Archive for September, 2008

An Evening with ex-professor Holford

September 30, 2008

Well I said I would do it and now I have done it.

Yes, that’s right I have paid £15 to attend a book promotion umm … I mean an academic seminar with ex-professor Patrick Holford. It had better be good that’s all I am saying.  If anyone is free next Thursday evening and is in London perhaps they would like to join me.  I am quite excited about it all!!

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Introducing the Dip IONs – Patrick Holford’s Shock Troops of Optimum Nutrition

September 18, 2008

(1) Ex-professor Patrick Holford of Teeside Univesity and Head of Science and Education at Biocare is not alone. (And we are not talking about his collection of free range rabbits here.) As you know the learned scholar set up the Institute for Optimum Nutrition back in 1984. It is registered as a charity whose object is

the preservation and protection of health of the general public.

Unfortunately, none of Patrick’s pills can help him to be in more than one place at the same time so the ION was given the task of training the next generation of shock troops in Optimum Nutrition. One might describe it as a kind of franchise operation. Many of them, possibly a majority, are available to the general public for consultations. The ION website provides a handy directory to enable us to find out who these pioneers of new thinking are. Could we possibly be wrong? Should we be recommending to you all that you consult an ION trained nutritional therapist? Well we thought we would do a meta-analysis using information from the websites of all the Dip IONs we could find. After all it is easy to laugh at the lunatic fringe, but to find out how good they are you have to consider them as a group. (We MUST make it clear before you read any further that all the following information was found on publicly available websites. We are unable to comment on those without websites.)

(2) Now at Through a Glass Darkly we are sometimes accused of claiming that nutritional therapists are stupid. We are pleased to report to the world at large that this is not the case. Nearly all are relatively well-qualified. Indeed, around thirty appear to come from a science or health related background including three with PhDs. Some worked in the food industry so obviously know a lot about food. Others have come from fields such as nursing. It is great that Patrick has such discerning people promoting his work. Presumably they will know to treat his wilder ideas with, if you’ll pardon the expression, a pinch of sodium. We do not have any quarrel with these people and hope they can bring a bit of scientific rigour to the world of optimum nutrition.

(3) Unfortunately, more than half of Dip IONs with websites do not appear to have a background in science or if they do they are not telling us about it. Nothing wrong with that. Many seem to be undertaking a career change. It takes a great deal of courage to train for a new career, but what kind of training are these folks given? Well for a start you do not need A-levels in chemistry and biology. You merely need to take a few science access courses which

concentrate on aspects of these subjects that are particularly relevant to nutrition

It would be interesting to know how they decide what to leave out but there you go. The course itself is three years part-time and is summed up in a nice little booklet. This contrasts with the training that dieticians undergo. They do a full-time three year honours degree in nutrition followed by a year’s postgraduate clinical experience. In contrast the ION diploma course is equivalent to a two year foundation degree. Of course, the ION has recently launched a BSc honours degree in co-operation with the University of Bedfordshire. Although, it is a full-time degree only one day a week is required at the university. How much time for clinical practice does this leave …? Incidentally, in his recent book Ben Goldacre points out (Bad Science p178, Harper Collins 2008) that the university of Bedfordshire has been subject to criticism with regard to its accreditation of foundation degrees. Read paragraphs 45 to 52 of this report if you are interested in finding out more about the establishment with which the the ION decided to link itself.

(4) It does not look like any of these Dip IONs are planning to convert their qualification into an honours degree. Though let’s be fair possibly, again, they just don’t want to tell us about it. It could be they are too busy studying for their next diploma in complementary medicine. Many seem to be experts in metabolic typing, phytobiophysics, iridology, colour analysis, bowen therapy, emotion freedom techniques, applied metabolic ecology, bio-energetics (SCENAR) and blood microscopy. If you understand what half of these things are please enlighten us. Most of us struggle to be competent in one discipline so you have to marvel at these polymaths. Strangely enough there seems to be a correlation between those without scientific or healthcare qualifications and those who practice alternative therapies.

