/ 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
Andrea says:
17 January 2012

i totally agree with Jane Reed. I too have been a subscriber to Which and would always have deemed the magazine to be scrupulous, fair and ethical. Without reference to a complete transcript I feel certain aspects of advice may well have been published out of context to give sensationalist headlines.
Unfortunately there are therapists with dubious qualifications who are practicing and I agree with tight regulation but a lot has been done to address this. Unfortunately, as with any profession, there are always those who slip through the net. However many nutritional therapists have worked hard for a degree which has a very solid scientific background, is evidence based, includes a research project and has clinical practice, despite what is implied.
Why be so sceptical about anecdotal evidence. The proof is in the pudding and many nutritional therapists are making a very positive contribution to people’s health. In a time when the government is desperately trying to reduce obesity I would have thought nutritional therapists should be embraced not making it harder for them to make a living. Whatever is being done in the public health domain at the moment regarding the obesity and chronic disease epidemic is certainly not working. Bring on the nutritional therapists I say!!

It is funny you should say that, if a nutritional therapists are worth the money. I often think the same thing when visiting my GP

Alan Henness says:
17 January 2012

Sue

I’m not sure I understand what you’re saying – can you please explain? Thanks.

Colette says:
19 January 2012

Alan,
I would have thought it’s pretty obvious what Sue is saying. How many useless GP’s and dieticians are there out there? And which is more dangerous between a useless nutritional therapist and a useless GP? This article is sensationalist and incorrect and it has sparked a brainless mob mentality reaction from a pathetic UK public.

Alan Henness says:
19 January 2012

Colette

No doubt there are useless GPs and Dietitians out there. However, Which? chose to investigate nutritionists on this occasion and found that some gave dangerous advice. Do you think that should be ignored? Does the fact that some GPs or Dietitians are useless in some way excuse what the nutritionists told the researchers?

Colette says:
19 January 2012

Alan, what I am disputing is that the panel was not fairly represented. The title of the article in question does not clearly differentiate between “some” and “all”. Do you really think that the headline, “Are NT’s worth the money” is a fair one? Or does the whole feel of it seem to tar all NT’s with the same brush and feel like a witch hunt? I do not think that bad advice should be ignored – however on this occasion Which? is attacking NT’s as a whole and not individually and this I do not agree with. It would be like a panel of homoeopathists or herbalists visiting 6 GP’s who failed to recognise a disease first go (which would not be uncommon; it seems most GP’s get it wrong first time round) and then publishing an article damning all GP’s as a profession; advising the public to steer clear of them altogether. Can you imagine how ridiculous that would seem to most people in this day and age? Simply because it is an established profession (and it was certainly not always the case – what about the very first physicians, pioneers in their field who threatened the theological viewpoints of the time? Perhaps you should read the following and stop attacking without hearing the other side.http://www.bant.org.uk/bant/pdf/WHICH/UPDATED_RESPONSE_FROM_BANT_TO_WHICH_ARTICLE_20120118.pdf

Sophia says:
17 January 2012

David, if you had read the whole abstract, which I’m sure that you did, you would have noted the following:
“Among overweight women, we observed an association between GI and breast cancer” and
“We also observed a direct association between carbohydrate intake, GL, and estrogen receptor–negative breast cancer risk. Conclusions: Rapidly absorbed carbohydrates are associated
with postmenopausal breast cancer risk among overweight women and women with large waist circumference. Carbohydrate intake may also be associated with estrogen receptor–
negative breast cancer.”

So in my opinion it would be prudent to advise a woman with early breast cancer that a high GI/GL diet is associated with a greater risk of breast cancer. This is in complete contrast to the advice that dietitians give to cancer patients to add sugar (and fat) to their meals to maintain caloric intake. Where is the evidence for this dietetic advice?

Considering the link with IGF1, in biochemical terms, consuming a high GI/GL diet when one has cancer is like ‘pouring petrol on a fire’.

You made no comment on the Klement paper from the university of Wuerzburg – they in fact recommend a low carbohydrate diet for precisely the reasons I have cited above and based on their own animal model work. And they’re not nutritional therapists – they are oncologists.

