Blame everyone but yourselves

July 25th, 2008 by Ben Goldacre in alternative medicine, BANT, dangers, detox, media, nutritionists, regulating nonsense, telegraph | 55 Comments »

Ben Goldacre
The Guardian,
Saturday July 26 2008

image Like many professions who kill people with some regularity, doctors have elaborate systems for seeing what went wrong afterwards, and the answer is rarely “Brian did it”. This week the papers have been alive with criticism for quack nutritionism after the case of Dawn Page, a 52 year old mother of two who ended up being treated on intensive care, with seizures brought on by sodium deficiency, and left with permanent brain damage, after following the advice of “nutritional therapist” Barbara Nash. She denies liability. Her insurers paid out £810,000.

I will now defend the nutritional therapist Barbara Nash.

There is no doubt that people who declare themselves to be healthcare practitioners are a risk, by virtue of sheer uncallibrated self-belief. It takes strong nerves to tell a customer, as they are following “The Amazing Hydration Diet” – dramatically increasing water intake, and reducing salt intake – that their uncontrollable vomiting is simply “part of the detoxification process” (with shades of the doctor’s reassuring tones). In fact, Mrs Page’s lawyers explained, at this point she was told by Ms Nash to increase her water intake to six pints a day.

But I put it to the kangaroo court of the international news media – since this story has now spread as far as America and Australia – that Barbara Nash’s confidence in her own judgement cannot be seen outside of its social context, and will doubtless have been bolstered by a number of different factors.

After completing the rigorous training at the “College of Natural Nutrition” anyone would naturally believe themselves to be appropriately qualified, and able to give advice confidently. That is certainly the impression I have from reading their website. Barbara Nash’s confidence in her own abilities seems entirely congruent with that world view.

Then there are the professional bodies. They have been rather keen to distance themselves from Barbara Nash. In the Daily Telegraph, for example: “The British Association for Applied Nutrition and Nutritional Therapy (BANT) which has its own code of conduct, said Mrs Nash was not a member.” This is not the entire truth. Barbara Nash is advertised on yell.com as a member of BANT. In fact, she was indeed a member of BANT, until 2007.

Membership of BANT carries such privileges as “a listing in the BANT Directory of Practitioners, which is available to the public and entry on the BANT web site” and “acknowledgement of professional status by the Nutritional Therapy Council”. So endorsed, Barbara Nash would once again have perfectly reasonable grounds for a strong faith in her own abilities. The episode with Dawn Page on intensive care occurred in 2001. These honours were conferred upon her by BANT in 2005.

And of course, we should not forget the wider social context: food has become the bollocks du jour, with no regard for accuracy whatsoever. As I said last week, this stuff has become so prevalent I have given up trying to document it: the Daily Telegraph was printing advice from a self-declared nutrition therapist on folic acid in pregnancy that may actually increase the risk of disabling neural tube defects in babies, in the same week that it ran a news story telling women that red wine prevents breast cancer when actually it increases it, and the sofas of daytime television are filled with self-declared nutritionists, because they give us what we want to hear: technical, complicated, sciencey-sounding health advice.

Looking at Barbara Nash’s website, I see she carries testimonials from her own appearances on ITV Central’s Shape Up For Summer slot: “When I met Barbara (who was the nutritionist for this Central T.V. program), I wasn’t really sure how her eating plan would help me…However, it did involve one aspect that I found very difficult to follow, drinking 4 pints of water a day. I would be the first person to say that I was sceptical but as I had volunteered to take part, I felt that I at least owed it to everyone to try. Was I surprised by the results!”

Promoted, endorsed, trained and buoyed, Barbara Nash had good reason to think that what she was doing was sensible and correct. Dawn Page, for all that you might think, in an unkind moment, that she was a little gullible, similarly had every reason to believe that Nash was competent. They were both reinforced in these views by the College of Natural Nutrition, the British Association of Nutritional Therapists, Central TV, and every single journalist, editor, commissioner, and producer who has shepherded this bizarre world of made up nutritional nonsense into our lives. The specific harm done in this one episode is tragic. It always is. The real measure of professionalism is how you investigate, and what you change: no system would be perfect, but in this case, everyone is queueing up to hold out Barbara Nash as solely responsible, and there is not one single crack of critical self-reflection.


