In a surprise move, the British Association for Applied Nutrition & Nutritional Therapy (BANT) have formally written to the Health & Care Professions Council (HCPC) requesting that the register of dietitians is modified to allow for the entry of nutritional therapists. This would give Nutritional Therapists equal statutory footing to Dieticians and give them all the privileges and protections that only Dieticians currently have.
In a notice to their members, BANT says,
BANT has formally written to the Health & Care Professions Council (HCPC) requesting that the register of dietitians is modified to allow for the entry of nutritional therapists. This will require clarification from the HCPC over the applicable standards of proficiency for dietitians and what is legally required to demonstrate that applicants can meet those standards. We expect to write to the HCPC shortly to follow-up on these points after considering this matter further with our lawyers. We also understand that the matter will be discussed at the next HCPC Council meeting on 3 December. Members should also note that we have been in correspondence with the Privy Council on these points and we will keep members updated on developments.
There is the hint of legal issues being raised here as to why Dieticians can have statutory protection, but Nutritional Therapists cannot.
This is a latest in a long war of division between the two communities. But it is a division that deserves to be there, and the HCPC would be doing a great diservice to the public to allow the legalistic merger of the two groups.
In the words of Dieticians, they are,
the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level. They work with both healthy and sick people. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices.
Their statutory status means that only Regsitered Dieticians may describe themselves as such. In return, they are required to have specified training and are governed by a strict code of conduct.
Nutritionists, on the other hand, are people who provide information to people about healthy eating. They are not qualified to work with sick people and are not regulated by law – anyone can call themselves a nutritionist. Nonetheless, there are many people out there who work as nutritionists who undoubtedly do a good job in helping people to eat well.
Nutritional Therapists though, as represented by BANT, are a special breed. These include people who believe, without sound scientific evidence, that illness is often caused by ‘nutritional imbalances’ and can be treated by regimes of detox, massive vitamin doses, hugely restrictive diets and ‘allergy’ avoidance. They use dubious and unrecognised testing and diagnositic practices, such as blood tests and hair mineral analyses, and then sell expensive supplement regimes of the back of the tests. Nutrional Therapists are firmly in the camp of ‘Alternative Medicine’, and, as such, I would consider many of their practices as straightforward quackery.
And it is not just me with such views. Which, a highly respected consumers watchdog, ran an article in their magazine on the practices of Nutritional Therapists after conducting their own undercover research in 2012. They considered that 6 out of the 15 consultations they looked gave dangerous health advice. This included nutritionists advising against surgery or chemotherapy for cancer. Only one consultation was given a ‘borderline pass’ by their experts. The Daily Mail reported on the results quoting one DIetician saying that a visit to a Nutritional Therapist was like ‘playing Russian roulette with your health’.
Bloggers have also uncovered dubious practices and questionable claims over the years. For me, the most worrying was how the Code of Conduct for BANT specifically allowed their members to take kick-backs from supplement suppliers when selling pills to their clients. Nutritional Therapists were quite rightly accused of being just sales people for vitamin pill companies and BANT being “little more than an unprincipled opportunistic trade organisation”. Currently, the BANT website does not appear to make their Code of Conduct public.
The training of Nutritional Therapists has also been called into quesiton. Many appear to come from Patrick Holford’s Institute of Optimum Nutrition. I am sure you have read about Patrick in Ben Goldacre’s best selling book Bad Science.
To find out more about Patrick Holford’s influence on the world of Nutritional Therapy, read my posts:
Holfordism: Understanding Patrick, Optimum Nutrition, and the Nutritionist Industry
Patrick Holford and Scientology: the Church of Optimum Nutrition?
Other institutions that provide courses, and who ought to know better like Thames Valley University, have also been panned for their ‘Nutritional Fairy Tale’ courses. Their material showed they based their ideas on medaeival ideas of vitalism,
Vitalism is the notion that life in living organisms is sustained by a vital principle that cannot be explained in terms of physics and chemistry. This vital principle, often called “the life force”, is something quite distinct from the physical body and is responsible for much that happens in health and disease.
So, The British Dietetic Association and their members ought to be going spare at the prospect of their status being completely undermined by this highly questionable approach to health and illness. Patients deserve to know that they are being given evidence-based advice from trusted professionals. To allow equal status for those that believe uncritically that food is medicine and vitamin pills can cure all would do nothing but put patients at risk.
