Should you let a ‘nutritional therapist’ treat your children?

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

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

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

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

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

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

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

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

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

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

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

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20 Comments

Filed under British Association for Nutritional Therapy, Food for the brain, patrick holford

20 responses to “Should you let a ‘nutritional therapist’ treat your children?

  1. Steve

    That’s right – raise totally unfounded allegations of potential child abuse against people with who you do’t agree.

    Where is your evidence?

  2. Uh Steve, no allegations against anyone. It just looks like fair comment that the so called profession of nutritional therapists may want to run a tighter ship.

  3. Thanks for the comments.

    Steve- As Andy says, my post was certainly not accusing BANT members of anything (I even went out of my way to point out that some BANT members may do a good job). I was, however, critical of BANT’s efforts to regulate its members. The issue I raised above is not whether BANT members are good practitioners, but whether BANT is doing enough to make sure that its members are good practitioners. This is something that one would hope a good professional body would do – but, as argued above, I don’t believe that BANT is doing a particularly good job of this. Steve- do you think that BANT is doing enough to keep standards up, to regulate its members, and to protect the clients of BANT members?

  4. Pingback: Patrick Holford and Chineham Primary School: Where does the praise belong? « Holford Watch: Patrick Holford, nutritionism and bad science

  5. New regulatory body for Nutritional Therapists

    Voluntary regulation of the nutritional therapy profession is now being overseen by the Nutritional Therapy Council (NTC), which works closely with The Princes’ Foundation for Integrated Health (FIH) to provide a national registration scheme for nutritional therapists.

    The NTC mission is to establish, uphold and advance the standards of qualifications, competence and conduct of those who practise nutritional therapy as a profession, in order to protect the public and provide guidance to practitioners. It has now launched a new national register, so that members of the public will have access to a single register of practitioners.

    Nutritional therapists provide one-to-one counselling to address specific health issues through diet and nutritional support. Practitioners can apply for registration through the voluntary scheme and will be assessed on their training and experience. If they meet agreed National Occupational Standards and can demonstrate that they provide safe and effective nutritional therapy, they are able to join the register.

    Maintaining professional standards is a vital element of regulation and practitioners will be required to undertake continuing professional development to ensure that they continue to meet standards.

    For further information please contact: PPR@nutritionaltherapycouncil.org.uk or visit our website http://www.nutritionaltherapycouncil.org.uk

  6. thanks for the comment, NTC. I’d be delighted to see the development of an effective regulatory framework for those marketing themselves as ‘nutritional therapists’, although links to Charlie’s FIH don’t exactly full me with confidence. Clearly, the post above focuses on BANT, though: I haven’t yet been able to look into the NTC in any great detail.

    It does seem like there’s a lot of work to be done before ‘nutritional therapists’ can be on the same footing as dietitians. For example, are there plans to move to a four-year full-time accredited university course (or a 3yr BSc and 1 year postgrad course) before NTC therapists are allowed to practice? And will the NTC regulate members with at least the same degree of thoroughness and transparency as the HPC regulates dietitians?

  7. LeeT

    The comment that, “CRB checks are up to the employers of BANT members where such members fall under the ambit of the legislation,” is rather pointless. The majority of nutritional therapists listed on the ION website directory seem to operate in one of two ways – (1) as a self-employed individual or (2) as a member of a health clinic/alternative therapy centres. Even in the latter case I would have thought they are self-employed and merely rent a room in the centre for their consultations. Consequently they have no employers!

    To be fair to practitioners, rather strangely, it is not possible for them to apply for CRB certificates on their own behalf: http://www.crb.gov.uk/Default.aspx?page=289&qid=447
    However, the CRB website did speak of registered bodies that dealt with applications: http://www.crb.gov.uk/Default.aspx?page=289&qid=456 Presumably BANT or the NTC could become one or seek a relevant umbrella body if they are going to be submitting less than 100 applications a year. They would certainly need to look in to the issue and perhaps lobby the government if it is not possible for organizations like theirs to register with the CRB. At the moment they seem to be saying, “Not our problem guv’.”

    One of the benefits of BANT membership is “low-cost professional and indemnity insurance.” If I were an insurer I would want to be certain those being insured were proven to be of the utmost integrity. If they cannot or will not obtain a CRB check would it not be sensible for BANT members to state on their literature and websites they can only see those over the age of eighteen?

