Reading the comments on a dubious New York Times blog post offering a list of 11 foods to eat, we were very concerned to see Tara Parker-Pope’s response to one comment. The comment states that “Your list of 11 foods is fine except for anyone on a renal diet in advanced stages of CKD [Chronic Kidney Disease].” Tara Parker-Pope replies by advising that “obviously people with specific dietary concerns need to discuss the issue with their doctor or nutritionist.”
Unfortunately, as we have explained on many occasions, ‘nutritionist’ is not usually a protected title. While there are no doubt a number of well-qualified, university-level-credentialled and capable individuals practising as nutritionists, in most states absolutely anyone is able to call themselves a nutritionist. As Ben Goldacre’s dead cat Hettie demonstrated, you don’t even need to be alive or human in order to be a credentialled nutritionist.
If people want to pay an unqualified and unregulated nutritionist (who could have extremely limited skills, knowledge, abilities and common sense) for dietary advice, they are quite entitled to do so – though we would prefer that nutritionists made their status and qualifications known to clients prior to any consultation, so that properly informed consent can be attained. However, it is irresponsible for Tara Parker-Pope to suggest that people in the advanced stages of CKD consult a ‘nutritionist’ without adding in the need for appropriate credentials: in such cases, bad advice from an unqualified and unregulated nutritionist could have extremely serious consequences. As could advice from a nutritionist who does not recognise that s/he is acting beyond the bounds of their competence and knowledge.
The fact that such advice is offered on a New York Times blog is particularly unfortunate: it makes this advice look more credible. It is also regrettable that – while helping to promote the role of nutritionists – Tara Parker-Pope fails to mention the possibility of consulting a Registered Dietitian who is especially knowledgeable about renal disease, the effects of the usual drugs and dialysis (as appropriate): these practitioners are appropriately qualified and regulated (‘dietitian’ is a widely protected title) and are experienced in dealing with patients with CKD. If suffering from CKD and concerned about diet, you should consult the doctor, consultant or dietitian who is part of your care team: this is a specialist, and important, issue on which to receive dietary advice.
The New York Time’s slogan is, famously, “All the news that’s fit to print”. Tara Parker-Pope’s advice to this commenter was – quite simply – not fit to have printed on a New York Times blog.
Update: h/t to Lee from the comments: Detox diet lead to brain damage.
Mrs Page’s legal team alleged Mrs Nash advised her to increase her water intake by six pints a day – and to avoid salt. They also said that when informed of Mrs Page’s symptoms, Mrs Nash said “what was happening was not unusual” and “was part of the detoxification process”.
We are very sorry to read about this case and wish the family well. It is a wretched example of what can happen in such circumstances. It is difficult to know what happened here as there may be a non-disclosure agreement.
In this case it seems as if the nutritional therapist in question had received her education at a college of natural health and was practising in the naturopathic tradition.
In general terms, there is a very real difficulty when some therapists are acting so far outside their sphere of competence that they are not aware that they should be urging a client to seek medical assistance.
Update 7.07: Quackometer comments on the case: Alleged Victim of Oxford Nutritionist ‘Detox Diet’ wins £810,000.
It is particularly irritating that Tara Parker-Pope does not seem to realise that she has strayed far beyond her level of knowledge/competence with some of the advice that she has handed out in the comments. Nor that some searching on PubMed for an adequate-looking review does not mean that she has anything like a decent overview of the state of the research in cinnamon, turmeric etc.
After all, several commenters have pointed out that the devil is in the detail and that there is rather more nuance to even a recommendation for pomegranate juice than there might seem.
This strong response and the nature of many of the questions makes it seem that the NYT would do well to employ an RD to answer detailed food questions on a regular basis. Mind you, so could some of the UK press.
Speaking as a reader who thinks (perhaps wrongly) that newswpapers such as the NYT have an especial responsibility to provide accurate, well-supported health information, it is usually gratifying when a writer acknowledges that they may have erred in their perspective. However, TPP shows little sign of this. I wonder if she has even looked at the modules of the CCNH PhD course in Holistic Nutrition to see just what level of expertise she was recommending to her readership.
Can I suggest that she has painted herself into such a corner that she can’t afford to specify “appropriate credentials” for a nutritionist.
Here is what happened to some one who consulted a “privately trained nutritionist.”
http://www.oxfordmail.net/display.var.2380792.0.detox_diet_led_to_brain_damage.php
Lee, thank you for posting that albeit it is a wretched event for the woman involved and her family. One can only be grateful that the nutritionist in question carried insurance.
Barbara Nash on her nutritional therapy programme:
One has to wonder if hyponatraemia played any part in the catastrophe that Mrs Page experienced yet this nutritional therapist is still demonising salt.
