I hope you all had an excellent Naturopathic Medicine week in 2019!
As always, I will conclude the week with a blog post detailing the research into Naturopathic Medicine. Each year seems to bring new advances, which I am immensely grateful for. To begin with, we should discuss Naturopathic regulation globally, something that the World Naturopathic Federation has done wonderfully in the following paper. One of my own teachers, Dr. Mike Prytula, ND, has also made a lovely introductory video on Naturopathic Medicine.
To begin with, two reviews of all clinical trials on Naturopathic medicine have been conducted. The first was done in 2015, and found clinical trials on 13 conditions, finding statistically significant results in 10 of them. A second review conducted in 2019 found 33 trials, with Naturopathic medicine being found effective in pain, cardiovascular illness, type 2 diabetes, PCOS, depression and anxiety.
A newer review was also performed, specifically in regard to side effects of Naturopathic medicine and surgical practice. The reviewers found a number of potential benefits naturopathic treatment could have in relation to surgery that demand further study, and no reports of serious side effects present.
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%).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.
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 standard set of physiotherapy exercises to do on their 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, particularly 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.
Finally, there is a free documentary showing Naturopathic medicine being practiced in India, to fully scope, in in-patient facilities. I encourage you to watch it. It is my hope that the example of India in medical equality and non discrimination will be followed by Canada and other Western countries, giving all citizens the potential for access to the benefits of Naturopathic Treatment.
Happy Naturopathic Medicine Week Everyone!