Lajous abstract:
Results: Dietary carbohydrate and fiber intakes were not associated with overall breast cancer risk. Among overweight women, we observed
an association between GI and breast cancer (RRQ1–Q4: 1.35;
95% CI: 1.00, 1.82; P for trend 0.04). For women in the highest
category of waist circumference, the RRQ1–Q4 was 1.28 (95% CI:
0.98, 1.67;Pfor trend0.10) for carbohydrates, 1.35 (95% CI: 1.04,
1.75; P for trend0.01) for GI, and 1.37 (95% CI: 1.05, 1.77; P for
trend 0.003) for GL. We also observed a direct association between
carbohydrate intake, GL, and estrogen receptor–negative
breast cancer risk.
Conclusions: Rapidly absorbed carbohydrates are associated
with postmenopausal breast cancer risk among overweight
women and women with large waist circumference. Carbohydrate
intake may also be associated with estrogen receptor–
negative breast cancer.

Sophia says:
17 January 2012

Just to be clear, I’m not defending any practitioner (NT or dietitian) who gives unfounded advice to a client, especially to one with a potentially life threatening condition.
However, the evidence that sugar does play a significant role in cancer occurence and progression has been dismissed by those that sat in judgment on these NT’s. So for their benefit – read on – and these again are from mainstream groups – one is a pharma company.

Oncogene. 2011 Jan 20;30(3):253-64. Epub 2010 Oct 25.
Sugar-free approaches to cancer cell killing.
El Mjiyad N, Caro-Maldonado A, Ramírez-Peinado S, Muñoz-Pinedo C.
Source
Cell Death Regulation Group, IDIBELL (Bellvitge Biomedical Research Institute), L’Hospitalet de Llobregat, Barcelona, Spain.
Abstract
Tumors show an increased rate of glucose uptake and utilization. For this reason, glucose analogs are used to visualize tumors by the positron emission tomography technique, and inhibitors of glycolytic metabolism are being tested in clinical trials. Upregulation of glycolysis confers several advantages to tumor cells: it promotes tumor growth and has also been shown to interfere with cell death at multiple levels. Enforcement of glycolysis inhibits apoptosis induced by cytokine deprivation. Conversely, antiglycolytic agents enhance cell death induced by radio- and chemotherapy. Synergistic effects are likely due to regulation of the apoptotic machinery, as glucose regulates activation and levels of proapoptotic BH3-only proteins such as Bim, Bad, Puma and Noxa, as well as the antiapoptotic Bcl-2 family of proteins. Moreover, inhibition of glucose metabolism sensitizes cells to death ligands. Glucose deprivation and antiglycolytic drugs induce tumor cell death, which can proceed through necrosis or through mitochondrial or caspase-8-mediated apoptosis. We will discuss how oncogenic pathways involved in metabolic stress signaling, such as p53, AMPK (adenosine monophosphate-activated protein kinase) and Akt/mTOR (mammalian target of rapamycin), influence sensitivity to inhibition of glucose metabolism. Finally, we will analyze the rationale for the use of antiglycolytic inhibitors in the clinic, either as single agents or as a part of combination therapies.

Perspect Medicin Chem. 2008 Jan 18;1:64-82.
The role of glucose metabolism and glucose-associated signalling in cancer.
Wittig R, Coy JF.
Source
R-Biopharm AG, Landwehrstrasse 54, 64293 Darmstadt, Germany.
Abstract
Aggressive carcinomas ferment glucose to lactate even in the presence of oxygen. This particular metabolism, termed aerobic glycolysis, the glycolytic phenotype, or the Warburg effect, was discovered by Nobel laureate Otto Warburg in the 1920s. Since these times, controversial discussions about the relevance of the fermentation of glucose by tumours took place; however, a majority of cancer researchers considered the Warburg effect as a non-causative epiphenomenon. Recent research demonstrated, that several common oncogenic events favour the expression of the glycolytic phenotype. Moreover, a suppression of the phenotypic features by either substrate limitation, pharmacological intervention, or genetic manipulation was found to mediate potent tumour-suppressive effects. The discovery of the transketolase-like 1 (TKTL1) enzyme in aggressive cancers may deliver a missing link in the interpretation of the Warburg effect. TKTL1-activity could be the basis for a rapid fermentation of glucose in aggressive carcinoma cells via the pentose phosphate pathway, which leads to matrix acidification, invasive growth, and ultimately metastasis. TKTL1 expression in certain non-cancerous tissues correlates with aerobic formation of lactate and rapid fermentation of glucose, which may be required for the prevention of advanced glycation end products and the suppression of reactive oxygen species. There is evidence, that the activity of this enzyme and the Warburg effect can be both protective or destructive for the organism. These results place glucose metabolism to the centre of pathogenesis of several civilisation related diseases and raise concerns about the high glycaemic index of various food components commonly consumed in western diets.

