Radio 4’s You & Yours today discussed the issues arising from the alleged injury of a client of nutritional therapist Barbara Nash, when Nash put the client onto a ‘detox diet’.
The programme (here and you can listen again here, while it’s still available) includes an interview with registered dietitian Catherine Collins, and the BANT Chair Emma Stiles: extraordinarily, Stiles apparently acknowledges that nutritional therapists do not practise evidence-based medicine. However, the segment began with Mr Page telling the sad story of how this diet - including lots of water and low sodium - progressed. Dawn Page consulted a nutritional therapist because she wanted to lose some weight, but she ended up in intensive care and still suffers from cognitive problems (this case was settled out of court for £810,000; Nash continues to deny responsibility for the injuries to Mrs Page, and due to the settlement there has not been a court finding on this case).
The programme then featured Registered Dietitian Catherine Collins: she pointed out that, while ‘dietitian’ is a protected term, and in order to earn the title one needs to have studied nutrition for at least four years:
The term nutritionist and nutritional therapist are not regulated by law in this country, so [talking to her interviewer] Peter you are a nutritionist or a nutritional therapist if you want to be.
While dietitians in the UK are - due to the protected status of the title - all regulated by the HPC, nutritional therapists are not. For example, Barbara Nash would be quite within her legal rights to continue practising nutritional therapy as before (and her website is still online, suggesting that she may still be practising). We don’t know her current status, but Barbara Nash has been listed as a member of BANT.
Emma Stiles - Chair of the British Association for Applied Nutrition and Nutritional Therapy (BANT) and a practising nutritional therapist - accepted Collins’ definitions of dietitians and nutritional therapists, and stated that BANT have been working towards voluntary regulation of nutritional therapy. Stiles discussed the Skills for Health Competencies Framework. However, as Collins points out
This is the only area of healthcare where the government is allowing enthusiastic amateurs who accept themselves that…they’re really not working to the level they should be, to…have a work in progress.
Clearly, as Collins observes, when one sees a health professional one wants them to be competent and to be properly regulated - it is not sufficient for them to be working towards competence. Some readers may recall Professor David Colquhoun’s experience with Skills for Health and his lack of confidence in their relevance.
The presenter, Peter White, then asked a bold question. He asked Stiles why there was a need for nutritional therapists and if they were, in fact, superfluous: a fair question, given that we already have properly trained and regulated nutrition professionals in the form of dietitians. At this point, I began to feel somewhat sorry for Stiles, who was left arguing that nutritional therapists address a particular niche for those whose issues have not been resolved by recourse to science-based methods.
[We] try to look at the outliers who have been through evidence-based medicine.
It thus sounds like Stiles - speaking as BANT chair - concedes the point that there is not a good evidence-base for some of the treatments that BANT nutritional therapists recommend. This concession appears to remove the putative niche for nutritional therapists: if evidence-based nutrition does not help a particular individual, it will not help to refer them to nutritional therapists who are (by and large) less well-trained than dietitians, inadequately regulated, and working without an adequate evidence base for their work (and, often, without an adequate understanding of what evidence does exist or its significance).
It seems appropriate to close with a quotation attributed to Emma Stiles in Food Habits and Social Change (pdf) March 2008. (A future foundation report for Kelloggs.)
“Everywhere you turn you’ve got Jamie, you’ve got Hugh, you’ve got the Daily Mail, you’ve the food doctor, you’ve got the eating disorder charity, you’ve got all these people and the people who are doing the real good actually have the quietest voice.” Emma Stiles, Chair of the British Association for Applied Nutrition and Nutritional Therapy
Given the inordinately high profile of many self-styled nutritionists and nutritional therapists, one has to imagine that Stiles is referring to registered dietitians. We hope that the quiet voice of the BDA and people like Catherine Collins is given more of a platform and an amplifier in the very near future. As LeeT points out in the comments, a fundamental problem is that not only do the public fail to understand the nature of the difference between a registered dietitian and a nutritional therapist, it seems that nutritional therapists misunderstand the nature of their own qualifications. (JKN’d with comments.)
Update: Corrected the spelling of Emma Styles to Emma Stiles and added in the quotation from the Kellogg’s Report.
Stiles has some comments about the evidence-base for functional foods (pdf).
Consumers appear to be attracted to functional foods as a way of maintaining good health and are used as an illness prevention,” suggests Emma Stiles, Chair of the British Association for Nutritional Therapy. “Taken on a regular basis (daily usually) they act as a peace of mind that the consumer is doing something for promoting good health.”
While there are no specific regulations governing functional foods, it is illegal for manufacturers to make any claim that their products can prevent, treat or cure disease. Despite some sceptics questioning the health claims of some products, however, Stiles is confident of their benefits.
“There is much research around each of the components used in functional foods,” she continues. “Due to the labelling and regulation they do not state how much benefit the products have - with some functional foods, you might only be getting a very small benefit. But it is a benefit none the less.”
We would suggest that it is debatable that that is true of all foods that are promoted as functional and would argue that it overlooks the issue of whether they represent value for money to consumers and support or detract from the idea of an adequately balanced food matrix that meets individuals’ needs and matches their lifestyle.
Update 18 July: BANT has responded to the Your and Yours programme in which they participated (JKN’d).
BANT is, and has always been, ready to comply with the request made in 2006 by the Health Professions Council that the British Dietetic Association, Nutrition Society and BANT work together to progress the regulation of the nutrition profession as a whole. Despite the negative comments in this program about nutritional therapy, BANT would like to reassure the public that BANT members are currently going through a process towards voluntary regulation.
