The Red Baron

July 8th, 2006 by Ben Goldacre in alternative medicine, bad science, mirror, nutritionists, PhDs, doctors, and qualifications, references | 29 Comments »

The Nutrition Society was founded in 1941 by Lord Boyd Orr. He was described in his obituary – rather fabulously – as “Baron and Nutritional Physiologist”, and in 1949 he casually picked up a Nobel Peace Prize. Since his time, the Nutrition Society seems to have gone rather badly downhill.

Here is a website, for example, run by two of the Nutrition Society’s “Registered Nutritionists” (www.nutrition-advice.com). They are “RNutr” like the rest, and they proudly display the Nutrition Society’s logo on their pages.

If you ask them to test you for nutritional deficiencies they offer you diagnosis by “electro-acupuncture”, and also provide “the very latest innovation in bio-energetic medicine”, their “Remedy Information Transfer Unit”. How does it work, you might ask? It can “copy and make up medicines homoeopathically”, and even more usefully “cancel out the bad vibrations of an allopathic drug”. Imagine a world in which that really worked: what if the machine got the frequencies just very slightly wrong, and cancelled out the vibrations of my body’s dopamine, or my insulin? After all, lots of “allopathic drugs”, or medicines as you and I might know them, are structurally similar, if not identical, to natural components of your factory fresh and unmodified human body. Forgive me if that inconvenient overlap interferes with your simplistic moral universe.

But this is surely one end of the scale, an extreme case? Maybe. But there is a more general problem here. The Nutrition Society is a genuine, sound academic body: they publish peer-reviewed journals like the British Journal of Nutrition and Public Health Nutrition. But now, alongside this serious academic work, perhaps flattered by the way their dry field has become so popular, they also vindicate a vast commercial industry of commercial “nutritionists” offering lifestyle advice in return for money.

“Nutritionism” is all about blurring the boundaries between sound theoretical academic research and lifestyle advice: as we have seen time and again in this column, the popular lifestyle nutritionists extrapolate from the behaviour of cells in a dish on a lab bench, when they have a nutrient squirted on them, to giving authoritative and highly specific, technical lifestyle advice; or they extrapolate from mere observational data to lifestyle advice.

I’ll explain what that means. You might remember Angela Dowden (RNutr), “Britain’s Leading Nutritionist” from last week. Here she is in the Mirror recently, writing about foods offering protection from the sun in the heatwave: “An Australian study in 2001 found that olive oil (in combination with fruit, vegetables and pulses) offered measurable protection against skin wrinkling. Eat more olive oil by using it in salad dressings or dip bread in it rather than using butter.” This is, forgive me, bread and butter nutritionism.

But the paper she refers to (Skin wrinkling: can food make a difference? Purba MB et al. J Am Coll Nutr. 2001 Feb; 20(1):71-80) was an observational study, not an intervention study. It did not give people olive oil for a time and then measure differences in wrinkles. I would not say this study justifies advising olive oil to reduce wrinkles, but you can make your own mind up. It pooled four different groups of people to get a range of diverse lifestyles, including Greeks, Anglo-Celtic Australians and Swedish people: it found that some people who already had completely different eating habits also already had different amounts of wrinkles. Imagine!

People with completely different lives will always have different diets, and different wrinkles, that doesn’t mean the food directly affects the wrinkles: it could be any number of other factors. I eat well and I don’t have many wrinkles. I also have a middle class background, an indoor job, and a life largely free from strife. To me, Dowden has extrapolated too far from the data (you may disagree) but she has done no more than any other commercial lifestyle nutritionist. The Nutrition Society, once a sober academic body, now endorses these commercially lucrative leaps of faith: or do they? I could complain to them about the wrinkle article, and see where they stand on such extrapolations, but they are so obsessed with secrecy that I wouldn’t be able to tell you the answer anyway. Here’s to Lord Boyd Orr.


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29 Responses



  1. Tessa K said,

    July 8, 2006 at 12:40 pm

    Olive oil might better prevent wrinkles if you rub it on your skin rather than eating it.

  2. Richard said,

    July 8, 2006 at 4:19 pm

    Instead of trying to prevent wrinkles, we should focus on trying to prevent the fear of wrinkles. Then the world would be a much happier place.

