/ 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
krystie says:
21 March 2012

It would be nice to see who dislikes comments as ‘Im not sure what iv’e written here that could be dislikeable?
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!

Am I more qualified if I say Im a dietician? I could do some extra units and become one?

I think If your going to dislike a comment have a comment to back up your reason.

@krystie – Annoying, isn’t it?

Having read your post, the first two sentences are statements about you and your opinions – nothing to disagree with there unless someone knows you better than you do! And anyone who believes that we all have the same body and can stick to the same [eating] plan must have been force-fed Champagne and caviar as a young child. God help them when they reach old age and have a delicate digestion.

Post again – and ignore some of the mindless responses we all get from time to time.

Many click on agree/disagree without explanation on Which? Conversation. The reason why there are no comments may be that you have not given any detail about any of the points you have made.

This Which? Conversation is about nutritional therapists, though that might not be obvious from the comments posted so far. 🙂 This and the previous Conversation relate to a Which? report that found evidence of poor practice among nutritional therapists. It would be good to have your input, since many of the contributors to this website are quite old.

I nearly commented about the fact that you and other students have privileges that allow access to a wide range of scientific reviews and papers, whereas nutritional therapists will only have access to those articles that are free to the public, unless they pay quite a lot of money. I suggest that you make use of your access privileges while you are a student and keep copies of useful articles for use in your career.

Jenny says:
21 March 2012

I await Shefalee’s opinion but promoting high sugar foods as part of evidence-based healthy eating advice does not strike me as good practice.

If you read the accompanying information to the Eatwell Plate you will see that foods with a high sugar content are NOT being promoted, and there is advice on cutting down sugar intake.

Would you deprive children of all sweets or try to encourage them not to eat too many (and brush their teeth afterwards)?

Lex says:
21 March 2012

The Eatwell Plate is used as a Guide to Advise the average person upon which food groups should be eaten and in what quantity. The portion sizes for each group apart from the one in question ‘food and drinks high in fat and/or sugar’ are based on scientific evidence, studies and basic metabolism. The group in question is simply an Acknowledgement that these foods are present (and in quite large quantities in some cases!) within a person’s diet and so the advice is to eat less of them. The Eatwell Plate does not tell people to eat high fat or high sugar foods or drinks. Without the inclusion of this group it would be an unrealistic expectation for people to actually follow it. Once you have been in a community based setting and have been asked questions about a healthy diet and not acknowledged the fact that people eat these foods and are not willing to cut them completely from their diet then maybe you will understand where the FSA are coming from and we can discuss it again.

We are not here to turn everyone into the same person with the same diet – we are working towards everyone reducing their risk of CHD, Hypertension, Strokes, Cancer and other awful and potentially fatal health problems.

This debate surrounding the Eatwell Plate has unfortunately gone off the subject and I am unsure what you are trying to achieve by dismissing the years of work and research which have gone into creating advice surrounding a healthy diet – which works! This is a clear example of how different Nutritionists and nutritional therapists work and why I posted my original comment about being annoyed and upset when the two are grouped together as though the same profession. It’s a shame that the two cannot work together in some instances – this being a prime example of why.

Jenny says:
21 March 2012

One of the five groups on the Eatwell Plate is titled ‘Food and drinks high in fat and/or sugar’ – it should not be there. The US choosemyplate.gov does not promote unhealthy foods which would be banned from advertising. Why does the Dept of Health have a section on its healthy eating plate which comprises foods which by definition would fail nutrient profiling and come under advertising restrictions? Perhaps its just me and I’m going mad —- but this seems to be a perfect example of the Eatwell Plate representing the Emperor’s diet, so he can get in his shiny new clothes.

Lex,
your post which begins………..
“The Eatwell Plate is used as a Guide to Advise the average person”………….

I would like to know your thoughts/opinions on my own post which begins…………….
“I am in agreement with you Jenny re’ the inclusion of some junk food in the eatwell plate”.

…………………as surely this isn’t just about high fat/sugar foods, but some of their harmful chemical constituents which are claimed to be carcinogenic. Blanketing some foods/drinks on the Eatwell Plate as being just high fat/sugar, and their recommended limited intake, is a little over-simplified would you say?

