/ 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
Catherine says:
19 January 2012

Do we not think there should have been someone from the nutritional therapy world on the ‘expert’ panel? Shall we conduct a review of GPs with a panel of experts from the alternative therapy world? I wonder what results that would produce! And yes, who are David and Alan?!

Karen Shields says:
19 January 2012

Here’s an idea, why don’t Which? continue along this investigative path and mystery shop a few Dieticians as well. It would be interesting to see the results.

Caroline says:
19 January 2012

Following the totally ineffective and in some cases unhelpful advice from GPs I asked a nutritional therapist to help me overcome CFS. I had clear improvement within a couple of months and have been able to make a full recovery as a result of her advice and guidance. There may well be practitioners who are not well-trained and use more questionable approaches such as irridology – I would use my own judgment with this in exactly the same way I would look for a good dentist or a good builder – check references and credentials properly. To use this survey to potentially undermine the very real impact that nutritional therapy can have when used in proper coordination with GPs and other practitioners is doing the public a great disservice.

dilys says:
20 January 2012

I would like the name if this Therapist as I also have CFS and would love to be wholly well

Arthernegusenjoys says:
19 January 2012

Sorry, but did I just read that a professor of pharmacology has told me that it is ok to continue smoking as long as already have lung cancer.

I’m not sure my GP would agree.

In fact, it sounds like a dangerous fail

Alan Henness says:
19 January 2012

Arthernegusenjoys said:

“Sorry, but did I just read that a professor of pharmacology has told me that it is ok to continue smoking as long as already have lung cancer.

I’m not sure my GP would agree.

In fact, it sounds like a dangerous fail”

What David Colquhoun said was:

“Even if we took something like cigarette smoking, for which causality is established beyond reasonable doubt. it would be astonishing if stopping smoke after being diagnosed with lung cancer would have much benefit. It would be too late.”

Could you read this again and say how you managed to contrive the meaning you did out of that?

Many the people who study Nutritional therapy and go on to practice it are those who have had conditions, chronic and acute and have found relief in using nutrition as a healer. All most of them want to do is pass on the knowledge about how to use nutrition to create better health. There are some therapists that are not so well trained it’s true, and I am not condoning anyone that encourages any kind of dangerous therapy or advises against conventional medicine (before Mr Hennesse asks!), and this is an area that BANT and other NT bodies can help to improve.

NT is an emerging profession and it will take time to regulate properly but BANT and the NTC have been doing a good job. Perhaps the medical profession could work more closely with BANT, because lets face it the nations health is not getting any better and people need all the help they can get.

I want to mention about the cost of a consultation. It can be and should be around £80-£90. A practitioner has put a lot of money and time into training first of all. The consultations are long and there is extra work of research and writing up of personal plans. A medical consultation (private) can cost £2-300 for 30-40 minutes. When you consider that a massage in a good spa can cost £75-£120 and you just feel the affects for a day, where as that one consultation with a Nutritional Therapist can change your whole outlook on dietary habits and could change your health for the better.

My husband and I use food supplements all the time now as it makes a huge difference to our general overall health, energy and well-being. I never get colds, my children hugely benefit from my nutrition knowledge, and they never pick up what’s going around the school.
Eating healthy foods is one of the most positive things that you can do to protect your health. There is so much lack of knowledge amongst the public about nutrition, that it is vital that there are NT’s that are easily accessible to people who seek more knowledge about health and the foods they eat.

Roz Kadir says:
19 January 2012

How disappointing that Which, a magazine revered for providing impartial advice should produce such a report. It is unbalanced and full of statements that are refutable. I have been in practice for many years, I work closely with medical practitioners; in fact I was trained as a nurse many years ago and worked in ITU and CCare. I have many colleagues with similar backgrounds who practice safely, using evidence bases and who are registered with bodies such as CNHC who check our credentials, qualifications and practice.
Many of us practice using a Functional Medicine model which is highly researched and evidence based.
I would like to see Which do a report on GPs and many very expensive “Harley St” consultants, many of which are not up to standard. As in any practice you will always find some excellent ones and others who are not so good.
Why did you not ask a highly trained Nutritional Therapist to sit on your committee? Why did you not invite BANT? Or CNHC?
I will never trust a report from Which again – what a pity.

Alan Henness says:
19 January 2012

Roz Kadir said:

“It is unbalanced and full of statements that are refutable.”

Please feel free to provide these statements and your refutation of them.

Until nutritional “therapy” has been subjected to properly conducted double blind trials, no amount of anecdotes will convince me that it is any better than the great swathe of so-called “alternative therapies” which now infest our society.

As the “Which” investigation has shown, most so called nutritional therapists are nothing more than salespersons for unnecessary mineral and vitamin supplements. Eating a diet containing lots of vegetables and fruit, with small amounts of meat and carbohydrates, will provide all the vitamins and minerals that are necessary for a healthy life (except perhaps for very elderly people, with restricted appetites and lacking access to sunlight). Many properly conducted studies have shown this to be the case.

It is a pity that “Which” is only read by a relatively small segment of the population, most of whom probably enjoy a very sound diet anyway. Even the report earlier in the week on “You and yours”, (in which the “BANT” representative did not distinguish herself) will only have reached a similar demographic to that of “Which”.

Monika says:
19 January 2012

Derek – “Properly conducted double blind trials” would be welcomed indeed. Bring them on!
The small snag, however, is that they require funding which is easier for big pharma companies than organic farmers…….and so the vicious circle carries on.

Alan Henness says:
19 January 2012

Monika

“The small snag, however, is that they require funding which is easier for big pharma companies than organic farmers…….and so the vicious circle carries on.”

