Applied Evidence

Naturopathic medicine: What can patients expect?

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Naturopathic care—covered by many major carriers—can complement customary clinical practice.


 

References

Practice recommendations
  • Patients who inquire about naturopathy will want to know that clinical tools typically include nutrition evaluation and dietary revision, counseling for lifestyle modification, botanical medicine, homeopathy, physical medicine, and mind-body therapies.
  • Advise patients who wish to seek naturopathic care to contact the state licensing authority to learn the scope of naturopathic practice allowed in their local area.

What can patients expect when they seek a naturopathic approach to disease management? A case presented in this article illustrates the applications of naturopathy in practice (see Naturopathic approach to one patient’s case: A summary).

Naturopathic physicians (NDs) diagnose and treat conditions typically seen in a “first contact” setting. They are not trained in the advanced use of highly technical conventional therapies for life-threatening diseases. Rather, they focus primarily on health issues encountered in out-patient ambulatory care settings (see Naturopathic training).

Though some tools of naturopathic practice differ from those of conventional practice, the goals of naturopathic medicine parallel those of family medicine in providing for and maintaining the well-being of both the patient and the healthcare system as a whole.

Collaboration is growing between conventional and naturopathic communities to examine the safety and efficacy of naturopathic medicine in preventing and managing a broad range of common conditions, and to determine whether availability of naturopathic services will improve patient health in a cost-effective manner.

Naturopathic approach to one patient’s case: A summary

Patient encounter
Martha S., a 39-year-old Asian-American

Presenting complaint
Has not felt well since onset of light-headedness, fatigue, muscle pain, and lassitude 4 years earlier/muscle tightness or tension and achiness come and go, often relieved by chiropractic treatment/some fuzzy cognition/dry gritty feeling in back of eyes/decreased libido/intermittent heart palpitations/sadness, easy weeping in conjunction with menses, lessens somewhat with St John’s Wort/disturbed, unrefreshing sleep 4 out of 7 days/body pain worse on waking

History
Three normal births and 3 spontaneous abortions with anticardiolipin antibodies that resolved after pregnancy/2 D&Cs, no other surgery/incidental finding of partially empty sella tursica on MS MRI investigation

Extensive specialty workups since 2001 have ruled out disease/internist who coordinated specialty consultations favors diagnosis of generalized anxiety disorder/some improvement with low doses Celexa, but unacceptable side effects (same with Effexor)/has tried amitriptyline/husband travels and she is uncomfortable with a “drugged sleep” when alone with the children

Fell off horse as teenager/no other physical injury or significant viral or bacterial illness/job exposes her to adversarial atmosphere and also requires occasional extensive hours at keyboard/infertility issues; experience of foreign adoption was a prolonged stressor

Family
Maternal aunt and grandmother had breast cancer age 50+; both survivors/paternal grandmother had stroke/father had postoperative DVT

Social
1–2 glasses wine/week; recreational drug use over 10 years in past/no regular exercise/attorney for city/married 11 years; husband 48, Euro/American, smokes, on anti-HTN medication/adopted sibs from Korea 1 year ago, 5-yr-old girl, 2-year-old boy, some malnutrition, parasites, now recovered

Exam
Patient is pleasant, articulate/no active disease/5’8”, 128#, BP 128/62, P 82/findings normal for HEENT, neck, chest, heart, abdomen, extremities, neurology, and skin/tender trigger points at bilateral trapezoids, paraspinal to subscapular, upper third gluteal and at hips

Lab
extensive records provided, essentially normal, none since 11/2003

Medications
None now

Allergies
Sensitive to drug side effects, but no known drug allergies

Management plan discussed with patient
In absence of other underlying disease, would like to treat you for fibromyalgia syndrome from long-term professional and personal stress/will work to recover your system from the physiologic effects of tension, worry, and hard work over past decade/if progress unsatisfactory after 3 months, we will revisit the diagnosis

Plan is to restore-rejuvenate your body, which knows how to right itself/think 6 months to a year for full recovery, after which you will have new knowledge of yourself and tools to maintain your well-being/details of the plan will shift as you recover and learn to use developing self knowledge to protect yourself during new challenges/flexibility and resilience are key and develop continually from self awareness/note what works for you and what doesn’t

Diet Goal
Hypoallergenic, whole-foods; small, frequent meals/adjust eicosanoid balance to increase systemic circulation, musculoskeletal flexibility, and cellular repair (patient given background article)/decrease production of pain-signaling chemistry, swelling that presses on nerves and creates the sensations of pain and stiffness; avoid sweets and refined carbohydrates, in order to maintain steady blood sugar levels

Use serotype diet (diet printed for patient) for the next 6 weeks/stick with best foods; dip into OK foods as little as possible/whet appetite for best food by “selfishly” focusing on your recovery/invite family to share meals, but primary purpose is your recovery; this can be hard for a mom to pull off; please invite your husband to call me if I can help him understand how he can enable you accomplish goal

Possible further steps
(see online version for details of action steps):

  1. Support/restore digestive tract: May not be making optimal gastric acid and other digestive factors as a result of long term stress stealing circulation away from those tissues that produce it.
  2. Eliminate simple sugars and refined flour products: Will help reduce pain/simple sugar creates hypoglycemic episode that can be experienced as nameless anxiety, weakness, fatigue, and dizziness/stable blood sugar essential for sense of well-being/eat pears, berries, or nuts if you need dessert.
  3. Exercise: Aerobic exercise 45 to 60 minutes, 3 or more times/week
  4. Sleep: Melatonin 250 μg to 500 mcg 30 or so minutes before bedtime/Deeper, assisted sleep will help, and you can adjust dosages to keep head clear in morning.
  5. Fundamental supplementation: For general well being, including fish oils, vitamins, and minerals.
  6. Adrenal recovery formula: We can presume your endocrine system has been affected by perceptions of threat (anxiety as related to the mystery of your physical pains) as well as long-term pain/recommend adrenal function test, to more closely determine optimal timing and doses of raw material that supports adrenal function
  7. Massage/body work
  8. Generalized anxiety disorder: your internist is convinced of this diagnosis; let’s discuss.

Outcome

Over 2 months: Sleep improved; trigger point pain diminished in upper body (by 30%), in gluteal and hips (80%)/able to manage diet “70% to 80% of the time”/exercise 3 to 5 times weekly, less when husband travels

Vacation interlude: Treatment plan jettisoned for vacation/return of rheumatic symptoms; dizziness and lassitude, however, continued to improve

Next 2 months: Continued improvement, with trigger point pain flaring only on long drives

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