/ Food & Drink, Health

Bite-sized views from our nutritional therapists Conversation

With almost 2,000 comments on our nutritional therapists Conversation, it’s by far our most popular to date. Consumers, therapists, scientists and organisations all joined the debate. So what did they say?

When we investigated nutritional therapists we found some worrying practices, such as therapists advising against going to your GP.

The investigation wasn’t presented as a scientific study, where a bigger sample would have been required, but it did uncover a number of therapists giving advice that could potentially harm their clients.

We felt this proved that the nutritional therapist professional body, the British Association for Applied Nutrition and Nutritional Therapy (BANT), needed to undertake a full investigation.

But we also wanted to hear about your experiences of nutritional therapists. We were blown away by the response. With hundreds of comments rolling, we’ve tried to sum them up below.

Positive experiences of nutritional therapists

Kate describes her positive experience of visiting a nutritional therapist:

‘I spent years battling irritable bowel syndrome until I was recommended a nutritional therapist . Within a few months my symptoms were about 85% better.

‘While I have good and bad days, she has taught me how to manage my symptoms without drugs – I wasted 15 years going back and forth to my GP which got me absolutely nowhere.’

John R has also benefited from visiting a therapist:

‘I suffered with arthritis, insomnia and chronic fatigue for a number of years. My niece took one of these courses at Westminster University and I must admit I thought it was a dressed-up cooking class. I was started on fish oils with a number of other dietary tweaks and supplements and my pains eased significantly. Nutrition hasn’t cured me but I now feel more “normal”again.’

Nutritional therapists have their say

Jenny, a nutritional therapist, shared the process therapists should follow with their advice:

‘We are all trained to 1. Use food first. 2. Back up all recommendations with evidence-based research or biochemistry. 3. Never diagnose. 4. Refer to a GP for testing. 5. If testing, use appropriate laboratory serum/urine/stool analysis. 6. If necessary, before supplementing individual supplements – test. 7. Send results to GP. 8. Never advise to cease any prescribed treatment. It is a pity not all practitioners follow these rules.’

Aravenscroft, also a nutritional therapist, agreed that they held their advice to a high standard:

‘I would NEVER advise a client to go against the wishes of their doctor and cease conventional treatment. I would NOT diagnose, use unproven testing and suggest that a client spends a large amount of money on expensive supplements. I take my clients’ health and budgets incredibly seriously and would NEVER endanger anyone.’

Giving nutritional medicine a bad name

Angie was more worried about what our investigation uncovered:

‘It makes me very sad to read about so called therapists cashing in on what can be a beneficial approach to health when combined intelligently with help and advice from GPs. It gives nutritional medicine a bad name.’

Stuart felt a full investigation was required:

‘If I was a member of a professional body and some members were providing dangerous advice which risks people’s health and devalues my training, I would be incandescent with rage.

‘There are clearly different factions with nutritional therapists, some of which stick closely to the guidelines and some who desire to use nutritional therapy to treat illness and have delusional views of its usefulness. I would urge reasonable nutritional therapists to engage BANT en mass and ask for a full investigation.’

Clare feels dieticians and therapists should learn from each other:

‘I have been shocked at the evident antipathy between dieticians and nutritional therapists. Aren’t we trying to achieve the same things?

‘Both professions have skills to bring to the table to improve health through good nutrition. Couldn’t we start a dialogue and learn from each other the best elements of each profession, rather than mud-slinging?

Wavechange wanted to put our investigation into perspective:

‘The Which? study may have been small but is enough to suggest that nutritional therapists may not be giving the public a good service. These findings can be used by others to carry out a more thorough investigation.

‘I believe that Which? has found a problem that deserves investigation. When Which? has investigated optometrists and dentists it has come under criticism, but the purpose is to alert the appropriate authorities of possible problems that needs further exploration in the public interest.’

Where do we go from here?

Of course, with 1,945 comments we haven’t been able to feature them all, nor have we been able to cover every single view. But there are some questions we’d like to answer.

How was the panel selected? Our expert panel, including a GP and a qualified dietician, were chosen because of their extensive experience in the fields of nutrition and health.

How did we choose the nutritional therapists? The therapists involved were chosen completely at random from across the UK, using methods we believe most consumers would use to find a therapist – namely, searching online and using professional directories.

