Back to the top.
FAQ #20: How do naturopathic doctors help address fertility and infertility?
View the printable PDF version
The AANP and the INM would like to acknowledge Jaclyn Chasse, ND, for her contributions to the content of this FAQ.
If you and your partner are struggling to have a baby, you are not alone. One in eight couples
in the United States have difficulty getting pregnant or staying pregnant. Infertility, defined as trying to conceive for one year (or six months after age 35) with no success, affects both men and women ages 15 to 44. And new data
suggests that infertility is on the rise.
Fertility challenges often take physical, emotional and financial tolls on a couple. Between repeated visits to reproductive endocrinologists, prescription medications, hormone injections and labs, trying to have a baby can feel like an exhausting, mechanical series of procedures. Some couples will consider reproductive technology (ART) such as artificial insemination, intrauterine insemination (IUI), and in-vitro fertilization (IVF) to achieve pregnancy. While these approaches can be effective, they are financially out of reach for numerous families. Given that success rate
s of treatments like IVF are between 13 percent and 36 percent for women over 35, couples want to optimize their health first to maximize their outcome. They may also be concerned about long-term risks
of ART for the health of the baby. With all of these variables, patients often wonder if they have other options.
Trained to treat the whole person, naturopathic doctors (NDs) have helped countless men and women resolve fertility challenges and conceive easily, safely, and cost-effectively. With a focus on uncovering what is preventing a couple from conceiving, naturopathic doctors address underlying causes of infertility whenever possible. NDs look at each patient as a unique individual. They guide couples in improving fertility with a goal of conceiving naturally and avoiding interventions when possible. Addressing health beyond conception, NDs also focus on helping you achieve a healthy pregnancy and baby.
Identifying Underlying Causes
Naturopathic doctors begin by assessing the whole couple. Initial appointments generally last one hour or more
, and include a detailed family history, medical history, discussion of diet, physical activity, environmental exposures, sleep patterns, and psycho-emotional stressors for both partners. You can expect a conversation about your lifestyle, menstrual cycle, and what you’ve been doing to try to conceive. Your ND may order blood work, imaging, and nutritional labs. They will dig deeper if tests uncover red flags.
There are a wide variety of reasons a couple may have difficulty conceiving. Although some receive a diagnosis from conventional doctors, many have “unexplained infertility.” Fertility challenges can be caused by poor sperm health (for men), poor egg quality, hormonal imbalances including cycle abnormalities (for women), obesity, and more. A number of root causes are linked to lifestyle and environmental factors, and NDs are trained to look for and uncover these underlying issues.
There are many safe, natural, and effective lifestyle modifications and therapies that can address these problems, strengthen your overall health, and improve your chances of getting pregnant. Because of their rigorous training in clinical nutrition
, lifestyle counseling, botanical medicine and more, licensed naturopathic doctors are experts at engaging and empowering patients to make lifestyle changes, proven to improve health outcomes.
Proper preconception care
has been shown to enhance fertility and lead to healthier outcomes, both for couples who are conceiving naturally and for those who are using assisted reproductive technology (ART). Naturopathic doctors work to help you cultivate a healthy body first to maximize pregnancy success and nourish the growth of a healthy baby. NDs encourage couples to take a few months of time to prepare for conception. In this period, NDs work with couples to:
Poor Egg Quality
- treat underlying health conditions, such as obesity in both men and women
- optimize diet and nutrition
- manage stress
- incorporate comprehensive micro-nutrient support
- optimize intercourse timing through education about the menstrual cycle
While fertility obstacles and treatments are highly individual, for women, poor egg quality is a common underlying cause. Egg quality can decline naturally with age or prematurely. In both cases, finding out the ‘why’ of the decline is essential. Causes can be nutritional and hormonal. Research has demonstrated that for nutritional causes, supplementation with antioxidants such as melatonin
, vitamins such as DHEA
, and other plant-based antioxidants
can be helpful to improve egg quality. Hormonal irregularities affecting egg quality and ovulation include endometriosis and Polycystic Ovarian Syndrome (PCOS). Naturopathic medicine has many different remedies to help women address these imbalances, including the use of botanical therapies
Poor Sperm Health
For men, sperm production, quality, and motility are often at the heart of fertility challenges. While individual recommendations are tailored, naturopathic doctors help support sperm health through: 1) optimizing lifestyle choices such as quitting smoking and limiting alcohol consumption; and 2) optimizing diet and nutrition, including supplementation with micronutrients such as zinc
, and antioxidants such as selenium
Enhancing Clinical Care with Tender Loving Care (TLC)
The journey to pregnancy can feel like a physical and emotional rollercoaster. Naturopathic doctors provide patients with a high level of emotional and psychological support from start to finish. Adding psychological support and sympathetic counseling to clinical care not only feels better, but also has been shown to improve pregnancy success rates
Back to the top.
May 2018 | How do naturopathic doctors help women during perimenopause?
View the printable PDF version
The AANP and INM would like to acknowledge Tori Hudson, ND for her contributions to the content of this FAQ. Some of the content first appeared in an article on Dr. Hudson’s blog.
An estimated two million U.S. women reach menopause every year
. But many begin to experience an array of physical, mental, and emotional symptoms long before menopause (12 consecutive months without a menstrual period). The gradual transition to non-reproductive years is called perimenopause, and usually occurs from around age 40 to 51. Perimenopause can be brought about prematurely by surgical removal of ovaries, chemotherapy, radiation therapy, or certain anti-hormone drugs. Unique for every woman, the transition can lead to symptoms that interfere with quality life. Whole-body health evaluation and care during perimenopause is vital, both to manage troubling symptoms, and to preventively address changes that can impact heart, bone, and brain health.
Focusing on the whole person, licensed naturopathic doctors (NDs) take the time to identify and address the genetic, personal medical history, hormonal, and lifestyle factors that impact perimenopause and associated health changes in women. NDs provide a high level of emotional and educational support. Aiming to help strengthen the foundation of a woman’s health so that she can thrive through menopause and age optimally, NDs utilize a large spectrum of treatment modalities including nutrition, nutraceuticals, botanical medicine, lifestyle counseling, hormone therapy and, at times, select pharmaceuticals.
Symptoms and Underlying Biological Changes
During perimenopause, a woman’s hormone levels change and fluctuate considerably, often leading to changes in the pattern of menstrual periods. As you become postmenopausal, reproductive hormone levels decrease, resulting in levels of estrogen and progesterone which are inadequate to produce a menstrual period. Symptoms are varied, unpredictable, and often go unrecognized as perimenopause symptoms. They can include:
As ovulation becomes irregular, the length of time between periods may be longer or shorter, your flow may be lighter or heavier, and you may have random spotting or skip periods. It is important to manage excessive bleeding, and rule out endometrial hyperplasia (when the lining of the uterus becomes too thick).
Hot flashes and night sweats are common, with varying intensity, length and frequency. They can be aggravated by lifestyle factors including environment, nutrition, stress, alcohol, and tobacco use. It is important to differentiate other medical conditions from menopause-related hot flashes, including hyperthyroidism, anxiety, and more.
Vaginal dryness and thinning.
Decreased estrogen can cause vaginal tissues to become thinner, drier, and less elastic, making vaginal penetration painful. Diminishing estrogen can also leave you more vulnerable to vaginal infections, urinary tract infections, and urinary incontinence. It is important to rule out other causes of these symptoms including malignancies, vulvar dystrophies and dermatoses, infection, allergies, and skin conditions.
Changes in the skin begin to occur with brown spots, dryness, easy bruising, and increased wrinkling. Skin is partially composed of collagen, and with age, collagen decreases. During the first five years after the menopause, 30 percent of skin collagen is lost
Fatigue/sleep disturbance. Sleep problems
are often due to hot flashes
or night sweats, but sometimes sleep becomes unpredictable even without them.
and other changes in sexual response are common during perimenopause. Hormone levels, anatomy, physiology, psychological factors, stressors, and co-existing medical problems are all potential contributors to changes in sexual function.
Depression, anxiety and/or mood swings.
The cause of these symptoms, including increased irritability and anxiety/panic disorder, may be sleep disruption associated with hot flashes, or other factors not related to the hormonal changes.
is caused by declining estrogen levels, and can increase your risk of osteoporosis and bone fractures.
Changing lipid profiles.
Decreasing estrogen levels may lead to unfavorable changes in your blood cholesterol levels, including an increase in low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — which contributes to an increased risk of heart disease. At the same time, high-density lipoprotein (HDL) cholesterol — the "good" cholesterol — decreases in many women as they age.
Other symptoms associated with perimenopause can include: changes in memory and cognition, scalp hair loss, facial hair growth, acne, palpitations, nausea, and headaches.
Using a whole-body approach and natural therapies whenever possible, NDs help women address perimenopause symptoms and implement proactive prevention to optimize health as the body ages. NDs typically spend one to two hours with patients
in an initial appointment to gather information about physical, mental, emotional, genetic, environmental, social, and other factors that affect a woman’s health. NDs apply their rigorous training in clinical nutrition
, lifestyle counseling, botanical and nutraceutical medicine, and other treatment modalities (including use of pharmaceuticals when state license permits) to provide individualized evaluation and therapeutic guidance for patients, including:
- Medicinal plants that contain phytoestrogens, such as ginseng, red clover, and soy to reduce hot flashes, decrease vaginal dryness, increase energy, and improve moods.
- Non-phytoestrogen plants such as Black Cohosh and Kava to reduce hot flashes.
- Vitamin D, calcium and other nutrient supplements to help prevent osteoporosis.
- Mind-body medicine such as stress reduction, meditation, and yoga for mild to moderate depression, cognitive decline, and hot flashes.
- Bacopa to improve memory.
Individual assessments and recommendations about the use of either botanicals, nutraceuticals, bio-identical hormones including customized compounds, and/or conventional hormone therapy
(HT) need to be made for each woman based on her symptoms, risk factors for osteoporosis/cardiovascular disease/dementias/other conditions, and preferences. When appropriate, NDs are trained to use both conventionally available hormone replacement options and also specialty compounded hormone formulations. Their guidance both in addressing perimenopause symptoms and proactively strengthening overall health has helped countless women age through menopause with greater ease.
Back to the top.
Why is doctor as teacher a principle of naturopathic medicine? May 2018
View the printable PDF
The AANP & INM would like to acknowledge Amy Rothenberg, ND, and Allison Willette, RN, ND for their input on this FAQ.
Naturopathic doctors follow six guiding principles that serve as a philosophical platform for everything they do. The principles influence how they think about medicine, how they make clinical decisions, and most importantly, how they treat you as a patient. Each principle plays a role in guiding naturopathic doctors in diagnosis and treatment. The doctor as teacher
is one of these six core principles.
If you don’t always follow your doctor’s instructions, you’re not alone. Studies
show that non-compliance to doctor recommendations is epidemic, and it can lead to ineffective treatment or further health concerns. Non-compliance often stems from not having a clear understanding of the treatment plan and strategy. Many patients
struggle to understand “physician-speak,” and may not fully grasp clinical explanations and care directions.
Licensed naturopathic doctors (NDs) believe that an informed patient is ready to take an active role in the healing process. Naturopathic doctors work to explain each health concern you have and each approach that will be utilized to help address it. NDs aim to answer your questions so you can fully understand and participate in your therapeutic plan.
Communication with you, the patient, is an essential element of working with any naturopathic doctor. Because each patient is seen as an individual, not just a diagnosis, naturopathic doctors prioritize empathy, connection, and sharing of relevant information. In order to educate and inform patients adequately, NDs often spend one hour or more
with patients in an initial appointment, compared to an average 20 minute
appointment with a conventionally trained physician.
Educated patients who understand the treatment recommendations often have better success with treatment and feel more confident about their health care choices. Research
shows that better communication and collaborative decision making between doctors and patients drives health care costs down.
Because of their focus on patient education and patient empowerment, naturopathic doctors may be a good fit for individuals who prefer to be active participants in their health care, and who are looking for a fresh perspective on preventive care and natural treatment options for improved health.
Back to the top.
How do naturopathic doctors help address men’s health? June 2018
View the printable PDF
Five key lifestyle changes can add up to 12 years to a man’s life, according to a new Harvard study
. But unhealthy lifestyle habits, less frequent screening, and late treatment for preventable chronic diseases all result in men dying at greater rates than women from causes including heart disease, diabetes, accidents, and cancer. In fact, half of American men—who already have lower life expectancy
than women—don't bother
with annual checkups. Licensed naturopathic doctors (NDs), with their emphasis on preventive and lifestyle medicine can help to address some of these disparities. A visit with an ND might appeal more to men who have avoided doctor visits because NDs prioritize natural, non-prescription drug approaches, focus on patient education
, and are trained to empower patients
to make lifestyle changes for optimal health. They spend extra time
with you in appointments to identify underlying causes of your health concerns, and focus on supporting your body’s innate ability to heal. Here are some key areas of men’s health where NDs specialize:
Prostate cancer, which impacts one in six men, is best treated when found early. Education about risk factors
--which impact when regular screening should begin and how often it should take place--is essential. Main risk factors include: being African American, aging, family history of prostate cancer, obesity, exposure to certain chemicals, diet, and elevated testosterone levels. Studies
show that prevention works and lifestyle factors
impact cancer incidence and aggressiveness. If prostate cancer is diagnosed, using naturopathic medicine approaches
alongside conventional care can help enhance efficacy, decrease side effects, and help prevent recurrence.
Sexual dysfunction is a complaint that actually brings men to doctors’ offices. Defined
as an inability to attain or maintain an erection adequate for the sexual satisfaction of both partners, sexual dysfunction may also be an indication of other health conditions. For instance, cardiovascular disease with atherosclerosis causes clogging of blood vessels, which can cause impotence
. Sexual dysfunction can also be a symptom of diabetes
, related to poor circulation, or other endocrine system disorders. Side effects of commonly prescribed medications such as antidepressants, antihistamines, and anti-hypertensives can contribute to sexual dysfunction, as can alcohol and drug use. A naturopathic doctor can help you figure out underlying causes of sexual dysfunction and create a treatment plan that addresses your risk factors or pathology. NDs use a whole body approach, including a prescription for diet and exercise, to help improve circulation. They work with natural supplements
and with botanical
medicines to address sexual dysfunction.
, which remains the number one killer of American men, is largely preventable if caught and treated early. By treating the whole person, naturopathic doctors address the genetic, environmental, and behavioral/lifestyle factors that lead to cardiovascular disease. Learn more in this FAQ
about naturopathic medicine and heart disease.