As per the JKN comments, it might have been more useful if BANT were to review their membership requirements and assure the public that they were reviewing their safety procedures and minimal training requirements for membership. After all, this might have been a better use of their discussion time than amending their ethics code to permit commission payments from supplements sales.
Included LeeT’s observation about some nutritional therapists’ misunderstanding about their own qualifications and included a link to David Colquhoun’s assessment of Skills for Health.
Update 22 July: Daily Mail covers the story: Mother winds £800,000 payout after ‘four pints of water a day’ detox diet leaves her brain-damaged. The Times also carries it: Dawn Page receives £800K payout for brain injury caused by high fluid diet. Although both papers give adequate coverage of the story, it might have been helpful for their readers if they had asked the BDA or similar body for appropriate guidance for readers considering a similar “Amazing Hydration diet”. Neither paper used this as a teaching opportunity for their readership to advise them on appropriate credentials for readers who are looking for guidance for weight loss or food-related issues and guide them towards a registered dietitian. To be fair, the Daily Mail does carry a comment from RD Nigel Denby.
July 23: BBC version of the Page-Nash detox story with input from Catherine Collins representing the BDA and Andrew Fadge of the FSA.
Daily Express runs the story Danger of detox diets - doctors issue a warning. Again, a comment from RD Nigel Denby but also, oddly, from Claire Dunt of foodmentor.com who displays a slightly different misunderstanding about her qualification from ION.
Claire founded Food Mentor in 2006 after gaining her Nutritional Therapist’s Diploma from the Institute for Optimum Nutrition, and an FdSc in Nutrition Science from the University of Bedfordshire.
As regular readers know, the DipION/FdSc is the same qualification and FdSc is the abbreviated form of Foundation Degree: the University of Bedfordshire describes if as FdSc/DipION Nutritional Therapy.
The Sun is covering the story with input from Catherine Collins, representing the BDA: Dangers of Detox Diets. They have also, very helpfully, included a link to the BDA for guidance about appropriately-qualified dietitians.
There are currently more than 200 items about this news story but too many of them overlook the obvious opportunity for telling their readership about appropriate sources of advice.
Rose Shapiro has a piece that warns about the dangers of unaccredited nutritional therapists and the typically evidence-free health advice that is bandied about in women’s magazines: Rose Shapiro on how to spot quacks. She also recommends that people who need advice should consult dietitians: “If you want reliable dietary advice it is dietitians, not nutritional therapists, who are properly trained to provide it”. Quite.
July 26: Daily Mail provides some detail as to the symptoms experienced by Mrs Dawn Page as a result of the hyponatraemia: Water ‘detox’ robbed me of my wife. It seems that Dawn Page experienced epilepsy and psychosis amongst other adverse events: both then and later, it seems to have been both harrowing and gruelling for her and her family.
September 21: Through A Glass Darkly has now posted about the qualifications and career backgrounds of DipION practitioners.
59 responses so far ↓
Dark Prince // July 17, 2008 at 7:20 pm
Catherine Collins seems to be the only public face of Dietetics in this country, and she does a very good job even though she is apparently fighting a lone and losing battle. It is a shame the same can’t be said of the the hierachy of the BDA (but that has been done to death over on Quackometer).
I am interested by Sykes argument though - if NTs really are going to look at outliers “who have been through evidence-based medicine” presumably the first thing an NT would do with a prospective patient who has not yet consulted a Registered Dietitian would be advise that they do just that? I can just imagine how short Holford’s GMTV consultations would be if every answer was “see a Registered Dietitian”.
Returning to earth for a second - maybe the fact that these NTs are soon to have formal recognition via the CNHC will mean that the line between RDs and NTs will become even more blurred and more members of the public will end up losing out.
Let’s just hope that the Chief Exec of the BDA resolves his conflict of interests and dalliance with the CNHC and starts ensuring that Dietetians become the first and only port of call for people who need nutrition advice.
LeeT // July 17, 2008 at 9:04 pm
“outliers” - what an odd use of language. My dictionary defines the word as “a person or thing situated away or detached from the main body.” Not sure if it is linguistically correct to describe a person with an incurable chronic condition like that.
Perhaps it is BANT and the ION who are the outliers?
Mary Parsons // July 17, 2008 at 9:46 pm
I would think that it is very unusual for someone to have been previously referred to a dietitian in the circumstances that Emma Styles outlined.
I don’t understand why faffing round with someone who spouts pseudoscience and provides science-sounding explanations for food and supplement recommendations would work when actual science-based interventions hadn’t.
Are we back to the assumption that what makes the difference is having a 30-60 minute session of talking to someone? Is there social reinforcement for the idea that particular diet restrictions and supplements will do people good and it is therefore a good placebo theatre?
dvnutrix // July 18, 2008 at 12:05 am
The discussion was interesting in the implicit admissions. It was bizarre that BANT Chair Emma Stiles was trying to argue that protocols and an evidence-base were restrictive and that dietitians do not tailor their advice to the individual.
All the more tragic in the context of a case where Mr Page was effectively saying that the nutritional therapist in question was ‘reassuring’ them with science that he didn’t understand but persuaded them that the symptoms were not untoward. Is that the sort of individual care that Emma Stiles is promoting as the upside of consulting a nutritional therapist?