Lex says:
21 March 2012

Once again Chris the Eatwell Plate is an acknowledgement that these foods are eaten and so included in a picture of ‘what your plate should ideally look like’ – not ‘this is what we want your plate to look like to achieve optimum health’. In comparison to what the average person’s plate currently looks like it is a great difference and positive change. I agree completely that the foods in that section in an ideal world should not be consumed, but this is not an ideal world. We have many battles to be won in the UK with relation to health and each must be fought step by step. I’ll use the example of salt consumption:

Ideally you should not consume more than 4g/day. As a nation we consume over 10g/day – the advice given to drop salt consumption from 10g/day to 4g/day would be unrealistic and laughed at by the general public. We therefore work to one step closer by advising a reduction to 6g/day. Can you see where I am coming from?

I had a choice when I began my studying – I could either complete a distance learning course in nutritional therapy and learn about optimum nutrition (and believe me I read many books relating to this in preparation for my decision, many of which promoted supplements) or I could go to university and learn about a topic which would enable me to help people in my local community achieve a healthier lifestyle day to day and step by step within their working budget. I believe the Eatwell Plate works and I have seen the impact that that little bit of knowledge has had on a person’s life. It appears that there will always be a difference of opinion on these guidelines. I am happy to accept that some people will not use it in their profession. Personally I will continue to use it and believe in its positive effects.

Lex says:
21 March 2012

May I also add that until the food manufacturers and supermarkets stop producing and selling these unhealthy products we must all fact the fact that they will be consumed. Is it not better to work alongside someone you are trying to help by accepting their current lifestyle and advising changes for the better than to fight against them and simply tell them they are doing wrong and give them unrealistic goals?

Thank you for that explanation Lex.
I appreciate your comments.

Apologies for taking the discussion off topic by mentioning the Eatwell Plate. Our topic is nutritional therapists and not nutrition.

It would be good to have some input from NTs and those who have used their services.

Jenny says:
22 March 2012

Well perhaps it should be both – I detect some double standards here and await Shefalee’s opinion.

Jenny says:
22 March 2012

Thank you Shefalee for confirming that Which? supports the Eatwell Plate – and I accept the rationale that you, Lex and Wavechange have put forward that it is a pragmatic tool — but as such it is ‘belief-based’ and not ‘evidence-based’ and should not be portrayed as something it isn’t.

Jenny,
I think you will find that it is the influence of the Corporate food industry that has shaped the way we eat and drink, and under such powerful lobbying, the eatwell plate has been coerced into including some foodless and mostly harmful foods/drinks.
Money being the name of the game here, as with any other powerful corporate lobbying/influence, and esp’ the Pharmaceutical Cartel both here and in the United States.
http://freefromharm.org/food-safety-food/food-industry-influence-over-food-regulators-a-growing-problem/
http://www.guardian.co.uk/politics/2010/dec/09/health-policy-extent-corporate-influence
http://www.foodpolitics.com/food-politics-how-the-food-industry-influences-nutrition-and-health/

The Eatwell Plate was designed by our “independent” Food Standards Agency, where top individuals on their board have “industry ties” and are in favor of GM foods despite the growing scientific evidence against its use……………………………
http://www.powerbase.info/index.php/Food_Standards_Agency

Jenny says:
23 March 2012

While the influence of the food industry is not to be under-estimated the Eatwell Plate is not of their making. The 1991 COMA report led to the ‘Balance of Good Health’ and this was the Dept of Health. When Food Standards Agency took over they updated the graphic and launched the Eatwell Plate – but there was never any updating or revision of the science that underpinned it. That was a missed opportunity and somewhat suprising given the millions the FSA has ploughed into nutrition research. We still basically are working on the 1991 COMA advice, and the COMA report itself did not play down the problems with the science underpinning it – it was a best guess at the time and there was nothing wrong with that. But 20 years on it is now ‘evidence-based’ – but the evidence actually doesn’t bear much scrutiny.

And my advice to Lex is go and do a 1-year masters in dietetics — having a degree in Public Health Nutrition and only being allowed to promote the Eatewell Plate is pretty much useless. And public health nutritionists are only allowed to giving healthy eating advice to healthy populations. Obesity is a disease – and therefore only dietitians should be giving advice to those who are obese.

Selina Import says:
23 March 2012

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

Patrick there is always room for improvement in whatever we do and also room for being understood. Do we consider the NHS as an “industry”? I suppose we do.

I do believe Nutritional therapy has an important place in our society. Functional medicine and nutritional therapy is about health promotion and enabling people to find ways of being really well.

We need to work towards nutritional therapists and NHS professionals understanding each other.

