Holford Watch: Patrick Holford, nutritionism and bad science

Food for the Brain’s website sometimes suggests that parents use a ‘nutritional therapist’ to monitor potentially harmful nutritional interventions. Certainly, treatments like exclusion diets - while sometimes very useful - also have health risks attached, and (especially in children) should be monitored by a competent professional. So, can one assume that a ‘nutritional therapist’ is competant to do this?

The fact that someone calls themselves a ‘nutritional therapist’ does not demonstrate anything much. The title is not protected, and anyone (or thing) is free to call themselves a nutritional therapist. For example, Ben Goldacre’s dead cat has achieved fame as a prominent member of the American Association of Nutritional Consultants. As part of our fundraising strategy, I’ve decided that that very sweet blue duck at the top of your screen - we call him Quacky - is also a nutritional therapist. When a client sees Quacky, he’ll quack once if they’ve got a wheat allergy, twice if they’ve got a milk allergy, or three times if we need to perform an exorcism; a bargain at £100 per session.

Of course, there are some organisations that might look like they regulate ‘nutritional therapists’. One of these - the British Association for Nutritional Therapy (BANT) - is affiliated with Food for the Brain. Food for the Brain also suggests that allergy “[t]esting is best done under the guidance of a nutritional therapist (BANT registered)” or an allergy expert. One might then assume that - if a nutritional therapist is registered with BANT - this demonstrate’s that they’re more suitable to give health advice to children than our friend Quacky. Sadly, you’d be wrong.

I recently e-mailed BANT to ask whether their members - practising as nutritional therapists - needed to have a Criminal Records Bureau (CRB) check: it is common for people working with children or other vulnerable clients to have such a check - to make sure that they don’t have any criminal convictions that make them unsuitable for such work). It is generally mandated that caretakers, cleaners and other ancillary staff in UK schools should have an enhanced CRB check because of possible interactions with children: one would therefore expect that Food for the Brain nutritional therapists (and other staff) had to obtain a CRB clearance before participating in their school ‘trials’. However, regarding nutritional members practising elsewhere, BANT told me that “CRB checks are up to the employers of BANT members where such members fall under the ambit of the legislation”. In other words, just because someone is a member of BANT does not mean that they do not hold a criminal record or that they are a suitable person to work with children.

I also e-mailed BANT to express my concerns that a BANT-registered nutritional therapist was practising Applied Kinesiology (AK) allergy testing. This method of allergy testing was completely discredited by John Garrow’s excellent (and free to access online) test of the reproducibility of its results. Garrow showed that AK testing - which lacks any plausible mechanism of action - produces results similar to chance when subjected to blind testing. I mention above that Quacky sometimes recommends exorcism as part of his nutritional therapy. That might have sounded like I was being unfairly disparaging of nutritional therapy; however, the evidence base for exorcism is about as good as that for AK allergy testing.

AK might seem like a nice, fluffy alternative therapy. However, to give advice on allergy is - as any sensible nutritionist should know - a serious thing: false positive results can lead to people unnecesarily excluding foods from their diets, while false negative results could lead people being exposed to foods that they are allergic to and therefore suffering unnecessary illness or death. AK allergy testing is thus potentially harmful to the patients of nutritional therapists. You might therefore expect BANT to speak out against it and prevent their members from practising such testing; however, you would be disappointed. BANT have informed me that:

As is often the case, our members may have trained other allied disciplines. We have no remit to question, test or verify how, where, when or at what level they trained in other disciplines…We do require that any professional requirements of them in other disciplines are fulfilled and that they are adequately insured to work in those fields. It is the duty of the other professional body to ensure that their members are adhering to their codes of ethics.

Personally, if a registered nutritional therapist is offering allergy testing, I would expect this to be part of their nutritional therapy. However, BANT appear to assume that AK testing is an “other discipline”, and therefore not something that one could complain to them about. BANT does ask that any professional requirements are fulfilled - AK allergy testing is useless, so god only knows what a ‘professional requirement’ might be - and that practitioners are insured. However, if a child is harmed by dubious nutritional practice, being able to claim compensation from a BANT member’s insurance is not likely to be much compensation.

As shown above, anyone can call themselves a nutritional therapist - being alive or human is not even a requirement. Being blue and plastic also does not preclude practitioners from using this title. So, if you’re taking your kid to see a ‘nutritional therapist’, you want to make sure that they’re properly qualified and regulated. One route to take is, of course, to use a registered dietician: there is an established process for qualifying and regulating these practitioners, and - in the UK - only those who are qualified are allowed to call themselves a dietician.

If you want to see a ‘nutrional therapist’, though, I wouldn’t take their membership of BANT as meaning much. As I’ve previously shown, BANT is (by their own admission) not a regulator - so you can’t rely on them to regulate what a ‘nutritional therapist’ does to your child. Also, as shown above, just because someone is a member of BANT does not mean that you can assume that they’re suitable to work with children: they could, for example, have criminal convictions which would preclude them from working as an NHS dietician. A final point to note is that BANT does not regulate the way in which their members practice ‘allied disciplines’ - a BANT-registered nutritionist could therefore use all kinds of weird, wonderful, useless and harmful techniques on your child, in addition to the nutritional therapy you might be expecting.

BANT might look convincing on the surface. However - while it’s quite possible that some BANT members do good work in their nutritional practises - BANT fails to ensure that this will be the case. If you put your child in the hands of a BANT-registered nutritional therapist, you might luck out and get a good one. Or you might get a therapist that’s no more effective than Quacky or, worse, a therapist who recommends harmful nutritional interventions and/or has criminal convictions that should preclude them from working with children.