I haven’t got round to looking at the other papers yet. You quote the paper accurately but the patient in this case was not overweight, so the bit I quoted was the relevant part.

In any case, as I’m sure you know, cutting out sugar does no necessarily mean a low glycaemic load. There are lots of other rapidly absorbed carbohydrates.

Apart from all this. the data are correlations, which, as you know, don’t necessarily imply cause. I’m not aware of any evidence that stopping sugar, or even stopping all high glycaemic foods affects the course of cancer that you already have.

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

Colette says:
19 January 2012

David – it wouldn’t do any harm though, would it??? Please open your eyes and see the big picture people!

Alan Henness says:
17 January 2012

Andrea said:

“I too have been a subscriber to Which and would always have deemed the magazine to be scrupulous, fair and ethical. Without reference to a complete transcript I feel certain aspects of advice may well have been published out of context to give sensationalist headlines.”

If you’ve always ‘deemed the magazine to be scrupulous, fair and ethical’, what makes you think that is wasn’t this time? Have you demanded transcripts for other investigations so you could check for yourself? If not, why not?

juba says:
17 January 2012

I am extremely disturbed by the biassed reporting which totally lacks any kind of science behind it. I am a subscriber to Which? but will be closing my subscription pretty quickly.

I am not a health professional of any kind but I did witness something which totally contradicts your so called findings.

My husband had oesophageal cancer and the first endoscopy (which I witnessed) showed a growth of cauliflower like appearance blocking the entire tube. I saw ALL the endoscopies and the final one showed a thin ring around the inner edge of the tube. This took all of 5 months to accomplish. He had NO radio, NO chemo but did avoid sugar and a number of other things and did take good quality supplements.

Synthetic supplements are the ones which are a waste of money. The best are wholistic and as near food state as possible – simply because some things act synergestically and big pharmas habit of “isolating the active ingredient, synthesising it and passing it off as the real thing” is what you should be raging about.

The conventional dietician who was brought into the diagnosis meeting was morbidly obese! She told him it was a great time because he had to stop the weight loss and could stuff himself with cakes and chocolate! Great health advice indeed.

Cancer can be beaten. I was asked by a friend who had invasive breast cancer what we had done. I told her. Her cancer was incurable and inoperable – the worst to have. Her doctor (who she failed to inform about the alternative diet and supplement regime she was undertaking) was amazed when the lesions began to heal and the lump began to go. Then she fell off the wagon and it is back – two years later. No idea what she will decide to do this time round. Because it is not an easy diet and it IS for life.

Goodbye Which? – off to find my log on details and cancel.

Alan Henness says:
17 January 2012

juba said:

“I am extremely disturbed by the biassed reporting which totally lacks any kind of science behind it.”

Why do you say it’s biased reporting?

“I am not a health professional of any kind but I did witness something which totally contradicts your so called findings.”

How does you anecdote about what you witnessed contradict Which’s findings that some nutritionists gave dangerous advice to their researchers?

Benjamin Edom says:
17 January 2012

Alan Hennes quotes:

“…some nutritionists gave dangerous advice to their researchers.”

Was the advice dangerous because a researcher was harmed in any way by following the advice or was it labeled as “dangerous” simply because the researched did not agree with the research upon which the advice was given?
Any panel of experts have an agenda to uphold. A conventionally trained nutritionist, a GP (I understand that GPs are given only a few days training in nutrition before being deemed fit to practice) and a particularly a pharmacologist might be expected to disagree with much of what well trained, widely read and conscientious nutritional therapists would be inclined to suggest.

Alan Henness says:
17 January 2012

Benhamin Edom said:

“Was the advice dangerous because a researcher was harmed in any way by following the advice or was it labeled as “dangerous” simply because the researched did not agree with the research upon which the advice was given?”