@Lee - very odd language. However, in this context ION and BANT are more the cowboys of the unregulated Wild West of nutrition, more outlaw than outlier if you will.
dvnutrix // July 18, 2008 at 12:10 am
@DP - A completely miserable yet realistic prospect. One of my major apprehensions is that the BDA’s PR is so poor while that of the nutritional therapists is excellent - if they are not careful, the new Darzi-hyped polyclinics will give contracts to nutritionists rather than RDs when it comes to putting together their portfolio of services. From what Stiles says, the message seems to be that nutritional therapists are the equivalent if not better than RDs in some contexts, yet the reality is that they can be profoundly ill-equipped in their training and profoundly anti-science - to the point of being dangerous.
Unfortunately, it is not as if fundholders in PCTs etc. can be relied upon to know better.
Claire // July 18, 2008 at 9:26 am
“From what Stiles says, the message seems to be that nutritional therapists are the equivalent if not better than RDs in some contexts…”
And I’m afraid out in the real world this message is being - literally - bought. Oh dear, going anecdotal again, but a recent conversation with a former nurse highlighted this: I was reproved for defending the notion that someone who has been accepted into and completed an honours degree in human nutrition and whose title is protected (i.e. you’ve got to show evidence of achieving a certain standard to call yourself an RD) could possibly be a better prospect than someone who may only have done a part time correspondence course for which the entry requirements are not stringent.
There is a genuine issue about difficulty in some areas in getting access to a specialised dietitian in cases of suspected food allergy or intolerance. There is a Food Allergy and Intolerance Specialist Group within the BDA (some information about it here: http://www.bsaci.org/dietitians.html ) so perhaps the message needs to be communicated that people with concerns in this area who experience difficulty in accessing an RD should contact the BDA for advice. Interesting to note that BSACI does not have a section for nutritional therapists!
I share DVN’s concern about the BDA’s PR failure and her worries about future provision of healthcare via commercial organisations, which I’m sure the manufacturers of supplements, home tests etc are eyeing with interest.
LeeT // July 18, 2008 at 9:57 am
Part of the problem seems to be that many Dip IONs rather worryingly don’t understand the level of qualification they have obtained. It is actually equivalent to a HND or foundation degree. Some of them seem to think they have undergone post-graduate training in nutrition. See for example:-
http://www.nationalnutritionclinic.com/hannah-love-profile.htm “This led to her embarking on a three year post-graduate course to become a nutrition therapist”
http://www.naturallynutrition.co.uk/Profile.html “with a postgraduate diploma from Patrick Holford’s world-renowned Institute of Optimum Nutrition.”
Claire // July 18, 2008 at 10:20 am
I followed Lee T’s first link (thank you) and found this:
http://www.nationalnutritionclinic.com/allergy-screening.htm
“An Allergy Screening With Instant Results
Thanks to our latest bio-dermal clinical screening technology, we can identify your allergies without taking blood and give you the results immediately.
All you do is hold a metal probe in each hand while we send a signal for each of the allergens listed below. If you are sensitive to that allergen, it will show up on your report.
The whole process takes just 45 minutes, and we discuss the findings with you to agree what to do next.
What Allergies Do We Screen You For?
We screen for 136 allergens in your 45 minute session. Just click on each of the categories below for a full list of the allergens you will be tested for:
Allergen Sensitivity
Air Pollutants
Animal Danders
Chemicals
Clothing Materials
Food Sensitivity
Fossil Fuels
Harmful Energies
Heavy Metals
Pests
Pollen Mix …”
head>>desk
draust // July 18, 2008 at 2:19 pm
“Thanks to our latest bio-dermal clinical screening technology, we can identify your allergies without taking blood and give you the results immediately.
All you do is hold a metal probe in each hand while we send a signal for each of the allergens listed below. If you are sensitive to that allergen, it will show up on your report.”
Crikey. Diagnostic electro-dowsing! Or should that be “bioelectric applied kinesiology”?
In fact it is an updated version of a time-honoured Alt.Reality quack electro-device, the “Vega-test” system. Plus ca change…
PS Loved LeeT’s quote from someone calling the IoN “world-renowned”. It’s a bit like someone calling the late Herr Hitler a “world-renowned political leader”.
draust // July 18, 2008 at 2:20 pm
PS Oops - forgot to include a URL for teh Vega-test quackery: a good one is here.
Claire // July 18, 2008 at 2:54 pm
I wonder what the therapy for “Harmful Energies” is - exorcism?
jdc325 // July 18, 2008 at 3:19 pm
Listened again last night. Thought Catherine Collins came across well. Good questions from Peter White too - particularly the one prompting the admission that Nutritional Therapy (I mean as practised by unregulated, partially-trained nutritionists rather than referring to dietetics) is not evidence-based.
I thought Emma Stiles sounded nice actually and it was certainly brave of the BANT chair to agree to the debate - given the way some high profile NTs refuse to engage in debate (or even to discuss their ideas) and the fact she was, essentially, defending the indefensible.
Claire // July 18, 2008 at 5:44 pm
@ JDC, I’m sure most nutritional therapists are very nice, well-meaning people but I’ve been looking at some of the websites given in BANT’s find a practitioner service (follow link given in post; click on the button in l-hand sidebar), and quite a few so far appear to offer unvalidated allergy/intolerance testing, e.g. here:
http://www.homeopathinessex.co.uk/
Obviously, I have no idea if this sites I have looked at are representative of BANT members’ knowledge of allergy/intolerance testing in general, given I don’t have time to look at all of them and many don’t have website links. But what I’ve seen so far concerns me.
pv // July 18, 2008 at 6:20 pm
Indeed. In other words, hobbyists and daydreamers who like to play at being doctors for pocket money. BANT, being their representative organisation, are also hobbyists as evidenced by the meaningless fake code of ethics. ION is a hobby.
