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1. WHAT IS IT?
- DIET AND LIFESTYLE ADVICE
- VITAMIN SUPPLEMENTATION
- BOTANICAL (HERBAL) MEDICINE
- SPINAL MANIPULATION
- DETOXIFICATION (DETOX) THERAPIES
6. IS IT SAFE?
WHAT IS IT?
Naturopathy is a system of alternative medicine that incorporates many different natural health/alternative medical practices. It is based upon several beliefs and guiding principles [1-3]:
1) The Healing Power of Nature (Vis Medicatrix Naturae): the human body possesses self-healing capabilities
2) Identify and Treat the Cause (Tolle Causam): treat the underlying cause of illness as opposed to the symptoms
3) Doctor as Teacher (Docere): educate patients and encourage individual responsibility for health
4) Treat the Whole Person: treatment should take a holistic approach and consider all aspects of a patient (physical, mental, emotional, social, spiritual, etc.)
5) Do No Harm (Primum Non Nocere): minimize harmful side effects of treatment, use the least “force” necessary to diagnose and treat illness, and avoid the harmful suppression of symptoms
Some of these principles are shared with conventional medicine, while others are borrowed from traditional (non-evidence-based) philosophies [4-5].
Naturopathy employs numerous “natural healing” approaches, which are claimed to promote or augment the body’s inherent healing powers . Such practices include:
- Diet and lifestyle advice (“Clinical Nutrition”)
- Vitamin supplementation (see: Vitamin Supplements)
- Botanical (herbal) medicine (see: Herbalism)
- Homeopathy (see: Homeopathy)
- Spinal manipulation (see: Chiropractic)
- Acupuncture and Traditional Chinese Medicine (see: Acupuncture)
- Detoxification (“Detox”) therapies
- Many more
Despite claims to the contrary, naturopathy is generally opposed to conventional medicine and scientific inquiry . Some of the philosophies underlying naturopathy outright reject evidence-based medicine , while others promote distrust of conventional treatments . Anti-vaccine views are also common amongst naturopaths [6, 7-8].
DO NATUROPATHS HAVE THE SAME TRAINING AS DOCTORS?
Naturopaths (also known as Doctors of Naturopathic Medicine, ND) are not medical doctors (MDs). They receive less training than MDs and are taught diagnostic approaches and treatment practices that are rejected by conventional medicine and science . Their education is not generally recognized by medical professionals as being sufficient to allow accurate diagnosis of illness or the provision of appropriate therapies .
Naturopathic training programs are typically 4 years in duration, where the first 2 years are spent in a classroom, and the last 2 are spent in clinical experiences. Most naturopaths begin practicing after these 4 years. Some may choose to pursue an additional 1 year residency, which consists of further clinical training .
Medical school is also 4 years in duration, with 2 years of classroom learning and 2 years of clinical placements. However, after these 4 years, medical doctors are not allowed to practice medicine. They must first complete an additional mandatory 2-6 years of residency training, depending on their specialty. Family physicians require 2-3 years of residency training .
In total, naturopaths receive approximately 15,000 fewer hours of training than a family physician .
As mentioned, the content of the training is also drastically different. Naturopath programs dedicate significant numbers of hours to instruction on unscientific views of health and disease, and provide training in modalities that lack scientific support (see below: What’s the evidence?). Additionally, some naturopathic schools foster anti-science views amongst their students [6, 8]. In studies of a Canadian naturopathic school, anti-vaccine attitudes were held by over 80% of students, with those beliefs increasing as students progressed through their 4 years of training [6, 8]. Mistrust of conventional medicine was also prevalent amongst these students .
In summary: at best, naturopaths receive less than a third of the training time of family physicians, where much of it includes unproven theories of disease development and management.
DOES IT WORK?
A large part of naturopathic practice involves providing general diet and lifestyle advice (i.e. coaching on healthy eating and exercise). These methods are known to be effective for preventing disease and promoting good health. Therefore, when it comes to these interventions, naturopaths are probably quite helpful.
For the majority of other naturopathic practices, there is little or no reason to believe that they are effective.
WHAT'S THE EVIDENCE?
Quick Definition: "Systematic Review"
A systematic review (and/or “meta-analysis”) is a scientific study that examines the agreement between many clinical trials. Instead of looking at a single study, systematic reviews attempt to analyse the totality of evidence related to a topic. By doing so, the true answer to a given question can be more accurately estimated. For example, a single study might indicate that a particular treatment is effective, leading readers to believe that this treatment works. However, what if three other studies conclude that the same treatment does not work? A systematic review might analyse the data from all four of these trials and conclude (correctly) that the totality of the evidence indicates that the treatment does not work (3 say no, only 1 says yes). The relative importance of each study is determined by things like study size (number of participants – more is better), chance for bias, consistency of measurements, and many others.
Because of their strength, systematic reviews are generally considered one of the highest standards of evidence. However, they are also not perfect, and are subject to the quality of the contributing clinical studies. Hence, if only low-quality studies are used, low-quality results will emerge (a.k.a. “garbage in, garbage out”).