(5) One of the more controversial aspects of nutritional therapy has been the tests its practitioners offer. There are a wide variety available. For example, click here if you want to find out what one Northern Ireland therapist offers. Now I have neither the time, expertise or inclination to analyse all the tests nutritional therapists use to find out about our supposed problems. However, one is particularly controversial namely hair mineral analysis. The American Medical Association has gone so far as banning its practitioners from using the technique. To find out why you might like to read this article by the Little Black Duck last year. However, as you are probably aware the AMA and the Quackometer blog are not sources likely to be trusted by supporters of the ION and Patrick Holford. Consequently, we were very surprised to read an article on the subject of hair mineral analysis in Optimum Nutrition Magazine’s October 2007 edition. (Optimum Magazine magazine if you have never heard of it is the in-house journal of the ION.) The author science writer Alex Gazzola states:

“HMA is perhaps best viewed as an evolving area in need of open-minded scientific review. It has a limited present value because of the lack of evidence behind it – but it MIGHT [my emphasis] have untapped potential of enormous value. (Optimum Nutrition Magazine, p.30 Winter 2007.)

(We have a scanned copy of the article that can be sent to you if you want to read it.) Shockingly, many Dip IONs still declare they offer Hair Mineral Analysis. We have to wonder whether they are aware of the lack of evidence as to its usefulness for detecting mineral deficiencies.

(6) We are a bit concerned that nutritional therapists can be let loose on vulnerable people with so little training. How do they decide when they are out of their depth? Are they possibly assigned a mentor? Many of them speak of how they are bound by the BANT code of ethics, but BANT describes itself as the professional regulator working towards The Nutrition Therapy Council’s code of practice. However, the NTC refers those wanting to complain back to BANT as part of what they call

transitional arrangements

If you are confused by the above don’t worry so are we. May we suggest that, for the time being, all complaints are directed to HRH Prince Charles as he seems to be the driving force behind the regulatory plans for the nutritionista industry. Statutory regulation of doctors began with the Medical Act 1858 and if you have a complaint you can, ultimately, take it to the GMC. A similar arrangement exists with dietitians and despite what Holford Myths says they are regulated by the Health Professions Council and NOT the British Dietetic Association.

(7) It seems strange that many Dip IONs put the letters MBANT after their name on their websites. This might lead to the impression they have studied for another qualification when actually all they have done is pay their membership dues to the recently renamed British Association for Applied Nutrition and Nutritional Therapy. After all, members of the Chartered Institute of Management Accountants and the Chartered Institute of Marketing and the Chartered Institute of Purchasing & Supply only get one set of letters. We have to point out dietitians don’t put MBDA after their names! Several give the impression – we are sure it is unintentional – that their Dip ION and Foundation Science Degree (FdSc) from the University of Bedfordshire are two separate qualifications, for example see here and here. They are, of course, actually one and the same. Presumably, the proper way to display the letters on the door at your “clinic” is Dip ION or Dip ION/FdSc. Some appear to misunderstand the nature of their qualification. One describes herself as having

a Post Graduate Diploma from Patrick Holford’s world renowned Institute for Optimum Nutrition.

A few years after leaving university I did an afternoon first aid training course. I wonder if that counts as postgraduate medical training in the eyes of the ION? Three describe themselves as Clinical Nutritionists even though BANT advises its members to describe themselves as nutritional therapists. (See “Understanding The Differences Between Nutrition Health Professionals” The Nutrition Society, Sep 2004, p34)

(8) Consequently, we regret at this stage we do not feel we can recommend a visit to a nutrition therapist. If you want to learn more about nutrition why not buy a copy of Nutrition for Dummies written by Sue Baic and Nigel Denby, two state registered dietitians. It may be that you feel that you are a bit overweight in which case you might want to book an appointment with the practice nurse at your local health centre. He will be able to give you plenty of advice about routes to a healthier lifestyle. If you feel you have a serious problem go and see your GP who, if necessary, can refer you to a dietitian. A nutritional therapist practising in the south of England put it rather well: ***Always consult your GP if you have a health problem.*** [See small print at the very bottom of your screen]