  3. kim said,

    July 8, 2006 at 4:29 pm

    Tessa, your comment made me laugh. Does anyone else remember the days when the olive oil was kept in the bathroom cabinet rather than the kitchen cupboard? My parents used to use it instead of suntan lotion. (I strongly doubt that it worked.) And also, disgustingly, for softening up ear wax.

  4. bazzargh said,

    July 8, 2006 at 5:55 pm

    Some bad science today in the grauniad:
    lifeandhealth.guardian.co.uk/experts/joannahall/story/0,,1814242,00.html
    Joanna Hall advising exercises to target the muscles of the waist to get rid of a flabby tummy.
    Ab exercises for a fat belly? Ehmmmm… doesn’t work. Katch, F. I., Clarkson, P. M., Kroll, W., McBride, T., and A. Wilcox. “Effects of Sit Up Exercise Training on Adipose Cell Size and Adiposity.” Research Quarterly for Exercise and Sport 55: 242-247, 1984. Or more recently, pubmed PMID 2528028: “These results suggest that abdominal weight machines or traditional incline sit-ups are effective in altering abdominal muscular function, but local abdominal exercise alone is unsatisfactory for reducing stomach skinfolds or girths.” Last year, the FTC in the US of A took action against bunch of ab-fabulising machine advertisers, specifically mentioning that ‘spot reduction’ claims have no evidence to back them. In Joanna Hall’s defence she does advise calorie control and mentions that “No single exercise will create the perfect flat tummy”; but why not recommend a general exercise program instead?

  5. Michael Harman said,

    July 8, 2006 at 7:02 pm

    KIm, your post reminds of an old woman of Irish origin who is a neighbour. She was told to use warm olive oil to loosen her husband’s earwax, and asked “Should I use virgin”?

  6. superburger said,

    July 8, 2006 at 11:18 pm

    From the website “Meanwhile, if you drink over 5 cups of coffee a day, your risk of a heart attack increases by120% !”

    homepage.mac.com/f.mulder/nutritionist/Personal74.html

    This sounds like the sort of rubbish that regularly gets torn apart in bad science columns. Perhaps there are certain groups of people for whom excess coffee (what type? filter, instant, espresso) can increase the risk of heart attack.

    But to imply that everyone who drinks > 5 cups of coffee is at risk of a heart attack is patently untrue.

    The authors of crap like this should be stuck off their ridiculous register.

    What I never understand is why state regsitered dieticians don’t act more assertivley on quacks moving in on their turf.

  7. Ben Goldacre said,

    July 9, 2006 at 4:30 am

    My favourite work by Angela Dowden is her earnest explanation of how pork is good for you in a lavish glossy leaflet she produced for “The British Pig Executive”

    www.meatmatters.com/sections/recipes/pdfs/HealthyPork2.pdf

    It’s not that i think the content is particularly dodgy – it was too boring to read very attentively – I just love the sound of the “The British Pig Executive” and I wish I could work for them too.

  8. wotsisnameinlondon said,

    July 9, 2006 at 2:02 pm

    Like Kim (comment 3) I remember the use of Olive Oil as sun protection while on holidays in Spain in the 1960s. My parents’ friends recommended its use but to be most effective, they also advised sitting under a sun shade.

    You know, the combination of the two worked very well although the odour of frying was mildy offputting.

    This aslo brings to my mind the use of vegetable oils to power Diesel engined vehicles such as they do in Austria for public buses. Are there any Nutrional benefit to inhaling the exhaust gases and would the addtion of “essential oils” make a difference?. I think that an Intervention study wherein the popular nutritionists (RNutr) mentioned so many times in this journal should attached to the back of both vegetable oil powered Austrian buses and normal Derv powered UK buses for a significant period and the effects measured. Must be good for both a Government grant and a bunch of laughs.

    Finally (thankfully I hear) has anyone else spotted the phonetic similarity between RNutr and Ah! Nutter ?.

  9. Tony Hatfield said,

    July 9, 2006 at 4:54 pm

    Richard,
    Surely we should be tough on wrinkles and tough on the causes of wrinkles
    t

  10. Richard said,

    July 9, 2006 at 5:13 pm

    Nah, it’s fear of wrinkles that is the problem. Embrace your wrinkles!

