The role of nutrition in both illness and in health has long been a
bone of contention between conventional and complementary medicine.
The subject has been brought even more sharply into focus over the
last few years by the high profile claimed for optimum nutrition by
the relatively new discipline of Nutritional Therapy, now striving
to achieve acceptance alongside the more conventional practice of Dietetics.
Since practitioners of both professions offer help to those battling
with illness which they suspect to be food related we felt that a little
clarification on the roles, qualifications and practices of each might
be helpful.
The fundamental difference between the two lies in their approach.
Dietitians, for the most part, are trained in and work within conventional
medicine, alongside doctors and other health professionals; nutritional
therapists base their medical philosophy and practice on that of the
Naturopath.
State Registered Dietitians must study both the theory and practice
of nutrition and dietetics for 4 - 5 years to achieve a legally recognised
and externally regulated degree level qualification. Once qualified
they aim to translate the evidence based science of nutrition into
practical and comprehensible advice about food. Much of their clinical
work lies in the management of severe illnesses, post operative and
tube feeding, the correction of obesity or malnutrition, the management
of diabetes, hyperlipidimia etc. Certain specific conditions (heart
disease, hypertension, gallbladder disease etc) are recognised to have
a nutritional link and dietitians do believe that a healthy, balanced
diet promotes good health in the short and long term.
However, with
the exception of problems such as severe vitamin deficiency, under-nourishment,
constipation, osteoporosis, anaemia and some metabolic disorders, micro
nutrient deficiency and megadose nutritional therapy are not seen to
play a causative or curative role in the treatment of chronic or acute
disease.
In nutritional terms most dietitians would accept that Government determined
nutritional criteria for healthy eating were sufficient to prevent
illness. They therefore maintain that micronutrient deficiencies are
rare amongst those eating a balanced diet, except where there is a
specific medical condition, and that higher range dietary supplements
are, for most people, unnecessary. However, they are now participating
in scientific studies designed to investigate a possible connection
between intolerance to certain foods and conditions such as migraine,
arthritis, candidiasis, irritable bowel syndrome and chronic fatigue.
Dietitians are bound by a strict ethical code of conduct and normally
work in conjunction with hospitals or general practitioners although
they are also to be found in health promotion, education, research
and in business. To receive therapeutic dietary advice a referral is
no longer required from a medical or dental practitioner although dietitians
will liase with the client’s GP after referral.
The Nutritional Therapist's training is based on a large selection
of research studies from both recent and older peer reviewed literature.
As of now they have nothing in the way of formally recognised qualification
although the University of Westminster will be offering a BsC degree
in Complementary Therapies as from this autumn which will include substantial
modules in Nutritional Science and Therapy. Nutritional therapists
have no conventional medical training.
Nutritional Therapists work in accordance with holistic naturopathic
principles. They believe that nutritional deficiency (in terms of micro
nutrients), food intolerance and general toxic overload play a causative
role in most chronic disease conditions and that a partial or total
cure can often be achieved by addressing these areas.
They also believe that the intake of micro and other nutrients which
would result from the consumption of a diet meeting the WHO's guidelines
for the prevention of cancers and heart disease is not necessarily
sufficient, given the stress and toxic overload to which 20th century
living subjects the individual, to prevent illness. They therefore
believe that micro nutrient deficiency is a factor in the development
of a wide range of chronic illnesses.
Nutritional therapists work entirely within the complementary field
and have no conventional medical training or expertise in the management
of severe metabolic illness. The Nutritional Therapist's aim is to
reverse chronic, and prevent severe illness by the use of nutritional
supplements, including herbal supplements, pro-biotics and cleansing
diets with which they hope to reduce the stress placed on the patient
thereby building up their natural resistance to disease.
Coming from such very different starting points it is understandable
that dietitians should sometimes feel concern that nutritional therapists,
without adequate training, may miss symptoms of severe metabolic disease
while overloading their patients with unnecessary or potentially harmful
doses of vitamin pills - or advising them on overstrict diets. On the
other hand nutritional therapists fear that dietitians may not fully
recognise the fundamental role they feel nutrition plays in all aspects
of ill - and good - health and may therefore fail to take sufficient
account of their patients' nutritional status in their treatment.
For the patient, both disciplines offer benefits and the wisest choice
may be to consult a judicious combination of the two.
British Dietetic Association www.bda.uk.com
Society for the Promotion of Nutritional Therapy www.bant.org.uk
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