The Therapeutic Order is a tool that helps guide naturopathic treatment approaches. I explain how naturopathic doctors’ healing philosophy might differ from the conventional medical model.
Hi, guys, I’m Dr. Talia Marcheggiani and I’m recording to you guys from my clinic in Bloor West Village and today I’m going to talk about some myths about naturopathic medicine, especially regarding our relationship with conventional medicine and medications and, in order to talk to you about that, I want to talk to you about something called the Therapeutic Order. So the therapeutic order is from our traditional roots in the formation of the profession of naturopathic medicine. This is one of our philosophical ideas about how to treat somebody that comes in our door and how people should be treated in terms of the medicine that we practice. And this is a 7-step process, or a hierarchy, of what our treatment goals are for seeing somebody. And the reason that I’m relating the Therapeutic Order to medications is because one of the steps in this hierarchy of the Therapeutic Order is pharmaceutical medication. And so I feel that, in naturopathic medicine, most of us, and certainly in our philosophy, in regards to medication, it’s not that we don’t agree with medication or surgery or conventional treatments, it’s our agreement about when they’re implemented and it’s also about our efforts to treat patients before the need for surgery or medications arises. And so, the Therapeutic Order is a system of interventions and we go from lower-force interventions to higher force interventions and the first step in the Therapeutic Order is to remove obstacles to health.
So, anytime someone walks into my office, and is displaying certain symptoms, I’m always looking for, what are the obstacles that their body is facing when it’s trying to achieve its optimal state of health and wellness. Our bodies have evolved over 300 billion years, from whatever our common ancestor was, that first created life, we’re this result of a lineage of survivors, if we’re here on the planet today. And so our bodies have evolved amazing mechanisms to preserve our health and well-being to ensure that our genes are carried on to future generations. So when somebody is coming in in the initial stages of disease, and so this may manifest for you as just this subclinical feeling of “imbalance”, for lack of a better word, there’s often an obstacle in the way. And a big obstacle that often presents itself in my patients’ lives is stress. That’s one that’s huge and that’s the reason that I talk about it so often. Another is toxic burden from our environment. Things like pesticides, plastics, smog pollutants in our air, in our water, in our food, that can also cause an obstacle to health or just give our bodies some extra things it has to deal with that divert it from its job of making us feel and look our best. And another thing, of course, is diet that’s inadequate, that’s not providing us the nutrients that we need or a diet that’s providing us with anti-nutrients, so it’s preventing us from absorbing the vitamins, the minerals and the macronutrients that we need to function optimally.
And some naturopathic doctors will focus on the energetic aspect, the spiritual aspect. So, is the person in front of them pursuing a meaningful life, do they feel satisfied with their work, are they satisfied with their relationships. So, anytime one of these major pillars of our health is lacking that can also present an obstacle to us feeling our best. And oftentimes the obstacle is a mental-emotional one, even if the symptoms that are manifesting are physical.
So, another video that explains this is my wheel of balance video in talking about stress and when I work with mental health, a stage to mental health promotion is emotional wellness, which is why I use that term so often, rather than focusing on eradicating or eliminating or managing symptoms of mental “illness”—and I prefer to say mental health conditions, rather than mental illness—how can we improve our emotional wellness, how can we improve our mental wellness, as opposed to focusing on disease.
Most naturopathic doctors will focus on this level, this will be inherent in our philosophy we’re always going to be looking for what the obstacles are that are in the way of our patients’ achieving symptom-free lives or a life of low or no symptoms, and a life of abundant wellness and energy, and healthy weight management and healthy mood and all of the things that indicate robust health. This will always be inherent in our philosophy.
The second step in the Therapeutic Order is to stimulate the Vis, so this is the “vis medicatrix naturae”, which is Latin for the healing power of nature, which may seem a little bit woo woo to some people, but you can think of the Vis as metabolism or homeostasis, and this is the idea that our body is primed for optimal health, and our body is always striving to maintain balance. And there’s this idea in naturopathic philosophy that sometimes this inherent energetic mechanism that causes life and all living beings, that sometimes it needs to be stimulated and oftentimes the therapies to do this are more in the energetic realm. So things like homeopathy and acupuncture and hydrotherapy as well, so using water and various temperatures to increase metabolism, hormonal balance, homeostatic balance and blood flow, so those are all scientific terms for what I think the Vis attempts to describe.
So, I tend also to use diet in this realm and herbs. I believe that herbs, and there’s some research for this, some evidence that herbs are modulating, that herbs, as opposed to drugs, kind of seek where things are lacking and they balance our hormonal milieu, our hormonal landscape, more than a medication, which is man-made and an example of this is that some people supplementing with straight vitamin A experienced some negative outcomes in large studies that were done. But if you eat foods that are high in vitamin A, those negative symptoms from vitamin A supplementation seem to balance themselves out and that’s because there are some nutrients present in vitamin and nutrient-rich foods that we haven’t discovered yet and that seem to act synergistically with other chemicals, natural chemicals, that are present in those foods. And so, by taking nature into our bodies through forest bathing, so physically being in nature, or through the consumption of plants and natural substances, I believe that we receive some of those messages from nature. And I can get into this in future videos. I find that herbs have intelligence behind them. And that’s not necessarily woo-woo or pseudoscientific, there’s some research for sure that show that herbs modulate through their anti-inflammatory effects, their anti-oxidant effects, and their hormone-balancing effects, in ways that pharmaceuticals don’t do to the same extent.