Diet and Lifestyle Advice
As mentioned above, a large part of naturopathy is simply diet and lifestyle advice . It is well-established that proper nutrition and appropriate lifestyle choices (e.g. regular exercise, not smoking, stress reduction, etc.) are highly effective methods to prevent disease and promote good health [11-15]. Therefore, when used by naturopaths, diet and lifestyle counselling are likely to benefit their patients. The results of a clinical trial support this assumption: when patients were given additional nutritional and lifestyle advice from a naturopath over the course of a year, measurements of their cardiovascular disease risk decreased . However, it should be noted: this trial did not compare naturopathic diet/lifestyle advice to conventional (i.e. doctor/dietician-provided) diet/lifestyle advice. It simply compared “normal treatment” (visiting a family doctor) to “normal treatment” plus “naturopathic care” (visiting a family doctor and a naturopath, where the naturopath gave additional diet/lifestyle advice). Essentially, the study was only testing what would happen if patients were given more counselling on nutrition and lifestyle – the fact that a naturopath was involved was likely irrelevant. If the same advice had been given by a dietician or doctor, the effect would be the same .
Proper nutritional and lifestyle counselling are not unique to naturopathic practice. As noted, the benefits of diet and lifestyle modifications for the prevention of disease are well-established and based on rigorous scientific research. For this reason, conventional medicine incorporates these practices as essential components of chronic disease management and health-promotion strategies. For example, nutrition and lifestyle interventions are foundational to diabetes management, acting as the first steps of therapy before drug treatments are started [12-13]. Likewise, proper diet, exercise, and smoking cessation are considered essential for preventing heart disease, and are strongly recommended by medical guidelines [11, 14-15]. The same is true for cancer prevention and other diseases . Thus, it is important to recognize that the inclusion of diet/lifestyle counselling in naturopathic practice does not represent a special quality of naturopathy, but instead emphasizes the universal value of scientifically-proven health-promotion strategies.
Naturopaths use many different treatment modalities. Overall, the majority of these practices have little to no evidence to support their use. A 2011 study investigating the most commonly advertised services by naturopaths concluded that most of these practices are not supported by scientific evidence . The study emphasized that even if some naturopaths use evidence-based treatment approaches, their most highly-advertised (and likely most profitable) services are without a solid scientific basis.
The evidence (or lack thereof) behind some of the most common/popular naturopathic treatments is discussed below.
Naturopaths routinely recommend high-dose vitamin supplementation for general health promotion, disease prevention, and the treatment of specific illnesses that are not necessarily related to nutrient deficiencies [3, 19-21]. These supplements are typically advertised and sold as pills or injections. While it is true that some clinical conditions associated with nutrient deficiency/increased nutrient needs (e.g. vitamin deficiency, pregnancy, alcoholism, nutrient malabsorption, others) may require vitamin supplementation, there is little to no evidence to support most of the vitamin-related claims of naturopaths. Systematic reviews of many clinical trials demonstrate that there is no reliable evidence to suggest that taking vitamin supplements extends life, improves general health, or reduces the occurrence of disease (including heart disease and cancer) [22-28]. Hence, there is no good reason for healthy people to take (or spend money on) vitamin supplements, especially in the high doses recommended by many naturopaths.
Some naturopaths also sell vitamin injections as a treatment for cancer . There is no credible evidence to support this potentially dangerous practice.
For more information about vitamin supplementation, please see: Vitamin Supplements.
Botanical (Herbal) Medicine
Naturopaths often prescribe herbal remedies for the treatment of various illnesses [3, 19-20]. While some herbal products are known to have medicinal properties, the vast majority of those available on the market (either over-the-counter or from a naturopath) are not effective . Furthermore, the practice of “individualized” herbalism – whereby naturopaths/herbalists prescribe unique mixtures of herbs that are catered to treating a patient’s specific combination of symptoms and illnesses – has not been shown to be effective for any condition .
It should also be noted: herbs with medicinal properties should be treated like drugs (indeed, they are essentially unpurified pharmaceuticals). Although they may be “natural”, they are not necessarily safe or without side effects. Many herbal remedies cause moderately severe side effects , and others may negatively interact with conventional pharmaceutical drugs . Thus, before using an herbal remedy from a naturopath (or any other source), patients should ask their doctor about any potential interactions with their current prescriptions.
For more information regarding the medicinal value (or lack thereof) of specific herbal remedies, please see: Herbalism.
Homeopathy is commonly used by naturopaths for the treatment of a wide variety of illnesses [3, 19-20]. However, there is no evidence to support this practice. Systematic reviews of hundreds of clinical trials consistently demonstrate that the use of homeopathy cannot be justified for any health condition [33-37]. Simply put: homeopathy does not work.
For a more in-depth discussion about homeopathy, please see: Homeopathy.
Spinal manipulation therapy appears to be effective for the treatment of chronic low-back pain . However, for other pain-related conditions, the evidence is either unclear  or it does not support spinal manipulation therapy [40-41]. For all other non-musculoskeletal conditions, this practice does not work [41-42].