The supplements industry is a multi-billion pound one.

However, BANT alone claim to have 2,400 members (although their ‘Practitioner search’ on their website only returns details of 1,816). I suspect there are thousands more who are members of other organisations.

To raise, say, £100,000 for a trial would require BANT members to donate a mere £42 each (about half the cost of just one consultation).

Assuming they see – let’s take a guess – just 4 customers a day, 5 days a week, 40 weeks of the year, that would amount (if they passed it on) to an additional 5.2p per customer per visit.

If they wanted to raise £1 million – just think what could be achieved with that – these 800 customers per nutritionist per year would only need to come up with 52p each per visit.

Sam gave us figures of £80 to £90 per consultation, so this additional levy would add just 0.6% to their bill.

Does that sound an unreasonable price to pay for the properly conducted double blind trials you would welcome?

ente1 says:
19 January 2012

Eating a diet containing lots of vegetables and fruit, with small amounts of meat and carbohydrates, “will provide all the vitamins and minerals that are necessary for a healthy life (except perhaps for very elderly people, with restricted appetites and lacking access to sunlight). Many properly conducted studies have shown this to be the case.”

Errrr…
– research DOES show that farming methods since WWII the nutritional quality of food is poorer
– if you think that is true – then why are scientists worldwide doing studies to determine the effects of additional nutritional supplementation on a variety of health issues? Just .browse PubMed (while you still can since it might not be free for much longer)
– “access to sunlight” is not just about being outdoors – research has shown that latitude counts and emerging research shows that Vitamin D deficiency in northern climates is common because it’s quite difficult for most people to get enough UVB radiation required in winter months because there simply isn’t enough daylight so that supplementation is commonly recommended.

I realise that “double blind” studies are considered to be a great thing. Not disputing that. But my first introduction to the scientific method, a very long time ago, taught us that observation and forming a hypothesis from observation and experience was important. As stated previously by someone else here – many NTs have gone into the profession because they have been helped themselves through health problems by applying nutritional therapy principles for diet and/or supplementation. This knowledge has been built up through years, may we even say in some cases, centuries, of observation and experience. It may not be perfect 100% of the time but it doesn’t mean it still isn’t effective. Hm – Could we often say the same thing about drugs tested by double blind studies too not to mention the GPs who prescribe them?

Derek…maybe you should start reading more.

At random, a very brief snapshot of the trials you want to know about. There are thousands:

Folkers K, Simonsen R. Two successful double-blind trials with coenzyme Q10 (vitamin Q10) on muscular dystrophies and Neurogenic atrophies. Biochimica Biophysica Acta 1995;1271:281-286 1995.
Folkers K. (Ed). Biomedical and clinical aspects of coenzyme Q. Volume 3. Elsevier, Amsterdam, 1981 1981.
Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995 1995.
Levin B. Coenzyme Q: a clinical monograph. Quarterly Rev Nat Med Fall 1994;235-249 1994.
McGuire JJ, Kagan V, Ackrell BAC, et al. Succinate-ubiquinone reductase linked recycling of alpha-tocopherol in reconstituted systems and mitochondria: requirement for reduced ubiquinol. Arch Biochem Biophys 1992;292:47-53 1992.
Mellors A, Tappel AL. Quinones and quinols as inhibitors of lipid peroxidation. Lipids 1966;1:282-284 1966.
Tanaka J, Tominaga R, Yoshitoshi M, et al. Coenzyme Q10: the prophylactic effect on low cardiac output following cardiac valve replacement. Ann Thorac Surg 1982;33:145-151 1982.
Turunen M, Wehlin L, Sjoberg M et al. beta2-Integrin and lipid modifications indicate a non-antioxidant mechanism for the anti-atherogenic effect of dietary coenzyme Q10. Biochem Biophys Res Commun 2002 Aug 16;296(2):255-60 2002.
Yammamura Y. A survey of the therapeutic uses of coenzyme Q. In: Lenaz G (Ed). Coenzyme Q. Wiley and Sons, New York, 1985 1985.