So, these two stages, when patients are coming in and we’re focusing our treatment, we’re removing obstacles and stimulating the body’s capacity to heal and you can think about this. If you break a bone, we’re definitely going to remove the obstacle, which is whatever broke the bone in the first place, and then we’re going to promote the body’s ability to heal. It’s not conventional medicine that heals the bone, we simply align the bone so that it can fuse together. It’s the body that heals it. So, we’d be promoting the healing of that tissue with some of the nutrients that the body needs. So this can be applied no matter how serious the medical condition, but definitely it will always be implicit in our treatment plans and how we look at the body. And sometimes that’s enough, if somebody is just coming in with a general feeling of imbalance or, you know, someone who’s coming in with a good state of health, without a loss of apparent symptoms that just wants to manage their health in general, then we’ll kind of stop there, but we might teach you some ways to detoxify, to encourage a healthy diet, and the healthy consumption of health-promoting foods and we’ll let you sort of maintain that on your own.
But what often happens is that people are coming in, because we’ve been taught in our culture in North America and Canada, especially, to come in and seek medical care when we’re feeling ill, a lot of the time people will come in with some kind of issue, so some specific symptoms, and oftentimes these symptoms are apparent or located within one organ system. And so the third step in the Therapeutic Order is to strengthen weakened systems. So this might be somebody who’s coming in a liver issue and this may be a diagnosed issue, or based on their symptoms, we’re noticing some impairment in the liver in general. And so we take treatment a step further and we start to focus on actually repairing the tissues that are present in the liver and so we’ll be using some, perhaps, liver detoxification, some more intense diets, so diets that are geared more to therapeutics, and using some herbs and nutrients to clean out the liver.
We can also use some of our energetics, at this stage, acupuncture, homeopathy, hydrotherapy, self-care practices, and we’ll definitely be removing obstacles to cure, so high-sugar diets, or overconsumption of alcohol, or a high toxic burden. We’ll be looking at those things as well, but we’re also taking it a step further and specifically focusing on the liver in this case.
At this stage of treatment, acupuncture therapy becomes a powerful tool to complement the healing process. By targeting specific points in the body, acupuncture helps to balance energy flow, reduce inflammation, and promote the body’s natural healing abilities. This approach is particularly beneficial for those dealing with chronic conditions or weakened systems, as it provides a holistic method to address underlying issues.
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And this is something that I see most of in my practice, is people coming in with hormonal imbalance, with a mental health condition, with digestive issues, skin issues, hair falling out, and so we’re ordering labs, we’re targeting specific organ systems, and we’re, maybe not necessarily putting these symptoms into a diagnostic category, that would be diagnosed by a conventional doctor, so sometimes these are still subclinical, but there’s definitely symptoms present, people are suffering and they’re noticing a change and they’re probably have already sought help with their medical doctor and maybe were told everything was fine, or maybe they received a diagnosis.
The 4th stage in the Therapeutic Order is to correct structural integrity. So, if our posture, if our alignment is off, then our health is not going to work properly, there’s not going to be proper nerve conduction, there won’t be proper circulation, there won’t be proper functioning of our organ systems. If our rib cage is collapsed, we won’t be breathing properly and we won’t be oxygenating our tissues. If our pelvis is out of alignment we won’t experience proper digestion and digestive regulation. And I often refer out for this stage, I might refer to an osteopath or a chiropractor, or a physiotherapist or massage therapist. I might so some acupuncture myself, but typically for structural correction, I’ll refer to another practitioner and I myself see a massage therapist, chiropractor, osteopath and do quite a bit of hydrotherapy and work on aligning my body through yoga and things like that because of its importance and just general health maintenance.
While this is the 4th stage in the Therapeutic Order, I often recommend that it be implemented as some kind of healthcare strategy that focuses on structural integrity be implemented early on or as a maintenance, especially because we’re so sedentary and we spend so much time in front of our computers and often engage in repetitive exercise. Working on structural integrity management is so important.
The 5th stage in the Therapeutic Order is the use of natural substances to restore and regenerate. And so this is a little bit like symptom management, if you can imagine that. The objective of naturopathic medicine is not necessarily to fix a specific disease, which is often confusing, because we have a very disease-focused healthcare system, not necessarily a health-focused one. And so we’re sort of indoctrinated into this view that if you don’t have a diagnosis that you’re healthy, or that health is the absence of symptoms, which is certainly not the philosophy of the world health organization who believes that health is a mixture of our mental and spiritual and emotional and physical wellbeing and not simply the absence of disease, however we do have a sickcare system rather than a healthcare system, and so we’re educated not to go to the emergency room or your family doctor unless you feel like it’s serious enough to warrant a diagnosis and, if it’s not, then you’re often sent home and told everything’s fine. And patients will always come in having told me that their labs are fine. And they are, they’re fine in the framework of not requiring a diagnosis, or pointing to necessary pathology, but they’re certainly not fine in the sense that not things that we can improve on and that are not giving us warning signals of what could come in the future.
We often focus on disease prevention and healing the body rather than focusing on the symptoms or the pathology. We’re looking for the underlying cause. However, sometimes we get far enough along that we do need to manage symptoms, otherwise people aren’t going to notice benefit. And, so, further along the disease process, further along the naturopathic order we need to reach. To manage the diseases. These are a little bit higher-force interventions, rather than sort of encouraging tissue repair, like we were doing in the 3rd stage of the Therapeutic Order, now we’re focusing more on managing symptoms, managing inflammation through herbs that are going to calm it down quickly, and detoxify quickly, and we’re going to manage headaches with herbs, that are just generally anti-inflammatory. So we’re going to be looking at symptom-management. And so a lot of the time we’ll do that in conjunction with the other 4 stages of the Therapeutic Order, but this time there is a heavy focus on keeping symptoms under control for better quality of life and to move the needle further.
