Naturopathic Prevention and Management of Type 2 Diabetes

Written by Institute for Natural Medicine Staff

Contributors: American Association of Naturopathic Physicians (AANP)

Medically Reviewed by Signe Poquette, ND

Published March 29, 2024
Last Updated March 29, 2024

Despite its growing prevalence, type 2 diabetes (T2D) is a widely underestimated health hazard in the United States. T2D’s toll on individual and community health, healthcare infrastructure, and the economy deepens yearly.

In 1994, the Centers for Disease Control and Prevention declared diabetes a national epidemic. Diabetes costs surged for the more than two decades that followed, reaching $412.9 billion in 2022. People diagnosed with the disease now account for one in every four healthcare dollars spent in the United States. Diabetes alone is responsible for an $80 billion increase in healthcare costs over the past ten years, with direct medical costs exceeding $306 billion in 2022.¹

Alongside skyrocketing care costs, the shortage of U.S. health practitioners will likely worsen in the coming years. This complex tangle of issues might make for the perfect storm if not for the fact that type 2 diabetes is largely preventable.

Fostering broader understanding of naturopathic medicine and implementing effective natural prevention and treatment for T2D could alleviate unnecessary strain on the country’s overburdened healthcare system. Natural interventions and whole-person strategies address patients’ unique circumstances and preferences to develop a customized treatment plan with lasting positive effects.

Risk Factors for Type 2 Diabetes

Type 2 diabetes (T2D) affects up to 36 million Americans, and rates are rising.² With T2D, which affects 90% to 95% of people with diabetes, the body doesn’t make enough insulin or use it properly. When sugars linger in the blood, long-term health issues can result, including heart complications, nerve damage, and vision loss.³

Several factors increase T2D risk. However, diabetes doesn’t just suddenly appear. “The number one risk is prediabetes,” says naturopathic doctor and endocrine specialist Alan Christianson, NMD. “Fasting glucose above 100 is defined as being in that risk range. Being consistently above 100 or 125 is considered diabetes. In current stats, that’s about 38% of adults.”

Obesity is another risk factor. Dr. Christianson notes that about 42% of adults in the United States are considered overweight, and 30% are considered obese—an astonishing total of 72% of the U.S. adult population. “There’s also a subset of those who have a healthy body weight but are considered thin on the outside and fat on the inside,” says Christianson. “This is called ‘skinny fat’ and [makes up] another substantial percentage of the population.” People who exercise fewer than three times a week are also at increased risk for diabetes, which Christianson notes is about 72% of U.S. adults.

Additional risk factors include non-alcoholic liver disease and diabetes during pregnancy (gestational diabetes). Women whose babies weigh more than nine pounds at birth are also at higher risk. Being over 45 or having a parent or sibling with T2D also raises the risk.⁴

Diabetes rates are higher among racial and ethnic communities in the United States than in white populations. American Indian and Alaska Native adults have the highest rates of diagnosed diabetes at 13.6%, followed by Black non-Hispanic/Latinx adults at 12.1%, Hispanic/Latinx adults at 11.7%, non-Hispanic/Latinx Asian adults at 9.1%, and white non-Hispanic/Latinx adults at the lowest rate of 6.9%. Diabetes rates are also higher for people with less education, as well as people living in rural areas.² Black Americans with diabetes pay the most in direct healthcare costs.¹

“We see disproportionate risks among different ranges of socioeconomic status,” Dr. Christianson says. “Lower socioeconomic status itself is an independent risk factor for developing diabetes. But this also increases risks for complications because many of these populations are underserved medically.”

Serious complications linked to type 2 diabetes include an increased risk of limb amputation, heart attack, blindness, stroke, and kidney failure. High blood pressure, high cholesterol, nerve damage, and depression may also result.⁵ While these conditions affect quality of life and health spending for all people with diabetes, those already struggling with social and financial challenges are particularly hard hit.

States With the Highest Diabetes Burden

The charts below show diabetes prevalence by state and states with the highest proportion of diabetes (by percentage of population).

Figure 1: Diagnosed Diabetes Cases by State

Figure 2: Percentage of State Population with Diagnosed Diabetes

*Charts adapted from the American Diabetes Association, Statistics by State*⁶

Although California has the highest number of diabetes diagnoses (over 3 million), that statistic represents just over 11% of adults in the state. West Virginia has the highest percentage of people diagnosed with diabetes (15.9%), which translates to 226,300 residents.

Only three states appear in Figures 1 and 2: Texas, Ohio, and North Carolina, all part of the “Diabetes Belt,” where provider burden, poor access to care, and healthcare costs are arguably more significant. Nearly all the states in Figure 2 are in the Southern United States.

