Naturopathic Medicine Q&A

FAQ #1: How are naturopathic doctors educated, trained, and licensed?

Accredited naturopathic medical schools are four-year, in-residence, hands-on medical programs consisting of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention and clinical techniques.

In addition to a standard medical curriculum, schools require their graduates to complete four years of training in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed professionals.

Given the importance of hands-on, clinical experience for naturopathic medical students, the accrediting body for naturopathic medical colleges does not recognize degrees from online programs of study.

Differences between how MDs and DOs and naturopathic doctors are trained

The general educational structure for naturopathic doctors is comparable to that of conventional medical doctors (MDs) and osteopathic doctors (DOs). In all three medical programs, the first year emphasizes biomedical sciences such as anatomy and biochemistry. Second year classes focus on the diagnostic sciences, including areas such as evidence-based medicine and physiological assessment. All programs progressively increase students’ problem-based learning and integrated coursework, enabling students to learn how different concepts affect one another.

After the first two years, the curricula of the three medical programs focus on applying medical knowledge to real-life situations with simultaneous classroom studies supporting this training. Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

Third- and fourth-year naturopathic medical students have opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

A major difference between the training of the MDs and naturopathic doctors is medical residencies. MD residencies are mandated and regulated by conventional medical schools. As a result, many opportunities for residencies exist at a wide variety of medical facilities and are funded by the federal government.

Naturopathic medical residencies are not nearly as common because they are not yet required by most states (Utah is an exception) or funded by the federal government. In place of a residency, many new naturopathic doctors choose to practice with or shadow an experienced doctor before setting up their own practices.

Like MDs, a growing number of naturopathic doctors choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology. In addition, while practicing Family Medicine, many naturopathic doctors choose an area of focus based on a therapeutic, condition, or population subset.

Prerequisites

Prior to admission into an accredited naturopathic medical school, the typical entering student has completed three years of pre-medical training and earned a bachelor of science degree. Students are expected to have completed courses in English and the humanities as well as math, physics, and psychology, with a strong emphasis on chemistry and biology. In addition to prerequisite course work, prospective students must demonstrate appropriate observational and communication skills, motor function, intellectual-conceptual abilities, integrative and quantitative abilities, and behavioral and social maturity.

Accredited schools

There are currently seven accredited schools with eight campus locations in the United States and Canada. A degree from an accredited medical school is required for licensure or certification by a state.

The following accrediting institutions provide accreditation services for naturopathic medical schools:

College accreditation is issued by the U.S. Department of Education (ED). All AANMC member schools have been accredited or are in candidate status for accreditation by an ED-approved regional accrediting agency.

Programmatic accreditation is issued by the Council on Naturopathic Medical Education (CNME). All AANMC member schools have also been accredited—or are candidates for accreditation—by the CNME, the recognized accrediting body for naturopathic medical programs in North America.

The exam required to qualify for naturopathic doctor licensure is administered by the North American Board of Naturopathic Examiners (NABNE). The Naturopathic Physicians Licensing Examinations (NPLEX) is a two-part examination. Only students and graduates from accredited or candidate naturopathic programs are eligible to sit for the NPLEX. Passing the NPLEX is required before a doctor of naturopathic medicine can be licensed by a state.

Licensure and certification

Licensure and certification are the highest forms of regulation. They are designed to protect the public by ensuring that certain minimum competency requirements are met. They also set standards for the profession.

Currently 20 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands offer licensure or certification for naturopathic doctors. The American Association of Naturopathic Physicians maintains a list of states and territories that license or certify naturopathic doctors.

FAQ #2: What is Naturopathic Medicine

Naturopathic medicine is a distinct practice of medicine that emphasizes prevention and the self-healing process to treat each person holistically and improve outcomes while lowering health care costs.

Naturopathic doctors are educated and trained in accredited naturopathic medical colleges. They diagnose, prevent and treat acute and chronic illness, restore and establish optimal health by supporting the person's inherent self-healing process. Rather than just suppressing symptoms, naturopathic doctors work to identify underlying causes of illness, and develop personalized treatment plans to address them. Their Therapeutic Order™, identifies the natural order in which all therapies should be applied to provide the greatest benefit with the least potential for damage.

Remove Obstacles to Health. Health, the “natural state” of one’s body, is disturbed by obstacles that lead to disease. The first step in returning to health is to remove the entities that disturb health such as: poor diet, digestive disturbances, inappropriate and chronic stress levels, and individual disharmony. Naturopathic doctors construct a healthy regimen based on an individual’s “obstacles to health” to change and improve the terrain in which the disease developed. This allows additional therapeutics to have the most beneficial effects possible.
Stimulate the Self-Healing Mechanisms. NDs use therapies to stimulate and strengthen the body’s innate self-healing and curative abilities. These therapies include modalities such as clinical nutrition, botanical medicines, constitutional hydrotherapy, homeopathy, and acupuncture.
Strengthen Weakened Systems. Systems that need repair are addressed at this level of healing. Naturopathic doctors have an arsenal of therapeutics available to enhance specific tissues, organs or systems including: lifestyle interventions, dietary modifications, botanical medicine, orthomolecular therapy (use of substances that occur naturally in the body such as vitamins, amino acids, minerals), and homeopathy.
Correct Structural Integrity. Physical modalities such as spinal manipulation, massage therapy, and craniosacral therapy are used to improve and maintain skeletal and musculature integrity.
Use Natural Substances to Restore and Regenerate. Naturopathic medicine’s primary objective is to restore health, not to treat pathology. However, when a specific pathology must be addressed, NDs employ safe, effective, natural substances that do not add toxicity or additionally burden the already distressed body.
Use Pharmacologic Substances to Halt Progressive Pathology. NDs are trained in pharmacology and how to use pharmaceutical drugs when necessary. If their state license permits, they can prescribe these agents themselves or if not, refer to a conventional medical colleague.
Use High Force, Invasive Modalities: Surgery, Radiation, Chemotherapy. When life, limb, or function must be preserved, NDs refer patients to MDs who are expertly trained in these arenas. At the same time, NDs use complementary or supportive therapies to decrease side effects and increase the effectiveness of these invasive procedures.

While many naturopathic doctors are trained in primary care, like conventional medical doctors (MDs), some choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology.

Naturopathic medical education curricula include certain areas of study not covered in conventional medical school. At the same time, aspiring naturopathic doctors receive training in the same biomedical and diagnostic sciences as MDs and osteopathic doctors (DOs). The result is a comprehensive, rigorous, and well-rounded scientific medical education that is both comparable and complementary to that of MDs and DOs. For more information on how naturopathic doctors are educated, trained, and licensed, see FAQ#1 in this service, available here.

FAQ #3: Under what circumstances should I choose to see a naturopathic doctor?

1. You want a doctor who will treat all of you, not just your illness.

Naturopathic doctors (NDs) are trained to treat the whole person. This requires taking the time to listen and understand the genetic, environmental, and behavioral/lifestyle factors that can affect your health. At your initial appointment, you’ll spend up to an hour or more talking with your ND.

2. You want personalized treatment.

NDs understand there is no one-size-fits-all treatment that works for everybody. After your visit with an ND, you’ll leave the doctor’s office with a treatment plan uniquely tailored to you, your health status, your health goals, and your lifestyle.

3. You want to treat the root cause of an illness, not just the symptoms.

Sometimes having trouble sleeping, aches and pains, strange or hard to treat skin rashes, and indigestion or stomach discomfort are symptoms of an underlying illness. While these symptoms can be managed, it’s more important to understand and treat the root cause—which is the focus of naturopathic medicine.

4. You want to actively participate in managing your own health.

An ND will help you learn what your body needs to get well and stay healthy. Patients have the opportunity to feel empowered and hopeful when they understand and are actively engaged in managing their own health.

5. You have chronic pain and don’t want to use pharmaceutical drugs such as ibuprofen, acetaminophen, or highly addictive opioids to manage it forever.

Pain that lasts six months or more is more complex than acute pain and requires a holistic, long-term approach to manage. NDs are trained to work with you to determine which combination of therapies will work best for you to heal or manage your pain safely so that you can resume daily activities.

6. You have tried all conventional medical options for diagnosing and treating a health condition.

Certain chronic health conditions that have symptoms such as fatigue, insomnia, or gastrointestinal distress can be difficult to diagnose and treat, and can benefit from a holistic approach. NDs use diagnostic tools common in conventional medicine, such as detailed health, disease, and prescription drug histories, physical exams, and targeted laboratory testing and imaging. NDs also consider detailed diet history, lifestyle habits and choices, exercise history, and social/emotional factors to assess patients’ needs. These approaches can open doors to new treatment pathways and options.

Licensed naturopathic doctors and their scope of practice

Licensed naturopathic doctors combine knowledge of the body’s natural healing properties with the rigors of modern science to focus on holistic, proactive prevention and comprehensive diagnosis and treatment. By using protocols that minimize the risk of harm, naturopathic physicians help facilitate the body’s inherent ability to restore and maintain optimal health.

Naturopathic doctors treat all medical conditions and can provide both individual and family health care. They can work as primary care providers and as part of an integrated healthcare team. Among the most common ailments they treat are allergies, chronic pain, digestive issues, hormonal imbalances, obesity, respiratory conditions, heart disease, fertility problems, menopause, adrenal fatigue, cancer, fibromyalgia, and chronic fatigue syndrome. Naturopathic doctors can perform minor surgeries, such as removing cysts or stitching up superficial wounds, however they do not practice major surgery. They also are trained to use prescription drugs, although they emphasize less toxic substances that promote natural healing first, following the Therapeutic OrderÔ to provide the greatest benefit with the least potential for damage. For more information on the Therapeutic Order, see FAQ #2 in this service, available here.

Naturopathic doctors can order all blood reference range and diagnostic imaging tests. They can also order individualized specialty functional medicine labs, such as those for assessing digestive impairment, hormone imbalances, heavy metal and/or environmental toxin exposure, nutritional deficiencies, and adrenal dysregulation. They will evaluate your lab results in combination with your clinical presentation, your health history, and lifestyle and environment factors that might be preventing you from having optimal health.

Choose your naturopathic doctor wisely

When seeking medical care from a naturopathic doctor, it is important to select a doctor who has a naturopathic medical degree earned from an accredited, four-year, in-residence, naturopathic medical college and is licensed or certified. For more information on how to choose a naturopathic doctor, see FAQ #1 in this service, available here.

FAQ #4: What is the difference between a licensed naturopathic doctor and an unlicensed naturopath?

Licensed naturopathic doctors, sometimes referred to as naturopathic physicians, are regulated at the state level to practice naturopathic medicine. Naturopathic medical students attend accredited, four-year, in-residence, naturopathic medical schools where they study biomedical sciences such as anatomy, physiology, biochemistry, pathology, and pharmacology. Their medical education incorporates the latest advances in science and natural approaches to illness prevention and management. Students complete a minimum of 4,100 hours of class and clinical training, including over 1,200 hours of hands-on, supervised, clinical training.

Naturopathic doctors can order diagnostic tests such as blood tests, X-rays, MRIs, and, in some states, prescribe prescription drugs and hormones and perform minor surgery. According to the Association of Accredited Naturopathic Medical Colleges (AANMC) 2015 survey of alumni, 50 percent of naturopathic doctors practicing full-time self-report as primary care physicians, while 28 percent report working as natural health specialists. In addition, like conventional medical doctors (MDs), a growing number of naturopathic doctors choose to focus their practices in specialty areas. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Intravenous Therapies, Pediatrics, Primary Care Medicine, and Oncology.

A naturopathic doctor must pass rigorous professional board exams prior to being licensed or regulated in a state that regulates the practice of naturopathic medicine. State mandated regulatory bodies oversee standards of practice, complaints, and discipline for all licensed jurisdictions. Licensed naturopathic doctors also carry malpractice insurance and maintain a commitment to lifelong learning through continuing education. These requirements are safeguards to ensure patients’ rights to quality naturopathic care.

In some states with laws regulating naturopathic doctors, the use of the term “naturopath” or “naturopathic physician” by anyone other than a licensed naturopathic doctor is prohibited. However, not all states regulate naturopathic doctors and not all states that do protect the term “naturopath.”

Therefore, unlicensed naturopaths can have varied levels of education and experience, often from a purely online or correspondence format. Such education is not accredited by an agency recognized by the U.S. Secretary of Education and does not qualify students to take the NPLEX examination or apply for licensure in any regulated jurisdiction in North America.

Be aware that while the terms may be used interchangeably, they are not the same

As a patient, you should also know that the terms “naturopathic doctor”, “naturopathic physician” and “naturopath” are often used interchangeably by medical practitioners in other disciplines and the public, even though unlicensed naturopaths do not have the same training or privileges. Knowing the difference between licensed naturopathic doctors and unlicensed naturopaths can help you make informed decisions about which type of provider can best help you.

For more information on how naturopathic doctors are educated, trained, and licensed, see FAQ#1 in this service, available here.

FAQ #5: How should I choose a naturopathic doctor?

The most important criteria in selecting a naturopathic doctor are that the doctor 1) has a naturopathic medical degree earned from an accredited, four-year, in-residence, naturopathic medical college and 2) has passed rigorous board exams as part of a licensure or certification process.

There are currently seven accredited naturopathic medical programs in North America. They are: Bastyr University, National University of Natural Medicine, National University of Health Sciences, Southwest College of Naturopathic Medicine, University of Bridgeport—College of Naturopathic Medicine, Canadian College of Naturopathic Medicine, and Boucher Institute of Naturopathic Medicine.

Twenty-three states and U.S. territories permit access to safe, effective, and affordable licensed or certified naturopathic doctors. These include Alaska, Arizona, California, Colorado, Connecticut, District of Columbia, Hawaii, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and the U.S. territories of Puerto Rico and Virgin Islands. For a map of regulated states and states seeking licensure, click here.

What to expect in your first visit

During your first visit, your licensed naturopathic doctor will take your health history, ask questions about your diet, stress levels, lifestyle habits and exercise, use of tobacco and alcohol, prescription drugs and supplements you are taking, and discuss the reasons you sought out a naturopathic doctor. He or she might also perform a physical examination and order diagnostic tests. Based on findings, the doctor will work with you to set up a customized treatment plan and health management strategy. If necessary, the doctor will refer you to other health care practitioners.

Naturopathic doctors understand conventional medicine and use many of its diagnostic tools and treatments in their practices. They also bring an array of treatments and insights into treatment plans and health management strategies that typically are not taught in conventional medical schools and might not be available from a conventional medical doctor. One example is the use of plant-based medicines (botanicals). Used correctly, these medicines along with lifestyle changes can improve many aspects of a patient’s health.

Be prepared for your naturopathic doctor to focus on understanding the root causes of health symptoms you might be experiencing as well as your overall health and wellness goals. This takes time. As a result, your first visit might last an hour or more and follow-up visits could last 30 minutes or more, although this varies depending on the individual.

How to find a naturopathic doctor

Licensed naturopathic doctors work in a variety of clinical settings, including private practices, hospitals, clinics, and community health centers. As a service to consumers, the AANP provides a naturopathic doctor directory of its members and finder tool on its website, available here.

FAQ #6: How does naturopathic medicine lower health care costs?

As concerns grow over high health care costs and poor health outcomes in the United States, a growing number of policymakers, health care practitioners, and other stakeholders are calling for an expansion of the focus of our health care system to keeping people healthy in addition to providing medical treatment after a person gets sick. To accomplish this change, health care professionals from a broad range of disciplines must come together in primary care teams. Trained as primary care doctors and to emphasize prevention, licensed naturopathic doctors have a central role to play in these efforts.

Naturopathic medicine is a distinct practice of medicine that emphasizes wellness and the self-healing process to treat each person holistically. Licensed naturopathic doctors are known for following a unique Therapeutic Order, an approach that identifies the natural order in which naturopathic therapies should be applied to provide the greatest benefit with the least potential for harm. This approach leads to improved outcomes and lower health care costs.

Here are eight ways naturopathic medicine lowers health care costs:

1. Address the root causes of illness.

By addressing and treating the root causes of disease rather than its symptoms, the need for repeated, expensive, and sometimes ineffective treatment is eliminated. For example, the underlying causes of conditions such as high cholesterol and diabetes is often poor diet and lifestyle factors such as lack of exercise. Changing these lifestyle factors can eliminate the need for one or more prescription medications that would typically be recommended for the rest of that patient’s life.

2. Offer less expensive diagnosis and treatment.

Naturopathic medical diagnostics and treatments are often less expensive than those in conventional medicine. Many treatments incur no cost whatsoever. One example is taking the time to engage patients in ongoing discussions of lifestyle choices, making the connection between these choices and their health condition and guiding patients to healthier options.

3. Reduce the need for expensive surgical procedures, when appropriate.

According to the American College of Surgeons and the American Medical Association, among the most common surgeries performed in the United States are coronary artery bypass surgery, carotid endarterectomy, and low back pain surgery.