And the 6th step of the Therapeutic Order is similar to the 5th, except we’re using pharmacological devices and so it’s not that we’re against pharmacology and medications in naturopathic medicine, at all, we simply want to encourage patients to come and see us before things get to the point where you require medications and I certainly believe and I think even many conventional practitioners agree with me on this, that medications are probably too widely prescribed or over-prescribed. And this may be that there are no other solutions and, as a clinician, you want to help the person sitting in front of you and aren’t really sure how to go about that. So somebody comes in to your office who has depression and you’re going to reach for the selective-serotonin reuptake inhibitor, the SSRI, the Prozac or Cipralex, you’re not going to tend to risk using herbs or focusing on diet or digestion or those kind of things, you’re going to use this “proven method” and you’re going to implement that right away, whereas my philosophy would be to, depending on how serious the case is, to implement other interventions and make sure that our terrain is being treated, that we’ve removed some obstacles to cure, we’ve encouraged spiritual and life-meaning pursuits and we’re stimulating the body’s own healing mechanisms and anti-inflammatory mechanisms, and that maybe we’re directly targeting the brain with some nutrients and some vitamins and that we’re making sure structural integrity is there, and that we’re even using some herbs to manage depression because we know that St. John’s Wort works very similarly to an anti-depressant in terms of its efficacy. And then, if those things are not working or not having enough of an impact, then we might talk about an SSRI, depending on how severe the case is.
And I say this not to create a stigma around medication use at all. Every single body is different and everybody’s going to need a different treatment concoction and it’s never going to be just one treatment or very rarely will it just be one panacea, no matter how much we wish that there were, it’s going to be a few things that we need to implement to help manage our own health, so that’s when we’ll reach for the pharmaceuticals, when the natural treatments are not having enough of an impact, or the disease process has progressed far enough.
And then the last is the use of high-force interventions, so surgery, radiation and chemotherapy. When you’re diagnosed with cancer, then it’s definitely appropriate to do radiation and chemo or to excise the tumour, or if there’s joint degeneration to the extent that it can’t further be repaired, and you can’t sort of prevent it any longer, because you’ve reached the point where the cartilage in your joint is damaged, then a joint replacement is appropriate. It’s not that we’re against these things either, it’s that we believe in trying as hard as we can to prevent them from being necessary. But when appropriate, they’re definitely a gift that we have in our culture and the time that we live in that we can use these kinds of things to improve our quality of life and to get us back on track in terms of our health. And so very rarely will I see somebody who requires this stage of intervention, even naturopaths that work with cancer, their focus is not to treat cancer with natural therapies but to support the whole patient and to improve the outcomes of the high-force interventions, often an obstacle to healing from cancer is that patients aren’t able to finish their course of chemo due to the side effects, and so a lot of the natural therapies can help boost the efficacy of the medication and reduce the side effects and make patients feel better, so that they’re able to complete their treatment and then have better outcomes. So, at these two, the last two stages, where we’re using medications and high-force interventions, natural medicine is working to support the terrain and to support the body, through the therapies, through the side effects and to also encourage the therapies to work better.
And just to recap, the stages of the Therapeutic Order are first, number one, remove the obstacles to health, number two, stimulate the Vis Medicatrix Naturae, or stimulate homeostasis, improve our body’s self-healing mechanisms through applying nutrients, or looking at energetics, or using herbs to balance our systems and promote proper hormone balance. And the third is to strengthen weakened organ systems, focusing on one organ that may be the culprit in causing symptoms in particular, and really using nutrients that target that organ and the tissues that that organ has. Number four is to correct structural integrity, creating proper alignment and healing the musculoskeletal system through things like chiropractic medicine, osteopathy, massage therapy, even hydrotherapy and acupuncture, doing exercise like yoga as well fits under there. And number five is to use natural substances to restore and regenerate, so this is using natural substances to work directly with symptoms, to promote healing, but in patients that are further along the road to pathology and maybe already have a diagnosis of some health condition. And number six is to use pharmaco-substances to halt progressive pathology, so these are palliating, they’re stopping disease, they’re treating somebody who is either not responding enough or whose disease has progressed far enough that natural therapies are no longer strong enough. And then the seventh stage of the Therapeutic Order is to use high-force invasive modalities, such as surgery, radiation and chemotherapy and, again, these are removing the disease. Often that stage is usually life or death situations, we’re working to remove what’s causing a danger to our body and to our ability to survive. And so naturopathic medicine cover this whole spectrum. We have therapies that cover the whole spectrum of these stages and we’re working to treat the whole person not focusing on the disease or the symptoms, but looking at the person in front of us, and taking into account their lifestyle their preferences, their unique individuality and genetic expression and individual expression. My name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and I work at Bloor West Wellness in Bloor West Village in Toronto. Take care.
Polycystic Ovarian Syndrome, or PCOS, is the most common hormonal imbalance in women of reproductive age and can result in weight gain, infertility, acne, irregular cycles and unwanted hair growth. I talk about a naturopathic and functional approach to managing symptoms of PCOS and restoring hormone balance.
