ION Diplomates Do Not Know Enough Pharmacology!!

As you may be aware The Nutrition Therapy Council was set up to help regulate the nutrition therapy industry.  The ever-so-generous department of health awarded them £900,000 for the task: http://www.bant.org.uk/bant/pdf/NTC/NTCUPDATE_Dec2005.pdf Still, according to question one on page three it is all voluntary at the current time as, “the cost of statutory regulation may be disproportionate to the rewards expected.”  I am not really sure what that means. Perhaps some one could enlighten me.

You may be wondering how nutrition therapists at The Institute for Optimum Nutrition measure up. You only need to look at their website to find out.  See the following two documents:

http://www.ion.ac.uk/Grandparenting/GP_Route_CPD_Requirements_ION.doc

http://www.ion.ac.uk/Grandparenting/GP_ION_Notice_of_Assessment_for_Course_Mapping_Route_C.doc

Now, I am only an Arts graduate so do not really understand long words such as “pharmacodynamics”, “pharmacokinetics” and “nutraceuticals”. However, my interpretation is that the document is saying that people who finished the ION course between 2001 and 2007 do not know enough about the effect of drugs on the body and the implications for human nutrition.  Possibly they are not that interested in pharmacology.  After all ION founder, Patrick Holford, did write a book called “Food is Better Medicine Than Drugs”: http://www.amazon.co.uk/Food-Better-Medicine-Than-Drugs/dp/0749927100 However, one would have thought that many people consulting nutrition therapists would be suffering from chronic long-term conditions.  Therefore, one would have thought it pretty essential for people claiming to be nutritionists to at least have some understanding of the relationship between food and medicine.

Help is at hand though as the lack of knowledge can be rectified by purchasing “Dr Cliff Whelan’s 2005 lecture: Therapeutic Module: Pharmacokineticys. This will help to rectify areas of this subject missing from the course.”  According to the above NTC memorandum they have until September rectify their lack of knowledge

So what exactly are the implications of this gap in their knowledge?  I asked expert and renowned Bad Science blogger Dr Aust to comment. Here is what he had to say:

I’m not a pharmacologist (physiologist strictly, although I do teach some pharmacology too) but one lecture on pharmacokinetics does strike me as a bit, er, laughably thin, given the propensity of some “nutritional” therapies to interact with other conventional drugs people may be taking. A famous example is St John’s Wort, which interacts with almost everything and in Germany is a prescription medication. David Colquhoun, who is a real “Pharmacology ninja”, would probably have other examples.

“Conventional” prescribers (doctors, of course, and now the nurses) get a fair bit of teaching about pharmacology. To be strictly accurate, the amount they are explicitly taught about pharmacokinetics specifically may be quite small (1-2 lectures on the principles, usually early in the course). However, this is reinforced by the fact that, for every drug they are told about, their attention will typically be drawn to its unwanted effects, possible actions in overdose and common and/or potentially serious interactions. They will also have it drummed into them ad nauseam that before prescribing something they always need to CHECK for interactions with other medications the person might be taking, and other contra-indications,  in the British National Formulary (BNF) – http://www.bnf.org/bnf/

From this POV, my opinion would be that one online lecture as a “retrospective bolt-on” is too little, too late.

The Manual of Dietetic Practice has a very informative table on the nutritional implications of certain medications. If such a book sounds too complicated the table has been adapted for inclusion in Nutrition for Dummies.   I wonder whether either book is actually held in the library of the Institute for Optimum Nutrition.  The strangest thing is that Patrick Holford thinks it is a myth that only dieticians and doctors are qualified to give diet advice and claims that the ION’s diploma, “provides considerably more qualification to advise an individual [his emphasis] about their nutritional needs than either a medical training or a dietetic training.”  http://www.patrickholford.com/content.asp?id_Content=2178

For once words fail me. For the time being, Patrick, I’ll stick to my doctor.

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6 Responses to “ION Diplomates Do Not Know Enough Pharmacology!!”

  1. dvnutrix Says:

    Some RDs have alarming stories about the lack of pharmaceutical knowledge of nutritional therapists – stories that include such therapists recommending supplements that are known to cause renal insufficiency to patients with kidney disease.

    Some therapists seem unaware of the implications of the amount of supplements that they recommend that contain substances that contribute to blood thinning: the additive affect of green tea, fish oils and similar can be substantial.

    Some also seem to be unaware that formulations that contain substances such as piperine to increase bio-availability might also prolong the action of other drugs/supplements that the person may be taking, increasing their chances of adverse effects.

    As for that last past, it stretches credulity that Holford is equating 3 years of part-time lectures on the odd weekend with the rigour of a full-time 3 years course in dietetics followed by a year of clinical experience.

  2. LeeT Says:

    “Nutrition for Dummies” has chapters on vitamins, minerals and dietary supplements. Possibly the book should be compulsory reading at the start of the Dip ION course. Then they will actually have a good grounding in basic nutrition whatever cranky theories they may be exposed to later!

    If only the Oxfordshire-based nutritionist we discussed recently had read chapter 12 on water and electrolytes …

    I’ll review the book at some point in the next couple of weeks. Next time you are in WHSmith check out pages 14 to 17 on “How to evaluate scientific studies.”

  3. draust Says:

    Well, Patrick’s remark makes perfect sense if one considers that “advising .. about their nutritional needs” means “advising them to take all sort of useless (but expensive) supplements which do nothing, either good or bad”. This builds on the classic catch-all get-out that supplements are licensed as “foods” and therefore only really have to meet the standard of being “not poisonous or harmful”.

    Of course, As DVN points out, there are plenty of examples where the “nutritional advice” CAN be harmful – and the dafter and more extreme the advice (e.g. “drink six extra pints of water a day and avoid all salt”) the more potentially dangerous.

    The mere idea of someone with kidney disease getting told what to eat and drink by some IoN-trained muppet makes my blood run cold. Mrs Dr Aust, who was once a Kidney Doctor and used to run the dialysis and renal failure clinics, is even more outraged. She thinks any “nutritionista” who advises a kidney patient to eat a potentially kidney-damaging diet or supplement should be (i) legally prevented from ever “practising” again and (ii) prosecuted for “reckless endangerment” (or similar). The public needs protecting against these idiots.

  4. jdc325 Says:

    Good post Lee – keep ’em coming!

    I was disproportionately amused to see pharmacokinetics spelled three different ways in the first Word doc you linked to: pharmacokinetics, Pharmacokineticys, and Pharmacokinetices. The person at ION who wrote that doc didn’t need medical knowledge – a spellchecker would have done. I know it’s a minor point, but it doesn’t exactly inspire confidence does it?

  5. leet01 Says:

    Goodness me, I thought they were three different words.

  6. dvnutrix Says:

    Catherine Collins has previously provided a very robust response that describes the work and scope of registered dietitians.

    Abel Pharmboy has some good links that distinguish pharmacology, pharmacognosy etc. in his left-hand side-bar (I’m not including them in an attempt to dodge the **** filter).

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