1Because naturopathic doctors often suggest less expensive, non-surgical options to patients, some of these expensive surgeries can be avoided. One major study investigating the effects of lifestyle improvement in patients with coronary atherosclerosis found that after only one year of following lifestyle recommendations, about 80 percent of participants were able to bring about plaque regression and avoid surgery without the use of lipid lowering agents.2 The study estimated that this would save almost $30,000 per patient in the first year alone.3

1 Stanford Health Care. General Surgery-Common Surgical Procedures. Online access: https://stanfordhealthcare.org/medical-treatments/g/general-surgery/procedures.html

2 Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129–133.

3 Guarneri E, Horringan, BJ, Pechura, CM. 2010. The Efficacy and Cost-Effectiveness of Integrative Medicine: A Review of the Medical and Corporate Literature. Bravewell Collaborative Report. June, 2010.

4. Decrease costs associated with adverse reactions to prescription drugs.

According to a 2014 report from the Harvard University Center for Ethics, there are 2.7 million serious adverse reactions to prescription drugs that have been legally prescribed each year, resulting in 128,000 deaths. This makes prescription drugs a major health risk, ranking fourth with stroke as a leading cause of death. Whenever possible, naturopathic doctors prescribe natural therapies first, turning to prescription pharmacology when they are necessary.

5. Reduce the incidence of illnesses and fatalities caused by hospital errors.

Research shows that preventable hospital errors are the third leading cause of death in the United States.1 Naturopathic medicine focuses on preventative care and patient education, which can reduce the length of hospital stays and hospital readmissions. The power of patient education has been well documented. A case study at Sentara Virginia Beach Hospital found that when heart failure patients were provided with education on their condition, their readmission rates dropped by 74 percent and hospital stays were 13 percent shorter.2

1 Makary MA, Daniel M. Medical error-the third leading cause of death in the US. BMJ. 2016 05 3;353:i2139. doi: http://dx.doi.org/10.1136/bmj.i2139 PMID: 27143499. Online access: https://www.ncbi.nlm.nih.gov/pubmed/27143499

2 GetWellNetwork. Improving Heart Failure Outcomes through Interactive Patient Care: The Sentara Virginia Beach General Hospital Experience. 2009. Online access: http://amandanenaber.weebly.com/uploads/6/1/7/6/6176087/hf-_get_well_network.pdf

6. Lower malpractice rates, resulting in reduced patient costs.

Malpractice insurance rates are much lower for naturopathic doctors than they are for conventional medical doctors. According to NCMIC, the largest malpractice insurer for naturopathic doctors, the yearly rate for naturopathic doctors in Arizona, Oregon, Minnesota, and New Hampshire is approximately $3,803. Rates for MDs in the same states are $18,646.1

1 Whitmer, Mike. Letter to Ron Mensching at National University of Health Sciences. Jan 2017.

Online access: https://www.naturopathic.org/files/NCMIC%20Letter%20re%20Malpractice%20Risk%201-26-17(2).pdf

7. Offer disease prevention.

Naturopathic doctors emphasize health-building practices such as weight bearing exercise and adequate vitamin D intake to prevent osteoporosis and the importance of eating a nutrient dense diet with healthy fats to help prevent heart disease. These practices can reduce the high future cost of preventable degenerative and chronic health conditions.

8. Reduce insurance costs.

Naturopathic medicine billing is far lower per patient than conventional medical billing. One study compared health care expenditures between complementary and alternative medicine (CAM) users and non-users, with CAM providers being defined as naturopathic doctors, chiropractors, acupuncturists, and licensed massage therapists. While CAM users had higher outpatient expenditures, they had lower inpatient and imaging expenditures. Overall, CAM users had a lower average expenditure than non-users during the one-year study, at $3,797 versus $4,153.1

1 Lind BK, Lafferty WE, Tyree PT, Diehr PK. Comparison of Health Care Expenditures Among Insured Users and Nonusers of Complementary and Alternative Medicine in Washington State: A Cost Minimization Analysis. J Altern Complement Med. 2010;16(4):411–7. doi: 10.1089/acm.2009.0261. Online access here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110809/

FAQ #7: How do naturopathic doctors help people manage chronic pain without highly addictive opioids?

Anyone who has ever experienced chronic pain knows how debilitating it can be. Yet the most commonly recommended conventional medical solution—prescription opioid painkillers—is turning out to be worse than the problem. Opioids may stop the pain, but at a high price: growing numbers of deaths due to opioid overdose and higher rates of addiction and misuse.

As a medical discipline that emphasizes a holistic approach and natural treatments, naturopathic medicine offers safe and effective alternatives to highly addictive drugs for managing chronic pain. Licensed naturopathic doctors are educated at four-year, post-graduate medical schools to start with non-drug approaches to chronic pain management, and use opioid painkillers as a last resort.

Naturopathic doctors are also trained to develop personalized pain management treatment plans. These plans take into account each individual’s lifestyle, nutrition, work and leisure activities, current and past stressors, and relevant previous injuries—in other words, the root causes of each person’s pain and all its manifestations. The plans use various combinations of dietary recommendations and nutritional supplements along with botanical medicines to help reduce inflammation and the pain it causes. Exercise, physical rehabilitation, and mind-body approaches that are known to reduce perception of pain are also included in the plans.

In addition, naturopathic doctors recognize the value of working closely with conventional and alternative medical providers and will make appropriate referrals for further diagnostic work-up, treatment support, or surgical intervention as indicated. In turn, a growing number of conventional medical doctors refer patients and colleagues looking for a fresh perspective for difficult-to-treat chronic pain to naturopathic doctors.

Perspective: a national crisis that is only getting worse

Drug overdose is the leading cause of accidental death in the United States. Of the more than 52,000 deaths due to drug overdose in 2015, prescription opioid painkillers such as oxycodone, hydrocodone, codeine, morphine, and fentanyl accounted for about 20,000. Of the 20.5 million Americans over the age of 12 who had a substance use disorder in 2015, 2 million involved prescription opioids.

How did this happen? According to the National Institute on Drug Abuse, in the late 1990s, pharmaceutical companies reassured health care providers that people would not become addicted to prescription opioids. As a result, physicians began to prescribe them at greater rates, leading to widespread misuse. Between 21 percent and 29 percent of people who are prescribed opioids for chronic pain misuse them; between eight percent and 12 percent develop an opioid use disorder.

Opioids aren’t the only dangerous pain management drug. Numerous studies link aspirin to a broad range of side effects ranging from gastric ulcers to cerebral bleeding. And a growing body of research links ibuprofen to adverse health effects, including increased risk of heart attack and stroke, gastrointestinal complications including ulcer, acute kidney failure, anemia, DNA damage, hypertension, and miscarriage.

The Centers for Disease Control and Prevention estimates that the total economic burden of prescription opioid misuse alone in the United States is $78.5 billion a year.

Naturopathic doctors play an important role in the opioid wars

Along with medical professionals from other disciplines, naturopathic doctors are actively engaged in collaborative efforts to solve America’s opioid problem. This includes participating in working groups to develop better pain management practices and modify national prescribing habits to limit the overuse of opioids. One example is the policy brief for the PAINS project, “Never-Only Opioids: The Imperative for Early Use of Non-Pharmacological Approaches and Practitioners in Pain Care.” Naturopathic doctors played a leading role in the development and dissemination of the brief.

FAQ #8: How do naturopathic doctors and conventionally trained doctors work together?

There are a number of situations where naturopathic and conventionally trained doctors working together deliver care for some patients. Examples include:

People with one or more chronic diseases or lifestyle-related conditions such as heart disease, diabetes, or hypertension, which require a high level of patient engagement in their own health as well as time to realize the full benefits of recommended treatments
People with cancer or other diseases where commonly used medical treatments can cause significant side effects that can undermine health
People seeking relief from chronic pain without using highly additive opioids
People who want to build and maintain a foundation of optimal health and well-being
People with symptoms such as fatigue, insomnia, and gastrointestinal distress who have exhausted options with conventionally trained medical doctors and still do not have an actionable diagnosis or are not improving with current treatments

These are areas where naturopathic medicine excels, providing diagnostic approaches and treatments that complement those of conventionally trained doctors. Naturopathic doctors are educated and trained in accredited naturopathic medical colleges to diagnose, prevent and treat acute and chronic illness and restore and establish optimal health by supporting a person's inherent self-healing process. In addition, they are trained to identify underlying causes of illness and develop personalized treatment plans to address them. They also are known for their unique Therapeutic Order, which identifies the natural order in which naturopathic therapies should be applied to provide the greatest benefit with the least potential for adverse reactions.

In collaborations with conventionally trained doctors, the Therapeutic Order can help guide decision-making for the care team.

Diagnostic tools commonly used by conventionally trained doctors include detailed health, disease, and prescription drug histories, physical exams, and targeted laboratory testing and imaging. Naturopathic doctors also consider detailed dietary records, lifestyle habits and choices, exercise history, and social/emotional factors to assess patients’ needs. These approaches can open doors to new treatment pathways and options.

For example, significant research shows that lifestyle-change programs that focus on nutritional interventions, resiliency, exercise, and emotional well-being can sometimes reverse the progression of chronic diseases such as heart disease, diabetes, hypertension, obesity, and high cholesterol.1 Naturopathic medical treatment plans include these and other therapies such as botanical medicines and clinical nutrition, acupuncture, hydrotherapy, and counseling, just to name a few.

In collaborations of naturopathic and conventionally trained doctors, sometimes one practitioner takes the lead and sometimes the other. An example of a situation in which a conventionally trained doctor would provide primary treatment and a naturopathic doctor would provide adjunctive treatment is cancer care. For cancer patients, surgeons, medical oncologists, and radiation oncologists provide surgery, chemotherapy, and radiation as primary treatments while a naturopathic doctor supports a patients’ vitality and natural ability to heal, which helps them tolerate the often difficult or toxic side effects of cancer treatments.

While patients can benefit from these collaborations, naturopathic and conventionally trained doctors who work together report that each practitioner learns from the other—opening up new possibilities for both and improving patient outcomes.

For more information on how naturopathic doctors are educated and trained, see FAQ #1 in this series, available here.

For more information on naturopathic medicine and the Therapeutic Order, see FAQ #2 in this service, available here.

1 Guarneri E, Horringan, BJ, Pechura, CM. 2010. The Efficacy and Cost-Effectiveness of Integrative Medicine: A Review of the Medical and Corporate Literature. Bravewell Collaborative Report. June 2010.

FAQ #9: How does naturopathic medicine support breast cancer prevention and treatment?

Emphasizing a holistic approach, naturopathic medicine offers complementary natural therapies to support and strengthen the body and mind before, during, and after conventional medical breast cancer treatment. Naturopathic medicine can help optimize tolerance to conventional treatments while also providing strategies to reinforce the body’s natural defenses and recovery systems so that each individual is at their strongest capacity to fight the disease.

One out of eight women in the United States will develop breast cancer over the course of her lifetime, and while rare, breast cancer is also diagnosed in men. While conventional medical treatments such as surgery, radiation therapy, chemotherapy, and pharmaceutical drug therapy are often essential components of breast cancer treatment, they can cause significant side-effects and can increase the risk of other health conditions. Additionally, battling breast cancer takes a tremendous mental and emotional toll on the patient.

When treating breast cancer patients, licensed naturopathic doctors develop personalized, whole-person treatment plans taking into consideration the stage and type of breast cancer that a person has, their physical and emotional constitution, lifestyle habits, and the conventional therapies being received. Specifically, naturopathic doctors help to:

Boost and sustain the immune system and minimize inflammation after biopsy, lumpectomy, or mastectomy surgery[1],[2] with the goal of shortening recovery times
Safely reduce side effects of radiotherapy, chemotherapy, and pharmaceutical drug therapies, as well as provide natural synergists to these conventional treatments to enhance their efficacy[3]
Support the patient through mental and emotional stresses that any cancer diagnosis and treatment brings[4],[5],[6]
Emphasize prevention measures in healthy patients motivated to reduce their cancer risk[7]
Develop post-treatment recommendations to reduce the risk of recurrence[8],[9]

Licensed naturopathic doctors are educated at four-year, post-graduate medical schools. While providing support to people diagnosed with cancer is within the purview of all naturopathic doctors, there are naturopathic doctors who specialize in naturopathic oncology. Naturopathic oncologists are board certified by the American Board of Naturopathic Oncology after completing a two-year residency or a minimum of five years in specialized naturopathic oncology practice. They are designated as Fellows of the American Board of Naturopathic Oncology (FABNO).

Working both in hospital oncology settings and in private practices, naturopathic doctors and naturopathic oncologists aid and collaborate closely with conventional oncology treatment teams. They understand both standard treatments employed by medical oncologists and how best to work in a collaborative model of cancer treatment that includes complementary and integrative therapies.

While naturopathic medicine treatment plans are personalized to each patient after a comprehensive consultation, and adjusted as needed during and after treatment, prescribed therapies may include:

Dietary and lifestyle modifications
Botanical medicine
Vitamins and supplements
Psychological/emotional care
Intravenous therapies
Homeopathy
Acupuncture

In addition to providing care to individuals diagnosed with breast cancer, naturopathic doctors can also help individuals at risk identify and implement strategies that can reduce their chances of developing breast cancer. These strategies include natural lifestyle modifications to diet, nutrition, sleep, and exercise, as well as stress reduction. Naturopathic doctors are trained to focus on these health-building areas in order to establish and restore optimal health.

[1] Dirican A., Andacoglu O., Johnson R., McGuire K., Mager L., Soran A. The short-term effects of low-level laser therapy in the management of breast-cancer-related lymphedema. Supportive Care in Cancer. 2011; 19(5): 685-690. Available here: https://link.springer.com/article/10.1007/s00520-010-0888-8

[2] National Cancer Institute. Lymphedema (PDQ)-Health Professional Version. Available here: cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq

[3] Vollbracht C., Schneider B., Leendert V., Weiss G., Auerbach L., Beuth J. Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo. 2011; 25(6): 983–990.

[4] Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. 2015; 121(8): 1231-40. Available here: https://www.ncbi.nlm.nih.gov/pubmed/25537522

[5] Garssen B, Boomsma MF, Meezenbroek Ede J, et al. Stress management training for breast cancer surgery patients. Psychooncology. 2013; 22: 572-580. Available here: http://onlinelibrary.wiley.com/doi/10.1002/pon.3034/full

[6] Phillips KM, Antoni MH, Lechner SC, et al. Stress management intervention reduces serum cortisol and increases relaxation during treatment for nonmetastatic breast cancer. Psychosom Med. 2008; 70: 1044-1049. Available here: https://www.ncbi.nlm.nih.gov/pubmed/18842742

[7] Anand P. et. al. Cancer is a Preventable Disease that requires major lifestyle changes. Pharmaceutical Research 2008; 25: 9.

[8] Greenlee, Heather, et al. Antioxidant Supplement Use after Breast Cancer Diagnosis and Mortality in the Life After Cancer Epidemiology (LACE) Cohort. Cancer. 2011; 118(8): 2048–2058.

[9] Pierce, John P., et al. Greater Survival after Breast Cancer in Physically Active Women with High Vegetable-Fruit Intake Regardless of Obesity. Journal of Clinical Oncology. 2015. Available here: https://arizona.pure.elsevier.com/en/publications/greater-survival-after-breast-cancer-in-physically-active-women-w

By AAMPsite

FAQ #10: How do naturopathic doctors empower people to take charge of their health?

Empowering people to become more informed about their health options, more involved in decisions made about their health, and more capable of maintaining their own good health can lead to better health outcomes and lower costs.1

In addition to diagnosing and treating illness, licensed naturopathic doctors are uniquely educated and trained to treat the whole person, to focus on prevention, and to empower patients to make lifestyle changes in order to achieve optimal health. This attention to patient-centered care is especially valuable when it comes to the prevention and treatment of chronic illnesses such as heart disease, hypertension, and diabetes.

Among U.S. adults, 90% of Type 2 diabetes, 80% of cardiovascular disease, 70% of stroke, 70% of colon cancer are potentially preventable by modifiable lifestyle changes. Research has shown that for many people, these conditions can be prevented or better managed through dietary and lifestyle changes—treatments that require patients to actively participate in their own care.

For example, a major study investigating the effects of lifestyle changes in patients with coronary atherosclerosis found that after only one year of following lifestyle recommendations, about 80% of participants were able bring about plaque regression and avoid surgery without the use of lipid lowering agents.3 In addition, studies have shown that proper testing, treatment, and lifestyle changes such as losing weight, adopting a healthy diet, and physical activity have beneficial effects on people with type-2 diabetes and are the cornerstones of diabetes prevention in at-risk individuals.4

With compelling evidence of the value of actively participating in our own health, why doesn’t everyone do it? There are many reasons, but one stands out: it’s human nature to want a quick fix, and taking charge of your own health takes time and work.

Naturopathic doctors work to identify underlying causes of illness, and develop personalized treatment plans to address them. They believe you know your body better than anyone else, and will ask you detailed questions not only about your symptoms, but also about your environment, living situation, mental health and family history in order to understand what might be causing your symptoms.

Naturopathic doctors will use diagnostic tools such as detailed health, disease, and prescription drug histories, physical exams, and targeted laboratory testing and imaging when assessing your needs. Then, when a treatment plan is being considered, naturopathic doctors will want to make sure you know your options and will collaborate with you on decisions regarding your care.

