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The problem of alternative nutrition

Susan Holmes
BSc(Hons) PhD SRN FRSH
Director of Research and Development/Professor of Nursing
Faculty of Health
Canterbury Christ Church University College
Canterbury
Kent

Despite the many different food habits and eating patterns around the world, reflecting the individual nature of food consumption and nutritional intake, the vast majority of us are well nourished. Even the significant shifts in eating habits in the UK in recent generations have largely been achieved without any demonstrable evidence of malnutrition. It is generally only in the presence of intervening factors (such as illness, poverty and famine) that malnutrition arises. We are now healthier and living longer than ever before.
 
This increase in longevity largely reflects significant developments in the prevention and cure of disease, improved medical care and better living conditions, including marked improvements in the quality of the food supply. Although we may be forgiven for believing that the converse is true, the reality is that the nutritional value of modern foods is significantly improved, and provided a varied diet is consumed in adequate amounts, it is rare to encounter nutritional deficiencies in the UK.
 
This is not to ignore specific nutritional problems of some population subgroups, such as rickets in some Asian children or malnutrition accompanying disease or illness.

The rise of "alternative" nutrition
Despite this, there has been escalating interest in "alternative" nutrition. There is, of course, nothing new about the use of diet or food in preventing and/or treating disease. For example, "folk remedies" have been used for centuries to treat many conditions, such as the use of cider apple vinegar and honey as a cure for arthritis.
 
Throughout history diet has been used as a means of healing. Folk remedies rarely have any scientific justification but have been "handed down" between generations, ultimately becoming "fact" by virtue of their prolonged use.

Alternative nutrition has become a rapidly expanding commercial venture preying on the psychologically vulnerable. Since consumers increasingly accept greater responsibility for their health they often seek information about diet and food, thus creating the ideal climate for nutrition misinformation to flourish. Much of this comes from the media, but news reports rarely provide sufficient information to enable the material to be put into context or the advice to be appropriately interpreted.
 
Many promoters of nutritional products turn preliminary research findings into "sales pitches" based on inadequate evidence, often for the sole purpose of economic gain.(1) Consumers/clients are often convinced that maximal health is impossible without individual eating plans or dietary/ nutritional supplements comprising specific, and often expensive, products.
 
Diet is known to be important in maintaining health; it is this very knowledge that is used to justify the need for alternative approaches to eating or to support the requirement for dietary supplementation. However, the truth is that for the vast majority of the population, neither dietary modification nor nutritional supplementation is necessary.

What can we do?
As health practitioners we must advocate and promote sound, scientifically based nutrition information to the public, and act to correct nutritional misinformation. The professions best qualified to achieve this are those of nutrition and dietetics. These professionals are carefully monitored and regulated; they also meet the required standards of training and professional expertise and hold the only recognised nutritional qualifications in the UK - State Registered Dietician (SRD), Registered Public Health Nutritionist (RPHNutr), and Registered Nutritionist (RNutr).
 
There are other bodies who claim such expertise, but their "qualifications" are not recognised and are not acceptable for employment in the NHS.(2) The nutritional guidance and advice offered by their exponents must therefore be treated with scepticism, and although many such practitioners claim to be "nutritionists" or "nutritional therapists", they are not recognised by the Department(s) of Health.
 
Their "training" often comprises short courses, which may be undertaken by post and are rarely accredited by any educational establishment. Many practise from unusual premises such as private houses or beauty salons, although it is worrying to see that some organisations, and even some GP practices, now employ inappropriately qualified "nutritional therapists" or "clinical nutritionists".
 
The latter are particularly worrying since the Which? report on nutritional therapists revealed that the advice provided by many such "therapists" is not scientifically sound, often comprising contradictory or bizarre dietary exclusions and unnecessary supplementation with substances such as blue-green algae and digestive enzymes.(3)

Beware of spurious claims
This multimillion pound industry has many dangers. Questions arise when recommended substances or dietary regimes are inadequately tested, purported benefits are based on flimsy evidence, dangerously large amounts of individual nutrients are recommended, or individual foods/nutrients are used to excess or to the exclusion of those containing a range of nutrients.
 
The advice provided by those who are inappropriately qualified is often both dangerous and expensive. They may, for example:

  • Encourage delay in seeking medical advice or, in extreme cases, advise discontinuation of ­prescribed therapy.
  • Incorrectly diagnose and treat life-threatening conditions, such as cancer, diabetes, ­hypertension, cardiovascular disease and eating disorders.
  • Encourage overdosage of vitamins or minerals.
  • Undermine the role of medical practitioners.

Despite this, there are a wide variety of alternative diets claiming not only to maintain or promote health, but also to treat diseases such as cancer or cardiovascular disease. The underpinning rationale for much of these diets is shrouded in mystery, and many are themselves nutritionally deficient. They may be supported by "megadoses" of vitamins and minerals, often at levels significantly above the recommended daily amounts. This can be dangerous particularly, but not exclusively, in the case of nutrients such as fat-soluble vitamins, such as vitamin A, or antioxidants, such as selenium.

Many also rest on the principle of "detoxification", based on the belief that "toxins" (waste products) "interfere" with metabolism and healing; it is only by eliminating these toxins that health can be restored, provided that essential nutrients are present in body cells. This spurious logic often does more harm than good.

By involving followers so closely in maintaining their health and/or treatment, these approaches enable individuals to play active rather than passive roles in maintaining their own health. This means that they are inherently attractive to some people for whom they may represent an ideological choice meeting an unrecognised need. This can be difficult for health practitioners to overcome; we must be aware of the dangers inherent in our paternalistic approach to care provision.

The final word
While it cannot be denied that those who are truly nutritionally compromised can benefit from dietary advice and, in selected cases, nutritional supplementation, the evidence reveals that those who are most likely to need supplementation are the least likely to receive it.(4) Similarly, it is clear that misinformation about food and nutrition can have many harmful effects on both the health and the economic status of consumers.
 
Healthcare practitioners must question the expertise of those offering nutritional advice, validate their recommendations and support their patients.
 
Since modern information technology makes scientifically valid nutritional information readily available to all practitioners, our patients need no longer rely upon spurious and, at times, dangerous nutritional advice.

References

  1. Ayoob KT, Duyff RL, Quagliani D. Position of the American Dietetic Association: food and nutrition ­misinformation. J Am Dietetic Assoc 2002;102(2):260-6.
  2. British Dietetic Association. Dietitians welcome Which? report on nutritional therapies. Media release. Birmingham: British Dietetic Association; April 2000.
  3. Consumer's Association. Which? report on nutritional ­therapists. London: Consumer's Association; 2000.
  4. British Dietetic Association. The dietary supplement paradox. Media release. Birmingham: British Dietetic Association; June 1999.

Resources
British Nutrition Foundation
High Holborn House
52-54 High Holborn
London WC1V 6RQ
T:020 7404 6504
F:020 7404 6747
W:www.nutrition.org.uk
British Dietetic Association
5th Floor
Charles House
148/9 Great Charles Street Queensway
Birmingham
B3 3HT
T:0121 200 8080
F:0121 200 8681
W:www.bda.uk.com
American Dietetic Association
W:www.eatright.org
Tufts University (USA)
W:http://navigator.tufts.edu
International Bibliographic Information on Dietary Supplements Database
W:http://ods.od.nih.gov/databases/ibids.html