F1000Research 2015, 4:169 Last updated: 25 JUN 2015
OPINION ARTICLE
Naturopathic medicine: Nine parts negative, one part positive
[v1; ref status: awaiting peer review, http://f1000r.es/5k4]
Norman Temple
Centre for Science, Athabasca University, Alberta, T9S 3A3, Canada
First published: 25 Jun 2015, 4:169 (doi: 10.12688/f1000research.6707.1)
Open Peer Review
v1
Latest published: 25 Jun 2015, 4:169 (doi: 10.12688/f1000research.6707.1)
Referee Status: AWAITING PEER
Abstract
REVIEW
Naturopathic medicine, also known as naturopathy, is a type of complementary
and alternative medicine. It appeals to many people, especially those who
desire a  holistic approach to both prevention and treatment. While there is
Discuss this article
much variation in the types of treatment used by different naturopaths,
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commonly used ones include acupuncture, herbalism, and homeopathy. These
types of treatment often lack sound supporting evidence of efficacy. But at the
same time naturopaths are often hostile to conventional drugs, even those that
are of proven effectiveness and pose little risk of harmful side effects. Many
naturopaths employ treatments, such as diet, herbs, fasting, and colonic
irrigation that are claimed to  detoxify the body and thereby lead to improved
health. There is a complete absence of supporting evidence for this type of
therapy. Some aspects of the theories and practices employed by naturopaths
are well supported by the evidence. In particular, the emphasis that naturopaths
place on leading a healthy lifestyle so as to prevent disease is entirely
consistent with modern concepts in this area. Overall, the positive aspects of
naturopathy are greatly outweighed by the negative aspects.
Corresponding author: Norman Temple ([e-mail])
How to cite this article: Temple N. Naturopathic medicine: Nine parts negative, one part positive [v1; ref status: awaiting peer review,
http://f1000r.es/5k4] F1000Research 2015, 4:169 (doi: 10.12688/f1000research.6707.1)
Copyright: © 2015 Temple N. This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Data associated with the article
are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).
Grant information: The author(s) declared that no grants were involved in supporting this work.
Competing interests: The author declared no competing interests.
First published: 25 Jun 2015, 4:169 (doi: 10.12688/f1000research.6707.1)
F1000Research
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F1000Research 2015, 4:169 Last updated: 25 JUN 2015
Introduction One of the core principles of naturopathic medicine is to use treat-
Naturopathic medicine  naturopathy  is a popular type of comple- ments that minimize risk to the patient. Of course, conventional phy-
mentary and alternative medicine (CAM) that has steadily evolved sicians also claim to follow this principle. However, there is no doubt
over the last 100 years1. Naturopaths believe that the human body that on many occasions physicians have indeed given inappropriate
strives toward health and is its own best healer. Naturopaths claim treatments causing harm. The obvious solution to this is to improve
to treat the whole person using natural therapeutics and cures2. the quality of treatment given by conventional physicians. But we
However many aspects of naturopathy suffer from a serious lack of must recognize that harmful side effects are often the price patients
solid supporting evidence. must pay in order to receive benefit. For example, cancer therapy
often involves the use of drugs, radiation, and/or surgery which while
helpful in the treatment of the disease can have harmful side effects.
Patients choose to visit naturopaths for a variety of reasons. The
most important of these is an attraction to the overall philosophy of
naturopathy, including the desire for a more  natural and  holistic Many naturopaths believe the suppression of symptoms should be
approach that (supposedly) addresses the root of the problem2. avoided because such an action interferes with the healing process6.
Other reasons include general dissatisfaction with the care pro- This leads to a situation where naturopaths may refuse to give anal-
vided by conventional health-care providers, wanting more time gesic medications to a patient with arthritis or anti-depressants to
and attention, and having had a previous positive experience with one with depression, thereby depriving the patient of potentially
a naturopath. The patients who most often visit a naturopath are helpful treatments6. Moreover, there is no evidence that these drugs
white, middle-aged, female, and have a chronic condition3. prevent the healing of the joints in arthritic patients or impede the
brain from normalizing the neurochemical imbalances causing
some forms of depression.
