A commenter recently posted some thoughts, opinions and questions that raised the wider question: Is Holfordism harmless? She obviously has a sufficiently strong interest in nutrition to prompt her to consider dedicating time and money to studying it.
I saw Patrick Holford on tv the other day and was quite impressed. I have also been thinking about studying nutrition and looking at his institute as a place to study.I certainly don’t agree with everything alternative medicine has to offer, but some of it does work, so please don’t criticise too much!
Nutritionists (as opposed to dieticians) want to help people towards optimum health – who doesn’t want to feel good? Some of us can’t seem to get the balance right ourselves and, since doctors and buying heavily marketed products often doesn’t help (docs, like dietitians, tend to want to cure rather than prevent), we want to ask someone who knows more than us.
Why do you not think that people who have studied the subject for a few years and gained a qualification, are qualified to help people in this way?
Who else would you suggest consulting?
I ask this as someone who both wants nutrition / health advice, and who is considering re-training under the nutrition umbrella.
I was a little taken aback at this characterisation of the work and practice of dietitians; I did wonder what had led this commenter to form such a partial opinion. We were very fortunate to have an excellent and robust response from Registered Dietitian, Catherine Collins.
As a practicing Registered Dietitian (RD), I’m concerned about the biased and inaccurate views that you have of my profession.I guess you’ve been reading prospectuses from ‘self-styled nutritionist’ organisations such as ION or CNELM – or perhaps the pseudo-regulatory organisation BANT, which typically make these inaccurate claims. I guess this is their way of trying to justify their ‘nutrition-lite’ practices to people like yourselves who are thinking of training in this field.
RD’s are basically BSc graduate nutritionists with an extra year of study tagged on to the original 3 years to learn and practice the interface of nutrition with clinical disease. As such it gives us a very broad and deep spectrum of expertise which we can use to work in any arena we like.
In the community we work in private practice, health promotion attached to local education and health authorities, self-help groups and organisations, and increasingly sports nutrition (2012 beckons!). Our skills are valued by the food industry, food retailers, and other businesses related to healthcare – or not.
Alternatively – and as in my case – we have the skills to work with the clinically unwell in a hospital setting. Yes, some aspects of our work are dealing with those who abrogate health and nutrition issues until seriously unwell. But my field of intensive care also deals with those unfortunate individuals in the wrong place/ wrong time, and for whom nutrition treads a fine line of providing fluid, electrolytes,and macronutrients in the presence of multi-organ failure.
I take your point regarding the occasional benefits of non-conventional approaches to illness. Yet in the field of nutrition, you will find that the ‘alternative’ do not use a parallel evidence base (such as TCM does when compared to western medicine)- they just misintepret the SAME clinical evidence to promote their practices and wares – as this excellent site demonstrates.
It’s rather ironic of you to agree that “buying heavily marketed products” is not the key to good nutritional health, yet you feel an affinity towards an organisation and an individual which – from this site alone- can be seen to promote products which existing research indicates are futile, or even harmful.
Why should self-styled nutritionists take this approach? I guess it comes down to two reasons –
EITHER
they are unconciously incompetent (so they THINK they know the subject, but they don’t have the ability to translate it accurately or in context for the individual or group)
OR
they are deliberately misleading those who seek their advice…..But where does that lead dietitians? well, you won’t find us promoting detox or superfoods or megadose vitamins – because ‘sexing up’ key nutrition research distorts the context for the public, and we don’t expect our patient to become guinea pigs for future interest – as all the work on high dose vitamins is increasingly demonstrating.
Equally, you won’t find dietitians pestering for column inches and broadcast time. We are well respected in the media because of our sound background, ethical approach and our conduct – incidentally, being the only nutritional professionals regulated by law (HPC Act 2002, formerly the CPSM Act 1980). Just google the term ‘dietitian’/ ‘dietician’ and you can see how we feature ‘out there’.
Finally, I wish you well on whatever nutrition path you take. Check out the dietitians website…or the bona fide Nutritionists website.