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55 Responses



  1. peterd102 said,

    July 26, 2008 at 12:25 am

    How Very True. One cannot lie unless one knows the truth. Barbra Nash is more technically Defined as a bullshitter – one who adopts a casual approach to the truth. I almost feel sorry for her, she didn’t know what she was doing was wrong and is probably constantly wondering why what happened happened.

    I hope the Nutritionist Teachers and Institutions get sued a few months from now.

  2. drunkenoaf said,

    July 26, 2008 at 1:22 am

    What? Who’s fault is it that she’s an idiot? Society’s? Uncaring mummy? Professional bodies helping to reinforce a delusion of competence can’t help, but like a mental illness, where did it stem from? No, really, where? I don’t know. You’d think a love of biology or chemistry at school would set somone down the healthcare path– but surely some sensbility in terms of human physiology would have been picked up. So I suspect she didn’t enter the field this way. How the help did she end up in that job with this tragic outcome?

  3. heavens said,

    July 26, 2008 at 1:32 am

    I must not have all the facts on this, because I’m confused. It’s “very difficult” to drink four pints of water in a day? That’s just eight 8-ounce glasses of water a day — the amount that everyone is “supposed to” drink. (It’s several times what your body technically needs, but a very common recommendation and not harmful to a normal, healthy person). An athlete on a hot day might drink twice that much. Heck, *I* drink more than that even when it’s not hot. So why am I never vomiting from it?

  4. Pro-reason said,

    July 26, 2008 at 2:07 am

    I agree with Heavens. Four pints (in archaic units)? Isn’t that less than a couple of litres? I certainly drink way more than that every day. I get thirsty otherwise. Most of the time it’s in the form of beer, soya milk, tea, or fruit juice, but it’s quite often just water with a dash of lemon.

    On my cycling tour around Tasmania a few months ago, I probably doubled my daily intake.

    You should probably make it clearer that it’s the reducing her salt intake to zero that screwed her.

  5. Ben Goldacre said,

    July 26, 2008 at 2:16 am

    It was an extra four pints of water a day, on top of normal input.

    On the other thing I should also be very clear: alongside the other players in this unhappy situation, including the patient, obviously I think Nash – like any clinician in this situation – does carry some responsibility in this case, from what is reported.

  6. nickyb said,

    July 26, 2008 at 5:06 am

    This story has had me more than a bit worried….I know I’m a bit of a freak, but I usually drink between 15 and 20 LITRES of water a day. Sometimes even more..otherwise I get really thirsty. I have quite a good idea of how much I drink as I have to buy all of my water in bottles (I live in China). Is there something wrong with me? Had numerous blood and urine tests for the obvious and found nothing abnormal at all. I am on longterm tricyclic ADs, which would account for some of the thirstiness but…

  7. jodyaberdein said,

    July 26, 2008 at 7:36 am

    The minimum amount of urine you need to make is about 600ml per day: that is the maximal concentrating effect of the kidney, and you need to excrete a certain amount of inorganic acid etc.

    Polyuria is generally and arbitrarily defined as over a bout 3 litres per day. Most people will pee 1 to 2 litres a day.

    The body has exquisite mechanisms to regulate both fluid volume and tonicity, and a person without hormonal or renal pathology would have to try very hard to reduce serum sodium by drinking water: so called psychogenic polydipsia patients have to get to 10 or more litres a day before you see a problem. At this stage the maximally dilute urine is of large enough volume that the total sodium loss is greater than intake.

    And here’s the key: It is the combination of water intake and sodium restriction.

    And presumably the nutrition societies give clear training on how to exclude underling renal or hormonal problems before embarking on a regime such as the above….

  8. drunkenoaf said,

    July 26, 2008 at 8:50 am

    nickyb, what blood tests?! ADH? What salt intake must you take to keep from diluting yourself to death?

  9. nickyb said,

    July 26, 2008 at 8:56 am

    @ianbetterbridge: I’ve discussed it with doctors many times, and had various checks.

    diabetes, kidney, liver and thyroid function etc. Every test has been well within normal, as has my urine (apart, obviously, from being copious and very dilute).

    I’ve been like this for years. And my salt intake is minimal..very rarely add any at all to any food.