The Food for the Brain Foundation Needs YOU

September 6, 2008

Readers I have just been sent an email (see below) from The Food for the Brian Foundation (CEO: ex-professor Patrick Holford offering me the chance of a job. Lucky old me ehhhh? Unfortunately, it is not one for which I am remotely qualified so I don’t think I’ll be applying. They are looking for “a BANT registered nutritional therapist with clinical experience.” Now I don’t wish to boast here, but I think I must be one of the country’s leading experts on Dip ION qualified BANT nutritional therapists. Yes, yes I know the research has not yet been published but do give me time my dear readers. Some of them I have read their websites so many times they seem almost like family. Obviously, I need to organise a safe house to go to before I upset the alties. Is there anyone on a Pacific island reading this who might be interested in helping me out? Ummm, sorry now where was I?

The trouble is that very few of them are actually qualified to do an MSc project in nutrition and mental health. A Dip ION is actually a foundation degree in science from the University of Bedfordshire. Quite sneaky that ehhh – two qualifications for the price of one? Of course, no one would be dishonest enough to put the letters Dip ION/FdSc on their website to imply they had two separate qualifications would they? Umm … we shall return to that matter on another occasion. A foundation degree is actually equivalent to two years full-time study. So “Food for the Brain” is actually specifically targeting people for an MSc – nutritional therapists – who have skipped the final year of their degree. However, we must be fair here. It is possible to convert the Dip ION/FdSc in to a University of Bedfordshire honours degree. However, on looking at Dip ION websites it would not appear that not very many have done so. Also it has be said that many Dip IONs have first degrees in relevant things like nutrition, biological sciences or nursing. These qualifications were obtained before they went down the Dip ION route.

However, I would estimate that there are probably less than a few hundred people in the whole country who are both BANT registered nutritional therapists AND holders of a relevant first degree in nutrition/biologicial sciences or health care. Presumably there are thousands of bright young things out there with good degrees in psychology, medicine, life sciences or nutrition who might be qualified to do an MSc about nutrition and mental health, but Food for the Brain want a nutritional therapist and THAT is THAT. Possibly, if we were being a bit cynical we might think they already have some one in mind.

What of the research itself? It is all jolly vague. They are looking for some one to evaluate the clinical efficiency of ADHD (does that stand for Always Dependent on Holford’s Direction?), schizophrenia or depression. It is as if they are saying “come on now we don’t care what research you do as long as it is something that proves there is a reason for our existence.” Usually, you would expect a prospective employer to provide a job specification. In this case “Food for the Brain” are inviting research applicants to set the agenda. One would have expected their scientific advisory board to have a few meetings and make a decision: “Okay, the scientific world is skeptical that nutritional approaches can help schizophrenia. Let’s do some research to prove them wrong and win ourselves a Nobel prize in the process. We can then come back and cure depression and ADHD in 2010 and 2012.” The way they have behaved is not very well-organised or proactive is it? Perhaps I’ll send in application to research the training and continuing professional development of nutritional therapists. What they are trying to do is find some one to prove the concept of optimum nutrition more technically known as orthomolecular medicine. If you remember the religion of orthomolecular medicine was founded more than thirty years ago by Abram Hoffer,“the pioneer and perfector of the faith.” They want some one to review both mainstream and anecdotal evidence. Fortunately, Ernst and Singh have recently reviewed the mainstream scientific evidence in their book “Trick or Treatment?”. Here is what they had to say:

“Proponents of this approach believe that low levels of these substances cause chronic problems which go beyond straightforward mineral or vitamin deficiency. These problems include a tendency to suffer from infections such as the common cold, lack of energy or even cancer. [Readers of Optimum Nutrition for the Mind will know that ex-professor Holford believes other conditions such as autism, schizophrenia, ADHD and bipolar disorder can similarly be cured.] (…) The hallmarks of orthomolecular medicine are the extremely high doses that are usually suggested and the individualization of the prescription.”

