Naturopathic Medicine

The Role of Naturopathic Medicine in the Health Care System

N

aturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease.

Naturopathic doctors receive between seven and 12 years of post-secondary education. They use treatments including diet and lifestyle changes and/or natural therapies including botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation and acupuncture / Asian medicine. Treating both acute and chronic conditions, naturopathic treatments are chosen based on the individual patient – their physiological, structural, psychological, social, spiritual, environment and lifestyle factors.

In Canada, the naturopathic medical profession’s infrastructure includes accredited educational institutions, professional licensing, national standards of practice, participation in many federal health committee initiatives, and a commitment to state of the art scientific research.

Extended wait times and accessibility, limited patient rights and information, and a poor range of services; these are just a few of the prevailing criticisms when it comes to Canada’s health care system.

In 2008, Canada received a ranking of 23 out of 30 when compared to European health care systems. When the money spent on health care per capita was included, Canada fell to the 30th spot. In fact, the first annual Euro-Canada Health Consumer Index, published in January of 2008, finds Canada’s performance “in the bottom tier”. While it suggests that Canada compares well in outcomes with the best health care systems, the Euro-Canada Health Consumer Index blames wait times and accessibility for Canada’s over-all bottom tier performance.

A recent Conference Board of Canada Health Survey gave Canada a ‘B’ rating and ranked our country 10th out of 16 countries for health performance; a sharp drop from the previous 5th place in the 1990s. Our low rankings on the world stage exist despite increases in health care spending; Canada is one of the top 5 countries when it comes to money spent on health care per capita. link And, as this 2007 survey suggests, there is an “increasing prevalence of chronic diseases”. The survey goes on to conclude that “Canada must adopt a new business model for health care that focuses on both preventing and managing chronic disease”. link

Clearly there is a need in Canada to develop a health care system that is more proactive, efficient, effective, and ultimately more sustainable. When we speak about the environment, we speak about a sustainable future achieved by lowering our individual carbon footprint. The same idea applies to building a sustainable health care system in Canada. Namely, we need to lower our “health care footprint” and minimize the impact we have on the costs of maintaining a health care system that remains socialized and accessible to all. One of the best ways to accomplish this end is to improve our health promotion strategies, and support regulated health care professionals with expertise in health promotion and preventing and treating disease.

70-80% of all chronic diseases are preventable by dietary and lifestyle changes (Kiberstis P and Roberts, L, 2002; Boswell-Purdy, J et al., 2007). Naturopathic doctors (NDs) are well trained to deliver this message of prevention to Canadians and implement the necessary treatment strategies to help develop a more sustainable health care system.

Naturopathic doctors are regulated as primary health care providers in six provinces in Canada and 15 states in the USA. NDs are one of only three health professions that provide primary health care for patients, along with medical doctors and nurse practitioners. Naturopathic Doctors prevent and treat many different illnesses ranging from the common cold to terminal cancer. NDs can contribute to a more effective health care system in Canada by reducing patient overload for often over-worked MDs. In particular, NDs are well trained to diagnose and treat chronic conditions; conditions that tend to be very time consuming and cost prohibitive to the mainstream medical system.

This paper will focus on three main areas of naturopathic practice and how they can contribute to the creation of a more sustainable health care system in Canada. This discussion will include:

1. The safe and effective use of Natural Health Products (NHPs) in treating acute and chronic diseases
2. The importance of therapeutic detoxification in an increasingly toxic world
3. The importance of healthy dietary and lifestyle habits in preventing chronic disease

The safe and effective use of NHPs in treating chronic diseases

It was estimated in a recent Health Canada survey that 71% of Canadians use NHPs regularly to help treat and prevent illness link. It is important to note that not all NHPs have equal value when it comes to efficacy and safety in treating disease.