Our food researcher, Shefalee Loth, who was involved in the investigation, comments:

‘Our findings show that the nutritional therapy industry requires tighter controls and better regulation to make sure it meets the high standards Which? Conversation commenters expect. So, we were very pleased to hear that on the back of our research, BANT and the Nutritional Therapy Council have decided to investigate with an expert panel.’

It’s clear that the topic of nutritional therapists is a controversial one, and all of your comments show that there are differing experiences. To open up the debate again – do you think the nutritional therapy industry needs to improve, and if so, how?

Comments

What does the nutritional therapy industry need to do to improve, and if so, how?

Perhaps statutory regulation and the control of standards could be an answer, but I believe the real issue here is twofold: one of general acceptance of NT as a part of functional medicine within Orthodoxy, and the outcome/conclusions from BANT’s independent expert panel into the original investigation by WHICH. Only then shall we be able to move on.

Jacquie says:
14 March 2012

The Nutrition Society should be involved in any discussions on the standard of nutritional therapy.
They publish a list of accredited nutritionists – who are well qualified professionals. I think the term ‘nutritional therapist’ is used by a wide range of competencies from anyone with very minor or no qualifications and to people who are well qualified to help consumers with their dietary health. There needs to be standards of qualification applied to the term so consumer know what they are getting. Dieticians/Accredited nutritionists are qualified to national standards and are the most appropriate professionals for consumer advice on diet – not nutritional therapists unless they are to be qualified to nationally recognised standards – which is not at present the case, leading to advice not firmly based on the rigorous application good science.

Chloe says:
14 March 2012

THe problem is that the nutrition society has a different definition of what a competent nutritionist/nutritional therapist should be to the functional medicine definition of a good nutrition ist/nutritional therapist. Involving the nutrition society is not the way to resolve things. Nutritional therapy needs to be assessed in its own right as part of functional medicine.THe problem is that functional medicine is not recognised. This is essentially what CHris b has said. So how do we go from here ??

ExR&D says:
14 March 2012

“Do you think the nutritional therapy industry needs to improve, and if so, how?”

Part of the improvement process is plain-English statements for all to read. As a start, I suggest these statements might cover the following:

1. What is nutritional therapy?.

2. What is optimum health? Is it merely absence of disease, or is it a state that goes beyond absence of disease, a state where disease is unlikely to be triggered?

3. How does nutritional therapy differ from what dieticians offer? For example, is my understanding correct that dieticians deal with symptoms (like GPs), whereas nutritional therapists root out causes of ill health and treat those? Also, what would be the nutritional therapist’s approach to helping an overweight/obese client who wished to lose weight compared with the approach of a dietician?

4. Do nutritional therapists adopt a multi-pronged approach to healing and prevention? For example, there may well be a psychological component to a client’s health issues – for example, being overweight/obese. Are nutritional therapists aware of the possible need to refer a client on to someone for psychotherapy? I say psychotherapy deliberately rather than counselling, as the former is more likely to deal with causes while the latter tends to address symptoms.

5. What is the role of nutritional therapists in the wider context of healthcare and prevention of illness?

Patrick wrote: ….do you think the nutritional therapy industry needs to improve, and if so, how?

1. Nutritional therapists should agree that certain treatments should NOT be offered, on the basis that there is little or no evidence of benefit. Iridology is one example that was discussed in the previous Conversation.

2. Nutritional therapists should not sell supplements or benefit from their sale, since this could encourage recommendation of supplements that are unnecessary. They should, instead, make their money from consultancy fees. (In the UK, GPs and consultants do not benefit from prescription of drugs.)

3. Nutritional therapists should not recommend supplements unless there a requirement has been demonstrated by testing or there is a reasonable case that they are required. The top priority should be to ensure that clients receive good dietary advice.

I believe that there is plenty of opportunity for nutritional therapists to act as private dieticians – providing individual care for their clients, beyond that which can be provided by the NHS. They can help investigate challenging problems such as identification of food intolerances.

To put this in perspective, I believe that GPs should also be prescribing fewer drugs and that there is a case for reviewing the current official recommendations for vitamin intake and use of supplements.