He goes on to conclude:

“The concepts of orthomolecular medicine are not biologically plausible and supported by the results of rigorous clinical trials. These problems are compounded by the fact that orthomolecular medicine can cause harm and is often expensive.” (Trick or Treatment? Alternative Medicine on Trial, Ernst and Singh, p.320, Bantom Press 2008)

So there we have it conventional science is not yet very impressed by the claims of ex-professor Holford and his friends. However, the researcher is also going to be expected to investigate “anecdotal evidence of nutritional interventions”. I bet there are going to be one or two of those ehhh readers?!! Heyyy, let me tell you a joke: “What did the alternative therapist think was the plural of anecdote?” “Data!” Oh no, don’t tell me you have already heard that one before. I’ll get back to being serious then.

Earlier this year I read a little book in Oxford University Press’ Very Short Introduction series. Have you read any of them? Most of them are quite excellent and enable you to become an expert on a subject in a very short space of time. The one I was reading was by two people – Professor Chris Frith and Professor Eve Johnstone – who are very respected in the field of schizophrenia. Do you think they spent much time discussing nutritional interventions in schizophrenia? Unfortunately, for Food for the Brain in more than 150 pages there was not one mention of nutrition even to demolish the idea that it could help those with schizophrenia. You would think that if there was any merit in the idea Professor Johnstone would have come across it at some point in the last forty years. Oh dear.

Research Opportunity Researcher for a MSc project on nutrition and mental health We are seeking a BANT registered nutritional therapist with clinical experience, to undertake a MSc research project evaluating the clinical efficacy of a nutrition-based approach in the treatment of depression, ADHD or schizophrenia. The research will involve both a comprehensive literature review and analysis of client data treated at the Brain Bio Centre. The objective of this research is to review both mainstream and anecdotal evidence of nutritional interventions in depression, ADHD or schizophrenia, and to determine whether individualised nutritional interventions, as an add-on to existing treatment, improve psychometric scores in specific patients using an open label study design. Applicants need to have previous research experience. Please send your CV plus an example of any research, indicating which mental health condition you are interested in to info@foodforthebrain.org entitled ‘MSc Research. Please submit your details by October 1st 2008.

What is septoplasty and what is the evidence for its effectiveness?

September 5, 2008

Readers I have been “on the sick” this week. Quite shocking really usually I am like Patrick Holford and never have the need to see a doctor. However, for the first time in my life I have been confronted with a document known as the GP note.

The reason I have been taking some time off is that last week I had a bit of minor surgery known as septoplasty. Before I went to see the ENT consultant on 25 June I had never heard of the condition. This week, with a bit of time on my hands, I thought I would do a bit of research. According to Wikipedia, “Septoplastry is a corrective surgical procedure done to straighten to the nasal septum, the partition between the two nasal cavities. (…) When it deviates into one of the cavities, it narrows that cavity and impedes air flow.”

The nasal septum impeding air flow can have a number of consequences. Most importantly off all your breathing is rather irregular and you may have difficulties with exercise. This may mean that you conclude you are not a sporty person and that you give up on exercise which itself may have consequences for your health. A few months ago some one asked me if I smoked, presumably because I get out of breath rather easily. Other problems could include bad snoring and a poor sense of smell both of which I have suffered from. It can also have an effect on the sinuses.

Now for many years I have had problems with concentration and often felt tired even when I had managed to obtain a good night’s sleep. Sometimes the lack of sleep was so bad that I was left with a headache. In short, I was one of those vaguely unwell people looking for something or some one to put him on the path to health and happiness. I spent about £700 on counselling to try to turn myself in to a normal person, but that did not seem to work. Back in January 2004 I had an appointment with the local Patrick Holford representative. He prescribed me with lots of pills and a new diet, both of which were soon discarded.