Adams MR, Golden DL, Chen H et al. A Diet Rich in Green and Yellow Vegetables Inhibits Atherosclerosis in Mice. The Journal of Nutrition. Bethesda: Jul 2006. Vol. 136, Iss. 7; pg. 1886-1889. 2006.
Anthon GE and Barrett DM. Characterization of the temperature activation of pectin methylesterase in green beans and tomatoes. J Agric Food Chem. 2006 Jan 11;54(1):204-11. 2006.
Baardseth P, Bjerke F, Martinsen BK et al. Vitamin C, total phenolics and antioxidative activity in tip-cut green beans (Phaseolus vulgaris) and swede rods (Brassica napus var. napobrassica) processed by methods used in catering. J Sci Food Agric. 2010 May;90(7):1245-55. 2010.
Blackburn GL, Phillips JC, Morreale S. Physician’s guide to popular low-carbohydrate weight-loss diets. Cleve Clin J Med 2001 Sep;68(9):761, 765-6, 768-9, 773-4 2001. PMID:18590.
Danesi F and Bordoni A. Effect of home freezing and Italian style of cooking on antioxidant activity of edible vegetables. J Food Sci. 2008 Aug; 73(6):H109-12. 2008.
EL-Qudah JM. Identification and Quantification of Major Carotenoids in Some Vegetables. American Journal of Applied Sciences, 2009; 6(3):492-497. 2009.
López Hernández J, González-Castro MJ, Simal-Lozano J et al. GC determination of fatty acids in green beans grown in Galicia (N.W. Spain). Grasas y Aceites, 1996; 47(3):182-185. 1996.
Luthria DL and Pastor-Corrales MA. Phenolic acids content of fifteen dry edible bean (Phaseolus vulgaris L.) varieties. Journal of food composition and analysis, 2006; 19(2-3): 205-211. 2006.
Nursal B and Yücecan S. Vitamin C losses in some frozen vegetables due to various cooking methods. Nahrung. 2000 Dec; 44(6):451-3. 2000.
Oomah BD, Corb A and Balasubramanian P. Antioxidant and Anti-inflammatory Activities of Bean (Phaseolus vulgaris L.) Hulls. J. Agric. Food Chem., 2010, 58 (14), pp 8225-8230. 2010.
Ranilla LG, Genovese MI and Lajolo FM. Effect of different cooking conditions on phenolic compounds and antioxidant capacity of some selected Brazilian bean (Phaseolus vulgaris L.) cultivars. J Agric Food Chem. 2009 Jul 8; 57(13):5734-42. 2009.
Rickman JC, Barrett DM and Bruhn CM. Nutritional comparison of fresh, frozen and canned fruits and vegetables. Part 1. Vitamins C and B and phenolic compounds. J Sci Food Agric 87:930-944 (2007). 2007.
Rumm-Kreuter D and Demmel I. Comparison of vitamin losses in vegetables due to various cooking methods. J Nutr Sci Vitaminol (Tokyo). 1990; 36 Suppl 1:S7-14; discussion S14-5. 1990.
Sripanyakorn S, Jugdaohsingh R, Dissayabutr W et al. The comparative absorption of silicon from different foods and food supplements. The British Journal of Nutrition. Cambridge: Sep 28, 2009. Vol. 102, Iss. 6; pg. 825-834. 2009.
Tosun BN and S. Yucecan. Influence of Home Freezing and Storage on Vitamin C Contents of Some Vegetables. Pakistan Journal of Nutrition, 2007; 6(5):472-477. 2007.
Venkateswaran S, Pari L and Saravanan G. Effect of Phaseolus vulgaris on Circulatory Antioxidants and Lipids in Rats with Streptozotocin-Induced Diabetes. Journal of Medicinal Food. June 2002, 5(2): 97-103. 2002.

Abbott LG, Rude RK. Clinical manifestations of magnesium deficiency. Miner Electrolyte Metab 1993;19:314-322 1993.
Bengtsson BL. Effect of blanching on mineral and oxalate content of spinach. J Food Technol 1969;4:141-145 1969.
Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995 1995.
Iseri LK, French JH. Magnesium: Nature’s physiologic calcium blocker. Am Heart J 1984;108:188-193 1984.
Lindberg JS, Zobitz MM, Poindexter JR, et al. Magnesium bioavailability from magnesium citrate and magnesium oxide. J Am Coll Nutr 1990;9:48-55 1990.
Meiners CR, Derise NL, Lau HC, et al. (1976). The content of nine mineral elements in raw and cooked mature dry legumes. J Arg Food Chem 1976;24:1126-1130 1976.
National Research Council. Recommended dietary allowances. 9th edition. National Academy of Sciences Press, Washington, DC, 1980;134-136 1980.
Pearson HA, Campbell V, Berrow N, et al. Modulation of voltage-dependent calcium channels in cultured neurons. Ann N Y Acad Sci 1994;747:325-335 1994.
Shils ME. Magnesium. In: Shils ME, Olson JA, and Shike M. Modern nutrition in health and disease. 8th Edition. Lea and Febiger, Philadelphia, 1994;164-184 1994.
Touyz RM. Role of magnesium in the pathogenesis of hypertension. Mol Aspects Med 2003 Feb 6;24(1-3):107-36 2003.
Wester PO. Magnesium. Am J Clin Nutr 1987;45(suppl):1305-1312 1987.