The variability in the quality of nutritional supplements was recognized in Canada and NHPs are now a subset of drugs with their own distinct regulations under the Food and Drugs Act to ensure all NHPs meet high standards of safety, quality and efficacy. In 2004, the Natural Health Products Directorate (NHPD) was created, a branch of Health Canada that is responsible for developing regulations and providing regulatory oversight for NHPs link . By the end of 2010, all NHPs in Canada will be required to have either a Natural Product Numbers (NPN) or Drug Identification Number-Homeopathic medicine (DIN-HM). This will ensure that all of the NHPs Canadians purchase in health food stores, natural pharmacies or at their health care professional’s office, will have met high standards of safety, quality and efficacy.

Naturopathic doctors are highly trained health care professionals in the safe and effective use of NHPs and therefore, have been closely involved in every step of the creation and implementation of this important federal regulatory system. The first Director General of the NHPD was an ND and more than ten (10) NDs are employed at the NHPD and in various other departments within Health Canada. NDs sit on the Expert Advisory Committees of the NHPD and the Vigilance of Health Products. Furthermore, there are increasing opportunities for NDs to assist in educating other health care professionals about the safety and efficacy of NHPs (Lescheid DW, 2008; Lescheid DW, 2007).

The high quality NHPs used by NDs have been shown in many different clinical trials to effectively treat chronic disease. For example, melatonin (Jung B and Ahmad N, 2006), green tea extracts (Carlson JR et al., 2007), curcumin (Anand P et al., 2008), resveratrol (Aggarwal BB et al., 2004), milk thistle (Greenlee H et al., 2007; Meeran SM and Katiyar SK, 2008) have been shown to be effective adjunctive therapies in the treatment and prevention of cancer. Intravenous vitamin C has also shown promise in the treatment of cancer (Frei B and Lawson S; Padayatty SJ et al., 2006) and many NHPs reduce some of the risk factors for the development of heart disease. Some examples include Coenzyme Q10 (Pepe S et al., 2007; Rosenfeldt FL, et al., 2007), omega 3 fish oils (Schwalfenberg G., 2006), curcumin (Miriyala S et al., 2007), resveratrol (Das S and Das DK. 2007), isoflavones (Sacks FM et al., 2006), Vitamin D (Michos ED and Blumenthal RS, 2007) and green tea extracts (Wolfram S., 2007). Many of the NHPs listed above are effective treatment and preventative agents because of their ability to modulate inflammatory cytokines. Chronic inflammation has been established as a major risk factor in the development of many different chronic diseases (Licastro F et al., 2005).

When a person’s current state of health is first assessed, lifestyle changes are the first to be addressed. From there, naturopathic doctors use botanicals along with vitamins and minerals. These natural medicines work best, provided they are dosed in the right quantity with the correct dosing schedule. Naturopathic doctors are experts in natural medicine and therefore able to provide advice that would result in the best health outcomes from NHP supplementation with a minimal risk of side effects.

The importance of therapeutic detoxification in an increasingly toxic world.

It is becoming increasingly evident that persistent exposure to certain environmental toxins can have a negative impact on health (Liska and Bland, 2002). Some recent examples of environmental toxins with well-documented negative effects include Bisphenol A (Lang IA et al., 2008; Von Saal FS and Myers, JP, 2008), phthalates (Lottrup G et al., 2006; Stahlhut RW et al., 2007), mercury (Dufalt R et al., 2009; Mahaffey KR, 2005; Mahaffey KR et al., 2009) and certain common food additives (McCann D et al., 2007). Several recent surveys by the Environmental Defense Group have shown that Canadians of all ages, ethnic backgrounds and geographical locations contain significant amounts of potentially harmful toxins (http://www.environmentaldefence.ca/toxicnation/home.php).

Toxins interfere with normal homeostasis and biorhythms. The body can often self-regulate and heal itself if these toxins are removed however, not all of the marketed detoxification protocols are safe and effective. Indeed some individuals, depending on their current health and medication, might receive no benefit or actually be harmed by an inappropriate detoxification protocol. The safest, most effective detoxification is achieved when the process is supervised by a qualified, regulated health care professional such as an ND.