An important underlying principle of naturopathic medicine is “doctor as teacher.” Naturopathic doctors will often spend 30-90 minutes with their patients and also want you to ask questions and interact with them to make sure you thoroughly understand your overall health, chronic issues you might have, or diseases for which you might be at risk.

Equally important, naturopathic doctors will work closely with you over time to help ensure your success. For example, they might help you shift your mindset to make and sustain lifestyle changes or modify your expectations about how quickly you will see improvement. As an empowered patient, here’s how you can help naturopathic doctors help you:

Get to know yourself and your body better so you can provide detailed information about symptoms and how you feel
Try to answer questions you’ll be asked about all aspects of your life and lifestyle as honestly as you can
Be prepared to ask questions of your own, engage in a dialogue about your health, and participate in decision-making about treatment options.

Bottom line, what you choose to do can make as much or more of a difference to your health than any decisions even the most knowledgeable and skilled naturopathic doctor might make for you.

For more information on naturopathic medicine, see FAQ #2 in this service, available here.

1 Health Policy Brief: Patient engagement. Health Affairs. February 14, 2013. Accessed October 17, 2017

http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf

2 Oberg EB, Bradley R, Hsu C, Sherman KJ, Catz S, Calabrese C, et al. (2012) Patient-reported experiences with first-time naturopathic care for type-2 diabetes. PLoS One 2012;7:11. Accessed October 17, 2017 https://doi.org/10.1371/journal.pone.0048549

3 Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129–133. Accessed October 17, 2017 http://www.thelancet.com/journals/lancet/article/PII0140-6736(90)91656-U/abstract

4 Asif M. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern. J Educ Health Promot. 2014;3:1. Accessed October 17, 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3977406/

FAQ #11: How do naturopathic doctors treat patients with diabetes?

Licensed naturopathic doctors are trained in both conventional and integrative approaches to treating all types of diabetes, including types 1 and 2, gestational diabetes, and prediabetes.

Focusing on the whole person, naturopathic doctors take the time to identify and address the genetic, environmental and behavioral/lifestyle factors that play significant roles in diabetes. Lifestyle changes around diet and exercise are essential in the treatment of all types of diabetes. However, many patients have a difficult time making such changes. Advanced training in nutrition and counseling enables naturopathic doctors to be highly effective in engaging patients to take control of their own health.[1] Additionally, because they emphasize educating the patient, naturopathic doctors are often successful in helping individuals with diabetes to make and sustain shifts in nutrition and physical activity that can improve or reverse progression of the disease.2

Naturopathic doctors are also trained in the pharmacological treatments which are commonly prescribed by conventionally trained MDs. In some states, NDs have scope/authority for prescription pharmaceutical management, which may be necessary depending on the patient's condition. In many cases, NDs will work in conjunction with conventional endocrinologists and diabetes specialists to co-manage patient care.

Diabetes is one of the most common health conditions in the United States. On the rise for the last decade,3 today an estimated 30.3 million people—representing 9.4 percent of the population—live with the disease.4 There are several types of diabetes: gestational, which occurs when a woman develops diabetes during her pregnancy; type 1, caused by an auto-immune disease that destroys cells in the pancreas, and; type 2, caused by lifestyle choices and occurring in 90-95 percent of people with diabetes, including children. Prediabetes is a condition in which blood sugar levels are higher than normal, but not yet high enough to be considered full-blown type 2 diabetes. Without lifestyle changes like those advised by naturopathic doctors, most people with prediabetes go on to develop type 2 diabetes.

Type 2 diabetes is related to insulin resistance, which means the body’s cells are no longer able to get glucose out of the blood and use it properly. Therefore glucose levels in the blood stay high. Over time, having glucose levels too high in your blood can cause serious health problems such as heart disease, nerve damage, eye problems, and more.

Regardless of the type of diabetes, naturopathic treatment strategies aim to get a patient’s blood sugar levels back within a healthy range. For example, even though type 2 diabetes is caused by a number of factors, most of them are controllable, including diet, physical activity, stress, eating habits and behaviors, and obesity. Nutritional deficiencies, environmental toxins and hormonal imbalances can also contribute to insulin resistance, and require special training to evaluate. A naturopathic doctor explores all of these factors to determine which ones should be prioritized and how they can be modified.

A visit with a naturopathic doctor to address diabetes will include a comprehensive intake and physical exam, along with review of health history, diet, and lifestyle factors. Any recent lab work will be reviewed, and new labs will be ordered if needed.

Generally, a naturopathic treatment approach for diabetes includes a combination of:

Review of diet diary and/or blood sugar log
Dietary guidance to strive for more balanced blood sugar throughout the day
A thorough review of other systems impacted by diabetes, including the heart, kidney, liver, and brain
Lifestyle counseling strategies to engage patients in their own disease management and encourage lifestyle improvement
Preventative strategies to avoid disease worsening
Herbs and/or nutritional supplements to correct nutritional deficiencies and/or support blood sugar management
Consultation on medication management (including insulin)

Following an initial appointment, a naturopathic doctor will determine which areas are the highest priority to address and which approaches are likely to be most effective. These will be used to create a personalized treatment plan.

[1] Oberg EB, Bradley R, Hsu C, Sherman KJ, Catz S, Calabrese C, et al. (2012) Patient-reported experiences with first-time naturopathic care for type-2 diabetes. PLoS One 2012;7:11. Accessed October 17, 2017 https://doi.org/10.1371/journal.pone.0048549

2 Bradley R, Sherman KJ, Catz S, Calabrese C, Oberg EB, Jordan L, Grothaus L, Cherkin DC. Adjunctive naturopathic care for type 2 diabetes: Patient-reported and clinical outcomes after one year. BMC Complementary and Alternative Medicine. 2012. 12:44. doi:10.1186/1472-6882-12-44

3 Klonoff DC. The increasing incidence of diabetes in the 21st century. J Diabetes Sci Technol. 2009;3(1):12. Accessed November 6, 2017: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769839/

4 https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes

FAQ #12: Is naturopathic medicine safe?

Naturopathic medicine emphasizes prevention and the self-healing process to treat each person holistically and improve health outcomes. As a health care consumer evaluating whether naturopathic medicine is safe, you should be aware of the following facts:

Numerous research studies of naturopathic treatments for common conditions such as heart disease, diabetes, chronic low back pain, and anxiety have shown that naturopathic medicine is both safe and effective.
Licensed naturopathic doctors complete a rigorous, four-year, in-residence, science-based, post-graduate medical education consisting of 4,100 hours of coursework and clinical training at an accredited naturopathic medical school.
Medical malpractice insurance rates for naturopathic doctors are among the lowest of any medical services provider.
Few medical treatments are 100% safe, but some are safer than others.

1. Numerous research studies of naturopathic treatments for common conditions such as heart disease[1], diabetes[2], chronic low back pain[3], and anxiety[4] have shown that naturopathic medicine is both safe and effective.

Significant research shows that lifestyle-change programs that focus on nutritional interventions, exercise, and emotional well-being can sometimes reverse the progression of chronic disease safely and effectively. Naturopathic medical treatment plans focus on these and other therapies, such as botanical medicine, clinical nutrition, hydrotherapy, and counseling to name just a few.

Naturopathic doctors are trained to diagnose and evaluate health conditions as primary care physicians and understand when and if a referral to a conventional health care provider is indicated, or if further diagnostic evaluation is necessary.

Naturopathic and conventionally trained doctors may also work together to deliver safe and effective health care. One such example is cancer care. For cancer patients, surgeons, medical oncologists, and radiation oncologists provide surgery, chemotherapy, and radiation as primary treatments while naturopathic doctors support a patient’s vitality and natural ability to heal, which helps them tolerate the often difficult side effects of conventional cancer treatments. For information on how naturopathic medicine supports breast cancer prevention and treatment, see our FAQ on the topic here.

2. Licensed naturopathic doctors complete a rigorous, four-year, in-residence, science-based, post-graduate medical education consisting of 4,100 hours of coursework and clinical training at an accredited naturopathic medical school.

During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention.

Accredited schools require graduates to complete four years of training and cover disciplines including: a standard medical curriculum, clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the last two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed doctors.

To be licensed, naturopathic medical students must pass two sets of board exams. Educating competent, well-trained clinicians is how naturopathic medicine maintains its excellent safety record. For more information on the education and training of naturopathic doctors, see our FAQ on the topic here.

3. Medical malpractice insurance rates for naturopathic doctors are among the lowest of any medical services provider.

The average annual medical malpractice insurance rate for naturopathic doctors was $3,802 annually as of January 2017, according to NCMIC, the largest malpractice insurer for naturopathic doctors. By comparison, the average annual rate for conventionally trained MDs was $18,646.[5]

A number of factors go into determining malpractice rates for a medical professional. Most important are whether there is the potential for a severe claim based on the nature of typical injuries or damage, and whether prior claims have been filed against a doctor. Malpractice rates for naturopathic doctors are almost five times lower than those for conventionally trained medical doctors because insuring an MD is riskier for an insurance company than insuring a naturopathic doctor.

4. Few medical treatments are 100% safe, but some are safer than others.

Few medical therapies are safe for everyone, in every situation in which they are used. For example, there are 2.7 million serious adverse reactions to legally prescribed prescription drugs each year, resulting in 128,000 deaths.[6] Having said that, naturopathic medicine is known for its unique Therapeutic Order, a set of guidelines naturopathic doctors use in clinical decision making to provide the greatest benefit to the patient with the least potential for damage. The Therapeutic Order begins by offering minimally invasive therapies aimed at supporting the body and ends in more invasive procedures such as chemical therapies and surgery. For example, naturopathic doctors will help patients achieve optimal health by first removing obstacles such as poor diet and lifestyle behaviors; stimulating self-healing mechanisms, strengthening weakened systems, and correcting structural integrity with minimally invasive therapies; and using natural substances to restore health.

[1] Seely D, Szczurko O, Cooley K, et al. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. CMAJ. 2013 Jun 11;185(9):E409-1. Accessed October 24, 2017: https://www.ncbi.nlm.nih.gov/pubmed/23630244/

[2] Oberg EB, Bradley R, Hsu C, Sherman KJ, Catz S, Calabrese C, et al. (2012) Patient-reported experiences with first-time naturopathic care for type-2 diabetes. PLoS One 2012;7:11. Accessed October 24, 2017 https://doi.org/10.1371/journal.pone.0048549

[3] Szczurko O, Cooley K, Busse JW, et al. Naturopathic care for chronic low back pain: a randomized trial. PLoS One. 2007 Sep 19;2(9):e919. Accessed October 24, 2017: https://www.ncbi.nlm.nih.gov/pubmed/17878954

[4] Cooley K, Szczurko O, Perri D, et al. Naturopathic care for anxiety: a randomized controlled trial. Naturopathic care for anxiety: a randomized controlled trial. PLoS One. 2009 Aug 31;4(8):e6628. Accessed October 24, 2017: https://www.ncbi.nlm.nih.gov/pubmed/19718255

[5] https://www.naturopathic.org/files/NCMIC%20Letter%20re%20Malpractice%20Risk%201-26-17(2).pdf

[6] Light, DW. New prescription drugs: a major health risk with few offsetting advantages. Harvard University Center for Ethics blog. 2014 June 27. Accessed October 24, 2017: https://ethics.harvard.edu/blog/new-prescription-drugs-major-health-risk-few-offsetting-advantages

FAQ #13: How do naturopathic doctors help prevent and treat cervical dysplasia and Human Papillomavirus (HPV)?

Cervical dysplasia refers to pre-cancerous changes in the cells on the surface of the cervix. While dysplasia can be caused by a number of factors, one common cause is the presence of one of the strains of Human Papilloma Virus, or HPV. Often times, the body will heal an HPV infection on its own and cervical cells go back to normal as the infection clears. In some cases, however, the grade of cervical dysplasia can worsen. Without treatment, advanced cervical dysplasia can progress to cervical cancer. In the U.S., Pap Smears have cut the incidence of cervical cancer in half over the past 40 years due to early detection. But approximately 40 percent of American women (and 45 percent of men) currently have some form of HPV, putting them at risk.

Focusing on the whole person, naturopathic doctors take the time to identify and address the genetic, environmental, and behavioral/lifestyle factors that cause cervical dysplasia. Naturopathic doctors who specialize in women’s health offer you and your sexual partner both preventive education and natural treatments for dysplasia and HPV. Naturopathic doctors focus on the least invasive, most natural, effective treatments first, and partner with conventionally trained specialists if surgical interventions are needed.

Risk Factors

The main risk factor for cervical dysplasia is the presence of HPV. Other risk factors include:

Multiple sexual partners
Young age at first intercourse (<16)
Having intercourse with uncircumcised partner
Unprotected intercourse
Chlamydia and HIV
Compromised immune system
Smoking1
Nutritional deficiencies
Diethylstilbestrol (DES) exposure
Long term oral contraceptive use (>5 years)
Low socioeconomic status

Screenings and Prevention

Naturopathic doctors follow the American College of Obstetricians and Gynecologists (ACOG) guidelines for dysplasia and HPV screenings in women 21-65 years old, utilizing the Pap Smear and HPV tests. Additionally, naturopathic doctors recommend and perform screenings for HPV and dysplasia in the mouth, throat, and anus, where the virus can also be spread through contact with sexual partners.2,3 Patients who have an abnormal result or test positive for HPV are advised to have their sexual partners also be tested and treated, to prevent further transmission.

Naturopathic doctors emphasize these important preventive measures:

Practicing safe sex. Safe sex decreases transmission of HPV, HIV, and other sexually transmitted diseases.
Smoking cessation. Smoking is linked to cervical cancer as it increases the duration of infection with high risk HPV.4 Smoking also weakens the immune system.
Optimizing nutrition. Poor nutritional status is linked to cervical cancer. Folate and B12 deficiencies have been associated with increased HPV infection.5 Low serum retinol levels have been linked to increased risk of dysplasia.6 Naturopathic doctors have advanced training in nutrition and will provide a comprehensive nutritional intake and individualized dietary counseling to address nutritional deficiencies.

HPV vaccination can reduce the risk of infection by the HPV types targeted by the vaccine. Because none of the currently available HPV vaccines protect against all HPV infections, it is important for vaccinated women to continue to undergo cervical cancer screening.

Diagnosis

If you are diagnosed with cervical dysplasia and/or HPV after your Pap Smear and HPV test, your naturopathic doctor may refer you for a colposcopy, a procedure which uses a special magnifying instrument (colposcope) to determine the extent and degree of dysplasia. Dysplasia is then categorized as cervical intraepithelial neoplasia (CIN), and graded level I (lower grade change in cervical cells), II, or III (highest grade change).

Treatment

Depending on your diagnosis, conventionally trained doctors often suggest one or more of four treatment approaches for dysplasia: 1) “watch and wait” and repeat the Pap Smear every three to six months, 2) cryoptherapy to freeze abnormal cells, 3) loop electrosurgical excision procedure (LEEP), which uses electricity to remove affected tissue, and/or 4) cone biopsy, to remove the affected portion of the cervix. Risks and complications of surgical procedures can include scar tissue, prolonged bleeding, and infection. These complications can have longer term effects on conception and childbirth.7 Additionally, these treatments may not address the underlying cause of the cervical dysplasia, which is the HPV infection.

Naturopathic doctors offer natural therapies to treat dysplasia and HPV directly, and to help the body’s immune system fight the virus. In doing so, naturopathic doctors may reverse low grade cervical cell abnormality and eliminate HPV. Naturopathic doctors treat low- and mid-grade dysplasia with a combination of lifestyle modification, therapeutic diets, nutrient and botanical therapies, and local treatment of the cervix. Specific therapies are individualized to the patient based on their diagnosis, emotional, and physical constitution. Nutrient and botanical therapies may include:

Folic acid8
Indole-3-carbinol9,10
Antioxidants11,12
Vitamin C13,14
Green tea extract15
Coriolus versicolor16
Curcumin17
Methyl B1218

Local cervical treatments may include:

Vaginal suppositories consisting of green tea and/or curcumin, which draw infection out of the cervical cells and boost the immune system.19,20
Escharotic treatment, which uses natural enzymes and herbal solutions to remove abnormal, damaged tissue and stimulate the regrowth of normal tissue. This treatment is performed two times per week for approximately six weeks.21,22

Thousands of patients have safely benefited from this treatment, but larger clinical studies are needed.

It is important to have a comprehensive diagnosis and consider all of your options for managing cervical health. There are times natural medicine is not an option for treating cervical cell changes due to the severity and location of disease. In many cases, however, naturopathic treatment of cervical dysplasia and HPV is a safe and effective option.