  10. realitycheck said,

    July 26, 2008 at 10:47 am

    As someone who is familiar with traditional Chinese medicine, CAM, and alopathic medicine, I can say that if you take a truly holistic view of health, or anything for that matter, balance is the most important thing to achieve.

    Therefore, if someone is sick, you always look for the root cause – which is always an imbalance in their system. Then you recommend a way for them to regain balance. A good way is never going to be severe or extreme, and any changes should be gradual and done in a way that you can check the persons progress, to see how they are responding; you can then change your approach to match their progress.

    Because everyone is different, the root causes are always different. That’s why you need to thoroughly check them before anything happens.

    I drink a lot of water (about 3 litres/day – which is about 5.3 pints) because I was recommended this to clean my system out (by a TCM practitioner). But I didn’t start at 3 litres, I worked up to it, naturally. At the same time, I started adding salt to my food, because the same person recommended it to me, and I had been salt free before. Since drinking more, I feel amazingly better, and also, the salt has made me feel better too (sea salt, which has other useful compounds in it too); I have much more energy.

    When I was younger, I used to drink a lot of alcohol – sometimes 10 pints of beer in one night, at my worst, but that seemed to be normal then. But it made me sick and hung over, naturally!

    A few years ago, I guy who mused to be a friend of mine went on an Anthony Robbins course – and died from drinking too much water.

    Mostly, most people don’t drink enough, but finally, the balanced, natural experience I got from Chinese medicine has taught me that the middle path is the best… but you still need good advice from someone who has a deep understanding about health – not just a scientific one. I get the feeling that Nutritional therapists have no natural medical experience, and use cod science cobbled together from a bunch of scientific research, that as usual, treats people like robots, and thus misses the point that we are made of much more than flesh, bones, blood etc.

    Nickb, if you are in China, get your self along to a proper TCM doctor, because 15-20 litres of water sounds like you have some major imbalances in your system. Also, check out any Qi Gong / relaxation classes you can find, because those things will all help you regain and keep your balance.

    Good luck!

  11. perspix said,

    July 26, 2008 at 11:33 am

    I would disagree with the pont, “it’s not her fault”. Society works best when we take responsibility for our own actions, despite the actions of those about us in the herd/pack.

    And that is the point I take from Ben’s article. We ALL need to take responsibility for the things we beleive in, espouse, practice and pass on to others.

    Just because you can blame BANT doesn’t mean you can’t blame Nash. Others may have shouted “fire” but it was Nash that pulled the trigger.

  12. muscleman said,

    July 26, 2008 at 12:20 pm

    Nicky B you need rather than liquid something to fix your thirst driven by the drug you are taking. Water is no good for this. What you need is acid/astringent/tannic things. So strong tea. My wife swore by lime lemonade and bitters which I used to make her by the half dozen every day.

    The idea is to stimulate your salivary glands to fix your dry mouth. Small amounts of things that do this are better than vast quantities of water. Experiment, try iced tea for eg.

    For on thing it will keep you out of the loo quite so much ;-)

  13. lawrabbit said,

    July 26, 2008 at 1:02 pm

    nickyb: Have you ruled out diabetes insipidus and psychogenic polydipsia?

  14. raygirvan said,

    July 26, 2008 at 2:00 pm

    Agreed. IANAD, but diabetes insipidus was what first crossed my mind. Forget “proper TCM” doctors – the whole TCM thing was cooked up in the Maoist era to keep the proles happy when China couldn’t afford real medicine.

  15. secretlondon said,

    July 26, 2008 at 2:36 pm

    I was worried by the media (think the BBC) telling people to drink less water..

  16. muscleman said,

    July 26, 2008 at 5:11 pm

    Realitycheck so everyone with measles has a different cause do they? what complete crap that is.

  17. JQH said,

    July 26, 2008 at 7:49 pm

    “drop in vaccination uptake” makes more sense.

  18. Sili said,

    July 26, 2008 at 7:55 pm

    So when OfQuack comes into effect, how long from when someone dies of a preventable illness due to using homoeopathy or acupuncture till The Prince’s Trust can be sued?

  19. gadgeezer said,

    July 26, 2008 at 10:55 pm

    There’s another Daily Mail item that looks like it expands on the You and Yours interview:

    Geoff says: ‘I remember seeing the leaflet and it looked professional. Her qualifications were listed.

