Naturopathic medicine:  Nine parts negative, one part positive

Introduction

Naturopathic medicine – naturopathy – is a popular type of complementary and alternative medicine (CAM) that has steadily evolved over the last 100 years¹. Naturopaths believe that the human body strives toward health and is its own best healer. Naturopaths claim to treat the whole person using natural therapeutics and cures². However many aspects of naturopathy suffer from a serious lack of solid supporting evidence.

Patients choose to visit naturopaths for a variety of reasons. The most important of these is an attraction to the overall philosophy of naturopathy, including the desire for a more “natural” and “holistic” approach that (supposedly) addresses the root of the problem². Other reasons include general dissatisfaction with the care provided by conventional health-care providers, wanting more time and attention, and having had a previous positive experience with a naturopath. The patients who most often visit a naturopath are white, middle-aged, female, and have a chronic condition³.

Naturopathic physicians (NDs) are trained as primary-care physicians in four-year, accredited doctoral-level naturopathic medical schools. There are several such schools in the USA and Canada⁴. The legal status of naturopaths varies between states and provinces. Some jurisdictions permit registered naturopaths to carry out minor surgery, write prescriptions for at least some drugs, give vaccinations, and carry out spinal manipulations.

Guiding principles of naturopathy

Naturopathy embraces the concept of prevention which is best accomplished by educating their patients to lead a healthy lifestyle. In that respect naturopathy resembles health promotion. A generally healthy lifestyle is now recognized as the ideal way to prevent many diseases including coronary heart disease, type 2 diabetes, and hypertension⁵.

Naturopaths take a holistic approach to treatment and thereby aim to treat the whole person^4,6. They see this approach as being superior to that of conventional medicine which takes a mechanistic view of disease (reductionism) and then focuses on symptoms. With some diseases a whole-person (holistic) approach can make good sense. For example, coronary disease is the result of a generally unhealthy lifestyle that causes dysfunction in several body systems. A generally healthy lifestyle is effective for not only the prevention of coronary heart disease but also as a treatment⁵. This is also the case with type 2 diabetes and hypertension⁵. A holistic approach may also be of value in patients with cancer as they need nutritional support to help the body recover as well as social and emotional support. A holistic approach to coronary disease and cancer is hardly controversial and most cardiologists and oncologists would probably support this, provided, of course, that effective treatments that target the specific disorder are also employed.

An altogether different story presents itself with other disorders. With arthritis and depression, for example, there can be a specific dysfunction in a single body system. Conventional medicine has treatments of proven effectiveness that target the problem. In these cases treating the whole body will likely lead to poorer outcomes.

One of the core principles of naturopathic medicine is to use treatments that minimize risk to the patient. Of course, conventional physicians also claim to follow this principle. However, there is no doubt that on many occasions physicians have indeed given inappropriate treatments causing harm. The obvious solution to this is to improve the quality of treatment given by conventional physicians. But we must recognize that harmful side effects are often the price patients must pay in order to receive benefit. For example, cancer therapy often involves the use of drugs, radiation, and/or surgery which while helpful in the treatment of the disease can have harmful side effects.

Many naturopaths believe the suppression of symptoms should be avoided because such an action interferes with the healing process⁶. This leads to a situation where naturopaths may refuse to give analgesic medications to a patient with arthritis or anti-depressants to one with depression, thereby depriving the patient of potentially helpful treatments⁶. Moreover, there is no evidence that these drugs prevent the healing of the joints in arthritic patients or impede the brain from normalizing the neurochemical imbalances causing some forms of depression.

The practice of naturopathy

Practitioners of CAM use a wide range of therapies, several of which have been adopted by naturopathy. These include herbalism, homeopathy, acupuncture, hydrotherapy, physical therapy, spinal manipulation, lifestyle counseling, nutrition (including the use of vitamin and mineral supplements), and psychological counseling. Some of these treatments do not stand up to close scrutiny. There is much variation in the eclectic choice of therapies used by individual naturopaths. As part of their practice naturopaths carry out patient assessment and diagnosis using standard approaches including physical examination, lab tests, and clinical assessment.

As noted above, the logic of naturopathy dictates that practitioners should whenever possible avoid giving pain killers to a patient with arthritis or anti-depressants to one with depression. But most naturopaths strongly support the use of herbal medicine^3,6. For example, naturopaths sometimes recommend the use of herbal medicines for treating cervical dysplasia⁶, despite a lack of supporting evidence. By contrast, the standard medical procedure involves minor surgery, which is safe and effective. Similarly, mistletoe may be recommended by naturopaths for the treatment of hypertension⁶, even though it has not been properly tested in clinical trials and is toxic. Yet, drugs are often avoided despite being reasonably safe and effective.

Herbal medicines are merely plant extracts that contain chemicals with drug-like action. Indeed, many of today’s drugs started life in previous centuries as herbal treatments. The attitude of naturopaths towards herbal medicines and drugs is therefore irrational.

Similar irrationality is seen with homeopathy, a type of CAM that is highly controversial and far from being proven as effective^7,8. Nevertheless, the therapy is an integral part of the practice of many naturopaths^1,3,9. Acupuncture is another modality often used by naturopaths as a treatment for many disorders^3,9 but its proven value is very limited beyond the control of pain¹⁰.

