Who should I listen to about what to eat?

Confused, as I think many of us are, with whom to listen to in this increasingly shouty world of health and nutrition I wanted to get to the bottom of all the qualifications available.

This is a) because I want to know who to trust and how qualified the people are that I listen to and b) because this whole journey is making me consider that maybe, just maybe, I should investigate getting some sort of qualification of my own. No promises kids, it’s just an idea at this stage.

There are a few useful articles and resources out there already about this topic – Laura Thomas PhD and Plant-based Pixie wrote this piece for the Huffington Post, Registered Nutritionist Rhiannon Lambert wrote a piece called 'Who can you trust to give nutritional advice?' on her website and there's a super clear and helpful table of the different nutrition expert roles on this table from the Association for Nutrition.

Combining what they’ve said and also throwing in a few other qualifications and experts I’ve heard about along the way, here’s a list of the experts and job titles out there and what they mean.

 

GPs (doctors)

Dr Rupy Aujla from The Doctor's Kitchen and also a GP

Dr Rupy Aujla from The Doctor's Kitchen and also a GP

Who runs the course?
Universities

How qualified are they?
Doctors have a medical degree, foundation training, core medical training, specialty training and then general practice training as well as continuing professional development throughout their careers.

How long is the course?
Medical degree – anything up to 6 years, foundation training for 2 years, core medical training for up to 2 years, specialty training for anything up to 6 years, general practice training 3 years and CPD for life. 

What do they do?
According to the NHS website GP's: "treat all common medical conditions and refer patients to hospitals and other medical services for urgent and specialist treatment."

The key here is that GPs may well not have expertise in nutrition, diet or related studies. At last week's Health Bloggers Community Summit, Dr Rupy Aujla at The Doctor’s Kitchen explained on one panel that in 6 years of medical training there are less than 10 hours (!) teaching about nutrition and advising patients what to eat. 

This was evident from the GP I went to see originally about my IBS symptoms. I was handed a leaflet about the FODMAP diet (which I've since discovered should never be attempted without the guidance of a dietitian) and told "some people find cutting out gluten and dairy helps." Not exactly expert advice, which is exactly the point - your GP is not a diet and nutrition expert! 

Please don't get me wrong - GPs can be absolutely brilliant. But I know many people who suffer with IBS or worse feel they aren't sufficiently supported by their local doctor and don't get the referrals to a specialist they sometimes need.   

Some GPs do have a passion and expertise for nutrition and are furthering their qualifications in this area. GP's like Dr Rupy at The Doctor’s Kitchen are on a mission to not only help their own patients understand the benefit of a great diet but are also trying to encourage other GP's to do the same.

How are they regulated?

The General Medical Council is the regulatory body for doctor's licensing in the UK and they "take action to prevent a doctor from putting the safety of patients, or the public's confidence in doctors, at risk."

However the GMC and it's international equivalents can't completely stop people with doctorates publishing books or papers making certain diet related claims that are unbalanced or poorly researched.

Dr T. Colin Campbell is one such example - with a BSc, MSc and PhD he published The China Study which many claim is "insidious, as well as unreliable." And in the world of yeast free, two doctors - Dr William Crook and Dr Zoe Harcombe PhD are both champions of the anti-candida diet which most experts in fact agree is based on very unreliable science. 

 

Registered Dietitian (also called RD's)

Nichola Whitehead RD, Helen West RD (of Rooted Project fame) and Dr Megan Rossi (who is an RD and a doctor!)

Nichola Whitehead RD, Helen West RD (of Rooted Project fame) and Dr Megan Rossi (who is an RD and a doctor!)

What do they do?

"Dietitians are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public-health level... Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices."

Taken from the British Dietetic Association (BDA) website

Who runs the courses?
Universities e.g. London Metropolitan or the University of Surrey

How qualified are they?
RD’s have at least an undergraduate BSc degree. Some RD’s will have undergraduate degrees in a related science subject and then have added further training in the form of a postgraduate Diploma or Masters in dietetics.

How long is the course?
Courses are three or four years. If those wanting to become RD's already have an applicable undergraduate science degree they can take a postgraduate Diploma or Masters in dietetics to become one.

