/ 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

Experienced dietitians are telling cancer patients to consume foods high in refined sugars because they are a good source of energy. Nutritional therapists tell cancer patients not too consume refined sugars because they can promote cancer growth. There is a very clear divide here and I would like to know which group is right. As Which? is a champion for all consumers, including cancer patients, I think the least it can do is review the evidence-base for the dietetic advice, and come out with a clear statement that it is OK for cancer patients to eat foods high in refined sugars, particularly high fructose, that those foods are a good source of energy and will not promote cancer.

Yes I recall you said that wavechange, and I have not posted here on any of those subjects, it is just that your mindset perceives this to be so.

Selina Import says:
15 November 2012

Hello Which Mark Helen Chrisb wavechange and Nutrihealth. So much has been challenged in the recent past whether the topic here or politics, police, NHS, greed or strange human behaviour. Views are often of the closed minded varity and polarised. Words are misinterpreted rather than the meaning understood Let us hope we are in an opening up period where we can understand that we can no longer rely on the experienced or “scientific proof”. I don’t know whether I avoided a recurrence of aggressive breast cancer because I avoided refined and even a lot of unrefined sugars. I am very grateful and happy and joolly glad that I spent much time finding out what information there was available that would enable me to be healthy.

One of the problems of trying to link dietary changes which diseases like cancer is that it is research trials like the one mentioned above are very hard to carry out especially when they rely on government/charity funding (i.e. when there is no commercial incentive). A more fundimental problem with RCTs (randomised clinical trials) is that you must only change one variable at a time and so can often only get a small change in patient outcomes. What fascinates me is the historical epidemiological data which shows that the age adjusted cancer rates in Japan in the 1970s are between 10-20 TIMES smaller than current rates in Europe/US. Further studies have excluded genetic differences by following Japanese migrants into the US where they soon suffer US levels of cancer. Therefore it should be possible to reduce UK cancer levels by 90-95% by studying the diet and lifestyle that existed in Japan at that time. It might be that to get full benefits, we would have to make dozens of diet and lifestyle changes and therein lies the problem. Current UK medical interventions are primarily authorised following RCTs but such experiments would be impossible to manage with so many variables. However it is a scientific fact that living like a 1970s Japanese person massively reduces your cancer risk. I have visited Japan around 20-30 times and would not like to speculate what the key factors are but I can tell you that I was never once offered sugary puddings. Interesting!!

Selina

I am very glad to hear that you did not have a recurrence of breast cancer but you have zero evidence that this is due to eliminating sugars from your diet. You are implying that others are close minded but you should consider that your hypothesis could be flawed.

As Guy says, there many factors involved and in the case of cancer and luck is one of them. How we prepare food (high temperature cooking) and preserve meat and meat products contribute to cancer risk, and so do many environmental factors. We know about some of these and have yet to learn about some of the risks.

As I have said before, I believe that nutritional therapists can provide dietary advice and other support for individuals but they need to distance themselves from worthless quackery such as iridology.

Selina, it is good to hear that your breast cancer has not recurred, perhaps because of your choices in avoiding dietary sugars, and this we can only speculate as being coincidental, and I find Guys comments particularly noteworthy and relevant re’ the Japanese and their much lowered incidence of cancer. This has been attributable by some to their intake of iodine, which is much higher in Japan than with their American counterparts, where Japanese women consume 25 times more dietary iodine than North American women, who have much higher breast cancer rates.
http://theiodineproject.webs.com/cancerandiodine.htm
http://www.naturalnews.com/027530_iodine_breast_cancer.html
This I feel is just the tip of the iceberg, because as Guy rightly points out, RCT’s only allow a change in one variable at a time, rather than treating the body holistically (the whole person) as is practiced within functional medicine and other alternative health-modalities.
I do however, agree with Wavechange, that Nutritional Therapists can provided excellent dietary advice and support for individuals, but they do need to distance themselves from worthless quackery such as iridology.