If ever anyone needed a finer example of a cargo cult!
jdc325 // July 18, 2008 at 7:48 pm
“I’m sure most nutritional therapists are very nice, well-meaning people but…”
Ha - yes, I think perhaps the appeal to niceness should be recognised as a logical fallacy. I was trying not to be critical of the person while criticising their actions [sort of 'love the sinner, hate the sin' if you will] rather than trying to defend her. I remember Sue McGinty on Rise of the Lifestyle Nutritionists - she came across as being very nice and very reasonable and she was willing to go on a programme about nutritionists presented by someone who has been critical of nutritionism and debate the subject. Despite this, I still found some of her comments amusing. I can’t find the programme she was on now (part one is still on ‘listen again’, part two is not as far as I can tell), but if there is a transcript of the prog anywhere (I can’t find one) I should say that her definition of ‘phenotype’ is worth keeping an eye out for.
Admin: you’re right, Part 2 does seem to be down at present, we have emailed the BBC to ask if this is permanent.
Upate 21 July, Part 2 is now live again.
Catherine Collins RD // July 18, 2008 at 9:52 pm
Well thank you, Holfordwatchers, for maintaining your usual high standard of critique regarding a Patrick Holford/ self-styled nutritionist story.
As a London based dietitian it’s relatively easy for the media to find me for comment. But my fellow dietitians up and down the country also contribute to the wider public debate about nutrition, as we can see from our cuttings agency figures. Despite having a miniscule PR team (compared to Mr Holfords empire) at BDA HO their ‘backroom’ activities generate much of our press interest - which ultimately lead to our opinions being heard. Increasingly so, as journalists realise that poor quality comments from self-styled experts can negatively impact on their future commissions.
So thank you for all your sterling work. There is much to be learnt from your critical reviews and supporting evidence when faced with the musings of ‘enthusiastic amateurs’. And may the media continue to use RDs as their primary source of sound nutritional opinion!
LeeT // July 18, 2008 at 10:04 pm
Claire
I have analysed all the websites of Dip ION therapists that I could find - about eighty. Following a bit of spreadsheet meta-analysis I have to report that a large minority of them: (1) are either bonkers or (2) do not understand the nature of the qualification they have or (3) do not come from a science background
I’ll publish my research once my Word Press/blogging skills are a bit better and when some one offers me a PhD for my work.
jonhw // July 19, 2008 at 12:24 am
Lee - will look forward to the post :)
JDC325 wrote:
I agree - she did come across as pretty nice, and relatively up-front about the limitations of nutritional therapy and nutritional therapists. The problem I have is with the approach to nutritional therapy that Stiles was defending…
LeeT // July 19, 2008 at 9:56 am
It is all very sad - most nutritional therapists are not quacks or crooks. Most of them are intelligent and enthusiastic. What they need is better leadership. Here is what I propose:-
(1) The ION distances itself from Patrick Holford and, like the University of Teeside, asks him to stop visiting
(2) The ION asks the BDA to take a critical look at its curriculum
(3) It is made clear to all Dip IONs that their diploma/foundation degree MUST be converted to an honours degree within two years or they will no longer be able to practice
(4) Whilst studying for the honours degree they will be closely monitored in terms of the clients they deal with
(5) In the first two years after graduation they will be operating under licence, possibly under the supervision of a dietitian. After that period, like other helath professionals, they will be committed to continuing professional development which will consist of more than attending Patrick Holford seminars or sales conferences by vitamin pill salesman.
UK dietitian // July 19, 2008 at 10:49 am
LeeT
now thats an interesting idea.
A simpler way way forward, hypothetically, would I suggest be that -
1) Dept of Health ‘donate’ a sum equivalent to that already given to woo therapy (to ‘regulate’ themselves), but this time for a large PR campaign about how to spot a nutriquack. (Come to think of it, even half of thast £800k would do nicely).
2) The practice of clinical nutrition for the prevention and management of disease (ie dietetics) becomes protected to those qualified in the subject. (Note parallels with the protection of role for the medical profession, with self-styled doctors ending up with prison sentences for fraud)
3) The sterling work of the ASA in highlighting fraudulent marketing claims should combine with the DoH to scrutinise what is actually going on at these nutritional madrassahs. That should lead to closure of most - if not all - of the current ‘Institutes’ and ‘Schools’.
This will also prevent those interested in the subject from being mislead about where exactly their diplomas and certificates will lead them when they ‘qualify’. ie not into clinical nutrition areas that they are currently incompetent to practice in, but by necessity into their own private practice.
4) those enthusiastic about the subject will then be trained in any of the legit universities offering dietetic degrees. Both graduates and their patients find it a rewarding experience.
*btw - do we know what the ION has done to ensure that the substandard training on ‘nutritional pharmacology’ has been addressed by the 2001 - 2007 cohort of ‘dipION’ graduates?
UK dietitian // July 19, 2008 at 10:51 am
……….and
5) Patrick can ‘come out’ as the fully fledged vitamin pill pusher that he is, without the need for convoluted and contortional Holfordisms about nutrition to support his musings. There will be no more missives from the master, and Holfordwatchers can take that well deserved holiday.
dvnutrix // July 19, 2008 at 11:35 am
I actually feel that I am owe some apology along these lines to my brain cells having subjected them to Holford’s vaccination, salvestrols and other bits of thought abuse.
I don’t think that I can answer *btw, Prof UK dietitian, but we may have some information on the way ahead for the ION that we might post later as everything else we want to write about is pretty intricate (Holford is wrong but he has mixed up some things that make this hard to disentangle) and we are waiting for responses from various academics, researchers etc.