Diabetes is the sixth leading cause of death for men, and a chronic disease that has enormous impact on quality of life. Naturopathic doctors have a broad set of guidelines and an extensive toolkit
to work from in order to help patients with diabetes. Their advanced training in clinical nutrition and behavioral medicine helps individuals make and sustain shifts in lifestyle that can improve or reverse disease progression
Men often struggle with chronic pain
from a number of potential sources including injuries, arthritis, fibromyalgia and other causes. Naturopathic doctors excel in non-opioid approaches to chronic pain. By developing personalized pain management treatment plans that include dietary recommendations, nutritional supplements, botanical medicines, physical rehabilitation and mind-body approaches, NDs partner with patients to effectively help reduce pain from inflammation and other causes.
Men may experience depression differently
than women. For example, some men with depression may experience anger or aggression instead of or in addition to sadness. Men may talk more about the physical symptoms of depression such as fatigue, headaches, or changes in appetite. Prioritizing behavioral medicine, nutrition
, botanical medicine
and selected nutraceuticals
along with other natural medicine approaches, naturopathic doctors help men address depression. NDs are also trained in the pharmacological treatments which are commonly prescribed by conventionally trained MDs. In some states, NDs have authority for prescription pharmaceutical management. They can work in conjunction with conventional mental health specialists to co-manage patient care.
For men seeking care for these common complaints and others, naturopathic doctors have answers based on rigorous training in therapeutic nutrition
, behavioral medicine, botanical medicine, and an emphasis on addressing underlying causes of disease.
Back to the top.
Why are a growing number of medical doctors (MDs) working collaboratively with naturopathic doctors (NDs)? June 2018
View the printable PDF
The AANP and the INM would like to acknowledge Leonard A. Wisneski, MD, FACP and Dave Johnson, MD, FACC for their contributions to the content of this FAQ.
Conventionally trained medical doctors find that naturopathic doctors have education, training and a practice approach that enhances care and expands treatment options for patients. Specifically:
- NDs take a whole-body approach to health. There are many factors that affect your health. Naturopathic doctors take the time to explore as many of these factors as possible, including diet, lifestyle, family genetics, psycho-emotional, spiritual, socioeconomic, and environmental issues, and more. They typically spend one hour or more with patients in an initial exam to uncover the underlying causes of health concerns.
- NDs prioritize natural therapies. Naturopathic doctors utilize minimally invasive treatments whenever possible. Clinical nutrition, behavioral and lifestyle medicine, and botanical medicine are just a few of the many therapies NDs apply to support the body’s health restoring processes, as opposed to just reducing symptoms. While NDs are trained in medical school to use prescription drugs, they emphasize less toxic substances that promote natural healing first. If their state license permits, NDs can prescribe medications when necessary. If not, they will refer patients to, and collaborate with, an MD colleague.
- NDs have rigorous training in clinical nutrition. Naturopathic doctors recognize nutrition as a cornerstone of health. During medical school, ND students complete an average of 155 classroom hours of nutrition education. They provide individualized nutrition assessment and guidance utilizing evidence based recommendations. Their deep experience spans areas including macronutrients, micronutrients, dietary assessments, diet types, diet and nutrient therapy, supplement-drug interaction, nutrition technology, and more.
- NDs have advanced training in behavioral medicine. NDs recognize that lifestyle and environment play a pivotal role in your health. A large percentage of chronic conditions are potentially preventable by modifiable lifestyle changes. Having completed more than 100 hours of behavioral medicine coursework in medical school, NDs are trained to uncover the social, cultural, cognitive, environmental, and emotional issues that influence your overall health. They empower patients to make and sustain changes for optimal health and wellbeing.
- NDs provide highly individualized care. NDs understand there is no one-size-fits-all treatment. Utilizing a patient-centered approach, NDs take the time to understand your health goals and to explore the genetic, environmental, and behavioral/lifestyle factors that may be roadblocks to optimal health. Naturopathic doctors create treatment plans uniquely tailored to your health status, goals, and lifestyle.
- NDs are fluent in integrative and complementary approaches. Because of their diverse training in complementary therapeutic modalities, NDs know when and how to utilize integrative approaches in a patient’s overall treatment. Incorporating treatments such as acupuncture, mind-body medicine, chiropractic and other integrative disciplines, NDs will refer to other expert practitioners as needed/if appropriate.
are looking for complementary, integrative and whole-body approaches to health care. Wellness, prevention, and health creation beyond disease management are just a few of the reasons why. In response, bi-partisan policymakers
are joining forces to advocate a whole-person, integrative model of healthcare. And numerous national physician groups are now recognizing the value of complementary approaches, putting forth new treatment guidelines
for centuries-old problems, such as chronic pain. Naturopathic medicine, which emphasizes prevention, self-healing, and natural therapies, offers patients a compelling whole-body health care choice.
Today there are approximately 6,000 licensed naturopathic doctors practicing in the U.S. Twenty-three U.S. states and territories currently license NDs. Educated and trained in four-year, post-graduate, accredited naturopathic medical colleges, NDs diagnose, prevent and treat acute and chronic illness. They restore and help establish optimal health. Trained as primary care doctors, NDs can play a central role in reversing the current U.S. chronic disease epidemic
. Increasingly, they are working in collaboration with conventional medical doctors, and are recognized as a vital part of a patient’s health care team.
A growing number of prominent health systems
, hospitals, and cancer treatment centers now have one or more licensed naturopathic doctors on clinical staff at their facilities. Medical doctors who champion naturopathic doctors recognize that NDs can help deliver better health outcomes at lower costs. They refer out to and collaborate with NDs both in primary care and in specialized areas including cancer treatment
, chronic pain
, gastrointestinal disease
, heart disease
Back to the top.
What advanced training do naturopathic doctors have in behavioral medicine? July 2018
View the printable PDF
The AANP and INM would like to acknowledge Brad Lichtenstein, ND, BCB, Bastyr University
Associate Professor and Katie Stage, ND, RH (AHG), Southwest College of Naturopathic Medicine Division Director of Therapeutics for their contributions to the content of this FAQ.
is one of the most important influencers of your health. Your lifestyle and the conditions
in which you grow up, live, work, and age shape your well being. In addition to diet, exercise, and other lifestyle behaviors
, social, economic and cultural factors are often at the root of preventable chronic disease
. In fact, up to 70
percent of primary care visits are driven by psychological and/or social factors. But too often primary care providers do not spend enough time addressing these issues.
Licensed naturopathic doctors (NDs), who are trained to treat the whole person, take the time to address multiple causes of health concerns. Appointments are guided by the Therapeutic Order
, a natural approach to therapeutic intervention used to help discover and evaluate multiple obstacles to healing, including social, cultural, cognitive, environmental, emotional, and other factors impacting your health. During medical school, NDs complete an average of 150 classroom hours of behavioral medicine education. Because of their rigorous training, naturopathic doctors go far beyond treating physical symptoms; they help patients understand and address the underlying social, emotional, and psychological patterns that influence health.
Naturopathic doctors are trained to utilize a broad range of therapies including dietary and lifestyle interventions, stress reduction, psychotherapy, and counseling. They have the knowledge and experience to empower patients to make and sustain lifestyle changes that improve health and lower
Behavioral medicine and lifestyle counseling are taught in a series of courses that build upon each other through an ND’s four-year, science-based medical education
. Naturopathic medical schools are accredited and are recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings, including over 1,200 hours of clinic rotations with patients. Areas of course concentration include:
, addressing patient-centered listening, motivational interviewing, and developing the doctor-patient relationship
focusing on biological and psychosocial bases of psychological conditions, including clinical assessment using DSM criteria for diagnosis of mental disorders
Lifestyle change/behavior change
, including biological and psychological factors, health risk and health promotion factors, medical decision making, and medical adherence
, including evidence-based behavioral medicine treatment and mind-body medicine techniques such as: mindfulness, therapeutic exercise/yoga, biofeedback, progressive muscle relaxation, breath work, meditation, and guided visualization
Addictions and disorders
, focusing on the nature and treatment of addictions, including neurological, biochemical, cognitive, emotional, and socio-political factors
Nervous system and mental health,
focusing on evaluation tools and therapies for nervous system and common mental health related conditions, employing evidence-based practices of nutrition, botanical medicine, and pharmacology
Social & cultural issues in health care
, focusing on social determinants of health and chronic disease including: socioeconomic status, social support, socio-demographics, social inequalities, and psychosocial stressors
When you see a naturopathic doctor, they will take the time
to understand your concerns and symptoms in the context of your lifestyle, behavior, and social-cultural environment. By examining the details of your diet, stress level, sleep, physical activity and more, they aim to identify the underlying causes of your health concerns. Naturopathic doctors engage patients step-by-step to make lifestyle and behavior changes, and they empower them to sustain these changes. This kind of empowerment
leads to greater patient satisfaction, better health outcomes, and lower costs. NDs are also trained to recognize when you need more specialized mental health care, and will collaborate with and refer to mental health specialists when appropriate.
*** Use of the term psychotherapy may vary based on jurisdictional legislation
Back to the top.
What do naturopathic doctors mean by treat the whole person? July 2018
View the printable PDF
The AANP and INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.
Naturopathic doctors (NDs) follow six guiding principles that serve as a philosophical platform for all of naturopathic medicine. The principles influence how NDs think about medicine, make clinical decisions, and most importantly, how you are treated as a patient. Treat the whole person
is one of these six core principles.
Multiple factors contribute to your health, including: diet, lifestyle, genetics, psycho-emotional make up, spirituality, socioeconomic position, environmental issues, and more. While most primary care providers are trained to treat the body, few also address matters of the mind and spirit, elements that are equally important
. Licensed naturopathic doctors are trained to uncover, evaluate, and address relevant obstacles to healing. They take extra time
with patients and provide highly individualized care.
Guided by the Therapeutic Order
, naturopathic doctors focus on identifying the underlying cause(s) of your health concerns and empowering you to engage actively in restoring and managing your own health. Research shows that whole-person care often leads to higher patient satisfaction and improved
Identifying Underlying Causes of Illness
Sometimes aches and pains, stomach discomfort, trouble sleeping, and numerous other symptoms are indicators of underlying illness. While these symptoms can be reduced or managed, it is more important to understand and treat the root cause
, which is the focus of naturopathic medicine. This takes time and comprehensive evaluation encompassing physical, behavioral, emotional, and other key components of your health.
Providing Individualized Care
Treating the whole person involves giving each person tailored and personalized therapies specific to their genetics, nutrition status, lifestyle, and capacity for implementing suggestions, not just a set of instructions to follow. In order to assess, educate, and inform patients adequately, NDs often spend one hour or more with patients in an initial appointment, and 30+ minutes in subsequent appointments, compared to an average 20 minute
appointment with a conventionally trained physician.
Addressing Behavior and Lifestyle Factors
NDs recognize that both psycho-social factors
and lifestyle choices are central contributors to illness and chronic disease. Among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable
by modifiable lifestyle changes. NDs’ rigorous training in areas such as clinical nutrition
, behavioral medicine
, botanical medicine, and others makes them expert at prescribing and supporting essential, effective, and enduring behavior and lifestyle modifications which impact health outcomes.
Because of their focus in these areas and others, naturopathic doctors may be a good fit for people looking for a more comprehensive perspective on health concerns, or for a whole-person approach to health care.
Back to the top.
How do naturopathic doctors help people manage blood pressure? August 2018
View the printable PDF
The AANP and the INM would like to acknowledge Kasra Pournadeali, ND, for his contributions to the content of this FAQ.
Forty-six percent of U.S. adults, and nearly 80 percent of those aged 65 and older have high blood pressure, or hypertension
, according to new guidelines
from the American Heart Association. High blood pressure, which often occurs without symptoms, boosts the risk of stroke and heart disease
. Further, patients diagnosed with high blood pressure are estimated to pay almost $2,000 more
in annual healthcare costs than those who have blood pressure in the normal range. While blood pressure medications represent some of the greatest advances in healthcare pharmacology, they have side effects
with long-term use. Whole-body health evaluation and care is vital to identify the underlying cause(s) of high blood pressure, to proactively make changes that can impact overall health, and to minimize reliance on prescription medications when possible.
Licensed naturopathic doctors (NDs) are trained to evaluate and treat the whole person. They help patients identify the well-known causes of and modifiable risk factors for hypertension, as well as less-examined causes that include vitamin and mineral deficiencies
What do blood pressure numbers really mean?
Your blood pressure measurement is made up of two numbers that reflect the different pressures in your blood vessels. The systolic number is the pressure in your vessels when your heart contracts, and the diastolic number is the pressure when your heart is at rest between beats. Numbers greater than the ideal range indicate that your heart is working harder than ideal to pump blood to the rest of your body. Over time, untreated high blood pressure damages the delicate tissues inside blood vessels, in the eyes, brain, heart, and other areas. This can cause blindness, atherosclerosis (clogged arteries), and stroke. High blood pressure can also impact kidney function and in long term and severe cases, cause kidney failure.
What causes high blood pressure?
Causes of high blood pressure are different for every person and are often called “risk factors.” Well-known modifiable risk factors
include: being overweight or obese, having a sedentary lifestyle, using tobacco, having an unhealthy diet (high in sodium), excessive alcohol usage (more than one drink per day for women and two drinks per day for men), stress, sleep apnea, and diabetes. Non-modifiable risk factors include: age, race, and family history. Other well-known causes of high blood pressure include side effects from certain medications, hormonal imbalances, and kidney disease.
Naturopathic medicine approach and therapies
Naturopathic doctors take enough time
to identify and address the genetic, environmental, and behavioral/lifestyle factors that raise blood pressure.
NDs offer a large spectrum of treatments including: clinical nutrition, exercise prescriptions, botanical medicine, behavioral medicine, and, at times, standard medications. Naturopathic doctors work with and refer to other physicians and specialists when indicated.
Because of their extensive training in clinical nutrition
, NDs are well-equipped to help people with diets and nutrition, which is essential. A large body of evidence now supports specific diets
in the treatment of high blood pressure.
Naturopathic doctors provide highly individualized therapies. They follow the Therapeutic Order
, leading with minimally invasive therapies that support the body to restore healthy function, whenever possible. Meeting the patient where they are, NDs might recommend dietary approaches, vitamin supplements, exercise training, stress management, or even prescription medications when needed, depending on the unique situation of each patient. The naturopathic medicine principle of recognizing the healing power of nature
always brings NDs back to health-promoting, natural approaches that support the body’s effort to repair itself.
How to measure your blood pressure at home
- Find a time when you can rest for several minutes.
- Use a cuff that will inflate and deflate automatically.
- Sit comfortably and keep arms at heart level. Take your measurement 2 to 3 times, between 1 and 2 minutes apart. Write the numbers down. If there is something stressful happening, make a note of that, too. Take your recorded measurements to your doctor.