Naturopathic physicians (NDs) are trained as primary-care physi-
cians in four-year, accredited doctoral-level naturopathic medical
schools. There are several such schools in the USA and Canada4. The practice of naturopathy
The legal status of naturopaths varies between states and provinces. Practitioners of CAM use a wide range of therapies, several of
Some jurisdictions permit registered naturopaths to carry out minor which have been adopted by naturopathy. These include herbalism,
surgery, write prescriptions for at least some drugs, give vaccina- homeopathy, acupuncture, hydrotherapy, physical therapy, spinal
tions, and carry out spinal manipulations. manipulation, lifestyle counseling, nutrition (including the use of
vitamin and mineral supplements), and psychological counseling.
Some of these treatments do not stand up to close scrutiny. There
Guiding principles of naturopathy
is much variation in the eclectic choice of therapies used by indi-
Naturopathy embraces the concept of prevention which is best
vidual naturopaths. As part of their practice naturopaths carry out
accomplished by educating their patients to lead a healthy lifestyle.
patient assessment and diagnosis using standard approaches includ-
In that respect naturopathy resembles health promotion. A gener-
ing physical examination, lab tests, and clinical assessment.
ally healthy lifestyle is now recognized as the ideal way to prevent
many diseases including coronary heart disease, type 2 diabetes,
and hypertension5. As noted above, the logic of naturopathy dictates that practition-
ers should whenever possible avoid giving pain killers to a patient
with arthritis or anti-depressants to one with depression. But most
Naturopaths take a holistic approach to treatment and thereby aim
naturopaths strongly support the use of herbal medicine3,6. For
to treat the whole person4,6. They see this approach as being superior
example, naturopaths sometimes recommend the use of herbal
to that of conventional medicine which takes a mechanistic view of
medicines for treating cervical dysplasia6, despite a lack of support-
disease (reductionism) and then focuses on symptoms. With some
ing evidence. By contrast, the standard medical procedure involves
diseases a whole-person (holistic) approach can make good sense.
minor surgery, which is safe and effective. Similarly, mistletoe may
For example, coronary disease is the result of a generally unhealthy
be recommended by naturopaths for the treatment of hypertension6,
lifestyle that causes dysfunction in several body systems. A gener-
even though it has not been properly tested in clinical trials and is
ally healthy lifestyle is effective for not only the prevention of coro-
toxic. Yet, drugs are often avoided despite being reasonably safe
nary heart disease but also as a treatment5. This is also the case with
and effective.
type 2 diabetes and hypertension5. A holistic approach may also be
of value in patients with cancer as they need nutritional support to
help the body recover as well as social and emotional support. A Herbal medicines are merely plant extracts that contain chemicals
holistic approach to coronary disease and cancer is hardly contro- with drug-like action. Indeed, many of today s drugs started life in
versial and most cardiologists and oncologists would probably sup- previous centuries as herbal treatments. The attitude of naturopaths
port this, provided, of course, that effective treatments that target towards herbal medicines and drugs is therefore irrational.
the specific disorder are also employed.
Similar irrationality is seen with homeopathy, a type of CAM that
An altogether different story presents itself with other disorders. is highly controversial and far from being proven as effective7,8.
With arthritis and depression, for example, there can be a specific Nevertheless, the therapy is an integral part of the practice of many
dysfunction in a single body system. Conventional medicine has naturopaths1,3,9. Acupuncture is another modality often used by
treatments of proven effectiveness that target the problem. In these naturopaths as a treatment for many disorders3,9 but its proven value
cases treating the whole body will likely lead to poorer outcomes. is very limited beyond the control of pain10.
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F1000Research 2015, 4:169 Last updated: 25 JUN 2015
One of the fundamental principles of naturopathy since its birth a strong support for health promotion and various efforts to prevent
century ago is the general claim that much sickness is caused by disease at the population level. In addition, conventional physicians
an accumulation of toxins in the body1. Accordingly, an important routinely screen middle-aged patients for such conditions as dia-
therapy in curing disease is the application of treatments that help betes, hypertension, and high blood cholesterol. Interventions are
eliminate these toxins. This concept  detoxification  is still the then made where appropriate so as to prevent disease. However,
basis for various naturopathic therapies today6. Fasting is often what conventional physicians do, more often than not, is to write a
employed in the belief that it induces detoxification. A variation of prescription rather than encourage their patients to follow a healthy
this approach is autotoxicity where the focus is toxins in the colon. lifestyle. For example, one study on obesity showed that less than
This is commonly treated by colonic irrigation, a procedure that is one third of Canadian physicians advised their overweight patients
potentially harmful as it can hyper-extend the colon11,12. to lose weight18.