  11. Dr Aust said,

    July 9, 2006 at 5:41 pm

    Hmmm

    ..but would it be kosher to work for the British Pig executive, Ben?

  12. Dr Aust said,

    July 9, 2006 at 5:45 pm

    On the subject of wrinkles, anyone have the impression they need protecting on TV?

    Think about it. TV is ever more Americanised, and no American (women especially) can be allowed on TV if s/he has wrinkles, and since Botox now allows the over-30 to de-wrinkle (at the cost of total unexpressiveness)… wrinkles are endangered.

    What we need is a Campaign for Real Faces.

  13. Michael Harman said,

    July 9, 2006 at 8:51 pm

    To pick up a minor poiint of almost complete irrelevance, how was it that Derv became a synonym for diesel, or indeed came into use much at all? My understanding is that DERV = Diesel Engined Road Vehicle.

  14. JQH said,

    July 10, 2006 at 10:02 am

    I suppose it was originally “DERV fuel” and it got changed to cerv by someone who didn’t know that it was an acronym.

  15. Tessa K said,

    July 10, 2006 at 12:40 pm

    I remember olive oil and other cooking oils being used not as sunscreen, but as as a sun tan lotion by students who could not afford the real thing. Fry your way to a tan.

    And, of course, olive oil is a more skin-sensitive alternative to baby oil (which contains lanoline) for adult fun.

  16. outeast said,

    July 11, 2006 at 11:29 am

    All this talk of olive oil puts me ion mind of that old boddington’s ad: ‘Pass the chip fat will you love!’

  17. drewprice said,

    July 11, 2006 at 11:57 am

    Does anyone know if Peter Abu-Jabir from the site in question (www.nutrition-advice.com) finished his postgraduate studies in Dietetics at Kings? He doesn’t put the letters after his name but, if he had completed the course they offer (which includes clinical experience), provided he kept up with CPD that would entitle him to use the title State Registered Dietician, would it not?

  18. Daveyboond said,

    July 11, 2006 at 12:22 pm

    I’ve been looking at the requirements for membership of the Nutrition Society, from their website. It seems that the key requirement is a BSc Hons or postgrad. qualification in “nutrition or appropriate subject” (www.nutritionsociety.org/documents/20060410section1.pdf). After 2007, this qualification will “normally ” need to be from a course accredited by the Society. There is also a new requirement for 5-yearly re-registration contingent on providing evidence of continuing professional development.

    This all seems reasonable, so if it is indeed true that there are a lot of charlatans on their books (to be fair, so far we’ve only identified a few), then I wonder why this is the case. Presumably these people do indeed have degrees in nutrition – maybe they are just selling stuff they know to be ineffective in order to make a fast buck, or perhaps nutrition degree courses are not particularly rigorous?

    Maybe the new CPD requirement will eventually weed out the malpractors (is that a word?). As the document linked above says “A guide is available as to how CPD can be proved, by emailing office@nutsoc.org.uk” – maybe someone else less desultory than me can do so and find out.

  19. Dr Aust said,

    July 11, 2006 at 2:06 pm

    Daveyboond:

    Two things to point out here:

    1. Re the accredited B.Sc. degrees, it will depend critically on how rigorous they are scientifically, which will in turn depend on the Universities and their staff. Do they want to run a degree that turns out scientists with a specialisation in nutrition ( which is what I would say a B.Sc. implies)? Or do they want to attract and train people who fancy dishing out trendy but largely baseless “holistic nutrional advice” a la Emma Mitchell? I would HOPE the former, but, given that academia is a “bums on seats” business these days, I suspect the latter,as that is likely to be where the prospective punters, sorry students, are.

    …If you want to see where you can end up when Univs start going Alt Therapy, see David Colquhoun’s pages at:

    www.ucl.ac.uk/Pharmacology/dc-bits/quack.html#univ

    2. Re. training, they currently allow people to join their RNutr register by having an accredited OR SUITABLE OTHER degree and “relevant professional experience” or similar. Reading between the lines, I take this to mean that if I have ANY biomedical science-related honours degree, did a course unit or two in nutrition as part of that degree, and have spent three years as a journalist writing a “natural health” column then I would qualify. I guess this is better than just being a glib self-styled expert with an arts and management degree, a correspondence Ph.D. and a TV show, but I am still dubious.

