By Meleni Aldridge, executive coordinator and CNHC registered nutritional therapist

In December 2016, 22-year-old dietetics student Harriet Smith, launched a UK e-Petition calling for the title of ‘Nutritionist’ to be legally protected. Harriet is one of three young trainee dietitians advocating, that, “Dietitians are the only qualified (and legally regulated) health care professionals that can assess, diagnose and treat dietary related medical conditions”.

Citing a lack of regulation, which means that, “…anyone can set up and practice as a nutritionist/nutritional therapist”, the petitioner and her supporters are asking the UK Government to, “…take action to prevent unqualified people from potentially putting people’s health at risk”. Whilst the e-Petition text seems innocuous enough on the surface — relevant even — the devil, as always, is in the detail. The use of the words “evidence based advice” at the end of the text signposts a potentially less innocuous motive and agenda behind this petition.

The petitioner Harriet Smith is a member of a band of three trainee dietitians who are the creators of the website ‘Fight the Fads’. They’ve had a lot of recent airtime in the British press – far more than might be typically justified for a trio of students. The raison d’être for the website is apparently the “debunking [of] nutritional myths & fads with science”. From their extremely prolific posts, it’s evident that healthy (dare we say clean…!) eating, nutritional, functional, integrative medicine-based therapists and natural health bloggers fall squarely into this definition.

When you scratch below the surface of the Fight the Fads website (as slick and beautiful as it is), you’ll find a mish-mash of articles created specifically to challenge areas of nutritional science that are emerging, not yet subject to scientific consensus – and some about which it is clear the young students know very little.

Moreover, the same rhetoric we see time and time again from the skeptic movement is repeated throughout, which in our view masks any rational and objective message they may have been trying to convey. Perhaps if these young women spent as much time studying the more recent evidence base for nutritional science, as they do trying to grab headlines and posting on e-Media platforms, we could expect more accuracy and less ‘old-science’ in their outputs.

The right to be heard

The right to petition the Crown and Parliament to air grievances is a fundamental constitutional right in the UK. In July 2011, it became possible for UK citizens to circumvent the historically lengthy petition processes and submit an e-Petition online. Achieve 10,000 signatures and we’re told you can expect a response from Parliament. Achieve 100,000 signatures and your e-Petition will be considered for debate in Parliament. The operative word here being ‘considered’. Since its inception, a total of 28,129 petitions have been created, but only 50 have actually been debated in Parliament, with a further 13 awaiting debate. Some of those cast into history without a hearing number in their millions.

Whilst there are myriad ways of taking a case to the UK Parliament, e-Petitions have caught on. Not least of all because of the speed at which someone feels they can have their say, tick said grievance off their hit list, then go about their business and forget all about it. We can’t deny, we’re living in a time of instant gratification — and therefore desirous of instant complaint, action or retribution. Yet, at ANH-Intl, we’d argue that there isn’t always sufficient information in a petition’s header text to make a considered action, especially when that action may have further reaching consequences than one might have expected.

What’s in a term?

In the nutritional/dietetic practitioner space, the term ‘evidence-based’, is often used like a slur by dietitians to denigrate nutritional therapists and practitioners using a more functional based approach to nutrition. It’s a ‘them and us’ situation, given that the former are statutorily (state) registered under the Health & Care Professions Council (HCPC) — along with osteopaths, chiropractors and physiotherapists — and the latter are voluntarily registered under the Complementary & Natural Healthcare Council (CNHC).

The HCPC requires the therapies it regulates be evidence based and that therapeutic interventions used must be able to be shown to be demonstrably effective using suitable (conventional/mainstream) experimental designs. Whilst there exist some therapeutic interventions that are poorly evidenced (based on conventional study criteria) or un-evidenced for historic reasons in many HCPC regulated professions, there is a requirement for a reasonable evidence base for the general therapeutic approach, and a commitment to evidence based practice going forward. This is the reason why dietitians keep banging on about evidence based practice, bandying the term about like a stick to beat nutritional therapists into submission. But the scope of practice between the two disciplines can be like chalk and cheese in reality, and we feel that it’s the public’s right to have the freedom to choose which type of practitioner and therapeutic model that’s most appropriate for them. There is also extensive clinical experience from nutritional therapy and related disciplines, including functional medicine, that demonstrates very high levels of effectiveness of the often multi-stranded therapeutic approach that generally aims to deal with the underlying causes and triggers of health dysfunction.

By contrast with the HCPC, the CNHC with whom most nutritional therapists are currently registered, is accredited by the Professional Standards Authority for Health and Social Care being the holder of an Accredited Register. Its key purpose is to act in the public interest and enable proper public accountability of the complementary therapists that it registers. This is in effect a system of voluntary regulation. Registrants with CNHC willingly come forward to be regulated, being confident in their professional standards of practice.

