I’ve known Mr. G. for about a year now. When he first presented to me he’d had about 6 months of hand swelling and pain, and by the time I met him he had fusiform swelling of all his PIPs. There was no doubt that he had rheumatoid arthritis.
But we had a problem, sort of. Mr. G. had a history of drug and alcohol abuse but had turned his life around. Now that he was the model of an upright citizen, he had no interest in becoming dependent on more Western medicine.
Before he saw me, he had consulted a naturopath, who recommended that he follow an anti-inflammatory diet. After my admonitions about joint damage and internal organ involvement, I ultimately agreed to let him try the diet, but only if he agreed to regular follow-up with me.
I saw him for follow-up 6 weeks later – he had followed the diet to the letter, and, contrary to my expectations, his joints were about 50% better. In broad strokes, the anti-inflammatory diet is based on the premise that the intake of fruit and vegetables as well as whole wheat is inversely associated with the risk of inflammation, for which there is support in the literature (Int. J. Vitam. Nutr. Res. 2008;78:293-8). Some variations on the diet include using organic sources as much as possible, staying away from sugar and artificial sweeteners, and avoiding tomatoes, potatoes, and eggplant.
Now of course we as doctors are not satisfied with 50% better. Our patients want to be completely pain free, and we twist ourselves into knots trying to help them achieve that. But Mr. G. was content with the state his hands were in. He felt healthy and his discomfort was manageable. He said he could live with this state of affairs.
This got me thinking about naturopathic medicine. What is it, and how does it differ from our usual advice?
In the process of answering those questions, I got to meet with Celeste Ruland, N.D., a naturopathic doctor and personal trainer. Here’s what I learned from our conversation and my own research:
Naturopathic medicine is a 4-year graduate program. Just like students of allopathic medicine, students of naturopathic medicine study anatomy, physiology, biochemistry, microbiology, pharmacology, and other basic sciences. Students of naturopathic medicine have an organ system–based curriculum. In addition, they study Chinese medicine, herbal medicine, manipulation, and homeopathy. To practice, naturopaths have to meet licensing requirements.
The philosophy, I gathered from speaking to Dr. Ruland, is to treat illness and prevent it, using the "mind/body balance."
"Where are they out of balance, and what is the best way to balance them?" she asked. "The key is to empower the patient to stay well." While prescribing remedies such as homeopathy is sometimes part of the solution, the larger part involves altering the patient’s diet, lifestyle, and environment to restore the mind/body equilibrium.
This may sound like excessive tree-huggery, but I do think there is some value to this. After all, how often do we preach lifestyle modification? It is a very mainstream concept. Recently, Dr. Dean Ornish published a piece in the New York Times about how to eat healthily. How much evidence is there that viscosupplementation works? How much evidence is there that acupuncture works? If something does not harm the patient and could be potentially helpful, I certainly have no objections. I can’t embrace the concepts of naturopathic medicine to the exclusion of Western medicine, of course, but I see a place for it in conjunction with allopathic medicine.
In addition, I kind of like the idea that there are health care providers who don’t have the same constraints that those of us who take insurance do. These providers can spend way more time counseling patients on good sleep hygiene and avoiding highly processed foods, on exercise and stress-reduction – conversations that we would love to have with our patients but don’t have time for.
Epilogue: About 8 months after his diagnosis, Mr. G developed serositis. We managed to treat it – grudgingly on his part – with steroids, but our agreement, after all, was that when the time came he would trust me with my Western medicine. He is now on a biologic DMARD and is doing very well, much better than the initial 50% improvement that had him so satisfied.
Dr. Chan practices rheumatology in Pawtucket, R.I.