LeeT // July 19, 2008 at 12:32 pm
UK Dietitian
Take a look at the following on the ION website:
http://www.ion.ac.uk/Grandparenting/GP_ION_Notice_of_Assessment_for_Course_Mapping_Route_C.doc
“All ION graduates from 2001-2007 applying for Route C are recommended to purchase Dr Cliff Whelan’s 2005 lecture: Therapeutic Module: Pharmacokineticys. This will help to rectify areas of this subject missing from the course. LO3/5”
I assume what diplomates (note I don’t use the word graduate) from 2001-2007 will have to do is order a recording of Dr Whelan’s lecture and then sign a bit of paper confirming that they have listened to it.
If anyone can prove to me that they actually have do anything substantial I’ll eat a page of “The Optimum Nutrition Bible”.
Mary Parsons // July 19, 2008 at 12:57 pm
Lee - it’s not your fault but you have made me very sad. It looks like they sign to say that they have listened to a lecture? But then again, as UK dietitian hints, it is plausible that ION lacks any appropriately active clinical staff who would be capable of setting/marking an adequate exam. The same might be true of clinical supervision.
Wulfstan // July 19, 2008 at 3:52 pm
Ben Goldacre reveals that The Telegraph lost its science editor and its science correspondent in two months.
That is a sad reflection on UK journalism and probably demonstrates Nick Davis’ argument about what is happening to specialist journalists and the rise of churnalism. Riffing off your previous post about science blogging and journalism, maybe it an opportunity for The Telegraph to do something interesting and radical like consulting a few science bloggers and the BDA to beef up their coverage?
I think that they do need to employ specialist journalists but this would be a good experiment and its boldness would seem novel for that newspaper.
LeeT // July 19, 2008 at 11:19 pm
Mary
It is not all bad. Some Dip IONs are actually very highly qualified. Take a look at the following two websites:-
http://www.fitwithfood.co.uk/about.html
http://www.nutritionandallergyclinic.co.uk/aboutme.asp
An old friend of mine trained as a nutrtion therapist. She has a good science degree from a good university and I would not describe her as a quack.
The challenge is to harness all the enthusiasm and passion they have for nutrition for the service of evidence-based science.
Lee
UK dietitian // July 20, 2008 at 9:43 am
Sorry, Lee T - but I fail to see how someone ‘very highly qualified with a PhD in Physiology’ + ‘interest in food’ = ‘highly qualified nutrition professional’.
Actually, they’re not. They are a clever individual who knows a lot about how the body ticks. With a PhD behind them that will mean they have a lot of knowledge about a teeny weeny little part of how the body works.
This ABSOLUTELY does NOT mean that they have more than a rudimentary knowledge of nutrition, and of how dietary manipulation can influence bioavailability and cell functioning. They will have ABSOLUTELY NO knowledge of the medical conditions, management and how diet can interfere or positively interact with health.
I’m sure they’re a very nice, clever person. But having seen plenty of physiologists, graduate nutritionists, and biochemists who have all decided to retrain as dietitians they would be the first to tell you that their first or higher degrees provided a mere background to their current studies.
Afraid a lovely personality doesn’t cut the mustard, so to speak. if you or your friend think otherwise, afraid you’re both sadly deluded.
LeeT // July 20, 2008 at 11:43 am
@UKD - No, I was not suggesting that having a lovely personality helps you to make the grade. In fact, as the most recent post on my own blog make clear my personal experience is many alternative practioners don’t have lovely personalities. What I am wondering is what to do with these people now that we have them. What worries me is that plans I have seen for regulation just risk giving legitimacy to nonsense.
@Mary Parsons - if you are go on to the ION website you will see in the top left-hand corner they are trying to recruit new tutors. I think they have clinical practice in the third and possibly second years of the diploma. Earlier this year “Optimum Nutrition” magazine was advertising for volunteers for free nutrition consultations - presumably for student clinical practice? I did think about volunteering, but was afraid I would get in to an argument with the “clinician” and never be seen again! One thing I did notice when looking at Dip ION website is that several students “graduated” to being tutors or clinicians after finishing their courses.
Has anyone seen the ION curriculum? The only thing I have able to find is a pamphlet about the course on the website.
dvnutrix // July 20, 2008 at 12:18 pm
iirc, Ben Goldacre asked to see the course notes, lecture materials or exam papers etc. and was told that he could not as there are copyright restrictions.
ION provided Goldacre with a list of tutors and 7/24 list the DipION as their sole qualification another 1 also lists that she is part-way through a Dip Natur. so - at that time, 8/24 had no graduate background.
Somewhere on the Bad Science Forum is a 2007 list of ION lecturers and the module that they teach. However, the search function is broken so we can’t link to it.
The curriculum outline is sketchy but probably light to reflect that this is a part-time course with occasional w/end lectures. In Year 3:
Given the standard of Holford’s own literature reviews and the fact that he thanked a couple of IONistas in his recent mailout for the research that they had contributed, it would probably be interesting to see some of those reviews.
LeeT // July 20, 2008 at 2:16 pm
Thanks DVN, that’s brilliant and just what I need - not sure how I missed it on my travels around planet ION! Half of the eight modules are – in my subjective opinion – rather woolly and don’t seem to involve learning anything.
Something I have discovered is that there seems to be a relationship between Dip IONs without other science qualifications and an interest in alternative therapies.