How are they regulated?
The BDA website says: "Dietitians are the only nutrition professionals to be regulated by law, and are governed by an ethical code to ensure that they always work to the highest standard. "

Once registered as a practitioner, RD’s are required to retain their names on the register with the Health and Care Professions Council (HCPC). This requires them to keep their knowledge and skills up to date and also pay an annual retention fee. 

 

Registered Nutritionists - (RNutr) and Associated Registered Nutritionists (ANutr)

Claire Baseley MA (Oxon) MMedSci RNutr, Kawther H MSc RNutr and Rhiannon Lambert BSc MSc and ANutr (more on them below) 

Claire Baseley MA (Oxon) MMedSci RNutr, Kawther H MSc RNutr and Rhiannon Lambert BSc MSc and ANutr (more on them below) 

What do they do?

"Registered Nutritionists provide scientific evidence-based information and guidance about the impacts of food and nutrition on the health and wellbeing of humans (at an individual or population level) or animals."

Taken from the Association for Nutrition website

Put simply Nutritionists provide the scientific evidence about food and nutrition and the Dietitians use this science to help their patients. 

Who runs the course?
Universities

How qualified are they?
RNutrs have to have the minimum of a BSc in nutrition, and many have advanced degrees.

However 'Nutritionist' is not yet a regulated term which means anyone can use the title - hence why it's so confusing to know who to listen to sometimes! But a great petition set up by Fight the Fads has just passed 10,000 signatures to try and change this and get the term protected, so watch this space.

How long is the course?
Three or four years then an additional three years supervised practice to move from being an Associated Registered Nutritionists (ANutr) to a full RNutr.

How are they regulated?

"RNutr's are voluntarily regulated by the Association for Nutrition who has very stringent criteria for registration. AfN governs the UK Voluntary Register of Nutritionists (UKVRN) to distinguish nutrition practitioners who meet rigorously applied training, competence and professional practice criteria.  Its purpose is to protect the public and assure the credibility of nutrition as a responsible profession." 

 

Nutritional Therapists 

Amelia Freer (photographed by Ali Allen) is a Qualified Nutritional Therapist FdSc, Dip ION, mBANT

Amelia Freer (photographed by Ali Allen) is a Qualified Nutritional Therapist FdSc, Dip ION, mBANT

What do they do?

“Nutritional Therapy is the application of nutrition science in the promotion of health, peak performance and individual care. Registered Nutritional Therapists use a wide range of tools to assess and identify potential nutritional imbalances and understand how these may contribute to an individual’s symptoms and health concerns…Nutritional Therapy is recognised as a complementary medicine and is relevant for individuals with chronic conditions, as well as those looking for support to enhance their health and wellbeing.”

Taken from the BANT website

Who runs the courses?
The Nutritional Therapy courses that are approved by the NTEC and BANT (see below) are run by organisations including The Institute for Optimum Nutrition and The College of Naturopathic Medicine (CNM) right through to universities such as the University of West London and the University of Worcester who run undergraduate and postgraduate degrees in nutritional therapy.

However I did also spot a Nutritional Therapist course being advertised on Groupon for £59 with The Health Sciences Academy which is CPD approved (Continued Professional Development) but doesn’t seem to have the stamp from NTEC or BANT (see below).

How qualified are they?
In their Huffington Post article Laura and Pixie say nutritional therapists “don’t have to have a degree in nutrition or dietetics - or any degree at all”. However the National Careers Service says “you'll need a recognised degree or diploma in nutritional science or nutritional therapy" to become a Nutritional Therapist. 

So there seems to be some disparity here. You can call yourself a Nutritional Therapist after doing a £59 Groupon course or after doing a three year undergraduate degree. [[UPDATE! Please read the comment below from Nutritional Therapist Kimberly from The Little Plantation who says these courses should only be viewed as 'top ups' to full degrees or diplomas in Nutritional Therapy, and not a qualification to practise as a Nutrtional Therapist on their own]] 

In addition the National Careers Service says “you'll also need to make sure your course is recognised by a professional body, like the Nutritional Therapy Education Commission (NTEC) or the British Association for Applied Nutrition and Nutritional Therapy (BANT)."

