relating to conditions, use, dosage, training of practitioners, etc, etc, etc then you can start thinking about what regulation might be appropriate to protect the public. You can’t regulate nonsense – you have to first show that it’s non nonsense.

“I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies”

I can’t disagree with the first bit – it’s just how you can come to the conclusion that they are soundly based that I have problems with.

“delivered by dedicated and well trained Practitioners.”

I have little doubt that most providers of alternative therapies are dedicated and well trained (in whatever they are trained to do), but being dedicated and well-trained in nonsense still leaves them practising nonsense.

“Sadly jumping through some ‘orthodox hoops’ might make the work of delivering these valuable Therapies more successful and effective.”

Providing robust evidence isn’t jumping through ‘orthodox hoops’: it’s about providing a good level of assurance that the public are not going to be harmed and that there is a good chance they will be helped.

“The biggest question is who will foot the bill?”

Not me! Do you agree the onus is firmly on those who want their treatment to become accepted to come up with the money?

Guest
Maria says:
22 February 2012

Liz said,

“I believe the lack of credible/indisputable evidence of efficacy is the main reason why detractors can do so much damage to the reputation of soundly based Therapies delivered by dedicated and well trained Practitioners.”

The lack of credible evidence is one of the mains reasons, the fact that they are not “soundly based” is the other. The lack of scientific plausibility coupled with the lack of evidence for efficacy is the reason why any further research into a “therapy” like homeopathy is a waste of time.

Guest
Maria says:
22 February 2012

Sorry, I cross-posted with Alan. Didn’t mean to pile on.

Guest

Barney, your reply to Alan………………..

“Alan, it would indeed be wonderful to compare just how many people have been helped by non-orthodox medicine with those helped by conventional methods, just as it would be marvelous to know for sure just how many people are injured and killed by both approaches”.

Now let’s see, Modern Medicine has been around for about 150 years or so, give or take a decade, whereas Alternative Therapies have been around for thousands of years, such as TCM about 2500 years; Ayurvedic Medicine about 5000 years and so on.

Now if we use a bit of logic/reasoning (popular here BTW) and some here say that I am devoid of, then these Alternatives would have vanished into the night as being ineffective hocus-pocus, but here they are today being used by thousands if not millions.
This of course presupposes that all these millions of people are mindless gullible morons, who have been duped, and had their money extracted from their wallets under false pretences.
Does anyone seriously believe that these therapies, which have stood the test of time, are worthless and ineffective, and kill on a scale akin to the holocaust?
Logic dear friends. Logic.

Guest
Stuart says:
23 February 2012

“whereas Alternative Therapies have been around for thousands of years, such as TCM about 2500 years; Ayurvedic Medicine about 5000 years and so on.”

An thinly veiled appeal to tradition.

“then these Alternatives would have vanished into the night as being ineffective hocus-pocus, but here they are today being used by thousands if not millions.”

An appeal to popularity which says nothing about how effective something is. Smoking has been around since 5000BC, and we only discovered relatively recently that its harmful. Smoking is still very popular today.

“This of course presupposes that all these millions of people are mindless gullible morons, who have been duped, and had their money extracted from their wallets under false pretences”

Strawman. No it doesn’t. It supposes that human beings are capable of wrongly attributing cause and effect, and are succeptible to conformation bias, placebo effect etc. No-one has accused anyone of fraud, although its telling you feel the need to defend it against this accusation.

“Does anyone seriously believe that these therapies, which have stood the test of time, are worthless and ineffective, and kill on a scale akin to the holocaust?”

Are you close minded to that possibility? How can you regulate alt med if you cannot at least consider its potential for harm. No-one mentioned the holocaust, or any scale.

Guest
Stuart says:
23 February 2012

You haven’t answered alans question.

How many people have been helped by drugs and conventional medicine, lets include any intervention which saved a life, improved quality of life, relieved pain etc.

How many? Simple question. Then we can discuss those harmed by it and look at risk/benefit.

Guest
Barney says:
23 February 2012

Come on Stuart, you cannot simply dismiss with an airy wave thousands of years of human experience and learning, to which chrisb was referring, as “a thinly veiled appeal to tradition”. This experience is a form of scientific evidence: observational, experiential, a process of development over long periods of time. It may not be randomised, controlled, clinical trials, but it’s still a genuine form of scientific evidence. If you’re going to base your position on what you term ‘science’ and ‘critical reasoning’, jettisoning huge portions of the data simply won’t do. And if you’re going to wait for the clinical trials evidence of every aspect of traditions like TCM and Ayurveda, you’ll be here until Doomsday.

As I mentioned in my previous post, it’s difficult if not impossible to obtain figures for morbidity and mortality caused by non-orthodox methods, purely since they are overwhelmingly practised outside the big institutions that collect those data. On the other hand, providing figures for how many people have been helped by orthodox medicine – or non-orthodox, for that matter – is far from a “simple question”! If it was such an easy matter, don’t you think someone would have done it by now? You’re asking for the numbers of people who visit their GPs, receive medicine and get better as a result of the medicine and not regression to the mean; for the numbers of people who go to hospital, receive treatment and get better as a result; for the numbers of people who take an aspirin for a headache, who take an antacid after a big meal, who take Alka-Seltzer after a night out, etc. etc. etc. I’m pretty sure those data aren’t available, anywhere, but I’m open to being proven wrong. Ditto for the numbers of people helped by non-orthodox approaches.

