Dietetics and Nutritional Therapy

Contrasting views on nutrition - with reference to food allergy and intolerance - Frances Dale

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