Hello, everybody. My name is Dr. Talia Marcheggiani. I’m recording to you guys from my clinic in Bloor West Village. It’s called Bloor West Wellness Clinic. And today I want to talk to you guys about one of my favourite conditions to treat when it comes to naturopathic medicine. And this condition is called Polycystic Ovarian Syndrome. And this is an endocrine, or hormonal condition, and it affects about 10% of women. It’s the most common cause of hormonal imbalance in women of menstruating age. And it’s a syndrome, so it’s not a disease. There’s a different constellation of symptoms that arise with it and this could be one of the causes of infertility in a lot of women. And because the symptom pictures are so diverse, it’s really hard for a lot of women to be suspected for a diagnosis of PCOS, or polycystic ovarian syndrome.
So, PCOS, the hallmark, the diagnostic criteria, based on the Rotterdam Criteria, is having either two of these three symptoms: anovulation or oligomenorrhea, which means having periods that are irregular. So, either having more than one period per month or missed cycles and long cycles of 6 weeks or more. The average female menstrual cycle is about 26-34 days, so having periods outside of that “normal” range could indicate one of the symptoms of PCOS. The other one is something called “hirsutism”, which is caused by high androgens, or male sex hormones, like testosterone or DHEA. And some of the symptoms of that are acne, so hormonal acne, those pustular, cystic acne that happens around the chin and jaw-line, or the chest and back. And “hirsutism”, which is the male-pattern hair growth, which is great, if you’re a woman, to have, which is the hair on the mustache and chin. So, you kind of sport a Frida Kahlo mustache and probably have to deal with that on the regular. Similarly, having hair loss on the scalp, is another sign. So, when you think of men, men will typically experience male-pattern hair loss, and hair-growth in the facial area.
And the third symptoms is the presence of cysts on the ovaries, which is diagnosed or sighted with a transvaginal ultrasound. There’s a scope placed through the vagina and an ultrasound is done to see if there are cysts on the ovaries.
It can also be diagnosed with lab work, so that’s not using the Rotterdam criteria, but there are two hormones that the brain makes that control the ovaries and these are called FSH, or follicle-stimulating hormone, and LH, lutenizing hormone. The brain makes the hormones and they tell the ovaries when to ovulate and the ovaries also make LH, lutenizing hormone after they’ve ovulated, or after the corpus luteum forms, after ovulation should happen, so whether the egg is fertilized or not, the corpus luteum will form.
And so PCOS is probable when you order labs and find that, so the FSH and LH should be almost the same, they should be at a 1:1 ratio and PCOS suspect when the LH to FSH ratio is 2:1 or higher. So you have either 2 or more times the LH than you have FSH. And this is because in PCOS, the ovaries will secrete a lot more LH and that is one of the reasons why they hypothesize that there are high androgens, because the LH can stimulate more androgen release.
So, there’s a “skinny PCOS”, so these are women with those symptoms that don’t experience obesity or metabolic syndrome, and then there’s the metabolic syndrome type of PCOS and in these patients there’s an insulin-resistance present, or a glucose-intolerance. And so these women will frequently experience hypoglycaemic crashes. They’ll also probably be on the obese side and really struggle to keep weight off and they’ll experience the low energy, the cravings for carbs. They’ll experience the hunger that comes two hours after a meal, despite having eaten an adequate amount of fat and protein, and this is really problematic for them because they’re set up for diabetes and for cardiovascular disease down the line. And then they’re also experiencing symptoms of obesity and they’re not super happy with how they look.
And we’re not exactly sure what causes PCOS in women. There’s evidence for it being heritable, so genetically passed on. There’s evidence for it being caused by insulin-dysregulation, and perhaps the ovaries are not responding properly to insulin. What insulin does, is it helps us take in fuel or glucose into our cells and, just like all the cells in our body, the ovaries require insulin to absorb glucose so that they can function properly. And so one of the theories of PCOS is that the ovaries are resisting insulin and the insulin is signalling them to grow, but they’re growing in the absence of proper fuel, or proper glucose as fuel and so they’re creating these follicles, or cysts.
And so, absence of periods, or irregular periods; male-pattern hair growth; obesity; infertility and then the presence of those cysts on the ovaries are all symptoms of PCOS. So, when we’re trying to get a diagnosis, we’ll send patients in for a transvaginal ultrasound. We’ll also look at their fasting blood glucose and fasting insulin. We’ll look at their progesterone and estrogen, because oftentimes these women are suffering from estrogen-dominance: there’s low progesterone and high estrogen in relation to the levels of progesterone. We’ll look at their FSH and their LH, and I’ll also check out their thyroid because oftentimes the symptoms of hypothyroidism and PCOS are overlapping and so I want to find out if there’s a thyroid pathology happening in the background.
So, one of the main reasons that women will come in with PCOS is because they’re trying to get pregnant, or they want to preserve their fertility in the future. They might come in for acne issues or the hair growth, or just to sort out their periods, but the main reason that they come in is fertility. And 40% of women with PCOS do experience infertility or fertility challenges. So this is a big issue for them.
And the reason I love treating PCOS in my practice is I find that, and this is sort of perhaps not technical or scientific, but I find that the personality of women with PCOS tends to be more phlegmatic, so they’re usually more agreeable, and happier and patients that really want to do good work and so it’s really enjoyable to work with them. But also, the reason I love treating patients with PCOS is because there are so many effective strategies that naturopathic medicine offers and I don’t see an equal amount of strategies in the conventional system.