Here is my favourite one:
http://www.focusnutrition.com/www.focusnutrition.coms/info.php?p=13&pno=0
An individual who has knowledge of metabolic typing, kinesiology, iridology and phytobiophysics but nonetheless “believes in the evidence-based approach to health where possible.”
Better stop this in case anyone thinks my interest in Dip IONs has become a certifiable obsession ….
PS Does anyone know what phytobiophysics is?
Mary Parsons // July 20, 2008 at 4:54 pm
Surely phytobiophysics is some quantum vibration thingummyjib of plants with a healthy dose of flapdoodle? Maybe you should write and ask Ann Walker, she is bound to know.
draust // July 20, 2008 at 6:03 pm
Hmm… one might cynically suspect that the IoN students’ “dissertations” could well provide some of the laughable “research” that ends up on the IoN website.
Of course, as H’watch has already pointed out, having Patrick’s IoN-trained proteges as the students’ tutors pretty much ensures that a lack of understanding of what it really takes to assess biomedical literature properly, and an uncritical acceptance of unproven nutri-nonsense, is being passed on as mother’s milk, as it were.
Although you can learn to spot SOME classic failings of bad science easily (like no blinding, or no proper control group) it takes a lot of know-how and experience to be good enough at literature interpretation to (say) run a meta-analysis, or referee papers for journals. Speaking as a career scientist, I would say that you really only start learning the very basics of interpreting and grading scientific literature as an undergraduate student, and that’s if you do a real B.Sc. degree taught by proper scientists, not a bunch of re-badged bollocks delivered by smiley IoN nitwits.
You get a lot better at scientific literature interpretation by the time you finish a Ph.D., but really it takes that AND typically three-plus years as a postdoc fellow before you have anything like the expertise necessary to referee a paper for a proper journal properly. It is being asked to referee papers and grant proposals that tells you when you are at the point where your peers regard you as “fully fledged”.
Of course, Patrick and his IoN friends no doubt think they have reached that point as they doubtless get asked to “referee” papers for Cargo Cult journals like the “Journal” of Orthomolecular Medicine“. Any real scientist who has ever glanced at the hobbyist nonsense that fills various Journals of Alt.Reality will know different.
Talk about the blind leading the blind…
Claire // July 20, 2008 at 8:21 pm
@Lee T
In second link you provide, to the Nutrition and Allergy Clinic, there is some indication that they subscribe to Clinical Ecology/Idiopathic Environmental Intolerance/Multiple Chemical Sensitivities theories. I’m not qualified to comment on the validity of these, but would just note that these theories are controversial in medical allergy and bodies like the AAAAI are cautious.
Admin edit for spelling as per later comment.
Claire // July 20, 2008 at 8:23 pm
P.S. many thanks to the Blue Writing Genie (Dr Aust)!
draust // July 20, 2008 at 10:19 pm
Mary is spot on about the use of “phytobiophysics” being flapdoodle.
The word itself COULD exist. “Phyto-” just means “plant-derived”, which biophysics is… [while], biophysics, the application of the concepts and methods of physics to biology. You can of course apply biophysical methods or ideas to plant-derived whatever just as well as to anything else. For instance, if I tried to use a fancy microscope to work out the deformability of lignin derived from a plant, that would be a piece of “phytobiophysics”.
In contrast, it is pretty clear that it is being used in the example above in the Prince Charles sense of “ummm umm, plants, umm quantum thingy, sort of mysterious healing, y’know”.
Admin edit: [while] as per later comment.
LeeT // July 20, 2008 at 11:09 pm
@Claire - unfortunately, I am not qualified to comment on the claims made on the website. She did look more impressive than anyone else ….!
Perhaps Dr Aust would be willing to peer review her research papers which are also detailed on the website….?
UK dietitian // July 20, 2008 at 11:22 pm
you know, the level of banter on this site is such fun. Unlike the Dr Briffa site which is full of tedious point scoring.
LeeT, Claire, Mary,Wulfstan, jdc, et al - great to blog-comment with y’all
:)
draust // July 21, 2008 at 2:15 am
Sorry, mean “while” at the end of the first line there. Blame lousy typing.
Claire // July 21, 2008 at 9:44 am
Correction to spellings my last post - it is of course ‘idiopathic environmental intolerance’ and ’sensitivities’.
On this topic, Dr Adrian Morris (pdf warning) has written an analysis, which leans towards the conclusion the psychological factors are playing a major role
draust // July 21, 2008 at 3:19 pm
Lee - re your last comment.. what research papers? …couldn’t find any listed (and her name doesn’t give any “hits” on PubMed).
Presumably I’m being dense and her complete lack of any papers is the point.
Must say I am still tickled by the random use of the term “phytobiophysics”. I must start a collection somewhere of these sort of “ten dollar words” (as the Americans say) which have actual real meanings, but are used by Woos to lay claim to a kind of spurious “science-y-ness”. Anything with “Quantum” in presumably qualifies.
PS What with inflation, nowadays they are probably “fifty dollar” or “twenty pound” words. So it goes.
Admin edit: Dr Aust, we think the reference is to these papers by Margaret Moss.
jdc325 // July 21, 2008 at 6:21 pm
Thanks to whoever in admin emailed the Beeb about the Rise of the Lifestyle Nutritionist - good to see it’s back up.
PS: Can I please point out, just to be absolutely clear, that I do not think that Stiles’s niceness in any way validates her views on nutrition? As I said, she was defending the indefensible. Apologies to anyone who read my post for any ambiguity. I don’t think my use of the word ‘actually’ helped either.