One of the fundamental principles of naturopathy since its birth a century ago is the general claim that much sickness is caused by an accumulation of toxins in the body¹. Accordingly, an important therapy in curing disease is the application of treatments that help eliminate these toxins. This concept – detoxification – is still the basis for various naturopathic therapies today⁶. Fasting is often employed in the belief that it induces detoxification. A variation of this approach is autotoxicity where the focus is toxins in the colon. This is commonly treated by colonic irrigation, a procedure that is potentially harmful as it can hyper-extend the colon^11,12.

There is no credible evidence that detoxification treatments, such as dietary changes, consumption of herbs and supplements, fasting, or colonic irrigation, can remove toxins from the body or lead to improved health. These beliefs seem to be based on little more than speculation. Nevertheless, a survey of naturopaths in the USA found that 92% reported using detoxification therapies¹³. Similarly, a survey of naturopaths in Canada found more than half were using fasting as a treatment for various conditions⁹.

Hydrotherapy is another healing modality that naturopathy inherited from previous times. This treatment was very popular in central Europe where many people would go to a spa and sit in a pool containing spring water that was credited with healing properties. Indeed, this therapy is still popular in parts of Europe. The therapy was imported into the USA. Hydrotherapy is advocated by many naturopaths, often with the claim that it aids in detoxification and helps strengthen immune function¹. Certainly, spending time in a sauna, hot tub, spa, or sanatorium is relaxing, but there is little evidence that hydrotherapy has any more direct therapeutic value. Interestingly, a recent observational study carried out on men in Finland reported a protective association between use of a sauna and reduced risk of cardiovascular disease and of all-cause mortality¹⁴.

Iridology is a technique where practitioners examine a patient’s eye and then make a diagnosis based on changes in the iris. The technique rests on the claim that many disorders can be diagnosed using the technique but it has no scientific basis¹⁵. Nevertheless, 23% of naturopaths in Canada reported using iridology in their practice⁹.

Positive aspects of naturopathic medicine

Some aspects of naturopathic medicine compare favorably with conventional medicine. As was stated earlier, naturopathic medicine places a strong emphasis on avoiding treatments that pose a risk. Unfortunately, what this can often mean is that patients are denied treatments that are effective while posing an acceptably low risk of harm. But conventional physicians often go too far in the opposite direction. In particular, there have been many stories over the past several decades of medications being prescribed that cause significant harm. A recent example is OxyContin, an opioid widely used for the relief of pain. The over-prescribing of this medication by physicians has led to an epidemic of addiction and resulted in many deaths^16,17.

Naturopaths place a strong emphasis on preventive medicine by means of encouraging their patients to live a healthy lifestyle. Moreover, they have been critical of conventional medicine for failing to be active in this area. There may have been much truth to this in the past but over the last several decades conventional medicine has given much attention to this crucial area. This includes strong support for health promotion and various efforts to prevent disease at the population level. In addition, conventional physicians routinely screen middle-aged patients for such conditions as diabetes, hypertension, and high blood cholesterol. Interventions are then made where appropriate so as to prevent disease. However, what conventional physicians do, more often than not, is to write a prescription rather than encourage their patients to follow a healthy lifestyle. For example, one study on obesity showed that less than one third of Canadian physicians advised their overweight patients to lose weight¹⁸.

The obvious explanation for why conventional physicians routinely ignore lifestyle when treating their patients is lack of time. Counseling patients on making lifestyle changes takes far more time than writing a prescription for drugs that treat hypertension or high blood cholesterol. In a system where physicians generally spend no more than 10 or 15 minutes on each consultation, it is simply not possible to make a serious effort to assess a patient’s lifestyle and then deliver appropriate counseling. Naturopaths, by contrast, spend much more time with their patients; a typical first office visit to a naturopath takes one hour⁶ while an average visit takes around 42 minutes³.

Conclusions

A challenge in analyzing the practice of naturopathy and of critically evaluating its advantages and disadvantages is that relatively few research studies have been carried out. There is an urgent need for more research.

Naturopathic medicine offers an approach to health that appeals to many people: it is considered to be “holistic”, based on prevention, promises treatments that “detoxify” the body, and avoids the potential hazards often seen with conventional medicine. However, naturopathic medicine has serious negative features including the use of treatments that have little or no supporting evidence, such as homeopathy and treatments intended to bring about detoxification. Similarly, naturopaths use treatments where the supporting evidence is weak, such as many uses of acupuncture and herbalism. Naturopaths frequently fail to prescribe drugs where the benefit strongly outweighs the risk.

Naturopathic medicine does have some positive features, especially its strong emphasis on encouraging patients to prevent disease by living a healthy lifestyle. Conventional physicians, by contrast, are much less likely to dispense lifestyle advice, mainly due to lack of time. However, this is a rather weak advantage of naturopathy as the benefits of a healthy lifestyle are already well known by the majority of the population, especially by people who are most likely to visit a naturopath.

Overall, the positive aspects of naturopathy are greatly outweighed by the negative aspects.