To apply to the HCPC would appear to the next natural step in the Nutritionists long-term campaign in gaining respectability through the imprimateur of regulating authorities. For the past few years, nutritionists have been able to register with the CNHC (www.ofquack.org.uk) who in turn have now been recognised as an accredited register by the Professional Standards Authority. The PSA appear to be on a mission to completely undermine meaningful public protection through regulation by approving homeopaths, nutritional therapists and craniosacral therapists. On their waiting lists to join are reiki masters, anthroposophists, kinesiolists and crystal healers.
BANT would now appear to be serious and are undoubtedly primed to take a legal approach if they are denied. In a tweet today, after critcism of their intent appeared online, they tweeted,
Our members may have seen tweets recently about NTs and @The_HCPC On legal advice BANT is unable to comment on social media at present
— BANT (@BANTonline) December 1, 2014
Now is the time for Dieticians and their leadership at the British Dietetic Association to take a strong stance and let the HCPC know in no uncertain terms that this would be a completely unacceptable move that would undermine patient trust in healthcare professions and risk patient welfare. The BDA leadership have been somewhat soft in the past on this. Now is the time to be unequivocal and resolute in order to protect evidence-based healthcare.
9th December 2014
The correspondance between BANT and the HCPC is now online. It is very revealing. You can see it here by clicking on the letter:
It is quite interesting the arguments that BANT make. One of the most worrying is how they try to claim that because BANT members are trained in administering herbal preparations then this is an area where their expertise is greater than dieticians. Herbal preparations are for the most part unlicensed medicines and it would be illegal for BANT members to prescribe them. It does look like one goal of this excercise is to get statutory status in order to comply with EU directives on the prescribing of herbal remedies.
Of course, one cannot be an ‘expert’ in prescribing herbal remedies and prescribe them. Since, there is no good evidence base for the vast majority of herbal concoctions, any training in such practices is merely the systematic inculcation of incompetence. There are good reasons why Dieticians do not prescribe herbal remedies and are not trained to do so.
There is a good reason why there is a statutory register of nutrition health workers who have met appropriate standards and that is to protect the public from those with inadequate or imcompetent training. For BANT to suggest that this barrier is removed will simply put the public at risk.
Although the document is very long, it is worth skipping to the end where veiled legal threats are made and the HCPS respond appropriately.
‘Nutritionists’ can achieve their hearts desire by qualifying as dieticians.
Why they do not do so is for them to explain, but at first sight it apperars that what they really want is not to have recognition for themselves so much as ‘official approval’ for their faith and belief sysyem.
There is no place for the HPC (or any other institution) to regulate faith.
To do so would destroy any concept or meaning of the term, principles and practices which we now know of as ‘science’.
Patients would be misled, and harmed. That is why we have developed guilds, colleges, laws, regulatory authorities over the past seven hundred years. To protect the pubic, patients, and intellectual integrity.
Those with different belief systems must be respected. Their beliefs need not be.
This situation is akin to an imam demanding a seat on the Synod of the Church of England. Or a Christian demanding to pray to his god in a mosque and to proselytise there. Or a sunni demanding a shia….well you get the picture.
The BDA should send interested ‘nutritionists’ all the details they need to join the present regulated profession. End of. Except that there so many other practitioners of faith waiting in the wings. That is why this is such an important issue.
As Prof. Baum pointed out, it’s terribly important that people know they are consulting a genuine charlatan rather than just somebody masquerading as one!
Copies of the correspondence between BANT and the HCPC can be found here http://www.hcpc-uk.org/assets/documents/100049A4Enc17-CorrespondencewiththeBritishAssociationforAppliedNutritionandNutritionalTherapy.pdf
There’s a lot of it but the HCPC’s response is basically –
i) Acceding to BANT’s petition would be illegal. The HCPC does not have the power to decide which professionals are regulated. It’s a matter for Ministers.
ii) Varying the standards for dieticians is not possible as it could impact on safety.
BANT make a huge deal out of the use of herbal products in their petition. Many herbal products would be classed as medicines, based on marketing claims. It is likely that some of these products are unlicensed medicines and that those prescribing them, supplying them to the product are in breach of medicines legislation.
BANT mention genetics. What they are talking about is something they call “Nutrigentics”. One can become a “Nutrigenetic Counsellor” by sending them a cheque and promising that you read the instructions on genetic tests that you buy for patients.
Whilst I agree that nutritionists shouldn’t be put in the same category as dietitians I feel that this article puts genuine nutritionists in a bad light.
I did my degree alongside dietitians and gained a BSc in Public Health Nutrition a highly recognised degree not a qualification that can be brought from the Internet.
Genuine nutritionists have the same beliefs as dietitians and merely promote a healthy balanced diet, with no fads or herbal intervention. I myself work with the dietitians in the local community to provide the best advice, care and education possible for each individual.