Measure twice daily: once in the morning and once in the afternoon/evening, 30 minutes before eating, drinking, or exercising.
Back to the top.
What do naturopathic doctors mean by first, do no harm? August 2018
View the printable PDF
The AANP and INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.
Licensed naturopathic doctors (NDs) follow six guiding principles that serve as a philosophical platform for all of naturopathic medicine. The principles influence how NDs think about medicine, make clinical decisions, and most importantly, how you are treated as a patient. First, do no harm
is one of these six core principles.
Naturopathic doctors follow a hierarchy in patient evaluation and treatment guided by the Therapeutic Order
. To do no harm
- Acknowledge and respect the individual's healing process, using the least force necessary to diagnose and treat illness.
- Avoid, when possible, the harmful suppression of symptoms.
- Use treatments that minimize the risk of harmful side effects.
The body works hard on its own to support recovery from injury
and illness. But certain genetic, environmental, and behavioral/lifestyle factors can slow or prevent optimal healing and recovery. Naturopathic doctors spend extra time
with patients to identify and remove these obstacles to recovery in order to facilitate healing.
Therapies are aimed at supporting the body’s health restoring and maintenance processes, as opposed to only reducing symptoms. Naturopathic doctors view symptoms as nature’s attempt to correct imbalances. Consequently, naturopathic treatments are geared toward allowing the body to reestablish balance and heal rather than suppressing symptoms, which can disable the body’s most primary way of communicating that something is wrong.
Naturopathic doctors choose the gentlest and least-invasive therapies first to achieve the desired outcome for each patient. NDs apply their rigorous training in clinical nutrition
, behavioral medicine
, botanical medicine, and other natural therapies to provide the most beneficial and least harmful treatments. They are also trained to use pharmacological drugs when necessary. If their state license permits, an ND can prescribe medication as a bridge to manage symptoms while the body repairs itself. If such healing is not possible, naturopathic doctors refer patients to conventional medical colleagues and work collaboratively. For those patients who need to be on medications, naturopathic doctors can help to prevent side effects.
For example, here’s how a naturopathic doctor would apply first, do no harm
to a patient who is diagnosed with gastroesophogeal reflux disease (GERD). The ND would:
- Carefully examine and adjust the patient’s diet and lifestyle to identify and address behaviors that may be underlying causes for stomach discomfort and heartburn, such as overeating, alcohol consumption, spicy foods, lying down after eating, stress, and more.
- Use lab tests and other clinical diagnostic approaches to assess the operation of the sphincter muscle and/or address inflammation in the lining of the esophagus, stabilizing these systems with natural supplements if appropriate.
- Aim to avoid or eliminate the prescription of proton pump inhibitors (PPIs) like Prilosec, which can impair digestion, damage the body’s microbiome, are linked to depression, and other side effects.
About 15 million
people in the U.S. use PPIs every year, but studies suggest as many as 70 percent
do not benefit from the prescription.
Because of their focus on the most natural, least toxic approaches to health care, naturopathic doctors may be a good fit for people looking for a more comprehensive perspective on health concerns, or for those seeking non-drug therapies.
Back to the top.
How and why do naturopathic doctors use botanical medicine? September 2018
View the printable PDF
The AANP and the INM would like to acknowledge Patricia Gaines,
ND, and Sheila Kingsbury,
ND, for their contributions to the content of this FAQ.
Botanical medicine, also known as herbal medicine, is the science and practice of using medicinal plants and extracts to improve overall health, support wellness, and treat acute and chronic disease. Many conventional pharmaceutical drugs are derived from plants
. Modern botanical medicine combines evidence-based science along with centuries-old experience to provide safe and effective treatments that support the body’s ability to heal.
A cornerstone of naturopathic medicine, botanical medicine is one of the most effective therapies that licensed naturopathic doctors (NDs) use to gently and safely treat illness while minimizing the risk of harmful side effects. Botanical medicine expands treatment options for patients. Alone or in combination with other naturopathic treatments, botanical medicine can be a safe, appropriate, and effective choice for addressing numerous health concerns ranging from frequent illness to gastrointestinal discomfort to depression, and more. During medical school, NDs complete an average of 130 classroom hours of botanical medicine education.
Botanical medicine is taught in a series of courses that build upon each other through an ND’s four-year, science-based medical education. Naturopathic medical schools are accredited and are recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings, including over 1,200 hours of clinical rotations with patients.
Naturopathic Botanical Medicine Curriculum
Through this rigorous curriculum, naturopathic doctors learn how to choose and effectively prescribe herbal medicines to treat the underlying cause(s) of illness, minimize side effects and drug interactions, and individualize doses and formulations for the maximum therapeutic benefit. Core areas of focus in naturopathic botanical medicine curriculum include:
- History and current use of Western herbal medicine
- Herbal properties and actions of plants
- Herbal constituents (compounds that have medicinal properties), medicinal actions (function in the body), and indications
- Critical evaluation of literature and research in regard to both efficacy and interactions/contraindications of botanical medicines
- Optimal extraction and delivery for a variety of plants
- Botanical prescription writing
- Organ systems-based botanical medicine formulation and topical application, including: gastrointestinal, respiratory, immune, cardiovascular, ears/eyes/nose/throat, reproductive, urinary, endocrine, musculoskeletal, and nervous systems
- Choosing, assessing and preparing herbal medicine in various forms including aqueous extracts, tinctures, herbal oils and salves, syrups, capsules, oxymels, poultices, and compresses. This includes evaluating comparable advantages and disadvantages of each type of preparation
- Dose ranges, contraindications, toxicity, side effects, and interactions
- Sustainability of herbal medications
- Effective creation of individualized formulas for patients
- Translation of labels to determine the purpose and application of over-the- counter herbal products
This comprehensive training combined with a focus on treating the whole person—mind, body, and spirit—enables naturopathic doctors to utilize botanical medicine when best suited to effectively treat the patient based on their diagnosis and presentation. By spending extra time to evaluate and diagnose patients
and then drawing on a spectrum of therapies including botanical medicine, clinical nutrition
, and behavioral and lifestyle medicine
, naturopathic doctors tailor comprehensive treatment to each patient, with a close eye on safety.
Botanical Medicine for Cold and Flu
Naturopathic doctors individualize botanical medicine treatments for numerous acute and chronic conditions. One example is cold and flu prevention/treatment. More people are seeking alternatives to prescription pharmaceuticals such as antibiotics, which can damage the gut
, and to over-the-counter medications such as analgesics, decongestants, and antihistamines, which can suppress the body’s ability to produce antibodies and/or cause unwanted side effects. Examples of safe and effective botanical medicines commonly used by NDs for cold and flu prevention and treatment include:
—a flower or berry that can be used as an anti-inflammatory, anti-viral, antioxidant, often used in syrup form
—an anti-microbial herb that can help break up mucus, and is delivered through tinctures, syrups, capsules, or crushed fresh
—an anti-microbial herb, also an immune stimulant, effective against biofilms, and can also help relax a spastic cough
—an anti-inflammatory, immune modulating herb that can activate white blood cells to fight infection and also be used for prevention
While licensed naturopathic doctors are also trained to use pharmaceutical drugs, and can prescribe them where state license permits, they emphasize less toxic substances like botanical medicine that promote natural healing first, following the Therapeutic Order
to provide the greatest benefit to patients with the least potential for damage.
Back to the top.
Why and how do naturopathic doctors focus on prevention? September 2018
View the printable PDF
The AANP and INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.
Naturopathic doctors (NDs) follow six guiding principles that serve as a philosophical platform for all of naturopathic medicine. The principles influence how NDs think about medicine, make clinical decisions, and most importantly, how you are treated as a patient. Prevention
is one of these six core principles.
Half of all Americans
live with at least one chronic disease, like heart disease
. Chronic conditions are the leading causes of death and disability and a leading driver of health care costs
in America. But among U.S. adults, 90 percent of Type 2 diabetes, 80 percent of cardiovascular disease, 70 percent of stroke, and 70 percent of colon cancer are potentially preventable by modifiable lifestyle changes
. The right preventive care at every stage of life helps Americans stay healthy, avoid or delay the onset of disease, and keep diseases they already have from becoming worse or debilitating. However, Americans use preventive services
at about half the recommended rate.
Licensed naturopathic doctors (NDs) proactively focus on prevention both to benefit individual patients and to improve public health. Beyond reactively treating disease, naturopathic doctors emphasize and help individuals build optimal health by:
NDs are educated
- Spending extra time with patients to identify the determinants of health and disease
- Approaching health through the lens of the whole person—body, mind, and spirit
- Educating about and promoting healthy lifestyle choices
- Assessing and addressing risk factors and implementing early interventions
- Determining genetic and hereditary susceptibility to disease
- Evaluating and addressing environmental and other external impacts on health
- Determining the impact of social relationships and community on health, and working to improve them, when relevant
and trained to use pharmacological drugs when necessary and can prescribe medication to manage symptoms if their state license permits. However, because naturopathic doctors focus on supporting the body’s health restoring and maintenance processes
, they offer the gentlest, least toxic, evidence-based treatments first.
Non-drug approaches offer effective prevention strategies that can improve health outcomes. Studies have found a 40 percent average reduction in LDL
(i.e., comparable to statins) in patients who were asked to consume a whole foods plant-based diet low in both fat and refined carbohydrates (along with moderate exercise, meditation/yoga, and social support). In addition, studies have shown that proper testing, treatment, and lifestyle changes such as losing weight, adopting a healthy diet, and physical activity have beneficial effects on people with Type 2 diabetes and are the cornerstones of diabetes prevention for at-risk individuals.
For those with an established disease that is not going away—such as chronic arthritis or permanent disabilities—naturopathic doctors use prevention strategies to strengthen health and improve quality of life and life expectancy. NDs’ rigorous training in areas such as clinical nutrition
, behavioral medicine
, botanical medicine,
and other natural treatments makes them expert at prescribing and supporting essential, effective, and enduring behavior and lifestyle modifications.
Back to the top.
How do naturopathic doctors treat anxiety? October 2018
View the printable PDF
The AANP and INM would like to acknowledge Moira Fitzpatrick PhD, ND, FICPP, CHT, for her contributions to the content of this FAQ.
40 million adults in America suffer from anxiety
, the most commonly diagnosed mental condition in the country. Unique for every person, Generalized Anxiety Disorder (GAD) is often experienced as excessive, uncontrollable worry about a variety of topics in a manner disproportionate to their potentially posed risk. Chronic nervousness, agitation, a restless mind, muscle tension, racing heart, and sleep disturbance are common symptoms.
Anxiety can have a variety of root causes from genetic to biological to environmental. Common first-line treatments often focus on prescription medications and/or therapy. While pharmaceutical drugs can provide symptom relief, these same drugs often have limited effectiveness
. Drugs such as Benzodiazepines can also be highly addictive
and can cause unwanted side effects
. A growing body of research is uncovering dangers associated with commonly prescribed drug treatments
including selective serotonin reuptake inhibitors (SSRIs) such as Prozac and Lexapro, and with benzodiazepines
such as Xanax and Ativan.
Licensed naturopathic doctors (NDs) excel at treating anxiety because they focus on treating the whole person, and on addressing the underlying causes of the condition. NDs have a deep toolbox of evidence-based, natural therapies including clinical nutrition
, botanical medicine
, and behavioral medicine
to draw from.
Identifying Underlying Causes of Anxiety
Naturopathic doctors begin by assessing the whole person. Initial appointments often last one hour or more
and include a detailed family history, medical history, discussion of diet, physical activity, environmental exposures, sleep patterns, and psycho-emotional stressors. There are a wide variety of underlying causes for anxiety. Naturopathic doctors consider:
— An understanding of genetic markers and pathways contributes to a more precise and personalized approach to treatment. Single Nucleotide Polymorphisms (SNPs) are the most frequent type of mutation. NDs look at patterns in SNPs and see how they affect B vitamins, hormones, nutrients, neurotransmitter production, and breakdown. This information provides foundational support to treatment planning.
—The balance of chemicals in the brain helps control mood and can play an important role in anxiety. Your ND will look for imbalances in serotonin, gamma-aminobutyric acid (GABA), and norepinephrine.
—The microbiome or ‘good germs’ that line your digestive tract play an important role in balancing your nervous, hormonal, and immune systems. Your ND may order a stool analysis test to evaluate the health of your GI tract. You can also expect a detailed discussion of your diet, and potential labs to identify food sensitives and nutritional deficiencies.
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis
—Your HPA axis is your body’s stress response system. In the face of chronic psychological stress, the adrenal glands excrete an abnormal amount of cortisol in an abnormal rhythm. This can be caused by a number of factors, including blood sugar imbalance, lack of sleep, caffeine, toxins, and allergens. Your ND may order lab testing if this condition is suspected.
Evidence-Based Naturopathic Medicine Treatments
Naturopathic doctors provide highly individualized therapies. They are trained in the pharmacological treatments commonly prescribed by conventionally trained MDs, and in some states, have scope for prescription of pharmaceuticals when necessary. When it is necessary to use medications, genetic testing can help determine which medications you will be responsive to with the least side effects. NDs lead with minimally invasive therapies that support the body to restore healthy function. Naturopathic therapies include:
Improve gut health.
Research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connection
supports the importance of a nutritional and diverse diet, and supplementation with probiotics. NDs have the expertise to balance the microbiome and address food sensitivities and leaky gut thanks to their rigorous training in clinical nutrition.
Repair and restore with nutritional and botanical supplements.
NDs utilize a multitude of evidence-based nutritional and botanical supplements for their calming effects to help reduce the frequency, severity, and duration of generalized anxiety and panic disorders. These treatments are individualized and evaluated carefully for safety in every patient. Effective supplements include: Gamma-aminobutyric acid
(or GABA), L-theanine
, scutellaria lactiflora
, Piper methysticum
, adaptogens such as Withamnia Somnifera
(ashwagandha), lithium orotate
, and magnesium
Manage stress with behavioral medicine.
NDs are trained to evaluate your symptoms in the context of your lifestyle, behavior, and social-cultural environment. By examining the details of your diet, stress level, sleep, physical activity, and more, they can prescribe the most effective, evidence-based behavioral medicine treatments and mind-body medicine techniques. These include mindfulness, therapeutic exercise/yoga, biofeedback, progressive muscle relaxation, breath work, and meditation. For some patients, addressing repressed or current trauma can play a significant role in treating anxiety. Naturopathic doctors who are highly specialized in mental health, such as those certified by the Psychiatric Association of Naturopathic Physicians
, can offer energy-based therapies which focus on the release of trauma. These may include hypnotherapy, guided visualization, cranial sacral therapy, and other specialized modalities.