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Naturopathic Management of Type 2 Diabetes

Nutrition and lifestyle changes are the cornerstones of naturopathic practice and diabetes management. Naturopathic doctors (NDs) support whole-person health and the body’s natural healing ability, focusing on self-care, prevention, diet, physical activity, and stress management. The next steps in naturopathic treatment are clinical nutrition (i.e., targeted nutrients for specific diseases), herbal medicine, homeopathy, and hands-on manual therapies.³ Medications and surgery are considered, but not as a first line of treatment. As Figure 3 shows, this approach to health also effectively reduces economic burdens.

Figure 3: Hierarchy of Therapeutics Used in Naturopathic Medicine and Cost Implications for Health Care in the United States

Early Diagnosis

More than 8 million Americans have diabetes but don’t know it. How can naturopathic doctors facilitate early diagnosis and management? “With better access to NDs,” says Dr. Christianson, “people can have better access to care. Many populations don’t trust conventional medicine, but many will seek out those they perceive as outside that system.”

Although patients may not initially see an ND for diabetes testing, the first appointment with an ND often reveals disease likelihood. “Often, the symptoms they are complaining of (chronic pain, fatigue, weight struggles) can be tied to blood sugar regulation,” says Christianson. “If there are more NDs out there, they can help connect more people with what’s happening and screen better. Just diagnosing people can be a huge step toward improved care.”

Tackling Prediabetes

The progression of uncontrolled blood sugar to type 2 diabetes diagnosis can take years. A critical window lies between prediabetes and diabetes, when NDs can intervene to help actively reverse disease. “At later stages of diabetes, lifestyle changes can help,” notes Dr. Christianson. “But the real opportunity is prediabetes—when lifestyle changes are huge. We can guide them toward effective, evidence-based approaches, keep them away from fads, and give them a sense of accountability. They have a partner who sees their gains and can measure their progress.”

Comprehensive Nutrition Education

Naturopathic doctors complete intensive training in clinical nutrition, one of the starting points for type 2 diabetes prevention and treatment. Many ND–recommended dietary strategies and supplements for T2D effectively reduce risk factors.³ Putting their “doctor as teacher” motto to work, NDs focus on educating patients to form healthy eating habits that have lasting effects.

Practical Guidance

A healthy diet isn’t the only lifestyle change that can help prevent and address type 2 diabetes. Dr. Christianson emphasizes the need for quality sleep and more exercise to support the hypothalamic–pituitary–adrenal (HPA) axis, counter stress, and keep the body balanced.

Naturopathic medicine also recognizes the strong impact of mental health—emotional, psychological, and social well-being. People with diabetes frequently experience depression, which may prevent them from adopting or adhering to a healthy lifestyle. Supporting mental health through counseling, yoga, mindful activities like meditation, supplements, and other modalities could also reduce the long-term trajectory of type 2 diabetes.³

Although conventional doctors may recommend dietary and lifestyle changes, licensed naturopathic doctors take an intensive, hands-on approach to supporting patients. “Often, patients are not given logistic tools to implement these changes,” explains Christianson. “We’re uniquely poised, as this is the center of our whole focus. How do you make that happen? How do you implement that? We’re the experts in that.”

Compared with conventional treatment, naturopathic care emphasizes non-medication and non-surgical options, customizing care to each patient’s preferences and needs. Naturopathic practice flips the script from the traditional “top-down” approach to care, putting more agency and decision-making power in patients’ hands. Research shows that trusted and balanced doctor–patient relationships not only improve health outcomes but may also reduce healthcare costs.³ With collaborative care, doctors and patients work together to identify harmful behaviors, self-care strategies, and modifiable environmental and contextual factors to optimize overall health, minimize drug dependency, and avoid higher-force interventions.³

Expanding Access to Naturopathic Care

A projected shortage of 17,800 to 48,000 primary care physicians is projected by 2034. Two to five of all practicing physicians will be 65 or older within the next decade, approaching traditional retirement age.⁷ There are growing concerns about physician burnout (worsened by COVID–19), which may contribute to early retirement.