BenJie says:
16 November 2012

Deafening silence from Which. Why? Mark is right, the two groups do have diametrically opposed advice on sugar and cancer. Any cancer sufferer reading the Which article will have had the clear impression that sugar was OK. So why are Which not coming straight out in support of the Royal Marsden dietetics advice, and presumably their own expert dietitian Catherine Collins. Or is Which now worried that the nutritional therapists may be right and that any cancer patient at the Royal Marsden following their own dieticians advice may be playing Russian roulette with their health. Come on Which, you cannot stay silent on this, you have a responsibility now.

Chrisb and Wavechange. You are both absolutely correct that Nutritional Therapists must adhere to functional medicine approaches using only evidence based scientific approaches. Their professional organisation (BANT) should ensure that their code of conduct is clear in this regard. I would say that nutritional therapists probably do themselves a disservice when they refer to their approach as an ‘alternative therapy’ rather than a ‘complementary therapy’. The former phrase suggests that they can work in isolation of the patients GP and the phrase also implies that the approach is not mainstream (which it should aspire to be). The model working relationship between a nutritional therapist and a GP has been once again highlighted in the second series of the Food Hospital on channel 4. Although the therapist in that case is a dietician, she appeared to be working in a mode which both nutritional therapists and dieticians would approve of.
On a related subject, I have almost finished reading Ben Goldacre’s new book ‘Bad Pharma’. In the WHICH discussions earlier this year, I challenged WHICH to stop chasing around trying to find the small minority of NTs who might be poorly qualified and instead deal with a big issue such as mis-selling of pharmaceutical drugs. I am delighted that Ben has tackled this subject and written an excellent book which is full of truly shocking stories. He often mentions the Cochrane collaboration which is a not for profit organisation which tries to improve the clarity of knowledge on treatments by issuing ‘Systematic Reviews’ of various drugs and treatments. However this collaboration has no public-facing website describing their findings in terms which the layperson can understand. Perhaps Cochrane and WHICH could collaborate in a synergistic manner to improve the accuracy and quality of the information that the public receives regarding medical interventions of all types.

What Which? has done is to alert us to a concern that should be taken up by BANT and the other organisations discussed in the previous Conversation. The only positive development that I have heard about is that the Chair of BANT who practised iridology was replaced. BANT has still not made its code of conduct and ethics available to the public, as far as I can see.

I think you are right that nutritional therapists should be working with those in conventional medicine, providing the individual support that the NHS is unable to offer. Of course there are problems with mis-selling of pharmaceuticals and also with excessive use of powerful drugs by GPs and hospital doctors, plus supermarket shelves full of ineffective or unnecessary non-prescription items. It is good that these problems are gradually being exposed.

I don’t see it as the role of Which? to pursue a more detailed investigation. If Which? finds a problem with MOT inspections or garages it informs the appropriate authorities and the companies that have provided sub-standard service. Which? often carries out another investigation a couple of years later.

Unless someone can correct me, I am not aware of any other WHICH investigation into any of Mainstreams practices, including that of NHS Dieticians; this has left me wondering WHY they haven’t, IF they haven’t. In my view this would go towards balancing the equation.

Therefore, the legacy and overall perception by the general population of this highlighted and well-publicised NT investigation, is that of a tarnished and reputable profession, which for the most part would have sincere and reputable professionals. Similar professions and professionals seem to have escaped scrutiny.
Food for thought perhaps?

nutritihealth says:
18 November 2012

In my honest opinion, I see Nutritional Therapists being slated because, compared to Dieticians, they’re a much newer health profession who has had the advantage of developing mainly in the private sector. This has given it the opportunity to explore options that would have been totally refuted by the medical establishment, e.g. NHS.

The rise of Functional Medicine means that many Dieticians are now in fact practising Nutritional Therapy in their private practices. This clearly puts our Government in a situation that’s tricky because if we have 2 lots of individuals practising the same type of healthcare, but one is fully regulated (as in statutorily so) and the other one isn’t.

I would personally vote for Nutritional Therapists to be statutorily regulated, that way we wouldn’t be having this conversation and the appropriate body administering the register would be able to strike them off if they had seriously cocked up. As Mark says, what about those Dieticians who are advising their patients to eat high sugar foods. Everyone knows that sugar gives you a priority ticket to illness… The sooner the whole profession is regulated and united, the better.

Nutritional therapists are not going to gain respect until they distance themselves from selling or making a profit from supplements.