And I’ll talk a little bit about some of the conventional therapies of PCOS. So, what happens is, in conventional therapy, is they kind of look at the symptoms in the syndrome spectrum and they kind of try to deal with each symptom individually. So they look at irregular periods and they’ll prescribe a birth control pill. So, like, “ok, we’ll just over-ride your own hormonal production and we’ll control your periods and get you cycling regularly”, which obviously doesn’t treat the underlying hormonal imbalance, because you’re just placing exogenous, fake hormones on top of the picture.
Or they’ll say, “ok, there’s blood-sugar dysregulation, so I’m going to prescribe a diabetic medication called ‘metformin’, which will help resensitize your cells to insulin”, which again is not the best strategy, although there’s some evidence to support that this helps. But, we’re not again treating the underlying issue of insulin resistance and metformin is pretty toxic to oocytes, or ovarian cells, so when you’re treating infertility you’re not setting the body up for healthy ovulation and producing a healthy baby. So, ehh, metformin.
And then we have, they’ll treat the high androgen symptoms, the hirsutism symptoms, the hyperandrogenism, by prescribing spironolactone, or Yas or Yasmin birth control pills, that block androgens. And, again, not the best strategy because it’s not treating the underlying cause, and there’s some evidence that Yas and Yasmin are one of the oral contraceptive pills that set you up for a higher risk of blood clots compared to other pills. So, women who are taking these are slightly higher than normal, compared to other birth control pills, risk of pulmonary embolism, deep vein thromboses, and those kind of blood clotting issues, which could be fatal. So, that’s an issue, right? And, again, not treating the underlying cause.
So there’s not that many great therapies and they’re not holistic. They’re not looking at the whole picture, they’re kind of reactionary and they’re just treating the symptoms. And then in terms of fertility, so women will undergo IVF treatments or they’ll be prescribed ovulation drugs like Clomid, which increase estrogen and get your body ovulating, kind of forcing ovulation to happen and again can be an issue because these women with PCOS are having sometimes an estrogen dominance picture, so their estrogen is high in relation to their low progesterone and so adding more estrogen-promoting drugs like clomid could just make life a mental and emotional disaster for these women while they still have the drug in their bodies. That could happen to a lot of women, but, again, not the best. It could achieve the end goal of getting pregnant, by increasing your chances, but we’re not looking at what’s going on.
And so, what happens, if when I first see a patient with PCOS, we’ll run the labs, or I’ll get the labs that their family doctor has run, if that was done recently, and we’ll take a look at their symptoms, so I’ll ask them how their periods are, and if they get PMS symptoms, and how often their periods come. And I’ll get them to track their periods, so I can see are they happening regularly, and they’re just very far apart? Or are they all over the place? We’ll look at their FSH and their LH, to see if they have that classic high LH to FSH ratio, and we’ll look at their insulin and fasting blood glucose and their testosterone. And I’ll ask them about symptoms, like acne and hair growth and we’ll talk about weight loss and if they’re getting those hypoglycaemic or insulin resistance symptoms. And we’ll talk about mood and emotions and digestion as well, which I talk about with all my patients, and energy and things like that, because we want to get a holistic picture and we want to —the reason is when I’m treating people I’m treating from the premise that it’s possible to be healthy and we can influence our health and the more I examine healthcare, and the healthcare model that is conventional, the more I doubt that that’s the premise that they’re standing on. Right? They’re kind of looking at making symptoms manageable, or maybe achieving outcomes or end goals, or preventing death and things like that, but they’re not coming at health conditions from a place of: “this person can influence the situation that they’re in through targeting and trying to understand the root cause of what’s going on, and then treating that.” So that’s where I’m coming at it. I’m looking at the whole picture, and I’m trying to understand this person’s unique hormonal imbalance and what the symptoms are that manifest from that.
Then it comes to choosing a treatment plan, so there’s lot of treatment that have a robust amount of evidence surrounding them and so you frequently hear people say that naturopathic medicine, or functional medicine, of these natural forms of medicine have no evidence and they’re pseudoscientific, well there’s tons of evidence for increasing fertility and improving PCOS using natural remedies, like nutriceutical remedies and herbal remedies.
So, first of all we have something called inositol. Inositol acts like a sugar in the body and what it does is it re-sensitizes the ovaries to insulin and serves as a fuel for the ovaries. And inositol doesn’t have much of a taste, it doesn’t have any side effects. It actually has some positive effects in helping with bipolar disorder and psychosis and those kind of mental health disorders, so if those are comorbid, then it’s great. If you have PCOS and you have bipolar, then inositol is a great choice. And with inositol, there’s some studies that show that in 3 months of supplementing with inositol periods have become regular, hyperandrogenism symptoms have gone down, so the acne and hair growth, and women had a 1 in 2 chance of getting pregnant. And then another 3 months of that, and their chances went up. So, inositol on its own is pretty powerful.
Another nutriceutical is N-acetyl cysteine, so NAC, which helps the liver clear out hormones and rebalance hormones and another great remedy for PCOS. We’re not exactly sure how it works, but there’s some theories about it rebalancing hormones, and perhaps through it’s antioxidant activity, because NAC creates an antioxidant, the main antioxidant in the body called “glutathione”. So, probably through its antioxidant activity, it’s helping the mitochondria, those fuel-houses for the cell, work better.
Another thing, when it comes to PCOS are some herbal remedies. So there’s an herb called vitex that helps establish a healthy hormonal estrogen and progesterone balance and that could be appropriate for some women. And there’s some studies using white peony and licorice that can help lower those hyperandrogenism symptoms. And then there are some herbs like saw palmetto that can help balance those high androgens as well, as they bind up testosterone and DHEA in the blood, so they increase something called sex hormone binding globulin (SHBG) and that can help clear out excess testosterone.