Tolstrup, J, Munk, C, Thomsen, B, et al. The role of smoking and alcohol intake in the development of high-grade squamous intraepithelial lesions among high-risk HPV-positive women. National Center for Biotechnology Information. 2006. Available at: http://www.ncbi.nlm.nih.gov/pubmed/16929418. Accessed April 15, 2015.
http://www.mountsinai.org/patient-care/service-areas/ent/areas-of-care/head-and-neck-cancer/oral-cancer/hpv/hpv-faq
J Oral Pathol Med. 2015 Jan; 44(1): 28-36
Synder U. A look at cervical cancer. Medscape OB/GYN & Women’s Health. 2003;8(1):1-12
Weinstein SJ, et al. Low serum and red blood cell folate are moderately, but nonsignificantly associated with increased risk of invasive cervical cancer. J Nutr. 2001;131:2040-2048.
Schiff MA, et al. Serum carotenoids and risk of cervical epithelial neoplasia in southwestern American women. Cancer Epidemiol Biomarkers Prev. 2001;10:1219-1222.
Int J Gynaecol Obstet. 2016 Mar;132(3):266-71. doi: 10.1016/j.ijgo.2015.07.026. Epub 2015 Nov 28.
Marshall K. Cervical dysplasia: early intervention. Altern Med Rev. 2003;8(2):156-70.
Grubbs CJ, Steele VE, Casebolt T, et al. Chemoprevention of chemically-induced mammary carcinogenesis by indole-3-carbinol. Anticancer Res 1995;15:709-716.
Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecol Oncol 2000;78:123-129.
Palan PR, Mikhail MS, Basu J, Romney SL. Plasma levels of antioxidant beta-carotene and alpha-tocopherol in uterine cervix dysplasia and cancer. Nutr Cancer 1991;15:13-20.
Mikhail MS, Palan PR, Romney SL. Coenzyme Q0 and alpha tocopherol concentrations in cervical intraepithelial neoplasia and cervix cancer. Obstet Gynecol 2001;97:3S.
Ghosh C, et al. Dietary intakes of selected nutrients and food groups and risk of cervical cancer. Nutr Cancer. 2008;60(3):331-41.
Lee Gj, et al. Antioxidant vitamins and lipid peroxidation in patients with cervical intraepithelial neoplasia. J Korean Med Sci. 2005 Apr;20(2):267-72.
Ahn ws, et al. The protective effects of green tea extract on human cervical lesions. Eur J cancer prev2003;12(5):383-390
Bogdanova J. [Coriolus versicolor--innovation in prevention of oncogynecological diseases, especially HPV]. Akush Ginekol (Sofiia). 2008;47 Suppl 3:51-3.
Mishra A., Kumar R., Kohaar, Curcumin Modulates Cellular AP-1, NF-kB, and HPV16 E6 Proteins in Oral Cancer. Ecancermedicalsciene 9, 525 (2015).
Piyathilake CJ, Cancer Prev Res (Phila). 2014 Nov; 7(100): 1128-1137.
Int J Gynecol Cancer. 2010; 20(4): 617-624
Gattoc L. et al, Open Access J Clin Trials. 2017;9:1-10. doi: 10.2147/OAJCT.S105010. Epub 2016 Dec 22.Nov
Windstar, K., Dunlap, C., Zwickey H. Escharotic Treatment for ECC-positive CIN3 in Childbearing Years: A Case Report. Integr Med (Encinitas). 2014 Apr;13(2):43-9.

Swanick, S., Windstar-Hamlin K., Zwickey H., An alternative treatment for cervical intraepithelial neoplasia II, III. Integr Cancer Ther. 2009 Jun;8(2):164-7. doi: 10.1177/1534735409335504.

FAQ #14: Why do naturopathic doctors spend between one and two hours with patients in an appointment?

You may have noticed that it takes longer than ever to schedule a first appointment with a new health care provider. You’ve also likely spent more time in the waiting room than face-to-face with your physician. In the United States, consultation time in a conventional doctor’s appointment averages about 20 minutes. In contrast, naturopathic doctors (NDs) spend between one and two hours face-to-face with patients in an initial appointment, and 30 to 60 minutes in subsequent appointments.

There are many factors that affect your health. Naturopathic doctors, who are trained to treat the whole person, take the time to explore as many of them as possible. Intakes are guided by the Therapeutic Order[1], a set of guidelines naturopathic doctors use in clinical decision making to help uncover and evaluate multiple causes of health concerns including diet, lifestyle, family genetics, psycho-emotional, spiritual, socioeconomic, and environmental issues, and more. This framework, which also guides naturopathic doctors in clinical decision making, prioritizes minimally invasive therapies. These therapies are aimed at supporting the body’s health restoring and maintenance processes, as opposed to just reducing symptoms.

The extra time naturopathic doctors spend with you is often focused on identifying the underlying cause(s) of your health concerns and empowering you to engage actively in restoring and managing your own health. Research shows that whole-person care often leads to high patient satisfaction and improved outcomes.[2]

Identifying Root Causes of Illness

Sometimes aches and pains, stomach discomfort, trouble sleeping and numerous other symptoms are indicators of an underlying illness. While these symptoms can be managed, it’s more important to understand and treat the root cause, which is the focus of naturopathic medicine. Naturopathic doctors will explore the genetic, environmental, and behavioral/lifestyle factors that may impact your health. They’ll also take the time to understand your health goals.

What to Expect In Your First Visit

In your first visit with a naturopathic doctor, they will likely:

Take your health history and ask you many questions about your main health concerns. Your doctor may explore how you experience each problem, including timing, intensity, and impact on your life.
Perform a methodical review of your bodily systems—from your respiratory system to your digestive, musculoskeletal, skin and other key systems—which may be connected to your chief complaint(s) or which may reveal other important areas that require attention.
Ask you what you have tried/implemented to address your concerns, and what the effects have been. This includes a review of prescription drugs and supplements you may be taking.
Ask you detailed questions about your diet and physical activity. Sometimes, your ND may ask you to keep and bring in a diet and activity log.
Discuss your lifestyle, social setting, and support systems. Your ND will want to understand both your main stressors and your coping strategies. Your home and work environments and primary relationships with friends and family will be important considerations for your personalized health plan.
Actively listen as you share your story, build rapport and trust, and establish a connection with you to foster a positive doctor-patient relationship.
Perform a relevant physical examination, as needed.
Order appropriate diagnostic tests, and explain testing that can help determine what is going on inside your body. Tests may include diagnostic imaging, blood, saliva, urinary, and/or stool analyses.

Based on findings, your naturopathic doctor will work with you to develop a customized treatment plan and health management strategy. If necessary, your ND will refer you to and/or work collaboratively with other health care practitioners.

Empowering You to Achieve Optimal Health

Empowering people to become more informed about their health options, more involved in decision making about their health, and more capable of maintaining the best health possible, can lead to better health outcomes and lower costs.[3]

Naturopathic doctors are trained to empower patients to make lifestyle changes in order to achieve optimal health. They spend extra time with you in both initial and follow-up appointments in order to educate and guide you through these changes, so that you are encouraged and supported to maintain the positive modifications you have made.

This attention to patient-centered care is especially valuable when it comes to the prevention and treatment of chronic illnesses such as heart disease, hypertension, and diabetes. Among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by modifiable lifestyle changes. Such approaches take time, require patients to actively participate in their own care, and are a focal point of naturopathic medicine.

[1]https://www.researchgate.net/publication/273634914_A_Hierarchy_of_Healing_The_Therapeutic_Order_A_Unifying_Theory_of_Naturopathic_Medicine

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688715/

[3] Health Policy Brief: Patient engagement. Health Affairs. February 14, 2013. Accessed October 17, 2017.

FAQ #15: How do naturopathic doctors prevent and treat heart disease?

Heart disease, the leading killer for both men and women in the U.S., is largely preventable if caught and treated early. Naturopathic doctors (NDs) excel at preventing and treating cardiovascular disease because they focus on identifying the underlying causes of disease and empowering patients to make enduring lifestyle changes to restore and maintain their health. A study investigating the effects of lifestyle changes in patients with atherosclerosis (the buildup of fatty, cholesterol-rich plaque in the arteries) found that after only one year of following lifestyle recommendations, about 80 percent of participants were able to bring about plaque regression and avoid surgery without the use of lipid lowering agents.[1]

Trained to treat the whole person, naturopathic doctors address the genetic, environmental, and behavioral/lifestyle factors that lead to cardiovascular disease. While treatment approaches are individualized to each patient, here are six key focuses for naturopathic prevention and treatment of heart disease:

Comprehensive intake to identify risk factors and underlying causes. Root causes of heart disease often show up as warning signs in other bodily systems, and many times they are the result of chronic inflammation in the body.[2]Chronic inflammation can arise from poor diet, a sedentary lifestyle, stress, autoimmune disease, food allergies, and many other sources. Inside arteries, inflammation helps kick off atherosclerosis, which narrows the arteries and increases the risk they’ll become blocked. This can lead to heart attacks and certain types of strokes.[3]

Naturopathic doctors spend between one and two hours with patients in an initial appointment, and a good portion of this time is dedicated to identifying sources of inflammation. Trained to be “inflammation hunters,” NDs perform a methodical review of your major bodily systems (skin, digestion, joints, respiratory, etc.). They will also ask detailed questions about your diet and physical activity, and discuss your main stressors and coping strategies.

Naturopathic doctors look carefully for conditions such as insomnia, fatigue, and depression[4] because they are all serious risks for both heart disease and heart attack. These conditions deplete vital neurotransmitters, such as serotonin, that are essential for good endothelial (blood vessel) health. Your doctor will individualize treatment with an emphasis on natural agents, such as clinical nutrition, botanical medicine and counseling. Naturopathic doctors avoid the use of non-steroidal anti-inflammatory drugs (NSAIDs) if possible. NSAIDs such as ibuprofen have been associated with heart attacks[5] and heart failure[6].

Targeted labs for a clear picture of what’s happening inside your body. Naturopathic doctors will match diagnostic lab tests to findings from your intake in order to determine what is causing your symptoms. Just as the intake is a detailed interview process, so are labs an in-depth series of questions to your body. They will be individualized, and may include the following:

Lipid panel that includes oxidized LDL (the primary type of cholesterol found in plaques), inflammatory markers, autoimmune markers, and lipoprotein particle analysis
Full glucose panel
Comprehensive neurotransmitter profile

Management of vital signs with medications as needed. Naturopathic doctors follow the Therapeutic Order, a set of guidelines for clinical decision making that prioritizes minimally invasive therapies to support the body to repair itself. Because of this, NDs lead with natural treatments. However, they are also trained to use pharmacological drugs when necessary.

If their state license permits, NDs can prescribe medications such as diuretics, beta-blockers, and ACE inhibitors as a bridge to manage symptoms of chronic inflammation or cardiovascular disease (e.g. hypertension), until the body repairs itself. If not, they will refer patients to and collaborate with a conventional medical colleague.

Naturopathic doctors will help you balance potential unwanted side effects of these medications with natural protocols that can correct them. The goal is to reduce or eliminate reliance on medications in the long-term by addressing the root cause(s) of heart disease.

Optimizing gastrointestinal function. The gastrointestinal (GI) tract is a common source of inflammation in the body. Gut flora are living microorganisms that provide a wall of protection between your digestive tract and your blood stream. When the flora in your digestive tract are not in balance, you risk developing localized inflammation. This can lead to alterations in intestinal permeability (leaky gut) which can contribute to heart disease.[7]

Naturopathic doctors help repair the GI tract using their extensive training in diet and clinical nutrition. Restoring proper PH, balancing flora, correcting leaky gut and constipation – linked with a higher risk of dying from cardiovascular disease[8] – are focal points of naturopathic GI treatment.

Addressing endothelial dysfunction. The endothelium is the inner lining of your blood vessels. It is considered one of the largest organs in your body, and plays an important role in maintaining good heart health.[9] If the endothelium is not functioning optimally, you have an increased risk of arterial inflammation and plaque build-up, which can lead to heart attack or stroke.[10] Endothelial dysfunction is caused by lifestyle factors including tobacco use, obesity, age, hypertension, hyperlipidemia, physical inactivity, and poor diet.

A focus of naturopathic medicine is empowering patients to make lifestyle changes in order to achieve optimal health. Your doctor will work with you to restore normal endothelial function using a combination of lifestyle modification, botanical medicine[11],12, and/or clinical nutrients13,14,15.

Motivating physical activity. Exercise is linked to improvements in numerous cardiovascular risk factors such as obesity16, depression17, inflammation18, diabetes19, and more. Naturopathic doctors believe it is their duty to inspire patients to exercise, rather than just give them guidelines. Because of the extra time they spend getting to know your lifestyle and support systems, they are often able to give you creative and personalized recommendations for physical activity that you can not only implement, but also sustain.

[1] Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. 1990;336:129–133. Accessed October 17, 2017 http://www.thelancet.com/journals/lancet/article/PII0140-6736(90)91656-U/abstract

[2] Willerson, James T. M.D.;Ridker, Paul M. M.D. MPH Inflammation as Cardiovascular risk factor, 2004 American Heart Association, http://circ.ahajournals.org/content/109/21_suppl_1/II-2

[3] http://www.heart.org/HEARTORG/Conditions/Inflammation-and-Heart-Disease_UCM_432150_Article.jsp#.WlTw_pM-cWp

[4] Litchman JH, et al. Depression and coronary heart disease: Recommendations for screening, referral and treatment. Circulation, Oct 21 2008. 118(17):1768-1775.

[5] Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ.2017;357.

[6] Arfè A, Scotti L, Varas-Lorenzo C, et al. Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study. BMJ.2016;354:i4857.

[7] https://consultqd.clevelandclinic.org/2014/11/gut-flora-and-heart-health-a-new-novel-pathway/

[8] Honkura K, Tomata Y, Sugiyama K, et al. Defecation frequency and cardiovascular disease mortality in Japan: The Ohsaki cohort study. Atherosclerosis. 2016;246:251-256.

[9] Widmer, R. Jay and Lerman, A. Endothelial dysfunction and cardiovascular disease. Glob Cardiol Sci Pract. 2014; 2014(3): 291–308.

[10] Ganz P, Hsue PY. Endothelial dysfunction in coronary heart disease is more than a systemic process. Eur Heart J. 2013;34(27):2025-2027.

[11] Peters W, Drüppel V, Kusche-Vihrog K, et al. Nanomechanics and sodium permeability of endothelial surface layer modulated by hawthorn extract WS 1442. PLoS One. 2012;7(1):e29972.

12 Usharani P, Fatima N, Muralidhar N. Effects of Phyllanthus emblica extract on endothelial dysfunction and biomarkers oxidative stress in patients with type 2 diabetes mellitus: a randomized, double-blind, controlled study. Diabetes Metab Syndr Obes. 2013;6:275-284.

13 Heinisch BB, Francesconi M, Mittermayer F, et al. Alpha-lipoic acid improves vascular endothelial function in patients with type 2 diabetes: a placebo-controlled randomized trial. Eur J Clin Invest. 2010;40(2):148-154.

14 Gao L,Mao Q, Cao J, et al. Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis. 2012;221(2):311-316.

15 Shechter M,Sharir M, Labrador MJ, et al Oral magnesium therapy improves endothelial function in patients with coronary artery disease. Circulation. 2000;102(19):2353-2358.

16 Eckel RH. Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Association. Circulation.1997;96(9):3248-3250.

17 Mead GE, Morley W, Campbell P, et al. Exercise for depression. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD0044366.

18 Ford ES. Does exercise reduce inflammation? Physical activity and C-reactive protein among U.S. adults. Epidemiology. 2002;13(5):561-568.

19 Parlikar U. Tight blood sugar control in type 2 diabetes linked to fewer heart attacks and strokes. June 4, 2015. Harvard Health Publications. Available at: https://www.health.harvard.edu/blog/tight-blood-sugar-control-in-type-2-diabetes-linked-to-fewer-heart-attacks-and-strokes-201506048059. Accessed August 4, 2017.

FAQ #16: What do naturopathic doctors mean by the healing power of nature?

Naturopathic doctors follow six guiding principles that serve as a philosophical platform for everything they do. The principles influence how they think about medicine, how they make clinical decisions, and most importantly, how they treat you as a patient. Each principle plays a role in guiding naturopathic doctors in diagnosis and treatment. The healing power of nature is one of these six core principles.

The healing power of nature recognizes the body’s inherent ability to heal itself. This begins at the cellular level. The building blocks of your body—cells—are dynamic, living units that are constantly working to self-repair and regenerate.[1] For example, when your skin is cut or scraped, you start to bleed. Your blood platelets clump together and clot to protect the wound. Blood vessels allow fresh nutrients and oxygen into the wound for healing. White blood cells accumulate on the site of the wound to protect it from infection, and red blood cells arrive to build new tissue.[2] This remarkable process stops when healing is complete. Naturopathic therapies support and enhance the natural healing power of the body.

Self-healing extends beyond the skin level. The body works hard on its own to support recovery from injury and illness. Damaged, destroyed or dead cells are replaced daily and automatically in your major organ systems. When you have a virus, your immune system attacks it. The digestive system consistently replaces old cells that line the gastrointestinal tract with newer ones. When you break a bone, bone cells kick into action to grow back together.

But certain genetic, environmental, and behavioral/lifestyle factors can slow or prevent optimal healing and recovery. These factors, unique to each individual, get in the way of the body’s inherent ability to heal. Naturopathic doctors focus on identifying and removing obstacles to recovery, in order to facilitate the natural healing ability in patients.

For example, food sensitivities or intolerances, unmanaged emotional stress, insufficient physical activity, and an imbalanced lipid profile are a just a few examples of barriers to optimal healing that naturopathic doctors are trained to identify and treat. Naturopathic doctors often spend between one and two hours with patients in an initial appointment to uncover individual hurdles to optimal health.