Do nutritional therapists make a lot of money from selling supplements? Why should that make a difference to gaining respect? My dentist sells all sorts of stuff, and opticians don’t give away spectacles, far from it. I do not see that is relevant in private practice. Why would anyone pay to see a nutritional therapist if they were able to get decent advice from a dietitian for free on the NHS? I would be interested to know if the advice given out by the dietitian on The Food Hospital is what dietitians are telling their NHS patients. I have a sneaking suspicion that the FH team are looking to see what nutritional therapists do.

I have no idea whether NTs make a lot of money from selling supplements, but manufacturing them is big business. I am very glad that GPs cannot accept bribes from drug reps to prescribe their products. Well not nowadays.

None of my dentists has ever tried to sell me anything, but it would be better if they were not allowed to. Your point about opticians is a good one. There are a couple of Which? Conversations where this has been discussed and optometrists claim that they could not make a living from NHS eye tests, hence they rely on the lucrative retail side of the business. I see a strong case for separating the two functions. Likewise, it would be better if all MOTs were carried out by independent test centres and not garages that could make a profit from carrying out work on vehicles.

I am not trying to defend conventional medicine. I have quite a lot of inside knowledge through friends and family working in the NHS, and some personal experience. In the same way that I’m opposed to NTs recommending unnecessary supplements I feel very strongly about GPs and hospital doctors prescribing unnecessary drugs. We have not been invited to discuss these problems, however, so I have tried to focus on NTs when making comments.

I see consulting an NT as akin to seeking private medical advice. You are paying for more individual help than the NHS can provide. That could be important in investigation of food intolerances, which can take a lot of time and effort to understand.

Thank you for those links Wavechange. I became aware of that investigation shortly after posting. Is that the only one?
However, to speculate that NT’s should distance themselves from selling or making a profit from supplements in order to gain respect is really quite ridiculous, as supplements recommended by them would be prescribed on “individual need” and assessed on the Functional Medicine Model of bio-individuality only, and part of their professional remit. Quite a number of these supplements can be sourced from outside the practice of NT’s and where clients are often advised to do so. We should also bear in mind that the profit margin (if any) would be minimal.
NT’s are in private practice, so like any business or service industry, NT’s have to make a profit to stay in business otherwise they go under. The only relevant question is: are these profits excessive? and therefore unjustified. Hardly.

If you search the site you will see what topics have been discussed.

What is wrong with NT’s charging a realistic rate for their consultations and tests, just as a private consultant does? I don’t see that my suggestion is ‘really quite ridiculous’, as you suggest. If all a person needs is dietary advice then they don’t need supplements.

For most people, a balanced diet and a sensible lifestyle is all they need to be healthy. Maybe you regard that as really quite ridiculous. 🙂

I think I have had enough of discussing this topic. Why not join in on some of the many other Conversations? It would be good to find a few things we can agree on.

I was answering your original comment Wavechange that: “Nutritional therapists are not going to gain respect until they distance themselves from selling or making a profit from supplements”, which is not quite the same thing as stating in your next comment that: “What is wrong with NT’s charging a realistic rate for their consultations and tests, just as a private consultant does”…..and that you think I was suggesting. I made no reference to your latter comment, although I do agree with you on that.

The problem is that you (and many like you) fail to recognise that “a balanced diet, and a sensible lifestyle is all you need to be healthy”, does not necessarily achieve the desired results. Even the best of diets do not always provide the optimum nutritional intake that we need for optimum health, and where quality supplements can be used to achieve this, whilst simultaneously acting as a preventative, and even the cure of some diseases (Vitamin D was a case in point) but only the tip of the iceberg as present and future research will reveal in the fullness of time.

Nutritional Therapy has its origins within Functional Medicine whose premise is on treating the person/patient holistically, rather than just a set of symptoms that need to addressed or even suppressed. Targeted nutrition through supplementation has been found to be extremely valuable in achieving the above, and despite the very best of diets.
This is not academic conjecture, but an opinion based on personal experience as well, where supplements turned my life around, despite an exemplary diet for years prior to this.

I’ll take a look at some of the other conversations, because yes it would be nice if we could agree on something.