You can’t shortcut a route to nutrition, just as you can’t shortcut knowledge of atomic physics – despite what the nutrition-lite lobby will have you believe. If you choose the latter I guess you have to reset your moral compass or ignore the shortfalls in your training when it comes to dealing with the public who trust you……[Minor changes from the original to embed links.]
Depending on your budget, you might also compare and contrast the cost of studying with ION with that of obtaining a Registered Dietitian’s portable qualifications. If you don’t have science qualifications at ‘A’ Level, then ION offers Science Access Courses:
The Science Access courses are designed for those wishing to pursue the Nutritional Therapists’ Diploma/Foundation Degree Course (DipION/FdSc) but having insufficient background in the sciences to support study. The courses concentrate on aspects of these subjects that are relevant to nutrition.
So, you will pay around £3,090 for either the accelerated (3 month) version of this course, or the year-long course (texts and course notes included). You will also need to pick up the travel and maybe accommodation costs of attending the course in Richmond. For the (further) 3 years of the Nutritional Therapy Diploma course, you will need to pay tuition fees of £3,090 per year (I haven’t been able to establish whether the texts etc. are included in this).
If you wish to obtain a BSc in Nutrition Science in association with the University of Luton, you will need to dedicate another year of study and a further £3,000 in fees (if you study full-time, at current prices). I have not yet been able to discover how many ION graduates top-up their diploma with a BSc, nor the degree class that they commonly obtain.
Unlike most tertiary education establishments, ION doesn’t offer an overview of their research facilities, lecturers and researchers online. It would be useful to know the research projects that are in progress at ION and their list of publications. E.g., if I were interested in studying the Sports Nutrition module in Year 3, it might be helpful to know if I could have access to a gas analyser for the study of exhaled breath (e.g., useful for metabolic analysis) or something like one of the latest, very accurate body fat and metabolism analysers; I might want to know if I would be supervised by someone who is certified to conduct blood draws for lactic acid studies or similar. Coracle offers a very interesting overview of research funding in the UK and the research assessment exercise; it would be useful to know if ION is engaged in this sort of academic research .
It might be considerably faster and cheaper to study for a BSc in Nutritional Science; you may be able to qualify as a registered Dietitian in the time that it would take you to study for a Diploma with ION and then top-up to a BSc degree. You can assess for yourself the value of the assurance the DipION/FdSc is accredited by the University of Luton and validated by the British Association of Nutritional Therapists (BANT) and “meets BANT’s stringent requirements for certification of nutritional therapists”.
I’m sure that all of the contributors to Holford Watch wish the commenter well with any future studies and career. However, I am concerned at the role that Holfordism might have played in shaping the mis-perceptions of the role/practice of Registered Dietitians. Further than that, I’m slightly alarmed at the notion that nutritionists have the inside track to ‘feeling good’ or having “optimum health”. To me, this notion not only overlooks the appropriate intervention of professionals such as GPs but it deprecates people’s own commonsense. Is this harmless?
Well thanks for that, I’m genuinely honoured. Not to hijack the comments thread and turn this into some sort of love-in, but I really admire the quackometer and this blog.
As for the Scientology language, I’ve learned to spot it! It isn’t the first time I’ve noticed Scientologists joining these discussions, but in keeping with the ethos of science-critique forums I haven’t brought it up as it hasn’t been directly relevant.
Today it seemed to be, so I did.
Your work is greatly appreciated Monsieur le canard, you and all the others trying to maintain these calm islands of sanity in the never-ending storm of woo!
Some unexpected findings in a newly reported study of folic acid supplementation in colorectal cancer –
“New research indicates that folic acid supplementation does not decrease the risk of benign colorectal tumors, but may possibly increase the risk for some types of colorectal tumors, according to a study in the June 6 issue of JAMA. Some previous studies have suggested that folate supplementation may help to prevent colorectal tumors…”
The news release reporting this is at http://www.newswise.com/articles/view/530491
Thanks, Claire. It is fascinating to see that even relatively small amounts of some supplements (and this trial used a much smaller amount than the mega-doses that some people advocate) are being linked to adverse outcomes. The mechanisms involved are intriguing.