Do you think we should wait until actual harm has occurred before taking action? Anyway, I think it’s not just a case of not agreeing with the research, if indeed, the nutritionist’s advice was based on any research, robust or otherwise. Advising against cancer treatment prescribed by a doctor is what is dangerous. If the nutritionist believed his/her advice was supported by better evidence than what a doctor would give, then the ethical course of action would have been to pass this to the doctor and discuss with him/her, not straight out tell a patient to stop taking cancer treatment.

“I understand that GPs are given only a few days training in nutrition before being deemed fit to practice”

This is nonsense put about by those with an agenda to uphold (http://bit.ly/zpPTgH). Dr Margaret McCartney (who was one of Which’s experts) briefly debunks that myth: http://bit.ly/zOSqOr

“A conventionally trained nutritionist, a GP…and a particularly a pharmacologist might be expected to disagree with much of what well trained, widely read and conscientious nutritional therapists would be inclined to suggest.”

I’m not sure what a ‘non-conventionally’ trained nutritionist is (unless you mean the types that give out misleading and dangerous advice, possibly not based on sound science and evidence).

Judy Hayman says:
17 January 2012

Surely there will be good nutritionists and bad ones just as there are good doctors and bad doctors. In the light of the fact that so many doctors are totally ignorant on the benefits of nutrition thank goodness we have nutritionists.

Catherine says:
19 January 2012

Hear hear! it took my husand 6 trips to the doctors (over a 8 month period) with various ‘classic’ symptoms before they finally decided to run some tests and discovered he had leukaemia. I consulted a nutritional therapist and put him on a no sugar, low GI diet. He went into remission after the first course of chemotherapy but had to endure 3 more chemotherapy sessions, and we were told he would definitely be infertile at the end of it all. However he left the hospital after 4 months, feeling strangely healthier than hes ever been, which he puts down entirely to his diet. 3 years on and we still eat in a similar way – my husbands recovery has been astonishing, he completed a triathlon the year after his treatment and we have since discovered his fertillity has also returned! Inspired by all of this i am currently studying Nutritional therapy at the College of Naturopathic Medicine, and i am extremely impressed with the strong scientific teaching and also the professionalism in general of the course – we are taught never to interfere with treatment a client may be receiving from their doctor and always to try and approach the doctor and work with them, isn’t this the most sensible way? I too have cancelled my membership to Which, after a long career in journalism, i can tell a sensationalist story when i see one. I don’t believe the research was carried out in a professional or fair way, and the quality of Which reporting has for me been discredited.

lids says:
17 January 2012

I suffered from an aggressive form of eczema on my face, head, neck, chest and arms after the birth of my baby and I was told by my GP that I had to live with it.
Thank goodness I did not accept his/her judgement and sought the advice of a nutritional therapist who helped me to clear my eczema and made me a very happy client.
I recommended her to all my friends and haven’t seen my GP since!!

to Alan Henness. To explain it to you I often feel that my GP is not worth the money because all he does is he keeps doing is prescribing me prescription drugs that give me lots of side affects that adds to the problem. So in other words. He never cures he only medicates

And often very often he does not get to the root of the illness in the first place

Alan Hennsss says:
17 January 2012

Sue

All medications have side effects (because they have pharmacological effects). All decisions about your health should be taken in consultation with your GP where both the advantages and disadvantages of any treatment can be weighed up so you can come to an informed decision about your treatment. If your GP isn’t allowing you to do that, then perhaps you need to consider changing your GP. However, swapping your GP for a nutritionist – particularly if he/she is like the ones found by Which? – is not likely to be a particularly good move.

Alan Hennsss says:
17 January 2012

Sue said:

“And often very often he does not get to the root of the illness in the first place ”

Perhaps a better approach would be to get a second opinion from another GP or ask if you can be referred to a consultant. At least we know they have decent medical training (taking many years of extremely hard work and long hours) and are the acknowledged experts, rather than a nutritionist who – as Which? has found out – may not be able to supply good, safe information and who may not have sufficient medical training and knowledge to understand or treat your condition.

Sophia says:
17 January 2012

David, the following papers all report association between poorer outcome in cancer patients with hyperglycaemia:
Derr RL et al J Clin Oncol 2009 27:1082-1086 (glioblastoma)
Weiser MA et al, Cancer 2004, 100:1179-1185 (ALL)
McGirt MJ et al, Neurosurgery 2008, 63:286-291 (astrocytoma)
Maestu I et al, Ann Oncol 1997, 8:547-553 (small-cell lung cancer)
Krone CA et al Integr Cancer Ther 2005, 4:25-31.