  8. Pingback: Holford on Applied Kinesiology testing: “there is little doubt that it works” « Holford Watch: Patrick Holford, nutritionism and bad science

  9. Anon

    “However, BANT appear to assume that AK testing is an “other discipline”, and therefore not something that one could complain to them about.”
    The individual who is able to perform AK testing, is a profesionally qualified clinician to do so, seperate from Nutritional Therapy (NT). For example a GP who is NT qualified can take blood tests (i know of GPs who are NT qualified, just for reference). A NT cannot perform AK testing (without the relevant qualifications) and therefore is not covered by BANT because they are not allowed to do it!

    I have read alot of comments with unjustified opinions based on an irrational view of nutitional therapy ‘quackery’. I do agree that there is a long way to go in terms of protecting the title of ‘nutritional therapy’ and developing the profession to a standardised level. But you are missing the point, the reasons behind nutritional therapy clearly fills a void not covered by dietetics (please do not misconstrue this as me denouncing dieticians). I believe you would be suprised by the amount of knowledge needed to successfully treat a complex case that has been referred to a NT by a GP.

    I would be interested to learn if anyone who has slated NT has ever actually been to a NT session?

    Response to jonhw:
    Currently at the University of Worcester a minimum 2 years (Full Time) MSc in NT, (entry requires; a first or second-class Honours Degree in a relevant, cognate discipline or Professional qualifications in an appropriate area or Relevant practical experience). In the case of other practical experience and qualification an access course is needed to be passed. The course leader has excellent credentials including a PhD in genetics.

    It is strange because I hear articles such as this claiming ‘quackery’ yet through my NT MS all I have been ever taught is a scientific based approach to learning. This is really why i responded to these comment, during ‘struggling’ through a heavily scientific assignment.

    Patrick Holford…. well, really, what can i say! I think he’s self explanatory.

    I welcome criticism as this is the only way BANT/NTC are going to iron out the shortcomings. NT is not protected and this is a problem, allowing individuals to misrepresent and drag the profession down. Needs to be sorted really!

    • Thanks for the comments. A couple of things coming out of them:
      – What does NT-qualified mean? One issue currently is that anyone can call themselves a ‘qualified nutritional therapist’, even if they have nothing more than a mailorder diploma. Even with taught courses, standards vary dramatically.
      – If nutritional therapy is being misrepresented by some poor practitioners and media spokespeople, this is something that those in the profession need to address. I struggle to think of any cases of evidence-based and well-qualified nutritional therapists publicly criticising colleagues who are bringing the profession into disrepute. This is really a shame: if the way some individuals present NT works to “drag the profession down”, this should be challenged with by NTs and not some anon bloggers.
      – Re BANT ironing out shortcomings, we complained to them just over a fortnight ago. We have not yet had an an acknowledgement, let alone any evidence that they are taking action. This does not fill me with confidence.

  10. Anon

    In addition, every member has to have occupational health check, CRB, insurance, ID checks, Qualification checks. Exactly the same as the NHS (i work in the NHS).

  11. Anon said: “I would be interested to learn if anyone who has slated NT has ever actually been to a NT session?”

    Yes, I can help you out here anon. Do read the following post from my blog …

    http://leet02.wordpress.com/2008/06/15/going-to-see-a-dip-ion-nutrition-therapist/

  12. Anon

    Firstly sorry about the rushed first post!

    By NT qualified i refer to courses accredited by BANT. Yes courses do vary greatly, and as you say “nutritional therpist” is not a protected title.

    I can only speak from my own experience and not other courses, but surely it should be encouraged to develop the profession to meet recognised standards,from recognised universities? Or is it that you simply feel the field of NT is not worthy? I only ask this because I do feel it can be sometimes misunderstood (which is understandable due to the variation in teaching methods some of which I hear are poor to say the least).

    LeeT:
    Sorry, i didn’t mean an ION NT! ION is a diploma, not post grad, not even Bsc, so yeah something needs to be sorted out there! and yes i understand this is the problem, anyone can be a NT. I think BANT need to strive to improve this situation (which they are). With regards to your comments on BANT, come on guys, a low funded governing body of a ‘profession’ in its relative infancy. Of course there are going to many flaws, it will takes years to develop the ‘profession’ to the neccessary standards, this doesn’t mean NT isn’t a worthy profession.

    It’s a shame I do not currently have the extensive knowledge that I will have in a few years as I could probably argue my point a little more effectively!

    ‘Quacks’ are found in many professions and this is really the key, WHEN the profession is protected hopefully this whole quakery thing can be put to bed. I just don’t understand why everyone generalises comments regarding Nutritional Therapists. Is a GP who also practices NT a quack?