The problem, as I see it, is that “nutritional therapists” have shown themselves to be, on the whole, firmly in the world of alternative medicine. In other words, they are not really interested in evidence and have a tendency to be actually anti-science. I know there are some exceptions to this, but the very fact that the chair of BANT sells iridilogy should show what I mean.

This means that no amount of regulation will help, any more than it is possible to regulate homeopathy in any meaningful way.

As with any other form of alternative medicine, I have no wish to ban it. All that can be done, I think, is to apply properly existing law about making false health claims. There are actually quite strict laws about making claims that can’t be justified by evidence, but the responsibility for enforcing them lies with Trading Standards officers who fail to do their job, as shown recently when they were put to the test http://www.ncbi.nlm.nih.gov/pubmed/22403120

In contrast, the Advertising Standards Authority has done quite a good job, though it has no power to prosecute.

If nutritional therapists were to stay within the law, and stop promoting things that don’t work, then good luck to them. They may do some good by encouraging healthy eating. That’s a fairly limited role though, since advice on healthy eating is widely available and free.

David,
You mention that Nutritional Therapy or Therapists are not really interested in evidence and have a tendency to be actually anti-science.

Well, if you delve a little more deeply into what NT’s have to offer, you will find that much of the therapy is actually evidence-based, and certainly not anti-science at all.
http://www.bant.org.uk/bant/jsp/briefingNote1209.faces

For example, a report by the World Cancer Research Fund in 2007 stated “Nutrients and food constituents have effects that can either inhibit several events that lead to cancer or contribute to cancer development, by altering DNA itself or by altering how the genetic message in DNA is translated”………….
World Cancer Research Fund / American Institute for Cancer Research (2007) Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC. AICR

In fact food can be thought of as “information” that has the potential to alter cellular function……….
Bland, J.S. (2007) What role has nutrition been playing in out health? The xenohormesis connection. Integrative Medicine, 6(3): 22-24.

Nutritional Therapy therefore is a holistic complementary (not alternative) therapy based on scientific research and clinical findings, It supports the human body’s natural ability to heal itself by supplying the tools- the nutrients- for repair and renewal. It can be used alone or in conjunction with conventional medicine and other therapies.

However, I would agree with you that some therapies on offer by NT’s are not evidence-based and of dubious efficacy, but we should not forget, that Nutritional Therapy is mainly based on Nutrition, and the value of nutrition in restoring health as a primary healthcare modality.

A few years ago, one of the mum’s at a primary school, offered reflexology at a reduced price to her normal charges, at the school. My son had suffered from chronic constipation for many years and he went for a first session. My expectations were not high but as he’d had this for years and no medicines were working very well and the hospital consultant wasn’t able to help either, I thought worth a try. The first session went well and he was given nutrional advice – within 2 weeks he was 50% better and he continued the sessions for 6 weeks and more supplements were recommended – which we got from the health store. I couldn’t believe how quickly it all worked and the results from foot massage – I wouldn’t hesitate to recommend this form of therapy to anyone with the same or different health problems as this is something I now firmly believe in. It has changed my opinion of the medical profession as a whole and I am now far more open minded to other remedies!

For all of those disagrees I received from my reply to David, I suggest you all read this link in its entirety.
Thank you.
http://www.benthamscience.com/biot/samples/biot1-1/Zhao.pdf

It still seems that some of you are unable to comprehend the science that I posted on with this link……………..
http://www.benthamscience.com/biot/samples/biot1-1/Zhao.pdf

Nine disagrees so far in fact; so if those of you who are responsible for those disagrees come out and say why, and refute the scientific evidence, I’d be very grateful. Please also cite/supply the evidence for those reasons. If you are unable to refute this evidence with rational evidence-based science, then we know what that means, don’t we.
Thank you.

Selina Import says:
16 March 2012

Thank you Chris for your post yesterday and the link you posted today. I have passed these on to my MP.

