Archive for category Nutritional Therapy and Related Topics

The Difference between Nutritional Therapists and NHS Dietitians Part 2

This is the second in a series of briefing notes setting out the key differences between dietitians and nutritional therapists.

For dietitians the idea of aiding detoxification through nutrition is “a load of nonsense”. In January 2009 the British Dietetic Association issued a press release stating that the body has a well-developed system of the skin, gut, liver and kidneys all responding to chemical signals to constantly eliminate toxins. Proper hydration, a sensible diet and regular physical activity “really are the only ways to properly protect your health for the year ahead”.

For nutritional therapists, detoxification, which is the biotransformation of harmful molecules, is a core determinant of physical and mental health and is dependent on nutritional status. Poor conjugation and poor excretion of exo- and endo-toxins, combined with elevated toxic load, results in insidious and cumulative damage to metabolic processes and increasing susceptibility to disorders such as inflammatory joint disease, neurological impairment, atherosclerosis, allergies, chronic fatigue, and cancer.

The primary mechanism of biotransformation involves activation of cytochrome P450 enzymes for Phase I oxidative metabolism followed by Phase II conjugation to facilitate excretion. Phase I metabolism can either directly neutralise some compounds or transform them to highly reactive metabolites ready for phase II conjugation. Balanced Phase I and Phase II activity is important to avoid increased production of intermediary metabolites which, without sufficient antioxidant protection, are damaging to DNA. Common variants (including deletions) in genes encoding for Phase I and II enzymes increase genome events which mediate aging (mitochondrial decay) and the disease process. Poor nutritional status leading to inefficient biotransformation contributes to long-term adverse health outcomes.

A healthy gut ecology is also important for optimal biotransformation and therefore hormonal balance and immunity. Biotransformed compounds can be deconjugated by enzymatic products of unfriendly gut flora and reabsorbed into hepatic circulation.

Functional testing is used by nutritional therapists to target individual advice.


2. Ames, BN, I Elson-Schwab,EA Silver: High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms. Am J Clin Nutr 75, 616-58 (2002).
3. Choi, W, SY Eum, YW Lee, B Hennig, LW Robertson,M Toborek: PCB 104-induced proinflammatory reactions in human vascular endothelial cells: relationship to cancer metastasis and atherogenesis. Toxicol Sci 75, 47-56 (2003).
4. Guengerich, FP: Influence of nutrients and other dietary materials on cytochrome P450 enzymes. Am J Clin Nutr 61, 651S-658S (1995)
5. Hennig, B, BD Hammock, R Slim, M Toborek, V Saraswathi,LW Robertson: PCB-induced oxidative stress in endothelial cells: modulation by nutrients. Int J Hyg Environ Health 205, 95-102 (2002)
6. Hennig, B, AS Ettinger, RJ Jandacek et al.: Using nutrition for intervention and prevention against environmental chemical toxicity and associated diseases. Environ
Health Perspect
115, 493-5 (2007).
7. Ito, S, C Chen, J Satoh, S Yim,FJ Gonzalez: Dietary phytochemicals regulate whole-body CYP1A1 expression through an arylhydrocarbon receptor nuclear translocator-dependent system in gut. J Clin Invest 117, 1940-50 (2007)
8. Loktionov, A: Common gene polymorphisms, cancer progression and prognosis. Cancer Lett 208, 1-33 (2004)
9. Ramadass, P, P Meerarani, M Toborek, LW Robertson,B Hennig: Dietary flavonoids modulate PCB-induced oxidative stress, CYP1A1 induction, and AhR-DNA binding activity in vascular endothelial cells. Toxicol Sci 76, 212-9 (2003)
10. Hattori M & Taylor TD: The Human Intestinal Microbiome: A New Frontier in Human Biology. DNA Res 16(1):1-12 (2009)
11. Round JL & Mazmanian SK: The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol 9, 313-323 (2009)


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The Difference Between Nutritional Therapists and NHS Deititians Part 1

In September 2004 the Nutrition Society published a Department of Health funded report on “Understanding the differences between nutrition health professionals” 1 . The report revealed the extent to which consumers appear to be fascinated by the links between food and health but are confused by the different types of individuals who give nutrition advice and are thus prevented from making informed choices. This confusion is no more apparent than in relation to what ‘optimum nutrition’ means to dietitians, nutritionists and nutritional therapists. This briefing note aims to clarify the position so that consumers can be clear as to the differences.

(1) For dietitians and nutritionists (registered with the Nutrition Society) advising a client on optimum nutrition comprises 2,3

  • taking measurements appropriate to body mass
  • explaining the links between different foods (e.g. meats, vegetables, fruits, convenience foods, drinks) and nutrient composition using the ‘Balance of Good Health’ model (
  • reviewing and analysing the client’s food diary, nutritional plan and other lifestyle changes to promote health.

(2) Public health nutritionists, toxicologists and food scientists work together to provide policy managers and legislators with advice needed to promote health in the population at large. In particular with regard to micronutrients, they need to establish levels of benefit and of risk and look at ranges of intake values which need to be both nutritionally adequate and non-toxic for the whole population. In this instance optimum nutrition is defined as “the intake at which there are equivalent risks of both inadequacy and toxicity” providing that “data on both are of equal quality, are related to hazards of comparable severity and are equally well defined” 4.

(3) For nutritional therapists (who practise Complementary and Alternative Medicine) optimum nutrition encompasses individual prescriptions for diet and lifestyle in order to alleviate or prevent ailments and to promote optimal gene expression through all life stages. Recommendations may include guidance on natural detoxification, procedures to promote colon health, methods to support digestion and absorption, the avoidance of toxins or allergens and the appropriate use of supplementary nutrients, including phytonutrients. Nutritional therapists advise on each person’s unique dietary and nutritional needs for metabolic and hormonal homeostasis, using a variety of biochemical and functional tests to inform recommended protocols and programmes.


1. Nutrition Society (2004) Understanding the differences between nutrition health professionals
2. Skills for Health Allied Health Professionals’ Competences 13 and 14.
3. The British Dietetic Association and the Nutrition Society (2002) Joint Professional Development Guidance on the Employment of Nutritionists in NHS Nutrition and Dietetic Departments.
4. Renwick, AG et al (2004) Risk-benefit analysis of micronutrients. Food Chem. Toxicol. 42 (1902-1922).

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Nutritional Therapy Training Providers

The Complementary and Natural Healthcare Council (CNHC) has approved direct FastTrack entry for graduates of the courses at the following training providers onto their national register:

Northern College of Acupuncture
PGDip/MSc Nutritional Therapy

Institute for Optimum Nutrition
DipION/FdSc Nutritional Therapy
Centre For Nutrition Education and Lifestyle Management

BSc Hons Nutritional Therapy/Fast Track + PG Cert Nutritional Therapy + Practitioner Development

UK College of Nutrition and Health (BCNH)
BCNH Diploma in Nutritional Therapy/BSc Professional Practice in Health and Social Care (Nutritional Health) with Clinical Training

University of Worcester
PGDip/MSc Nutritional Therapy

University of West London (UWL)/Thames Valley University (TVU)

BSc/BSc(Hons) Nutritional Therapy


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