Optimize lifestyle factors.
Because of the extra time they spend getting to know you, NDs uniquely tailor recommendations to optimize lifestyle habits such as sleep, diet, exercise, and reduction of stimulants, all of which play contributing roles in anxiety.
NDs may evaluate and utilize additional strategies and therapies for different types of anxiety disorders, including anxiety in perimenopausal women, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and panic disorder.
Back to the top.
How do Naturopathic Doctors Treat ADHD? October 2018
View the printable PDF version.
The AANP and INM would like to acknowledge Paul Herscu, ND, MPH, for his contributions to the content of this FAQ.
Attention Deficit Hyperactivity Disorder (ADHD) is a chronic, neurobiological condition that affects nine percent of children and four percent of adults in America. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity, and impulsive behavior. Many diagnosed with ADHD also struggle with concurrent states such as low self-esteem, troubled relationships, poor performance in school or work, anxiety, learning disabilities, and other mental, emotional, and behavioral disorders.
The common first line of treatment for ADHD is medication such as a stimulant (e.g. Adderall, Ritalin) or non-stimulant (e.g. Intuniv, Strattera) for those age six and above. While prescription drugs can be extremely effective addressing symptoms in the short-term, for many, the effects fade after prolonged use. Additionally, these medications may not address underlying causes or concurrent conditions, and frequently cause unwanted side effects including weight and height disturbances, sleep disruption, personality changes, “tics,” and even addiction. The consequences of taking stimulants for years on end have not been fully evaluated in studies, and use during pregnancy is still in debate. These challenges lead many to discontinue medication, seeking complementary or alternative approaches. Whole-person treatment can help address these hurdles.
Licensed naturopathic doctors (NDs) excel at treating ADHD because they focus on treating the whole person—mind, body, and spirit. Understanding how each person is experiencing their ADHD symptoms and discovering what is most limiting for them is important in the naturopathic approach. NDs have rigorous training in evidence-based treatments that have been shown to address underlying causes while improving ADHD symptoms. These treatments include clinical nutrition, behavioral medicine, and botanical medicine. Depending on the individual, naturopathic treatment can support conventional care, or be a primary treatment.
Whole Person Whole Patient, Individualized Approach
Naturopathic doctors spend extra time with patients to evaluate the whole person, including: diet, lifestyle, genetics, psycho-emotional makeup, socioeconomic position, environmental issues, and more. They are able to provide patients and their families with a high level of emotional and psychological support. Often, NDs assess multiple body systems including digestive/gastrointestinal (for inflammation), nutritional (for deficiencies or sensitivities), immune, and neurological (neurotransmitter regulation) to get a full picture of the patient's needs. The goal is to identify areas of dysfunction and then develop a plan to restore optimal function. In addition to the physical body, how an individual with ADHD feels mentally and emotionally always influences which therapies are selected. The age of the patient is taken into careful consideration. All of these pieces are taken together when building a comprehensive naturopathic care plan tailored to the patient.
Evidence-Based Naturopathic Treatments
Diet and lifestyle changes. Diet plays an enormous role in brain function. An ADHD assessment and treatment plan may include food sensitivity testing to pinpoint and help avoid those foods that are contributing to hyperactivity and distraction. An elimination diet can be effective, where common allergens and foods containing artificial dyes and high levels of salicylates are removed from the diet. A Mediterranean diet, rich in fruits and vegetables, whole grains, seafood, nuts and legumes, and olive oil may also be considered. It is also important to make sure blood sugar levels stay balanced through regular protein consumption. Additionally, improving sleep hygiene can play a role in managing ADHD symptoms. Emerging evidence shows that physical exercise, yoga, and time spent in nature can benefit children with ADHD.
Supplementation. Deficiencies in magnesium, iron, and vitamin-D are associated with ADHD. Research also supports a connection between B-vitamin deficiencies and ADHD symptom severity. NDs evaluate and address these deficits with proper supplementation. Further, numerous studies have demonstrated improvement in symptoms of ADHD through the use of supplemental fish oil. Because a good balance of healthy bacteria in the gastrointestinal system can positively impact brain health, supplementation with probiotics can also help reduce symptoms of ADHD.
Botanical medicine. Botanical or herbal medicines can help calm the nervous system and address restlessness, anxiety, and irritability associated with ADHD. Bacopa monnieri and Ginseng are just a couple examples of beneficial botanical medicines that NDs utilize. Naturopathic doctors will individualize formulations for patients.
Behavioral medicine. The American Academy of Pediatrics states that behavioral therapy should be the first step in treating ADHD in pre-school-aged children. Sometimes called behavioral modification, this approach works on resolving specific problematicbehaviors and offers solutions to help prevent them. Cognitive behavioral therapy (CBT) can help children and adults with ADHD overcome difficulties in everyday executive functions that are needed to effectively manage time, organize, and plan in the short term and the long term. CBT can also focus on concurrent and associated symptoms such as anxiety, emotional self-regulation, impulse control, and stress management. Neurofeedback is a therapy that uses real-time EEG data to help train brains to improve focus, impulse control, and other challenges associated with ADHD. A number of studies have shown that neurofeedback can improve certain ADHD symptoms. Naturopathic doctors refer patients to licensed therapists for these therapies as needed.
ADHD is a complex disorder impacted by numerous genetic, neurological, nutritional, and environmental factors. Whole-person naturopathic medicine strategies can offer patients many benefits.
Back to the top.
How do naturopathic doctors help prevent cognitive decline? November 2018
View the printable PDF version.
The INM and AANP would like to acknowledge Doni Wilson, ND, Sara Thyr, ND, and Amy Rothenberg, ND, for their contributions to the content of this FAQ.
As the aging baby boomer generation grows, a growing number of Americans are projected to have dementia and associated cognitive decline. Currently over five million Americans are living with Alzheimer’s, a degenerative brain disease and the most common form of dementia. By 2050 that figure is expected to rise to 14 million, a staggering number of afflicted patients causing overwhelming strain on caregivers and the economy. Licensed naturopathic doctors (NDs) have effective approaches for the prevention of cognitive decline based on rigorous training in therapeutic nutrition, behavioral medicine, botanical medicine, and an emphasis on addressing the underlying causes of disease.What is Cognitive Decline?
Risk Factors and Prevention
Cognitive decline describes a noticeable and measurable impairment in cognitive abilities, including memory, language, thinking, and judgement. It is characterized by damage to brain cells, specifically, an accumulation of amyloid plaques and neurofibrillary tangles in the brain. This accumulation is influenced by a number of lifestyle, environmental, and genetic factors.
Studies have suggested that one-third of dementia cases worldwide could potentially be prevented
through better management of health and lifestyle factors. The biggest risk factors for dementia
-related cognitive decline outside of age and family history/genetic pre-disposition are heart disease, diabetes, stroke, depression, and stress
. Addressing chronic illnesses and lifestyle choices helps reduce the risk of developing dementia. Prevention
is a focal point of naturopathic medicine, and NDs have a proven track record of helping patients manage specific chronic health conditions such as heart disease
, and diabetes
Exercise and Weight Loss
The role of exercise in prevention and slowing of cognitive decline
Back to the top.
is always part of the naturopathic medicine prescription. Naturopathic doctors spend extra time with patients
and caregivers to find and tailor opportunities for physical activity. Studies confirm that obesity late in life is another risk factor for Alzheimer’s
. Naturopathic doctors help address underlying metabolic imbalance
to support long- term healthy weight maintenance.
Diet and Supplementation
NDs assess and help optimize your diet
to decrease inflammation and maintain blood sugar balance. Therapeutic nutrition through food and supplementation are often part of the plan. A number of herbal supplements including curcumin
, and Bacopa monnieri
have been shown to help reduce inflammation in the brain and support brain health.
Studies show that insomnia and lack of sleep can increase the risk of Alzheimer’s
. Additionally, medications often used to help with insomnia also increase risk of cognitive decline. NDs are experts at resolving sleep issues using natural approaches
such as herbal medicine, hydrotherapy, and blue-light blocking goggles.
Treating the whole person, naturopathic doctors also educate and motivate patients to keep up ongoing social interaction
, an important factor for both the prevention and slowing of dementia. Emerging research has identified hearing loss
as a modifiable risk factor for dementia. Actively wearing aids, to help ease and encourage social interaction, has the potential to delay cognitive decline. You are more at risk for hearing loss if you have diabetes, heart disease, or if you smoke.
Helping families create, access, and integrate cognitive exercises
has also been shown to help prevent dementia. NDs can prescribe such programs, or refer you to and partner with, specialists in that field.
Naturopathic doctors often recommend mindfulness meditation, and other forms of stress reduction such as gardening, journaling, and listening to music for the prevention of cognitive decline and to enhance memory and quality of life
for those already diagnosed.
Minimizing Reliance on Drugs that Increase Risk
It is important to remember that memory loss and cognitive decline can be symptoms of other disease processes or drug side effects and may be reversible. A proper diagnosis with a licensed provider is essential before beginning any kind of treatment with conventional and/or naturopathic medicine.
Some commonly prescribed drugs create additional risk factors for dementia
, such as proton pump inhibitors for gastroesophageal reflux (GERD). Naturopathic doctors address GI concerns with natural and lifestyle approaches
. Research has also shown that long-term use of Zolpidem (Ambien)
one of the most commonly prescribed medications for sleep, is associated with an increased risk of Alzheimer’s.
While there are no known cures for Alzheimer’s and other forms of dementia, naturopathic medicine offers highly individualized, whole-person prevention strategies.
Back to the top.
How do naturopathic doctors diagnose and treat Crohn’s disease and ulcerative colitis? December 2018
View the printable PDF
The AANP and the INM would like to acknowledge Eric Yarnell, ND, for his contributions to the content of this FAQ.
When diagnosing and treating patients with acute or chronic gastrointestinal (GI) symptoms, licensed naturopathic doctors (NDs) address the whole person—including body, mind, emotions, genetics, environmental exposures, and socio-economic status. NDs employ a variety of diagnostic approaches to pinpoint the underlying causes of distress. Trained rigorously in clinical nutrition
, behavioral medicine
, botanical medicine
, and conventional pharmaceuticals, NDs draw on a broad and deep spectrum of treatments, expanding options for patients with Crohn’s disease and/or ulcerative colitis.
What are Crohn’s Disease and Ulcerative Colitis?
Crohn’s disease (CD) and ulcerative colitis (colitis or UC) are the most common disorders in a group of auto-immune GI diseases referred to as inflammatory bowel diseases (IBDs)
. Crohn’s may develop anywhere in the digestive tract; ulcerative colitis is limited to the large intestine and rectum. Thought to be caused by your body’s immune system having an abnormal reaction to normal bacteria in your intestine, both diseases are chronic, lifelong, and often debilitating. Intestinal pain, dangerous obstructions and blockages, abscesses and ulcers are all possible complications. Acute flare-ups can be triggered by foods
, or acute infections. Tobacco products can also trigger flares
of Crohn’s disease.
How are Crohn’s and Colitis Diagnosed?
Crohn’s and ulcerative colitis can be hard to diagnose because symptoms vary from person to person, and are similar to those of other diseases. For example, the most common symptoms of Crohn’s are intense abdominal pain and diarrhea. However, a person with Crohn’s disease can have constipation and diarrhea and sometimes blood in the stool, although some people with constipation will not have any diarrhea or blood in the stool. In addition, the typical symptoms of Crohn’s can be identical to those of small intestinal bacterial overgrowth (SIBO).
With ulcerative colitis, symptoms typically include bloody diarrhea, frequently accompanied by abdominal pain and weight loss.
Given the complexities of Crohn’s and ulcerative colitis, a correct diagnosis is essential to effective treatment. There is no one definitive test for Crohn's disease. Testing is determined by the suspected location, small vs. large bowel. In addition to a comprehensive health history and an in-office exam, a naturopathic doctor may order stool testing to assess gut bacteria, markers of inflammation, and immune markers. NDs may also order blood testing for food sensitivities/allergies, celiac antibodies, folic acid deficiency, and inflammatory indicators such as C-reactive protein.
Diagnosis usually involves endoscopic or imaging studies in patients with compatible clinical history, and naturopathic doctors refer patients to gastroenterologists for this vital testing. Colonoscopy is the most appropriate first test for a patient presenting with diarrhea and suspected large bowel CD. Wireless capsule endoscopy is increasingly being used for evaluation of suspected small bowel CD. Imaging studies are generally considered more appropriate for those with abdominal pain and to evaluate the small bowel. These can include upper GI radiography with barium, computed tomography (CT) and computed tomography with enterography (CTE), magnetic resonance imaging (MRI), and magnetic resonance enterography (MRE). Diagnosis can also be supported by specific findings such as perianal skin tags or abdominal tenderness.
Naturopathic doctors also frequently test fecal calprotectin
, an inflammatory substance produced by neutrophil white blood cells. Measuring calprotectin is helpful in establishing that there is inflammation in the lower intestinal tract.
Individualized Naturopathic Treatment for Crohn’s and Colitis
Once a patient has been diagnosed with Crohn’s, ulcerative colitis, or other IBDs, a naturopathic doctor will create a tailored treatment plan based on each patient’s individual presenting symptoms understood in context with the patients’ overall health and lifestyle. While there are no well-documented cures for either disease, the goal is to help prevent flare-ups, achieve and maintain remission, and heal as much of the underlying inflammation (even in periods without symptoms) as possible. Specific treatments a naturopathic doctor may recommend include:
- Elimination/challenge diets or other approaches to reducing food triggers (including elemental diets) to stop and prevent flare-ups
- Curcumin in tincture, capsule, or whole turmeric powder form to reduce inflammation (however, there are contraindications to the use of turmeric. For instance, turmeric should be avoided in patients who readily form calcium oxalate kidney stones)
- Probiotics to modulate the immune system and prevent flare-ups
- Stress reduction by various techniques
- Artemisia absinthium (wormwood) capsules
Because they are lifelong conditions, Crohn’s and ulcerative colitis must be carefully monitored and managed, with more aggressive interventions necessary during flare-ups. Research shows that a naturopathic medical approach emphasizing diet and other lifestyle changes can be used
to successfully manage these conditions. Naturopathic therapies may eliminate the need for prescription drugs
(such as prescription anti-inflammatory medications, immune system suppressors, and antibiotics) or surgery, which have the potential to cause more side effects and long-term problems. However, if natural approaches are not successful, naturopathic physicians do not hesitate to prescribe palliative medications (when in state scope of practice) or to refer patients for treatment with various medications, biologic drugs, or surgery. A naturopathic medical approach has the added benefit of focusing on engaging patients in managing their own health—a crucial component of living a long and healthy life with these challenging conditions.