All we can do at this stage is get an idea of the relative harm caused by orthodox and non-orthodox medicine. Yesterday, I provided robust data, taken from government institutions, meta-analyses and major peer-reviewed scientific papers, that orthodox medicine is likely the third-leading cause of death in the USA – a country using pretty much the same medical orthodoxy as the UK. As a comparison, data from the American Association of Poison Control Centers revealed 6 deaths from vitamins/minerals, herbs and homeopathy combined in 2010. I fully admit that these data are incomplete, and I fully admit that many alternative therapies are not included in the dataset. But I think it gives us a fair idea of the comparative safety of the two approaches. Do you have any data that indicates any different, please?

Guest
Stuart says:
23 February 2012

“Come on Stuart, you cannot simply dismiss with an airy wave thousands of years of human experience and learning, to which chrisb was referring, as “a thinly veiled appeal to tradition”.”

It an appeal to traditon which has no bearing on whether it works or not. Plenty have things have a long history and tradition. That doesnt validate them. People have been wrongt many many times.

“This experience is a form of scientific evidence: observational, experiential, a process of development over long periods of time. It may not be randomised, controlled, clinical trials, but it’s still a genuine form of scientific evidence.”

Agree. Would you also agree that its a form of evidence which we know can be subject to bias? Would you also agree that anecdotes are not a rational way of making decisions, since there is anecdotal evidence that everything works at some time? How do you propose dealing with that?

“If you’re going to base your position on what you term ‘science’ and ‘critical reasoning’, jettisoning huge portions of the data simply won’t do. And if you’re going to wait for the clinical trials evidence of every aspect of traditions like TCM and Ayurveda, you’ll be here until Doomsday”

Science is about using the best quality data we have, not all of it. High quality evidence is more rational and less subject to bias, and so its logical to give that greater weighting in decision making.
We know blood letting was anecdotally a good idea. When good quality evidence emerged it was harmful, did we simply ignore that? Of course not. We went with the stronger less biased evidence. The only reason for using less rigourous evidence is special pleading because it shows that your modality works . Luckily we don’t need to wait until doomsday. many of the alt med practices have been subject to controlled clinical studies which have either shown no effect or inconclusive results.

Guest

What do you mean by ‘Logic’.

Guest
Maria says:
23 February 2012

“What do you mean by ‘Logic’.”

Prime Minister raises a good question. chrisb, You are misusing the term ‘logic’ What you are offering here is not ‘logic’ (which is a system for determining the validity of arguments) but circular reasoning, which is a formal logical fallacy. Your argument boils down to this:

If it didn’t work, people wouldn’t use it, therefore it must work.

You supplement this with a number of other fallacious arguments. Stuart has pointed these out and offered rational counter arguments that counter the fallacy and which, unfortunatley, have been ignored by Barney who simply repeats the same fallacy, to which Stuart has had to respond again.

To stop going round in circles, let’s take a more critical look at your Appeal to Tradition (i.e. argument that a practice or a belief is justifiable simply because it has a long and established history).

You said, “these Alternatives would have vanished into the night as being ineffective hocus-pocus,”

I note you specify Modern Medicine as starting in the 19th century, which is fair enough but it’s actually irrelevant. Historical records indicate that people have always practised some kind of ‘medicine’ in the hope that it will have specific beneficial effects.

Historical records also tell us that much of what was used as medicine was, at best, useless superstition which had no beneficial effect and, at worst, was actively harmful. We now know that people didn’t necessarily abandon useless or harmful practices quickly. Some continued for thousands of years.

Why do you think people continued to use leeches and bleeding over centuries? Do you think it is because they worked, that they saved lives? Do you think the Big Pharma was forcing them on people?

No. People used harmful practices for the same reason they used harmless practises: because (a) they didn’t know what else to do and (b) they believed they could be effective. This raises the question of how people could possibly believe that practices like leeching and bleeding ever worked?

The answer is that some people recovered in spite of these practices, not because of them, and human beings erroneously (as we now know) saw a causal connection between the administered practice and the recovery. Exactly as they do today. This has nothing to do with what kind of treatment is being offered and whether it is ‘orthodox’ or ‘alternative’. It is to do with the flawed way human beings think: Sore throat better? Must have been the antibiotics/homeopathic remedy.

(Of course, when people died after whatever useless or barbaric practice was inflicted on them this was explained by the illness being too serious or advanced for treatment, coupled with speculation about God’s purpose.)

These are the same reasons why people use treatments of any sort today. The thalidomide tragedy is, in this way, no different from the tragedies of children like Cameron Ayres and Gloria Thomas. Notably, the first tragedy was caused by faith in modern medicine and the others were caused rejection of modern medicine.There is a point here being about proportioning one’s belief to the evidence.

Your ‘evidence’ that some therapies have lasted for thousand years and so people must have benefitted from them is undermined by the fact that some therapies, also lasted for thousands of years, even though they were worse than useless. People who are sick and who die whether in spite of or because of the treatment they were given, don’t leave testimonies.

I hope you can see the problem with your appeal to tradition now.

(If we were on anot