So those are just a few of these herbal and nutriceutical remedies that can be helpful in PCOS and I might prescribe some B-complex or some magnesium depending on how the adrenal glands are functioning and how hormones are cycling. And another thing we really like to do is tackle PCOS with diet and improve that blood-sugar balance if some of those insulin resistant symptoms or metabolic syndrome symptoms are there. And there’s a great study that shows that front-loading, so really increasing the calories that women are eating in the morning, having moderate calories at lunch and then having a lower or lighter dinner, kind of a snack for dinner, is really helpful in promoting fertility, lowering those androgens, resensitizing the ovaries and the other cells in their bodies to insulin and thereby resetting the hormonal stage. Really cool that this study just by changing your diet, although not the easiest change, is helpful for balancing hormones and you’re not doing something toxic, like the birth control pill or metformin, or something like that.
Also, a paleolithic diet, so changing the glycemic index of your diet by choosing fruits and vegetables that are lower on the glycemic index, so those leafy greens and adding fat and protein to every meal. It’s difficult as a vegetarian to shift hormones for the better and so I often recommend a more paleolithic diet to women, however, vegetarians, it is possible to increase your protein, it just takes a little bit more of conscious effort. And the reason that paleo diet is helpful is because it is lower glycemic index and has those higher fruits and vegetables with their antioxidant properties, but it also promotes the healthy fats and having an adequate intake of lean protein, such as your chicken, fish, lean beef, or eggs and even some dairy products depending on how someone tolerates that. And the last thing I’m going to talk about—this is just sort of a PCOS overview—the last thing I’m going to talk about is, with my patients I always work on self-care and stress relief because we know that the stress hormone cortisol can really mess up the other hormones in our body. It can contribute to insulin or worsen insulin resistance. It can worse that estrogen-dominance picture, it can prevent us from making enough progesterone because the progesterone and the cortisol pathway follows the same pathway and so that could be problematic if we need more progesterone but we’re using all of the resources to make it on making cortisol to deal with our stressful lifestyle. And a big part of managing PCOS, I find, is just getting cortisol under control and that might include increasing self-care, getting into things like yoga or meditation or doing some shin-rin yoku, like in the other video where I talk about Japanese Forest Bathing, so spending time in nature. That could be walking in the woods, or gardening, even watering a plant or hanging out with a pet or animal. Doing these things that feel nurturing and feel supportive to the mind and the emotions and help us face the daily stressors that we face with more resilience are all great strategies for managing hormonal health.
So, if you have any questions, just send me an email at connect@taliand.com or you can check out my website at taliand.com and my blog for other articles on hormonal balance, such as estrogen dominance, choosing an oral contraceptive pill, if you need one, and another article that I wrote about PCOS.
In this video I give an education talk to a group of seniors at the Bernard Betel Centre about naturopathic medicine. I discuss our philosophy, education, what kinds of conditions we treat and answer some questions along the way.
“I was born with an imbalance in my brain,” my patient explains to me, “The medication corrects it—Since I started taking Cipralex, I wake up feeling like a normal person again.”
It is estimated that about 10% of adults in North America are taking a medication to help them cope with anxiety and depression. Many people swear by these substances, others claim that they worsen depression, cause uncomfortable side effects and fail to treat the root cause of symptoms, numbing us to the experience and cause of our emotional pain and physical symptoms. The reality is, however, that prescriptions for these medications is increasing.
What are anti-depressants?
Most anti-depressant medication falls into the pharmaceutical category of SSRI, or Selective-Serotonin Re-uptake Inhibitors, like Prozac or Cipralex. These medications prevent the body from mopping up the “happy hormone”, serotonin, in the brain, making its feel-good effects last longer. The result is thought to be more serotonin in the brain and, therefore, increased feelings of happiness and euphoria. Other drugs work on preventing the re-uptake of other neurotransmitters, brain chemicals dopamine and norepinephrine, which also cause feelings of happiness, pleasure and reward, and give us energy.
The Monoamine Theory of Depression:
The leading theory of depression for decades, the Monoamine Theory, states that in people who suffer from depression, there is an imbalance in serotonin production and signalling in the brain—a “serotonin deficiency”—which SSRI medication corrects. Because this is how anti-depressant medication works, this has taken over as the prevailing theory of depression. However, there has never been a published study that proves that people who suffer from depression or anxiety have issues with brain serotonin production or metabolism. It almost seems that pharmaceutical companies have “reasoned backwards” creating a theory in order to support anti-depressant use.
As patients, we want to believe that the medicine our doctors give us is just that, medicine—something that treats the root cause of disease and makes us healthier, rather than covering up our symptoms while the underlying problem continues to worsen. However, most medications don’t work that way. While Advil may alleviate a headache, we intuitively know that our headache was not caused by an Advil deficiency. Likewise, alcohol may calm down those plagued by social anxiety, but we know that alcohol isn’t a cure for social anxiety; it is a drug that can temporarily help symptoms and relying on it will only cause further health problems down the line. We know that for most health conditions, while a drug may help temporarily, something else is going on inside our bodies that warrants attention.
While the percentage of people who are medicated for depression has increased in recent years, the rate of disability from mental health conditions is steadily on the rise. This is perplexing, especially if these drugs are doing what they’re “supposed to”, which is curing a brain chemical imbalance. Shouldn’t medicating patients with depression result in a cure, or at least a declining rate of disability for mental health concerns? Clearly, something else is going on.
