Jan 26 2012

Exposing Nutritional Pseudoscience

Which? magazine is the UK equivalent of Consumer Reports – an independent magazine primarily focused on product reviews and providing objective information to the consumer. They recently conducted an investigation of nutritional therapists, with scandalous (although not surprising) results.

This kind of expose is becoming more common, and that is a very good thing. The concept is very simple – just present as a typical client off the street and ask practitioners to do what they do every day, give their professional advice.

This is a good real-world assessment of what a profession is like. When they know they are in a public forum they try to put their best foot forward, and the more savvy members will know to pretend to be moderate and evidence-based. But when they do not think anyone is looking, they are more likely to represent what they are really about. And that’s what matters, of course – what they actually do in practice.

In this case they asked five investigators to pose as patients and consult three nutritional therapists each. They found:

Our expert panel concluded that visiting a nutritional therapist wasn’t worth the money – and in some cases could have actually endangered the health of the researcher. Six of the fifteen consultations were rated as ‘dangerous fails’.

Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

That’s 40% rated as dangerous fails, 53% regular fails, and 7% borderline pass. Those kind of numbers represent a broken industry. Of course, this is a study of only 15 therapists, but it is highly unlikely (assuming no cherry picking or missing data) that the therapists used in the study are significantly unrepresentative of UK nutritional therapists in general. Perhaps they just happened to hit 15 duds – but it’s unlikely.

They also found:

Of course, there is benefit in following healthy dietary advice, but most of what was provided by the nutritional therapists is freely available on websites such as the NHS site.

Plus, most of the therapists in our investigation recommended quite restrictive diets that excluded several foods (predominantly dairy and wheat) and taking expensive supplements.

If their experience is indeed representative then going to a nutritional therapist in the UK is likely to include wrong or even dangerous advice, recommending a restrictive diet that most people cannot follow, and recommending expensive supplements (and not to get them at chains where they might be cheaper).

Taken together this is a pretty good description of a scam. Some UK nutritional therapists even use iridology (a pure pseudoscience based on iris diagnosis) as a fake diagnostic method to determine which expensive supplements their clients need to purchase.

None of this implies that nutrition itself is not important. Perhaps the best nutritional advice is to have a varied diet with appropriate calorie control and sufficient fruits and vegetables. If you need more specific advice all of the science-based information is freely available on government and academic websites. If you have a serious chronic illness, like diabetes, and require medical nutritional counseling it is best to get this in coordination with your doctor.

There may even be competent independent nutritional therapists out there, but if this study is any indication they are few and far between.

This is all partly due, in my opinion, to attempts on the part of so-called “alternative” medicine proponents to make nutrition alternative. This is more than a bit of historical revisionism, but by trying to pull nutrition into the alternative camp they are encouraging the proliferation of non-science-based nutritional advice.

This is also a good example of what happens when a profession is regulated without a science-based standard. Regulation means nothing if there is no objective transparent standard of quality.

As Edzard Ernst said – regulating nonsense still results in nonsense.

 

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37 responses so far

37 Responses to “Exposing Nutritional Pseudoscience”

  1. ConspicuousCarlon 26 Jan 2012 at 2:46 pm

    This is all partly due, in my opinion, to attempts on the part of so-called “alternative” medicine proponents to make nutrition alternative.

    So the controlled experiment is this:

    Take a legitimate field like nutrition. Designate a portion as the test group, add a bunch of stupid or dangerous ideas, and you get alternative medicine. Meanwhile, nutrition without stupid ideas remains legitimate.

    And you will then have demonstrated why the NCCAM is inherently irrational and a failure. You can’t take the stupid out of alternative medicine because stupidity is its defining feature.

  2. ConspicuousCarlon 26 Jan 2012 at 2:51 pm

    Remember that commercial for string cheese, in which a bunch of kids walk into a pizza joint and say, “hold the sauce… and hold the crust”? The NCCAM is that bunch of kids.

  3. BillyJoe7on 26 Jan 2012 at 3:24 pm

    It might have been worth distinguishing Dietitians from Nutritionists.
    The former are science-based, the latter are not.

  4. cwfongon 26 Jan 2012 at 3:39 pm

    Quite simply, a basic definition of a Nutritionist would be any professional with an education in nutritional science, so as usual you’re way off the mark as to the certainty of your off the cuff pronouncements.