Naturopathic doctors utilize the Therapeutic Order[3], a natural order of therapeutic intervention used to help discover and evaluate multiple obstacles to healing, as a framework for diagnosis and treatment. These guidelines are aimed at supporting the body’s health restoring and maintenance processes, as opposed to just reducing symptoms. Naturopathic doctors view symptoms as nature’s attempt to correct imbalances. Consequently, naturopathic treatments are geared toward allowing the body to heal rather than suppressing symptoms, which can lead to a prolongation of the disease.

Naturopathic doctors individualize and prioritize natural, minimally invasive therapies. They are also trained to use pharmacological drugs when necessary. If state license permits, an ND can prescribe medication as a bridge to manage symptoms until the body repairs itself. If not, they will refer patients to a conventional medical colleague.

In focusing on the healing power of nature, naturopathic doctors empower patients both to understand the role their body plays in healing itself, and to engage actively in restoring and maintaining their own health. This kind of empowerment in health care can lead to better outcomes and lowered healthcare costs.[4]

[1] https://www.ncbi.nlm.nih.gov/pubmed/28596334

[2]https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=143

[3]https://www.researchgate.net/publication/273634914_A_Hierarchy_of_Healing_The_Therapeutic_Order_A_Unifying_Theory_of_Naturopathic_Medicine

[4] Health Policy Brief: Patient engagement. Health Affairs. February 14, 2013. Accessed October 17, 2017

FAQ #17: How do naturopathic doctors diagnose and treat digestive complaints?

The gastrointestinal (GI) system plays an essential role in your overall health. Often, imbalances in the digestive system lead to symptoms elsewhere in the body, including the nervous system, immune system, and skin. Trained to treat the whole person and address the root causes of symptoms, naturopathic doctors (NDs) excel at treating GI conditions. They are often able to get to the root cause of GI complaints that have defied conventional diagnosis, utilizing their meticulous evaluation process and advanced clinical nutrition training.

Known as “the second brain” of the body, the GI system lining houses hundreds of millions of neurons (the enteric nervous system) which manage the digestive process from swallowing to nutrient absorption to elimination.[1] Cells in the gut lining also produce 95 percent of the serotonin in our bodies.[2] The GI system acts as a communication center to the brain. When we're stressed, scared, or nervous, our brain notifies our gut, and we may experience abdominal symptoms. Additionally, the gut lining houses more immune cells than the rest of the body, defending us against viruses and bacteria.[3]

The health of this complex and essential body system relies on a combination of whole-body variables, including proper enzymatic function, nutrient absorption, microbiota (the body’s natural microorganisms) balance, tissue health, and elimination of waste. The ultimate goal is to have a digestive system that is functioning optimally. Naturopathic doctors will assess whether the GI system is performing at a level of optimal function, essential function, or dysfunction. They employ a comprehensive set of tools in their evaluation, including:

A comprehensive health history. Naturopathic doctors spend between one and two hours in an initial appointment with patients to gather information about physical, mental, emotional, genetic, environmental, social, and other factors that affect the health of the GI system. Often, simply taking the time to sift through deeper details related to symptom onset, food choices, or surgical history can be enough to uncover an unrealized association or cause. Naturopathic doctors will also perform a physical exam.

Targeted labs and tests. Naturopathic doctors have a distinctly large toolbox of evaluation strategies. Tests will be individualized, and may include: stool testing for healthy or disease causing bacteria, yeasts, markers of inflammation, blood, pancreatic enzyme levels, and immune markers. NDs may also order blood tests for food intolerances/allergies, celiac antibodies, hormonal and inflammatory indicators, nutritional deficiencies, diabetes indicators, liver function, and more. Naturopathic doctors might also take salivary or urinary measurements of stress hormones, toxins originating in the gut, reproductive hormones, and others. Concern for a more serious underlying condition may result in a referral for colonoscopy or other diagnostic imaging work.

In the United States, the top five GI diagnoses are abdominal pain, GERD/reflux, hemorrhoids, constipation, and nausea and vomiting.[4] Naturopathic doctors treat all of these conditions and others including: diarrhea, irritable bowel syndrome (IBS), celiac disease, gluten-intolerance, inflammatory bowel disease (IBD), Crohn’s disease, ulcerative colitis, microscopic colitis, small intestine bacterial overgrowth (SIBO), food allergies, leaky gut syndrome, ulcers, indigestion, gas, bloating, pancreatic enzyme insufficiency, gallbladder disorders, hepatitis, liver congestion, or fatty liver (alcoholic/non-alcoholic fatty liver disease), diverticulosis, and diverticulitis.

Treatment plans are carefully personalized, and may include:

A tailored diet based on an individual patient’s needs and condition. Common diets used for GI issues include:
- Low FODMAP (reduces fermentable carbs)
- Specific Carbohydrate Diet (SCD) (eliminates most carbs)
- SIBO specific diet (combines FODMAP and SCD diets)
- Anti-inflammatory diet (eliminates foods that can cause and/or aggravate inflammation)
- Elimination/challenge diet (to identify and eliminate food triggers)
Identifying and eliminating any dietary triggers (foods that can trigger allergic reactions, non-allergy intolerances, cravings or overeating)
Reducing inflammation and optimizing the health of the intestinal mucous membrane
Optimizing intestinal motility/bowel movement regularity
Eliminating any underlying infection
Supporting a healthy microbiome
Referral to a specialist when indicated for imaging or advanced care

NDs spend time empowering patients to make lasting changes, and helping them integrate treatment plans into their lifestyle for greater success.

[1] https://www.hopkinsmedicine.org/health/healthy_aging/healthy_body/the-brain-gut-connection

[2] http://www.apa.org/monitor/2012/09/gut-feeling.aspx

[3] https://www.sciencedaily.com/releases/2013/09/130916122214.htm

By AAMPsite

FAQ #18: What advanced nutrition training do naturopathic doctors receive?

Nutrition is often a pivotal component of an individual’s journey toward optimal health. Poor diet is also the leading preventable risk factor for disability or early death in the United States.[1] However, despite this and rising rates of obesity, diabetes, and other nutrition-related diseases, many U.S. healthcare providers are not adequately trained to address nutrition in a way that could help patients build a stronger foundation of health, or even lessen disease development or progression. Conventionally trained medical doctors receive a nominal amount of nutrition education in medical school.[2] A recent study found that only 12 percent of osteopathic doctors were aware of Dietary Reference Intakes, a key guide to differentiated nutrition requirements.[3]

Naturopathic doctors (NDs) recognize nutrition as a cornerstone of health. During medical school, ND students complete an average of 155 classroom hours of nutrition education. Coursework is similar to that taught to registered dietitians, with a focus on primary outpatient care. NDs’ understanding of food as medicine, passion for nutrition, and rigorous nutrition training enables them to go beyond offering patients dietary guidelines. Naturopathic doctors provide individualized nutrition assessment and guidance utilizing evidence based nutritional recommendations. They tailor nutrition treatment to a patient’s health concerns. They also empower patients to integrate better nutrition to support optimal health.

Nutrition curriculum in naturopathic medical schools is covered in a series of rigorous courses that build upon each other through an ND’s in-residence, four-year, science-based, post-graduate medical education, whose accreditation is recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings including academic teaching kitchens and over 1,200 hours of clinic rotations with patients. Areas of concentration include:

Macronutrients (proteins, fats and carbohydrates), their biochemistry, their role in a healthy body, and optimal amounts.
Micronutrients (vitamins and minerals), their bodily requirements, recommended daily intakes, food sources, toxicity sources, and how they are processed in the body (from absorption to digestion to storage to elimination).
Performing a dietary assessment to determine if an individual is getting enough macro- and micro-nutrients or has nutritional deficiencies, dysfunction, or pathology.
Analysis of diet types, including whole foods diets, low carb diets, Mediterranean diets, ketogenic diets, low FODMAP (short chain carbohydrates that are not properly absorbed in the gut) diets, and other evidence-based nutrition therapies.
Food attitudes, cultures, socio-economics, and pre-conceptions that impact an individual’s nutrition choices and ability to successfully adopt and maintain healthy nutrition.
Clinical nutrition, diet and nutrient (or nutraceutical) therapy, including evidence-based use of vitamins, supplements and diets as integral supports for the health and optimal function of all major body systems. This includes training on how adverse effects related to individual body systems can impact a person’s nutrition status, as well as how nutrition can be applied to optimize the health and performance of each system.
Advanced clinical nutrition, including the application of specific evidenced-based diets and nutrients to support treatment for specific conditions, e.g. Irritable Bowel Disease (IBD), heart disease, and more.
Supplement-drug interaction, including prescribed drug and nutrient interaction as well as nutrient-botanical interaction.
Specialized areas of nutrition including: pediatric nutrition, breast feeding nutrition, sports nutrition, community nutrition, eating disorders, and more.
Technology and nutrition, including how to leverage leading and evidence-based websites, applications (apps) and other technology resources to assist patients in nutrition planning and adherence.
Collaboration with registered dietitians, as needed.Many health symptoms and conditions have nutrition at the root of the issue. Trained to address root causes, naturopathic doctors are expert at identifying illnesses and conditions with nutritional causes and tailoring treatment to individual patient needs.

NDs understand how difficult it can be for individuals to change their diets, regardless of how medically essential it is. No two patients are alike, and many individual and societal factors impact food choices and nutritional status including family life, finances, time, personal preferences and more. Understanding where the patient is and meeting them there can make or break a patient’s nutritional success.

Naturopathic doctors take the time to investigate and incorporate all of these factors to individualize nutrition assessment and prescription. They work with patients in a step-by-step fashion to implement nutritional changes. By doing so, they empower patients to play an active role in their nutrition. This kind of empowerment can lead to better health outcomes and lower costs.[4]

[1] Murray CJ, Abraham J, Ali MK, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591-608. Medline

[2] https://www.medscape.com/viewarticle/886722_1

[3] https://medicalxpress.com/news/2017-10-medical-students-overconfident-underprepared-nutrition.html

[4] Health Policy Brief: Patient Engagement. Health Affairs. February 12, 2013.

FAQ #19: What do naturopathic doctors mean by identify and treat the root cause?

Naturopathic doctors (NDs) follow six guiding principles that influence how they think about medicine, how they make clinical decisions, and most importantly, how they treat you as a patient. Each principle plays a role in guiding naturopathic doctors through diagnosis and treatment. Identify and treat the root cause of illness is one of these six core principles.

When it comes to illness, naturopathic doctors distinguish symptoms from underlying root causes. While symptoms are the body’s way of communicating problems, they are not the cause of illness. Symptoms express a body’s attempts to heal, similar to the way a car’s check engine light demonstrates an engine’s unresolved issues.

Naturopathic doctors are trained to find and treat what’s “under the hood.” While they can and do provide relief from symptoms using natural approaches first whenever possible, their goal is to uncover and help heal the root causes of illness. In doing so, they facilitate the natural healing ability in patients, so that symptoms can be alleviated naturally. NDs believe that identifying and addressing the underlying root causes of disease whenever possible leads to the most positive and enduring health outcomes for patients.

Multiple factors contribute to both health and illness, including: diet, lifestyle, genetics, psycho-emotional, spiritual, socioeconomic, environmental issues, and more. Trained to treat the whole person, licensed naturopathic doctors utilize the Therapeutic Order[1] as a framework to help uncover, evaluate, and treat multiple obstacles to good health, which are also frequently root causes of illness. For example, NDs recognize that lifestyle choices are a central contributor to chronic disease. Among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by modifiable lifestyle changes. NDs’ rigorous training in areas such as clinical nutrition, lifestyle counseling, botanical medicine, and more makes them expert at prescribing and supporting essential, effective lifestyle modifications.

While it is human nature to want a “quick fix,” achieving and maintaining good health takes time and work. To identify root causes of illness, NDs often spend one hour or more with patients in an initial appointment, compared to an average 20 minute appointment with a conventionally trained medical doctor.

Because they focus on root causes, naturopathic doctors may be a good fit for individuals who have struggled with unresolved symptoms for months or years. Working together with a licensed naturopathic doctor can help you or your loved one determine the underlying cause(s) of your health concerns, and help you on your road to better health.

FAQ #20: How do naturopathic doctors help address fertility and infertility?

If you and your partner are struggling to have a baby, you are not alone. One in eight couples in the United States have difficulty getting pregnant or staying pregnant. Infertility, defined as trying to conceive for one year (or six months after age 35) with no success, affects both men and women ages 15 to 44. And new data suggests that infertility is on the rise.

Fertility challenges often take physical, emotional and financial tolls on a couple. Between repeated visits to reproductive endocrinologists, prescription medications, hormone injections and labs, trying to have a baby can feel like an exhausting, mechanical series of procedures. Some couples will consider reproductive technology (ART) such as artificial insemination, intrauterine insemination (IUI), and in-vitro fertilization (IVF) to achieve pregnancy. While these approaches can be effective, they are financially out of reach for numerous families. Given that success rates of treatments like IVF are between 13 percent and 36 percent for women over 35, couples want to optimize their health first to maximize their outcome. They may also be concerned about long-term risks of ART for the health of the baby. With all of these variables, patients often wonder if they have other options.

Trained to treat the whole person, naturopathic doctors (NDs) have helped countless men and women resolve fertility challenges and conceive easily, safely, and cost-effectively. With a focus on uncovering what is preventing a couple from conceiving, naturopathic doctors address underlying causes of infertility whenever possible. NDs look at each patient as a unique individual. They guide couples in improving fertility with a goal of conceiving naturally and avoiding interventions when possible. Addressing health beyond conception, NDs also focus on helping you achieve a healthy pregnancy and baby.

Identifying Underlying Causes

Naturopathic doctors begin by assessing the whole couple. Initial appointments generally last one hour or more, and include a detailed family history, medical history, discussion of diet, physical activity, environmental exposures, sleep patterns, and psycho-emotional stressors for both partners. You can expect a conversation about your lifestyle, menstrual cycle, and what you’ve been doing to try to conceive. Your ND may order blood work, imaging, and nutritional labs. They will dig deeper if tests uncover red flags.

There are a wide variety of reasons a couple may have difficulty conceiving. Although some receive a diagnosis from conventional doctors, many have “unexplained infertility.” Fertility challenges can be caused by poor sperm health (for men), poor egg quality, hormonal imbalances including cycle abnormalities (for women), obesity, and more. A number of root causes are linked to lifestyle and environmental factors, and NDs are trained to look for and uncover these underlying issues.

There are many safe, natural, and effective lifestyle modifications and therapies that can address these problems, strengthen your overall health, and improve your chances of getting pregnant. Because of their rigorous training in clinical nutrition, lifestyle counseling, botanical medicine and more, licensed naturopathic doctors are experts at engaging and empowering patients to make lifestyle changes, proven to improve health outcomes.

Pre-Conception Care

Proper preconception care has been shown to enhance fertility and lead to healthier outcomes, both for couples who are conceiving naturally and for those who are using assisted reproductive technology (ART). Naturopathic doctors work to help you cultivate a healthy body first to maximize pregnancy success and nourish the growth of a healthy baby. NDs encourage couples to take a few months of time to prepare for conception. In this period, NDs work with couples to:

treat underlying health conditions, such as obesity in both men and women
optimize diet and nutrition
manage stress
incorporate comprehensive micro-nutrient support
optimize intercourse timing through education about the menstrual cycle

Poor Egg Quality

While fertility obstacles and treatments are highly individual, for women, poor egg quality is a common underlying cause. Egg quality can decline naturally with age or prematurely. In both cases, finding out the ‘why’ of the decline is essential. Causes can be nutritional and hormonal. Research has demonstrated that for nutritional causes, supplementation with antioxidants such as melatonin, vitamins such as DHEA, and other plant-based antioxidants can be helpful to improve egg quality. Hormonal irregularities affecting egg quality and ovulation include endometriosis and Polycystic Ovarian Syndrome (PCOS). Naturopathic medicine has many different remedies to help women address these imbalances, including the use of botanical therapies.

Poor Sperm Health

For men, sperm production, quality, and motility are often at the heart of fertility challenges. While individual recommendations are tailored, naturopathic doctors help support sperm health through: 1) optimizing lifestyle choices such as quitting smoking and limiting alcohol consumption; and 2) optimizing diet and nutrition, including supplementation with micronutrients such as zinc, L-Carnitene, CoQ10, and antioxidants such as selenium.

Enhancing Clinical Care with Tender Loving Care (TLC)

The journey to pregnancy can feel like a physical and emotional rollercoaster. Naturopathic doctors provide patients with a high level of emotional and psychological support from start to finish. Adding psychological support and sympathetic counseling to clinical care not only feels better, but also has been shown to improve pregnancy success rates.

May 2018 | How do naturopathic doctors help women during perimenopause?

The AANP and INM would like to acknowledge Tori Hudson, ND for her contributions to the content of this FAQ. Some of the content first appeared in an article on Dr. Hudson’s blog.

An estimated two million U.S. women reach menopause every year. But many begin to experience an array of physical, mental, and emotional symptoms long before menopause (12 consecutive months without a menstrual period). The gradual transition to non-reproductive years is called perimenopause, and usually occurs from around age 40 to 51. Perimenopause can be brought about prematurely by surgical removal of ovaries, chemotherapy, radiation therapy, or certain anti-hormone drugs. Unique for every woman, the transition can lead to symptoms that interfere with quality life. Whole-body health evaluation and care during perimenopause is vital, both to manage troubling symptoms, and to preventively address changes that can impact heart, bone, and brain health.

