Is Holfordism Harmless? Part 1

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?

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49 Comments

Filed under BANT, BDA, British Association for Nutritional Therapy, dietician, dietitian, Holfordism, institute for optimum nutrition, institute of optimum nutrition, ION, Nutrition Society, patrick holford

49 responses to “Is Holfordism Harmless? Part 1

  1. Yes, please – communication details as per About.

    Oddly enough, I suppose that if people were to ‘top-off’ their qualifications to obtain the BSc, then they might be sufficiently qualified to work in the community but I would have thought that this would require them to do some clinical registration work as Catherine Collins describes in the above post. Strictly speaking, I suppose the author of the page might have been indicating that it is possible to use this qualification to progress and obtain other qualifications/experience that would permit this.

  2. Le Canard Noir

    medocs, like dietitians, tend to want to cure rather than prevent

    I love that phrase, typical of quackspeak. So many canards in so few words. let me count the ways…

    1)”Curing is bad” The moral undertones that it is your own fault if you are ill.
    2)”Doctors don’t prevent” – like anti-smoking and drinking(it was docs that proved the link between cancer an smoking), malaria prevention, sanitised operatations, condoms, excercise and eating advice and of course (in hushed tones) vaccination. Saved more lives than anything.
    3)”Prevention is sufficient” eat your ‘optimum’ diet and have 100% health as the nutriquacks would have it, like diet is the only factor in disease. Have they never heard of germs and viruses, genetic problems, accidents and trauma, aging diseases, mental health. Yes, nutritionists, I am sure, would have us believing that such things just require mega-doses of vitamins. Rot. Dangerous Rot.
    4) “Docs and Dieticians and somehow motivated only to ‘cure’.” ‘Big Pharma’ has got them!!! Push those pills.
    5) “Nutritionists don’t push pills”. One has to hold some severe doublethink to believe this.

  3. Shinga

    LCN – do you need to go and swim with some dolphins?

    Perhaps we would have a fuller understanding of such matters if Patrick Holford were to offer to donate a copy of ION’s Home Study Course. I am thrilled by this claim: “As you work through the Home Study we believe you will learn more than you ever thought possible and by the time you have completed the course, will know enough to keep you your family and friends in the best possible health” [mistakes are as in the text].

    Regards – Shinga

  4. Ciaran

    Have you three loosers really nothing better to do. With all the scams being pulled by pharmaceutical companies every day that are really costing lives and health and you waste you time spitting out ridiculous arguments. Who thinks curing is bad? Everybody thinks curing is good but most believe prevention is better than cure. Now that makes sense doesn’t it? Good.
    And who uses words like rot? Except maybe a stuck up stuffy old Tory fogy. Its high time you looked around and realised that modern diseases are caused mostly by modern lifestyles. Where was heart disease and cancer 200 years ago? The medical model needs to update itself urgently. Doctors who simply use the monthly magazine sent to them by pharmaceutical companies are in danger of loosing their patients. People want good heath service. They want to be taken care of all round and not just dosed up with drugs every time there’s a problem. You probably can’t see this because your Daddy is the director of a pharmaceutical company and you’ve been too busy fox hunting haven’t you?

  5. Shinga

    Hi Ciaran,

    Always a pleasure – I hadn’t realised that you had cut and pasted an entire satirical blog piece with the Hold It Up for Ridicule item – would you mind deleting it and replacing it with a short quotation and the link? If it is your copyright, would you mind making that clear?

    As for the rest – bless you, you have uncovered my eyes and when I have the time and resources I shall set off on a quest to discover my real father.

    Regards – Shinga

  6. Jon

    Right – Ciaran, I’ve deleted the comment where you post the whole Hold It Up For Ridicule piece on Goldacre. Feel free to post an excerpt if you’d like, or if you own the copyright just make this clear. Please don’t cut and paste any copyrighted material in full into the comments here, though.

    Anyway, Ciaran, thanks for the helpful comments. I’ve looked through the site, though, and I really can’t see where we’ve said prevention is a bad thing. Perhaps you could point that out to me?

    I never knew that doctors opposed prevention, either. Mine seems depressing keen to tell me to eat healthily, exercise, not drink too much, etc. Where are all these doctors who prescribe beer and pork pies to their patients – and how do I sign up!

    Oh yeah, and if I had a fiver for every person who has e-mailed me or commented on the blog to claim we’re in the pay of big pharma, the budget for Holford Watch would have been multiplied several fold :(

  7. Le Canard Noir

    ciaran, sorry for not replying sooner. You now how it is in the city, buy-sell, buy-sell. Anyway, before I go out and swill loads of champagne and run over some oiks in my range rover, I must say this:

    We three losers are not impressed by silly ad hom attacks. We use basic science to challenge Holford’s claims. If you spot we have got something wrong then please point it out to us and we will correct it. Your speculations about our lifestyles are just plain silly and your view of the medical profession offensive.