    ‘She had a DNN, which is a diploma in natural nutrition. We didn’t realise then that this didn’t mean anything and that nutritional therapists aren’t legally regulated…

    [Dawn Page shows symptoms.]

    Obviously, I was concerned and so I also rang the nutritionist.

    ‘I said, “I’m a bit worried. Dawn’s been sick and there’s water. There’s quite a lot of water and it has happened twice.”

    ‘She went on to explain what was happening, but in quite scientific terms that went over my head. It was done in such a fashion and with such expertise and confidence that I couldn’t contradict it.

    ‘In all truth, I was comforted by being told that what Dawn was experiencing appeared to be normal.

    ‘The nutritionist said the symptoms were typical of the ‘detoxing’ process and that Dawn should maintain the diet.

    ‘And she expressly emphasised the need to keep up the water intake. There was no view that we were in a dangerous situation.’

    There’s some discussion of the fact that vomiting clear water is supposedly a red flag and that hyponatraemia “only condition that produces that particular symptom”.

    The cognitive deficits that she experienced seem devastating.

  20. jodyaberdein said,

    July 26, 2008 at 11:34 pm

    Anyhow, surely this represents an opening?

    The Mail on Sunday said that the payout was made by Ms Nash’s insurance company. I never gave much thought to the fact that nutritionists might carry insurance. Presumably this is some kind of professional liability insurance tailored to nutritionists? It would be interesting to know how these policies are developed, and a potential inroad into regulation by market forces if the companies providing insurance actually looked at the advice being dished out on scientific grounds.

  21. Seahorse said,

    July 27, 2008 at 8:32 am

    Oh for goodness’ sake. A quick sojourn to BadScience.net and then on to the BBC News website, where I find that this – snipurl.com/35tzm – is currently their most popular video.

    I suppose it’s useful for teaching about logical fallacies.

  22. Salmo said,

    July 27, 2008 at 11:00 am

    I’m interested in the current fetish for frinking lots of water. It seems everyone is carrying round little bottles of the stuff and constantly guzzling from it. When asked why they often reply that the recommended daily intake is 4 pints (2 litres) a day (or something similar).

    But I don’t do this and I’m perfectly healthy. So does anyone know where this idea of drinking lots of water came from. Where’s the evidence? Or is it something dreamed up by the bottled water sellers?

  23. Delster said,

    July 27, 2008 at 12:01 pm

    love that bit from PV SAID web snippit

    “i have always been keen to keep up with the latest information and technology, as the field of nutrition moves so fast,”

    So far as i’m aware pretty much the whole of nutrition advise should be summed up as “eat a balanced diet” So where does it move onto from there?

  24. Dudley said,

    July 27, 2008 at 2:01 pm

    Defining “balanced,” which emans completely different things to a Mongolian, an Inuit, an Indian Buddhist and an Italian.

  25. sideshowjim said,

    July 27, 2008 at 11:20 pm

    Conversation I had once, with a co-worker about some tiny news story about water toxicity…

    Co-worker: “Well, I don’t believe any of what they say! Now they say drinking too much water is bad for you!”

    Me: “Well, of course it is…”

    Co-worker: “Duhh! It’s water! It’s good for you! How can drinking too much of it be bad??”

    Me: “That’s what “TOO MUCH” means”.

  26. peterd102 said,

    July 28, 2008 at 12:15 am

    Parcelus is attributed to saying words to the effect of:

    ‘The dose makes the poison’

  27. SteveNaive said,

    July 28, 2008 at 11:44 am

    There seem to be two groups of people in the world – people who seem ready to believe this kind of stuff and those who look for hard evidence every time. In my experience, the difference is independent of educational or social background. In fact, I know many people with good science training who seem eager to swallow ‘alternative’ therapies. The only vague observation I have is that it seems that the female:male ratio is higher in the CAM world. Someone needs to do a proper study.

  28. Twm said,

    July 28, 2008 at 4:30 pm

    Snopes debunked the 8-glasses a day myth.
    www.snopes.com/medical/myths/8glasses.asp

  29. Jo the Hat said,

    July 28, 2008 at 4:34 pm

    In fact, what he actually said was: “Well of course too much is bad for you, that’s what “too much” means you blithering twat. If you had too much water it would be bad for you, wouldn’t it? “Too much” precisely means that quantity which is excessive, that’s what it means.
    Could you ever say “too much water is good for you”? I mean if it’s too much it’s too much. Too much of anything is too much. Obviously. Jesus.”
    Genius [sighs].

