Category Archives: BANT

BANT fail to reply to complaint from 25/10/09

As noted here, I e-mailed the British Association for Nutritional Therapy (BANT) to complain about some of Holford’s problematic online health advice. I have not, as yet, even had a reply from BANT – not even an acknowledgement of my e-mail.

This is an organisation which represents itself as

a professional body for nutritional therapy practitioners and those working in the wider application of nutritional science

BANT asserts that it seeks to

promote high standards of education, training, practice and integrity in the nutrition profession

Given these goals, I am rather disappointed by this lack of response – I would argue that BANT should have sought to deal with this promptly.

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You & Yours on Barbara Nash and the risks of nutritional therapy Updated (again)

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). Continue reading

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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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Why it is easy to get the incorrect impression that BANT is a regulator

As I’ve shown, the British Association for Nutritional Therapy (BANT) is not a regulator for nutritionists, and does not fulfill the functions of a good regulator. If the organisation were represented as a non-regulator (as a lobby group, say) that would be fair enough. However, the way that some nutritionists describe BANT makes it easy to get the (mistaken) impression that BANT is a regulator.

Patrick Holford claims that BANT “is the self-regulating organisation that represents this profession” of nutritionists. He does not explicitly say that BANT is a regulator – but it would be very easy to get this impression. Statements by others in the field could also give this impression: for example, the nutritionist Josephine Ng states that “as a full member of…BANT…I am bound by its strict ethical code of conduct.”

I understand that there may, eventually, be moves to bring in a regulator of nutritional therapists. However, until this happens, nutritional therapists – or those advertising the services of nutritional therapists – should be sure that their (prospective) clients know if the therapists in question are not governed by any regulator. People may wish to take the risk of using an unregulated nutritional therapist – but that’s a decision which they need to take with their eye’s open.

BANT’s website states that they act as “a governing, professional body regulating the activities, training and Continuing Professional Development of its practitioners.” However, given the potential for people to assume – incorrectly – that BANT regulate nutritionists, I would suggest that it would be helpful if BANT stated, in a prominent place on their website and any promotional literature, that they are not a regulator.

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British Association for Nutritional Therapy – when an organisation looks like a regulator, quacks like a regulator, but isn’t a regulator

11111It is important for healthcare providers to be properly regulated. An important aspect of this is the transparency of the regulatory process: for example, the GMC (which regulates Britain’s medical doctors) makes its guidelines on good practice available on its website, along with its hearings and decisions. Dieticians are regulated by the HPC, and you can view the standards they have to abide by, and details of the complaints heard by the HPC, online. Transparency is significant – it allows the public to monitor the standards to which medical doctors are held, and ensure that these are satisfactory (while also encouraging those with genuine complaints to submit them – as they can see that they will be fairly treated).

The British Association for Nutritional Therapy (BANT) claims to be “a governing, professional body regulating the activities, training and Continuing Professional Development of its practitioners“. Patrick Holford is a member, and the wikipedia page on Holford states that “Holford is a Fellow of…BANT…one of a number of bodies that aims to regulate nutritional therapists in the UK.” So, BANT looks like a regulator, and quacks like a regulator; however, BANT has told me that they are “a professional association and not a regulator”.

BANT’s disciplinary procedure completely lacks the transparency of the procedures of convincing healthcare regulators. I’ve been in contact with BANT about their complaints procedures for a good month or so now – I’ll use this post to outline what I’ve found out, and some of my objections to their procedures.

I first contacted BANT to ask about their complaints procedure in early April. I asked – reasonably enough, I thought – to see a copy of their ethics code (which they use to evaluate complaints against members). I was initially told that this is not available to members of the public – BANT is apparently concerned that people might misquote or steal their ethics code. Like you do – there’s a thriving market in nicked ethics codes down my local.

I pushed BANT to see if they would give me any details on their ethics code (I can be relatively stubborn). At the end of April, BANT relented a little and told me that “decisions are now based against the Nutritional Therapy Council Code“. I then asked whether BANT’s decisions are based solely on this code, and on May 8 BANT told me that they use “a rigorous complaints procedure, the requirements of which are given in the NTC Codes and expanded for clarity in a BANT document that is currently not available for public release”. Given that this BANT document isn’t available to the public, there’s no way of knowing whether or not it’s satisfactory, or for members of the public to determine whether a BANT member has breached it.

Of course, another thing to look at when determining how BANT regulates its members is the disciplinary proceedings that have already taken place. When I asked BANT about this, I was told that:

A total of six complaints were received in the previous year of which one was later withdrawn by the client and one was still being considered at the end of the year. Following examination of the complaints and the members responses two members were asked to write letters of apology to their clients where they had not maintained the usual high standards expected. No complaint was considered of sufficient substance or gravity to require a member to be excluded, and accordingly no further information is to be made available.

The details of these complaints and hearings (or even the names of those involved) is not publicly available, so there is no way to tell whether or not they were handled appropriately. For all I know, the complaints could have been very minor, or involving serious and dangerous professional misconduct. The hearings might have been completely fair, or could have been a total whitewash.

As I’ve said, if you’ve got such concerns about organisations like the GMC, you can read details of the hearings yourself and make your own mind up. With BANT, though, you have to take their word on this as details of their Ethics committee’s meetings and decisions are kept hidden from the public (I should note that BANT have told me that that their “Ethics committee do indeed meet in a room but there is nothing secret about the meetings and we have a lay-member on that committee.”)

I would also argue that – because of the lack of availability of information on BANT’s ethics codes etc. – the number of complaints may be artificially low. I’ve been pushing BANT for over a month for the limited amount of information in this post – many would have given up far sooner.

To summarise, then:

  • BANT are not a regulatory body.
  • BANT’s ethics code is kept secret from the public.
  • BANT’s ethics committee meets in secret (sorry, meets in a non-secret room to which the general public does not have access, and does not publish details of its discussions)

While a ‘nutritional therapist’ being a member of an organisation like BANT might make prospective patients feel safe – lead them to assume that the therapist is properly regulated – I would therefore advise much greater caution. As BANT themselves acknowledge, they are not a regulator; I would also argue that there is no way of telling whether or not they adequately regulate their members.

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