/ 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
Member

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

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

Member
Simon Rogers says:
23 January 2012

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

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

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

Member
John says:
23 January 2012

Hi, Wavechange…

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

Member

Simon

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

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

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

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

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

Member

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

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

Member

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

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

Member

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

Member
Alan Henness says:
23 January 2012

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

Member
Barney says:
23 January 2012

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

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

Member

Hi Barney

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

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

Thanks, Hannah

Member
Barney says:
23 January 2012

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

Member

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

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

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

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

Member
Alan Henness says:
24 January 2012

chrisb said:

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

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

Member
nobbyuk says:
23 January 2012

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

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

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

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

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

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

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

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

Member
Maria says:
24 January 2012

I think you’re right, nobby.

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

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

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

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

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

A complete red herring.

Member
nobbyuk says:
24 January 2012

thanks maria for your reply.

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

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

Member

chrisb

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

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

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

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

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

Member

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

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

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

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

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

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

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

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

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

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

Member

David

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

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

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

Member

wavechange

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

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

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

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

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

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

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

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

Member

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

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

Member

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

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

Member
colette says:
24 January 2012

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

Member

colette

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

It really is as simple as that.

Member

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

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

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

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

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

Member
Alan Hennsss says:
24 January 2012

colette

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

Then you might just begin to understand.

Member

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

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

Member

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

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

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

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

Member

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

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

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

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

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

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

Member

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

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

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

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

Member
Irina says:
24 January 2012

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

Member
Barney says:
24 January 2012

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

It really is as simple as that.”

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

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

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

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

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

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

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

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

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

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

Member
Maria says:
25 January 2012

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

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

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

“This childish bullying affects people’s livelihoods,”

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

“…prevents people earning a perfectly legal living…”

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

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

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

“– people who choose to go to those therapists”

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

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

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

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

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

Member
Jamesy says:
24 January 2012

Wavechange

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

Member

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

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

Member
ExR&D says:
24 January 2012

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

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

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

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

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

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

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

Again, nuts and seeds are not mentioned.

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

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

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

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

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

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

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

Member

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

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

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

Member

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

Member
Sophia says:
24 January 2012

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

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

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

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

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

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

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

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

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

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

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

Member

Sophia

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

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

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

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

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

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

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

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

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

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

Member

Sophia

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

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

Member
Jamesy says:
24 January 2012

sorry about the double negatives

Member

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

Member

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

Member
maggie says:
24 January 2012

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

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

I do think

Member
Maria says:
24 January 2012

Maggie

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

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

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

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

Member
maggie says:
24 January 2012

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

Member

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

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

Member
Sophia says:
24 January 2012

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

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

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

Member
Maria says:
24 January 2012

Sophia

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

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

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

Member
Maggie says:
24 January 2012

Well responded Sophia…

Member

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

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

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

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

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

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