Hi Everyone. Happy Naturopathic Medicine Week 2018.
Every year I use Naturopathic Medicine Week as a reason to summarize whole Naturopathic research, highlighting recent research, and summarizing the overall field. I have decided not to focus on research on individual modalities like Acupuncture, Homeopathy or other specific medicines, but to focus on whole Naturopathic research, as this is what patient’s receive from Naturopathic Doctors, like myself. You can find my previous summary here. Contrary to the Fake News style propaganda used by detractors of our discipline, Naturopathic Medicine does have a wonderful research base of articles attesting to it’s efficacy in treating a number of conditions, many of which will be detailed below. We do not receive the large government subsidies for research that allopathic disciplines do in Canada and the United States, but the research we have conducted using the funding available is impressive.
To start with, for those unfamiliar with Naturopathic medicine, here is a great introductory video!
Naturopathic care in Cardiovascular disease was recently examined in a clinical trial. 246 postal workers received Naturopathic care (207 completed the study) in addition to normal family medicine from their MD. Lab chemistry was taken before and after Naturopathic care,and their risk of a major cardiovascular even was computed using the Framingham Risk Score method of computing the likelihood of a Cardiovascular event, and the Adult Risk Panel III to compute the prevalence of metabolic syndrome. One group in the study received Naturopathic care plus normal medical care, and another received only normal medical care. In this study a highly significantly reduced risk of a major cardiovascular event (risk reduction in control group of 10.81, risk in Naturopathic group of 7.74% for a reduction of 3.07%) and a reduction of metabolic syndrome (48.48% control group, 31.58% Naturopathic group for a reduction 16.9%).
This data was further analyzed in another paper for the economic impact of Naturopathic treatment. The above trial resulted in (corresponding to a 3.3% decreased risk of a Cardiovascular event) in a savings of $1138 in costs to society and $1187 in employer costs per year of Naturopathic treatment. The cost savings of livelong Naturopathic care that could be speculated on based on this remain staggering.
In response to this trial, this MD in CMAJ endorsed the idea of delegating some aspects of Cardiovascular care from Medical to Naturopathic Doctors. Many MDs would oppose this, but a significant minority of our Allopathic cousins would gladly cooperate with us in patient management.
Diabetes has also been examined in this way. In one trial, shown here, showed 65% of patients achieving a favorable outcome with 19% being able to stop antidiabetic medications completely. Furthermore, this trial clearly linked this to the Naturopathic intervention, with a 0.4% reduction in HA1C shown with with poor compliance to the interventions, 1.1% with moderate compliance and 1.7% with excellent compliance. For those who do not know, HA1c is a measure of glycated hemoglobin, a long term measure of blood sugar levels. Higher levels indicated higher chronic blood sugar. A second trial, shown here, in which not only did patient compliance and self care improve significantly, but HA1c also decrease relative to conventional care only at 6 and 12 months, although non-significantly.
I uncovered two other smaller studies on childhood otitis media, or middle ear infections . In the first study, 103 children with otitis media were treated with either a proprietary herbal product, or with an anesthetic and pain was assessed with a visual and an analogue scale over 3 days. Both groups resulted in very similar statistically significant reductions in pain. In the second study 171 children with ear pain were given either an anesthetic. While results were thought to be mostly due to time, the herbal ear drops did report a better outcome/
Naturopathic care of anxiety has a number of trials available now. In the first, published in 2009, 81 participants were randomized to recieve either Naturopathic care of a standardized Psychotherapy treatment. Thier symptoms were tracked with the Beck Anxiety inventory, the Short form-36, Fatigue Symptom Inventory, and MYMOP forms. The patient retention was high ( 75%) for at least 8 weeks. Both treatments resulted in highly significant reductions of the Beck Inventory. However, the Naturopathic treatments resulted in a highly significant ( p<0.003) reduction in anxiety relative to the standardized psychotherapy.
In the second more recent trial 112 patients from a Naturopathic community health centre in King County Washington were followd while undergoing Naturopathic treatment for depression and anxiety. Their initial and ending GAD-7 and PHQ-9 scores (both standardized questionaires to measure anxiety and depression respectively). The patients responded wonderfully, with a reduction of about 50% of their scores (depression average scores: 16.4 initially to 8.4, Anxiety average scores: 12.4 initially to 7.2). these results were highly statistically significant (p<0.0001).