Regards – Shinga
Hi just a quick note to any potential dietitians, food scientists, nutritonists…if you havent got the relevant science background to enter a science based degree course, you can do an access to science course, cost around 100 pounds. Check out your local community college. I studied at TVU Reading, an enjoyable year and am now studying Nutriton at uni. And a fellow student on the same course is going to Surrey to study dietetics. Im not sure how much the optimum nutrition people are charging for the science access? (Also most unis offer a foundation year of science)
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Mrs Jones was leaving her scientologist church. The pastor asked her how her husband was getting on. “Ohh,” she said, “he is ill.” “No,” corrected the pastor, “he is under the illusion that he is ill.” A few months later the pastor again asked how her husband was getting on: “He is under the illusion that he is dead.”
Love reading this website. You may have already heard the above joke before, but it is an amusing illustration of what can happen when you trust “alternative” remedies too much.
Best wishes,
Lee
“I have not yet been able to discover how many ION graduates top-up their diploma with a BSc, nor the degree class that they commonly obtain.”
The ION gives a list of practitioners across the country. Many of them, predictably enough, have their own website. I spent a little bit of time quickly looking through several dozen of them. The answer to your question would at first sight be, “none of them.”
I am very keen to avoid a libel writ from the ION arriving on my door mat so I should point that: (1) perhaps several have or are studying for a BSc in Nutrition, but did not see fit to mention it (2) possibly I did not spend enough time looking through the websites and several do indeed have a BSc in nutrition (3) it could well be that those without websites/those whose websites I did not look at are studying for the qualification.
Several have batchelors degrees such as biochemistry which combined with their ION diploma might entitle them to membership of The Nutrition Society. (Could some one from the NS clarify?) However, please see points one to three in the previous paragraph!
Would the ION be willing to confirm how many of its diplomates (is that the right word?) have or are studying for the aforementioned qualification? CPD is the buzz phrase amongst professionals today so what are they doing to encourage them to do so?
After all that research I think I deserve a handful of mixed nuts – unsalted of course ….
‘Bye for now,
Lee
Kudos for that level of research, Lee: that is dedication.
I have emailed the course organiser some time ago; I haven’t had a response so I must follow-up. I suppose that one of the difficulties might be is that there is no obvious financial or other advantage to slogging through another year’s study if the diploma is accepted as enough for some people to start private practice and they have no interest in working in the sort of areas that might mandate a degree qualification.
It was probably just as well for me that Sainsbury’s discontinued a particular mixed nut range with lemon and thyme…
How has the ION diploma changed now it is validated by the University of Bedfordshire?
It seems a bit unfair they get a diploma and foundation degree at the same time – that is the case isn’t it? You would think they would have to do a bit of extra work to get the foundation degree.
Other professional organisations take a different view. See, for example, The Institute of Credit Management’s website http://www.icm.org.uk/home.asp?edit_id=8&nav=8&branch=0 Their students study part-time for three years and have the option to go and do a foundation degree followed by an honours degree. The ICM’s diploma is validated by the Qualifications and Curriculum Authority.
I only mention the ICM’s education scheme because I am familiar with it. It would be interesting to hear other people’s experience of professional qualifications.
Actually, it hadn’t occurred to me that the Diploma now came with a side-order of Foundation degree :oops:
The ICM does seem to have an understandable framework for their qualifications which is a good role model.
Shinga
Yes, that would certainly appear to be the case – http://www.ion.ac.uk/education.htm
What I find a bit odd is that several Nutrition Therapists mention having a Dip ION and FdSc on their websites which leads to the impression they have studied for two separate qualifications. Courtesy (and cowardice!) prevents me posting the details on a public forum like this, but I could email them to you if you want to see them.
Also of interest may be The University of Bedfordshire’s information on the course -http://www.beds.ac.uk/courses/bysubject/biobiosci/fd-nutthe-iop
One of the possible career options is working in a GP’surgery!? How did they get that impression?
Lee
Not to hijack the comments thread and turn this into some sort of love-in, but LeeT rocks.
That’s jolly kind of you, James.