  30. johnsmith said,

    July 28, 2008 at 4:52 pm

    ‘The dose makes the poison’ – and that dose will be slightly different for everyone.

    Is it known whether anyone else has been given similar advice, and what, if anything happened to them? Are others following this “Amazing Hydration diet” and getting any benefit from it? Surely it’s not just the diet that caused this result – it’s the combination of that person and their diet. Maybe this advice wouldn’t have been so tragic if given to a different person??

    It seems there have been mistakes and/or misjudgements by several people/ organisations and you can probably make an argument to blame whoever you want to blame. There should probably be some blame (in differing amounts) on all the people/parties involved here. But it is very difficult to hand out smaller punishments and make changes to several different people/organisations. It’s very difficult to change the system, much easier to change the people. Life is a lot simpler when one person can be singled out and held solely responsible.

    Tragedies will always happen, the system will never be perfect and it is difficult to know whether any changes made will actually give us a better system. Maybe we shouldn’t leap to the conclusion that “something has to change” based on a single tragedy. These tragedies actually happen quite rarely, which is why they are such big news – which gives us the impression they happen far more frequently.

  31. Wonk411 said,

    July 28, 2008 at 6:49 pm

    @NRG

    Apparently you can buy anything on the internet:

    www.medmalpractice-ins.com/

  32. used to be jdc said,

    July 28, 2008 at 8:35 pm

    For readers interested in more debunking of water woo… you could try googling “hydrationistas”.

  33. Dr Aust said,

    July 29, 2008 at 1:34 am

    Warning: shameless self-plug follows:

    I did a fairly long post a while back about the lack of evidence for “eight glasses a day” and some of the various hydrationista myths.

  34. jonathanhearsey said,

    July 29, 2008 at 9:35 am

    But what of BANTs role in all this – how can they ‘distance themselves’?

    Bloomin CAMs and their regulatory bodies.

    jonathanhearsey.com/?p=47

    Idiots

  35. frisbee said,

    July 29, 2008 at 4:08 pm

    Re: 8X8 glasses of water. There have been several scientific reports on this, the essence of which show that there is no scientific evidence to support the notion.
    See American Journal of Physiology Regul Integr Comp Physiol (2002) Vol 283 pp R993–R1004 for a good review.

  36. frisbee said,

    July 29, 2008 at 4:09 pm

    Should say the autohor is Heinz Valtin, title of review is “Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8X8”?”

  37. pv said,

    July 29, 2008 at 8:48 pm

    jonathanhearsey said,

    July 29, 2008 at 9:35 am

    But what of BANTs role in all this – how can they ‘distance themselves’?

    Bloomin CAMs and their regulatory bodies.

    jonathanhearsey.com/?p=47

    Idiots

    Well, they aren’t regulatory bodies – BANT, the SoH and all of the CAM spokesorganisations. They exist to promote the scams they represent, not regulate them. It isn’t unknown for them to break their own codes of practice which demonstrates just how unregulatory they are. Marketing, devising schemes to part the gullible from their money… that’s their function, along with supplying an endless stream of bullshit to the media who lap it up because they can cash in too.

  38. jonathanhearsey said,

    July 30, 2008 at 4:10 pm

    …WHAT?

    Is this correct?

    What the freak are these professions doing? Actually – I’m beginning to think that I should stop referring to them as professions at all.

    Take it from an NHS quack that knows – this IS embarassing.

    JH

  39. pv said,

    July 30, 2008 at 6:05 pm

    See here about the uselessness of self regulation, and here is a whole lot of Quackometer stuff about the SoH. And here is Gimpy’s blog about a bunch of unethical, lying nitwits.

  40. pv said,

    July 30, 2008 at 6:13 pm

    The point I am trying to make here is that homeopaths and other sCAM operators frequently make claims that are contrary to their societies’ codes of ethics. Yet the societies concerned do nothing. I should have referred you to Gimpy’s blog here, with regard to Ralf Jeutter who is actually one of those reponsible for the SoH code of ethics.