    Sorry I haven’t got time to write any more, I will do as soon as i have the time, please excuse poor grammar!

  13. Steve

    If somebody has a genuine interest in diet/health then they can become a dietician. “Registered Dietitians (RDs) are the only qualified health professionals that assess, diagnose and treat diet and nutrition problems at an individual and wider public health level. ” The profession is well developed, so need to go down the route of the anti-science courses that are pushed by BANT and the like.

  14. Anon

    I don’t study anti-science, hence the fact I am studying a Master of Science Degree, in NT, if you took a look at the curriculum you would instantly agree. It’s not BANT pushing our course, rather we have a quality course but don’t currently have the protection or rights. I don’t see why BANT are demonised, like most things in modern society, it will become rationalised, and the problems will be erradicated. It’s all about progress, it’s not going to happen overnight.

    The ignorance you show typifies a person who doesn’t really know anything of which you speak, you believe what you’re told and don’t have room to critique what is in front of you without bias, how about you develop some of you’re own opinions.

    So Dietetics has always been well established in its long history? Everything has to start somewhere. There are clearly people slipping through the net of primary care if they are desperate enough to turn to a “quack” nutritional therapist? (i’m not claiming all or even most are qualified by the way).

  15. Anon

    In response to Steve you state: “The ignorance you show typifies a person who doesn’t really know anything of which you speak.”

    Now, I know considerably more about Mr Holford, his friends and BANT than I really want to. Just what exactly is nutritional therapy? Holford is idolised by most so called nutritional therapists. If you want to be taken seriously I would suggest that (1) you disance yourselves from Mr Holford (2) you cultivate a better relationships with dietitians and registered nutritionists and (3) you think critically about what you are doing and what you are trying to achieve

    • Anon

      I will respond to the rest of the post later but just to assure that i don’t know a single NT who idolises Mr Holford. I guess i don’t know many ION ‘graduates’ though.

    • Daniel

      Hi LeeT,

      I think you’re judging our anonymous friend a little too harshly.

      There seems to be a serious effort of “evidence-based debate” and the course at the University of Worcester that he mentions does at least exist. Also, the description page does not spill over with alternative medicine mumbo-jumbo. Unfortunately I don’t have excessive knowledge of the British University landscape, so I’d be happy to hear any assessment on the reputation of Worcester.

      To Anon: Would you be so kind as to provide more details on the curriculum? The information on the course page is well-sounding but quite thin.

      Greetings from Oslo,
      Daniel

      PS: People, let’s keep these discussions objective, and let’s not rule out the chance that there are reasonable people also on the NT side. (Although why then they should not simply choose to become dietitians is somewhat beyond me.)

  16. Anon

    Hi Daniel,

    Thanks for the post. My positive opinion of the university is most likely biased, with my best efforts to be unbiased i will say it is a rapidly growing university, mostly noted in excellence for its teaching, nursing and sports science courses. The science department was small with adequate facilties, the benefits being more lab time and tutoring. I remember a review commenting on the excellence of the lifesciences department, unfortunately i have no link. More recently (this year) it has grown with a brand new science department and an increase in courses, the nutrition BSc lecturers lead the NT MSc. On the negative side, the current library/resources aren’t really sufficient, and in terms of nutrition the access to quality licenced nutrition software is poor (Foodbase).

    Off the top of my head, the first module covers the most of the basics, nutrient interactions, professional and ethical considerations for NTs. The major learning outcomes i think focus on evaluating large amounts of interlinking research to form a critical understanding of current issues in nutrition. An e.g. assignment was a dietary analysis (and creation of a dietary management strategy, without supps) of a ‘fictional client’, a pregnant, overweight, vegan. Analysis. So yeah, alot of things to cover in that one! I should also mention, all the nutrition basics, biochem etc, are required upon entry to the course with a portfolio of evidence as proof, i.e. proof of study, for me my Bsc. A written essay and a physiology exam needs to be passed before entry to the course.

    I realise my description of topics in that module was a bit sketchy, i’m tired. I will try and get a list up soon so you can judge for yourselves

    “Kuhn’s (1996) ideas have been
    highly praised and, of course, derided, but they do raise the
    possibility of a critical defect that weakens and undermines
    the entire field of nutrition science; there is no basic
    unifying paradigm.”
    There is no exact science in nutrition, particularly when you get down to the level of the individual, protocol and the one size fits all approach doesn’t work at this level, this is where NT can be very beneficial.

    Ref:(google: The ancestral human diet: what was it and should it be a paradigm for
    contemporary nutrition?) too tired to reference a blog!

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