Lex says:
19 March 2012

This article does not differentiate Nutritionists from Nutritional Therapists, and yet a mention of dieticians and nutritional therapists working together is mentioned – does that mean that the authors of this article are including fully qualified Nutritionists (with a science degree) in with this ‘nutritional therapist’ group. As a qualified and registered Nutritionist who bases her advice on scientific evidence being compared to some nutritional therapists who get their qualifications online is slightly offensive. I worked extremely hard in the three years at university and was awarded a first class degree. When people have bad experiences with nutritional therapists and give Nutritionists a bad name as a result it is extremely frustrating and upsetting. I would only need to study for one more year to become a dietician… I refuse to pay the fees to simply get that title to be treated with the respect from the general public which should already be present. I am sure there are many nutritional therapists who work very hard and honestly, in the same way I’m sure that there are some Nutritionists who do not… I simply wish that the two were not constantly grouped together as though the same profession when there are clear differences between. It would be like grouping a Nutritionist and Dietician together – they both have similar interests in health but in practicality have different qualifications and areas of specialism.

I can sympathise, Lex. Perhaps the answer is to get everyone properly educated before they are let loose on the general public. The public needs to understand how how to choose someone competent and until this is done the lack of respect is likely to remain, especially since some NTs indulge in some questionable therapies.

Lex,
I agree with your comments for the most part but when you mention………..
“As a qualified and registered Nutritionist who bases her advice on scientific evidence being compared to some nutritional therapists who get their qualifications online is slightly offensive.”

I would beg to differ, as many Nutritional Therapists are also educated to degree level with BSc and MSc at nationally recognized Universities, basing this training on scientific evidence as well. So to group many of them into just holding online qualifications is not entirely accurate, as attendance is required for clinical experience in obtaining that degree.

There are also fundamental differences between Nutritionists and Nutritional Therapists, as the latter derive their expertise from Functional Medicine, which is also evidence-based………….
http://www.yourmedicaldetective.com/public/department50.cfm

Lex says:
20 March 2012

@chrisb

Hi Chris, I fully appreciate that some Nutritional Therapists will indeed have a degree and offer sound advice to their clients – as I did state in my earlier post. I agree that as professionals we should all work together with the same goal in mind. My upset comes from those that charge £80 per hour and give advice which results in bad press for Nutritionists who have nothing to do with the supplements or IBS advice given by some NT’s. If I ever had a client who insisted on using supplements instead of making dietary changes I would carefully recommend an alternate professional such as a well established and properly qualified NT who would be happy to suggest supplements. I personally do not promote supplements which is a clear difference in profession. Nutritionists and Nutritional Therapists – like Nutritionists and Dieticians – have different qualifications, education and areas of specialism (otherwise we would all just have the same job title).
To say I am slightly offended when I hear reports of Nutritionists being banded with NT’s who are giving the wrong advice I feel is within my right as a Nutritionist. I do not want to under mind anyone in their trade, I am simply hoping for a definite distinction between the professions so when the odd NT does crop up in the media for giving incorrect or potentially harmful advice it is not going to put my potential career in jeopardy within the eyes of the media or public.

Sam says:
20 March 2012

@Lex. I am glad a card-carrying nutritionist is at hand as I was not getting very far on the obesity conversation (Government Responsibility Deal etc). Perhaps you can point me to the evidence on which the Department of Health bases its advice that obese people should base their meals around bread, potatoes, rice and pasta (wholegrain where possible)? Many thanks.

