Which? magazine is the UK equivalent of Consumer Reports – an independent magazine primarily focused on product reviews and providing objective information to the consumer. They recently conducted an investigation of nutritional therapists, with scandalous (although not surprising) results.

This kind of expose is becoming more common, and that is a very good thing. The concept is very simple – just present as a typical client off the street and ask practitioners to do what they do every day, give their professional advice.

This is a good real-world assessment of what a profession is like. When they know they are in a public forum they try to put their best foot forward, and the more savvy members will know to pretend to be moderate and evidence-based. But when they do not think anyone is looking, they are more likely to represent what they are really about. And that’s what matters, of course – what they actually do in practice.

In this case they asked five investigators to pose as patients and consult three nutritional therapists each. They found:

Our expert panel concluded that visiting a nutritional therapist wasn’t worth the money – and in some cases could have actually endangered the health of the researcher. Six of the fifteen consultations were rated as ‘dangerous fails’. Of the remaining visits, eight were rated as ‘fails’ and only one was graded as a ‘borderline pass’. Our experts were disappointed by the advice given by therapists and concerned at their poor knowledge of the body and how it works.

That’s 40% rated as dangerous fails, 53% regular fails, and 7% borderline pass. Those kind of numbers represent a broken industry. Of course, this is a study of only 15 therapists, but it is highly unlikely (assuming no cherry picking or missing data) that the therapists used in the study are significantly unrepresentative of UK nutritional therapists in general. Perhaps they just happened to hit 15 duds – but it’s unlikely.

They also found:

Of course, there is benefit in following healthy dietary advice, but most of what was provided by the nutritional therapists is freely available on websites such as the NHS site. Plus, most of the therapists in our investigation recommended quite restrictive diets that excluded several foods (predominantly dairy and wheat) and taking expensive supplements.

If their experience is indeed representative then going to a nutritional therapist in the UK is likely to include wrong or even dangerous advice, recommending a restrictive diet that most people cannot follow, and recommending expensive supplements (and not to get them at chains where they might be cheaper).

Taken together this is a pretty good description of a scam. Some UK nutritional therapists even use iridology (a pure pseudoscience based on iris diagnosis) as a fake diagnostic method to determine which expensive supplements their clients need to purchase.

None of this implies that nutrition itself is not important. Perhaps the best nutritional advice is to have a varied diet with appropriate calorie control and sufficient fruits and vegetables. If you need more specific advice all of the science-based information is freely available on government and academic websites. If you have a serious chronic illness, like diabetes, and require medical nutritional counseling it is best to get this in coordination with your doctor.

There may even be competent independent nutritional therapists out there, but if this study is any indication they are few and far between.

This is all partly due, in my opinion, to attempts on the part of so-called “alternative” medicine proponents to make nutrition alternative. This is more than a bit of historical revisionism, but by trying to pull nutrition into the alternative camp they are encouraging the proliferation of non-science-based nutritional advice.

This is also a good example of what happens when a profession is regulated without a science-based standard. Regulation means nothing if there is no objective transparent standard of quality.

As Edzard Ernst said – regulating nonsense still results in nonsense.