Both the HCPC and the CNHC have been set up with Government approval and support and both have Codes of Conduct, Complaints Procedures and require registrants to hold appropriate insurance. In both instances the public are protected. Whilst we could have a supportive and inclusive network of healthcare professionals working for the benefit of the UK public, sadly, petitions like this demonstrate there’s a way to go still regarding basic professional respect and etiquette. We believe Harriett Smith’s petition has made an important and potentially misleading omission by not mentioning the CNHC voluntary regulation option widely used by nutritional therapists.

Back to the petition…

There is little doubt in our minds that the petition to protect the term ‘nutritionist’ has been set up as an anti-natural health/nutritional therapy move with exclusion rather than inclusion at its heart. Somewhat surprisingly, support for the petition is now coming from some corners of the nutritional therapy sector itself. This has confused many practitioners who would rather see it fizzle out at the end of its 6-month term, like so many worthier petitions before it.

The petition to protect the term ‘nutritionist’ has much deeper implications for nutritional therapists because it goes right to the heart of the statutory or voluntary regulation question. The British Association for Applied Nutrition & Nutritional Therapy (BANT), one of the main professional associations for Nutritional therapists, is a strong advocate for gaining statutory regulation under the HCPC. The association has also taken, what might be considered by some, an unprecedented step in supporting this petition. When asked his view, BANT chair, Miguel Toribio-Mateas, had the following to say:

“’Nutritionist’ is an umbrella term for us all providing nutritional recommendations and it is also a term that we as Nutritional Therapists are commonly known by the public and our clients, as is the case with dieticians and Association for Nutrition graduates. How the future registration and titles will work is still to be determined and all that BANT wants to achieve with this petition is to ensure that we are not excluded from the debate. If BANT chose to ignore the petition, this would provide ammunition to the other parties involved. In the hypothetical event that Parliament even considered debating this issue, it is paramount that the interests of BANT members be represented, and if we haven’t been seen to publically support a healthy debate about this all-important matter, it would be only too easy for BANT members to be excluded from it. So far from supporting a petition for Nutritional Therapists to change their name to “Nutritionists”, what we are supporting is a debate about what the different professions do so that MPs actually get a chance to understand what BANT members do daily in their jobs. With just over 6,000 signatures thus far, BANT asks members to put the ‘Fight the Fads’ petition in perspective.

ANH-Intl’s view

We see Harriet Smith’s petition as a bit of foot-stomping and tantruming by a 20-something skeptic-student who doesn’t fundamentally subscribe to a natural health position. UK citizens or residents have of course the freedom to either support the petition or not.

What we urge, is that should you choose to support the petition, you do it with full consideration of where it has originated from and also what it seeks to achieve. We recognise that having a legally protected title may benefit nutritionists but the tight controls likely to be implicit with becoming an HCPC registered profession may well considerably alter the scope and nature of practice of nutritional therapy. This has been a concern for some of the osteopaths and chiropractors who have been statutorily regulated, and for herbalists who were close to securing statutory regulation two to three years ago. In our view, given that the healthcare regulation debate with regard to non-conventional therapies has been going on for over two decades, it’s unlikely, though not impossible, for this petition to see the light of day in the UK Parliament. We also acknowledge and respect people’s reason for supporting the petition.

Our vote goes to….

We would however like to emphasise that our own position, given the facts today, is that the present voluntary regulation option provided by the CNHC should be maintained, whether statutory regulation for nutritional therapists becomes possible or not. And that improved standards of practice should continue to be advanced and evolved, particularly with regard to the evidence base congruent with the highly personalised and functional scope of practice. The UK Government has itself acknowledged in 2011, that for some groups of workers in the health and social care sector that statutory regulation may be a disproportionate response to the level of risk posed to the public. In the same report, the UK Government expresses its view that voluntary registration can be an effective and proportionate means of ensuring public safety.

UK citizens and residents, and especially fellow nutritional therapists, the choice is yours.

Facebook practitioner discussion group

Note: Practitioners wishing to debate this issue further can do so on our private ANH International Practitioner Support group on Facebook.