Lex says:
20 March 2012

Hi Sam, forgive me if some of the following information is glaringly obvious but in order to answer your question I must start with the basics. Bread, rice, potato and pasta are all carbohydrates which in the body contribute the main source of fuel (especially for the brain and muscles). Every person, including anyone with a weight problem should ideally base their meals upon carbohydrates in order to fuel their body efficiently. The phrase ‘everything in moderation’ is very fitting for this conversation as a fair number of people suffering with obesity consume far too many calories. This is the central problem – calories. If you have ever come across the energy balance cycle you may understand what I mean. If the energy (in this case calories) entering the body equals the energy being expended (through exercise or general living) then weight will be maintained. If you think that the energy coming in is more than that being expended i.e a person consumes 3000kcal per day but only expends 2500kcal than an excess of 500kcal is stored in the body. If the body does not need this extra 500kcal for general repair then it will simply store it as fat. Now it does not matter where these calories come from BUT there are far more calories per gram of fat (9kcal/g) than carbohydrates (4kcal/g) or protein (4kcal/g).
You may say to this ‘eat more protein then as carbs have a bad name’ but I would disagree. Protein is indeed needed in the body for many metabolic processes as well as growth and repair but in excess can cause toxicity. As a nation on average we eat enough protein without even trying so recommending someone to eat more (unless they require it) would not be a good thing to do.
Fat is of course the most calorific nutrient and is the one which should be closely monitored. We do need fat but it’s the saturated fat ie contained in things like butter and cheese that we ADD to carbohydrates which can lead to excess weight gain in most cases.
If you reduce your portion sizes, therefore reduce your calorie intake, and increase your energy expended you should (based on numerous scientific studies and basic math) lose or maintain weight. This advice therefore is suitable for anyone, including people who suffer with obesity. There are of course exceptions to the rule where genetic tendencies come into play but that is a whole other conversation and if someone has been advised to make dietary changes in order to lose weight it would be hoped that their GP has allowed and cleared that person from other medical complications.
In terms of the actual journals and studies in which all of this can be proven there will be hundreds, if you would like me to find one as an example I will certainly try. In the mean time please come back to me with any questions. I gained my degree in Nutrition and Public Health from an extremely well established university and was taught by several people each with a Doctorate in health sciences. We constantly referred to scientific data and I have no doubt in the credibility of the Department of Health, Food Standards Agency or NHS who provide the advice you refer to.

Thanks for that Lex.

Are you happy with the ‘Eatwell Plate’ promoted by the NHS and Food Standards Agency?
http://www.nhs.uk/Livewell/Goodfood/Pages/eatwell-plate.aspx

This came in for criticism in a Which? Conversation because it includes some food/drink that is high in fat and sugar. I see this as an acknowledgement that most of us will eat some of this food, for example if we eat out even if we are usually careful about what we eat. My suggestion would be to leave the high fat/sugar food in but suggest it should be avoided if possible, particularly by the obese.

Lex says:
20 March 2012

@wavechange.

I do agree with the Eatwell Plate and I agree with your comment that it should be left there but anyone discussing healthy eating or the Eatwell Plate should indeed advise that that particular food group be consumed in the smallest amount and with caution especially if they have a current weight or health problem.

The Eatwell Plate promotes a healthy diet which is achievable without watching calories ect for those not interested in assessing every detail of what they eat but would like a general guide to follow. If we excluded the ‘food or drinks high in fat and/or sugar’ no one would follow it because it is inconceivable to expect someone to completely cut out high fat or high sugar food/drinks from their diet every single day. It would be an unrealistic approach to healthy eating.

Once again I say ‘everything in moderation’. There are circumstances which may call for a more drastic diet but that is where health professionals come in to provide more tailored and detailed help, support and advice.

Krystie says:
20 March 2012

I’m studying a bachelors of science (Nutritional Medicine), and I believe we have a place in health care to work along side all other modalities. All assignments/work I complete at uni always use scientific/ medical journals and info. Everybody has a different body and not everybody can eat the same thing or stick to the same plan!

Lex,
Your post which began………..
“Hi Chris, I fully appreciate that some Nutritional Therapists will indeed have a degree and offer sound advice to their clients”.

I understand where you are coming from now so many thanks.

Lex says:
20 March 2012

Thanks Chris, I appreciate you response.

Jenny says:
20 March 2012

If the Eatwell Plate depicts high fat/sugar items that would not be allowed under nutrient profiling then it should not be touted as evidence-based healthy eating advice. That is clearly nonsense.

I have friends whose kids would happily tuck into unsweetened grapefruit and other healthy foods rather than eat sweets. It lasted until they went to school.

Perhaps we should be realistic and accept that most of us will eat a bit of food that is high in fat and/or sugar. There are people that need to be very careful about what they eat, such as those with allergies and intolerances, and diabetics. For the rest of us, a balanced diet (and not too much of it) and a reasonable amount of exercise is better advice. Many weight reduction diets have little success because they are too extreme.

Lex says:
20 March 2012

@ Jenny

The Eatwell Plate is a simple advisory tool which enables people to look at which food group you should ideally consume in large or small quantities. It is not a tailored plan to fit in with everyone’s individual circumstance and does not advise that high fat or high sugar food or drinks should be consumed. It is simply acknowledging the fact that those foods ar indeed consumed and promoted through the media and in supermarkets etc and therefore advise that if they are eaten to only consume a small amount each day or week.