  5. ConspicuousCarlon 26 Jan 2012 at 3:48 pm

    My understanding was that, though nutrition is a legitimate field, the word was not selected for regulatory protection and it can legally be used by idiots.

  6. cwfongon 26 Jan 2012 at 4:12 pm

    Certified Clinical Nutritionists are regulated, but then there are the other ones that practice homeopathic medicine and that’s the problem area, because you have Naturopathic Dietitians, etc., as well.

  7. tmac57on 26 Jan 2012 at 4:42 pm

    Sounds like they would have been much better off going to a Weight Watchers meeting.

  8. eiskrystalon 26 Jan 2012 at 7:49 pm

    Quite simply, a basic definition of a Nutritionist would be any professional with an education in nutritional science

    …and any unprofessional, so it’s meaningless.

    I have been told on good authority that dietician is the legally protected term. With nutritionist generally about on par with toothyologist.

    http://www.youtube.com/watch?v=YMvMb90hem8

  9. cwfongon 26 Jan 2012 at 8:27 pm

    eiskrystal, I’ve been told on good authority that yours is an argument from questionable authority, since there are frauds in any profession. Where I live, nutritionists are regulated as well as dietitians, but the differences are in the range of expertise and not in honesty of effort. But I’m sure you’ll find a way to disagree, as is your wont.

  10. BillyJoe7on 26 Jan 2012 at 10:17 pm

    “I have been told on good authority that dietician is the legally protected term. With nutritionist generally about on par with toothyologist.”

    That’s my understanding as well.
    Certainly here and in the UK, possibly also the USA.
    I don’t know about Asia.

  11. cwfongon 26 Jan 2012 at 10:40 pm

    You are simply wrong when you pronounce that nutritionists are not science based, since those where they are regulated are required to have been educated in nutritional science. Dietitians where I live in the US are required to have more and better education in the science than the also regulated nutritionists, somewhat analogous to doctors versus nurses (but I’m aware that you may not do analogies).
    I’m not sure what the situation is in Asia or in the remote aboriginal areas below the equator there.

  12. eiskrystalon 27 Jan 2012 at 4:06 am

    Where I live, nutritionists are regulated as well as dietitians, but the differences are in the range of expertise

    Also am i really supposed to compare a minimum amount of fraud that you always get within any regulated profession with:

    Six of the fifteen consultations were rated as ‘dangerous fails’.

    Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

    Sorry, but there is at least an extra order of magnitude of failure here… and I doubt it’s because the nutritionist didn’t do the next degree up.

    My flippant comment was based on England’s regulations, yknow, like the article. Since you don’t specify where you are from i will assume it’s Mars.

  13. BillyJoe7on 27 Jan 2012 at 5:00 am

    cwrong:
    “I’m not sure what the situation is in Asia or in the remote aboriginal areas below the equator there.”

    It’s called bush tucker – or survival – whatever you can find that doesn’t kill you and is just barely edible.

    eiskrystal:
    “My flippant comment was based on England’s regulations, yknow, like the article. Since you don’t specify where you are from i will assume it’s Mars.”

    I see you have cwrong worked out in the space of a couple of posts.

  14. ccbowerson 27 Jan 2012 at 10:15 am

    “Dietitians where I live in the US are required to have more and better education in the science than the also regulated nutritionists.”

    Keep in mind that in the US, requirements for professions: educations, licensure, etc are state specific and do vary from state to state

  15. cwfongon 27 Jan 2012 at 11:40 am

    Of course they vary from State to State. But to make a blanket statement that nutritionists are not science based is to be simplistically wrong and pointless as usual. His answer, again as usual, is to deflect the argument rather than to admit the error. Just as he did on the TCM post, and does virtually each time he comments. He BillyJoes it every time, and can’t seem to help it. Watch for his response.

  16. BillyJoe7on 27 Jan 2012 at 3:49 pm

    BillyJoe: “It might have been worth distinguishing Dietitians from Nutritionists.
    The former are science-based, the latter are not.”

    The article by Steven Novella is about the pseudoscience used by nutritionists (or nutrition therapists) in the UK. My response was to that scenario.

    My first point was to separate dietitians in the UK from nutritionists in the UK. My second point was to indicate that dietitians in the UK provide science-based advice and that nutritionists do not. The article by Steven Novella, based on a report of a study in a consumer magazine in the UK, demonstrates the fact that nutritionist do not provide science-based advice.