Back to the top.
How do naturopathic doctors treat hypothyroidism? January 2019
View the printable PDF version.
Of the 20 million Americans who have thyroid disease, most have hypothyroidism, a condition where the thyroid gland can’t make enough thyroid hormone to keep the body running normally. More common in women than men, hypothyroidism can have a number of genetic, nutritional, and immune-related underlying causes and contributing factors. Licensed naturopathic doctors (NDs) have effective approaches for the treatment of hypothyroidism based on rigorous training in therapeutic nutrition and botanical medicine, and an emphasis on addressing the underlying causes of disease.
Hypothyroidism: What is it and what are the symptoms?
The thyroid gland is a butterfly-shaped endocrine gland located in the lower front of the neck. The thyroid’s job is to make hormones which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body make energy, metabolize, regulate temperature, and keeps the brain, heart, muscles, and other organs working as they should. When the body isn’t making enough thyroid hormone, symptoms can include fatigue, weight gain, hair thinning, dry skin, and depression. Low thyroid hormone can also cause more serious symptoms like difficulty sleeping, changes in menstruation, or gastrointestinal symptoms. Because symptoms of hypothyroidism can resemble those of other diseases and vary widely from person to person, patients may not recognize them as a problem warranting exploration or treatment. Experts believe that between 40 and 60 percent of people with thyroid disease do not know they have it.
Typically, blood tests are used in the diagnosis of hypothyroidism. Three measurements are often considered: free thyroxine (T4) and free triiodothyronine (T3), both produced by the thyroid itself, and thyroid-stimulating hormone (TSH, also called thyrotropin), produced by the pituitary gland to regulate the thyroid. While many doctors follow the current TSH reference ranges for diagnosis (0.4 to 5.0mU/L), there is a lot of controversy about what is diagnosable and treatable as hypothyroidism and sub-clinical hypothyroidism (when blood levels of free T3 and free T4 are normal, but the level of thyroid-stimulating hormone is high). A blood test measuring thyroid antibodies anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-TG) is used to confirm or rule out autoimmune thyroid disease causing hypothyroidism.
Hypothyroidism: Underlying Causes
Naturopathic doctors treat hypothyroidism from the root of the problem. There are two main types of hypothyroidism, with numerous contributing factors:
Autoimmune thyroid disease (Hashimoto’s) is the most common cause of hypothyroidism. This is a form of thyroid inflammation caused by the patient's own immune system. Hashimoto’s is five to eight times more common in women than men. Elevated levels of anti-TPO antibodies are found in approximately five percent of adults and 15 percent of older women. Individuals with other autoimmune diseases such as type 1 diabetes, celiac disease, and rheumatoid arthritis have a higher prevalence of autoimmune thyroid disease.
Central or pituitary hypothyroidism, where the thyroid just isn’t making enough hormone, is often influenced by environmental and nutritional factors including: gastrointestinal system inflammation, vitamin and mineral deficiencies or imbalances, high levels of cortisol (due to prolonged stress or oral steroid use), and/or elevated estrogen. Surgery on the thyroid gland (to remove a goiter or nodule) and/or radioactive iodine treatment (to treat a thyroid nodule, hyperactive thyroid, throat cancer, and cancer of nearby sites) can also cause hypothyroidism.
The current conventional medical treatment for hypothyroidism is daily thyroid hormone supplementation with synthetic levothyroxine (T4), liothyronine (T3), or natural desiccated thyroid (T4 and T3) to correct low levels. While this treatment can be very effective for some patients, for others with Hashimoto’s taking thyroid hormone alone does not fully address the underlying cause of dysfunction. For some, the medication can create a yo-yo-ing of symptoms while trying to find the correct dosage. Other individuals don’t tolerate or absorb thyroid hormone well.
Naturopathic doctors are trained in the pharmacological treatments commonly prescribed by conventionally trained MDs, and in some states, prescribe pharmaceuticals when necessary. However, NDs rarely use medication as a standalone treatment.
If autoimmune disease is the main cause of thyroid dysfunction, NDs work to help control the inflammation and eliminate autoimmune triggers. Working to reduce thyroid antibodies, if possible, is the main goal of treatment. If the thyroid is just not producing enough thyroid hormone, NDs address lifestyle and environmental factors that may be contributing to low production. Although every hypothyroid treatment is carefully individualized, some common natural therapies for hypothyroidism include:
Diet and Microbiome
Many nutritional factors play a role in optimizing thyroid function, and the right diet is important to help prevent and manage conditions that can accompany thyroid disease. When it comes to Hashimoto’s and other autoimmune conditions, research shows that one important factor in autoimmune response is chronic, persistent microbiome imbalance and inflammation in the gut. Naturopathic doctors address microbiome dysfunction with nutritional therapies such as probiotics, cultured foods, and diets lower in sugar, starch, and carbohydrates, which help to decrease inflammation and balance immunity. Food allergy panels and/or an elimination diet can help identify food triggers to the autoimmune response for Hashimoto’s. Those with an autoimmune thyroid disorder should also be tested for celiac disease to determine if gluten elimination is needed.
Naturopathic doctors test for common nutrient deficiencies associated with hypothyroidism, and supplement as needed.
- Vitamin B-12 is very important for thyroid production. It helps improve cellular response to thyroid hormone and boosts energy production in cells to help with fatigue and other symptoms associated with hypothyroidism.
- Selenium supports efficient thyroid synthesis and metabolism and has been found in studies to reduce thyroid antibody levels in patients with Hashimoto’s.
- Zinc is beneficial in improving thyroid function and hormone levels and has been shown in studies to have a positive effect on thyroid function in overweight females.
There are several herbs that have been shown to benefit thyroid function, including adaptogens like Ashwagandha
, which was shown to improve thyroid function for subclinical hypothyroid patients. Adaptogens are herbs that work on several body functions at once to help balance out dysfunction and regulate metabolic processes. They are used with caution, however, in those with autoimmune thyroid disease as some botanicals can stimulate the immune system response. Other herbs such as gum guggal
can be used in all forms of hypothyroidism as they help to convert the inactive form of T4 to the more active form of T3. Any herbal treatment should be approved by a professional trained in herbal medicine to reduce side effects, prevent unwanted drug/herb interactions, and maximize treatment efficacy.
Regulation of thyroid function can be tricky and requires a whole-person approach. Naturopathic doctors lead with natural therapies that address underlying causes and support the body to restore healthy function.
Back to the top.
Who ensures the quality of naturopathic medical schools? January 2019
View the printable PDF version.
The AANP and INM would like to acknowledge Marianne Marchese, ND, and Daniel Seitz, JD, EdD, for their contributions to the content of this FAQ.
Accreditation is an external peer review and regulatory process for higher education. Its goal is to ensure high-quality education and training in various disciplines, including medical education, in order to protect the interests of students and the public, and to ensure safe and effective practice. Accreditation is usually carried out by private, non-profit organizations that are “recognized” (i.e., approved) by the U.S. Department of Education.
How are naturopathic medical schools accredited?
Naturopathic medical programs that award the naturopathic doctoral degree (ND degree) are accredited by the Council on Naturopathic Medical Education. This process is similar to the accreditation of the Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees, and the U.S. Department of Education recognizes the accrediting agencies that oversee schools granting these three degrees. All three of these degree programs—MD, DO, and ND—must go through a rigorous process of initial accreditation, as well as periodic, ongoing re-accreditation—generally every five to 10 years, depending on the field—to ensure continued high-quality education and training.
Why is accreditation necessary?
Accreditation ensures that high educational standards reflecting the needs of a given medical profession have been established and are being met. Additionally, accreditation provides the foundation for practitioner licensing and regulation. Specifically, accreditation signifies that a college or educational program has met or exceeded the standards for:
- educational quality with respect to mission, goals, and objectives
- governance, administration, and finance
- facilities, equipment, resources, faculty, student admissions, performance, and evaluation
- preclinical and clinical curriculum
- research and scholarship activity
Accreditation ultimately protects consumers and students, providing an assurance that a program has met set educational standards, and that if said standards are not maintained, recourse will be available for the student.
Who oversees accreditation?
There are three U.S. accrediting agencies for the recognized medical professions. The Liaison Committee on Medical Education (LCME) is the accrediting body for the MD degree. The Commission on Osteopathic College Accreditation (COCA) is the accrediting body for the DO degree. And, as mentioned above, the Council on Naturopathic Medical Education (CNME) is the accrediting body for the ND degree. These three accrediting agencies are recognized by the United States Department of Education (USDE). In some fields, there are accrediting entities that are not recognized by USDE; in some cases, these entities are not legitimate. Thus USDE recognition is an important distinction to be aware of.
How rigorous is the accreditation process?
Accreditation is a highly demanding process. Generally, it involves the submission of extensive information and documentation by a school seeking initial or renewed accreditation, followed by two to three days of on-site assessment. The on-site assessment encompasses careful observation and evaluation of many aspects of the school including: facilities, administration, faculty, curriculum, student performance, and more. Members of the on-site review team and of the accrediting bodies are unpaid volunteers, and every effort is taken to ensure that there are no conflicts of interest that may interfere with objectivity. The medical school accrediting agencies are made up of professional members (physicians), institutional members (faculty or administrators of schools), and public members. Some agencies have student representatives as well. The U.S. Department of Education oversees all three medical school accrediting agencies in order to ensure that the accrediting process is thorough, objective, and fair.
Back to the top.
Do naturopathic doctors prescribe medication? February 2019
View the printable PDF version.
The INM and AANP would like to acknowledge Christie Fleetwood, ND, RPh, for her contributions to the content of this FAQ.
Licensed naturopathic doctors (NDs) are trained as primary care providers to diagnose, prevent, and treat acute and chronic illness. NDs complete rigorous education in pharmaceutical drugs during their four-year, science-based medical education, and they may prescribe medications when indicated as allowed by state regulations. However, naturopathic doctors typically don't prescribe drugs at the first sign of symptoms or trouble. Instead, NDs choose to work with natural, less invasive therapies without strong side effect profiles before reaching for the prescription pad. They support and enhance a patient’s innate capacity for healing with evidence-based therapies such as lifestyle modification, clinical nutrition, botanical medicine, and behavioral medicine, to name a few.
Pharmacology education and training
Pharmacology is taught through a series of courses that build upon each other through an ND’s medical education. This training is reinforced through a minimum of 1,200 hours of hands-on, clinical training. Naturopathic medical programs are accredited
and are recognized by the United States Department of Education. Pharmacology is an essential part of the Naturopathic Physicians Licensing Examination (NPLEX)
, the passage of which is required before a doctor of naturopathic medicine can be licensed or regulated by a state/province.
As part of the pharmacology curriculum, naturopathic doctors learn both medical and clinical pharmacology. They study primary therapeutic uses, mechanisms of action, potential adverse effects, and drug/drug interactions of medicines commonly encountered, including prescription drugs, controlled substances, and over the counter (OTC) medications. Additionally, they learn how to prescribe and manage pharmaceuticals for the most common presenting concerns in primary care medicine.
While pharmacology coursework is comparable to that taught in conventional medical schools, NDs receive additional training and focus in two important areas:
- Botanical or herb/drug and supplement/drug interactions. Seventy-five percent of Americans regularly take herbs and dietary supplements, and they don’t always inform their primary care doctor. Naturopathic doctors complete approximately 130 classroom hours of botanical medicine education. This encompasses the science and practice of using medicinal plants and extracts to improve overall health, support wellness, and treat acute and chronic disease. An extensive knowledge of herbs and supplements allows NDs to better help guide patients and prevent harmful interactions.
- Identification of nutrient depletions caused by long-term use of drugs. Some of the most commonly prescribed or recommended drugs can interfere with or cause deficiencies of vital nutrients with ongoing use. These include medicines prescribed for acid reflux, heartburn, cholesterol, and more. Naturopathic doctors are expert at identifying signs of nutrient depletion, and apply their extensive knowledge of clinical nutrition and botanical medicine to help reverse these harmful side effects.
NDs are also trained to identify when and whether a patient is overmedicated, and when prescriptions, OTC medicines, and supplements can be tapered off or discontinued.
When NDs Use Pharmaceuticals
Naturopathic doctors prescribe drugs based on available evidence, clinical experience, patient preference, and the Therapeutic Order
. They match the patient’s level of health and pathology with the necessary level of intervention. As a principle, naturopathic doctors support and enhance the body’s inherent ability to heal
itself. They utilize a deep toolbox of natural therapies to help get a patient healthy enough to heal disease without strong interventions. Yet when a careful assessment
of lifestyle, social/emotional factors, physical exam, and/or targeted laboratory testing reveals that the patient is not able to heal with natural therapies, NDs will refer or prescribe appropriate medicine.
The Therapeutic Order is the framework NDs use to evaluate the patient’s obstacles to healing and to choose therapeutic approaches in the most logical, least invasive ways first. If NDs do prescribe medication, they anticipate and address potential side effects of that medication with natural therapies. For example, if a patient requires antibiotics, which are known to wipe out needed, healthy bacteria in the microbiome in addition to harmful bacteria, NDs may also prescribe probiotic foods or supplements to help keep the GI system in healthy balance.
Here are two care scenarios when a naturopathic doctor may use pharmacology in addition to natural therapies to treat acute or chronic illness:
- A hypertensive patient with a comprehensive physical exam showing multiple signs of ongoing vascular damage including swollen ankles, skin discoloration, hair loss, and multiple blood pressure readings of 200 over 120. A detailed intake reveals that the patient’s diet consists largely of fast food and coffee. In this case, the patient requires a high level of intervention to prevent further harm, and the ND is likely to write a prescription for an anti-hypertensive drug, a diuretic, and refer the patient to a cardiologist for further testing. This is in addition to recommending significant lifestyle changes and other natural medicine approaches.
- A patient is traveling and has left his "rescue inhaler" for asthma at home. He encounters an irritant (e.g. an excessive amount of smoke), and is wheezing and experiencing difficulty breathing. The ND would call in a prescription for an inhaler and work to restore the patient's health with natural approaches when he returns to his hometown.
Overall, naturopathic doctors believe that natural medicine and conventional medicine are not mutually exclusive. They recognize that there are times when both approaches can be utilized together for the patient’s benefit.
Back to the top.
How do naturopathic doctors treat insomnia and other sleep problems? March 2019
View the printable PDF version.
The AANP and the INM would like to acknowledge Amy Rothenberg, ND, for her contributions to the content of this FAQ.
