Naturopathy-Putting Nature Back into Medicine
By Stephen Parcell, N.D. (2002)
Bastyr Center for Natural Health
Remember your last visit to a doctor's office? Chances are, your doctor spent all of ten minutes "visiting" with you before prescribing the "appropriate" drug to "handle" your complaint. Though that's the way it is nowadays, that's not the way it has to be. There is an alternative-you could see a Naturopathic Physician. While conventional "Allopathic" doctors usually treat symptoms, Naturopathic Physicians treat "the whole person," taking into consideration the mind-body-spirit interconnection and the individual needs of the patient. Spending up to 90 minutes for an initial visit and an average of 45 minutes for follow-up exams, the Naturopath asks numerous questions, performs a detailed physical exam, thoroughly investigates symptoms and complaints, explains treatment options and includes the patient in choosing a treatment plan.
Naturopathic physicians are primary care providers (family physicians) and, like a conventional doctor, an ND will often use a number of laboratory procedures, as well as the exam, to make a diagnosis. Additionally, nutritional status, metabolic function, and toxic load are frequently used to aid in diagnoses and treatment decisions. The patient's mental, emotional, and spiritual status are also assessed. Noninvasive therapies, such as lifestyle or behavior modification and relaxation techniques, may be "prescribed." Spinal manipulation, massage therapy, therapeutic nutrition, botanical medicine, detoxification, physiotherapy, exercise therapy, homeopathy, acupuncture and psychological counseling may also be included in the treatment. In states where naturopathic physicians are licensed, NDs may also perform minor outpatient surgery, give vaccinations and administer selected prescription drugs. In the state of Washington, NDs can treat most conditions, with the exception of cancer or those requiring surgery. When prudent, an ND will refer patients to a specialist for a definitive diagnosis and advice.
Is A Naturopath Really A Doctor?
The first two years of naturopathic school are very similar to conventional medical school, requiring anatomy, physiology, pathology, biochemistry, neurology, radiology, minor surgery, microbiology, obstetrics, immunology, gynecology, pharmacology, pediatrics, dermatology and lab, clinical laboratory and physical diagnosis, among other courses. The second two years focus on clinical skills and a wide range of natural therapeutics. NDs receive training in naturopathic therapeutics such as botanical medicine, homeopathy, natural childbirth, acupuncture, physiotherapy and clinical nutrition. Because coursework in natural therapeutics is added to a standard medical curriculum, naturopathic doctors receive significantly more hours of classroom education in these areas than graduates of many leading medical schools. Students also complete a clinical internship consisting of 1,500 hours under the supervision of licensed naturopathic and conventional medical physicians in an outpatient setting.
Naturopathic medicine is not identified with any particular therapy, but with a philosophy that health and disease are a continuum, and that the body has a profound ability to heal itself-when given the proper conditions. Therefore, naturopathic patients are educated in ways to access the body's innate wisdom, promote vibrant health and prevent disease. Preventive care results in financial benefits, as health is maintained, disease avoided, and costly procedures averted.
Though Naturopathy came to the U.S just over 100 years ago, the natural therapies and the philosophy on which it is based have been effectively used to treat diseases for thousands of years. In fact, the word "physician" is from the Greek root meaning "nature." Hippocrates, a physician who lived 2400 years ago, coined the phrase, "nature is the healer of all diseases." This concept underlies the principles outlined in the "Hippocratic Oath," as stated below:
· First, do no harm.
· Act in cooperation with the Healing Power of Nature.
· Address the fundamental causes of disease.
· Heal the whole person through individualized treatment.
· Teach the principles of healthy living and preventive medicine.
Natural substances to treat pathologies are carefully prescribed and monitored before the consideration of surgery, toxic drugs, radiation or chemotherapy.
A Brief History of Naturopathy
The predecessor of naturopathy may have been the great Jewish philosopher Maimonides (1135-1204) who, in contrast to many of his medical colleagues, downplayed the importance of drugs and surgery and argued that diet, exercise, and mental outlook were the keys to vibrant health. A court physician to the royal family in Cairo, Egypt, his book Preservation of Youth, espoused completely natural methods. Written for a dissolute young prince who suffered everything from depression to indigestion, he warned, "overeating is like a deadly poison to any constitution and the principle cause of all diseases."
The German Christoph Wilhelm Hufeland (1762-1836), who served as royal physician to the King of Prussia, is regarded as one of the founders of holistic medicine. A prolific author and proponent of "Nature Cure," which consisted of hydrotherapy (cleansing the colon with a water flush), air and light baths, vegetarian diet and herbal remedies, Hufeland was also a great fan of mineral springs and "Water Cure" (popularized by Sebastian Kneipp). His most successful written work, The Art of Prolonging Human Life (1796), became one of the most widely read books on preventive medicine and was the first natural health best-seller. Hufeland coined the phrase "macrobiotics," later adopted by George Oshawa, an admirer of Hufeland and founder of the modern Macrobiotic movement. Hufeland was deeply influenced by the philosopher Jean-Jacques Rousseau (1712-1778), whose ideology fueled the philosophy of naturism and the nature cure movement, which became popular throughout Europe.
Naturopathy On The Rise
Naturopathy, which combined nature cure with homeopathy, massage, spinal manipulation, and therapeutic electricity, was developed in America largely through the work of Benedict Lust (pronounced loost; 1872-1945). From 1900-1938, naturopathic medicine flourished in America. Interest then declined, due to the emergence of "miracle medicine," surgical advances during WWII, and the growing political sophistication of the American Medical Association (AMA). Chiropractic and naturopathy were taught together until about 1955, when the National Chiropractic Association stopped granting accreditation to schools that also taught naturopathy.