Above I stated we should not be in the same catagory and the reason I say this because it is a nutritionists role to prevent illness through education and healthy eating advice whilst a dietitian’s role is to treat illness whilst educating in the same way.
A ‘nutritional therapist’ is not in the same catagory as ‘nutritionist’ who has worked hard to gain a highly recognised degree.
Do you know what nutritionists are doing to educate the public about the differences between nutritionists and nutritional therapists?
That is a very good point Alan as I do believe the general public do not no the difference and these days anyone can call themselves a nutritionist. For example people promoting and selling products such as herbalife and juice plus! These products do not promote what a healthy balance diet is about and unrealistic in the long term however good the short term benefits seem to be.
I know that myself for one working in the community steer clients away from such products but who else who calls themselves a nutritionist also does the same thing.
Back to your point on the difference between the two, I’m not sure what but something defiantly needs to be done, especially at a much higher level. After reading this article it has opened my eyes on something I had never really taken seriously before, even though, being naive I knew it was happening. I for one will be explaining to the general public and my clients in the future the difference especially when questioned on such products and ‘fad diets’.
I don’t suppose you have any contacts in the organisations that represent nutritionists? it would be good if they could do something about this situation.
The Nutrition Society represent Nutritionists. It would be interesting to know their stance on this. As for other contacts I don’t personally know anyone high up in the field but other bodies who could be involved are the Food Standards Agency and Department for Health.
Why did you choose to do a degree in ‘public health nutrition’ and not in dietetics or medicine.
And not only can ‘anybody call themselves ‘nutritionists’ nowadays’ – ’twas everthus.
Come to that, anybody can call themselves ‘doctor’. (But must not commit fraud by so doing).
True. I did two years as a dietitian but decided that the hospital environment wasn’t for me after working out in the community. Due to us do a lot of our training together I decided to change courses.
Fair enough, but you have forgone a degree which would have enabled registration with the HCPC – after which you could have practised ‘nutrition’ to your hearts content. Many dieticians work in the community.
That was your choice.
I do hope you are able to counsel intending students of ‘nutrition’ about these matters. Even encourage them to enter medicine. Or at any rate to avoid non-evidence based practices.
(I know medicine is not perfect when it comes to EBM, but we do try!)
Hello Dr. Lewis,
Many thanks for the incisive blog. Could you explain how blood tests form a part of fringe medicine. As a land professional, I admit to being rather confused.
It all depends what is claimed of the blood test. Claiming to be able to diagnose ‘nutritional deficiencies’ which can then be cured by selling you vitamin pills is fringe medicine. Not evidence based. Bogus .
Why do dieticians on oncology wards give children supplements made from 100% glucose when we all know that glucose feeds cancer quicker than anything else?
A dietician knows (after 2 years of study) how to make you fat or thin but they know absolutely NOTHING about nutrition and how we are exactly what we eat!
How is it that I know more about cancer and how to fight it with food than any of the dieticians I have had to come into contact with? Why is it that they all tell me to carry on doing what I’m doing because I actually know more than they do?
Really does fill me with faith….
How is it you have not qualified as a dietician?
You could then have practised ‘nutrition’ to your hearts content.
And as you know something ‘about cancer and how to fight it with food’, where have you published this most important work?
I have spent the last 5 years in hospital with my son who had two forms of cancer – I have been a little pre occupied saving his life to study for a qualification. Is that reason enough not to have a piece of paper that tells people that I know all about lipids?
I know alot about cancer and how to fight it, I share with those who wish to listen. Those who contact me because I have experience in the field rather than a piece of paper.
Did you know that Dr’s spend all of 2 hours, yes 2 hours in 8 years of studying on nutrition?
This would explain why my sons consultant told me to ‘feed him up on mars bars’ because he had lost so much weight due to the harsh and extreme ‘treatments’ that we deem necessary to inflict on young children and adults alike.
Glucose feeds cancer… what do you think mars bars are made of…
There is no limit to the stupidity of so called professionals.
It is a stupid myth that ‘sugar feeds cancer’ spread by nutriquacks wanting to peddle their wares.
Telling an underweight small and ill boy to eat the foods he might love and put on some weight does not only appear sensible but an act of kindness.
Really? So a radiologist injects my son with irradiated glucose because it feeds cancer quicker than anything else and she doesn’t know what she’s talking about? OK. I’ve also done my own research thank you. I take it you fully understand why a cancer cell occurs yes?
Kindness? What a pleb you are.
Let’s look at two possibilities here…
1) You misunderstand the metabolic processes within cancer cells and the use of radiopharmaceutials for diagnostic purposes.
