When I write about naturopaths, I frequently point out that their “ND” suffix, which they claim as “naturopathic doctor,” in reality should mean “not-a-doctor.” The reason, as I’ve documented over the years, is the pure pseudoscience and quackery at the heart of naturopathy, not to mention the antivaccine pseudoscience. Basically, naturopathy embraces a cornucopia of quackery, including antivaccine beliefs and homeopathy. It seems that naturopaths will embrace almost any treatment, no matter how ridiculous in concept, unsupported in science, and without evidence of clinical efficacy. (If you don’t believe me, just ask Britt Hermes, a former naturopath who realized that she had become a quack and turned her back on her former medical specialty and has become a target for her previous colleagues.) I also find it deceptive how naturopaths try to brand themselves as the true “doctors of prevention.” That’s why I was annoyed yesterday when I saw this:
Addressing the underlying causes of heart disease takes time and whole-person care. Naturopathic doctors excel at preventing and treating heart disease. Find out how in this new FAQ: https://t.co/ZFB0sEqRvf #heartmonth #naturopathicmedicine #naturopathic pic.twitter.com/DGPZOhAplr
— AANP (@AANP) February 1, 2018
Note the image. Note the fake doctor cosplaying a real doctor, complete with a naturopath wearing a stethoscope holding an exotic fruit as though it were medicine. I can’t help but note that, back when I was a surgeon, we used to make fun of docs who wore their stethoscopes like a fashion accessory, as this naturopath is. But let’s look at the claims contained in this Naturopathic Medicine FAQ published by the American Association of Naturopathic Physicians (AANP). The question: How do naturopathic doctors prevent and treat heart disease? The answer? They don’t, really, at least not nearly as much as they claim. Sure, anyone can recommend more exercise and a diet rich in plants and lower in foods that contribute to atherosclerotic heart disease, but there’s so much other nonsense.
So here we go:
Heart disease, the leading killer for both men and women in the U.S., is largely preventable if caught and treated early. Naturopathic doctors (NDs) excel at preventing and treating cardiovascular disease because they focus on identifying the underlying causes of disease and empowering patients to make enduring lifestyle changes to restore and maintain their health. A study investigating the effects of lifestyle changes in patients with atherosclerosis (the buildup of fatty, cholesterol-rich plaque in the arteries) found that after only one year of following lifestyle recommendations, about 80 percent of participants were able to bring about plaque regression and avoid surgery without the use of lipid lowering agents.
First of all, what is it with this antipathy towards statins? It’s also a fallacy that doctors go straight to statins. They already use the recommendations of the trial cited in this paragraph, which showed that lifestyle changes can potentially reverse atherosclerotic plaques in blood vessels. Naturopaths like to claim the use of diet, exercise, and other lifestyle changes to treat and prevent disease as though it’s their bailiwick, their purview alone. They also like to claim that they alone are the only ones who look for the “root causes” of disease:
Root causes of heart disease often show up as warning signs in other bodily systems, and many times they are the result of chronic inflammation in the body.2 Chronic inflammation can arise from poor diet, a sedentary lifestyle, stress, autoimmune disease, food allergies, and many other sources. Inside arteries, inflammation helps kick off atherosclerosis, which narrows the arteries and increases the risk they’ll become blocked. This can lead to heart attacks and certain types of strokes.3
Naturopathic doctors spend between one and two hours with patients in an initial appointment, and a good portion of this time is dedicated to identifying sources of inflammation. Trained to be “inflammation hunters,” NDs perform a methodical review of your major bodily systems (skin, digestion, joints, respiratory, etc.). They will also ask detailed questions about your diet and physical activity, and discuss your main stressors and coping strategies.
All of which sounds good on the surface. but what does this actually mean? According to the AANP, it equals this:
Naturopathic doctors will match diagnostic lab tests to findings from your intake in order to determine what is causing your symptoms. Just as the intake is a detailed interview process, so are labs an in- depth series of questions to your body. They will be individualized, and may include the following:
- Lipid panel that includes oxidized LDL (the primary type of cholesterol found in plaques), inflammatory markers, autoimmune markers, and lipoprotein particle analysis
- Full glucose panel
- Comprehensive neurotransmitter profile
OK, real doctors order lipid panels for patients at risk for atherosclerotic heart disease, as well they should. The same is true for a glucose panel, given that many patients at risk for atherosclerosis are also at risk for type II diabetes. But what the heck is a comprehensive neurotransmitter panel? I did a bit of searching and found one such panel, which includes Epinephrine, Norepinephrine, Dopamine, Serotonin, Glycine, GABA, Glutamate, PEA, Histamine. Another panel only includes six of these. Often these “neurotransmitter panels” include claims like:
Correction of imbalanced hormones is important but not always sufficient. Correction of imbalanced neurotransmitters, on the other hand, is imperative if clinical progress is to be made. Determining which neurotransmitters are low and which are high should precede clinical intervention.