There is no credible evidence that detoxification treatments, such The obvious explanation for why conventional physicians routinely
as dietary changes, consumption of herbs and supplements, fast- ignore lifestyle when treating their patients is lack of time. Coun-
ing, or colonic irrigation, can remove toxins from the body or lead seling patients on making lifestyle changes takes far more time than
to improved health. These beliefs seem to be based on little more writing a prescription for drugs that treat hypertension or high blood
than speculation. Nevertheless, a survey of naturopaths in the USA cholesterol. In a system where physicians generally spend no more
found that 92% reported using detoxification therapies13. Similarly, than 10 or 15 minutes on each consultation, it is simply not possible
a survey of naturopaths in Canada found more than half were using to make a serious effort to assess a patient s lifestyle and then deliver
fasting as a treatment for various conditions9. appropriate counseling. Naturopaths, by contrast, spend much more
time with their patients; a typical first office visit to a naturopath
Hydrotherapy is another healing modality that naturopathy inher- takes one hour6 while an average visit takes around 42 minutes3.
ited from previous times. This treatment was very popular in cen-
tral Europe where many people would go to a spa and sit in a pool Conclusions
containing spring water that was credited with healing properties. A challenge in analyzing the practice of naturopathy and of criti-
Indeed, this therapy is still popular in parts of Europe. The therapy cally evaluating its advantages and disadvantages is that relatively
was imported into the USA. Hydrotherapy is advocated by many few research studies have been carried out. There is an urgent need
naturopaths, often with the claim that it aids in detoxification and for more research.
helps strengthen immune function1. Certainly, spending time in
a sauna, hot tub, spa, or sanatorium is relaxing, but there is little
Naturopathic medicine offers an approach to health that appeals to
evidence that hydrotherapy has any more direct therapeutic value.
many people: it is considered to be  holistic , based on preven-
Interestingly, a recent observational study carried out on men in
tion, promises treatments that  detoxify the body, and avoids the
Finland reported a protective association between use of a sauna and
potential hazards often seen with conventional medicine. However,
reduced risk of cardiovascular disease and of all-cause mortality14.
naturopathic medicine has serious negative features including the
use of treatments that have little or no supporting evidence, such
Iridology is a technique where practitioners examine a patient s eye as homeopathy and treatments intended to bring about detoxifica-
and then make a diagnosis based on changes in the iris. The tech- tion. Similarly, naturopaths use treatments where the supporting
nique rests on the claim that many disorders can be diagnosed using evidence is weak, such as many uses of acupuncture and herbalism.
the technique but it has no scientific basis15. Nevertheless, 23% of Naturopaths frequently fail to prescribe drugs where the benefit
naturopaths in Canada reported using iridology in their practice9. strongly outweighs the risk.
Positive aspects of naturopathic medicine Naturopathic medicine does have some positive features, especially
Some aspects of naturopathic medicine compare favorably with its strong emphasis on encouraging patients to prevent disease by
conventional medicine. As was stated earlier, naturopathic medicine living a healthy lifestyle. Conventional physicians, by contrast, are
places a strong emphasis on avoiding treatments that pose a risk. much less likely to dispense lifestyle advice, mainly due to lack of
Unfortunately, what this can often mean is that patients are denied time. However, this is a rather weak advantage of naturopathy as the
treatments that are effective while posing an acceptably low risk of benefits of a healthy lifestyle are already well known by the major-
harm. But conventional physicians often go too far in the opposite ity of the population, especially by people who are most likely to
direction. In particular, there have been many stories over the past visit a naturopath.
several decades of medications being prescribed that cause significant
harm. A recent example is OxyContin, an opioid widely used for the
Overall, the positive aspects of naturopathy are greatly outweighed
relief of pain. The over-prescribing of this medication by physicians
by the negative aspects.
has led to an epidemic of addiction and resulted in many deaths16,17.
Naturopaths place a strong emphasis on preventive medicine by
Competing interests
means of encouraging their patients to live a healthy lifestyle.
Moreover, they have been critical of conventional medicine for fail- The author declared no competing interests.
ing to be active in this area. There may have been much truth to
this in the past but over the last several decades conventional medi- Grant information
cine has given much attention to this crucial area. This includes No funding was involved in supporting this work.
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F1000Research 2015, 4:169 Last updated: 25 JUN 2015
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