Arita M, Bianchini F, Aliberti J, Sher A, Chiang N, Hong S, Yang R, Petasis NA, Serhan CN. Stereochemical assignment, antiinflammatory properties, and receptor for the omega-3 lipid mediator resolvin E1. J Exp Med. 2005 Mar 7;201(5):713-22. 2005. PMID:15753205.
Bernard-Gallon DJ, Vissac-Sabatier C, Antoine-Vincent D et al. Differential effects of n-3 and n-6 polyunsaturated fatty acids on BRCA1 and BRCA2 gene expression in breast cell lines. Br J Nutr 2002 Apr;87(4):281-9 2002.
Chung H, Nettleton JA, Lemaitre RN et al. Frequency and Type of Seafood Consumed Influence Plasma (n-3) Fatty Acid Concentrations. The Journal of Nutrition. Bethesda: Dec 2008. Vol. 138, Iss. 12; p. 2422-2427. 2008.
Elvevoll EO, Barstad H, Breimo ES, Brox J, Eilertsen KE, Lund T, Olsen JO, Osterud B. Enhanced incorporation of n-3 fatty acids from fish compared with fish oils. Lipids. 2006 Dec;41(12):1109-14. 2006. PMID:17269556.
Erkkila A, Lichtenstein A, Mozaffarian D, Herrington D. Fish intake is associated with a reduced progression of coronary artery atherosclerosis in postmenopausal women with coronary artery disease. Am J Clin Nutr , Sept. 2004; (80(3):626-32. 2004. PMID:15321802.
Fickova M, Hubert P, Cremel G, Leray C. Dietary (n-3) and (n-6) polyunsaturated fatty acids rapidly modify fatty acid composition and insulin effects in rat adipocytes. J Nutr 1998 Mar;128(3):512-9 1998. PMID:8980.
Groff JL, Gropper SS, Hunt SM. Advanced Nutrition and Human Metabolism. West Publishing Company, New York, 1995 1995.
Heller A, Koch T. [Immunonutrition with omega-3-fatty acids. Are new anti-inflammatory strategies in sight?]. Zentralbl Chir 2000;125(2):123-36 2000. PMID:15830.
Lawson LD, Hughes BG. Absorption of eicosapentaenoic acid and docosahexaenoic acid from fish oil triacylglycerols or fish oil ethyl esters co-ingested with a high-fat meal. Biochem Biophys Res Commun. 1988 Oct 31;156(2):960-3. 1988. PMID:2847723.
Lininger SW, et al. A-Z guide to drug-herb-vitamin interactions. Prima Health, Rocklin, CA, 2000 2000.
Mahan K, Escott-Stump S. Krause’s Food, Nutrition, and Diet Therapy. WB Saunders Company; Philadelphia, 1996 1996.
Maillard V, Bougnoux P, Ferrari P et al. N-3 and N-6 fatty acids in breast adipose tissue and relative risk of breast cancer in a case-control study in Tours, France. Int J Cancer 2002 Mar 1;98(1):78-83 2002.
Matute P. Consumption of fish to allay obesity. Paper presented at the 6th Congress of the International Society for the Study of Fatty Acids and Lipids, Brighton, Great Britain, December 12, 2004. 2004.
Meng L, Wilkens L, and Kolonel L. How fish is cooked affects heart-health benefits of omega-3 fatty acids. American Heart Association’s Scientific Sessions 2009. Abstract 1404/Poster 2071. Orlando, FL. 2009.
Osmundsen H, Clouet P. Metabolic effects of omega-3 fatty acids. Biofactors 2000;13(1-4):5-8 2000. PMID:15800.
Popp-Snijders C, Schouten JA, Heine RJ, et al. Dietary supplementation of omega-3 polyunsaturated fatty acids improves insulin sensitivity in non-insulin-dependent diabetes. Diabetes Res 1987 Mar;4(3):141-7 1987. PMID:8990.
Serhan CN, Hong S, Gronert K, Colgan SP, Devchand PR, Mirick G, Moussignac RL. Resolvins: a family of boactive products of omega-3 fatty acid transformation circuits initiated by aspirin treatment that counter proinflammation signals. J Exp Med. 2002 Oct 21;196(8):1025-37. 2002. PMID:12391014.
Severus WE, Littman AB, Stoll AL. Omega-3 fatty acids, homocysteine, and the increased risk of cardiovascular mortality in major depressive disorder. Harv Rev Psychiatry 2001 Nov-2001 Dec 31;9(6):280-93 2001. PMID:15780.
Stoll BA. n-3 fatty acids and lipid peroxidation in breast cancer inhibition. Br J Nutr 2002 March;87(3):193-8 2002.
Stoll BA. Essential fatty acids, insulin resistance, and breast cancer risk. Nutr Cancer. 1998;31(1):72-77. 1998.
Vaddadi KS, Soosai E, Chiu E et al. A randomised, placebo-controlled, double blind study of treatment of Huntington’s disease with unsaturated fatty acids. Neuroreport 2002;13:29-33 2002.
Watkins BA, Li Y, Lippman HE, Seifert MF. Omega-3 polyunsaturated fatty acids and skeletal health. Exp Biol Med (Maywood) 2001 Jun;226(6):485-97 2001. PMID:15790.
Watkins BA, Li Y, Seifert MF. Nutraceutical fatty acids as biochemical and molecular modulators of skeletal biology. Am J Clin Nutr 2001;20(5):410S-420S 2001.
Wu M, Harvey KA, Ruzmetov N, Welch ZR, Sech L, Jackson K, Stillwell W, Zaloga GP, Siddiqui RA. Omega-3 polyunsaturated fatty acids attenuate breast cancer growth through activation of a neutral sphingomyelinase-mediated pathway. Int J Cancer. 2005 Nov 10;117(3):340-8. 2005. PMID:15900589.

Allman MA, Pena MM, Pang D. Supplementation with flaxseed oil versus sunflowerseed oil in healthy young men consuming a low fat diet: effects on platelet composition and function. Eur J Clin Nutr 1995 Mar;49(3):169-78 1995. PMID:18190.
Bazzano LA, He J, Ogden LG, Loria CM, Whelton PK. Dietary fiber intake and reduced risk of coronary heart disease in US men and women: the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med. 2003 Sep 8;163(16):1897-904 2003.
Bronner F, Pansu D. Nutritional aspects of calcium absorption. J Nutr. 1999;129:9-12 1999. PMID:9915868.
Brooks JD, Ward WE, Lewis JE, Hilditch J, Nickell L, Wong E, Thompson LU. Supplementation with flaxseed alters estrogen metabolism in postmenopausal women to a greater extent than does supplementation with an equal amount of soy. Am J Clin Nutr. 2004 Feb;79(2):318-25. 2004. PMID:14749240.

Enjoy!

Monika says:
19 January 2012

Alan – David

Re: “…it would be astonishing if stopping smoke after being diagnosed with lung cancer would have much benefit. It would be too late.”