  41. projektleiterin said,

    July 31, 2008 at 9:28 am

    Does anyone who is not British understand how much is in a pint or ounce…?

    And is it really possible that someone have a disease that makes him drink 15 – 20 liters a day???

  42. Dr Aust said,

    July 31, 2008 at 12:03 pm

    Could be one for a letter-writing to MPs campaign, I think: there is a strong push from Govt / Quangos for licencing of “para-health” practitioners. However, as David Colquhoun has discussed, what they are inching towards seems likely to be:

    (i) umbrella-ing existing quack bodies (about whose idiocies we have heard already) …and/or

    (ii) prescribing compulsory B.Sc degrees in nuttery for new “practitioners” (hence potentially many more B.Scs in Homeopathy, eastern mysticism, and “crystal healing”); and finally:

    (iii) “grandfathering” in any existing practitioner who can show they have been in business for a while.

    So the kind of regulation being proposed for things like acupuncture, if extended to the nutri-nutters, would almost certainly catapult “water detox” loons straight onto a “register of licenced nutritionists”.

    The pay-back is SUPPOSED to be that, once registration exists, one could de-licence, and thus prevent from working, people who do things like what is described in the post. However, I have to say I am not at all confident this would happen. After all, note that the pracitioner in this case admits NO liability. Can you imagine a disciplinary panel containing other “colon cleansing” types actually opting to discipline someone like this? Personally I very much doubt it.

  43. Dr Aust said,

    July 31, 2008 at 4:22 pm

    Projektleiterin wrote:

    Does anyone who is not British understand how much is in a pint or ounce…?

    ..the British don’t understand drink measures in ozs… only Americans use those…!

    And is it really possible that someone have a disease that makes him drink 15 – 20 liters a day???

    Certainly is. Diabetes insipidus (not related to sugar , so don’t confuse with diabetes mellitus) could be associated with a water intake of 100 mL/kg body wt/day or more. So 10 litres or more is possible. There is a little bit about DI, and some links, in my post on “* glasses a day” water-woo, which also discusses Heinz Valtin’s Am J Physiol review that Frisbee mentioned.

    DI is rare but can arise IN VARIOUS WAif you have problems with the brain centres that regulate thirst and/or kidney water reabsorption, or if the kidney water reabsorption mechanisms don’t work properly. It can also be “psychogenic”, normally in the sense of “caused by someone drinking vast amounts of water due to a mental health problem”. To quote the American DI Foundation:

    It is now known that there are four types of DI: (1) neurogenic (or central) DI, where the water diuresis results from a deficiency of the antidiuretic hormone (ADH), often referred to as AVP (arginine vasopressin); (2) nephrogenic DI, where water diuresis results from an inability of the kidneys to respond to ADH; (3) primary polydipsic DI (or primary polydipsia) in which the water diuresis is due to suppression of ADH by excessive fluid intake [the high intake can result from abnormal thirst (dipsogenic DI), from psychological or emotional disturbances (psychogenic DI) or from fashionable - but scientifically unproven - beliefs in the benefits of a high fluid intake (iatrongenic DI)];

  44. Dr Aust said,

    July 31, 2008 at 4:44 pm

    Projektleiterin wrote:

    Does anyone who is not British understand how much is in a pint or ounce…?

    ..the British don’t understand drink measures in ozs… only Americans use those…!

    And is it really possible that someone have a disease that makes him drink 15 – 20 liters a day???

    Certainly is. Diabetes insipidus (not related to sugar, so don’t confuse with the well-known diabetes mellitus) could be associated with a water intake of 100 mL/kg body wt/day or more. So 10 litres or more is certainly possible for an adult, and I have heard “up to 20 Litres” mentioned. There is a little bit about DI, and some links, in my post on “8 glasses a day” water-woo, which also includes an extended discussion of Heinz Valtin’s Am J Physiol review that Frisbee mentioned above.