    Right. Must dash. The peacocks on the lawn are attacking the labrador puppy again.

  8. Anonymous

    Ciaran says:

    Its high time you looked around and realised that modern diseases are caused mostly by modern lifestyles. Where was heart disease and cancer 200 years ago?

    er- totally correct, Ciaran. Thats because modern diet and modern lifestyles and modern medicine (based on evidence, not entrails or guru-speak) allows to all to live to a great old age – which unfortunately brings age-related problems such as, er, heart diseae and cancer…..
    lucky the 18th century dandy who died beautifully in bed, mid 30’s – heart intact, pity about the plague, the pox, the dietary deficiencies blah blah blah

    and just one more thing. Just to help you ‘place’ me as a working-class- bod-who-went-to-tory-grammar-school. Learn to spell. It’s not ‘Looser'(ie to slacken) – it’s ‘Loser’….. and ‘Fogie’/ ‘Fogey'(since 1780), not ‘Fogy’

    Good. sorted. off to read more interesting stuff on this website…..

  9. Jon

    anonymous- thanks for the kind words. Yes, it’s remarkable how much you can reduce cancer and heart disease diagnoses if you just ensure that people die relatively young. Of course, as a ‘cure’ for cancer this may not have many takers…

  10. Anonymous

    I happened to scan through this commentary. Reading all the criticism of a person is an admission of guilt of having done some harmful actions against the person or the field being criticised. Nutrition works. Why don’t you spent constructive time helping others and team up with Patrick Holford in his work to educate people on nutrition and correct lifestyles. Your criticisms only show your low levels of confront and what sticks out as a sore thumb are your hidden crimes which you hope no one will find out. Well they are there. I don’t care what they are. Get busy and do something constructive which you can be proud of.
    Sincerely
    Allan

  11. Shinga

    Well, bless you too, Allan. Do I take it that you are a signed up member so the Psychic Friends Network and this is where you have obtained your information about our “hidden crimes”?

    What with fox-hunting and hidden crimes – you and Ciaran are really putting together an interesing lifestyle profile for us.

    We are correcting Holford’s mis-interpretation of the literature and basic science in some of his promotional work for his vitamin sales. In many ways, we are helping him to disseminate a more accurate, evidence-based educational message about nutrition.

    Actually, if we can dissuade healthy people from paying out remarkable sums of money for supplements with no assessment of their likely clinical benefit – then I think that we can be proud of that…

    Regards – Shinga

  12. Anonymous

    Allan again,
    If you claim to correct, then what can you show for your work? Do you have a website, a book or materials that supplant the “lies” or “untruths” that we can access to?
    I design supplements and used some of Patrick’s work and had good results from the formulations. So how can I believe what you say?
    Show me your materials I can read and maybe I can use them to better my services.
    Sincerely
    Allan

  13. Shinga

    Allan – read through this site – particularly the references to homocysteine, the bioavailability of curcumin, the ‘quality’ of the research on MSM etc. There is a reasonable body of work here – particularly for a blog that has only been up for a few weeks.

    You might choose to believe what I write because I reference the technical literature and discuss it. By the by – what evidence do you have for the success of your supplement formulations? Is that published anywhere in any of the forms that you suggest?

    Are you challenging my costings for Holford’s supplements v. statins – because I took those figures from his site.

    Are you denying that he gave the wrong figures for the premature mortality figures to support his promotion of homocysteine testing etc.?

    If you have quoted Holford on any of the above, then you can already improve your materials by taking on board our comments.

    Regards – Shinga

  14. Anonymous

    Shinga,
    I just happened to come across your site and saw a lot of criticism. I didn’t honestly look closely at your materials. But what caught me is the criticism and if not backed up by corrective measures tells me something odd is going on.
    I now know your site and it can be a source of information for me. What is easier is books to read. Do you have books?
    I do nutritional research. I cured my asthma from studying and applying nutriton. I am not for mega doses of supplements, but I do recommend mega doses to people when they start their healing and then adjust their diets to eat the correct foods to prevent the illnesses and diseases from coming back. They then reduce the doses of supplements as the foods will be supplying them their nutrients. Depending on their lifestyles, they might need supplements that add to what their foods do not supply adequately.
    Let me get back to the reason I got on your site. I am researching information on the safety or dangers of aspartame. So if you know any information that can be trusted, let me know.
    On my product, I get feedback, it is prescribed by doctors and they report the results and it is working. I have not gone further. If it works, it gets recommended and it keeps selling.
    Chat to you then.
    Allan

  15. UKdietitian

    well Allan, I sincerely hope that you are not one of the ION acolytes typically working in the home counties…. you know, where a pretty face, a pseudo-clinical manner and a pretty office/ salon within a healthfood shop/ beauty parlour works wonders with the affluent codgers willing to part with lots of dosh for an hour of ‘holistic nutrition’ and an empathic manner.