If you struggle to fall asleep or stay asleep, you are not alone. Forty percent of American adults get less sleep than the nightly seven hour minimum recommended by the American Academy of Sleep Medicine. Good quality sleep is essential to whole-person health—mind, body, and spirit—and sleep deprivation can increase the risk of chronic disease, impact metabolism and hormone production, worsen cognitive and motor performance, and wreak havoc on your overall health. Licensed naturopathic doctors (NDs) are trained rigorously to identify and treat the numerous underlying causes of insomnia, and to address the psychological and biological impacts of not having enough sleep. With advanced training in therapeutic nutrition, botanical medicine, and behavioral medicine, NDs lead with safe, natural, and effective treatments to restore good sleep.
Why is sleep important for overall health?
The right quantity and quality of sleep is necessary to help optimize your mental health, physical health, quality of life, and safety. During sleep, your body is working to support healthy brain function and emotional well-being. While you're sleeping, your brain is forming new pathways to help you learn and remember information. Studies show that a good night's sleep improves learning and problem-solving skills. Sleep also helps you pay attention, make decisions, and be creative. Sleep deficiency has been linked to risk-taking behavior, depression, and suicide.
Sleep deprivation has been shown to have an adverse effect on heart health. Helping to maintain a healthy balance of the hormones that make you feel hungry or full, sleep affects how your body reacts to insulin, the hormone that controls your blood sugar level. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, hypertension, diabetes, and stroke. Sleep deficiency also increases the risk of obesity. Your immune system relies on sleep to stay healthy, and ongoing sleep deficiency can make it harder for your body to fight common infections. Sleep also plays a role in puberty and fertility, and helps support growth and development in children.
People who are sleep deficient take longer to finish tasks, have a slower reaction time, and make more mistakes. Studies show that sleep deficiency harms your driving ability as much as, or more than, being drunk.
What are the underlying causes of insomnia?
Lifestyle and environmental factors, psychosocial issues, and medical conditions can all influence sleep problems. Naturopathic doctors spend an hour or more assessing the whole person, exploring a wide variety of underlying causes for sleep disruption, including: Nutrition. Alcohol, caffeine, and nicotine may all contribute to insomnia. Refined sugar in desserts, sodas, and simple carbohydrates like white bread and barbecue sauce have also shown negative effects on restful sleep. When, what, and how much you eat can also interfere with your sleep.
Studies show that partial sleep deprivation alters the gut microbiome. Lower proportions of microbiota (specifically phyla Verrucomicrobia and Lentisphaerae) was associated with poor sleep quality. In simpler terms, this implies that increasing your gut microbiota should help improve your sleep. The easiest way to do this is through diet. Eat foods high in fiber, such as lots of vegetables, legumes, beans, and fruit to help stimulate gut bacteria, or biota, digestion.
Environment. Noise, light, room temperature, and other environmental irritants often affect sleep. NDs look for and address environmental exposures that may cause irritation, inflammation, and negatively impact Circadian rhythms. Common irritants include pollen, dander, noise, and blue light from phones and screens. Sufficient exposure to full spectrum light outdoors is also important to maximize melatonin production.
Emotional + psychological causes. The relationship between sleep and mood is complex, because disrupted sleep can lead to emotional changes, clinical depression or anxiety (as well as other psychiatric conditions), but these conditions can also compound or further disrupt sleep. Research shows that people with insomnia have greater levels of depression and anxiety than those who sleep normally.
Hormone imbalances. Imbalances in serotonin, cortisol, melatonin, estrogen, and testosterone can all contribute to sleep problems. Additionally, individuals with hypothyroidism, a condition where the thyroid gland does not make enough thyroid hormone to keep the body running normally, are also at higher risk of developing insomnia.
Medication side effects. Medications such as those taken for the common cold and nasal allergies, high blood pressure, heart disease, thyroid disease, birth control, asthma, and depression can cause insomnia. The side effects are often dose-dependent. Other drugs commonly prescribed for sleep problems, such as Ativan, can affect quality of sleep.
Individualized Naturopathic Treatments for Sleep
Whole-person treatment is individualized and focused first on lifestyle changes including optimizing diet, environment, and sleep hygiene, removing stimulants, increasing physical activity, and creating routines.
NDs carefully investigate and address microbiome imbalance with clinical nutrition, including probiotics and fermented foods. When emotional and/or psychological factors are involved, NDs work with patients and mental health professionals to identify and address depression, anxiety, and stress. They utilize behavioral medicine including mindfulness, breathing techniques, and meditation. When appropriate, NDs may prescribe botanical medicine to address stress, anxiety, and depression, including GABA, L-theanine, passionflower, and adaptogens such as Ashwaghanda. They will order lab testing if hormonal imbalances are suspected, and address them with nutraceuticals when possible, including melatonin, glycine, and tryptophan, as appropriate. NDs will also help identify prescription medications that may be negatively impacting sleep and, when possible and in communication with prescribing physicians, support patients reducing or discontinuing such drugs.
Naturopathic doctors appreciate that insomnia is both the cause the effect of many serious health conditions. By looking at the whole person, addressing underlying causes and supporting your self-healing capacity, naturopathic doctors have many tools to help in the treatment of sleep problems.
Back to the top.
How Do Naturopathic Doctors Treat Endometriosis? April, 2019
View the printable PDF version.
The AANP and INM would like to acknowledge Marianne Marchese, ND and Amy Rothenberg, ND for their contributions to the content of this FAQ.
Endometriosis is one of the common yet misunderstood medical conditions, affecting 10-15 percent of women of childbearing age.
Licensed naturopathic doctors (NDs) utilize effective diagnostic interventions for discovering underlying causes of endometriosis. Trained extensively in clinical nutrition, botanical medicine, pharmaceuticals, and lifestyle counseling, naturopathic doctors provide patients with various options for a comprehensive treatment plan catered to the patient’s personalized needs.
Endometriosis: What is it and what are the symptoms?
is the presence of endometrial tissue outside the uterus. This uterine tissue is not restricted to the uterus and can be found on the ovaries, fallopian tubes, in the abdominal cavity and in other places throughout the pelvic area. This misplaced uterine tissue responds to monthly hormonal cycles and wreaks havoc in many ways. Depending on where the uterine tissue located symptoms can include painful periods,
pain during or after intercourse, persistent lower back and pelvic pain, discomfort during bowel movements or urination, menses lasting longer than seven days, bloating, constipation, and diarrhea or nausea during menstruation. Endometriosis is also a common cause of infertility or endometrial cysts.
Endometriosis symptoms may include painful periods, persistent lower back and pelvic pain, bloating, constipation, infertility, and more.
Physicians diagnose endometriosis based on findings during a pelvic exam, presenting symptoms, and a thorough medical history. During the pelvic exam, doctors manually palpate the pelvis for abnormalities such as scars
behind the uterus or growths on reproductive organs. Pelvic ultrasound and MRI are often ordered to rule out other causes of the patient’s symptoms. Laparoscopy remains the gold standard for the diagnosis of endometriosis.
While the exact cause of endometriosis is unknown, there are several hypotheses regarding how endometriosis may develop. One possible factor is retrograde menstruation
, when the endometrial tissue flows backward, out through the fallopian tubes, and into the abdomen to implant and grow on organs in the pelvis. In addition, endometriosis lesions may arise from Mullerian anomalies
that did not correctly differentiate or migrate during fetal development. Other factors such as hormonal imbalance, inflammation, toxic environmental exposures, and immunologic dysfunction may determine why lesions implanted in the pelvic cavity cause symptoms and/or persist. There is also likely a genetic component as endometriosis does run in families.
Understanding multifaceted causes of endometriosis guides treatment for both acute and long-term challenges. Treatment for endometriosis begins by stimulation of the body’s innate ability to heal through restoring healthy inflammatory response, balancing hormones, and aiding the liver’s ability to break down environmental toxins and naturally occurring estrogens. For some, the treatment of endometriosis will also include surgery performed by a gynecologic surgeon.
Some factors that may contribute to endometriosis may include genetics, hormonal imbalance, environmental exposures, and immunologic dysfunction. Naturopathic treatment also addresses the whole patient. For many women, endometriosis can cause high levels of stress,
often due to pain, difficulty in diagnosis, and the trials associated with an often invisible illness. NDs help treat not just the body, but the symptoms of the mind and spirit too.
There are numerous nutritional influences related to endometriosis. Licensed naturopathic doctors often begin with the diet, where patients are able to take an active part in the management and prevention of symptoms. The recommendation of an anti-inflammatory diet is often part of the plan in order to reduce inflammation and help with the balance of estrogen.
In a study of 500 women, there was a significantly decreased risk of developing endometriosis
with higher consumption of fruits and green vegetables. Conversely, an increased risk for endometriosis was associated with high intake of red meat
. Foods high in dietary fiber are associated with a healthy balance of microorganisms in the gut flora, where they play a significant role in breaking down estrogens
and also reducing inflammation. Studies show that the inclusion of soy
with its isoflavones can reduce the proliferation of endometrial cells.
Naturopathic treatments including nutrition and dietary changes, botanical medicine, and supplementation have been shown to provide relief for endometriosis symptoms.
Botanical medicine has been shown to provide relief for some endometriosis patients, including:
- Vitex (Chaste Tree) has traditionally been used as a treatment for hormone imbalances in women, causing estrogen to be less available to stimulate endometrial tissue growth. Motherwort gently soothes cramps and pain during times of extreme discomfort in the uterus and other lower abdominal regions. As a mild sedative, motherwort helps with needed relaxation during menstrual cramps.
- Rosmarinus officinalis (Rosemary) has been researched as a strong anti-inflammatory herb and can be helpful for those with endometriosis pain.
- Curcumin has also been shown to reduce estradiol which helps to reduce endometriosis symptoms.
- Flax seeds with their anti-inflammatory impact and their capacity to reduce inflammation are also recommended.
- Pycnogenol derived from Pine Bark has been studied and shows the capacity to reduce many of the painful symptoms of endometriosis.
- Green tea has also shown promising results in the treatment of endometriosis.
Another natural treatment for endometriosis may include supplementation such as:
Treating endometriosis can be challenging and requires a whole-patient approach encouraged by naturopathic doctors. Natural therapies that address the root cause can lead to appropriate treatments to support the body in restoring optimal function.
Back to the top.
How Do Licensed Naturopathic Doctors Address Seasonal Allergies? May, 2019
View the printable PDF version.
Seasonal allergies can impact everything from energy level to sinus congestion and for many patients, allergy season is a dreaded annual ritual. Licensed naturopathic doctors address allergies by treating the underlying causes of allergic reaction and by supporting the body’s inherent healing capacity. Main approaches used include therapeutic nutrition, botanical medicine, and lifestyle modification. In many areas spring seasonal allergies can begin in February and last until the early summer.
Definition of an allergy
An allergy occurs when the immune system reacts to an allergen as if it were a dangerous bacteria or virus. An “allergen” is typically defined as a “usually harmless substance capable of triggering a response that starts in the immune system and results in an allergic reaction.”
During an allergic response, the body immediately begins producing “immunoglobulin E” antibodies, or IgE. These specific antibodies release chemicals like histamine that are designed to protect the body from allergens like pollen, mold, and dust. This histamine production is what ultimately leads to the annoying symptoms that plague us during pollen season: itchy eyes, runny nose, coughing, and more.
An allergy occurs when the immune system reacts to an allergen as if it were a dangerous bacteria or virus.
Seasonal allergies are typically plant-based. In the United States, spring allergies are usually associated with tree pollen, which can be combined with mold in a rainy season. Tropical climates often have grass pollen that can cause symptoms, while fall allergies have a strong association with ragweed blooms.
Three-quarters of people who are allergic to pollen are also allergic to ragweed, a plant that grows in the United States, especially in Eastern and Midwestern regions. Symptoms of a ragweed allergy are similar to pollen allergies with sneezing, stuffy or runny nose, itchy eyes, trouble sleeping.
What is oral allergy syndrome?
Those with allergies to ragweed may also be sensitive to some foods like cantaloupe, bananas, chamomile tea, sunflower seeds, zucchini, and cucumbers can also cause symptoms in a phenomenon called oral allergy syndrome. There is a similar connection between birch allergies and stone fruit like apricots, cherries, peaches, plums - anything with a hard seed or pit. These symptoms can also be affected by seasonal pollen in the air and plants.
What are some ways that naturopathic medicine can help during allergy season?
A naturopathic doctor will ask you in-depth questions about your diet and digestive system. Understanding the role of the microbiome in helping balance immune function is essential. Research underscores the idea that a basic probiotic supplement along with the addition of fermented and cultured food helps create a more robust and diverse microbiome, which in turn helps to calm immune system response and reduce allergy symptoms. Supporting gut function is vital and increasing beneficial bacteria is key.
Several herbs act as natural antihistamines
and can help reduce allergy symptoms without attendant side effects often associated with OTC and prescription medication. A few of the most studied herbs recommended by naturopathic doctors include:
There are a number of nutritional supplements that offer springtime allergy relief.
Acupuncture has also been shown
- Quercetin, found in onions, shallots, and citrus fruits, is a natural antioxidant with several anti- allergy properties including inhibition of histamine release and decrease of pro-inflammatory messengers.
- NAC (N-acetyl cysteine) is an antioxidant that supports the breaking up of mucus, making it an effective tool to help clear congestion. These both work well with antihistamine agents.
to be an effective tool for helping those with seasonal allergies. A neti pot
or other nasal sprays are good options to flush the nasal passage, where dirt and pollen are easily trapped. Flushing the nasal passages can reduce symptoms (i.e. coughing, sneezing, watery eyes), though it is important not to flush in excess, as this can wash away the healthy flora in the nasal cavity. With a neti pot, make sure you always use distilled water,
not tap water.
Natural allergy remedies can take time to reach full efficacy. Some patients experience success taking over-the-counter medication for a short time while natural approaches take full effect.
Should allergy season be a reason to avoid outdoor activity?
Naturopathic doctors will want you to continue to enjoy the outdoors. Limit your pollen exposure by first checking the weather. There will be local information provided on pollen levels; if the pollen count is particularly high on a certain day or time, save that long walk for later. A pollen count is usually higher at noon and afternoon. Pollution can also affect outdoor activity, as chemical pollutants can interact with pollen grains.
When exercising outdoors, consider wearing a mask so you don’t breathe in excess pollen.
Upon returning indoors, take a shower and wash all outdoor clothes to reduce continued exposure. Pollen sticks to clothes and hair, even when not visible.
Long-term use of OTC medication may cause complications
Americans spend billions of dollars every year on over-the-counter (OTC) medications including common products for allergy relief. For those who are elderly or have chronic health conditions, OTC medication may cause serious reactions or issues with other medication taken.