I then began wonder whether it my destiny to be permanently miserable, apathetic and unsuccessful. After all it would not be possible for Mr Holford and his friends to be successful if there were not lots of people like me around? However, feeling sorry for yourself is never a good idea in the long term especially if it involves comparing yourself negatively to some one like Mr Holford.

You may be asking yourself if there are any alternatives to septoplasty. It appears not: “Nasal drops, sprays or tablets will not relieve an obstruction caused by a bent nasal septum. They may improve nasal breathing a little, but problems return when the treatment stops. Using nasal drops for a long time may actually damage the lining of the nose (muscosa) and make the blockage worse.” http://www.privatehealth.co.uk/private-operations/ear-nose-and-throat/septoplasty/ So that little potion you get from a Chinese herbalist is not actually herbalist is not actually going to help you and make the problem worse. If you remember, going back to my first post, the only bit of original advice the nutritional therapist I saw in 2004 could offer me was to give up citrus fruits! Rather bizarrely, the author of this alternative medicine site: http://www.health-diseases-tips.com/does-septoplasty-work-44699.html says a doctor told him “that septoplasty rarely works”. This contradicts what my ENT consultant and all the anecdotal evidence I found on the internet. (Nonetheless, the site does advise those with sinus problems to let chiropractors put some micro balloons up their noses. I suppose some people like furry handcuffs and plastic whips whilst others go in for chiropractors and mini-balloons: whatever turns you on.)

The anecdotal evidence looks good, but that’s never enough really for those who believe in evidence-based medicine rather than quackery is it? What about the evidence gained from clinical practice, preferably clinical trials. See http://www.emedicine.com/ent/topic128.htm “which states Literature documenting the outcomes of septal surgery is not abundant. Siegal et al and Samad et al have reported patient satisfaction and clinical improvement rates after septoplasty, and both agree that success rates for septoplasty are approximately 70%.” When it comes to obstructive sleep apnea hypopnea syndrome septoplastry can be performed “to straighten a deviated nasal septum (cause of substantial nasal obstruction). This procedure has a very high rate of success in improving the nasal airway if the nasal septal deviation is the major etiology of the nasal obstruction. There are, however, no controlled studies that evaluate the long-term effect of septoplasty on OSAHS.” (See http://www.guideline.gov/summary/summary.aspx?doc_id=10809&nbr=5634&ss=6&xl=999) Also it would appear “nasal septoplasty results in significant improvement in disease-specific quality of life, high patient satisfaction, and decreased medication use.” (See Journal of Otalyngology: Head + Neck Surgery http://linkinghub.elsevier.com/retrieve/pii/S0194599803021673 ) I could go on, but I hope the above goes some way to proving the clinical effectiveness of septoplasty.

I was trying to think about how you could provide a placebo with this type of procedure. The only way I could think of would be to give 50% of patients in a given hospital the anaesthetic, tell them they had had the surgery and then ask them how their breathing was two months later. Presumably you would think it would be worse than those who had actually had the surgery! Still behaving like that would be a bit mean wouldn’t it?

Apparently, about 20% of randomly surveyed adults have problems that could be resolved or relieved by septoplasty. Possibly you are one of them. Many of those individuals will be wasting money consulting various quacks and therapists not realizing that the solution to their problems is very simple. The first thing to do is consult your GP. If necessary she will refer to an ENT consultant who will examine your ears, nose and throat to check what he thinks is causing the problems with your breathing. The waiting list on the NHS is four to five months, though could be a bit longer depending on where you live in the country. The only harmful side effects you may experience are nosebleeds. For the first few days after surgery you will find it difficult to eat and your nose will be blocked up. However, as time goes on your breathing should improve and hopefully will be better than when you went in. I’ll certainly report back. Who knows, as Patrick Holford, puts it the procedure may, “add life to your years.”