2) Your oncologist and radiologist misunderstands.
May I offer every condolence on your son’s problem?
But I fear you are yourself in need of much urgent support and can only hope you can find appropriate help at this difficult time.
If ever you do feel able to re-consider the issue of ‘nutrition’ please let us know – but in the meantime consider that it was you who raised the issue of dieticians and their professional ablity in the first place.
If dieticians are unfit to practice their professiopnal body will deal with them.
That is why I encourage those interested in nutrition to qualify as dieticians and join a regulated profession.
This blog is about regulating nutritionists – and as you tell us, you have no time for ‘qualifications’.
Their professional body? The ones who are the most corrupt of all? Ok.
I know enough about nutrition thank you – my son is now the correct weight, healthy and on NO pharmacutical drugs so I guess I do know what I’m doing because in the hands of the Drs he would be dead!
You are aware that the curriculum for dieticians is funded by the sugar, meat and diary companies?
Nutrition studies always had several levels: Nutritional Therapy (professional qualification), Nutritionist (Bachelor Degree) or even Dietician (Masters Degree). If the professional course (Nutritional Therapy) is recognised by a decent regulating organisation like: Ofqual for example, it will give a decent level of understanding of human nutrition similar to the University degrees in BSc and MSc. The base of science of human nutrition is always the same, the BSc and MSc will only deeper the student’s knowledge in scientific studies (BSc) and scientific research (MSc).
PS. The only problem would be with courses that are unregulated / unofficial.
What BANT are doing is trying to regulate Nutritional Therapy as an industry so individuals cannot ‘buy’ qualifications or indeed take part in a month long course and call themselves a NT or a nutritionist. How is this bad and why must it be berated? – quite immature. I feel the author is missing the point and trying to stir the pot, which is not very helpful. You can do a Bsc degree in Nutritional Therapy that teaches evidence based practice, codes of conduct and practice without lots of nutritional supplements. The issue is the people who do not follow these codes of conduct. Good, properly qualified Nutritional Therapists exist (they are not going away) and I think now work has to be done to regulate the whole nutrition industry. It is quite clear things are, and have to move on by looking at the rise of chronic diseases – the NHS is in crisis – sometimes medication alone does not work. I think it’s time to look a bit deeper and do some proper research into how proper qualified NT’s are helping people and can indeed work with the government and the medical industry. It is pretty obvious that what we put into our body has a direct effect on ones health – how can this be quackery? It is time to be a bit more mature about this and work together at the best level for peoples health and longevity.
Putting medication on a pedestal and knocking any other forms of treatment is outdated. We can progress with medication and nutritional intervention. This seems so obvious!
Let me try to explain this to you very simply. No one doubts that diet can influence health although there is much disagreement about much of it due to the difficulty in doing research. Nutritional Therapists though go one step further and believe you can treat food as medicine. This is based on poor thinking, pseudoscience, awful interpretation of existing research, over extrapolation and sometimes plain fraud. Quackery in other words. If you are planning to study nutritional the tap I suggest you bail out as soon as possible and look into properly regulated dietician qualifications.
Some, yes some are as you describe…but not all. It seems that you are being general and dare I say it not reviewing all the evidence. The industry is moving forward, developing (with scientific research) and you are not and what is worse, not even being open to new opinion and research. It has changed so much since you wrote the original blog.
This whole website must make you very cynical and not able to develop your opinions once you publish them. Everyone must be open to learn, evolve and develop.
You don’t have to insult me and insinuate that you need to write things simply for me. You have no idea of my profession or my qualifications. It is so important to challenge peoples opinions and present the other side of the argument, which I can see was the original intention of your blog/website. However, this is supposed to be a discussion not a ‘trolling exercise’ – and I think this is what you have reduced yourself to and I no longer will take part. Who is the quack now?
A couple of typos in Andy’s last post, but I endorse what he says.
It is over a year since the post on this theme prior to Amelia on August 21st 2016.
The first (mine), sets out the issue simply.
Folks who have an idea/vocation/faith/belief/desire to help others through the medium of food and nutrition can already join a regulated profession – that of dietician (if not medicine).
Of course they do need to have the ability – so be it.
Regulation of healthcare professions is how patients are protected.
Interesting that Amelia regards ‘nutritional therapy’ as an ‘industry’.
Given the volume of supplements and remedies sold, I suppose that is the case.
But please do not conflate ‘NT’ with ‘medicine and related professions’.
‘NT’ is the marketing arm of an industry with products to sell.
Trying to have NT regarded as a profession which cares for patients is false.
Perhaps Amelia can tell us why she has not qualified in medicine or as a dietician.