Harnessing the Placebo Effect:
Many patients report the fact that anti-depressant medications saved their lives, radically turning around serious and debilitating symptoms. I’ve heard quite a few stories from individuals who couldn’t get out of bed until they found the right SSRI for their body.
The data shows that SSRI medication has the ability to reduce depressive symptoms by 30% in individuals, a modest reduction at best, but still significant. But, do these medications work as well as the studies claim? A glance at the entire body of research casts doubt on the efficacy of anti-depressant medication:
Firstly, there is a large body of unpublished negative studies. This means that studies that show there is no difference in anti-depressant medication and placebo is left out of the body of literature, favouring a bias for positive publications, publications that find anti-depressants work. Medical research draws conclusions by producing studies over and over again. When the results of several studies are combined, doctors and researchers are able to draw conclusions about whether a medication works or not. When only positive research is published, without negative research to balance it out, it casts medications in a favourable light that they may not necessarily deserve. This is an unfortunate phenomenon in medical science as a whole, and often skews the evidence in favour of drugs that may not be as effective as we hope.
Secondly, the gold standard for evidence, the Randomized Control Trial (RCT) may have design flaws due to the nature of the medications being tested. In RCTs, patients are randomized into two groups. One group is given placebo and the other the active drug that is being tested. The subjects and the people evaluating them are both blinded—neither knows which group is given the drug and which is given the placebo. This reduces the possibility of bias in reporting and observing the effects of the medication. The idea is because an inert pill, or “placebo” may be able to exert the effects of a drug, providing about 30% benefit, according to some sources. However, when patients who are in the active group experience side effects of the medication: gastric symptoms, nausea, headaches, altered sleep and appetite, they quickly become alert to the that fact that they are in the medication group, leaving room for the placebo effect to occur. This is termed the “Active Placebo Effect”. When SSRIs are compared with active placebos—placebos that don’t act as medicine but produce the same side effects—we found their effects rapidly diminished, perhaps because the placebo effect was not taking effect anymore.
What about the people who SSRIs help?
To cast doubt on the efficacy of anti-depressants does not in any way invalidate those who have felt the medications helped them. Every body is different and I believe that it is not for us to say how someone should or shouldn’t be reacting to a medication or therapy. The mysteries of our bodies are vast and there is only so much that we’re aware of in the world of medicine and health. Furthermore, the placebo effect, while often being used to dismiss therapies (“oh, it’s probably just a placebo effect”) should really be viewed as an amazing miracle of medicine and evidence of how powerful our bodies and minds are. The placebo effect shows us that, according to our beliefs, we have the power to heal ourselves. We believe that we’re getting treatment, we believe the treatment will help us, and the very nature of those beliefs heals our physical bodies.
This does not mean that the people who were suffering before taking the medication were “faking it” or should have been able to just snap out of it—that’s not how the placebo effect works. The placebo effect is based on changing our beliefs, which, as you may know, is not something we can simply will ourselves to do. However, the fact that our beliefs hold this kind of healing power, I find, frankly, is amazing. The placebo effect shows us evidence of an almost magical ability of the mind-body connection to heal ourselves, without side effects, and I believe it is something that we should harness and celebrate.
What’s the problem, then?
While anti-depressants may be harnessing the placebo effect to help individuals heal, there are downsides to them as well.
Firstly, SSRI medications have a long list of side effects, from weight gain and fatigue to sexual dysfunction and vitamin deficiencies, being on these medications over the long-term can be unpleasant for some and seriously affect quality of life for others.
Secondly, anti-depressant medications are notoriously difficult to get off of. I have assisted many patients in getting off their medication, with the help of their medical team, but it’s never easy and must always be done slowly and responsibly. Getting off medication involves a slow wean over months with support of natural therapies, psychotherapy and lifestyle changes. Because these drugs force the brain to adapt, causing a very real chemical imbalance, oftentimes the withdrawal effects are so intolerable that patients are not able to come off.
Most patients who decide to try anti-depressant medications are not aware how difficult it will be to stop taking the medication, if they should eventually choose to do so. This is unfortunate, as I believe that full informed consent should be applied to patients so that they may make appropriate decisions about their health—patients should be made aware that they are expected to stay on the medication for life and that weaning will be very difficult and, in some cases, not possible.
Finally, there is a growing body of evidence showing that patients who do not receive medication, but other forms of help such as diet and lifestyle changes, psychotherapy and stress management, do better, have higher rates of remission and less relapse than those who are medicated. As we see with the studies that show that more medication is correlated with more disability from mental health concerns, it is possible that medicating depression is only worsening the problem for most people.
So, what causes anxiety and depression?
Scientists and clinicians are not sure what the cause of depression is. However, the Cytokine Theory of Depression and the Gut-Brain Connection are two areas that are gaining increasing interest from researchers. These theories state that depression may be a cause of inflammation in the body that affects the brain, and that imbalances in gut health, especially with gut bacteria may offset mental health, respectively. Naturopathic doctors also notice a clinical correlation between burnout or “adrenal fatigue” and mental health symptoms.
Healing the mind and body, however, starts with creating a therapeutic relationship with a professional that you trust. After that, I find that healing the gut, correcting inflammation and nutrient deficiencies while addressing harmful core beliefs and stress can have wonderful results for healing depression and anxiety.