An important part of therapeutic detoxification is recognizing that there are certain food substances that, if ingested on a regular basis, can cause chronic inflammatory reactions and therefore, disease in susceptible people. A few examples of these food substances include lactose (in dairy products) (Lomer MC et al., 2008) and gluten (in many different grains) (Catassi C and Fasano A., 2008; Rodrigo L, 2006). It was commonly believed that ingestion of these foods by susceptible people would result in gastrointestinal disturbances however, is it becoming increasingly evident that there are many extra-intestinal manifestations of lactose intolerance (Matthews SB et al., 2005) or gluten sensitive enteropathy (Gasbarrini G et al., 2008; Hernandez L and Green PH. 2006). If toxins and food disturbances are not identified and cleared before other treatments are given, recreating a healthy balance can take longer and therefore become more costly to the health care system. NDs can support the removal of these toxins and identify food intolerances through specific therapeutic detoxification protocols.

Naturopathic doctors are trained to test for these sensitivities to certain foods and provide alternative dietary suggestions. Several effective forms of detoxification used by NDs include food-based detoxification using diets restricted to foods and drinks with a low probability of causing hypersensitivity reactions (Nick G, 2002). Similarly, there are a number of different NHPs and functional foods that have been shown to improve the ability of the body to remove toxins. Specific oral or intravenous chelators can also be safely and effectively used to remove any heavy metals, such as cadmium, lead, aluminum and mercury that might be interfering with normal physiological pathways. Naturopathic doctors also use infrared saunas as another effective way to remove toxins, in particular toxins that are stored in adipose tissue.

The importance of healthy dietary and lifestyle habits in preventing chronic disease.

The two most common causes of mortality in Canada and most of the developed world are cancer and cardiovascular disease. link There are increasing reports that maintaining life long healthy dietary and lifestyle habits can prevent the development of these diseases in most individuals. For example, a recent report entitled “Food, nutrition, physical activity and the prevention of cancer: a global perspective” (www.dietandcancerreport.org) outlines the evidence supporting the benefits of certain foods and lifestyle choices in preventing the occurrence of different cancers. A recent review in Canada arrived at similar conclusions that diet and lifestyle had a major impact in the development of chronic diseases such as cancer (Boswell-Purdy J et al., 2007).

A recent expert review concludes that “Cancer is a preventable disease that requires major lifestyle changes” (Anand P et al., 2008). Other modifiable risk factors for the development of cancer and cardiovascular disease include energy intake, physical activity and obesity (Gutierrez DA et al., 2009; Pan SY and DesMeules M, 2009). The evidence also is increasing that dietary changes can reduce the risk of developing cardiovascular disease (Barbard ND et al., 2006; Jenkins DJ and Kendall CW, 2003).

Many Canadians need to be educated to understand that some of the lifestyle and dietary choices that they make will have a negative impact on their health. A recent global survey by the international union against cancer reported that most people were not aware of the modifiable risk factors for cancer. They identified the leading preventable risk factors as smoking, obesity, radiation, alcohol and physical inactivity. link

One of the principles of Naturopathic medicine is docere; doctor as teacher. NDs have the training and take the time (30 minutes to 1.5 hours per visit) to help teach their patients about the risk factors involved in the development of chronic disease and the behavior modifications needed to overcome those risks.

There also is increasing support for the impact of other more intangible risk factors such as chronic stress on the risk of cardiovascular disease (Brotman DJ et al., 2007) and sleep disturbance on the development of cancer (Blask DE, 2008). During their education, naturopathic doctors study lifestyle counseling techniques so that they can assist their patients with different ways to remove or modify the lifestyle factors associated with their disease.

Conclusion

Naturopathic doctors are highly trained health care professionals and experts in natural medicine. NDs are well suited to provide advice that would result in the best health outcomes from NHP supplementation. NDs can assure NHPs are provided in the right quantity with the correct dosing schedule. As a result, NDs lower the risk of side effects requiring further treatment, promote long term healing, and therefore, reduce additional costs to the health care system.

Toxins and food sensitivities are proven to have a negative effect on health (Liska and Bland, 2002). Naturopathic doctors offer safe and effective ways to detoxify the body. NDs also test for sensitivities to certain foods and provide alternative dietary suggestions thus educating patients and encouraging alternative options to food choices that may negatively affect health.