We do have a different “Eatwell plate”. We tend to look at symptoms and help people to work out what mught help them to reduce these. We don’t diagnose or treat disease. I would have thought that it would be difficult for a dietician/nutritionist to truly judge what we do because we come from a different standpoint. So we do have to wait for BANT to give us some understanding of the Which study

From the news we hear that there are 3 million elderly who are undernourished or malnourished. Whatever the real figure, I feel we need to use all possible approaches to enable the elderly, and all of us from an early age, to improve the health of the nation.

There have been various suggestions about better regulation of nutritional therapists in the Conversations. My understanding is that NTs can register with the CNHC, but this registration is voluntary and some have little respect for CNHC because of its involvement with certain aspects of complementary medicine.

Would it be best to set minimum training standards for NTs, set up a new regulatory organisation, and require all NTs to be registered with it?

To clarify my post, I am suggesting the possibility of having a new regulatory organisation specifically for nutritional therapists.

Lex says:
23 March 2012

I agree with you wavechange. I had to complete quite a rigorous application to become a registered Nutritionist and had to submit pages and pages (30 plus) of evidence to support my qualifications and experience. I am unsure what the process is for NT’s – perhaps someone could clarify? It would be hoped that they have to supply evidence to become officially registered as an NT?

I am also unsure about which regulatory bodies are the ones to look out for? I am only familiar with BANT.

I am currently registered with the Association for Nutrition which is recommended by the NHS – is there something similar in place for NT’s? It would be useful to know in case I have clients insisting upon taking supplements which I do not personally recommend.

I don’t think I can help. My background is in biochemistry/microbiology and I knew absolutely nothing about NTs before reading the Which? report. I am not happy with the popular belief that if we are unwell we automatically feel the need for pills, whether it is a GP’s drugs or an NT’s supplements. I know enough biochemistry to realise that these chemicals might interfere with our normal metabolism.

GPs do not profit from prescription of drugs but some NTs make money from the sale of supplements, which could encourage their use where not necessary. I’m firmly of the belief that NTs should charge reasonable fees from consultation fees and not as a result of sale or recommendation of supplements. It also worries me that supermarket shelves are stacked with supplements and their production is very big business.

Though some people will need supplements there does seem to be misuse of scientific literature to convince the public and some of the practitioners that most of us should be taking supplements. I hate this misuse of science. A sensible diet – and not too much of it – seems to me to be the top priority for most of us. It would be good if the NHS could provide every one of us with individual advice and support concerning nutrition but we don’t have the resources. Good NTs could fill the gap, but I think they have their work cut out to improve the reputation of their activities.

The need for pills of any kind I believe has been instilled into us over time by medicine generally, and where the majority of us have unwittingly delegated responsibility for our own health, into the hands of GP’s and Doctors generally.
Supplements, if recommended at all, are prescribed by NT’s and other health professionals such as Naturopaths, as a result of testing to deal with a biochemical/nutritional need, as opposed to the prescription of a pharmaceutical, which for the most part, will deal with the symptoms of a health-malady, rather than address the true causes of that malady. There are many examples of the latter, such as dealing with migraine headaches, or SSRI’s which only have a theoretical basis in dealing with depression. Numerous studies have shown that exercise is just as, if not more effective at dealing with this mental illness, than any prescription drugs.
Functional medicine, from which NT is based, addresses, or is alleged to address, the true causes of disease without masking symptoms.

Indeed, GP’s do not profit from prescription drugs, but then many NT’s and Naturopaths do not profit from the provision of supplements either, and we have had a few posts here that have mentioned they can be sourced from outside their own practice, as happened in my own case when I recently visited a Naturopath who offered me that choice.

Is there any need to be overly concerned about the sale of supplements in supermarkets? I for one have been very grateful for their ease of access, after my youngest daughter had suffered from three consecutive miscarriages, and despite her having a well-balanced diet and other measures, including freedom from stress. On the advice of her Mainstream Gynaecologist, she took a well-known brand of supplements targeted at pregnancy care, and after conceiving again, I am now expecting to become a grandad for the first time in late May.

In light of US National Cancer Institute study showing that cancer cells are ‘avid sugar consumers’
ref; http://jnci.oxfordjournals.org/content/early/2012/11/02/jnci.djs490.full , is Which? going to make some kind of apology to the poor nutritional therapist they vilified for telling a cancer patient not to eat sugar?

Helen Osbourne says:
13 November 2012

I wonder if Which? knows about this recent article on the Journal of the National Cancer Institute that clearly links high sugar/carbohydrate diets with increased risk of (at least some types of) cancer.