For further discussion of the evidence see
Seyfried TN et al, Nutr Metab (Lond) 2010, 7.7.
Also see the Klement paper referred to in an earlier posting, which reviews the evidence in detail and explains why they propose a low carbohydrate diet to cancer patients.

Of course association does not mean causation, but the evidence is stacking up in favour of manipulating the glucose metabolism in patients with malignant disease. Why wait until we have an anti-glycolytic agent when one can support the patient to modify diet?

Anna says:
17 January 2012

We are currently living in an epidemic of chronic disease and nutritional and lifestyle approaches are the only way to help reverse this. I dont agree with any Nutritional Therapist telling a patient not to take cancer treatment (this is indeed dangerous) and indeed Nutritional Therapists need to be careful to explain to their patients that they are not diagnosing any conditions. Additionally the profession really should be regulated – at the moment its only voluntary regulation. However I do have some issues with the survey design – it seems to be very biased and also seems as if it was designed to catch the people out rather than looking at any benefits. There are many Nutritional Therapists out there working very hard to provide the best possible service and devoting much of their free time to keeping up to date with peer reviewed research, doing masters degrees and so on,…and often because they have witnessed huge benefits from Nutritional Therapy. However I must say that in the light of this “which hunt” it just makes one want to give up… lets just forget the diet and lifestyle approaches, shut up shop, become drug reps instead and let this spiral of ill health continue… any scientist in obesity and diabetes research will tell you that nutrition and lifestyle is your best way out.. but never mind that!!!

Alan Hennsss says:
17 January 2012

Anna said:

“We are currently living in an epidemic of chronic disease and nutritional and lifestyle approaches are the only way to help reverse this.”

Without specifying which chronic diseases you are referring to, it’s difficult to agree or disagree that *only* nutritional and lifestyle approaches can help reverse them.

“However I do have some issues with the survey design – it seems to be very biased and also seems as if it was designed to catch the people out rather than looking at any benefits.”

I’m not sure what benefits they would have to have bestowed on the researchers that would counter the dangerous advice they gave.

“However I must say that in the light of this “which hunt” it just makes one want to give up… lets just forget the diet and lifestyle approaches, shut up shop, become drug reps instead”

There is, of course, nothing wrong with good nutritional advice – I’m sure we could all benefit from it. However, you offer a false dichotomy – there is no reason we can’t have good nutritional advice (which may help reduce the likelihood of some medical conditions) and visit our GP and take drugs as and when they are useful.

Colette says:
19 January 2012

Hi Colette, mods here. We understand that this is a heated debate but we can’t allow comments to get so personal so have had to delete this comment.

Alan Henness says:
19 January 2012

Colette

It’s unfortunate that you are not able to respond civilly.

It would be more helpful if you could actually respond to the serious concerns raised by the Which? report rather then trying to tell me what I think.

Kate says:
17 January 2012

I spent years battling IBS until I was recommended a nutritional therapist by a friend who had a really good experience. Within a few months my symptoms were about 85% better. She didn’t recommend any expensive tests or any supplements- just really practical advice. 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. When my sister had problems getting pregnant I suggested she also see a nutritional therapist. She was recommended a diet plan and a fertility multivitamin which didn’t cost a great deal and seemed sensible. Anyway, my sister fell pregnant after 4 months. So all I can say is for me and my family nutritional therapy works. Like previous people have said this Which report seems a little biased. I wished they had been more balanced about it all.

Monika says:
17 January 2012

It seems the very term Nutrition Therapist upsets some folks from the outset so I personally am going to call it a day on this discussion. At the end of the day – properly regulated Nutritional Therapists can and will and do help improve the health of many people. I and many others I know are working to ensure that happens. Thank you Sophia for all the great references. Good night all.

Alan Henness says:
17 January 2012

Monika said:

“At the end of the day – properly regulated Nutritional Therapists can and will and do help improve the health of many people”

At the end of the day, properly *trained* nutritional therapists can help improve the lives of many people. If they are trained in nonsense, regulation is a waste of time.

