FAQs

faqs-heading

1. How are naturopathic doctors educated, trained, and licensed?

The AANP and the INM would like to acknowledge the Association of Accredited Naturopathic Medical Colleges (AANMC) for its contributions to the content of this FAQ. The AANMC was established in 2001 to advance the naturopathic medical profession by actively supporting the academic efforts of accredited naturopathic medical schools.

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. During these later years, the education of MDs and DOs begins to differ from those of naturopathic doctors. For example, students of conventional medical complete clerkships, which are courses in various medical specialties. Although MD students see patients during these clerkships, their roles are primarily observational: they are not primarily responsible for patient care.

Third- and fourth-year naturopathic medical students have more 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.

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.

  1. 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
  2. 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.
  3. 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.
  4. Correct Structural Integrity. Physical modalities such as spinal manipulation, massage therapy, and craniosacral therapy are used to improve and maintain skeletal and musculature
  5. 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
  6. 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.
  7. 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

 

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.

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.

  1. 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.

  1. 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.

  1. 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.

  1. 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.

  1. 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 Order 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.

4. What is the difference between a licensed naturopathic doctor and an unlicensed naturopath?

The AANP and the INM would like to acknowledge the Association of Accredited Naturopathic Medical Colleges (AANMC) for its contributions to the content of this FAQ. The AANMC was established in 2001 to advance the naturopathic medical profession by actively supporting the academic efforts of accredited naturopathic medical schools.

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.

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.

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, and often from a purely online or correspondence format. Such education is not 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.

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.

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.

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

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. 

  1. 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.

  1. 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.1 Because 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.

  1. 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.

  1. 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

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

  1. 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.

  1. 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/

7. How do naturopathic doctors help people manage chronic pain without highly addictive opioids?

The AANP and the INM would like to acknowledge Amy Rothenberg, ND for her contributions to the content of this FAQ. Some of the content for the FAQ appeared in articles by Dr. Rothenberg in the Boston Globe and Huffington Post.

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.

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

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.

8. How do naturopathic doctors and conventionally trained doctors work together?

The AANP and the INM would like to acknowledge Len Wisneski, MD, FACP, and Holly Lucille, ND, RN, for their contributions to the content of this FAQ.

There 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 diet 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.

9. How does naturopathic medicine support breast cancer prevention and treatment?

The AANP and the INM would like to acknowledge Amy Rothenberg, ND and Heather Barrett, ND for their contributions to the content of this FAQ. Some of the content for the FAQ appeared in articles by Dr. Rothenberg in the Huffington Post and by Dr. Barrett on her blog.

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.

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 Vivo2011; 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

10. How do naturopathic doctors empower people to take charge of their health?

The AANP and the INM would like to acknowledge Holly Lucille, ND, RN for her contributions to the content of this FAQ. 

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 US 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/

11. How do naturopathic doctors treat patients with diabetes?

The AANP and the INM would like to acknowledge the contributions of Ryan Bradley, ND, MPH, to the content of this FAQ. Some of the content first appeared in an article by Mona Morstein, ND, DHANP, and on the AANP website.

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