In a 2015 article published in JAMA Internal Medicine, researchers describe a link between dementia and long-term use of anticholinergic drugs including antihistamines like Diphenhydramine and Loratadine. In this large study researchers saw participants who used anticholinergic drugs were more likely to develop dementia, and dementia risk increased with the cumulative dose.
As part of pharmacology training in naturopathic medical school, naturopathic doctors learn primary therapeutic uses, mechanisms of action, potential adverse effects, and drug interactions, including over- the-counter allergy medication. There are numerous effective agents to help prevent and treat seasonal allergies. A licensed naturopathic doctor can help you create a whole-person individualized plan to help reduce both reliance on both over-the-counter and prescription medication as well as the troubling symptoms of seasonal allergy.
The AANP and the INM would like to acknowledge Chrysanthi Kazantzis, ND, MS (Dr. Kaz), for her contributions to the content of this FAQ.
Back to the top.
How do naturopathic doctors use precision medicine? June 2019
View the printable PDF
version. The INM and AANP would like to acknowledge Peter D’Adamo
, ND, for his contributions to the content of this FAQ.
What if you could accurately predict your health risks, know what lifestyle changes may prevent you from getting sick, and have treatments tailored to your unique genetic, microbiome, and metabolic profile? This is precision medicine
, defined by The National Institutes of Health as an “emerging health care model for disease treatment and prevention strategies that takes into account each person’s genetic variations, environment and lifestyle.”
Though still an emerging area of diagnosis and treatment the goal of precision medicine
is to help clinicians deliver “the right treatments, at the right time, every time to the right person” utilizing new tools, knowledge, and therapies. Recent advances in genetic testing and targeted therapeutics
are helping to make precision medicine possible for conditions such as breast cancer, skin cancer, colorectal cancer, leukemia, lymphoma, ovarian cancer, pancreatic cancer, rheumatoid arthritis, and lupus, largely with targeted pharmaceutical drugs. A small but growing number of licensed naturopathic doctors (NDs) are also utilizing such sophisticated bioinformatics data combined with innovative analytic tools and extensive knowledge of natural medicine to help personalize the most effective natural, non-drug treatments for patients with a range of health risks and conditions.
Why do some naturopathic doctors utilize precision medicine?
Licensed naturopathic doctors (NDs) diagnose, prevent, and treat acute and chronic illness. Focused on identifying and treating the underlying causes of illness, NDs address the whole person and lead with natural treatments when possible. While many patients improve through committing themselves to lifestyle and environmental changes and pharmaceutical treatments if and when needed, some do not. Addressing the whole person, NDs may dig deeper to gather more information about individual factors that contribute to health and disease including genes, the microbiome, and the metabolic environment (aka metabolome). Utilizing this information, NDs qualified in using precision medicine can help patients figure out which foods they should eat or avoid, which type of physical exercise they are most likely to benefit from, and which supplements they need to take to address deficiencies or imbalances, all based on what best suits the individual’s particular biological makeup.
How does precision medicine work?
Human DNA is about 99.5% identical
from person to person. However, there are small differences that make each person unique. Single nucleotide polymorphisms
, or SNPs, are the most common type of human genetic variation. Each SNP represents a variation within a single DNA building block. Most SNPs do not impact a person’s health or development.
However, studies have shown that SNPs that may help predict an individual’s susceptibility to environmental toxins, the response to certain medications, as well as risk of certain diseases. CLIA certified labs
such as 23andme are making it easier and more affordable for people to analyze their genetic data and obtain a personalized report on hundreds of thousands of SNPs. These reports identify SNPs
related to late-onset Alzheimer’s disease, Parkinson’s disease, alpha-1 antitrypsin deficiency, celiac disease, hereditary hemochromatosis, hereditary thrombophilia, and age-related macular degeneration. The number of people getting DNA reports has been doubling
every year since 2010.
In one such application, Opus23
, a sophisticated suite of software developed by a licensed naturopathic doctor, an individual’s raw genetic data can be analyzed alongside data about their microbiome (or the genetic makeup of the microorganisms of the gut), and even their metabolically active molecules (metabolome) to provide deeper insight into their health needs. This information can then be cross-referenced against databases of naturopathic treatments--based on and hyperlinked to PubMed published studies--to help pinpoint preventative and therapeutic actions mostly likely to benefit that individual. These targeted therapies include specific lifestyle changes and particular forms of vitamins, herbs, and nutrients.
By using low impact substances to address a health issue multidimensionally, NDs can increase the efficacy of treatment without an increase in side effects. They also utilize precision medicine advanced bioinformatics tools to predict pharmacological genomic interactions.
How does precision medicine work with naturopathic medicine?
Precision medicine has numerous applications for patients in naturopathic medicine. Here is a specific example.
Anxiety. A patient managing anxiety for years with pharmaceutical medication was not getting sufficient results. Her naturopathic doctor analyzed her DNA and pinpointed variations in her genes responsible for making and breaking down neurotransmitters (e.g. dopamine, serotonin, and adrenaline). He determined that an excessive quantity of adrenaline was being produced, and these high levels weren’t being properly broken down. Because most neurotransmitters are made in the digestive tract and travel to the brain, the ND recognized a need to reduce inflammation in her digestive system. After three months of treatment with natural ingredients cysteamine and Withania somniferia and a genetically determined personalized diet, the patient gained control of her anxiety and is no longer dependent on drugs.
Back to the top.
What do naturopathic doctors do to treat toxin exposure? June 2019
View the printable PDF
What is Environmental Medicine?
Environmental medicine (EM) is a relatively new branch of medicine that explores how the environment interacts with the human body – especially the physical, mental, and emotional responses to environmental factors. Environmental medicine dovetails with other branches of medicine including toxicology, industrial medicine, and public health. EM uses a holistic, systems-wide based model to evaluate how various toxins, pollutants, chemicals, and microbes may be compromising the body.
Those working in environmental medicine leverage the concept of cumulative toxic load
– low- level exposure and interaction with various substances in food, water, air, homes, and communities – over time that may compromise fundamental systems which maintain overall wellness and support healthy aging. This field explores the link between the environment and the documented rise in chronic illnesses like cancer, metabolic, neurological, and endocrine disorders.
Where do toxins come from?
In the age of industrialization and modern society, pollutants, chemicals, and toxins are commonly encountered in daily life and range from pollutants that come through the atmosphere to packaging and consumed food. Several examples of chemicals and pollutants are listed below
||Persistent organic pollutants (POPs) Organophosphates (OCPs)
Pesticides: various herbicides, glyphosate Xenobiotics: Plastics, bisphenol A (BPA) Metals: Aluminum, arsenic, cadmium, mercury Alcohol
||Microorganisms Disinfectants: Chlorine Metals: Lead
Polycyclic aromatic hydrocarbons (PAHs) Perfluorocarbons (PFCs)
Volatile organic compounds (VOCs) Particulate matter
Sulfur and nitrogen oxides
||Parabens Phthalates Metals: aluminum
Naturopathic doctors understand that no two people are alike due to genetic biochemical individuality. Based on this principle and utilizing a patient-centered approach, naturopathic doctors evaluate how each person’s environmental exposure may be influencing their foundations of health. In addition to toxic load, an ND evaluates genetic variations, nutrient deficiencies, stressors, dietary choices, microbiome status, vitality, and associated conditions that may influence how a patient responds to toxins.
Given that chronic illness is typically caused by many factors, it is important to identify which toxins or elements in the environment are interacting within the body. Many of the above-named chemicals have a direct effect on a variety of tissues, leading to a potential cycle of oxidative stress inflammation. A number of environmental toxins have also been associated with endocrine disruption
. Research to date
alludes to the inflammation as the key driver of metabolic, neurologic, endocrine, and cellular malfunction leading to a rise in obesity, neurodegenerative disease, autoimmune conditions, reproductive disorders, and cancer.
How naturopathic doctors evaluate a patient who has many symptoms of toxic exposure?
While assessing if the environment is contributing or causing a specific illness, a naturopathic doctor (ND) begins with a thorough case history, sometimes using a comprehensive environment – a targeted questionnaire that helps identify signs of toxic overload. Several questions are asked to help identify what chemicals are involved in the timing of exposure is consistent with symptom development, and what systems in the body are compromised by the possible exposure. For example, if a patient began complaining of an increase in allergies, brain fog, headaches, and skin rashes upon moving into an old modular home located in a humid area, a naturopathic doctor may be suspecting mold contamination and compromised lung, immune, and neurological function.
In addition, there are various specialty laboratory tests available
to practitioners. To identify toxic load, advanced laboratory testing may be necessary, including serum or urine testing, which assesses for metals, mold derivatives, solvent metabolites, and organophosphate metabolism
. To work up specific systems implicated by environmental exposure, a doctor may explore microbiome testing, hormone testing, organic acid testing, micronutrient panels, genetic panels, and oxidative stress markers before implementing a targeted treatment plan.
What treatments are available in environmental medicine?
Naturopathic doctors work through the therapeutic order while treating patients
. Given environmental medicine can be so complex and multi-modal, the primary factor in treatment is to identify the source and remove it. Avoidance alone can make a notable difference in a
. Next, targeted therapeutics depends on the individual’s genetic make-up, biochemical, and metabolic needs. Treatment may include:
Supporting functional genetics with added vitamins, nutraceuticals, and lifestyle changes.
- Certain genetic variations in our detoxification pathways have been shown to require added support in their function with specific minerals or stimulation through botanicals that influence antioxidants.
- Single Nucleotide Polymorphisms (SNPs) are also continuously being transcribed through our DNA, and new research has found that moderate exercise is capable of controlling the genetic expression of unfavorable genes.
Supporting liver detoxification
with botanicals, protein, and vitamins
- Phase 1 and phase 2 detoxification require a broad series of B vitamins, bioflavonoids, sulfur metabolites, protein, and fat-soluble vitamins.
- Botanicals such as milk thistle have been shown in various clinical studies to increase cellular glutathione, the body’s primary antioxidant, in addition to strengthening antioxidant defense systems.
- Dietary modification including the increase of cruciferous vegetables such as Brussels sprouts, broccoli, and kale.
- Increasing system-wide antioxidants with green tea, N-acetyl cysteine, anthocyanins, polyphenols, and citrus bioflavonoids.
Supporting elimination pathways
through the gut and skin.
- Stimulating the liver in detoxification can become troublesome without focusing on elimination pathways, so optimizing bowel and kidney function is key to a successful detoxification program.
- Focus on adequate water intake for proper kidney elimination may be recommended along with therapeutics that address overall gut health such as colonics, castor oil packs, and/ or high fiber diets.
- Sauna/infrared saunas are found to stimulate detoxification and clearance of toxic metals through the skin.
Facilitating environmental change in the home.
- Water filtration systems for drinking and shower water.
- Air purification filters (such as HVAC or house plants), especially for those in urban areas.
- Reduction in carpet surface area. Carpets are known to store various pollutants from the air in homes.
- Clean paint to prevent lead off-gases from being absorbed through the respiratory tract.
Preventing other toxins from impacting the body in the future.
- Strengthening the microbiome with broad-spectrum probiotics, fermented foods, and stress modification.
- Improving the gut epithelial lining with proteins and minerals such as glutamine or zinc carnosine, which are shown to maintain a healthy inflammatory response, support the gut immune system, and prevent “leaky gut.”
- Exchanging personal and household care products to be paraben and phthalate free.
- Opting for organic, cleanly washed produce and either wild caught or grass fed, hormone free meat/fish.
With modern advancements in biotechnology and advanced therapeutics, many naturopathic doctors are trained and specialize in and promote detoxification in a controlled setting. Such treatments are done under medical supervision.
As society continues to evolve, the care for nature and our environment is becoming more popular. There are now many ways patients can be proactive about their environment using resources from the Environmental Working Group
and understanding the Dirty Dozen
, downloading apps like Think Dirty
, and following health blogs that educate about DIY tactics for creating a healthy home environment.
While our environment is ever changing and nearly impossible to avoid complete exposure to pollutants, chemicals, and toxins, seeking out the advice of a licensed naturopathic doctor can help you understand the way your body is responding to your environment and lifestyle, and help support your system in order to maintain optimal function and prevent chronic disease.
- Murray MT, Pizzorno JE. The encyclopedia of natural medicine. Rev. 3rd ed. New York: Atria Books; 2012. x, 1219 p. p. 109-130.
- Pizzorno JE. Total wellness: improve your health by understanding the body's healing systems. Rocklin, CA: Prima Publishing; 1996. xi, 419 p. p. 87-162. Crinnion W, Pizzorno JE. Clinical environmental medicine: identification and natural treatment of diseases caused by common pollutants. St. Louis, Missouri: Elsevier Inc.; 2019. p. p.
- Bijlsma N, Cohen MM. Expert clinician's perspectives on environmental medicine and toxicant assessment in clinical practice. Environ Health Prev Med. 2018;23(1):19.
- Nasri H, Baradaran A, Shirzad H, Rafieian-Kopaei M. New concepts in nutraceuticals as alternative for pharmaceuticals. Int J Prev Med. 2014;5(12):1487-1499.
- Herr C, Otterbach I, Nowak D, Hornberg C, Eikmann T, Wiesmuller GA. Clinical environmental medicine. Dtsch Arztebl Int. 2008;105(30):523-531.
- Lampe JW. Diet, genetic polymorphisms, detoxification, and health risks. Altern Ther Health Med. 2007;13(2):S108-111.
How do naturopathic doctors promote healthy aging? July 2019
View the printable PDF version. The AANP and the INM would like to acknowledge Michelle Simon, PhD, ND, for her contributions to the content of this FAQ.
Expected lifespan at birth is declining - and steadily so. The last time the United States experienced such a long and sustained decline
was a century ago during World War I when an influenza pandemic crossed the country. According to the Centers for Disease Control and Prevention
(CDC), in 2017, average life expectancy in the U.S. was 78.6 years, one tenth below the previous year. And the trend does not seem to be a global issue. Life expectancy at birth in Europe
is stable, even increasing, clocking in at 81 years in 2016.
In addition to a decrease in life expectancy at birth, age-specific death rates
increased in the
U.S. for age groups including 25-34, 35-44, and 85+. The leading causes of death in the U.S. remained the same in a year-over-year comparison, indicating a lack of progress in treating heart disease, cancer, unintentional injuries, chronic lower respiratory diseases, stroke, Alzheimer’s disease, diabetes, influenza, pneumonia, kidney disease, and suicide.
How are naturopathic doctors uniquely positioned to promote healthy aging?
Aging is a natural process. It can be accelerated or impeded depending on diet, nutrition status, and lifestyle. Naturopathic doctors (NDs) specialize in delivering actionable information to patients by offering personalized treatment plans. Licensed NDs are experts in natural medicine, which may be the best way to support the natural aging process.