    So the purpose of my comment, which I thought would have been clear to most, was to not lump in dietitians with nutritionists, and that perhaps Steven Novella might have made that distinction in his article.

  17. BillyJoe7on 27 Jan 2012 at 3:55 pm

    ….in fact, I have just found a comment on the study from The British Dietetic Association:

    Anybody can set up shop as a nutrition therapist, with no qualifications. Registered dieticians working in the UK are educated to degree level and must be registered with the Health Professions Council.

    They were keen to make it clear that trained dietitians are very different from nutrition therapists.
    That is exactly the point I was making.

  18. cwfongon 27 Jan 2012 at 4:26 pm

    See what I mean, deflection and diversion. He now says he didn’t want to lump in dietitians with nutritionists, because nutritionists (in his view) do not provide science based advice. That’s just as bad as his saying earlier that they are not science based, because of course, he’s still wrong in presenting this distinction without evidence. Distinction without a difference? Indeed.

    Here is a summary of the facts in the UK, where he’s now restricted his comments to:

    “Nutritionists most commonly work in industry, education or research jobs that require them to apply their scientific knowledge of food. Unlike ‘Dietitian’, ‘Nutritionist’ is not a protected title under statutory regulation and therefore anyone is able to refer to himself or herself as such, even if they do not posses adequate training and experience. However, there are various voluntary registers that have been developed for nutritionists who are qualified to provide general information about food but not advice about specific therapeutic diets.”

    So does this tell us that nutritionists in the UK are not science based? No, just that some people can pass themselves off as such without the adequate training that nutritionists are expected to have.
    Completely beside the point as to what a legitimate nutritionist does, and should do, and will be capable of doing.

  19. cwfongon 27 Jan 2012 at 5:20 pm

    For more information on the legitimate nutritionists in the UK, see this site:
    http://www.nutritionist-resource.org.uk/

  20. BillyJoe7on 28 Jan 2012 at 2:39 am

    cwfong: “Here is a summary of the facts in the UK, where he’s now restricted his comments to:”

    Steven Novella writes an article about a report on the practices of nutritionists in the UK.
    I respond to that article and somehow I am not talking about nutritionists in the UK? WTF?
    My guess is that cwfong failed to realise that the article was about nutritionists in the UK.

    “He now says he didn’t want to lump in dietitians with nutritionists”

    What part of this from my first post does he not understand:
    It might have been worth distinguishing Dietitians from Nutritionists.

    “So does this tell us that nutritionists in the UK are not science based? No, just that some people can pass themselves off as such without the adequate training that nutritionists are expected to have.”

    Yet here we have a report that demonstrates that advice given by nutritionists was “40% rated as dangerous fails, 53% regular fails, and 7% borderline pass”.

  21. BillyJoe7on 28 Jan 2012 at 2:41 am

    Cwfong: “His answer, again as usual, is to deflect the argument rather than to admit the error. Just as he did on the TCM post,”

    Cwfong must have missed where I conceded to sonic, after his patient explanations, that wave-particle duality could indeed be seen as an example of yin yang. I quite clearly changed my mind about that.

  22. cwfongon 28 Jan 2012 at 4:14 am

    The report concerned nutritionist therapists that professed to be science trained yet were frauds. There is a difference, as the source I cited indicates, between those therapists and the regular nutritionists who join the voluntary registries and work legitimately. The point again being that they, as opposed to your claims, are scientifically trained.
    As to your alleged admission that wave particle duality could be seen as an example of yin yang, all I can find is that you continue to deny that wave particle duality exists.

  23. cwfongon 28 Jan 2012 at 4:33 am

    # BillyJoe7on 23 Jan 2012 at 5:01 am
    *My point was that an electron is not sometimes a particle and sometimes a wave, but something else entirely all of the time, which has no parallel amongst the objects in our everyday experience.
    “You said, “In any case, yin and yang gives no insight into quantum physics.”
    I believe Mr. Bohr would disagree with you about that. And I would suggest that while he didn’t mean the yin-yang to convey a precise scientific definition- neither does ‘wave-particle’ duality or ‘wave’ or’ particle’ or any of the other terms we use to describe the quantum world.*

  24. BillyJoe7on 28 Jan 2012 at 4:58 am

    cwfong: “The report concerned nutritionist therapists that professed to be science trained yet were frauds”

    On the contrary, and I quote from the report:
    “…the majority of therapists visited were registered with the voluntary industry body BANT”

    “The point again being that they, as opposed to your claims, are scientifically trained.”