Yes, I’ve heard the propaganda numerous times before. 🙂

Perhaps we could discuss something that has nothing to do with nutrition – elsewhere of course.

I used to think as you do Wavechange re’ a balanced diet is all that is needed for good health, and those taking supplements (along with other remedies) belonged to the “expensive urine society”, and the quackery club, but ill-health led me elsewhere, and in desperation, into researching other options. Mainstream had failed me for years, and despite comprehensive testing and investigation. This has been a growing trend, partly because of the failure of Modern Medicine, but also because many of these remedies actually work in addressing the cause of the malady.

I respect your viewpoints, but only as an anachronism in the stagnation of healthcare and the recovery of health. True healthcare, as opposed to disease-care and disease-management, is evolving into something of real substance, with actual results that seem to be unobtainable within Modern Medicine, and the huge influence of vested interests intent on the profit motive.

Supplements may have turned your life around but please don’t push them on the rest of us.

I’ve been reading one or two articles about supplement obsession. Maybe Dr Mercola would have something to treat this condition. 🙂

I am far from bored with this conversation. I think it is very interesting that Which has not been able to come out instantly in support of the Royal Marsden dietetic advice that high sugar foods are a good source of energy for cancer patients. Why not, Patrick? After all Which started this. Or did it? Can Which confirm that it did not have any communication with either the British Dietetic Association or the Association for Nutrition over its investigation before it published the original article?

Absolutely Mark, I am not bored with this topic at all, and your comment is interesting re’ the silence of WHICH in the lack of support for the dietetic advice at the Royal Marsden for cancer patients. From the Royal Marsden website, the dietetic advice (amongst other things) includes: sugar, honey, syrup, treacle and sugary foods, such as chocolate, cakes and sweets, which they comment are good sources of energy!! but in reality are considered by many to be disease-causing foods, in and by themselves.
It would be of huge interest to discover as well who actually instigated/prompted the investigation in the first place.
Answers on a postcard please, so thank you WHICH for any comments?

Now come on Wavechange, I am not, or ever have been, “pushing” supplements onto anyone, but at the very least, that is an option that people should be aware of, and then use their own judgement as to whether that is right for them. I am not an isolated example either, as there are thousands like me who have received the same benefit.

I suppose supplements can become an obsession, like anything else in life, but that would be a lame excuse and reason not to at least consider them, and especially when there is a perceived need and not only because of deficiencies, but also because of their healing qualities in aiding the body into wellness. Nutraceuticals aid healing at the cellular level where Health Canada defines them as, “A nutraceutical is a product isolated or purified from foods that is generally sold in medicinal forms not usually associated with food. A nutraceutical is demonstrated to have a physiological benefit or provide protection against chronic disease.” .
Some Scientific studies………………….
http://www.ana-jana.org/reprints.cfm?cfid=9866161&cftoken=98bf1773e4db178f-F1160582-1231-380F-4DD02B346FF64FB9
Your comment on Dr Mercola is noted, but then perhaps the evidence from his articles and research should be considered first and foremost, without recourse to any blanket prejudice and/or sarcasm.

nutritihealth says:
19 November 2012

I am also beginning to really get into this conversation, and look forward to Which’s reply on whether the British Dietetic Association or the Association for Nutrition were involved in any discussions with Which? before the original article was published.

Also, I’m really interested to hear what Which? has to say regarding the dietetic advice for cancer patients. As a consumer who’s interested in health matters myself, I would be horrified to hear that Which? is supporting nutrition advice that is scientifically proven to increase the risk of cancer.

Which?, you can no longer sit on the fence. I’ll be looking forward to your reply.

Helen Osbourne says:
19 November 2012

I’m fully in support of the views by nutrihealth, Mark and chrisb and look forward to a satisfactory reply from Which?…

WHICH, I believe we are still waiting for your response to our requests for an answer to the current dietetic advice given to cancer patients at the Royal Marsden. If you would be so kind as to comment. Thank you.
You might also wish to research the Ketogenic Diet in the treatment of cancers before making any reply, as this relies on ketones or fats for the bodies fuel, as opposed to glucose as fuel: as someone said “sugar feeds cancer” which was denied by the Allopath supporters in the original debate.
http://www.thebarrow.org/Research/Neuro_Oncology/213930