If you have ever worked with people within a community based setting you must surely appreciate that a ‘optimum diet’ which includes none of these foods is an unrealistic approach. You only have to look at food packaging and labelling or even population studies to see that – whether we should be doing or not – we eat these foods in our diet and it would be extremely difficult to cut them out completely. The Eatwell Plate is therefore a realistic guide for the average person (Guide and Average Person being the operative words there). There will be some dispute I’m sure and those who disagree, personally I always refer to the Eatwell Plate within the community and believe it is a good start and an excellent basis for a healthy diet.

I don’t know if the Eatwell Plate is promoted in schools, but being visual it would probably be useful. Although school kids rebel against advice from teachers and parents, it is surprising how much we do take on board when we are young.

I am in agreement with you Jenny re’ the inclusion of some junk food in the eatwell plate. In particular I think that a can of coke is displayed, and where this soft drink has been in the news of late: Pepsi for example have been using “aborted fetus cells” in soda flavoring research, and although these cells are not necessarily in the final products made by PepsiCo, such cells appear to play a needless part in the production of artificial flavor chemicals used by these and other companies.
Many soft drinks/sodas contain phosphoric acid, a substance which health experts have long warned can destroy tooth enamel.
One study links the consumption of soft drinks to pancreatic cancer
http://www.reuters.com/article/2010/02/08/idUSN07113352
Coca-Cola has also announced it will change the coloring in its signature soft drink, after health authorities in California threatened to force the company to affix a “carcinogen” label to the beverage. The chemical in question is 4-methylimidazole, a component of the chemical stew that’s typically simplified down to “caramel coloring” on food labels.
The Center for Science in the Public Interest estimated that this chemical in “Coke and Pepsi products tested is causing about 15,000 cancers in the U.S. population.”
http://www.theglobeandmail.com/life/the-hot-button/coke-changes-ingredient-to-avoid-carcinogen-label/article2362975/

I find it quite amazing that foods/drinks of this kind, can be included in the eatwell plate at all.

Jenny says:
20 March 2012

If the Eatwell Plate is supposed to be ‘evidence-based’ healthy eating advice then Which? are right to challenge it for displaying foods high in sugar/fat. I do not understand Lex/Wavechange how you can support advocating advice that is simply not grounded in science and the consumption of foods which would be banned under the scheme to protect children from junk food. It is extraordinary if the Department of Health policy makers should be content to promote as ‘healthy’ on one hand what they put subject to restrictionson advertising on another. The whole thing is barmy, and cannot be defended. Lex is just about to start professional life — are you seriously going to go out and promote something you know is not evidence-based? And in schools?

I have explained my reasoning, Jenny.

I would be happy on a ban on advertising of junk food and recommendation that takeaways and restaurants offer smaller portions where appropriate. As far as the science goes, I have never seen anything to suggest that a small amount of junk food does any harm.

You are missing out if you never eat any chocolate and it’s not much fun if children cannot have a few sweets – as part of a balanced diet. Lex advocates ‘everything in moderation’ and I completely agree. It would be interesting to have Shefalee’s opinion.

Lex says:
20 March 2012

@Patrick Steen

Hi Patrick, thank you for responding to my comment. I appreciate you clearing up the matter that it was in fact a commenter and not the authors or yourself that made the statement about Dieticians and Nutritional Therapists working together which instigated my own comment regarding Nutritionists.

I do feel that the differences between all three professions should be made clear by the media and I have followed several debates where nutrition organisations have felt the same frustration as I do when the matter is discussed. I presume that the debate will still continue for some time! Once again, thank you for your response.

Lex

Jenny says:
21 March 2012

I too would be interested in Shefalee’s opinion as to whether evidence-based healthy eating advice should include foods which would fail nutrient profiling and be subject to advertising bans.

Which? supports the Eatwell Plate. The aim of the plate is not to say that the foods high in fat and sugar should be included in your diet but to show the balance of foods you should eat, so that if you do eat high fat/high sugar foods the proportion these should make up of your diet in relation to the other food groups – that is, not very much.