How long is the course?
Nutritional therapists could have taken a distance learning online course, or a short course or a three year diploma or degree, it can vary widely.

How are they regulated?
Nutritional therapists can be registered with the Complimentary and Natural Healthcare Council or The General Regulatory Council for Complementary Therapies, or the British Association for Applied Nutrition and Nutritional Therapy (BANT) but it's not compulsory. 

It has to be said though... I am writing this post in the same week that this rather dreadful piece was published in the Daily Mail. It was overwhelmingly slammed by Nutritionists and Dietitians on social media as scaremongering about perfectly healthy food. Among the comments on Twitter I noticed that BANT was given a pretty bad rap. If BANT registered nutritional therapists are telling people they wouldn't touch raw kale and that we should all fear tomatoes from a can.... is it a register of experts we can rely on? 

The Angry Chef wrote this response to the Daily Mail article quoting a number of Dietitians and Nutritionists. I was massively disappointed to see Nutritional Therapist Eve Kalinik on the list as someone contributing to the Mail article, someone I have formerly quoted on the blog - doing this post has really made me think about where I turn for advice. 

 

Health Coach 

Me out on a running session with Health Coach Anna Desogus

Me out on a running session with Health Coach Anna Desogus

What do they do?
I talked to Health Coach Anna about this definition and she said her favourite way to describe a Health Coach is as:

"masters of behaviour change. They help with the development of healthy habits - be it in the area of food, exercise, work, relationships and more.... Whatever behaviour is damaging your health rather than boosting and protecting it, this is what you would work on with a health coach."

Who runs the courses?
IIN (Institute of Integrative Nutrition), Functional Medicine Coaching AcademyOxford Learning College, The Health Science Academy and others.

How qualified are they?
The Oxford Learning College health coach course results in a “Level 3 Diploma.” No pre-requisite of any science background is required. OLC says "high school level science can be helpful... but no prior experience or educational paperwork are required." However that doesn't mean Health Coaches never have qualifications!

How long is the course?
Approx. 1 year, but can vary according to participant and how quickly they choose to complete the course. 

How are they regulated?
A brand new UK Health Coaches Association will be launched on 17 May 2017. This new organisation will act as a united voice for the profession so the wider public can understand the role of Health Coaches and how they can be of service in the UK, both within the public and private sector. There will be a directory which will help people find coaches. Watch this space!

Beyond this, Health Coaches aren't regulated - but that's similar to many other professions, so that isn't necessarily a negative reflection of the quality of information or advice they provide. On this topic Joshua Rosenthal who founded IIN recently published this statement about being a Health Coach:

Health Coaching...does not require a license in any state.
Health Coaches work in many settings and, among other services, provide general wellness and nutrition information, options, recommendations, guidance, motivation, and skill-building to establish healthier lifestyle routines and to achieve client-focused personal health goals.

 

So... who should I listen to? 

This has been a really useful exercise to get the qualifications straight in my head and get to the bottom of some of the acronyms out there which mean nothing to a lay-person like me.

There are a whole range of qualifications for nutrition experts and some are more solid, thorough and science backed than others. 

However what I can also see is qualifications aren’t everything. And they certainly do not mean you are infallible.

I am not going to say I will never listen to a Nutritional Therapist or a Health Coach just because they might not have a degree. Equally you can see from my own personal experience with my GP that those with more qualifications aren't always the right people to turn to.

What I think we should all try to do is learn from those with the best and most relevant experience and qualifications we can find. But in addition, remember to question what we read and hear about nutrition and challenge it if we don’t think it’s right - regardless of who's saying or sharing it.

I don’t want to live in an echo chamber as Registered Nutritionist Claire Baseley wrote about in her brilliant blog post lately, citing me as an example! I want to continue to learn and grow by hearing all opinions, not just live in a bubble only listening to the people I think I agree with.

So I hope this list has helped you a bit. Let me know what you think and who you listen to. I'm thinking about a post on the top nutritionists to follow next, what do you reckon?