Naturopathic Doctors are experts in natural medicine. Treating both acute and chronic conditions, naturopathic doctors treat the individual patient after assessing their physiological, structural, psychological, social, spiritual, environment and lifestyle factors. In addition to diet and lifestyle changes, natural therapies including botanical medicine, clinical nutrition, hydrotherapy, homeopathy, naturopathic manipulation and acupuncture/Asian medicine may also be used during treatments.

Naturopathic Doctors teach patients about diet and lifestyle changes, about health promotion and about disease prevention. Naturopathic doctors are well suited to be at the forefront of a shift towards a more sustainable health care system in Canada because they treat the root cause, encourage long term results and teach patients to manage their own health. NDs minimize the dependency of ill individuals on their health care providers. Their ability to encourage, educate and help implement health promotion strategies and disease prevention initiatives can help aid an already burdened health care system.

references:

• Kiberstis P and Roberts L. It’s not just the genes. 2002. Science 296(5568): 685
• Boswell-Purdy J et al., 2007. Population Health Impact of Cancer in Canada. Chronic diseases in Canada, 2001: 28(1-2): 42-55.
• Lescheid D. W. Sept 19-20, 2008. Clinical decision making in community practice. Ontario Pharmacists annual conference: Niagara Falls, ON.
• Lescheid DW. May 9, 2007. Naturopathic medical approaches to common ENT disorders. Abbot Labs Pharmaceutical Symposium for ENT specialists. Toronto, ON.
• Jung B and Ahmad N. 2006. Melatonin in cancer management: progress and promise. Cancer Res 66(20): 9789-93.
• Carlson JR et al., 2007. Reading the Tea Leaves: Anticarcinogenic properties of (-)-Epigallocatechin-3-Gallate. Mayo Clin Proc 82(6): 725-732.
• Anand P et al., 2008. Cancer is a preventable disease that requires major lifestyle changes. Pharmaceutical Res 25(9): 2097-2116.
• Aggarwal BB et al., 2004. Role of resveratrol in prevention and therapy of cancer: preclinical and clinical studies. Anticancer Res 24(5A): 2783-840.
• Colomer R et al., 2007. N-3 fatty acids, cancer and cachexia: a systematic review of the literature. Br J Nutr 97(5): 823-31.
• Greenlee H et al., 2007. Clinical applications of Silybum marianum in oncology. Integrative Cancer Therapies 6(2): 158-165.
• Meeran SM and Katiyar SK. 2008. Cell cycle control as a basis for cancer chemoprevention through dietary agents. Front Biosci 13:2191-2202.
• Frei B and Lawson S. 2008. Vitamin C and cancer revisted. PNAS 105(32): 11037-11038.
• Padayatty SJ et al., 2006. Intravenously administered vitamin C as cancer therapy: three cases. CMAJ 174(7): 937-42.
• Pepe S et al., 2007. Coenzyme Q10 in cardiovascular disease. Mitochondrion 7S: S154-67.
• Rosenfeldt FL et al., 2007. Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials.J Hum Hypertens 21(4): 297-306.
• Schwalfenberg G. 2006. Omega3 fatty acids: their beneficial role in cardiovascular disease. Can Fam Physician 52: 734-740.
• Miriyala S et al., 2007. Cardioprotective effects of curcumin. Adv Exp Med Biol 595:359-77.
• Das S and Das SK., 2007. Resveratrol: a therapeutic promise for cardiovascular disease. Recent Patents Cardiovascular Drug Discov 2(2): 133-8.
• Sacks FM et al., 2006. Soy Protein, Isoflavones, and Cardiovascular Health An American Heart Association Science Advisory for Professionals From the Nutrition Committee. Circulation. 113: 1034-1044.
• Michos ED and Blumenthal RS, 2007. Vitamin D supplementation and cardiovascular disease risk. Circulation. 115:827-828.
• Wolfram S. 2007. Effects of green tea and EGCG on cardiovascular and metabolic health. J Am Coll Nutr. 26(4):373S-388S.
• Licastro F et al., 2005. Innate immunity and inflammation in ageing: a key for understanding age-related diseases. Immunity and ageing 2(8): 1-14.