However, I just have to confess to being some one who bought “Optimum Nutrition for the Mind” and “The Optimum Nutrition Bible”. I also took supplements including one specially formulated by Patrick Holford to aid concentration and memory. It did not do much good.
Presumably, in view of the latest ASA adjudication he and Higher Nature (www.highernature.co.uk) will be revising the website. Not that they have to given the ASA’s remit does not cover websites. Still, I have got a magazine. Alternatively, the MHRA may be interested given the unsubstantiated medicinal cliams such as “aids memory and concentration”….
The above notwithstanding, I have met a number of good people in nutritoinal therapy. So going right back to the original question (!) “Is Holfordism harmless?” – probably most of the time.
Indeed, James. Take the internet
loveapprobation where you can get it, LeeT.It seems that one of my earlier comments failed to post, I would imagine that people who take the top-up degree are entitled to go and acquire clinical experience in a recognised venue and thence on to a NHS surgery?
If the 2003 adjudication that LeeT located didn’t prompt them to word the websites more appropriately, then I doubt that this 2007 one will, sadly.
Holfordism may be comparatively harmless in the West, with a mostly well-nourished and comparatively disease-free population: I would argue that that doesn’t obtain in countries such as South Africa where he is gaining more influence.
Actually, I may turn this into another post.
“I would imagine that people who take the top-up degree are entitled to go and acquire clinical experience in a recognised venue and thence on to a NHS surgery”
You would hope so since prospectuses for, for example, law degrees usally point out their course will enable students to go on and train as lawyers. Presumably some one at Bedford or the ION has checked or is checking? It would be quite tragic if some one got to the end of the degree disillusioned with the ION, but found the only career option open to them was as a BANT nutritional therapist.
It would certainly be extremely interesting to hear about nutritonal therapy in South Africa.
Well, Holford is the man to tell you about nutritional therapy in South Africa as he has been appointed as Patron of the SA equivalent of BANT…
Hello all. I stumbled across this site quite by accident and hope you won’t mind me sticking my oar in!
I am a former NHS senior sister (London teaching hospitals) and also have a BSc Hons and an MSc. I am only telling you this in the hope that you won’t classify me as a new-age pseudoscientist type because I am also a graduate of ION.
Firstly, in defence of ION, the training really was quite rigorous (I have no idea what it is like now) and whilst there was the odd lecturer who either did not reference research properly or who seemed to ‘misinterpret’ research findings, on the whole most of the tutors were quite careful to present information that had its basis in research and that was referenced properly so one could check it oneself, including the all important methodology of course. The reason I think this important is because there seems to have been a lamentable trend over the past decade for professional/scientific journals to accept and publish research which, in terms of methodology, probably wouldn’t have made the grade in times past (in my humble opinion), and in the opinion of many of my medical colleagues and friends.
Anyway, that aside, I think one of the major problems with ION, and places like it, largely lies with there approach to admissions. I will give an example. I was an early applicant for the year I enrolled and I applied as a person with 12 yrs experience as a registered general nurse, 3 yrs experience as a senior sister, and with a BSc and MSc in health related subjects. They still demanded that I did the ‘quicky’ science foundation course. I felt suspicious at the time that this was all about money since they did not know how many applicants they would ultimately receive that year and they wanted as much money as early in the year as possible. However, I did it anyway. As it turned out I quite enjoyed refreshing my memory re chemistry and biochemistry but really could have done without the anatomy and physiology etc. The tutor was also very able and was an A level science tutor at a public school if I remember correctly. Incidentally, quite a few people didn’t make it through this stage. After I’d started on the three yr course, I came across people who’d applied after me, who had no background whatsoever in health, science or anything even remotely related, but who were accepted and not required to do any science foundation courses – presumably because it was too late and there were still vacancies for the DipION for that yrs intake.
Generally the students could be divided into those with a background in health (including a few GP’s, nurses like myself etc), people with science degrees, and people who had no background in health or science. There was quite a high failure and drop out rate among those without a background in health or science because it really was quite a difficult course. Also, I used to be concerned about students checking research for themselves if they had no prior experience of doing so, rather than just taking the word of the lecturer and then blindly referencing the same source themselves ad infinitum.