    DI is rare but can arise in various ways. To quote the American DI Foundation:

    It is now known that there are four types of DI:

    (1) neurogenic (or central) DI, where the water diuresis results from a deficiency of the antidiuretic hormone (ADH), often referred to as AVP (arginine vasopressin);

    (2) nephrogenic DI, where water diuresis results from an inability of the kidneys to respond to ADH;

    (3) primary polydipsic DI (or primary polydipsia) in which the water diuresis is due to suppression of ADH by excessive fluid intake [the high intake can result from abnormal thirst (dipsogenic DI), from psychological or emotional disturbances (psychogenic DI) or from fashionable - but scientifically unproven - beliefs in the benefits of a high fluid intake (iatrogenic DI)];

    (4) gestagenic DI, which occurs only during pregnancy and is due to destruction of vasopressin by the placenta.

    – emphasis mine.

  45. Pro-reason said,

    August 1, 2008 at 4:46 am

    I think there are some important lessons here, and they don’t include “drink more” or “drink less”.

    People are all different, so an intake that makes one person full of vitality can kill another person. It depends on what you’re used to. It seems that this woman went from 2 to 6 pints a day. Six pints is a not a lot. It’s more the fact that she suddenly tripled her intake, whilst no doubt keeping her intake of nutrients such as salt no higher than they were.

    People’s own sense of thirst is quite often a sufficiently accurate guide.

    We can recognise the above (and therefore understand cases holistically) without indulging in hippified qigong nonsense advocated by “realitycheck” in his/her comment. It’s doctors like Ben who are the most holistic.

    Above all, the best lesson here for woosters is that if something you do makes you ill, then think about stopping it, rather than stepping it up on the basis that it’s just the “detox” process.

  46. Nicolo said,

    August 4, 2008 at 8:45 am

    …advice from a self-declared nutrition therapist on folic acid in pregnancy that may actually increase the risk of disabling neural tube defects in babies…

    Sorry, I’m not sure if I got this right.

    Did you mean that the Daily Telegraph was wrong because they alleged folic acid supplementation for pregnant women increases the risk of neural tube defects in babies? Or did you mean that they wrongly alleged that it decreases such risk?

    Last I knew, folic acid supplements at the time of conception and throughout the first 12 weeks of pregnancy reduces NTDs by approximately 70%. I haven’t had time to dig through recent literature but Harrison’s Principles of Internal Medicine, 17th Ed., pegged the recommended daily intake at 0.4 mg. If I recall correctly, Williams Obstetrics says the same thing. I just don’t have my copy with me right now so I haven’t been able to double check.

  47. used to be jdc said,

    August 4, 2008 at 6:35 pm

    @Nicolo –
    “Did you mean that the Daily Telegraph was wrong because they alleged folic acid supplementation for pregnant women increases the risk of neural tube defects in babies? Or did you mean that they wrongly alleged that it decreases such risk?”

    I took it to mean that the Telegraph was wrong because they recommended pregnant women take Folic Acid for the first four weeks of pregnancy, whereas “both Department of Health and NHS guidelines are identical, recommending very clearly that potential mothers should take a 400-microgram supplement from the time that they start trying for a baby, or from when contraception is stopped, up to and including the 12th week of pregnancy” [Linky]
    If women took the Telegraph’s advice at face value, then they would be at greater risk of having a baby with NTDs than the women who took the DoH and NHS advice, because (1) they wouldn’t be taking Folic Acid from the time they started trying for a baby – only beginning once they had a positive test and (2) they would cease taking the Folic Acid after four weeks instead of twelve.

    Cheers,
    jdc.

  48. Nicolo said,

    August 5, 2008 at 4:49 pm

    @JDC

    Oh, all right. Thanks!

  49. evidencebasedeating said,

    August 15, 2008 at 12:45 am

    projektleiterin said,
    July 31, 2008 at 9:28 am

    Does anyone who is not British understand how much is in a pint or ounce…?

    Ah, the difference is in the ‘country of origin’

    a UK pint is 20 fl oz or 568ml
    a US pint is 16 fl oz or 454ml

  50. Anne Stewart said,

    August 19, 2008 at 11:35 pm

    Looking at the very one sided evidence published so far, looks like what this lady drank is inconsistent, Mr Page admits the nutritionist gave him an adds and avoids which said to drink 4 pints of water! many articles are inferring a high water diet with no mention of food, this is inconistent, how much she drank has been inconsistent. Many newspapers left out that it appears she drank 5 litres of water in the day of admission, as noted in the medical records,therefore she appears to have disregarded what the nutritionist told her to drink. who’s fault is that?