Dr Aust // July 21, 2008 at 9:25 pm
Admin edit: Dr Aust, we think the reference is to these papers by Margaret Moss.
Cheers.
Scanning the titles they almost all seem to be in one journal, the Journal of Nutritional and Environmental Medicine. The journal doesn’t appear to have an impact factor, so I don’t know if it is indexed on PubMed.
I dialled up the website for the journal to check out the editorial board. The names make interesting reading. Possibly a post in this, but I will merely note in passing that:
(i) the Senior Editor is Dr Damien Downing, known in the Badscience blogosphere for his fearless defences of “natural” waffle ‘n’ piffle, up to and including homeopathy; and
(ii) that a bit of Internet digging reveals that several of the UK-based people on the board seem to have long histories with the rather fringe-y nutrition charity Foresight.
The journal appears to be linked to the British Society of Ecological Medicine. Various bits of their website worry me too, especially the bit about “multiple chemical sensitivity”. But other warning signs can be found here and there on the BSEM’s site, like “kinesiology” and “chelation”.
Any of the more nutrition-literate hereabouts care to tell me more about the J Nutr Env Med? Is it OK but wacky, or is it (worst case scenario) another what I would call a “Cargo Cult Cabal journal”, like Abrams Hoffer’s “Journal of Orthomolecular Medicine” (see comments passim?)
Claire // July 22, 2008 at 12:29 pm
The editor of that journal is given as W A Shrader, MD (USA). If this is the same person, he appears to be an enthusiast for Enzyme Potentiated Desensitization.
Dr Adrian Morris has this to say about EPD:
“Caution: This article relates to Allergen Specific Immunotherapy (SIT and SLIT) which should not be confused with Enzyme Potentiated Desensitisation (EPD). This is an entirely different procedure which employs an enzyme (B-glucuronidase) mixed with numerous allergens and then injected into the skin. This practice was recently reviewed in the British Medical Journal and found to have no therapeutic value and is thus not recommended (Radcliffe M.J. et al, BMJ; 2003: 327: 251).”
Scary Outcome for a Fad “Detox” Diet « Balanced Health and Nutrition Rebecca Scritchfield’s Blog // July 22, 2008 at 10:12 pm
[...] on ‘The Amazing Hydration Diet‘. Her “nutrition therapist and life coach” Barbara Nash, told her that it was part of the detox [...]
dvnutrix // July 22, 2008 at 11:42 pm
Belatedly, Daily Mail covers the story: Mother winds £800,000 payout after ‘four pints of water a day’ detox diet leaves her brain-damaged. The Times is also a late-comer: Dawn Page receives £800K payout for brain injury caused by high fluid diet.
Both papers would have improved their coverage if they had:
*asked the BDA or similar body for appropriate guidance for readers considering a similar “Amazing Hydration diet”.
*used this as a teaching opportunity for their readership to advise them to consult a registered dietitian when looking for guidance for weight loss or food-related issues.
Claire // July 23, 2008 at 10:05 am
It’s also on the BBC website and they are asking for comments from people who have been on a detox diet and from nutritionists. But the article does conclude with the views of Andrew Wadge and Catherine Collins:
“…Detox diets are based on the theory that toxins from “unhealthy” food and drink build up in the body and can lead to health problems.
Purging those toxins - through restricted diets, lots of water or using particular supplements - is meant to leave people feeling better and, often, thinner.
But critics disagree with the principle. Dr Andrew Wadge, of the Food Standards Agency, has branded detox regimes “nonsense” and said the body has its own system of getting rid of toxins - the liver.
Dieticians are regulated by law in the UK, but nutritionists and nutritional therapists are not.
Catherine Collins, chief dietician at St George’s Hospital in Tooting, told the BBC: “As a dietician I frequently see people who have been given the wrong information by nutritionists or nutritional therapists and we deal with the consequences,” she said. “
dvnutrix // July 23, 2008 at 1:32 pm
We’ve just heard that The Rise of the Lifestyle Nutritionists is going to be repeated in a prime-time slot on R4 in the near future (Fridays at 11:00).
dvnutrix // July 23, 2008 at 9:34 pm
Another update that we have added in - The Sun has good coverage of the detox diet story and they have linked to the BDA for guidance on who to consult for dietary advice.
Rose Shapiro has a piece that warns about the dangers of unaccredited nutritional therapists and the typically evidence-free health advice that is bandied about in women’s magazines: Rose Shapiro on how to spot quacks. She also recommends that people who need advice should consult dietitians: “If you want reliable dietary advice it is dietitians, not nutritional therapists, who are properly trained to provide it”.
V Mitch // July 23, 2008 at 11:20 pm
Hi all. Just want to get in on the act. As an ex- personal trainer and nutrition adviser (I do have a BSc. in Nutrition and Health and currently doing postgraduate in Dietetics) at a top health club in London, it was frustrating to work with trainers who insist on giving specific nutrition and diet advice to clients. Metabolic typing diets and detox diets are rife and every personal trainer and fitness instructor is a nutrition expert. I was eventually asked to resign as I did not want to endorse such diets. This encouraged me to go back to uni. It is a shame that people are easily misled by persuasive and sweet talking therapists and fitness trainers to part with their hard earned cash to find a cure to what is ailing them. Gillian McKeith and Patrick Holford have a lot to answer for!
dvnutrix // July 24, 2008 at 12:08 am
V Mitch, sorry to hear that such an attitude prevails in health clubs and that it led to your resignation; that is very disappointing and doesn’t bode well for the quality of advice that is available from such sources.