Common sense would suggest that this is a silly statement to make. The evidence (preliminary) also agrees. Please see the folowing meta-analysis
Parsons et al (2010) Influence of smoking cessation after diagnosis of early stage lung cancer on prognosis: systematic review of observational studies with meta-analysis
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809841/

Monika
Thanks very much for that reference, Interesting.
But I hope that it was obvious that I wasn’t advocating that people should continue (or indeed start) to smoke. This arose because I was pointing out that there was no good evidence that a sugar free diet would help a person who had been diagnosed with breast cancer. You produced a lot of references that failed to show that, though they do suggest that it might be worth organising a proper trial to test that idea. Until such a trial is done, I continue to believe that it was bad advice, specially because the patient was advised not to see a real doctor unitl it was tried.

I feel rather strongly about this because it isn’t long since my wife was found to have breast cancer at routine screening. It was at an early stage, and thanks to our wonderful NHS it was soon found that there was no spread to lymph nodes, and that it was ER-positive. She had a mastectomy and needs only to take tamoxifen now.

If she had been to a nutritional therapist who advised 6 months delay, the tumour might have grown and metastasized to a point where radiotherapy was needed. Or she might be dead.

Monika says:
20 January 2012

David – Sadly many of us also have an all too close personal experience of cancer and also feel very strongly about this issue. Research into one (of many) aspects of this disease strongly suggests that inflammation is involved in (at least some) tumour formation and this is sufficient to provide a molecular rationale for developing new drugs, for example that target eicosanoid pathways to manipulate the tumour microenvironment. These same molecular pathways are also the target of modification through nutritional means, such as avoidance of inflammatory foods or incorporating more antiinflammatories into the diet. It is not a cure. It is not established beyond doubt. But the evidence points to the likelihood, which in some cases is significant.
My experience is that this is only very rarely, if ever explained to a cancer patient by their oncologist or GP – mainly because they don’t have time either to spend looking into the evidence or to spend with the patient. Yes – let’s keep doing the trials but let’s also integrate current understanding. You keep saying dietary advice is in (over) abundance. I couldn’t agree more. But often it’s outdated, wrong or unspecific for the needs of a patient despite the fact that more targeted use has already been shown to be beneficial.

Irina says:
19 January 2012

My grand children’s other grandmother died of smoking – related lung cancer. Their diet is loaded with sugar. I am making enormous attempts to reverse the situation to the best. Now.. When the parents of my grandchildren (who are an absolute product of modern lifestyle – high sugar, trans-fats diets, low exercise etc) read such a report from “Which”, would they listen to me and share my concerns about the danger of such a diet?!
This is an obvious opposition with only one side has been given a chance to express their arguments. However, these are our children who will pay for this argument. Very – very sad.

I’d like to point out that all the research about healthy diets, trans fats, diabetes, smoking etc etc has been done by conventional doctors and scientists. Our knowledge, such as it is. about what constitutes a healthy diet comes wholly from them. I’m not aware of any substantial research done by nutritional therapists.

There is an abundance (some might say an over-abundance) of advice about diet from conventional sources, and so no need to take advice, often it seems less reliable, from alternative practitioners.

It’s also true that the extensive research that shows most people are not helped by taking vitamin pills comes from the same source. though research of that sort tends to be ignored by people who make a living selling vitamins (and that includes Boots the Chemists).

As the report stated, some of the therapists didn’t even know about the trans fat content of common foods.

Monika says:
20 January 2012

David –
Once again you are making this into a “them and us” issue. This is what many of us find so disturbing about your approach. Research is being done by scientists, nutrition scientists included. The results of that research are studied by those who can apply it in practice, NTs inluded. Most GPs are not research scientists but it does not mean we condemn all of the advice they give.
Many of us have already agreed that regulation is needed. Perhaps you would like to offer constructive rather than destructive criticism if your aim is to help.

French says:
19 January 2012

Dieticians in the panel are not partial as they are only interested in protecting their involvement in the NHS and prevent nutritional therapists from joining. I saw a dietician for my 5 years old son who was under weight and what she recommended to help him put on weight was shocking: regular snacking with chocolate, mars bars and crisps and fizzy drinks!!!!

Carole says:
19 January 2012

Alan
You asked another blogger to feel free to point out those aspects of the investigation that might be refuted….. I’m sure they will respond as well, but I wanted to point out that BANT have posted on this blog their updated response to the Which? Article. It details some aspects of the investigation and of its conclusions that might be refuted or at least seriously questioned… and their response is based upon the transcripts …..
http://www.bant.org.uk/bant/pdf/WHICH/UPDATED_RESPONSE_FROM_BANT_TO_WHICH_ARTICLE_20120118.pdf

* Proposes the report is somewhat biased and gives examples
* Cannot find evidence in the transcripts that the Practitioner involved directly made any recommendation to the Client with regard to refraining from pursuing their cancer treatment and in fact made it clear that the Client’s oncologist should be involved
* Has found examples in the report where the expert panel appear to have misrepresented or misinterpreted the contents
*Where cases 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 that they were not willing for their GP to be contacted or were changing GP’s and so not keen for the action to take place.

So personally I would still question the validity and fairness of the investigation and the report

Alan Henness says:
19 January 2012

Carole

I do not have access to the transcripts that BANT have had for some time now, so I cannot comment on the accuracy of the Which? report, so, for the time being, if I had to make a decision, I am left with having to decide who is more credible: an organisation with a reputation for impartial consumer advice who consulted three medical experts and a trade body whose stated aim is to “promote and safeguard members’ interests” (http://j.mp/x9JHBx).

However, BANT have not given any specific details of the alleged bias so we can’t decide for ourselves and they have simply raised some general issues as to why they think the report might have been biased.

Maybe we will see BANT issue a detailed rebuttal of the investigation in due course, with sound reasoning as to why their opinion differs from that of Which? and the panel of experts, citing the transcript, studies, etc where appropriate.