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Comments

  1. NO! No protection. it’s a racket. This exercise is to stop rational, open discussion/advice by the better read. RDs etc have to peddle the calories, cholesterol, RDAs, food groups etc deliberate misinfo that keeps the sheeple sickly, weak, overweight, tired, stressed and later.. unnecessarily medicated for life. How else can a 3.5T$ annual Sickness Industry flourish in just the US/

  2. I am a student studying nutrition science with CNELM and hope to qualify as a nutrition therapist in the not too distant future. Firstly, I am a bit disturbed at the inference in your article that dietician follow evidence based interventions but nutrition therapists do not. The course I am following is ALL about evidence based practice and BANT insist on nothing else. Secondly this article completely ignores the fact that regulation is there to protect the public so that they can have confidence in choosing an appropriately qualified professional in the field but that regulation also gives more credibility to a profession, as evidenced by the CNHC being referred to around the Internet as ‘quackery’. Harm has been done to people who seek nutrition advice and fall on someone who took a free online 18 hour course and consider themselves a pro in the field. It is a very interesting debate, and I would be very interested in putting the other side to Ms Aldridge’s argument if you would like, in an opposing article – not hidden in a FB group, but here so that both sides can be digested by all. Let me know!

    1. Hi Tiffany

      Thanks so much for taking time time to reply to us. I’m especially grateful for you raising this point as it allows me to clarify further in case anyone else has read the same meaning from the article.

      Contrary to how you’ve interpreted the piece, we are not for one minute taking the stance that dietitians are working from an evidence base and nutritional therapists are not. It’s the dietetic associations globally which are making the distinction and using it to create confusion and misunderstanding for the public that they are therefore somehow more appropriately qualified than practitioners such as NTs using functional based protocols. We recognise fully that our functional based protocols are themselves evidence based, however they rely on different types of evidence.

      The term ‘evidence-based’ as used by dieticians refers to the very narrow interpretation of evidence-based medicine as used to define approaches meeting the standards of Cochrane, NICE and other similar institutions. This involves use of the classic hierarchy of evidence, in which primary emphasis is placed on randomised controlled trials (RCTs) and, even more particularly, on meta-analyses and/or systematic review of RCTs. This approach is valid for many types of intervention, but as you will know, is less than ideal for many nutritional interventions. By comparison, functional medicine approaches rely extensively on observational evidence, case reports, supporting biochemical evidence and RCT evidence when it is available and relevant. It is however then validated often by years of clinical experience. In that sense it fulfils the original concept of evidence-based medicine as defined by Sackett et al back in 1992.

      Thank you for your offer, but there is really no need for “putting the other side” to my argument as we’re very firmly on the same side as you — and all functional based practitioners/therapies. In fact, as an organisation, we’ve been deeply committed to righting the wrongs committed in the name of ‘evidenced-based medicine’ (EBM) since our inception in 2002 and you will find much to read of our historic work in this area on our website.

      I hope this helps to clarify our position and the meaning of the text in the article, but please do come back if you’ve still got questions.

      Best wishes

      Meleni

      1. Hi Meleni,

        Your article was very clear. You are definitely on the side of Nutritional Therapists and on the side of EBM. I understood clearly and I am really surprised that Tiffany did not understand your clear point.

        I was very concerned a few months ago when I saw this petition and some fellow nutritional therapists were signing and asking other people to sign in Facebook. When I researched the petition, I realised it was started by a young dietetics trainee that basically hates nutritional therapists and is very scared of the competition that they represent. I immediately contacted some of my colleagues to warn them about the petition they were supporting. They were obviously unaware that the petition is actually against nutritional therapists.

        I understand that nutritional therapists with degrees would like the profession more regulated and the nutritionist title protected so that people doing a 6 months course cannot call themselves nutritionists. Also I understand BANTs position as it is better to be part of the argument and staying silent could look like an admission that we do not use EBM.

        Thank you for bringing this issue to light so that some well qualified nutritional therapists stop supporting this bratty dietetics student.

        Best regards,

        Tatiana

      2. Hi Meleni and thanks also for your reply. While I am glad that there was a misinterpretation on my part, I am still a bit confused at your distinction between the types of evidence that is used by dieticians and Nutritional therapists. I am being taught to critically evaluate evidence but to value RCTs and meta analyses above all as being at the top of hierarchical evidence as you say, but observational evidence etc has not even entered into the curriculum.

        We are not really on the same side either as I am firmly in favour of statutory regulation but not at all in favour of the CNHC voluntary system as it doesn’t give enough credibility to its member professions as evidenced by the fact that the URL ofquack.org.uk leads to the CHNC website and it is regularly referenced on sites like ‘badscience.com’ further damaging the credibility of the professions.

        There are also, unfortunately, too many voluntary registers that in themselves are confusing for the public as each demand different evidence of skill: there is BANT, the AfN, and fntp among others that hold voluntary registers and reflect different and varying levels of qualification not to mention titles.