Interesting comments on bias affecting the Which research from http://thehealthbank.co.uk/whichs-brew/

“Which? offers no insight into how the sample was selected – it should of course be completely random but in the absence of confirmation doubts must remain. Certainly if it transpires the nutritional therapists were individually selected by the review panel, the entire basis of the study is undermined. This is known as selection bias.”

“One supposed aim of the study was to measure the quality of advice on offer by nutritional therapists. The questions were designed specifically to tempt the subjects into indiscretion and error, which clearly implies the covert real aim of this project was to ‘expose’ supposed charlatans much in the way the late and unlamented News Of The World might have approached the question. Secretly recording advice given in good faith in response to questions partly designed by those with a conflict of interest is good tabloid journalism, but extremely bad science. This is a fine example of measurement bias”.

The review panel had nothing to do with the selection of the therapists. Our job was merely to read through the transcripts and to assess the quality of the advice that was given.

I have no idea where you should say “The questions were designed specifically to tempt the subjects into indiscretion and error”. How can you know that (unless you are one of the people who was visited)? In fact the transcripts show nothing of the sort. The ‘patients’ said nothing that a real patient wouldn’t say.

David, I was quoting another website. Meanwhile we await information on how the Nutritional Therapists involved were selected. If the panel only reviewed the transcripts, which I assume were available after the visits took place in October, why does your blog state that you were working on a project for Which much earlier (I think in August this is mentioned)? It does give the impression that you were involved much earlier.

@JSB
I’m glad to see that you read my blog, but sorry, there is no conspiracy. I agreed to take part in the project some time ago, but my job was to read the lengthy transcripts when they arrived. Until that point, my only involvement was to help with the decision about what sort of conditions ‘patients’ would present with. Neither I nor any other panel member had anything to do with the selection of therapists, and we have never met the ‘patients’.

I understand that Which? staff selected the therapists in a way that mimicked what a present day consumer might do. They used google and online directories, and chose the therapists that were at the top of the search results. Thus, the sample was not a random sample of all nutritional therapists, but would be like the therapists that were chosen by googling. It would be biassed towards the more popular (and therefore perhaps better?) therapists. It is a worry that less popular therapists might have given worse advice than was found in this case.

Anna says:
17 January 2012

Hi Alan,
yes indeed chronic disease such as heart disease and diabetes can be treated with pharmaceutical drugs and the data shows that drug treatment can extend life in these patients. However diet and lifestyle is the only option for trying to prevent these diseases in the first place and certainly can have a huge impact on the disease when someone has got it. I am not suggesting its an either/ or situation although I appreciate my previous post might have sounded like this.

My comments about swapping career to become a drug rep relate to the fact that one feels rather persecuted being a Nutritional Therapist and it really does feel like a witch hunt!

Alan Henness says:
17 January 2012

Anna

Some of the commenters here have referred to a witch hunt (or even a Which? hunt!), but I see none. What Which? have shown is that there are *some* nutritionists who have been caught giving bad or dangerous advice. Some who say they have been helped by nutritional advice have given their own stories (whether at the behest of the ANH (see http://bit.ly/zpPTgH) or not). That is fine, but none of that negates what Which? have found.

This should not be the end of the issue. Whether or not Which? are able to do any further research is up to them. However, it is now incumbent on the various trade bodies, associations and ‘regulators’ to pick up the challenge of investigating further, finding out the true extent of the misleading and dangerous advice and ensure that training and education courses are corrected; that rules and codes of practice are reviewed and strengthened; that these rules and codes are properly enforced so that the public are properly protected from these dangers, which is surely what we all want and deserve.

There are many nutritionists who are properly trained and who would not dream of offering such poor or dangerous advice. They must now use their influence to make sure that the rest fall into line and that the different representative bodies take the appropriate firm action and do not simply ignore what has been shown to be happening.

If they don’t take action, the next time this comes up might be at a coroner’s inquest. That would be tragic indeed, particularly if the problem had already been highlighted, yet no proper action taken.

BANT, NTC, ION, CNHC and others: it’s up to you now.

In criticising anything, it is important to ensure that results are presented in relative terms (i.e. Is A better than B ?, rather than critising A in isolation). For example nuclear power is regularly critised as a dangerous way to generate electricity and yet the worst nuclear accident was trivial in comparison to the worst hydroelectricity accident ( see http://en.wikipedia.org/wiki/Banqiao_Dam ).