It would also be good to hear from the CNHC (http://j.mp/z0epLC) (as one of the main ‘regulators’ of nutritionists) about what they propose to do about the very serious concerns raised by the Which? report.

Sad to say, the reaction of BANT in their updated report was simply to deny everything. They make no mention of absurd methods of diagnosis like “iridilogy” and hair analysis and even manage to deny that a patient was encouraged not to see their doctor.

What they should have said that they were horrified by some of the advice, and they’d take immediate steps to try to improve things. then one could have some respect.

In fact all they have done is to say nothing is wrong. That seems to make BANT part of the problem. that than being part of the solution.

I can’t help but think this research is flawed and biased. I’ve formally studied nutrition at grad level, under mainstream conditions, in labs and all, so I understand the biases and myths that abound on both sides.

I agree there’s all too much ‘hair analysis’, crystal gazing and wacky testing from the alternative and complementary side.

However, my long experience is that mainstream GPs, hospitals et al know virtually nothing about the vital importance of food and supplementation and the positive differences they can make. Unfortunately most of what’s published to the public from e.g. the NHS is IMHO just glossy sound-bite fluff.

Even senior NHS consultants I’ve spoken with are hopelessly clueless about micro-nutrients, let alone those of the macro sort: ‘it’s cooking, that’s wimmin’s stuff’ is the type of reception one receives!.

In many patient’s experience, the vast majority of mainstream doctors are obsessed with pushing drugs that, whilst perhaps useful in relieving immediate symptoms, actually deplete the body’s other healing mechanisms. Antibiotics are a classic ‘miracle-cure’ case – and one which has proven to be quite disastrous on both a personal level and societally. I suspect the next massive drug mistake to be uncovered will be in respect of the £multi-million anti-depressant industry.

Frankly, I avoid both wacky alternatives and mainstream cluelessness wherever possible. I treat many of our family ailments with thoroughly researched and tested supplements and plain, fresh, tasty food. If you look, there is actually much robust research on the nutraceutical efficacy of foods, or ‘super-foods’, and their constituents. Not one mainstream doctor I’ve ever spoken with has ever discussed my diet with me in relation to healing my illnesses. (Except once to totally and patronisingly dismiss the subject when I raised it).

I’m sorry, but mainstream medicine has nothing to offer me or mine in this respect – yet what we eat quite literally becomes us! It’s the most vital building block of health or illness. And, in practice, mainstream medicine almost completely ignores this in favour of loading our bodies with yet more and more expensive, ‘advanced’ and synthetic chemicals. Good food which hasn’t been mucked about with is actually very reasonably priced and easily available. In both cases, mainstream cluelessness and alternative wackiness, ‘follow the money’ is a useful piece of advice when weighing up their advice.

I am certain that Which could just as easily find equal horror stories from mainstream medicine.It would be good to see a thoroughly and robustly administered piece of research from Which on this vital area, not just some sound-bite, headline-grabbing horror stories.

What is the cancer and sugar connection, and why does it invoke such scorn.

Certainly all competent Nutritional Therapists will avoid stating that someone should discontinue treatment instigated by a medical professional, and whilst the selected comments from the which report suggest this was not done, lets avoid vilifying the practitioner, it is quite likely that this was not what was stated – but was extracted in a contextual manner that suited our trio of ‘non biased’ experts to further the condemnation of Nutritional Therapy.

There have already been some posts on the role of sugars and cancer and Prof Colquhoun supported by his ally Mr Henness of the Nightingale Collaboration have suggested that this would be entirely inappropriate advice. Prof Colquhoun suggests that there is no suitable evidence that reducing sugar/carbohydrate intake would benefit the breast cancer patient and even suggests that removing sugar rather than allowing ad hominem input of foods is a better idea.

The difference between researchers (Dr Colquhoun) and practitioners is that researchers rarely ever have to face the thorny question of uncertainty wrapped in a human experience and mostly fail to recognise that the act of undertaking a change in lifestyle empowers the individual to feel they have some control and this in turn imparts benefits. These benefits may be dismissed as unsubstantiated but as well described by Darwinian Medicine and the ‘meaning response’ and many individuals would rather act, than be a passive recipient of treatment.

It is not acceptable to suggest completely unsubstantiated recommendations but whilst the simplistic comment of avoiding all sugars suggests a lack of specificity there is credible logic to the concept of reducing insulin promoting foods when seeking to both prevent and manage breast cancer.

Researchers know that the liquid soup of glucose, EGF and insulin promotes cell growth in culture. Insulin, a hormone produced in the pancreas, is more commonly known for its role in diabetes. But its reputation may be changing. Insulin and a related hormone known as insulin-like growth factor (IGF) are now at the centre of a growing wave of research around the world aimed at elucidating what many scientists consider to be their critical role in fueling a wide range of cancers.

Elevated levels of insulin and IGF are also the leading candidates to explain a significant correlation in epidemiology that has gained attention over the past 30 years: Obese and diabetic individuals have a far higher risk than lean healthy people of getting cancer, and when they do get it, their risk of dying from it is greater. And now that obesity and diabetes rates are skyrocketing, the need to understand this link has become far more urgent.

Whilst it seems logical that obesity and increased insulin output go together the fact that the client discussed was not obese does not exclude her from experiencing insulin resistance – a pre diabetic state, and whilst it appears this was not tested for, it may still be a reasonable assertion.

In the decades since Warburgs work, researchers have debated whether the amount of blood sugar available to the tumour could be a driving or limiting factor in tumour development. As Prof Colquhoun suggests there is always glucose around and simply excluding sugars is unlikely on its own to have much of an impact without significant total food reduction. But managing insulin promotion does appear to confer benefit. Breast cancer cells express insulin receptors, even though the cells from which the tumours derive do not.