    I think the Devil is in the Detail here. How rigorously are the NutSoc going to enforce these rules, both on qualifications and on conduct? An interesting test Q – would “Dr” Gillian McKeith get on their register? She doesn’t. strictly speaking, meet their criteria as she has no science degree (bachelor or postgrad). Wonder if she will apply?

    Personally I am marginally in favour of registration and the need for kosher degree courses for people offering this sort of “nutritional advice”, on the grounds DaveyBoond indicates, i.e. that it MIGHT help eliminate the charlatans.

    BUT…. it will depend very heavily on whether the NutSoc, and the Univs, have the balls to set proper “evidence based” standards for what they teach and what the the “practioners” they train/register are allowed to dish out.

    I also think it won’t work unless you pass a LAW saying ONLY a person on a register can actually call themselves a “nutritional health practioner”. This is typically how these “para-health” professions are regulated in continental Europe.

  20. Tony Hatfield said,

    July 11, 2006 at 5:55 pm

    Tessa,
    “I remember olive oil and other cooking oils being used not as sunscreen, but as as a sun tan lotion by students who could not afford the real thing”

    That must have been when you bought to stuff from Boots?
    BTW, did extra virgin providea higher protection factor?
    t

  21. David Mingay said,

    July 11, 2006 at 8:35 pm

    If you rummage around on www.nutrition-advice.com, you can find out more about the “Practitioners” (who are important enough to be Capitalised), Peter and Sylvia Abu-Jabir. It turns out they “graduated with Honour Degrees in Applied Nutrition from The University of Greenwich in London and have Diplomas in Bio-Energetic Medicine and other Complimentary Medicine Fields”. While I have a deep distrust of complementary medicine, I do like the idea of “complimentary medicine” — medicine which presumably tells you things like “My goodness, despite your eczema, you look lovely” are bound to have a beneficial effect.

  22. JQH said,

    July 12, 2006 at 10:44 am

    So they can’t even spell the name of their field of er competence?

  23. raygirvan said,

    July 12, 2006 at 3:00 pm

    So they can’t even spell the name of their field of er competence?

    Always a bad sign. Colleague I knew in Birmingham walked out of a hair clinic consultation when the supposed expert repeatedly used the word aloplecia

  24. Dr Aust said,

    July 12, 2006 at 8:47 pm

    Perhaps it was a Freudian slip?

    Remember that a lot of the placebo effect that dominates complementary therapy is down to the therapist-”patient” relationship.

    So complimentary (“You are a powerful person.. ! You are in charge of your life… You can do it…! Seize the day…! YOU have the power…!”) is arguably the same as complementary – at least some of the time.

  25. Registered Dietitian said,

    July 13, 2006 at 11:20 pm

    Hiya,

    Thankyou so much Ben Goldacre for outing some of these charletons!! Unfortunately the general public seem to view nutritionists as higher up the trust scale as dietitians, and i have lost count of the number of times patients of mine will defer to Gillian McKeith’s/ any other ‘nutrition expert’s’ advice over my sensible, evidence-based advice. Unfortunately, I doubt many of these people read the guardian, but never mind – your column makes me feel better!

    I just wanted to clarify the whole dietitian vs nutritionist issue – you can generally trust a dietitian’s advice to be based on the best possible evidence – however, when there is no evidence base to draw on – as often the case, as there is very little high quality research being done into nutiritonal interventions – they will base their advice on professional consensus , with the underlying principle of doing no harm. You can check a dietitian’s registration, and make complaints etc on www.hpc.org.uk Anyone who claims to be a dietitian and is not registered can be fined (and please do report them!!!).

    We are desperate for the HPC (health professions council) to set up a similar ‘protected title’ and register for nutritionists – so that those who have valid training and experience can be valued and regulated. I work in the NHS alongside excellent nutritionists who carry out health promotion, education sessions and non-clinical advice ie basic healthy eating, weight management, infant feeding etc. However, at present, the best thing available is the Nutrition Society register.

    To be honest – i doubt that the RNut mentioned in these articles would be taken off the register, because my take on it is that they could be pretty trustworthy nutritionists, but the stuff on the site is more like ‘alternative nutrition’ ie not at all evidence based but probably not harmful.