Higher Dietary Glycemic Load Linked to Worse Colon Cancer Survival, available from http://jnci.oxfordjournals.org/content/early/2012/11/02/jnci.djs490.full.

It may turn out that what Nutritional Therapists are saying is right, and what Which? was claiming was wrong and biased?

Is Which? going to publicly apologise for this?

Thank you Mark and Helen. I was vilified here for daring to mention that there is any causal relationship between sugar and cancer, and that cancer feeds on sugars, so the apology should not only be directed to the Nutritional Therapists, but also to yours truly, and not only from WHICH themselves, but from the Mainstream apologists who contributed here originally.

Thank you Mark and Helen for bringing this research to our attention, which says there’s a link between cancer and sugar. We didn’t deny or dispute this in our article. We disputed the fact that a nutritional therapist told a patient that she could cure/rid her of cancer by removing sugar from her diet. The therapist implied she could reverse the cancer which is not medically proven.

To quote Shefalee’s words from the previous (now closed) Conversation on nutritional therapists: 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).

Anyone who ate a diet without sugars or carbohydrates would still have glucose in their bloodstream. It is needed by the brain. Cancer is complicated, hence the continuing lack of a miracle cure, but at the simplest level, that is why dietary changes will not cure cancer.

It’s fairly well known that being overweight or obese increases the risk of certain cancers and plenty of other health problems.

So Shefalee/Wavechange, can you please tell me whether you think the nutritional therapist advice to cut out sugar is prudent or whether cancer patients should follow the advice given by the dietetics department at the Royal Marsden, which includes the following:

“Sugar, honey, syrup, treacle and sugary foods, such as chocolate, cakes and sweets: These are a good source of energy”

http://www.royalmarsden.nhs.uk/cancer-information/living/pages/eating-well.aspx

How long is this farce going to continue about out-of-date dietetic practice being supported because dietitians are state-registered professionals and therefore must know what they are talking about.

My suggestion is that the nutritional therapist should leave it up to those experienced in handling patients with cancer.

You have selected foods that obviously contain sugars, from the Royal Marsden list. Unfortunately, every one of the other foods can be converted to sugars too.

Avoiding consumption of too much sugar may help in avoiding cancer, though there are many other factors, but as Shefalee has said there is no evidence that cancer can be reversed by diet. That is not for the want of trying.

Thank you for your comments Shefalee, but you have said that “the therapist “IMPLIED” she could reverse the cancer which is not medically proven”, which is not quite the same interpretation as “WILL” or “CAN” reverse cancer. This of course flies in the face of the evidence of the “Budwig Protocol”, named after Dr Johanna Budwig and Germanys leading Biochemist of her day holding a PhD in Natural Science, a doctorate in physics, and was a qualified pharmacologist and chemist. She was also the chief expert consultant for drugs and fats at the Federal Institute for Fats research.

Dr Budwig gave numerous conferences, after which The Central Committee for Cancer Research were not happy with many of her statements, which finally lead to their taking court action against her.

In court, the judge, after having reviewed the evidence from both sides, pulled the cancer research people aside and told them not to take on this woman. The court records quote the presiding judge: “Doctor Budwig’s documents and papers are conclusive. There would be a scandal in the scientific worlds, because the public would certainly support Doctor Budwig.” and whose protocol has a proven track record of curing over 90% of terminally ill cancer patients via dietary means, the evidence of which has been ignored by the Medical fraternity.

Wavechange, we know that the bodys main fuel source is glucose, but this is not about complex sugars found in complex carbohydrates, but about excess dietary and refined sugars as found in many processed foods such as HFCS, and that Mark is referring to.
To mention that there is no evidence that cancer can be reversed by diet for the lack of trying is absolute and sheer nonsense, because the actual evidence has been ignored or suppressed by Mainstream Medicine, in favour of drug-based approaches, which have to date failed miserably in the “War on Cancer” instigated by President Nixon over 50 years ago.

chrisb

I am not interested in discussing quackery, supplements, fasting, etc. You may remember that I suggested that we had no further dialogue.

nutritihealth says:
13 November 2012

Thank you Shefalee for supporting obvious out-of-date dietetic practice. As Mark says, patients across the UK are being advised to “eat high calorie foods such as crisps or cakes and anything containing cream” to “build themselves up”. I have this in writing in a report from a dietician to my dear friend who suffers from Parkisons Disease.

This whole “investigation” was utterly biased to start with and you’re Which? is now starting to show its true colours.