There are other factors of course, not suitable for such a short window or space, but it is being discussed that tumour may be split between those that are insulin sensitive and those that are not.

To suggest that once diagnosed, that modifying insulin production through the avoidance of simple sugars will resolve the breast cancer is likely a step too far, but the concept that sensible eating that includes phytonutrient and fibre rich foods as complex carbohydrate rather than simple non fibre bound foods to limit inappropriate promotion of insulin is not. Most researchers studying the Warburg effect now believe that the signalling pathways driving it are the insulin and insulin-like growth factor pathways.

• Goodwin PJ, Ennis M, Pritchard KI, Trudeau ME, Koo J, Madarnas Y, Hartwick W, Hoffman B, Hood N. Fasting Insulin and Outcome in Early-Stage Breast Cancer: Results of a Prospective Cohort Study. J Clin Oncol. 2002;20:42-51. http://tinyurl.com/8a48ncj
• Augustin LS, Dal Maso L, La Vecchia C, Parpinel M, Negri E, Vaccarella S, Kendall CW, Jenkins DJ, Francesch S. Dietary glycemic index and glycemic load, and breast cancer risk: A case-control study. Ann Oncol. 2001;12:1533-1538. http://tinyurl.com/823m4kp
• Messina M, Lampe JW, Birt DF, Appel LJ, Pivonka E, Berry B, Jacobs DR Jr. Reductionism and the narrowing nutrition perspective: time for reevaluation and emphasis on food synergy. J Am Diet Assoc. 2001;101:1416-1419.
• Potischman N, Coates RJ, Swanson CA, Carroll RJ, Daling JR, Brogan DR, Gammon MD, Midthune D, Curtin J, Brinton LA. Increased risk of early-stage breast cancer related to consumption of sweet foods among women less than age 45 in the United States. Cancer Causes Control. 2002;13:937-946. http://tinyurl.com/7xz43wk

Have just received the latest Which? magazine after 30yrs membership! It seems that the once impartial and objective advice has been replaced by material from opinionated young hopefuls trying to attract media attention to boost awareness. In my view, misinterpreting data to do this discredits the magazine. Had the same researchers approached dieticians directly, and likewise GP’s too, I wonder how varied the advice would have been? About the ‘dangerous fails’ – did the therapists actually say to delay GP’s cancer treatment – or did the researcher make up excuses why he/she couldnt see the GP? How much of this report has been taken out of context to achieve the clear objective of rubbishing Nutritional Therapy? Using non professionals to comment as an authority in the field of Nutritional Therapy seems to be bad science in itself. The report implying a significant risk to health using ‘high dose’ supplements is without scientific foundation. Drugs and their side effects to alleviate the effects of junk food diets are not the future of medicine, good preventative diets are. A bad fail for Which? as far as I am concerned! I see no value in buying a magazine if the reports are so biased, opinionated, and untrustworthy. D R West MSc (Nutrition)

I’m rather flattered if David West is classifying me as a “young hopeful”

I suppose that, being a nutritional therapist yourself, it’s understandable that you don’t like what some of the therapists said. But I’d me more impressed if your reaction had been “what can we do to improve the standard of advice” rather than simply denying everything. It is precisely that inability to admit that there are problems that does the nutritional therapists such harm.

Marilyn Gilbert says:
19 January 2012

I have suffered from low stamina and a weak back all my life. I have had 4 miscarriages, have had difficulty getting pregnant, my son was born prematurely and I suffered what I thought was a nervous breakdown 30 years ago. My consultant gynaecologist did not know why I miscarried or had infertility problems; he performed a laparoscopy and artificial insemination to no avail. My GP and also a private GP had no idea what was wrong with my nervous system. My GP sent me to ‘Back School’ at the local hospital to teach me how to move and lift etc. Many ECGs were done and there was nothing wrong. I eventually found out more about my nerves but did not discover the whole truth until I studied nutritional therapy. I know now why I had fertility problems and miscarriages, low back pain, low stamina and nerve problems. Everything has fallen into place and at last I can connect the dots and treat myself – for adrenal and thyroid imbalances. GPs only believe that the adrenals work perfectly or do not work at all; they are not aware of the grey area in the middle. My thyroid tests done by my GP came back normal but I knew that I had many signs of hypothyroidism. It is only my training and the confidence in my training that has enabled me to improve my health. I now have more energy than I had 30 years ago and I am now able to help others. Unfortunately people see a NT as a last resort when there is a lot to sort out, as well as trying to undo the harm done by drugs. Unfortunately my GP practice is not interested in even wanting to learn more about NT. I believe we should all work together for the benefit of the patient, rather than trying to score points off each other as to who has managed to ‘cure’ the patient. We all have our own expertise and we should combine this knowledge. No one person will ever know all there is to know about the human body.