In 1956, doctors founded the National College of Naturopathic Medicine in an attempt to keep the profession alive. Dr. John Bastyr, considered the father of naturopathy, served as executive director. A chiropractor, naturopath and obstetrician, he began his practice in Seattle in the depths of the Great Depression; Bastyr was so revered as a physician and teacher that the Naturopathic College (Bastyr University) in Seattle was named in his honor. The key to Bastyr's legendary clinical successes lay in his basic philosophy. In a 1985 interview, asked to distinguish between naturopathy and conventional medicine, he said, "The basic difference is that in naturopathy it's not the doctor who does the curing, it's the patient."
That idea appealed to many Americans in the 1970's, when the public's growing awareness of the importance of nutrition and the environment, along with disenchantment with organized institutional medicine, brought new waves of students to Naturopathy.
A Real Life Case
Let's look at a real-life naturopathic "case." Bob, a graduate engineering student in his 30s, came to the Bastyr Center for Natural Health, complaining of a peptic ulcer and increasing fatigue. He had been to his allopathic doctor repeatedly over the last six years because "the ulcer kept coming back."
When he came to our office, we asked Bob about his stress level, sleep, diet, drug use, social life, family support network, ability to relax, and exercise. Bob's lifestyle was pretty good, other than diet and his stress level, which was high due to school and finances. Although he appeared to have a healthy diet, when considered over a two-week period it fell short on fruits, vegetables and healthy fats, while sugar intake was too high. When asked about caffeine, Bob proudly said "gave it up-switched to decaf a year ago." We asked him to stop the decaf because both caffeinated and decaffeinated coffee increase acid production, too much of which can cause over-acidic blood levels, creating an environment for disease. We also explained to him how animal fats are implicated in inflammatory disorders and that eating high sugar foods can also increase stomach acid secretion.
After looking at his medical tests to make sure he was not someone who secretes excess acid (people with peptic ulcers can have low, normal, or above normal acid levels) we offered him an alternative to antacids. We recommended he take deglyrrhizinated licorice (DGL) and explained to Bob why most antacids are not good for him:
"Most antacids are mixtures of aluminum hydroxide and magnesium hydroxide that neutralize stomach acid. Complications of aluminum hydroxide treatment include constipation and excess aluminum ingestion. Magnesium stimulates gastrin release, leading to increased gastric acid secretion (acid rebound). Calcium carbonate is another potent and inexpensive antacid. Like magnesium hydroxide, calcium carbonate ingestion is also associated with acid rebound. Chronic excessive calcium carbonate administration may cause kidney stones and possibly kidney disease."
Goals of treatment for Bob included pain relief, acceleration of ulcer healing, and prevention of ulcer recurrence and complications. In approaching a case like this we need to ask, "why is this happening?" What is the cause of this person's inability to maintain an adequate mucosal defense against stomach acid? Many of us have H. Pylori but do not get ulcers, so clearly this bacterium is not solely responsible.
The normal stomach and duodenum resist the corrosive effects of acid and pepsin by secreting a gel-like coating that allows gastric juices to flow in a one-way direction from the stomach lining to the stomach cavity. Once secreted, the gel layer protects the stomach lining from its corrosive effects. It is the breakdown of this protective coating that predisposes to ulcer formation. Food allergy can cause inflammation and a release of histamine. Histamine strongly stimulates acid secretion (it is through blocking histamine that drugs like Tagamet work to reduce acid). Our treatment for Bob included:
Lab tests: blood tests to check for different types of anemias and other abnormalities; a urea breath test to check for presence of H. Pylori. To promote ulcer healing: DGL, the amino acid Glutamine, zinc, and copper, and buffered vitamin C. To rule out food allergy: a diet diary to take home and fill out; a recommendation for food allergy screening. General supportive therapies: a probiotic supplement to help reestablish healthy intestinal microflora (disrupted from the antibiotics and the acid blocker); a high quality multivitamin without iron; a diet that included more fish and olive oil and less animal fat; a relaxing, enjoyable activity at least five times a week.
Bob returned for three visits over the course of three months, after which time his ulcer symptoms were completely gone and his fatigue had improved. He is currently taking only the multivitamin and the DGL. Bob realized that he needed to reduce his stress level and incorporate more fruits and vegetables into his diet. To further improve his energy level, we suggested food allergy testing. Because his insurance would not cover this, we had him remove two of the most likely culprits: milk and wheat. As you can imagine, Bob was pleased with the results of his Naturopathic Care.
It can not be overemphasized how important factors such as stress, nutritional deficiencies, food allergies, lack of sleep, toxin overload, emotional distress, and poor diet play in the cause of many illnesses. Stress alone can lead to a variety of common complaints such as irritable bowel syndrome, constipation, ulcers, stomach pain, and headaches, to name a few. Often, a prescription drug is not the best long-term answer to treating and preventing illness; whereas preventing disease in the first place through maintenance of the immune systen makes much more sense.
So, How Do I find an ND
Currently, NDs are licensed in Alaska, Arizona, Connecticut, Hawaii, Maine, Vermont, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. In unlicensed states, NDs are allowed to practice, but not to the full extent of their training. Look through this magazine for a naturopath or go to the AANP website at: http://www.naturopathic.org.