        I believe the title championed now by BANT for stat reg ‘functional dietician’ is a stroke of genius, alligning both professions while specifying the distinction giving the profession the credibility it deserves and the public the protection it needs.

        Best wishes,

        1. Hi Tiffany,
          Being a CNELM alumni myself I know what you refer to about being taught to respect the hierarchy of evidence.
          I believe there is more than one reason for this:
          CNELM wishes to turn out competent professionals with the skills to delve into literature on more than just a ‘skimming’ basis, and, who have the ability to engage public discourse by speaking the language of the current paradigm of science.
          Also of course (and primarily) the skill is necessary to actually find information.

          But the teaching builds to a point of explaining that NT currently does not and cannot meet these standards of evidence for every recommendation….you can’t blind diets etc etc….food delivers a matrix of ‘vectors’ therefore can’t be investigated like single agent drugs are etc etc. Therefore the profession needs to find a way to produce relevant and acceptable evidence of efficacy, but in the meantime I believe CNELM teaching recognises that we have to walk a line between using science as a guide (instead of a god), and honest reflective observational feedback based on other valid ways of seeing the world.
          One possible tool becoming available to us all is Big Data, garnered from the feedback of a multitude of practicing therapists worldwide. Mechanistic reasoning is also a key tool for us however it is low down the hierarchy of evidence for medical interventions because of the potential to produce enormous harm if it turns out to be wrong. Medical history records many incidences of this happening and thus ‘Medicine’ is understandably wary of placing high value on it. NT’s on the other hand, as I’m sure you know already, are not playing with such ‘live ammo’ as drugs and thus practice a naturally safer modality, thus can avail of these ‘lower’ levels of evidence because they make more sense to do so.
          These essentially do fall under the umbrella term of ‘observational data’ (which is dissed by so called Evidence Based promoters) but statistical Power can be assigned to them when used within the scientifically accepted structure of Baysian maths, coupled with modern processing power that is capable of making sense out of what otherwise looks like chaos (case controls, observation guided by known mechanisms, experience, etc etc to which Melani alluded to).
          My point is A: We are zeroing in on a proper way to produce real evidence about interventions that really help people and which will be acceptable to the status quo, and B: There will always be detractors and different worldviews so everyone will always have to fight their corner, if we try to avoid the stress by moving to someone else’s corner then we risk giving up what we have…especially when we are so close.

          By the way the ofquack.co.uk domain is owned by quack buster Andy Lewis, who set it up and redirected it’s IP address to the CNHC website in a cynical (or perhaps humorous) attempt to confuse people…the very thing he claims to be working against! Whilst I personally believe that adversaries like Andy can often be our best teachers, the reality is there will always be Andy’s ready to rail against what they don’t like (or perhaps understand) which is of course their right! It’s something NT’s need to find a way to be at ease with.
          Look forward to meeting you someday!

        2. Hi Tiffany

          I wish that we had that much power over how the concept of evidence based medicine (EBM) was viewed! Sadly we don’t. In short, it’s not our distinction between types of evidence used by dieticians and NTs, it’s the way the mainstream, with which the dietitians are aligned, sets that particular agenda. This debate over different interpretations of EBM and the hierarchy of evidence has been raging for over 2 decades now, and it’s something that our scientific director, Rob Verkerk PhD, has been centrally involved in studying and influencing, in relation to natural health modalities. We think it might be helpful for you to read David Sackett’s original paper that launched EBM (JAMA. 1992; 268(17): 2420-2425), a reflection paper published some 4 years later (BMJ. 1996; 312(7023): 71-2) that stressed the importance of clinical experience and more recent paper pointing some of the biases of EBM against patients and carers (BMC Med. 2015; 13: 200).

          There is a strong, emerging view that in order to best inform the clinical practice of nutrition, a body of evidence including epidemiological studies, cohort studies and case control studies may provide more relevant information than RCTs (Semin Oncol. 2010; 37(3): 282–296). RCTs are only able to evaluate the effect of a single intervention in isolation which is at odds with how epigenetically unique individuals are exposed to foods in the real world. Accordingly, a null finding in an RCT does not preclude the likelihood of an effect in practice (ibid).

          In final clarification on the matter of regulation, we are not anti statutory regulation and I’m not really sure how you could read this into what is written in the article. However, in our view, it’s important not to throw the baby out with the bathwater and lose the route of voluntary regulation through the CNHC, because there is a valid and rational argument for keeping it. Many NTs, like the herbalists before us, will want to maintain their registration through the CNHC and not be ring-fenced with dietitians in the RD route through the HCPC. As an organisation, we have always championed informed choice and are firm believers in putting all available information in front of people so that they can make a fully informed choice. This is no different and I really don’t feel there is any need for anyone to ‘take sides’, creating more of the ‘them and us’ scenario, damaging as it is, that currently exists. There is sufficient professional space for both to exist concurrently.