Focusing on the whole person, licensed naturopathic doctors (NDs) take the time to identify and address the genetic, personal medical history, hormonal, and lifestyle factors that impact perimenopause and associated health changes in women. NDs provide a high level of emotional and educational support. Aiming to help strengthen the foundation of a woman’s health so that she can thrive through menopause and age optimally, NDs utilize a large spectrum of treatment modalities including nutrition, nutraceuticals, botanical medicine, lifestyle counseling, hormone therapy and, at times, select pharmaceuticals.

Symptoms and Underlying Biological Changes

During perimenopause, a woman’s hormone levels change and fluctuate considerably, often leading to changes in the pattern of menstrual periods. As you become postmenopausal, reproductive hormone levels decrease, resulting in levels of estrogen and progesterone which are inadequate to produce a menstrual period. Symptoms are varied, unpredictable, and often go unrecognized as perimenopause symptoms. They can include:

Irregular periods. As ovulation becomes irregular, the length of time between periods may be longer or shorter, your flow may be lighter or heavier, and you may have random spotting or skip periods. It is important to manage excessive bleeding, and rule out endometrial hyperplasia (when the lining of the uterus becomes too thick).

Hot flashes. Hot flashes and night sweats are common, with varying intensity, length and frequency. They can be aggravated by lifestyle factors including environment, nutrition, stress, alcohol, and tobacco use. It is important to differentiate other medical conditions from menopause-related hot flashes, including hyperthyroidism, anxiety, and more.

Vaginal dryness and thinning. Decreased estrogen can cause vaginal tissues to become thinner, drier, and less elastic, making vaginal penetration painful. Diminishing estrogen can also leave you more vulnerable to vaginal infections, urinary tract infections, and urinary incontinence. It is important to rule out other causes of these symptoms including malignancies, vulvar dystrophies and dermatoses, infection, allergies, and skin conditions.

Skin changes. Changes in the skin begin to occur with brown spots, dryness, easy bruising, and increased wrinkling. Skin is partially composed of collagen, and with age, collagen decreases. During the first five years after the menopause, 30 percent of skin collagen is lost.

Fatigue/sleep disturbance. Sleep problems are often due to hot flashes or night sweats, but sometimes sleep becomes unpredictable even without them.

Decreased libido and other changes in sexual response are common during perimenopause. Hormone levels, anatomy, physiology, psychological factors, stressors, and co-existing medical problems are all potential contributors to changes in sexual function.

Depression, anxiety and/or mood swings. The cause of these symptoms, including increased irritability and anxiety/panic disorder, may be sleep disruption associated with hot flashes, or other factors not related to the hormonal changes.

Bone loss is caused by declining estrogen levels, and can increase your risk of osteoporosis and bone fractures.

Changing lipid profiles. Decreasing estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age.

Other symptoms associated with perimenopause can include: changes in memory and cognition, scalp hair loss, facial hair growth, acne, palpitations, nausea, and headaches.

Naturopathic Treatment

Using a whole-body approach and natural therapies whenever possible, NDs help women address perimenopause symptoms and implement proactive prevention to optimize health as the body ages. NDs typically spend one to two hours with patientsin an initial appointment to gather information about physical, mental, emotional, genetic, environmental, social, and other factors that affect a woman’s health. NDs apply their rigorous training in clinical nutrition, lifestyle counseling, botanical and nutraceutical medicine, and other treatment modalities (including use of pharmaceuticals when state license permits) to provide individualized evaluation and therapeutic guidance for patients, including:

Medicinal plants that contain phytoestrogens, such as ginseng, red clover, and soy to reduce hot flashes, decrease vaginal dryness, increase energy, and improve moods.
Non-phytoestrogen plants such as Black Cohosh and Kava to reduce hot flashes.
Vitamin D, calcium and other nutrient supplements to help prevent osteoporosis.
Mind-body medicine such as stress reduction, meditation, and yoga for mild to moderate depression, cognitive decline, and hot flashes.
Bacopa to improve memory.

Individual assessments and recommendations about the use of either botanicals, nutraceuticals, bio-identical hormones including customized compounds, and/or conventional hormone therapy (HT) need to be made for each woman based on her symptoms, risk factors for osteoporosis/cardiovascular disease/dementias/other conditions, and preferences. When appropriate, NDs are trained to use both conventionally available hormone replacement options and also specialty compounded hormone formulations. Their guidance both in addressing perimenopause symptoms and proactively strengthening overall health has helped countless women age through menopause with greater ease.

Why is doctor as teacher a principle of naturopathic medicine? May 2018

The AANP & INM would like to acknowledge Amy Rothenberg, ND, and Allison Willette, RN, ND for their input on this FAQ.

Naturopathic doctors follow six guiding principles that serve as a philosophical platform for everything they do. The principles influence how they think about medicine, how they make clinical decisions, and most importantly, how they treat you as a patient. Each principle plays a role in guiding naturopathic doctors in diagnosis and treatment. The doctor as teacher is one of these six core principles.

If you don’t always follow your doctor’s instructions, you’re not alone. Studies show that non-compliance to doctor recommendations is epidemic, and it can lead to ineffective treatment or further health concerns. Non-compliance often stems from not having a clear understanding of the treatment plan and strategy. Many patients struggle to understand “physician-speak,” and may not fully grasp clinical explanations and care directions.

Licensed naturopathic doctors (NDs) believe that an informed patient is ready to take an active role in the healing process. Naturopathic doctors work to explain each health concern you have and each approach that will be utilized to help address it. NDs aim to answer your questions so you can fully understand and participate in your therapeutic plan.

Communication with you, the patient, is an essential element of working with any naturopathic doctor. Because each patient is seen as an individual, not just a diagnosis, naturopathic doctors prioritize empathy, connection, and sharing of relevant information. In order to educate and inform patients adequately, NDs often spend one hour or more with patients in an initial appointment, compared to an average 20 minute appointment with a conventionally trained physician.

Educated patients who understand the treatment recommendations often have better success with treatment and feel more confident about their health care choices. Research shows that better communication and collaborative decision making between doctors and patients drives health care costs down.

Because of their focus on patient education and patient empowerment, naturopathic doctors may be a good fit for individuals who prefer to be active participants in their health care, and who are looking for a fresh perspective on preventive care and natural treatment options for improved health.

How do naturopathic doctors help address men’s health? June 2018

Five key lifestyle changes can add up to 12 years to a man’s life, according to a new Harvard study. But unhealthy lifestyle habits, less frequent screening, and late treatment for preventable chronic diseases all result in men dying at greater rates than women from causes including heart disease, diabetes, accidents, and cancer. In fact, half of American men—who already have lower life expectancy than women—don't bother with annual checkups. Licensed naturopathic doctors (NDs), with their emphasis on preventive and lifestyle medicine can help to address some of these disparities. A visit with an ND might appeal more to men who have avoided doctor visits because NDs prioritize natural, non-prescription drug approaches, focus on patient education, and are trained to empower patients to make lifestyle changes for optimal health. They spend extra timewith you in appointments to identify underlying causes of your health concerns, and focus on supporting your body’s innate ability to heal. Here are some key areas of men’s health where NDs specialize:

Prostate Cancer

Prostate cancer, which impacts one in six men, is best treated when found early. Education about risk factors--which impact when regular screening should begin and how often it should take place--is essential. Main risk factors include: being African American, aging, family history of prostate cancer, obesity, exposure to certain chemicals, diet, and elevated testosterone levels. Studies show that prevention works and lifestyle factors impact cancer incidence and aggressiveness. If prostate cancer is diagnosed, using naturopathic medicine approaches alongside conventional care can help enhance efficacy, decrease side effects, and help prevent recurrence.

Sexual Dysfunction

Sexual dysfunction is a complaint that actually brings men to doctors’ offices. Defined as an inability to attain or maintain an erection adequate for the sexual satisfaction of both partners, sexual dysfunction may also be an indication of other health conditions. For instance, cardiovascular disease with atherosclerosis causes clogging of blood vessels, which can cause impotence. Sexual dysfunction can also be a symptom of diabetes, related to poor circulation, or other endocrine system disorders. Side effects of commonly prescribed medications such as antidepressants, antihistamines, and anti-hypertensives can contribute to sexual dysfunction, as can alcohol and drug use. A naturopathic doctor can help you figure out underlying causes of sexual dysfunction and create a treatment plan that addresses your risk factors or pathology. NDs use a whole body approach, including a prescription for diet and exercise, to help improve circulation. They work with natural supplements and with botanical medicines to address sexual dysfunction.

Cardiovascular Disease

Heart disease, which remains the number one killer of American men, is largely preventable if caught and treated early. By treating the whole person, naturopathic doctors address the genetic, environmental, and behavioral/lifestyle factors that lead to cardiovascular disease. Learn more in this FAQ about naturopathic medicine and heart disease.

Diabetes

Diabetes is the sixth leading cause of death for men, and a chronic disease that has enormous impact on quality of life. Naturopathic doctors have a broad set of guidelines and an extensive toolkit to work from in order to help patients with diabetes. Their advanced training in clinical nutrition and behavioral medicine helps individuals make and sustain shifts in lifestyle that can improve or reverse disease progression.

Chronic Pain

Men often struggle with chronic pain from a number of potential sources including injuries, arthritis, fibromyalgia and other causes. Naturopathic doctors excel in non-opioid approaches to chronic pain. By developing personalized pain management treatment plans that include dietary recommendations, nutritional supplements, botanical medicines, physical rehabilitation and mind-body approaches, NDs partner with patients to effectively help reduce pain from inflammation and other causes.

Depression

Men may experience depression differently than women. For example, some men with depression may experience anger or aggression instead of or in addition to sadness. Men may talk more about the physical symptoms of depression such as fatigue, headaches, or changes in appetite. Prioritizing behavioral medicine, nutrition, botanical medicine, exercise and selected nutraceuticals along with other natural medicine approaches, naturopathic doctors help men address depression. NDs are also trained in the pharmacological treatments which are commonly prescribed by conventionally trained MDs. In some states, NDs have authority for prescription pharmaceutical management. They can work in conjunction with conventional mental health specialists to co-manage patient care.

For men seeking care for these common complaints and others, naturopathic doctors have answers based on rigorous training in therapeutic nutrition, behavioral medicine, botanical medicine, and an emphasis on addressing underlying causes of disease.

Why are a growing number of medical doctors (MDs) working collaboratively with Naturopathic Doctors (NDs)? June 2018

Conventionally trained medical doctors find that naturopathic doctors have education, training and a practice approach that enhances care and expands treatment options for patients. Specifically:

NDs take a whole-body approach to health. There are many factors that affect your health. Naturopathic doctors take the time to explore as many of these factors as possible, including diet, lifestyle, family genetics, psycho-emotional, spiritual, socioeconomic, and environmental issues, and more. They typically spend one hour or more with patients in an initial exam to uncover the underlying causes of health concerns.
NDs prioritize natural therapies. Naturopathic doctors utilize minimally invasive treatments whenever possible. Clinical nutrition, behavioral and lifestyle medicine, and botanical medicine are just a few of the many therapies NDs apply to support the body’s health restoring processes, as opposed to just reducing symptoms. While NDs are trained in medical school to use prescription drugs, they emphasize less toxic substances that promote natural healing first. If their state license permits, NDs can prescribe medications when necessary. If not, they will refer patients to, and collaborate with, an MD colleague.
NDs have rigorous training in clinical nutrition. Naturopathic doctors recognize nutrition as a cornerstone of health. During medical school, ND students complete an average of 155 classroom hours of nutrition education. They provide individualized nutrition assessment and guidance utilizing evidence based recommendations. Their deep experience spans areas including macronutrients, micronutrients, dietary assessments, diet types, diet and nutrient therapy, supplement-drug interaction, nutrition technology, and more.
NDs have advanced training in behavioral medicine. NDs recognize that lifestyle and environment play a pivotal role in your health. A large percentage of chronic conditions are potentially preventable by modifiable lifestyle changes. Having completed more than 100 hours of behavioral medicine coursework in medical school, NDs are trained to uncover the social, cultural, cognitive, environmental, and emotional issues that influence your overall health. They empower patients to make and sustain changes for optimal health and wellbeing.
NDs provide highly individualized care. NDs understand there is no one-size-fits-all treatment. Utilizing a patient-centered approach, NDs take the time to understand your health goals and to explore the genetic, environmental, and behavioral/lifestyle factors that may be roadblocks to optimal health. Naturopathic doctors create treatment plans uniquely tailored to your health status, goals, and lifestyle.
NDs are fluent in integrative and complementary approaches. Because of their diverse training in complementary therapeutic modalities, NDs know when and how to utilize integrative approaches in a patient’s overall treatment. Incorporating treatments such as acupuncture, mind-body medicine, chiropractic and other integrative disciplines, NDs will refer to other expert practitioners as needed/if appropriate.

More people are looking for complementary, integrative and whole-body approaches to health care. Wellness, prevention, and health creation beyond disease management are just a few of the reasons why. In response, bi-partisan policymakers are joining forces to advocate a whole-person, integrative model of healthcare. And numerous national physician groups are now recognizing the value of complementary approaches, putting forth new treatment guidelines for centuries-old problems, such as chronic pain. Naturopathic medicine, which emphasizes prevention, self-healing, and natural therapies, offers patients a compelling whole-body health care choice.

Today there are approximately 6,000 licensed naturopathic doctors practicing in the U.S. Twenty-three U.S. states and territories currently license NDs. Educated and trained in four-year, post-graduate, accredited naturopathic medical colleges, NDs diagnose, prevent and treat acute and chronic illness. They restore and help establish optimal health. Trained as primary care doctors, NDs can play a central role in reversing the current U.S. chronic disease epidemic. Increasingly, they are working in collaboration with conventional medical doctors, and are recognized as a vital part of a patient’s health care team.

A growing number of prominent health systems, hospitals, and cancer treatment centers now have one or more licensed naturopathic doctors on clinical staff at their facilities. Medical doctors who champion naturopathic doctors recognize that NDs can help deliver better health outcomes at lower costs. They refer out to and collaborate with NDs both in primary care and in specialized areas including cancer treatment, chronic pain, gastrointestinal disease, diabetes, heart disease and more.

What advanced training do naturopathic doctors have in behavioral medicine? July 2018

Individual behavior is one of the most important influencers of your health. Your lifestyle and the conditions in which you grow up, live, work, and age shape your well being. In addition to diet, exercise, and other lifestyle behaviors, social, economic and cultural factors are often at the root of preventable chronic disease. In fact, up to 70 percent of primary care visits are driven by psychological and/or social factors. But too often primary care providers do not spend enough time addressing these issues.

Licensed naturopathic doctors (NDs), who are trained to treat the whole person, take the time to address multiple causes of health concerns. Appointments are guided by the Therapeutic Order, a natural approach to therapeutic intervention used to help discover and evaluate multiple obstacles to healing, including social, cultural, cognitive, environmental, emotional, and other factors impacting your health. During medical school, NDs complete an average of 150 classroom hours of behavioral medicine education. Because of their rigorous training, naturopathic doctors go far beyond treating physical symptoms; they help patients understand and address the underlying social, emotional, and psychological patterns that influence health.

Naturopathic doctors are trained to utilize a broad range of therapies including dietary and lifestyle interventions, stress reduction, psychotherapy, and counseling. They have the knowledge and experience to empower patients to make and sustain lifestyle changes that improve health and lower healthcare costs.

Behavioral medicine and lifestyle counseling are taught in a series of courses that build upon each other through an ND’s four-year, science-based medical education. Naturopathic medical schools are accredited and are recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings, including over 1,200 hours of clinic rotations with patients. Areas of course concentration include:

Patient-physician interactions, addressing patient-centered listening, motivational interviewing, and developing the doctor-patient relationship

Psychopathology, focusing on biological and psychosocial bases of psychological conditions, including clinical assessment using DSM criteria for diagnosis of mental disorders

Lifestyle change/behavior change, including biological and psychological factors, health risk and health promotion factors, medical decision making, and medical adherence

Counseling, including evidence-based behavioral medicine treatment and mind-body medicine techniques such as: mindfulness, therapeutic exercise/yoga, biofeedback, progressive muscle relaxation, breath work, meditation, and guided visualization

Addictions and disorders, focusing on the nature and treatment of addictions, including neurological, biochemical, cognitive, emotional, and socio-political factors

Nervous system and mental health, focusing on evaluation tools and therapies for nervous system and common mental health related conditions, employing evidence-based practices of nutrition, botanical medicine, and pharmacology

Social & cultural issues in health care, focusing on social determinants of health and chronic disease including: socioeconomic status, social support, socio-demographics, social inequalities, and psychosocial stressors

When you see a naturopathic doctor, they will take the time to understand your concerns and symptoms in the context of your lifestyle, behavior, and social-cultural environment. By examining the details of your diet, stress level, sleep, physical activity and more, they aim to identify the underlying causes of your health concerns. Naturopathic doctors engage patients step-by-step to make lifestyle and behavior changes, and they empower them to sustain these changes. This kind of empowerment leads to greater patient satisfaction, better health outcomes, and lower costs. NDs are also trained to recognize when you need more specialized mental health care, and will collaborate with and refer to mental health specialists when appropriate.