Anyway, the reason I say all this is because if ION and organisations like them are allowed to produce practitioners who are actually let loose on the public, I think what they really have to get right is who they accept on to the course in the first case. There are always ethical problems related to perverse incentives and moral hazard when it comes to private institutions of this type (they certainly exist in the private sector in health care too – in my experience), and this is where the gvmnt has been remiss with regards regulation. If the gvmnt are going to allow institutions like ION to offer the kind of training that produces practitioners who are going to work in a clinical setting and take money from people, they at least ought to tighten up admissions policies so that those trained have some prior background/qualification in health care/science. This might help weed out those who, quite frankly, are keen to make a quick buck from desperate people or those that are unquestioning/unconcerned about research findings or how they are presented and utilised.
In terms of Holford himself, he always referenced the research he referred to in lectures, so, although I didn’t always agree with his interpretation of the findings, at least I could check it for myself and refer to it in the way I understood it. His biggest fault imo is that he comes across as some kind of marketing guru and has his fingers in too many-money making pies for my liking. I don’t think its any accident that the most successful of ION’s graduates were people who previously worked in marketing either.
Having said that, when I worked as a research nurse I resigned in disgust because some dr’s seriously meddled with the research in order to get the desired result for the sponsor. And I do mean seriously meddled – one example being not reporting people who had withdrawn from the study because the medication/placebo made them feel ill. Instead the drs would continue to collect that subjects allocation of study drug/placebo and report on them as if that subject was still in the trial. I refer to this because one poster mentioned the fact that we can’t entirely trust medical research when it is so closely associated with drug companies etc and in my experience this is definitely true.
Considering this type of thing goes on in medical research (and I have many more examples), I thought I ought to provide a little balance in terms of the fact that there is corruption and greed associated with not only medical research but also in private medicine where drs conduct invasive tests (that are not without mortality risk/serious side effects) when the patient clearly doesn’t need them, and of course in institutions that churn out practitioners, some of whom really aren’t adequate to the task but don’t even know it, and worst still take people’s money.
So, whilst I understand and admire your desire to discuss the failings of an unregulated industry, and to expose pseudoscience where it exists, I do wish you wouldn’t tar all ION graduates/nutritionists with the same brush as many of us have a good grounding in health care and/or science to the degree necessary to serve our clients safely and well. So, in the interest of balance why not also address the failings / corruption / manipulation associated with medical research? Private health care? And of course there is always homeopathy…..
Hi Angelica, thanks for the very detailed reply :) Thanks for telling us about your experience of the ION, and of their ‘quicky’ course – very interesting to know. If you’d like to share any more details on your experience and education there, do let us know.
Re. Holford referencing his work – I can’t say what his lectures were like in the past, but reading his work now there are problems with referencing. E.g. he often includes references, but uses references that are not adequate to back up what he is saying – one example here, but we could go on…
While I wouldn’t want to ‘tar’ all DipIONs with the same brush, I am cautious about whether a 3yr part-time course can be adequate preparation for clinical practice (but some – as in your case – do have relevant pre- or post-DipION education).
re. corruption in medical research, flaws in homeopathy, etc – I’d point out that we all do things other than write this blog, and that some of us have addressed these issues elsewhere. In terms of poor quality journal articles – I’ve just posted about some of the problems with research presented as evidence for the Dore treatment. That said, though, there’s a limit to how much we can do – and I think that writing about Holford is one legitimate use of our energies.
@jonhw
perhaps one way of defending yourselves against charges of unfairly concentrating on Mr Holford (though the blog’s name is a teeny, weeny clue to your concerns…) would be to have a kind of miniblog sidebar thing. You could, in that way, alert readers to things like the ghostwriting article in the current issue of PLOS medicine or articles on problems in conventional medicine, CAM etc. Of course, I suggest this without the slightest idea of how much work something like this would entail!
thanks – I was thinking of something like that. Just need to work out details like how…and how much work it would take ;)