No, there is no good evidence that this is the case. As usual, this is an instance of naturopaths thinking that they understand how the body works and falling into the first year medical school trap of thinking that if there is a lab abnormality they have to chase it and try to correct it.
Now here’s one of the scariest parts:
Naturopathic doctors follow the Therapeutic Order, a set of guidelines for clinical decision making that prioritizes minimally invasive therapies to support the body to repair itself. Because of this, NDs lead with natural treatments. However, they are also trained to use pharmacological drugs when necessary.
If their state license permits, NDs can prescribe medications such as diuretics, beta-blockers, and ACE inhibitors as a bridge to manage symptoms of chronic inflammation or cardiovascular disease (e.g. hypertension), until the body repairs itself. If not, they will refer patients to and collaborate with a conventional medical colleague.
The thought of naturopaths prescribing real pharmaceutical drugs always sends a chill up and down my spine—and not in a good way. It’s more like this: The thought of unqualified quacks actually prescribing drugs with significant side effects makes me cringe with fear over what they are doing to patients. Fortunately, the vast majority of naturopaths are not permitted to use real drugs. Unfortunately, the line about how naturopaths will refer to real doctors if their “natural” remedies fail is a bit of—shall we say?—exaggeration. After all, naturopathy is a self-contained system of quackery. Things have to be really bad to make a naturopath admit defeat and refer a patient to a real doctor.
The gastrointestinal (GI) tract is a common source of inflammation in the body. Gut flora are living microorganisms that provide a wall of protection between your digestive tract and your blood stream. When the flora in your digestive tract are not in balance, you risk developing localized inflammation. This can lead to alterations in intestinal permeability (leaky gut) which can contribute to heart disease.
Naturopathic doctors help repair the GI tract using their extensive training in diet and clinical nutrition. Restoring proper PH, balancing flora, correcting leaky gut and constipation – linked with a higher risk of dying from cardiovascular disease8 – are focal points of naturopathic.
I can’t help but be amused that one of the references is to a video by the Cleveland Clinic (these days, not known for its adherence to science any more). It’s highly preliminary evidence, at best. Of course, naturopaths are all about glomming on to research findings that (they think) support their naturopathic world view and starting to incorporate them into what they do
to for patients, long before they are validated in later research and clinical trials. The problem? Most such early provocative findings, far more often than not, fail to be validated in later studies.
Then there’s the rebranding:
Addressing endothelial dysfunction. The endothelium is the inner lining of your blood vessels. It is considered one of the largest organs in your body, and plays an important role in maintaining good heart health. If the endothelium is not functioning optimally, you have an increased risk of arterial inflammation and plaque build-up, which can lead to heart attack or stroke. Endothelial dysfunction is caused by lifestyle factors including tobacco use, obesity, age, hypertension, hyperlipidemia, physical inactivity, and poor diet.
Yes, it is true that vascular endothelium is a critical component in the pathogenesis of atherosclerosis. It’s even true that chronic inflammation, particularly of the endothelium, is a factor in the pathogenesis of atherosclerosis. This is something that has been known for a long time, even if the exact inciting factors and causes are not always well understood. Naturopaths, of course, like to sound science-y even as they abuse science. So, instead of just saying that stopping tobacco use, reversing obesity, correcting diet, and the like can reverse atherosclerosis, they have to label these interventions as “normalizing” endothelial function.
Is it all bad? Even I can’t say that it is. For instance, the last bullet point in the FAQ is that naturopaths “believe it is their duty to inspire patients to exercise, rather than just give them guidelines” That’s a good thing. If only that were just the only thing that naturopaths devoted themselves to, in addition to promoting more healthy diets, I might not take such a dim view of them. That’s the problem, though. I like to echo Dirty Harry Callahan in pointing out that “A man’s got to know his limitations.” The problem is that naturopaths never do. They’d do more good as personal trainers, but that’s not what they want. They think they’re real doctors. As a result they don’t just limit themselves to scientifically defensible lifestyle interventions. They want to be doctors. They think they are doctors. They are not. So they add quackery that both fits within their worship of the “natural” as the best way to treat everything and makes them feel like real doctors.