In the case of the nutritional therapy, it is important to remember that good nutrition can complement and very often replace the need for pharmaceutical drugs. Adverse reactions to prescribed drugs lead to a huge 106,000 deaths per year in the US (see http://campaignfortruth.com/Eclub/130902/idahoobserverdeathbydocs.htm). If a similar rate applies in the UK (where such studies are harder to come by) this would equate to around 21,000 deaths per year. This ratio is of course crude but it is clear that drugs are likely to be killing many thousands of people per year in the UK.

This leaves me with a couple of questions. 1) Does Which? have the courage to take on big health issues such as this? and 2)Why do the pro-pharmaceutical bloggers (some of whom have written pieces above) fail to ever mention the risk of prescribed drugs?

Alan Henness says:
17 January 2012

guy

I don’t know who you are referring to specifically, but I have discussed the side effects of drugs and how they must be part of a benefit-harm discussion between a doctor and patient. Yes, there are problems with some pharmaceutical companies and the way they conduct some studies, but none of that is an excuse for a nutritionist giving dangerous or misleading advice, is it?

But if you want to try to talk about deaths caused by drugs, please also detail the numbers of lives saved by conventional medicine, the number of people living longer and with a higher quality of life because of conventional medicine, the number of babies who survive birth because of conventional medicine and the number of those who are suffering less and in less pain because of conventional medicine.

And then give the same numbers for whatever alternatives you feel might be better.

Tess says:
17 January 2012

Dear David Colquhoun,
We know that diabetics injecting insulin have increased risk of cancer. Would it not therefore make sense not to overstimulate blood glucose when this can be acheived relatively easily? Would it not make sense to get the body as healthy as possible? Apart from its effect on blood glucose, sugar would also be affecting the gut flora. Surely if the person is up for it then it just makes sense to get the body as healthy as possible.. I know someone who did this and despite what the oncologists had predicted he did actually reduce the cancer and was therefore in a better position to take on board the chemotherapy.

Of course it “makes sense to get the body as healthy as possible” . But endless studies have show that taking “nutritional supplements” has no health benefit (and in the high doses advocated by some alternative medicine people, can actually be harmful). In any case, the cancer ‘patient’ in this investigation was supposed to have cancer already, so urgent action would be called for, to prevent metastases.
If someone did a proper trial to test whether a “sugar free diet” was helpful in these circumstances, then we’d be interested to see the result, but no such trial has been done. But of course you’d have to cut carbohydrates too because your blood glucose doesn’t depend only on sugar intake.

Jenny says:
17 January 2012

Why is it when a dietician and GP use nutrition as a form of therapy (as in the Food Hospital) it’s “ground breaking stuff” but when a nutritional therapist does the same thing they are deemed to be “dangerous”. Most nutritional therapists are very well trained professionals who genuinely care about the health of their clients. This article does not fairly represent the profession. Anyone who has experienced a good nutritional therapist will know that. However, given the fact that Which refuses to share the transcripts and did not use an objective panel, what can you expect!

Alan Henness says:
17 January 2012

Jenny said:

“Why is it when a dietician and GP use nutrition as a form of therapy (as in the Food Hospital) it’s “ground breaking stuff” but when a nutritional therapist does the same thing they are deemed to be “dangerous”.”

I don’t recall anyone on the Food Hospital advising that cancer treatment was unnecessary.

“This article does not fairly represent the profession.”

As has been said many times, this survey of 15 does not and cannot mean that all nutritionists give misleading or dangerous advice. It highlight that there is a real problem and one that needs to be tackled.

The panel included a Professor of pharmacology, a GP and and one of the country’s foremost experts on nutrition. I’m not sure why you think they could not be objective.