Given the substantial current and anticipated shortage of primary care physicians across the United States, naturopathic doctors could effectively increase access to care for many patients. “In so many underserved areas, there just aren’t enough practitioners to go around,” Dr. Christianson notes. “This is heightened for those in rural areas or of lower socioeconomic status. That’s where the big need is for additional providers.” Among rural and low-income communities, diabetes rates are significantly higher.²

Dr. Christianson also points to opportunities for intergenerational diabetes care. “Primary care providers often become involved with the family,” he says. “In many ways, diabetes is a familial condition. There are genetic links, and lifestyle is often shared among families. NDs commonly treat multiple generations, and that’s the most effective approach. It’s easier to change [as a family] than just as an individual.” Family factors are especially relevant for T2D in children and teens, which continues to rise.⁸

On average, people with diagnosed diabetes have medical expenditures 2.6 times higher than those without diabetes.¹ As with many chronic conditions, treatment costs may increase as the disease worsens. Prevention alone can significantly reduce healthcare costs. “Anything done at the early stage can have pronounced, dramatic effects upon later stage care,” Dr. Christianson explains. “The big healthcare costs come from later-stage interventions. Big complications like kidney failure mean ongoing dialysis for many years. Amputation means surgery and hospitalization. These things are massive economic burdens. For each individual that does not get to that level of intervention, [any other preventive care] provides a great deal of return on investment.”

According to Christianson, there is a clear framework for curbing cases of prediabetes and T2D, starting with three basic questions: How do we help identify at-risk people, how can we get them proper care, and how do we keep the disease from progressing?

“When the body can’t keep glucose [within] its healthy window, nothing functions at its best,” says Dr. Christianson. “We can’t think, feel, or physically perform at our best. Quality of life is impaired in so many ways, and many of these symptoms of modernity can improve when someone gets better control of their blood sugar.”

Investing in Prevention

Productivity loss due to diabetes costs the United States $35.8 billion yearly, with missed workdays accounting for an additional $5.4 billion.

Spending on insulin has also tripled in the past ten years, reaching $22.3 billion in 2022.⁹ Estimated T2D costs per person amount to $85,200. Redirecting a mere 1% of these costs toward primary prevention would create a new market worth about $17 billion.³

Naturopathic practice is poised to attain the triple aim of health care: enhancing health outcomes and patient satisfaction while reducing costs. Coupled with the benefits of increased healthcare access, alleviating the shortage of primary care physicians, and fostering robust doctor–patient relationships, naturopathic medicine is a viable solution for revitalizing the country’s strained healthcare infrastructure and turning the tide on type 2 diabetes.

This article was produced jointly by the American Association of Naturopathic Physicians and the Institute for Natural Medicine as part of the Campaign for Natural Medicine, a public awareness effort to broaden understanding of naturopathic medicine and support access to naturopathic doctors.

Footnotes

1
Parker ED, Lin J, Mahoney T, et al. Economic costs of diabetes in the U.S. in 2022. Diabetes Care. 2024;47(1):26-43. https://doi.org/10.2337/dci23-0085
2
National Diabetes Statistics Report. Centers for Disease Control and Prevention. Published November 29, 2023. Accessed February 21, 2024. https://www.cdc.gov/diabetes/data/statistics-report/index.html
3
Bradley R, Harnett J, Cooley K, McIntyre E, Goldenberg J, Adams J. Naturopathy as a model of prevention-oriented, patient-centered primary care: a disruptive innovation in health care. Medicina (Kaunas). 2019;55(9):603. https://doi.org/10.3390/medicina55090603
4
Diabetes Risk Factors. Centers for Disease Control and Prevention. Published April 5, 2022. Accessed February 21, 2024. https://www.cdc.gov/diabetes/basics/risk-factors.html
5
Put the Brakes on Diabetes Complications. Centers for Disease Control and Prevention. Published November 3, 2022. Accessed February 21, 2024. https://www.cdc.gov/diabetes/library/features/prevent-complications.html
6
Statistics by State. American Diabetes Association. Accessed February 21, 2024. https://diabetes.org/about-diabetes/statistics/by-state
7
The Complexities of Physician Supply and Demand: Projections from 2019 to 2034. IHS Markit Ltd. Association of American Medical Colleges. June 2021. https://www.aamc.org/media/54681/download
8
Pinhas-Hamiel O, Zeitler P. Type 2 diabetes in children and adolescents—a focus on diagnosis and treatment. [Updated 2023 Nov 7]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK597439
9
New American Diabetes Association Report Finds Annual Costs of Diabetes to Be $412.9 Billion. American Diabetes Association. November 1, 2023. Accessed March February 21, 2024. https://diabetes.org/newsroom/press-releases/new-american-diabetes-association-report-finds-annual-costs-diabetes-be

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The Institute for Natural Medicine, a non-profit 501(c)(3) organization. INM’s mission is to transform health care in the United States by increasing public awareness of natural medicine and access to naturopathic doctors. Naturopathic medicine, with its person-centered principles and practices, has the potential to reverse the tide of chronic illness overwhelming healthcare systems and to empower people to achieve and maintain optimal lifelong health. INM strives to fulfil this mission through the following initiatives:

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Naturopathic Prevention and Management of Type 2 Diabetes

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Risk Factors for Type 2 Diabetes

States With the Highest Diabetes Burden