    If you want to ensure dietary advice is reliable for any clinical issue – allergy, diabetes, cancer, MS, etc etc, the public needs to make sure they see a dietitian. Any responsible nutritionist would never attempt to advise on these things.

    One to watch out for is the Nutrition Therapy Council – who are proposing to regulate Nutritional Therapists as the alternative to mainstream nutritionists/dietitians: www.nutritionaltherapycouncil.org.uk

    I think there is a place for these ‘practitioners’, for personal choice, as long as they are doing no harm.

    My major frustration is the TV coverage given to ‘nutritionists’. The British Dietetic Association have done a good job of engaging the press more, but popular daytime programmes will show a 5 minute sensible nutrition slot alongside contradictory alternative nutrition half an hour later – how confusing for a large sector of the general public. I was particularly disappointed withthe BBCs Fat Nation – as it was a great show, really sensible nutrition advice, but fronted by an Institute of Optimum Nutrition Nutritionist ‘Miss Chiplash’. In none of the programmes i watched did they acknowledge that behind the scenes were 4 dietitians advising families and advising the script writers – shocking!! – And chiplash has gone on to present other less sensible nutrition programmes. And it’s not that dietitians don’t try to get on TV – a colleague got down to the last two to present one of these programmes, but in the end the ‘nutritionist’ got the job. The reason? The programme was being sponsored by numerous nutritional supplement companies and so teh presenter was required to promote these in their advice given. The dietitian couldn’t agree to do this (promoting particular products without adequate evidence is forbidden in our code of conduct, and is of course pretty unethical), but of course the non-regulated nutritionist could! Pity!!

    I do feel that the TV companies who advocate presenting ‘nutritionists’ as experts are doing immense harm – it undermines the real experts, contradicts useful health messages, and makes it seem that healthy eating is difficult to achieve and expensive – completely the opposite to the truth!

    Anyway, enough of my moaning,
    RD

    p.s. for interest, reliable nutrition info can be found on www.eatwell.gov.uk and www.bdaweightwise.com

  26. Tessa K said,

    July 14, 2006 at 10:57 am

    Tony:

    “That must have been when you bought to stuff from Boots?”

    No, I am not that old! Plain old cooking oil does the job just as well.

  27. cath having fun said,

    September 3, 2006 at 1:18 am

    re: DrewPrice’s at no 17:
    you can check the credibility of a supposed dietitian using their surname at www.hpc-uk.org/aboutregistration/professions/dietitians/index.asp that allows you to identify currently Registered Dietitians in the UK.
    Unlike nutritionists – self styled or not – our professional practice is regulated by Act of Parliament (currently the Health Care Professions Act 2002, formerly the Professions Supplementary to Medicine Act, 1960), which rigorously protects the client from dodgy nutritional practices.

    So it is rather galling to see self-styled nutritionists with TLA ‘qualifications’ gaily accessing vulnerable groups, the worried well, and ‘meeja’ types (particularly the latter- brings in media kudos and more dosh) to promote their own bastardised view of nutrition – governed only by their own morals and ethics, and without fear of reprisal should any harmed punter care to sue – ‘I was only doing my best, m’lud’.

    it amazes me (as an RD) that some of my clients commonly waste hundreds of pounds on useless exclusions, irrelevant blood tests and dietary supplements sold to them by their ‘nutritionist’ – found in the local health food shop or ‘clinic’ run by the ‘training institute/ organisation’. Of even more concern is that its not just the ‘worried well’ wasting their money, but the vulnerable ill, who often don’t have the financial resources to begin with……

    but ‘doing your best’ is something you learn in Brownies – and just because everybody eats doesn’t make them an expert in nutrition. Serious nutritional manipulation is not for the ‘enthusiastic amateur’, however many capital letters appear after his or her name, or whatever crummy ‘world renowned institute/organisation ‘ that ‘trained’ them. Of course, any enthusiastic amateur in nutrition can do ‘Nutrition Lite’ – eat more fibre, eat less salt, up the fruit and veg and easy on the fat (unless its mono-unsat, or omega-3), but leave the serious stuff to those qualified to dish it out…

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