(Please note that some universities used to offer BSc in ‘homeopathy’! Perhaps some still do.
And as a surgeon I very rarely prescribed anything, other than antibiotics, analgesics and anticoagulants for prophylaxis).”
“Folks who have an idea/vocation/faith/belief/desire to help others through the medium of food and nutrition can already join a regulated profession – that of dietician (if not medicine)”
What about nutritionists who don’t intend to work with the sick? Perhaps in public health, policy making, research or the food industry?
I am a Nutritionist registered with the afn, I graduated with an accredited degree (BSc in Human Nutrition) then self funded my masters to help me specialise. I now work in the food industry, I help make foods healthier for the normal healthy population and specialise in food law and food labelling (training specific to the degree courses I have done instead of clinical training- I can not afford both!) I am a scientist in the field of nutrition and I am still studying alongside my job, I am working on a professional doctorate programme aimed at food industry professionals (Reading University before anybody questions the validity of the qualification). Should I have spent 18 months doing the MSc and industry placement for the career in dietetics that I would enter just because NT’s are tarnishing the name of qualified nutritionists? No. I would rather there was just more education out there about what we do!
Nutritionist = a scientist who works in the field of nutrition in either academia/public health/food industry settings
Dietitian = a scientist who works in the field of nutrition using diet in a clinical setting to treat the ill
Nutritional therapists = people who should stop calling themselves Nutritionists if they haven’t got the accredited scientific training to support their claim
I am a Nutritional Therapist with a Bachelor of science degree (that must take some of you mad) and am currently writing a dissertation to gain my honours. I may also go on to do a MSc and if I want a can register as a nutritionist after I do this. Those that think NT’s are a marketing arm for supplement companies are wrong. I was not trained that way at all – (ION may be a different story I admit). As the government has not regulated qualifications in nutrition now it is admittedly in a real mess which makes it easy for people to criticise – there are organisations working with the government to rectify this. I am trained to work with people on a long term basis, looking at how their current diet and lifestyle maybe be negatively affecting their health. What is wrong with someone on the cusp of getting type 2 diabetes going to a qualified NT to prevent them from developing it – Dt’s don’t have the time and are trained to give drugs after diagnosis. NT’s do not profess to offer medical treatment. I certainly don’t and would not. But I can spend more time with someone understanding their lifestyle, personality, obstacles and help them – nothing sinister there, some people need more help. I am trained to know the intricacies of the different body systems regarding the immune, endocrine, digestive system etc, looking at recognising imbalances. It’s quite common knowledge how important the GI tract is to health, how the killing of healthy bacteria negatively impact the immune system – I know all about this and have read many scientific articles that can prove it. Why must you think that just because some one is an NT that they are trying to sell supplements or indeed saying that medical treatment is bad. Is Dr Chatterjee a quack? He is a GP and trying to build diet and lifestyle advise into his practise. He talks about the important of stress on the adrenals, the gut and the importance of eating healthy. I went to a talk of his and he admitted that GP’s and the medical industry are behind and are not trained in this. I have been trained…everything he said (that was’t medical) I have been trained to do – you don’t need to be a Dr, but have a bachelor of science degree will do.
I actually know a dietician that moved out of the NHS because she couldn’t work with her patients the way she wanted to – which was in fact how I work with people. Of course I couldn’t do what. dietician does, I didn’t want to be which is why I didn’t train to be one. I wanted to work with people on a personal level.
Oh and by the way – drug companies are so corrupt and have been dominating the way GP’s have been treating people for years – there is nothing ethical about the way the NHS is run…all industries have their monsters. We are sadly more aware of this now more than ever.
How do you know you are not being taught pseudoscience?
I completely agree with Andy and Dr. Richard Rawlins. Dr. Rawlins – thank you for championing Registered Dietitians (RDs)! We salute you, Sir. I’m sure you have come across many of us during your time in the NHS, and I hope you have had wonderful experiences working with us.
Amita – I find it interesting that you say you didn’t want to be a Dietitian, that you “wanted to work with people on a personal level”. I work with people on a personal level – on an individual basis – and every single Dietitian I have ever known (in my 20 years proudly working for the NHS) does/has done the same. We do not believe “One Size Fits All”. Which is why we take a very detailed Medical History and Diet History – we are very thorough and patient-oriented! And that’s just for starters! We are bound by the Rules & Regulations of the HCPC and the BDA to provide research and evidence-based advice – we have worked hard to gain our Qualifications and Registrations. I have a BSc. (Hons) Hum Nut, a PG Dip Dietetics and an MSc. Nutr. Med. I love what I do.