    The sort of ‘nutritionist’ who finds it essential to have a ‘pretty’ website with lots of faux scienciness and pictures of green things to emphasise the ‘naturalness’ of your practice – perhaps even promoting other ‘soft sciencey”professionals such as chiropracter (pseudo physio), applied kinesiologist (pseudo allergy specialist) etc etc

    Perhaps I denigrate you incorrectly. But it appears you promote your ‘holistic but nutrition-lite’ approach to dealing with people with health issues serious enough for you to share ‘GP knowledge’ with.

    If you do, then your GPs are in breach of their PCT contracts that insist that a secondary referral is to a ‘qualified’ individual, which in Dept of Health terms means a Registered Dietitian, not an ION ‘nutritionist’.

    Its also worrying that you state you help ‘formulate supplements’ – at megadose levels for beginners, that you ‘do’ nutrition research and you are ‘researching’ that 10 year old, done and dusted alt.nutrition concerns about the ‘safety’ of aspartame.

    This does not fill me with confidence in the quality of your knowledge. But thats not your fault if you have to rely on Holford books from Holford institutes and Holford training programmes to educate you.

    There are sound nutrition manuals out there but because Holford has nothing to do with them you will not be aware of their existence. I think you would reconsider your practice substantially should you ever review non-Holfordesque opinions on nutrition, but I remain concerned about the level of nutrition information you impart to your clients.

    But well done in using this site as a potential resource. I find it useful as well.

  16. Anonymous

    Thanks.
    I am not part of any nutrition or diet related organisation.
    Have taken note of your site and will read through as needed.
    Regards
    Allan

  17. Shinga

    Allan – what is odd about promoting a more accurate, evidence-based view of nutrition, or whether or not a recommended device will actually reduce or increase EMR etc.?

    If you are selling a test and supplement programme by frightening people about their likelihood of premature mortality then I think that it does behove you to state the correct figures and not quadruple them – we may differ on this point.

    You say that you didn’t look at the materials – is it possible that you criticised first, checked your facts later? Likewise, for the accusation of “hidden crimes”.

    Hmm – Holford is not strong on the message of “you can get all the nutrients that you need from food”. In fact, you can see that he recommends a basic selection of supplements that you should “take every day” for a current special offer of £34.80 per month.

    As for the aspartame, apart from the odd turnaround from “So how can I believe what you say?” to asking me to cite research/sources on aspartame for your benefit – I shall decline on the grounds that we will likely differ on what we believe to be information that can be trusted.

    What product/s have you formulated and can I read about it somewhere?

    Regards – Shinga

  18. Jon

    Allan- could you please clarify. You say that “I am not part of any nutrition or diet related organisation.” However, I get the impression that you also have patients referred to you by doctors and ‘prescribed’ these pills – doesn’t that make you part of a nutrition-related organisation? Or, if not, how do you describe your work?

    What evidence do you have for megadoses of vitamins ‘working’? No-ones arguing that people prescribed megadoses will often get better. However, aside from the placebo effect, many illnesses would heal without any intervention (e.g. colds will get better with a megadose of vitamin C; they will get better without this, too, though…) That’s why randomised placebo-controlled trials are important.

  19. Persiflage

    “At 03 June 2007 17:12 , Anonymous said…

    I happened to scan through this commentary. Reading all the criticism of a person is an admission of guilt of having done some harmful actions against the person or the field being criticised. […snip…] Your criticisms only show your low levels of confront and what sticks out as a sore thumb […]”

    And jon said (much later): “…doesn’t that make you part of a nutrition-related organisation?”

    Guys, read the end of the first paragraph I quoted. I can tell you exactly what nutrition-related organisation he belongs to, as that “low level of confront” statement is immediately recognisable as a very specific brand of drivel: he’s a Scientologist. I’d imagine it’s the Narconon programme he’s associated with, with all the vitamin mega-dose buffoonery that implies.

    His weird statement about reading criticism of someone being tantamount to admission of harmful action is straight out of HCO (Hubbard Communications Office) bulletins explaining to the faithful why reading adverse material on LHR is wrong, now incorporated into their core teachings.

    Looks like Holfordism and $cientology are indeed excellent bedfellows, although I doubt Mr. H would want to flaunt that relationship to the general public just yet!

  20. Le Canard Noir

    Persiflage – you are my new best friend. What a marvelous spot re the scientology language. And thanks for the support on the quackometer too.

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