Did you enjoy your degree and are you currently enjoying the postgraduate course? Are you planning to specialise in sports nutrition or have you developed another interest along the way?
Ignore the questions if they are intrusive.
V Mitch // July 24, 2008 at 12:31 pm
dvnutrix, yes loved my undergraduate course and thoroughly enjoying my postgraduate course. Can’t wait to finish and work in healthcare. I was an accountant in a previous life, but decided on a career change later in life. I wanted to be a sports nutritionist, but have since developed a great interest in diabetes and obesity. I feel fortunate to have been accepted into the postgrad programme despite my age, but I am worried that it would be difficult to get that first job after qualifying.
Any suggestions on how to improve my chances. I have another year of study and my placements to go.
Admin edit: we’ve emailed a couple of people (don’t know about their holiday arrangements) and hope that someone will pop by to comment.
Angry_Nutritionist // July 24, 2008 at 1:47 pm
Just a note to say that there are in fact properly qualified nutritionists who are not dieticians. I am one, having a BSc & PhD in Human Nutrition. The appropriation of the word nutritionists by quacks has done untold damage to my profession.
I know the distinction between a dietician and myself. I know that I can not treat medical conditions, as a SRD can. But the pseudoscientific claptrap that holford & mckeith spout is done in such a way to capture a market of people, who in many cases are vunerable to this and they have the PR etc to continue to promote this.
This situation makes me so angry and the voices of proper professionals, be they dieticians or nutritionists, is lost. I am angry with the Nutrition Society for not defending us loudly enough and the governing bodies who continue to allow these fraudests to practise their witchcraft, undermining the true message regarding health and nutrition and putting the lives of their ‘patiences’ at risk.
dvnutrix // July 24, 2008 at 6:12 pm
Angry-Nutritionist, you have our sympathies. We have noticed a very recent series of attempts to distinguish nutritionists (such as yourself) from nutritional therapists but it is far too little, far too late.
What was the Nutrition Society thinking to allow this to happen? This whole sorry business is a grave disservice to you and those nutritionists like you and a detriment to the reputation of your profession.
As per the quotation from Emma Stiles - it does seem as if the quiet voice of appropriate professionals is being drowned out (albeit, we think that some of the BANT members are responsible for this).
Nutritionists such as yourself and RDs need to start a blog - detail what is happening to your respective professions and to no positive gain by the public. If you don’t want to start a blog - ask a friendly blogger if you might guest post on their blog. Debunk the nutritionism that passes for comment in the various media. Make sure that newspapers, radio, TV etc. know that they should only ask an appropriately qualified nutritionist (not a self-declared one) or RD to comment on stories, give advice etc.
V Mitch // July 24, 2008 at 7:21 pm
Angry_Nutritionist, unfortunately, as much as we qualified nutritionists want to protect our title just as dietitians are protected, the Nutrition Society’s admittance to their register is somewhat unfair to those with actual nutritionists with a BSc. They have 2 kinds of entry - one for graduates with 3 years experience and one of ‘grandparent entry’ with 7 years experience in nutrition practice. I must admit that I don’t know the criteria they use in order to admit those who apply for ‘grandparent’ entry. Graduates have a direct entry and cost £20 whilst indirect entry cost £100 and include graduates from non-approved nutrition courses, which probably include those who do weekend courses in nutrition. The ‘grandparent entry also requires a statement of competence and portfolio of evidence, but again I don’t know what they check for or if they actually do check that they are not the likes of McKeith and Holford. It’s a battle that seems unending.
dvnutrix // July 24, 2008 at 8:51 pm
@VM That’s an interim voluntary registration arrangement until people meet the 3 years and it doesn’t distinguish between the graduates and the others?
That is not a good arrangement. But you know that better than I do.
UK dietitian // July 24, 2008 at 9:45 pm
Think you will find that the Nutrition Society is desperate for HPC accreditation, akin the dietitians.
The only problem is that in order to do so a certain percentage need to be on their ‘Register’. Now, the academic ninja nutritionists don’t need the register - their research and kudos set their recognition.
But the relatively newbie graduate or the I-became-a-nutritionist-with-a-sciencey-background-in-non-nutrition-subject are dead keen to be able to claim RNutr or RPHNutrR status - and the NutSoc is keen as mustard to ‘register’ them so that they ‘count’ towards the standards the HPC require.
Unfortunately it allows for some discussion as to the ‘quality’ of those on the register. See http://www.badscience.net/2005/03/nutritionism/
LeeT // July 24, 2008 at 9:58 pm
That’s interesting because a few years ago they told The Guardian:“The Nutrition Society does not recognize BANT members unless they have degrees in nutrition, believing that they may not otherwise be sufficiently well qualified. [Some of BANT’s courses] (…) aren’t in enough depth [and] don’t do enough biochemistry or physiology or epidemiology.” http://www.guardian.co.uk/befit/story/0,,1379280,00.html
Which?, YorkTest and Cambridge Nutritional Services « Holford Watch: Patrick Holford, nutritionism and bad science // August 22, 2008 at 4:40 pm
[...] is a misnomer) is a guarantee of quality or even a decent selling point (as the sad case of Dawn Page and Barbara Nash illustrates). FoodScan is the only food intolerance test endorsed by Allergy UK. In addition to the support of [...]
College of Natural Nutrition: bizarre teaching revealed // November 14, 2008 at 12:47 pm
[...] College of Natural Nutrition diploma (over £1300) is the only qualification of Barbara Nash. Nash is the ‘nutritionist’ who treated Dawn Page with a ‘hydration diet’, that resulted in organ failure, epilepsy [...]
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