Natalie says:
19 January 2012

After reading your article I felt I had to reply. From a young age I had many symptons namely cystitis, itching eczema ears and constantly having a build of wax, bloating, back ache, horrible taste in mouth and many other symptons. I was always given antibiotics for the cystitis, steroid cream for the eczema, anti-inflammatories for my back but when asking if this would cure the cause was always told no just the symptom. After many years I found out after reading a book written by a Nutritionist that I had Candida Albicans. I completed a questionnaire was given a tailored made vitamin and mineral programme (which included taking high amounts of vitamin c until I had loose bowel movements then I knew I was taking enough. Your body just flushes out what it doesnt need and you will be surprised how many people do not eat a complete balanced diet and need high doses of vitamins and minerals while they are trying to get better. But I digress) and yes I felt a lot worse before I felt better where my body was ridding itself of toxins. I had to eat a yeast and sugar free diet which yes was extremely hard but after a few years I eliminated the candida. So yes there may be ‘wacky nutritionists’ out to rip you off and say stupid and dangerous things like do not have chemo if you have cancer but there are many many good ones who are actually there to help you because they have studied for many years and looking at what the body needs to function correctly. Our bodies are finely tuned and we completely abuse them with what we eat and drink and wonder why we feel ill. Yes you could not live without the medical profession as they also play their part in healing and there are some brilliant breakthroughs in medicine that save peoples lives but the ideal situation would be the medical professsion and nutritionists working together but that probably will never happen especially when the drugs companies have a say in the matter.

Peter venice says:
19 January 2012

Such a one sided debate and such a shame as nutritional therapists work so hard to get their qualifications and add so much value to people’s lives where the medical profession fails.

[Part of this comment has been removed by Mods -please remember not to make your comments personal attacks on others]

Colette says:
19 January 2012

Thank you for making me smile today! Hear hear!

Colette says:
19 January 2012

So enthusing to see so much support for NT’s instead of against – it makes me feel there is hope at the end of the medicated tunnel! Thanks to all who have participated at least there is some support for a worthwhile profession out there.

Sam
You do enormous harm to your case by saying
“Antibiotics are a classic ‘miracle-cure’ case – and one which has proven to be quite disastrous on both a personal level and societally”

If we listened to your advice, people would still be dying fro tuberculosis and all manner of bacterial infections that have become almost extinct since the discovery of antibiotics.

The people you should be criticising are industrial farmers who, by using antibiotics to promote animal growth have very probably contributed to the increasing problem of antibiotic-resistance. And alos the patients who bully GPs into prescribing antibiotics for conditions that they can’t benefit.

When people write as you do, I wonder how long their principles would last if they were unlucky enough to get tuberculosis, salmonella, syphilis or bacterial meningitis. Not long. I’ll bet.

Colette says:
19 January 2012

David, what a surprise to learn that you are in pharmaceuticals!!! I don’t suppose you feel remotely threatened by the fact that the topic you have dedicated your entire life to is coming under threat by the rapid increase in all chronic western diseases and that modern medicine, whilst having proven effective in preventing deaths from simple infections such as would have occurred 100 years ago, is proving useless in combating or preventing these modern epidemics such as obesity, type II diabetes, CVD and cancer. We now KNOW that prevention is the only way to fight these diseases and how to do this? Nutrition! Read all the comments of people who have had diseases their whole lives and have had absolutely no help or support from conventional medics but who have found homeostasis and relief from nutritional support. Stop your futile pharmacology fuelled ranting and accept that there may be another way!

Monika says:
19 January 2012

David –

“And alos the patients who bully GPs into prescribing antibiotics for conditions that they can’t benefit.”

Patients bullying their GPs into prescribing antibiotics ? So now it’s the fault of the patients>
As John McEnroe used to say – YOU CANNOT BE SERIOUS! My personal experience is that some will even prescribe when they have no clue what the problem is, even if it’s viral (now there’s an anecdote). And surely a GP should be trained not to be bullied. What next will they be prescribing because they’ve been BULLIED into it. Come on…oh deary me.

Um, and the industrial farmers are hand-in-glove with which industry exactly?! Not the NT profession!

‘Enormous harm’ does sound a wee bit melodramatic, David. I think you’ll find that anti-biotics were touted as a ‘miracle cure’ when they were first introduced – for very specific uses, including the diseases you mention. You’ve inferred advice that I actually wasn’t giving. How did you read such advice not to take anti-biotics into what I wrote? Is this how the Which report got skewed, by erroneously extrapolating and misinterpreting what NTs told their clients? (and I note that in at least two of the diseases you mention, high quality, fresh food would either avert or treat the illness).

NHS directives insist that doctors do not prescribe anti-biotics like sweeties and have done for a number of years. Show me a doctor who’s been bullied by a patient and I’m certain we can come up with a hundred patients who’ve been bullied or neglected by a GP. Sadly, even tragically for some families, no one wants to do anything like this sort of research on NHS doctors (qv. my reply further down regarding the NHS Legal Authority’s injunctions against research which uncovers very serious maltreatment which can and apparently routinely does lead to patient deaths.)

Maggie says:
19 January 2012

@ Hannah

Thank you for the reply, but I do not think you have moderated this area that well. You have clearly allowed The Nightingale Collaboration individuals to comment in a bias and derogatory manner. The report is one sided, and is very defamation of the profession so could be deemed libellous. The journalist who was involved in this and magazine owe the Profession an apology.

@ David Colquhoun…if you really call yourself a researcher, then you should know that no one can make a objective view, with only small percentage of facts…BANT it appears have the full transcripts, and it seems from what they have reported that not all facts have been mentioned. As most people have said on here, and who I agree with…There are good GP and there are Bad..There are good Nutritional Therapists and there are bad, there are good Dieticians and there are bad. No one can answer your question on the advice, since no one on here has seen the full transcripts.

@Which….I think you need to look your own ethics…

I can never take anything you do seriously now, and makes me wonder what else Which have done to others..

Alan Henness says:
19 January 2012

Maggie said:

“You have clearly allowed The Nightingale Collaboration individuals to comment in a bias and derogatory manner”

You have made an accusation, so please substantiate it: please cite what you think I have said that is derogatory and what you think I have said that is biased.