• Liska D and Bland JS, 2002. Emerging clinical science of bifunctional support for detoxification. Townsend Letter for Doctors and Patients. 231:42-43
• Lang IA et al., 2008. Association of Urinary Bisphenol A Concentration With Medical Disorders and Laboratory Abnormalities in Adults. JAMA 300(11): 1303-10.
• Von Saal FS and Myers, JP. 2008. Bisphenol A and Risk of Metabolic Disorders. JAMA 300(11): 1353-1355.
• Lottrup G et al., 2006. Possible impact of phthalates on infant reproductive health. Int J Androl 29(1): 172-80.
• Stahlhut RW et al., 2007. Concentrations of urinary Phthalates are associated with increased waist circumference and insulin resistance in adult US males. Environmental Health Perspective 115:876-882 (2007).
• Dufalt R et al., 2009. Mercury from chlor-alkali plants: measured concentrations in food product sugar. Environmental Health 8:2 (http://www.ehjournal.net/content/8/1/2)
• Mahaffey KR et al., 2009. Adult Women’s Blood Mercury Concentrations Vary Regionally in the United States: Association with Patterns of Fish Consumption (NHANES 1999–2004). Environ Health Perspect 117:47–53.
• Mahaffey KR. 2005. Mercury exposure: medical and public health issues. Trans Amer Clin Climatol Assoc 116: 127-154.
• McCann D et al., 2007. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. The Lancet 370: 1560–67.
• Nick GL. 2002. Detoxification Properties of low dose phytochemical complexes found with select vegetables. J Amer Nutra Assoc 5(4): 34-44.
• Lomer MC et al., 2008. Review article: lactose intolerance in clinical practice--myths and realities. Aliment Pharmacol Ther 27(2): 93-103.
• Catassi C and Fasano A. 2008. Celiac disease. Curr Opin Gastroenterol 24(6): 687-91.
• Rodrigo L. 2006. Celiac disease. World J Gastroenterol 12 (41): 6585-6593.
• Matthews SB et al., 2005. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J 81(953): 167-73.
• Gasbarrini G et al., 2008. Celiac disease: what's new about it? Dig Dis 26(2): 121-7.
• Hernandez L and Green PH. 2006. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep 8(5): 383-9.
• Boswell-Purdy J et al., 2007. Population Health Impact of Cancer in Canada. Chronic diseases in Canada, 2001. 2007, 28(1-2): 42-55.
• Anand P et al., 2008. Curcumin and cancer: an “old-age” disease with an “age-old” solution. Cancer Lett 267(1): 133-64.
• Gutierrez DA et al., 2009. Impact of increased adipose tissue mass on inflammation, insulin resistance, and dyslipidemia. Curr Diab Rep 9(1): 26-32.
• Pan SY and DesMeules M. 2009. Energy intake, physical activity, energy balance, and cancer: epidemiologic evidence. Methods Mol Biol 472: 191-215.
• Barnard ND et al., 2006. A low fat, vegan diet improves glycemic control and cardiovascular risk factors in randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 29: 1777-1783.
• Jenkins DJ and Kendall CWC. 2003. Effects of a dietary portfolio of cholesterol-lowering foods versus lovastatin on serum lipids and C-reactive protein. JAMA 290: 502-510.
• Brotman DJ et al., 2007. The cardiovascular toll of stress. The Lancet 370: 1089-100.
• Blask DE. 2008. Melatonin, sleep disturbance and cancer risk. Sleep Med Rev Dec 16 [Epub ahead of print]
• Stevens et al., 2007. Meeting report: The role of environmental lighting and circadian disruption in cancer and other diseases. Environ Health Perspect 115:1357-1362.

Canada’s health care system needs some significant changes to become sustainable and remain accessible to all Canadians. In your opinion, what are some of the key solutions to the creation of a more sustainable health care system in Canada?

• Increased emphasis on the importance of prevention of chronic disease?
• Increased input from allied health care professionals, especially those trained to prevent and treat chronic disease?
• A two tiered health care system? - Dr. David Lescheid
  

. . .