    I claimed no such thing. Here is what I said, and I quote:
    “The former are science-based, the latter are not”
    Again, I will remind you that my comment was in reponse to the article which is about how nutritionists practice their trade. Therefore, why would my comment about nutritionists not being science-based not be about how they practice their trade?

  25. BillyJoe7on 28 Jan 2012 at 5:01 am

    cwfong; “As to your alleged admission that wave particle duality could be seen as an example of yin yang, all I can find is that you continue to deny that wave particle duality exists.”

    Here is what sonic said:
    “If Yin-Yang are symbiotic and complementary, then the relationship between the two is an excellent analogy to the ‘wave-particle’ analogy– symbiotic and complementary- but just that- an analogy — like everything else we might say about them…”

    Here is my reply:
    I’m going to give you that as a win :)

    What could be clearer?

  26. cwfongon 28 Jan 2012 at 12:40 pm

    “But just that, an analogy.” You continue to deny that wave particle duality exists. What could be clearer indeed.

    And “not being science based” is still a wrong and pointless comment about those who use that science based profession to commit fraud. Now if they were chiropractors or acupuncturists, you might have had a point. But in this case, the fraud was that they pretended to be trained in the science of nutrition, but didn’t practice their pretended training because fraudulent practice was more lucrative.
    Of course it’s hopeless to explain any of this too you, if your ignorance is as fixed as it appears to be.

  27. BillyJoe7on 28 Jan 2012 at 10:40 pm

    … just read the report on which this article is based – nutritionists are dispensing unscientific advice with only 1 out of 15 getting as borderline pass, and the rest all failing.

  28. cwfongon 29 Jan 2012 at 12:19 am

    Every time you try to save yourself from ignorance, you get in deeper. These are alleged to be nutritional ‘therapists’, no? They pretend to have training because they are pretending to be the real thing. The point being that such professions need regulation to minimize the fraud, not that the profession itself does not require training in the science.
    Legitimate nutritionists have training in the science of nutrition. In an unregulated or even self-regulated system, fraud will inevitably occur. That was one of the points to be found in the post here, and not the point that, in your view, nutritionists as a profession are scientifically untrained.

  29. BillyJoe7on 29 Jan 2012 at 2:14 am

    ….14 were registered nutritionists which means they were trained nutritionists (that is a condition of registration). This seemed to make no difference – they still dispensed unscientific advice. That is the point I have been making all along and why I suggested Steven Novella distinguish dietiticians from nutritionists, otherwise they can end up being painted with the same brush.

  30. cwfongon 29 Jan 2012 at 3:03 am

    No, you simply said that nutritionists are not science based, which is untrue. And took no notice of the fact that dietitians are sometimes homeopaths, etc. So all your excuses for making that and the other meaningless and untrue comments here are bogus. Par for your course.

  31. BillyJoe7on 29 Jan 2012 at 3:21 am

    cwrong again!

    …out of context, as I already explained:
    The article is about the advice given by nutritionists in the UK – that it is not science-based.
    When I comment about an article that is about the non science-based advice given out by nutritionists in the UK, I am obviously taking about…non science-based advice given out by nutritionists in the UK!

    See how simple it is.

  32. cwfongon 29 Jan 2012 at 3:30 am

    So nutritionists in the UK are not science based? Because they are only pretending to be nutritionists?
    Since if they really were nutritionists, they would be science based?
    Nobody never ‘splained it that way before.

  33. BillyJoe7on 29 Jan 2012 at 3:52 am

    “See how simple it is.”

    Okay, so it’s not simple for you…why am I not surprised? ;)

  34. cwfongon 29 Jan 2012 at 4:10 am

    Because you knew in your heart that you were wrong?

  35. BillyJoe7on 29 Jan 2012 at 5:17 am

    …but you c, it’s cwrong who’s simply wrong.

  36. cwfongon 29 Jan 2012 at 12:15 pm

    Amazing. Most of us use trial and error. You use error and trial.

  37. amhovgaardon 06 Feb 2012 at 5:34 am

    BillyJoe7, I admire your patience.

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