          We think it’s a very important time for debate, especially while it will be some time before any solid proposal for statutory regulation is available for scrutiny by NTs or other categories of nutritional practitioner. Among the many issues to be determined will be acceptable educational standards, training/CPD requirements, and grand-fathering of those qualified before the passage of SR.

          Best wishes

          Meleni

  3. Nutritionals and homeopathy have kept me going for some 30+ years and I have no aches pains, diseases etc. I am now 70+ , outliving all my maternal family. I was extremely ill in my 30s/40s with acute attacks of asthma. Despite doing all the doctor told me, I ended up on a nebuliser and was pretty near death. Homeopathy actually cured the asthma. The human body is made to be self healing but it needs optimal nutrition, even more so now in dealing with pollution and especially if your inheritance is not so good.

    1. Thank you for sharing your experiences Jane. We’re glad to hear how well you’re doing.

      Warm Regards
      Melissa

  4. These so called Dietitians are trained in the limited mainstream views of diet which in my experience is a simplistic and largely irrelevant dogma based view of Natural Health. Such petitions appear to be nothing more than a thinly disguised effort to attempt to regulate and control an area of health i.e. ‘Natural Medicine’ they have little understanding of, and even less training in, that is rapidly overtaking the increasingly discredited mainstream approach.

  5. Hi Meleni, I am a BANT Fellow and CNHC-registered therapist. I have a BSc and a Doctorate in Nutritional Medicine. From my position as BANT Regulatory Coordinator for Europe, I have been involved in promoting statutory regulation in Europe for Nutritional Therapists. I totally agree with you about the differences between dieticians and nutritional therapists practice. I am also convinced, based on a profound evidence-based research in the issue, that the dieticians’ leadership is promoting a monopoly of nutritional advice worldwide lead by the American Academy of Dietetics. I am also aware of their official documents on how to “manage” their competitors in Nutritional advice. This aim is evident in the numerous Bills they have submitted in many states penalising nutritional advice for those without a Degree in Dietetics. If we hadn’t succeed to stop these Bills from being passed as laws several times with strong action with politicians and officials today healthcare practitioners without Dietetics Degree would have been sent six months to jail for a simple nutritional advice to a patient, as the Bill provided. The big problem is that in the last few years they are collecting all nutrition titles for themselves. I am sure you have noticed that all dieticians have arbitrarily added the word “nutritionist” to their titles. They all now call themselves “Dietician-Nutritionist” and all their courses are renamed to Dietetics and Nutrition. The are also, again arbitrarily, categorising all nutritionists under the Dietetics categories, an action which according to the law only the House of Representatives is allowed to do, and in some countries they publish their arbitrary decisions in official documents! It seems that if we don’t act we will find ourselves ‘outside’ not being able to use the term “NUTRITION” and “FUNCTIONAL” and so on. I believe BANT knows what is doing and we should trust the Council as it has proved until now that follows a wise and highly effective policy.

    1. Dear Dr Kiliari

      Thank you so much for your considered response. We totally concur with your views on the dietitians’ attempt to monopolise the delivery of nutritional therapies. Our sister organisation, ANH-USA, has been at the forefront of preventing the rights of practitioners of nutrition (non-registered dietitians) outside the Academy of Nutrition and Dietetics in the US from being usurped by registered dietitians at the state and national level.

      So while we fully recognise the desire among nutritional therapists to stand firmly together and be legally recognised by statute, our piece was simply drawing attention to our concern over with whom we share platforms. Our organisation has always been a leading proponent for informed choice. We had been asked by a number of practitioners to clarify this particular situation as they were confused. As an organisation we always feel that people should be given as much information as available in order for informed decisions to be made. The ‘Fight the Fads’ platform set up by three student dietitians who seemingly have an agenda that is at odds with our professional stance, in our view, is potentially an imperfect platform for our own profession if it is to be shared with those who support the very same values as the US Academy of Nutrition and Dietetics. But that is our view, it’s completely up to individual practitioners to make their own decision about what is right for them with the available information. I have been a BANT member for a long time now, so have also put my trust in the various councils that have been in place through the years, and I have every intention of continuing to do so.

      Kind regards

      Meleni

      1. Thank you very much for your response Melleni. One thing is for sure we are all on the same side fighting for a healthier world!
        Have a lovely weekend
        Nitsa

    1. Hi Catherine, sorry, we’ve looked too and can’t find one either. If one comes to light, we’ll let you know. Best, Meleni

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