    After she had been ill the nutritionist said drink up to 6 pints of water to rehydrate.

    It was this ladies responsibility to consult her GP. Why didn’t her husband call the GP regardless of what the nutritionist had said?

    People need to take responsibility for their decisions and not blame others.

    knowing how no win no fee cases work (see how confident the adverts are, where there is a claim there is a gain, guaranteed!)looks like the nutritionist got stitched up.

    What would the GP have recommended, drink plenty of fluids!

  51. macklin_uk said,

    October 2, 2008 at 12:57 pm

    I do not know enough about the details of this patient’s case and the recommended treatment to comment. However, I think it is appropriate to remind everyone that even doctors make huge mistakes and there are an average of 10,000 deaths per year due to the adverse effects of prescribed drugs. To put that into perspective, this is more deaths than are caused by road incidents.
    Something for you to think about!

  52. JMS said,

    October 3, 2008 at 2:38 pm

    @ macklin_uk

    Hmmm, so if doctors kill their patients its OK if Nutritionist do too?

    I think you missed the point of the article. Yes, doctors do occasionally injure and sometimes even kill their patients. The point is that they are not complacent about this but make strenuous efforts to do better next time. Shouldn’t Nutritionists and other CAM therapists try to do better next time too?

  53. mv said,

    November 12, 2008 at 1:58 pm

    This is why I always tell people: if your nutritionist is not a registered dietitian, AND/OR a registered CNS (from CBNS, not some made up organization), AND/OR does not have a graduate degree in nutrition from a real, accredited university, run for the hills and don’t look back. Any one of these three qualifications will ensure to a certain degree that the person with whom you are dealing is not a quack.

    That being said, I think, in most cases, quacks really believe what they are doing is correct, and since no law exists to keep them from practicing, can they really be blamed for their own ignorance? If they’re not smart enough to understand what is wrong with their particular brand of lifestyle/nutrition choices, can we really expect them to be smart enough to realize it would be best not to push said choices unto others?

  54. Nutritional Therapy said,

    November 11, 2009 at 1:59 pm

    I have read alot of comments with unjustified opinions based on an irrational view of nutitional therapy ‘quackery’. I do agree that there is a long way to go in terms of protecting the title of ‘nutritional therapy’ and developing the profession to the level it needs to be at. But you are missing the point, the reasons behind nutritional therapy clearly fills a void not covered by dietetics (please do not misconstrue this as me denouncing dieticians). I also know of GPs and other qualified dieticians who are also qualified nutritional therapists. Make what you will of that information.

    Currently at the University of Worcester a minimum 2 years (Full Time) MSc in NT, (entry requires; a first or second-class Honours Degree in a relevant, cognate discipline or Professional qualifications in an appropriate area or Relevant practical experience). In the case of other practical experience and qualification an access course is needed to be passed.

    (very similar to dietetics Msc entry requirements)

    I can assure you, everyone would be suprised at the scientific content of the course, we dont just say “ahhh just chuck 50 pints of water down ya, that’ll sort you out” as some may think.
    The in depth analysis of an individuals dietary intake, symptoms, family history, medical history, drug nutrient interactions, nutrient interactions etc (all specific to the indvidual, not as applied to the general population) requires a great deal of time and expertise. The assumed nutritional knowledge upon starting the course is very extensive and very biochemistry and anatomy heavy, rightly so.A profile submitting proof of learning for this knowledge is required.

    I welcome criticism as this is the only way BANT/NTC are going to iron out the shortcomings and improve standards (i.e. clamp down on the wishy washy courses!). NT is not protected and this is a problem, allowing individuals to misrepresent and drag the profession down. Needs to be sorted really because the individuals who are well educated and do have the potential to offer quality nutritional advice are dragged down.

    Its a bit of witch hunt instigated by an influential individuals’ views, most of you on this site have no idea the amount of scientific, evidence based work involved in NT. But I guess i can only speak for myself on that part, there are are more than questionable ‘universities’ which provide NT courses. In that sense i guess this is where the people who have studied for at least 5 years in nutrition get tarred with the same brush as the quacks.

    I would love Ben oldacre to have a discussion with a few of the more reputable people in NT (not Patrick Holford!), i think the lack of understanding of what we actually do combined with a, lets face it, poor regulatory body makes us an easy target.

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