I don’t even want to think about what is going on with that castor oil packing. How can these people believe that it melts “bad fats” through heat? I didn’t even know that naturopaths believed in light and colour healing.
Why am I not comforted by her advice that I should consult a “qualified naturopathic nutritional therapist” or is that an oxymoron?
Especially worrying is that it’s entirely plausible that Ms Nash is still practising as a Nutritionist. She would, legally, be quite within her rights to do so, and she will not face the type of investigation which the GMC or HPC would undertake following a similar case involving a practitioner who was regulated by them.
“Especially worrying is that it’s entirely plausible that Ms Nash is still practising as a Nutritionist”
It would appear so:
http://www.barbaranash.co.uk/index.html
The latest tranche of dietitians who have graduated and last year’s tranche are facing unemployment because there are not sufficient posts for them despite an urgent need in the NHS.
A surprising number of PCT staff find the work of Patrick Holford and his ilk plausible (presumably because they have never checked the references the way that you people do). They use the terms dietitian and nutritionist as if they are equivalent and a surprising number of them don’t know that the designation dietitian is protected and that RDs are registered with an appropriate body.
So, with the distinction blurred,and more and more publicity given to the ‘need to detox’, and the need to treat rampant food ‘allergies’ people end up consulting a nutritionist and think that they are receiving the same advice as they would get from a dietitian.
I hope that some RDs find their way to the blogs that are covering this and comment.
I am just trying to think whether there is anything that can be done to stop the therapist practising. The son of the woman concerned has now posted a comment against the Oxford Mail article. I was thinking about suggesting that he contacted the police. After all if your negligence kills some one you can be charged with manslaughter.
Has anyone else got any suggestions? It seems extremely unjust that she will not face any investigation.
The website does not provide any details about her training or qualifications, though it does say she was consulted by Central Television.
Lee, afaik, this settlement means that there is no ruling against Mrs Nash and no finding of culpability so I doubt that there would be sufficient grounds for even a civil case involving negligence or injury. IANAL however so would be interested in hearing from someone who is.
She is listed in Yell where she has a BANT membership. She lists a DNN here; in the link posted by TW (above) she refers to naturopathic practitioners – “Please do not try these techniques unless on a proper programme set out by a qualified naturopathic nutritional therapist”; she refers to naturopathic nutrition therapy; and finally, from a bio:
You can read all about the correspondence course qualification and other offerings at the College of Natural Nutrition.
The BANT is puzzling. According to the College of Natural Nutrition, their DNN (now?) only entitles people to membership of:
The Federation of Independent Therapists (F.I.T.)
The Institute of Complementary Medicine (I.C.M.)
The Complementary Medical Association (C.M.A.)
It obviously speaks to my frivolity and immaturity that I find the url of the College of Natural Nutrition entertaining –
http://www.natnut.co.uk/
natnut(s) indeed.
Barbara Nash has provided a timely (and unfortunate) example of why TPP was wrong to recommend a nutritionist without any caveat, but the case also highlights the dangers of unregulated nutritionists being allowed to practise. Unfortunately, there is also an argument that regulating nutritionists will give them ‘credibility’.
jdc, David Colquhoun would agree with you.
It is already difficult to track why some wording in particular media contravenes ASA regulations when written on a leaflet, but not when on a website; why it is possible to make claims for supplements in an email for which you signed up as long as you promote the link to the website to purchase that supplement in a separate email in which you water down those claims.
It is unbelievably confusing, and the next post will quote Robert Cialdini in some response to this.
As a dedicated NATNUT, I am still busting my brains studying for my certificate.
It is by no means easy; you have to study physiology, anatomy, chemistry, nutrition, take lots of case histories and learn to see the connections.
We are also taught to give different diets to different circumstances after a through analysis of their case which can take up to an hour and is extremely effective.
In contrast, a visit to a state registered dietician takes about five minutes and results in a standardised diet sheet which is pretty useless, as I have found out to my cost and a lot of pain over many years.
I have looked at all my notes over 2 years and nowhere have I found 6 pints of water to be recommended to a client.
Nobody knows the actual details of what went on between Barbara Nash and Dawn Page. How people can criticise and condemn others without having all the facts is very mystifying to say the least!
Personally, I am extremely happy with what I have learnt and have not been healthier. As a result of the knowledge gained, I have finally said bye bye to all my arthritic pains and am enjoying dingy sailing in my twilight years on a trapeze! Other people have said goodbye to their steroid creams and skin afflictions… The story goes on and on…
I feel privileged and very happy to be doing this course and would recommend it to any one.
The sad truth is, people are going to alternative therapies because they are not getting any results from their doctors or state registered dieticians or specialists.
I and others like me who have overcome their afflictions through natural means of are greatful to the College of Natural Nutriton and its teachings and can not praise enough its teachers.
The truth, fortunately, will always prevail…