*** Use of the term psychotherapy may vary based on jurisdictional legislation

What do naturopathic doctors mean by treat the whole person? July 2018

Naturopathic doctors (NDs) follow six guiding principles that serve as a philosophical platform for all of naturopathic medicine. The principles influence how NDs think about medicine, make clinical decisions, and most importantly, how you are treated as a patient. Treat the whole person is one of these six core principles.

Multiple factors contribute to your health, including: diet, lifestyle, genetics, psycho-emotional make up, spirituality, socioeconomic position, environmental issues, and more. While most primary care providers are trained to treat the body, few also address matters of the mind and spirit, elements that are equally important. Licensed naturopathic doctors are trained to uncover, evaluate, and address relevant obstacles to healing. They take extra time with patients and provide highly individualized care.

Guided by the Therapeutic Order, naturopathic doctors focus on identifying the underlying cause(s) of your health concerns and empowering you to engage actively in restoring and managing your own health. Research shows that whole-person care often leads to higher patient satisfaction and improved outcomes.

Identifying Underlying Causes of Illness

Sometimes aches and pains, stomach discomfort, trouble sleeping, and numerous other symptoms are indicators of underlying illness. While these symptoms can be reduced or managed, it is more important to understand and treat the root cause, which is the focus of naturopathic medicine. This takes time and comprehensive evaluation encompassing physical, behavioral, emotional, and other key components of your health.

Providing Individualized Care

Treating the whole person involves giving each person tailored and personalized therapies specific to their genetics, nutrition status, lifestyle, and capacity for implementing suggestions, not just a set of instructions to follow. In order to assess, educate, and inform patients adequately, NDs often spend one hour or more with patients in an initial appointment, and 30+ minutes in subsequent appointments, compared to an average 20 minute appointment with a conventionally trained physician.

Addressing Behavior and Lifestyle Factors

NDs recognize that both psycho-social factors and lifestyle choices are central contributors to illness and chronic disease. Among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by modifiable lifestyle changes. NDs’ rigorous training in areas such as clinical nutrition, behavioral medicine, botanical medicine, and others makes them expert at prescribing and supporting essential, effective, and enduring behavior and lifestyle modifications which impact health outcomes.

Because of their focus in these areas and others, naturopathic doctors may be a good fit for people looking for a more comprehensive perspective on health concerns, or for a whole-person approach to health care.

How do naturopathic doctors help people manage blood pressure? August 2018

Forty-six percent of U.S. adults, and nearly 80 percent of those aged 65 and older have high blood pressure, or hypertension, according to new guidelines from the American Heart Association. High blood pressure, which often occurs without symptoms, boosts the risk of stroke and heart disease. Further, patients diagnosed with high blood pressure are estimated to pay almost $2,000 more in annual healthcare costs than those who have blood pressure in the normal range. While blood pressure medications represent some of the greatest advances in healthcare pharmacology, they have side effects and consequenceswith long-term use. Whole-body health evaluation and care is vital to identify the underlying cause(s) of high blood pressure, to proactively make changes that can impact overall health, and to minimize reliance on prescription medications when possible.

Licensed naturopathic doctors (NDs) are trained to evaluate and treat the whole person. They help patients identify the well-known causes of and modifiable risk factors for hypertension, as well as less-examined causes that include vitamin and mineral deficiencies and inflammation.

What do blood pressure numbers really mean?

Your blood pressure measurement is made up of two numbers that reflect the different pressures in your blood vessels. The systolic number is the pressure in your vessels when your heart contracts, and the diastolic number is the pressure when your heart is at rest between beats. Numbers greater than the ideal range indicate that your heart is working harder than ideal to pump blood to the rest of your body. Over time, untreated high blood pressure damages the delicate tissues inside blood vessels, in the eyes, brain, heart, and other areas. This can cause blindness, atherosclerosis (clogged arteries), and stroke. High blood pressure can also impact kidney function and in long term and severe cases, cause kidney failure.

What causes high blood pressure?

Causes of high blood pressure are different for every person and are often called “risk factors.” Well-known modifiable risk factors include: being overweight or obese, having a sedentary lifestyle, using tobacco, having an unhealthy diet (high in sodium), excessive alcohol usage (more than one drink per day for women and two drinks per day for men), stress, sleep apnea, and diabetes. Non-modifiable risk factors include: age, race, and family history. Other well-known causes of high blood pressure include side effects from certain medications, hormonal imbalances, and kidney disease.

Naturopathic medicine approach and therapies

Naturopathic doctors take enough time to identify and address the genetic, environmental, and behavioral/lifestyle factors that raise blood pressure.

NDs offer a large spectrum of treatments including: clinical nutrition, exercise prescriptions, botanical medicine, behavioral medicine, and, at times, standard medications. Naturopathic doctors work with and refer to other physicians and specialists when indicated.

Because of their extensive training in clinical nutrition, NDs are well-equipped to help people with diets and nutrition, which is essential. A large body of evidence now supports specific diets in the treatment of high blood pressure.

Naturopathic doctors provide highly individualized therapies. They follow the Therapeutic Order, leading with minimally invasive therapies that support the body to restore healthy function, whenever possible. Meeting the patient where they are, NDs might recommend dietary approaches, vitamin supplements, exercise training, stress management, or even prescription medications when needed, depending on the unique situation of each patient. The naturopathic medicine principle of recognizing the healing power of nature always brings NDs back to health-promoting, natural approaches that support the body’s effort to repair itself.

How to measure your blood pressure at home

Find a time when you can rest for several minutes.
Use a cuff that will inflate and deflate automatically.
Sit comfortably and keep arms at heart level. Take your measurement 2 to 3 times, between 1 and 2 minutes apart. Write the numbers down. If there is something stressful happening, make a note of that, too. Take your recorded measurements to your doctor.

Measure twice daily: once in the morning and once in the afternoon/evening, 30 minutes before eating, drinking, or exercising.

What do naturopathic doctors mean by first, do no harm? August 2018

Licensed naturopathic doctors (NDs) follow six guiding principles that serve as a philosophical platform for all of naturopathic medicine. The principles influence how NDs think about medicine, make clinical decisions, and most importantly, how you are treated as a patient. First, do no harm is one of these six core principles.

Naturopathic doctors follow a hierarchy in patient evaluation and treatment guided by the Therapeutic Order. To do no harm, NDs:

Acknowledge and respect the individual's healing process, using the least force necessary to diagnose and treat illness.
Avoid, when possible, the harmful suppression of symptoms.
Use treatments that minimize the risk of harmful side effects.

The body works hard on its own to support recovery from injury and illness. But certain genetic, environmental, and behavioral/lifestyle factors can slow or prevent optimal healing and recovery. Naturopathic doctors spend extra time with patients to identify and remove these obstacles to recovery in order to facilitate healing.

Therapies are aimed at supporting the body’s health restoring and maintenance processes, as opposed to only reducing symptoms. Naturopathic doctors view symptoms as nature’s attempt to correct imbalances. Consequently, naturopathic treatments are geared toward allowing the body to reestablish balance and heal rather than suppressing symptoms, which can disable the body’s most primary way of communicating that something is wrong.

Naturopathic doctors choose the gentlest and least-invasive therapies first to achieve the desired outcome for each patient. NDs apply their rigorous training in clinical nutrition, behavioral medicine, botanical medicine, and other natural therapies to provide the most beneficial and least harmful treatments. They are also trained to use pharmacological drugs when necessary. If their state license permits, an ND can prescribe medication as a bridge to manage symptoms while the body repairs itself. If such healing is not possible, naturopathic doctors refer patients to conventional medical colleagues and work collaboratively. For those patients who need to be on medications, naturopathic doctors can help to prevent side effects.

For example, here’s how a naturopathic doctor would apply first, do no harm to a patient who is diagnosed with gastroesophogeal reflux disease (GERD). The ND would:

Carefully examine and adjust the patient’s diet and lifestyle to identify and address behaviors that may be underlying causes for stomach discomfort and heartburn, such as overeating, alcohol consumption, spicy foods, lying down after eating, stress, and more.
Use lab tests and other clinical diagnostic approaches to assess the operation of the sphincter muscle and/or address inflammation in the lining of the esophagus, stabilizing these systems with natural supplements if appropriate.
Aim to avoid or eliminate the prescription of proton pump inhibitors (PPIs) like Prilosec, which can impair digestion, damage the body’s microbiome, are linked to depression, and other side effects.

About 15 million people in the U.S. use PPIs every year, but studies suggest as many as 70 percent do not benefit from the prescription.

Because of their focus on the most natural, least toxic approaches to health care, naturopathic doctors may be a good fit for people looking for a more comprehensive perspective on health concerns, or for those seeking non-drug therapies.

How and why do naturopathic doctors use botanical medicine? September 2018

The AANP and the INM would like to acknowledge Patricia Gaines, ND, and Sheila Kingsbury, ND, for their contributions to the content of this FAQ.

Botanical medicine, also known as herbal medicine, is the science and practice of using medicinal plants and extracts to improve overall health, support wellness, and treat acute and chronic disease. Many conventional pharmaceutical drugs are derived from plants. Modern botanical medicine combines evidence-based science along with centuries-old experience to provide safe and effective treatments that support the body’s ability to heal.

A cornerstone of naturopathic medicine, botanical medicine is one of the most effective therapies that licensed naturopathic doctors (NDs) use to gently and safely treat illness while minimizing the risk of harmful side effects. Botanical medicine expands treatment options for patients. Alone or in combination with other naturopathic treatments, botanical medicine can be a safe, appropriate, and effective choice for addressing numerous health concerns ranging from frequent illness to gastrointestinal discomfort to depression, and more. During medical school, NDs complete an average of 130 classroom hours of botanical medicine education.

Botanical medicine is taught in a series of courses that build upon each other through an ND’s four-year, science-based medical education. Naturopathic medical schools are accredited and are recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings, including over 1,200 hours of clinical rotations with patients.

Naturopathic Botanical Medicine Curriculum

Through this rigorous curriculum, naturopathic doctors learn how to choose and effectively prescribe herbal medicines to treat the underlying cause(s) of illness, minimize side effects and drug interactions, and individualize doses and formulations for the maximum therapeutic benefit. Core areas of focus in naturopathic botanical medicine curriculum include:

History and current use of Western herbal medicine
Herbal properties and actions of plants
Herbal constituents (compounds that have medicinal properties), medicinal actions (function in the body), and indications
Critical evaluation of literature and research in regard to both efficacy and interactions/contraindications of botanical medicines
Optimal extraction and delivery for a variety of plants
Botanical prescription writing
Organ systems-based botanical medicine formulation and topical application, including: gastrointestinal, respiratory, immune, cardiovascular, ears/eyes/nose/throat, reproductive, urinary, endocrine, musculoskeletal, and nervous systems
Choosing, assessing and preparing herbal medicine in various forms including aqueous extracts, tinctures, herbal oils and salves, syrups, capsules, oxymels, poultices, and compresses. This includes evaluating comparable advantages and disadvantages of each type of preparation
Dose ranges, contraindications, toxicity, side effects, and interactions
Sustainability of herbal medications
Effective creation of individualized formulas for patients
Translation of labels to determine the purpose and application of over-the- counter herbal products

This comprehensive training combined with a focus on treating the whole person—mind, body, and spirit—enables naturopathic doctors to utilize botanical medicine when best suited to effectively treat the patient based on their diagnosis and presentation. By spending extra time to evaluate and diagnose patients and then drawing on a spectrum of therapies including botanical medicine, clinical nutrition, and behavioral and lifestyle medicine, naturopathic doctors tailor comprehensive treatment to each patient, with a close eye on safety.

Botanical Medicine for Cold and Flu

Naturopathic doctors individualize botanical medicine treatments for numerous acute and chronic conditions. One example is cold and flu prevention/treatment. More people are seeking alternatives to prescription pharmaceuticals such as antibiotics, which can damage the gut, and to over-the-counter medications such as analgesics, decongestants, and antihistamines, which can suppress the body’s ability to produce antibodies and/or cause unwanted side effects. Examples of safe and effective botanical medicines commonly used by NDs for cold and flu prevention and treatment include:

Elder (Sambucus)—a flower or berry that can be used as an anti-inflammatory, anti-viral, antioxidant, often used in syrup form

Garlic—an anti-microbial herb that can help break up mucus, and is delivered through tinctures, syrups, capsules, or crushed fresh

Thyme—an anti-microbial herb, also an immune stimulant, effective against biofilms, and can also help relax a spastic cough

Echinacea—an anti-inflammatory, immune modulating herb that can activate white blood cells to fight infection and also be used for prevention

While licensed naturopathic doctors are also trained to use pharmaceutical drugs, and can prescribe them where state license permits, they emphasize less toxic substances like botanical medicine that promote natural healing first, following the Therapeutic Order to provide the greatest benefit to patients with the least potential for damage.

Why and how do naturopathic doctors focus on prevention? September 2018

The AANP and INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.

Half of all Americans live with at least one chronic disease, like heart disease or diabetes. Chronic conditions are the leading causes of death and disability and a leading driver of health care costs in America. But among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by modifiable lifestyle changes. The right preventive care at every stage of life helps Americans stay healthy, avoid or delay the onset of disease, and keep diseases they already have from becoming worse or debilitating. However, Americans use preventive services at about half the recommended rate.

Licensed naturopathic doctors (NDs) proactively focus on prevention both to benefit individual patients and to improve public health. Beyond reactively treating disease, naturopathic doctors emphasize and help individuals build optimal health by:

Spending extra time with patients to identify the determinants of health and disease
Approaching health through the lens of the whole person—body, mind, and spirit
Educating about and promoting healthy lifestyle choices
Assessing and addressing risk factors and implementing early interventions
Determining genetic and hereditary susceptibility to disease
Evaluating and addressing environmental and other external impacts on health
Determining the impact of social relationships and community on health, and working to improve them, when relevant

NDs are educated and trained to use pharmacological drugs when necessary and can prescribe medication to manage symptoms if their state license permits. However, because naturopathic doctors focus on supporting the body’s health restoring and maintenance processes, they offer the gentlest, least toxic, evidence-based treatments first.

Non-drug approaches offer effective prevention strategies that can improve health outcomes. Studies have found a 40 percent average reduction in LDL (i.e., comparable to statins) in patients who were asked to consume a whole foods plant-based diet low in both fat and refined carbohydrates (along with moderate exercise, meditation/yoga, and social support). In addition, studies have shown that proper testing, treatment, and lifestyle changes such as losing weight, adopting a healthy diet, and physical activity have beneficial effects on people with Type 2 diabetes and are the cornerstones of diabetes prevention for at-risk individuals.

For those with an established disease that is not going away—such as chronic arthritis or permanent disabilities—naturopathic doctors use prevention strategies to strengthen health and improve quality of life and life expectancy. NDs’ rigorous training in areas such as clinical nutrition, behavioral medicine, botanical medicine, and other natural treatments makes them expert at prescribing and supporting essential, effective, and enduring behavior and lifestyle modifications.

How do naturopathic doctors treat anxiety? October 2018

The AANP and INM would like to acknowledge Moira Fitzpatrick PhD, ND, FICPP, CHT, for her contributions to the content of this FAQ.

40 million adults in America suffer from anxiety, the most commonly diagnosed mental condition in the country. Unique for every person, Generalized Anxiety Disorder (GAD) is often experienced as excessive, uncontrollable worry about a variety of topics in a manner disproportionate to their potentially posed risk. Chronic nervousness, agitation, a restless mind, muscle tension, racing heart, and sleep disturbance are common symptoms.

Anxiety can have a variety of root causes from genetic to biological to environmental. Common first-line treatments often focus on prescription medications and/or therapy. While pharmaceutical drugs can provide symptom relief, these same drugs often have limited effectiveness. Drugs such as Benzodiazepines can also be highly addictive and can cause unwanted side effects. A growing body of research is uncovering dangers associated with commonly prescribed drug treatments including selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Lexapro, and with benzodiazepines such as Xanax and Ativan.

Licensed naturopathic doctors (NDs) excel at treating anxiety because they focus on treating the whole person, and on addressing the underlying causes of the condition. NDs have a deep toolbox of evidence-based, natural therapies including clinical nutrition, botanical medicine, and behavioral medicine to draw from.

Identifying Underlying Causes of Anxiety

Naturopathic doctors begin by assessing the whole person. Initial appointments often last one hour or more and include a detailed family history, medical history, discussion of diet, physical activity, environmental exposures, sleep patterns, and psycho-emotional stressors. There are a wide variety of underlying causes for anxiety. Naturopathic doctors consider:

Genetic predisposition— An understanding of genetic markers and pathways contributes to a more precise and personalized approach to treatment. Single Nucleotide Polymorphisms (SNPs) are the most frequent type of mutation. NDs look at patterns in SNPs and see how they affect B vitamins, hormones, nutrients, neurotransmitter production, and breakdown. This information provides foundational support to treatment planning.