For a more in-depth discussion about spinal manipulation therapy, please see: Chiropractic.
Generally speaking, acupuncture does not work. For treating pain and nausea, acupuncture is probably better than nothing, but it is no different from “fake” (placebo) acupuncture [43-49]. In other words, it is a placebo effect. For all other conditions, there is no reliable evidence to support the use of acupuncture.
For a more in-depth discussion about acupuncture, please see: Acupuncture.
Detoxification (Detox) Therapies
Alternative detox therapies are advertised as a means to cleanse “toxins” from the body. Many naturopaths and detox-selling companies claim that the accumulation of environmental toxins in the human body can cause a wide range of illnesses and undesirable symptoms . Common uses for detox therapies by naturopaths include gastrointestinal disorders, autoimmune diseases, fatigue, inflammation, and general “cleansing” .
Typically, the naturopathic definition of “toxin” is vague and may include anything from synthetic chemicals to processed foods . As such, detox regimens are usually prescribed without any specific toxin being identified . Additionally, the mechanisms of action of detox therapies (i.e. how they work) are typically poorly-defined . This is perhaps reflected by the wide range of proposed detox methods, which include special diets, vitamin supplementation, electromagnetic devices, colon cleansing/enemas, sauna therapy, homeopathy, ear candles, chelation therapy, and others [51-52].
There is no credible evidence to suggest that the detox regimens sold by naturopaths and commercial entities have any meaningful effect on human health [51-53]. Reviews of the current evidence behind these practices have concluded that either a) no clinical studies have reliably demonstrated that detox treatments work, or b) that no such studies even exist (for specific treatments) [51-53]. Of those studies that do exist, all are of low-quality and questionable credibility . Simply put: there is no good reason to use (or purchase) alternative detox therapies.
SUMMARY OF COMMON NATUROPATHIC PRACTICES
IS IT SAFE?
The safety of naturopathy depends on the treatments being used. While many naturopathic practices are likely harmless, others have known side effects and risks. For example:
- Regular supplementation with certain vitamins may be harmful, especially at the high doses recommended by some naturopaths. For instance, clinical studies and systematic reviews have demonstrated that beta-carotene and vitamin E supplementation likely increase mortality (i.e. risk of death), and the same may be true of vitamin A [23, 54].
- Many herbal remedies cause moderately severe side effects , and others may negatively interact with conventional pharmaceutical drugs .
- Manipulation of the cervical spine (neck) may lead to a stroke .
- Acupuncture may cause infections and collapsed lungs [46, 56].
- Many others.
Perhaps the most important risk of naturopathy, however, is the potential indirect harm that may result if sick patients choose to use unproven therapies over science-based treatments. If patients avoid or delay medically necessary care because they have decided to use naturopathy instead, serious harm or death can result. This is especially concerning in the cases of disease prevention (e.g. vaccination) and serious illnesses. For example, if parents choose ineffective homeopathic “vaccines” (known as “nosodes” and offered by some naturopaths) in place of standard vaccination for their children, they may leave their children and the public vulnerable to vaccine-preventable diseases . Likewise, the delay or avoidance of treatment for serious illnesses (such as cancer, severe infections, severe depression, etc.) can lead to an unnecessary shortening of life and an increase in suffering. This type of harm has been documented for naturopathic practices [58-61].
IS IT ETHICAL?
Considering that most naturopathic practices are not supported by evidence, questions arise with respect to the ethics of advertising/recommending such practices to patients. Several authors have argued that this aspect of alternative medicine is unethical and unjustifiable, and emphasizes the lack of legitimacy that underpins practitioners of these therapies [62-66].
An important concept in medical ethics is informed consent. Essentially, this principle states that in order for a patient to protect their freedom of choice in health-related decisions (also known as their autonomy), they must fully understand the options available to them . This includes an understanding of the treatments in question, their benefits and risks, and the consequences of doing nothing. For consent to be truly informed, the patient must:
- Provide consent freely (i.e. they are not coerced)
- Be capable (i.e. the patient must be physically/mentally able to give consent)
- Be given full disclosure (the patient must be given accurate information and must comprehend the information)
If patients are not fully informed, their right to self-determination (i.e. to make decisions about their own body and life) is violated. Hence, providing a treatment without informed consent is unethical .
Given the fact that most naturopathic practices lack evidence of effectiveness, yet naturopaths tell their patients that such therapies are effective, it is reasonable to conclude that many naturopaths do not fully inform their patients . This would mean that naturopaths routinely violate a fundamental principle of medical ethics and do not obtain truly informed consent from their patients .
Selling Unproven Therapies
From a consumer protection perspective, some argue that many of the services/products sold by naturopaths represent dishonest business practices . Indeed, if a product is said to work, but there is no evidence to support that claim, promoting its use might be considered false advertising. Since most naturopathic practices do not work but are advertised as effective, similar conclusions may be drawn about naturopaths.
TOO LONG; DIDN'T READ!
Naturopaths may provide useful advice regarding proper nutrition and lifestyle choices. Unfortunately, the majority of naturopathic practices are not supported by reliable scientific evidence.
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