Another Clinical trial on the Naturopathic treatment of rotator cuff tendonitis was recently published. In it, a group of postal workers with diagnosed rotator cuff tendontis received either a stanrd set of physiotherapy exercises to do on thier own (an approach not unlike that which many MDs in family practice will use before a physiotherapy referral) as well as a matched placebo. Pain was measured using Shoulder pain and disability index scores, visual analogue pain score, Short form 36, and MYMOP. 87% of participants completed 8 weeks of treatment, SPADI scores decreased by 54.5% (p<0.0001) in the Naturopathic care group and 18% (p<0.0241) in the Exercise group. All measures showed significant differences in favor of Naturopathic care, with SPADI showing a difference probability of <0.0001 and no major adverse outcomes reported.
In a similar trial 75 postal employees with back pain greater than 6 weeks duration were given either Naturopathic medicine or standardized exercises ( again similar to what they might recieve at an MD practice) for 12 weeks. Progress was measured using the Oswestry disability questionaire, as well as the SF-36, lower back range of motion, weight loss and BMI. 92% completed at least 8 weeks of treatment. Back pain reduced significantly in the Naturopathic group (-6.92 on Oswestry, p<0.0001) and all other measure improved significantly as well.
The above trial was analyzed for economic impact. In the analysis, employees experienced 9.4 more perfect health days and reduced societal ( read employer) costs of $1212 per participant over the course of the study. The intervention cost $154 per day, compared with lost productivity costs of $178 per day, representing a return on investment of7.9%. Individuals participating saved $1096 each. Again this was from a single course of treatment. Imagine the cost savings applied society wide, particularily in countries like Canada with socialized medicine.
Another small Indian study showed significant improvements in PEFR, VC, FVC, FEV1, FEV/FEC%, MVV< ESR and Absolute Eosinophil count in Asthma patients undergoing a Naturopathic and Yogic treatment regimen.
In another study, patient outcomes from Naturopathic and Allopathic medical practices were compared in the treatment of menopausal symptoms. Consistent with other research, Naturopathic patients reported higher income, lower rates of smoking, higher rates of exercise, but interestingly, greater rates of fatigue, insomnia and hot flashes. Both patient groups resulted in improvements in anxiety, hot flashes, vaginal dryness and menstrual changes. Significantly better results were found in insomnia and fatigue.
One study was done on patients with Autism, 67 patients ranging from 3-58 years were given supplementation, with additional naturopathic treatments, such as enzymes, carnitine, epsom salts baths and a diet free of gluten, casein and soy. Lab results show a significant improvement of blood nutrient levels, and nonverbal IQ and autism symptoms also significantly improved.
Another study examines Polycystic ovarian syndrome patients who had undergone a Naturopathic and Yogic regimen for 12 weeks. 25 patients were given the intervention, while 25 others were placed on a wait list. Significant changes were observed in ovarian morphology and body measurements.
Recent Indian research has focused on a number of areas of integration of Naturopathic medicine and conventional care. This paper reviews the multiple ways many Naturopathic agents can aid in modulating cell signalling pathways in cancer. Another paper shows a similar conclusion, with Natural compounds showing great promise in decreasing resistance to one method of cell self destruction in cancers.
Much recent research has focused on the types of patients Naturopathic Doctors see. In one recent study a survey of 300483 visits to a Naturopathic teaching clinic was examined. It was found that Naturopathic clinics saw a similar range of problems to other primary care practices, that patients paid out of pocket more (unsurprisingly) and that Naturopathic clinics offered discounted care far more often.
Another recent study discussed characteristics of Pediatric patients coming to CCNM, a Naturopathic college in Toronto. Furthermore, a cross section of Naturopathic patients as a whole at CCNM was done, showing the incredibly wide variety of issues people come to Naturopathic Doctors with.
Another fascinating direction of research has emerged in the applications of Public health models of research to Naturopathic care, rather than more allopathic models a potential research enterprise with much potential. Another study measured the characteristics of rural Naturopathic practice in Australia, showing the important role played by naturopaths in the provision of underserved rural populations. Another study showed a high level of patient and staff satisfaction resulting from integration of Naturopathic medicine into an acute care hospital.
Perhaps most intriguingly in our survey of research is this paper, published in the Indian Journal of Medical Ethics. India is in the slow process of constructing a healthcare system of Universal coverage (often jokingly termed Modicare after the Indian Prime Minister Narendera Modi). Unlike in Countries such as Canada which have long traditions of public medicine that were built during the low point of Holistic medicine, in the 1960s, India likely will be including all systems of medicine in it’s public scheme, along with allopathic care. AYUSH is the term in India used for such systems, including Ayurveda, Therapeutic Yoga, Unani, Sidda, Homeopathy and Naturopathy. The above mentioned paper examined the AYUSH systems in light of a report on the Principles of Universal Care produced by the Planning Commission of India. In that paper, the authors conclude that not only does AYUSH meet the standards the India government wishes to see in it’s Universal system, they would actually further it’s goals more effectively in many cases than Allopathic care alone would be able to.