Naturopathic doctors emphasize the prevention of disease, helping to cut down on health care costs later in life. In addition, licensed NDs working in the primary care setting provide a deep understanding of patient care and treat each individual for their unique concerns.
What are the biggest health concerns related to aging?
Aging is negatively affected when physical ailments or lack of energy prevent an individual from being active. Some signs of aging include trouble sleeping, weight gain, especially around the middle, and loss of muscle mass. Starting at age 30, people can lose as much as five percent of muscle mass per decade of life
For some patients, hypertension (high blood pressure) comes from inactivity and weight gain
. A tendency for diabetes arises from poor dietary choices, stress, and inactivity. Likewise, cardiovascular disorders also arise from inactivity and stress, as well as depression.
A healthy body is best accompanied by a healthy mind, and cognitive decline is also a troubling symptom that may come with aging. In 2003, experts estimated that as many as 5.1 million Americans
65 years of age or older could have Alzheimer’s disease. That number is expected to grow to 13.2 million by 2050. A 2012 article published in The BMJ reported that cognitive decline can begin
as early as age 45. And in a 2013 article published in the Bulletin of the World Health Organization
, researchers described cognitive impairment as a chronic condition
that is a “precursor to dementia” in as many as one-third of all dementia cases. Genetics may be an uncontrollable factor for cognitive decline, but taking an active role in your diet, and emphasizing prevention and natural treatment of common chronic ailments helps prevent cognitive decline
. Naturopathic doctors help support patients to obtain a healthy weight and physical fitness. One important fact is that decreasing obesity lowers the risk
for cognitive decline.
Bone and joint health
Losses in bone density and joint fluid are common complaints individuals experience as they age. Osteoporosis is the most common type of bone disease affecting at least 50 percent of all women aged 50 and older
and also can pose a significant problem in aging men
Bone density loss occurs as bones lose calcium and other important minerals. Limbs become brittle and break more easily. Diminished cartilage and calcification in joints - often the hips, knees, and fingers - is an essentially universal problem in aging adults, with most adults experiencing at least minor arthritis. Fluid loss is partially responsible
for the loss of height with aging. Discs between spinal vertebrae become thinner, vertebrae lose bone density, and the spinal column compresses. In addition, foot arches may become less distinct.
At least one-third of older adults
Risks of multiple pharmaceuticals
between the ages of 75 and 85 take at least five prescription medications, a phenomenon called “polypharmacy.” Many medications prescribed are given to address the side effects of other prescriptions. Older adults are paying more for their healthcare
and are at a greater risk for negative side effects, dangerous drug interactions, non-adherence due to complicated medication regimens, and an overall decrease in functionality.
What are the aging differences between males and females?
Women lose muscle mass earlier than men, but women typically live longer than men and are more likely to reach the centenarian mark. Menopause
causes women to experience a more rapid hormonal change versus the gradual change felt by men.
These rapid changes experienced by women are responsible for the unique symptoms of menopause which can exacerbate bone density loss with age and increase the risk of breaking bones. Varying amounts of hormone production during menopause can also lead to
weight gain, moodiness or depression, sleeping problems, hot flashes, and pain during sex.
While men do not experience the rapid hormonal changes that characterize menopause, the gradual change in hormone levels men do have is associated with some health effects
like reduced testicular tissue mass, gradual decrease of testosterone increased risk of erectile dysfunction enlarged prostate gland (this affects 90 percent
of men older than 80 years).
What are some modifiable factors to increase bone, joint, and muscle health?
Exercise is the most important intervention to help increase the health of bones, joints, and muscles. Humans are meant to move. Exercise does not need to be marathon-running or competitive Olympic weightlifting. Even just three rounds of 20-second stair climbing three times per week can make a difference in cardiovascular health for untrained women
. A 2017 Osteoporosis International study
found that physical exercise positively influences muscle mass and muscle function in individuals 60 and older, most evidently by improving gait speed, balance, and other tests of physical performance. For people who are too frail for rigorous workouts or even walking, standing on one foot
offers an alternative way to support bone health. Even for those who exercise routinely, a few minutes on one foot helps promote core strength and balance. (Caution – as balance problems are also an important factor in the again process, standing on one foot is not recommended for those with existing balance issues, or who may be at risk of falls.)
A 2017 Oncotarget
study found that regular physical activity is associated with longer telomere lengths. Telomeres cap the ends of chromosomes, structures that package human DNA. Preserving telomere length preserves genetic information and a functional cell division process, which could reduce cellular aging and decrease the risk of age-related conditions such as cancer, heart disease, obesity, diabetes, chronic pain, and stress. How can we promote cognitive health
in older age?
Astaxanthin is a supplement with recent research
supporting muscle endurance and strength in older individuals.
Naturopathic doctors prescribe supplements
Supporting a healthy body with a healthy mind
including curcumin, resveratrol, and bacopa monnieri
as a way of optimizing brain health. Creating healthy sleep habits and reducing stress are also considered beneficial in the fight against cognitive decline. Naturopathic doctors have an opportunity to help prevent degenerative conditions.
supports the use of a multifactorial, individualized approach to cognitive decline which includes addressing the gut microbiome, heavy metal levels, neurotransmitters, and mitochondrial health. Understanding a patient’s genetic predisposition to particular risk factors for cognitive decline helps NDs develop a personalized approach to treatment.
NDs also support the positive role of work and community connections
to prevent and address cognitive decline. Regular social activity has been shown
to improve cognitive stimulation. NDs are equipped to help patients and their families identify appropriate programs to help in cases of cognitive decline and dementia.
How do dietary needs change with age?
Stomach acid levels typically decrease with age, altering digestive capacity. One result can be diminished absorption of nutrients
such as B12, calcium, iron, and magnesium.
Caloric needs decrease with age as a function of lower muscle mass and activity levels, but this proves detrimental to the accompanying increased need for specific nutrients. Maintaining this balance of optimal nutrition can be difficult for people as they age. Licensed naturopathic doctors can assist with targeted nutritional interventions.
As described above, menopause is often a time when bone density begins to diminish, leading to osteoporosis. One reason is the lowering of hormone levels that promote bone health.
Nutritional recommendations focused on bone health is advisable. Vitamins K, C, and D along with magnesium and calcium are helpful nutrients for bone health.
By addressing genetic propensity and lifestyle factors, naturopathic doctors can help you review the kinds of health challenges you might encounter and can make recommendations about modifiable risk factors in order to prevent or slow the aging issues. Prevention is always easier than treatment and having a naturopathic doctor on your team can be a wise investment in your healthy aging.
Back to the top.
How do naturopathic doctors diagnose and treat diastasis recti? July 2019
View the printable PDF version.
Postpartum physical health is an area that is often under-addressed in women’s health. The female body goes through many changes during pregnancy and not all of these changes immediately reverse, or reverse at all, after birth. A significant portion of mothers experience pain months
after birth, which may linger without proper muscle rehabilitation and treatment. Muscle areas involved often include the large muscle groups of the abdomen and/or back. Diastasis recti
(DR) is a condition describing a separation between the left and right side of the muscles that cover the abdomen called the rectus abdominis
muscles, which are often referred to as the “six-pack” muscles. DR is a common result of dysfunctional adaptation of the abdominal muscles to an increase in intra-abdominal pressure, such as in pregnancy.
Understanding diastasis recti
A 2016 study
found that from a study group of 300 women between 19 and 40 years old, 33 percent experienced DR by 21 weeks of pregnancy, 60 percent by 6 weeks after giving birth, 45 percent at 6 months after birth, and 33 percent at one year after birth. Potential risk factors
for DR include:
- Older age
- Giving birth more than once
- Giving birth via cesarean section
- Gaining more than the expected amount of weight during pregnancy
- High birth weight
is a sign of body misalignment, a weakened core, and misdirected pressure into the abdomen. Women with DR often experience symptoms as a result of weakened abdominal muscles after pregnancy, such as:
How is diastasis recti diagnosed?
- Continuing to look pregnant after giving birth; looking constantly bloated
- Cone-shaped belly when laying on back
- Painful sex
- Pelvic pain
- Back and knee pain
- Higher risk of injury in back, pelvis, and knees
- Pelvic muscle and tissue weakening
DR is not commonly diagnosed or discussed, and often women do not notice the signs of DR until past the standard six-week checkup after giving birth. Many women do not realize that the changes they notice in their body are because of DR, as opposed to common pregnancy weight gain. The American College of Obstetricians and Gynecologists notes
that 6-week follow-up visits may be lacking in comprehensive postpartum care, and that postpartum women may need more consistent and frequent follow-ups for several months.
A healthcare practitioner like a licensed naturopathic doctor
(ND) can diagnose DR through a detailed interview including a physical exam that feels for the separation of rectus abdominis muscles.
Why choose naturopathic care?
NDs understand and respect the unique postpartum body changes of pregnancy which can include DR. By addressing the whole person
and not just the immediate condition, NDs utilize skills in understanding body mechanics and alignment to diagnose where DR patterns have been established and offer solutions for improving functionality in the abdominal muscles.
DR is one of many physical complaints that may be experienced during postpartum recovery. Some NDs have additional training in pelvic floor rehabilitation that involves internal exams as well as reprogramming movement and breathing patterns. They can also offer exercises to provide support for physical complaints like backache and muscle and joint pain.
How is diastasis recti treated?
NDs focus on addressing dysfunctional movement and breathing patterns, use therapeutic nutrition, and may perform or recommend bodywork for patients with DR.
The first priority in addressing movement is to correct movement patterns like walking, sitting, standing, and sitting, and breathing patterns that may be leading to excessive intra-abdominal pressure. In treating DR, NDs will also assign appropriate core exercises to strengthen the connective tissue and abdominal muscles. Exercise during the antenatal period reduced the presence of diastasis of the rectus abdominis muscle by 35 percent
. These exercises take the place of crunches, sit-ups, and planks, which can exacerbate DR.
NDs might also tell patients to:
- Avoid wearing high-heeled shoes
- Increase fiber and water intake to maintain regular bowel movements and to prevent the need for straining.
may use compression wraps in an attempt to retrain core muscles and prevent DR, but NDs stress that “belly binding” after birth will only relieve symptoms - not the condition as a whole - and will only work temporarily. NDs instead focus on correcting the underlying problem to rebuild core strength and functional movement.
For patients with DR, NDs recommend
supporting tissue repair and collagen production using a combination of diet and nutrient supplementation to maintain optimal levels of protein, essential fatty acids, zinc, iron, and vitamins C, A, and B. Bone broth and collagen powders may be suggested.
In addition to implementing changes in physical activity and nutrition practice, NDs might recommend bodywork therapist such as:
- Craniosacral therapy: noninvasive manipulation of soft tissues and fascia, as well as relief of compression of bones in the head, lower back, and spinal column
- Internal pelvic floor therapy: physical therapy that may help relieve DR symptoms like incontinence and painful sex; a trained physical therapist works externally and internally to relax pelvic muscles
While mental health may not be a direct contributor to DR itself, it’s important to always recognize the effect that physical changes can have on mental health
after pregnancy. Naturopathic doctors understand the mind-body connection to help successfully treat postpartum patients.
Diastasis recti is a frequently experienced, but often under-addressed physical condition that is common after pregnancy. Treating this condition is an important part of addressing the whole patient and promoting maternal health. Your naturopathic doctor can support your postpartum journey with whole-body comprehensive care.
The AANP and the INM would like to acknowledge Morgan MacDermott, ND, for her contributions to the content of this FAQ. Find more from Dr. MacDermott @MilkMedicine
Back to the top
Veterans and Naturopathic Medicine: How can Licensed Naturopathic Doctors Improve Health Care for Veterans November 2019
View the printable PDF version.
The Veterans Administration (VA) serves over 9 million veterans
each year. Returning from combat finds many who serve with a collection of health concerns that span the physical, the psychological, and the psychosocial. Dr. Stephen Hunt, occupational and environmental medicine physician in primary and post-deployment care at the VA Puget Sound Health Care System says,
"This is a population that has unique health care needs
that need to be addressed. It's something that really needs to be done by a team. Some of the most common physical complaints of returning soldiers cannot be classified into a single disorder. They include nonspecific symptoms such as fatigue, pain, and cognitive disturbances such as memory and concentration problems.” Other common complaints include chronic pain, headaches, insomnia, anxiety, and depression.
Based on this constellation of symptoms, Tracy Gaudet, MD, who directs the VHA's Office of Patient Centered Care and Cultural Transformation, has stated that having licensed naturopathic doctors
(NDs) at the VA is consistent with the agency's goals of personalized, proactive, and patient-driven health care.
The American Association of Naturopathic Physicians
commissioned a nationwide survey
of a representative sample of America's veterans. Close to two-thirds of veterans (64 percent) said they would prefer a doctor who prescribes natural therapies before considering drugs or surgery. And almost three-quarters of veterans (73 percent) would consider seeing an ND if he or she were on staff at a nearby VA facility.
We know that naturopathic medicine
is both safe and effective. For example, studies
show efficacy when nutritional, botanical, and lifestyle medicine are employed for the treatment of anxiety and depression. Naturopathic medicine is both effective
and cost effective
for the treatment of chronic back pain. Research
underscores the positive impact of mindfulness meditation for insomnia. Prolotherapy is increasingly studied
for the treatment of chronic arthritis pain. Acupuncture has shown positive results
for veterans suffering with anxiety post substance abuse and is a promising intervention
for patients with chronic anxiety unresponsive to medication. Internet-based cognitive behavioral therapy has been proven
effective for the treatment of depression.
Insomnia is a challenge for many veterans. Naturopathic doctors have numerous non-pharmacologic approaches
to insomnia. The same is true of anxiety
and chronic pain
. Naturopathic doctors have advanced training
in behavioral medicine, which is an essential component in working with veterans and in creating whole-person health plans that often include the need for sustained changes in lifestyle and attitude.
A recent research article reflects the increase in interest and availability of integrative approaches within military populations. Also underscored in this study was the need to ensure that safe and effective treatments are offered. The authors of this study recognize that additional research is warranted and recommend inclusion of licensed naturopathic doctors. Licensed NDs undergo rigorous accredited medical education including a minimum of four years of hands-on training. Naturopathic medical education consists of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in natural medicine. Disease prevention and individualized care is emphasized throughout the four-year program.
In addition to a conventional biomedical sciences like gross anatomy and biochemistry, accredited ND schools require coursework in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed providers. Accredited programs are recognized by the U.S. Department of Education (ED).
Returning from service should not be as hard as it is for so many veterans. Adding naturopathic doctor expertise in the VA setting can benefit health outcomes and quality of life of our venerated veterans.
Back to the top.