Neurological imbalance—The balance of chemicals in the brain helps control mood and can play an important role in anxiety. Your ND will look for imbalances in serotonin, gamma-aminobutyric acid (GABA), and norepinephrine.

Digestive/microbiome dysfunction—The microbiome or ‘good germs’ that line your digestive tract play an important role in balancing your nervous, hormonal, and immune systems. Your ND may order a stool analysis test to evaluate the health of your GI tract. You can also expect a detailed discussion of your diet, and potential labs to identify food sensitives and nutritional deficiencies.

Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis—Your HPA axis is your body’s stress response system. In the face of chronic psychological stress, the adrenal glands excrete an abnormal amount of cortisol in an abnormal rhythm. This can be caused by a number of factors, including blood sugar imbalance, lack of sleep, caffeine, toxins, and allergens. Your ND may order lab testing if this condition is suspected.

Evidence-Based Naturopathic Medicine Treatments

Naturopathic doctors provide highly individualized therapies. They are trained in the pharmacological treatments commonly prescribed by conventionally trained MDs, and in some states, have scope for prescription of pharmaceuticals when necessary. When it is necessary to use medications, genetic testing can help determine which medications you will be responsive to with the least side effects. NDs lead with minimally invasive therapies that support the body to restore healthy function. Naturopathic therapies include:

Improve gut health. Research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connectionsupports the importance of a nutritional and diverse diet, and supplementation with probiotics. NDs have the expertise to balance the microbiome and address food sensitivities and leaky gut thanks to their rigorous training in clinical nutrition.

Repair and restore with nutritional and botanical supplements. NDs utilize a multitude of evidence-based nutritional and botanical supplements for their calming effects to help reduce the frequency, severity, and duration of generalized anxiety and panic disorders. These treatments are individualized and evaluated carefully for safety in every patient. Effective supplements include: Gamma-aminobutyric acid (or GABA), L-theanine, passionflower, scutellaria lactiflora (skullcap), hops, Piper methysticum (kava), lavender, adaptogens such as Withamnia Somnifera (ashwagandha), lithium orotate, and magnesium.

Manage stress with behavioral medicine. NDs are trained to evaluate your symptoms in the context of your lifestyle, behavior, and social-cultural environment. By examining the details of your diet, stress level, sleep, physical activity, and more, they can prescribe the most effective, evidence-based behavioral medicine treatments and mind-body medicine techniques. These include mindfulness, therapeutic exercise/yoga, biofeedback, progressive muscle relaxation, breath work, and meditation. For some patients, addressing repressed or current trauma can play a significant role in treating anxiety. Naturopathic doctors who are highly specialized in mental health, such as those certified by the Psychiatric Association of Naturopathic Physicians, can offer energy-based therapies which focus on the release of trauma. These may include hypnotherapy, guided visualization, cranial sacral therapy, and other specialized modalities.

Optimize lifestyle factors. Because of the extra time they spend getting to know you, NDs uniquely tailor recommendations to optimize lifestyle habits such as sleep, diet, exercise, and reduction of stimulants, all of which play contributing roles in anxiety.

NDs may evaluate and utilize additional strategies and therapies for different types of anxiety disorders, including anxiety in perimenopausal women, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and panic disorder.

How do Naturopathic Doctors Treat ADHD? October 2018

The AANP and INM would like to acknowledge Paul Herscu, ND, MPH, for his contributions to the content of this FAQ.

Attention Deficit Hyperactivity Disorder (ADHD) is a chronic, neurobiological condition that affects nine percent of children and four percent of adults in America. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity, and impulsive behavior. Many diagnosed with ADHD also struggle with concurrent states such as low self-esteem, troubled relationships, poor performance in school or work, anxiety, learning disabilities, and other mental, emotional, and behavioral disorders.

The common first line of treatment for ADHD is medication such as a stimulant (e.g. Adderall, Ritalin) or non-stimulant (e.g. Intuniv, Strattera) for those age six and above. While prescription drugs can be extremely effective addressing symptoms in the short-term, for many, the effects fade after prolonged use. Additionally, these medications may not address underlying causes or concurrent conditions, and frequently cause unwanted side effects including weight and height disturbances, sleep disruption, personality changes, “tics,” and even addiction. The consequences of taking stimulants for years on end have notbeen fully evaluated in studies, and use during pregnancy is still in debate. These challenges lead many to discontinue medication, seeking complementary or alternative approaches. Whole-person treatment can help address these hurdles.

Licensed naturopathic doctors (NDs) excel at treating ADHD because they focus on treating the whole person—mind, body, and spirit. Understanding how each person is experiencing their ADHD symptoms and discovering what is most limiting for them is important in the naturopathic approach. NDs have rigorous training in evidence-based treatments that have been shown to address underlying causes while improving ADHD symptoms. These treatments include clinical nutrition, behavioral medicine, and botanical medicine. Depending on the individual, naturopathic treatment can support conventional care, or be a primary treatment.

Whole Person Whole Patient, Individualized Approach
Naturopathic doctors spend extra time with patients to evaluate the whole person, including: diet, lifestyle, genetics, psycho-emotional makeup, socioeconomic position, environmental issues, and more. They are able to provide patients and their families with a high level of emotional and psychological support. Often, NDs assess multiple body systems including digestive/gastrointestinal (for inflammation), nutritional (for deficiencies or sensitivities), immune, and neurological (neurotransmitter regulation) to get a full picture of the patient's needs. The goal is to identify areas of dysfunction and then develop a plan to restore optimal function. In addition to the physical body, how an individual with ADHD feels mentally and emotionally always influences which therapies are selected. The age of the patient is taken into careful consideration. All of these pieces are taken together when building a comprehensive naturopathic care plan tailored to the patient.

Evidence-Based Naturopathic Treatments

Diet and lifestyle changes. Diet plays an enormous role in brain function. An ADHD assessment and treatment plan may include food sensitivity testing to pinpoint and help avoid those foods that are contributing to hyperactivity and distraction. An elimination diet can be effective, where common allergens and foods containing artificial dyes and high levels of salicylates are removed from the diet. A Mediterranean diet, rich in fruits and vegetables, whole grains, seafood, nuts and legumes, and olive oil may also be considered. It is also important to make sure blood sugar levels stay balanced through regular protein consumption. Additionally, improving sleep hygiene can play a role in managing ADHD symptoms. Emerging evidence shows that physical exercise, yoga, and time spent in nature can benefit children with ADHD.

Supplementation. Deficiencies in magnesium, iron, and vitamin-D are associated with ADHD. Research also supports a connection between B-vitamin deficiencies and ADHD symptom severity. NDs evaluate and address these deficits with proper supplementation. Further, numerous studies have demonstrated improvement in symptoms of ADHD through the use of supplemental fish oil. Because a good balance of healthy bacteria in the gastrointestinal system can positively impact brain health, supplementation with probiotics can also help reduce symptoms of ADHD.

Botanical medicine. Botanical or herbal medicines can help calm the nervous system and address restlessness, anxiety, and irritability associated with ADHD. Bacopa monnieri and Ginseng are just a couple examples of beneficial botanical medicines that NDs utilize. Naturopathic doctors will individualize formulations for patients.

Behavioral medicine. The American Academy of Pediatrics states that behavioral therapy should be the first step in treating ADHD in pre-school-aged children. Sometimes called behavioral modification, this approach works on resolving specific problematicbehaviors and offers solutions to help prevent them. Cognitive behavioral therapy (CBT) can help children and adults with ADHD overcome difficulties in everyday executive functions that are needed to effectively manage time, organize, and plan in the short term and the long term. CBT can also focus on concurrent and associated symptoms such as anxiety, emotional self-regulation, impulse control, and stress management. Neurofeedback is a therapy that uses real-time EEG data to help train brains to improve focus, impulse control, and other challenges associated with ADHD. A number of studies have shown that neurofeedback can improve certain ADHD symptoms. Naturopathic doctors refer patients to licensed therapists for these therapies as needed.

ADHD is a complex disorder impacted by numerous genetic, neurological, nutritional, and environmental factors. Whole-person naturopathic medicine strategies can offer patients many benefits.

How do naturopathic doctors help prevent cognitive decline? November 2018

The INM and AANP would like to acknowledge Doni Wilson, ND, Sara Thyr, ND, and Amy Rothenberg, ND, for their contributions to the content of this FAQ.

As the aging baby boomer generation grows, a growing number of Americans are projected to have dementia and associated cognitive decline. Currently over five million Americans are living with Alzheimer’s, a degenerative brain disease and the most common form of dementia. By 2050 that figure is expected to rise to 14 million, a staggering number of afflicted patients causing overwhelming strain on caregivers and the economy. Licensed naturopathic doctors (NDs) have effective approaches for the prevention of cognitive decline based on rigorous training in therapeutic nutrition, behavioral medicine, botanical medicine, and an emphasis on addressing the underlying causes of disease.What is Cognitive Decline?

Cognitive decline describes a noticeable and measurable impairment in cognitive abilities, including memory, language, thinking, and judgement. It is characterized by damage to brain cells, specifically, an accumulation of amyloid plaques and neurofibrillary tangles in the brain. This accumulation is influenced by a number of lifestyle, environmental, and genetic factors.

Risk Factors and Prevention

Studies have suggested that one-third of dementia cases worldwide could potentially be prevented through better management of health and lifestyle factors. The biggest risk factors for dementia-related cognitive decline outside of age and family history/genetic pre-disposition are heart disease, diabetes, stroke, depression, and stress. Addressing chronic illnesses and lifestyle choices helps reduce the risk of developing dementia. Prevention is a focal point of naturopathic medicine, and NDs have a proven track record of helping patients manage specific chronic health conditions such as heart disease, hypertension, and diabetes.

Exercise and Weight Loss

The role of exercise in prevention and slowing of cognitive decline is always part of the naturopathic medicine prescription. Naturopathic doctors spend extra time with patients and caregivers to find and tailor opportunities for physical activity. Studies confirm that obesity late in life is another risk factor for Alzheimer’s. Naturopathic doctors help address underlying metabolic imbalance to support long- term healthy weight maintenance.

Diet and Supplementation

NDs assess and help optimize your diet to decrease inflammation and maintain blood sugar balance. Therapeutic nutrition through food and supplementation are often part of the plan. A number of herbal supplements including curcumin, resveratrol, and Bacopa monnieri have been shown to help reduce inflammation in the brain and support brain health.

Sleep

Studies show that insomnia and lack of sleep can increase the risk of Alzheimer’s. Additionally, medications often used to help with insomnia also increase risk of cognitive decline. NDs are experts at resolving sleep issues using natural approaches such as herbal medicine, hydrotherapy, and blue-light blocking goggles.

Social Interaction

Treating the whole person, naturopathic doctors also educate and motivate patients to keep up ongoing social interaction, an important factor for both the prevention and slowing of dementia. Emerging research has identified hearing loss as a modifiable risk factor for dementia. Actively wearing aids, to help ease and encourage social interaction, has the potential to delay cognitive decline. You are more at risk for hearing loss if you have diabetes, heart disease, or if you smoke.

Helping families create, access, and integrate cognitive exercises has also been shown to help prevent dementia. NDs can prescribe such programs, or refer you to and partner with, specialists in that field.

Stress Reduction

Naturopathic doctors often recommend mindfulness meditation, and other forms of stress reduction such as gardening, journaling, and listening to music for the prevention of cognitive decline and to enhance memory and quality of life for those already diagnosed.

Minimizing Reliance on Drugs that Increase Risk

It is important to remember that memory loss and cognitive decline can be symptoms of other disease processes or drug side effects and may be reversible. A proper diagnosis with a licensed provider is essential before beginning any kind of treatment with conventional and/or naturopathic medicine.

Some commonly prescribed drugs create additional risk factors for dementia, such as proton pump inhibitors for gastroesophageal reflux (GERD). Naturopathic doctors address GI concerns with natural and lifestyle approaches. Research has also shown that long-term use of Zolpidem (Ambien) one of the most commonly prescribed medications for sleep, is associated with an increased risk of Alzheimer’s.

While there are no known cures for Alzheimer’s and other forms of dementia, naturopathic medicine offers highly individualized, whole-person prevention strategies.

How do naturopathic doctors diagnose and treat Crohn’s disease and ulcerative colitis? December 2018

The AANP and the INM would like to acknowledge Eric Yarnell, ND, for his contributions to the content of this FAQ.

When diagnosing and treating patients with acute or chronic gastrointestinal (GI) symptoms, licensed naturopathic doctors (NDs) address the whole person—including body, mind, emotions, genetics, environmental exposures, and socio-economic status. NDs employ a variety of diagnostic approaches to pinpoint the underlying causes of distress. Trained rigorously in clinical nutrition, behavioral medicine, botanical medicine, and conventional pharmaceuticals, NDs draw on a broad and deep spectrum of treatments, expanding options for patients with Crohn’s disease and/or ulcerative colitis.

What are Crohn’s Disease and Ulcerative Colitis?

Crohn’s disease (CD) and ulcerative colitis (colitis or UC) are the most common disorders in a group of auto-immune GI diseases referred to as inflammatory bowel diseases (IBDs). Crohn’s may develop anywhere in the digestive tract; ulcerative colitis is limited to the large intestine and rectum. Thought to be caused by your body’s immune system having an abnormal reaction to normal bacteria in your intestine, both diseases are chronic, lifelong, and often debilitating. Intestinal pain, dangerous obstructions and blockages, abscesses and ulcers are all possible complications. Acute flare-ups can be triggered by foods, stress, anxiety, depression, or acute infections. Tobacco products can also trigger flares of Crohn’s disease.

How are Crohn’s and Colitis Diagnosed?

Crohn’s and ulcerative colitis can be hard to diagnose because symptoms vary from person to person, and are similar to those of other diseases. For example, the most common symptoms of Crohn’s are intense abdominal pain and diarrhea. However, a person with Crohn’s disease can have constipation and diarrhea and sometimes blood in the stool, although some people with constipation will not have any diarrhea or blood in the stool. In addition, the typical symptoms of Crohn’s can be identical to those of small intestinal bacterial overgrowth (SIBO). With ulcerative colitis, symptoms typically include bloody diarrhea, frequently accompanied by abdominal pain and weight loss.

Given the complexities of Crohn’s and ulcerative colitis, a correct diagnosis is essential to effective treatment. There is no one definitive test for Crohn's disease. Testing is determined by the suspected location, small vs. large bowel. In addition to a comprehensive health history and an in-office exam, a naturopathic doctor may order stool testing to assess gut bacteria, markers of inflammation, and immune markers. NDs may also order blood testing for food sensitivities/allergies, celiac antibodies, folic acid deficiency, and inflammatory indicators such as C-reactive protein.

Diagnosis usually involves endoscopic or imaging studies in patients with compatible clinical history, and naturopathic doctors refer patients to gastroenterologists for this vital testing. Colonoscopy is the most appropriate first test for a patient presenting with diarrhea and suspected large bowel CD. Wireless capsule endoscopy is increasingly being used for evaluation of suspected small bowel CD. Imaging studies are generally considered more appropriate for those with abdominal pain and to evaluate the small bowel. These can include upper GI radiography with barium, computed tomography (CT) and computed tomography with enterography (CTE), magnetic resonance imaging (MRI), and magnetic resonance enterography (MRE). Diagnosis can also be supported by specific findings such as perianal skin tags or abdominal tenderness.

Naturopathic doctors also frequently test fecal calprotectin, an inflammatory substance produced by neutrophil white blood cells. Measuring calprotectin is helpful in establishing that there is inflammation in the lower intestinal tract.

Individualized Naturopathic Treatment for Crohn’s and Colitis

Once a patient has been diagnosed with Crohn’s, ulcerative colitis, or other IBDs, a naturopathic doctor will create a tailored treatment plan based on each patient’s individual presenting symptoms understood in context with the patients’ overall health and lifestyle. While there are no well-documented cures for either disease, the goal is to help prevent flare-ups, achieve and maintain remission, and heal as much of the underlying inflammation (even in periods without symptoms) as possible. Specific treatments a naturopathic doctor may recommend include:

Elimination/challenge diets or other approaches to reducing food triggers (including elemental diets) to stop and prevent flare-ups
Curcumin in tincture, capsule, or whole turmeric powder form to reduce inflammation (however, there are contraindications to the use of turmeric. For instance, turmeric should be avoided in patients who readily form calcium oxalate kidney stones)
Probiotics to modulate the immune system and prevent flare-ups
Stress reduction by various techniques
Artemisia absinthium (wormwood) capsules

Because they are lifelong conditions, Crohn’s and ulcerative colitis must be carefully monitored and managed, with more aggressive interventions necessary during flare-ups. Research shows that a naturopathic medical approach emphasizing diet and other lifestyle changes can be used to successfully manage these conditions. Naturopathic therapies may eliminate the need for prescription drugs (such as prescription anti-inflammatory medications, immune system suppressors, and antibiotics) or surgery, which have the potential to cause more side effects and long-term problems. However, if natural approaches are not successful, naturopathic physicians do not hesitate to prescribe palliative medications (when in state scope of practice) or to refer patients for treatment with various medications, biologic drugs, or surgery. A naturopathic medical approach has the added benefit of focusing on engaging patients in managing their own health—a crucial component of living a long and healthy life with these challenging conditions.

By AANPsite