Kirsty says:
17 January 2012

I am studying for a Nutritional Therapy degree at the moment and I am saddened and, like many of you who have already posted, shocked that a supposedly objective and unbiased organisation like Which has written an article that seems clearly to be biased. I also would be interested to see the full transcripts of these consultations and would like clarification on the selection of the participants and the results. Perhaps those of you who clamour for scientific and fairly executed trials and research to back up complementary medicine should direct some of this to Which who, in this instance, I do not feel have provided such a study. It is in fact untrue that Nutritional Therapists are not required to back up their work with scientific evidence. I am not allowed to (nor would I even consider) producing a piece of work or, as I progress in my career, assessing a client, without thorough research and valid evidence. Such research does indeed exist. To those of you who have dismissed other people’s comments and testimonials on here as ‘anecdotal evidence’ I would say that this is indeed required as well. Any therapist, doctor or any other kind of practitioner should not be basing their recommendations on anecdotal evidence, that is obvious. However, that does not mean that these comments are not proof that these treatments can help. Nutritional Therapists will not get it right all of the time, but I doubt that any good therapist would really be making big claims such as curing cancer or recommending or asserting that anything will definitely work for the patient. I am consistently reminded in my training that we should not be making these statements.

I would also like to point out that doctors do not get things right all the time either and are certainly capable of making grave errors. My father died of liver cancer 13 years ago. He was consistently misdiagnosed by his GP, who thought he may have acid indigestion or a stomach ulcer. Clearly the antacids he was recommended did not help! The night he was admitted to hospital the Doctor on duty put his hand on his liver and pointed out that it was not normal to be able to feel it protruding out of his body due to the inflammation (what turned out to be a tumour). One week later he was diagnosed with cancer and two weeks later he died.

My uncle is currently waiting for his second kidney transplant and has to undergo regular dialysis as his kidney is failing. His kidneys originally failed twenty years ago after he was wrongly prescribed beta blockers by his GP. He has been living with the effects of this misdiagnosis for the past 20 years and his health is extremely poor.

I am sorry that these are both ‘anecdotal evidence’, to me they are not, they are important and tragic events that have affected me and certainly influenced my decision to go into Nutritional Therapy. To me, it makes perfect sense to look at the patient as a whole and to get to the root of the cause of their symptoms, rather than treating the symptom itself. The two cases I have shared are perfect of examples of the mainstream health system treating the symptom rather than the cause. Despite my experience I do not believe that doctors are universally wrong, in my training I am taught the importance of working with the mainstream medical practitioners and I believe wholeheartedly that this is vital to the progression of medicine as a whole, both complementary and otherwise. It is called Complementary Medecine for a reason, it is supposed to complement and I do not see why the two cannot work together more.

Any good GP looks after the patient as a whole. And it is the aim of everyone “get to the root of the cause of their symptoms, rather than treating the symptom itself” But you cannot just invent the answers. There is a great deal that we don’t know about the causes of cancer and about the causes of renal disease. In fact it’s really only in the case of bacterial infections where the cause is known for sure, and can be eliminated to produce a total cure.

Despite the triumphs of modern medicine, it is still in a relatively primitive state. Serious medical research has been going on for barely 100 years and the mechanisms of things like cancer turn out to be very complicated. Although the prospects for cancer patients are better than they used to be, there is a long way to go.

A lot of effort is being put into the research by scientists and doctors, but we aren’t there yet. In contrast, no serious research into causes is being done by nutritional therapists, or other advocates of complementary medicine.

You say “It is called Complementary Medecine for a reason, it is supposed to complement and I do not see why the two cannot work together more”. But, as has been pointed out many times, if complementary medicine had come up with effective treatments, they would lose the ‘complementary’ label and just be called “medicine”.

It is common for people in complementary medicine to speak as though doctors were in some sort of conspiracy to deprive patients of effective treatments, This seems to me to be insulting and silly. The real problem is that, only too often, we don’t yet know the root cause of many conditions and have no very effective treatments for them. Low back pain is a good example. I have it myself and I don’t find analgesics very effective. We have yet to discover both causes and effective treatments. I hope that one day we will, but it doesn’t really help to give patients false hopes and ineffective treatments.

Chazza says:
20 January 2012

@ David
It is not my experience that my gp has ever treated me as ‘ a whole’ probably as they do not have the time to do so. if there is someone willing and able to provide an in depth consultation with the patient, who could potentially prevent future health problems should we not encourage this?

It’s time to put this in 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.

In scientific research, even leading scientists disagree about interpretation of studies, and involving those who have opinions but little or no specialist knowledge is not really likely to achieve much.

Rather than citing individual research papers it would be better to refer to reviews that critically evaluates and gives a balanced view of the main research studies on a subject.

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 – as I understand it – is to alert the appropriate authorities of problems or possible problems that needs further exploration in the public interest.