In January this year Which? published a report entitled Nutritional therapists - gambling with your health? that uncovered examples of dangerous advice and practices being carried out by practitioners who called themselves ‘nutritional therapists’. A flurry of media articles followed - headlines included ‘The nutrition ‘quacks’ who put patients’ health at risk’ (Daily Mail 16 January 2012), ‘Nutritionists give ‘dangerous’ advice’ (The Daily Telegraph 16 January 2012) and ‘They ignore alarming symptoms, rely on risibly absurd tests – and charge you a small fortune: The nutrition therapists who put your health at risk’ (Daily Mail 21 February 2012). This article gives a brief overview of the work, training and qualifications of nutritional therapists and how this differs from Registered Nutritionists and Registered Dietitians and discusses the impact of the Which? report on the nutrition profession overall. It is worth noting that, while this article discusses different professional titles and qualifications, the title ‘nutritionist’ is not protected and can currently be used by anyone, even those without any relevant nutritional qualifications.
What did the Which? report find?
On 16 January 2012 Which? published a report entitled Nutritional therapists: gambling with your health? which was a summary of their own investigation into the nutritional therapy profession. Which? sent five undercover researchers to each visit three nutritional therapists. Each researcher posed with a different health-related scenario, for example one researcher said that she had been trying unsuccessfully to conceive, another two said that they had been suffering from severe tiredness and a further two claimed they had been diagnosed with ductal carcinoma in situ (DCIS), a common type of non-invasive breast cancer. The visits were recorded and subsequently assessed by a panel of experts (a dietitian, a GP and a pharmacology professor).
There were 15 visits in total and six of the 15 visits were rated as ‘dangerous fails’ because, according to the expert panel, either the advice given was deemed to be harmful or diagnosis had been carried out without appropriate testing, or because the patients were advised not to visit their GP despite some potentially worrying symptoms. One therapist apparently advised one of the undercover researchers (diagnosed with DCIS) that she should try to get rid of the cancer through diet by cutting out sugar. Another researcher who claimed to be suffering from severe tiredness was advised to cut out red meat. Of the remaining visits, 8 were rated as ‘fails’ and only one was rated as ‘borderline pass’. Furthermore, many of the therapists recommended quite restrictive diets (for example excluding dairy and wheat) and supplements were commonly prescribed.
However, it should be highlighted that this was a small investigation which looked at the practices of only 3 nutritional therapists and so can only be a snapshot of what goes on within such consultations. It is not clear how the three therapists were selected and may not be representative of the field in general.
Nutritional therapists are trained to provide advice on diet and nutrition at an individual level, and usually see clients on a private basis. Their advice is based on a mixture of science and non-evidence-based practice. This is not consistent with the practice of Registered Nutritionists or dietitians and would not be considered ethical under guidelines from the Association for Nutrition (for Registered Nutritionists) or the British Dietetic Association, who regulate dietitians. Nutritional therapy is recognised as a form of complementary medicine and practitioners recommend personalised nutrition and lifestyle programmes to suit their clients.
The British Association for Applied Nutrition and Nutritional Therapy (BANT) is the professional association that represents nutritional therapists. Regulation of nutritional therapists is voluntary and currently offered by the Complementary and Natural Healthcare Council (CNHC), the government supported regulator for Complementary and Alternative (CAM) disciplines. According to the BANT website, full membership usually requires graduation from a course approved by the CNHC or a course accredited by the Nutritional Therapy Council (NTC).