Depression is a symptom:
Psychiatry would have us believe that depression and anxiety are conditions that we are born with. Conventional medicine states that perhaps we have a familiar tendency to develop these conditions, perhaps we’ve had them since childhood, but, and in this case it is clear, depression and anxiety are not things that you heal from; they are things you simply manage.
I disagree. I don’t believe that depression and anxiety stand on their own as diseases, but symptoms of a deeper imbalance. Like any symptom, I believe mental health concerns are trying to tell us something. Our bodies have no other way of communicating with us other than through the symptoms they produce: lack of motivation, sore muscles, bloating and diarrhea, headache, joint pain, brain fog, fatigue and so on. As naturopathic doctors, we are trained to listen, not just to our patients, but the messages their bodies are signalling to us through symptoms.
This means that, when I start seeing a patient with depression, whether they are on medication or not, we develop a full work-up, asking in-depth questions about sleep, diet, exercise, digestion, mental status, mood, energy, reproductive health and so on. I connect these symptoms together to find out what is going on beyond what may be immediately visible.
Depression and anxiety often have a root cause. The cause may be stress, childhood trauma, leaky gut, adrenal fatigue, inflammation or even medication and drug use itself. Through uncovering the root of the issue, we are able to treat it, helping the body restore itself to balance and health.
My philosophy of healing is that, sometimes, illness can be a gift, especially if it encourages us to delve deep into our lives and values and make the necessary changes for healing ourselves. Sometimes depression and mental health challenges can be the beginning of a grand and fulfilling journey where we learn to connect more deeply to our bodies, discover our life purpose and a greater sense of happiness and life satisfaction.
A singular narrative is told and retold regarding medicine in the west. The story goes roughly like this: the brightest students are accepted into medical schools where they learn—mainly through memorization—anatomy, physiology, pathology, diagnostics, microbiology, and the other “ologies” to do with the human physique. They then become doctors. These doctors then choose a specialty, often associated with a specific organ system (dermatology) or group of people (pediatrics), who they will concentrate their knowledge on. The majority of the study that these doctors undergo concerns itself with establishing a diagnosis, i.e.: producing a label, for the patient’s condition. Once a diagnosis has been established, selecting a treatment becomes standardized, outlined often in a cookbook-like approach through guidelines that have been established by fellow doctors and pharmaceutical research.
The treatment that conventional doctors prescribe has its own single story line involving substances, “drugs”, that powerfully over-ride the natural physiology of the body. These substances alter the body’s processes to make them “behave” in acceptable ways: is the body sending pain signals? Shut them down. Acid from the stomach creeping into the esophagus? Turn off the acid. The effectiveness of such drugs are tested against identified variables, such as placebo, to establish a cause and effect relationship between the drug and the result it produces in people. Oftentimes the drug doesn’t work and then a new one must be tried. Sometimes several drugs are tried at once. Some people get better. Some do not. When the list is exhausted, or a diagnosis cannot be established, people are chucked from the system. This is often where the story ends. Oftentimes the ending is not a happy one.
On July 1st, naturopathic doctors moved under the Regulated Health Professionals Act in the province of Ontario. We received the right to put “doctor” on our websites and to order labs without a physician signing off on them. However, we lost the right to inject, prescribe vitamin D over 1000 IU and other mainstay therapies we’d been trained in and been practicing safely for years, without submitting to a prescribing exam by the Canadian Pharmacists Association. Naturopathic doctors could not sit at the table with the other regulated health professions in the province until we proved we could reproduce the dominant story of western medicine—this test would ensure we had.
Never mind that this dominant story wasn’t a story about our lives or the medicine we practice—nowhere in the pages of the texts we were to read was the word “heal” mentioned. Nowhere in those pages was there an acknowledgement about the philosophy of our own medicine, a respect towards the body’s own self-healing mechanisms and the role nature has to play in facilitating that healing process. It was irrelevant that the vast majority of this story left out our years of clinical experience. The fact that we already knew a large part of the dominant story, as do the majority of the public, was set aside as well. We were to take a prescribing course and learn how primary care doctors (general practitioners, family doctors and pediatricians), prescribe drugs. We were to read accounts of the “ineffectiveness” of our own therapies in the pages of this narrative. This would heavy-handedly dismiss the experience of the millions of people around the world who turn to alternative medicine every year and experience success.
We were assured that there were no direct biases or conflict of interests (no one was directly being paid by the companies who manufacture these drugs). However, we forget that to have one story is to be inherently and dangerously biased. Whatever the dominant story is, it strongly implies that there is one “truth” that it is known and that it is possessed by the people who tell and retell it. Other stories are silenced. (Author Chimamanda Ngozi Adichie describes this phenomenon in her compelling TED Talk, “The Danger of a Single Story”).
Despite the time and money it cost me, taking the prescribing course afforded me an opportunity to step outside of the discouraging, dominant story of the standard medical model and thicken the subordinate stories that permeate the natural and alternative healing modalities. These stories began thousands of years ago, in India and in China, at the very root of medicine itself. They have formed native ancestral traditions and kept entire populations and societies alive and thriving for millennia. Because our stories are not being told as often, or told in the context of “second options” or “last resorts”, when the dominant narratives seem to fail us, the people who tell them run the risk of being marginalized or labeled “pseudoscientific.” These dismissals, however, tell us less about The Truth and more about the rigid simplicity of the singular story of the medical model.
It is frightening to fathom that our body, a product of nature itself, encompasses mysteries that are possibly beyond the realm of our capacity for understanding. It’s horrifying to stand in a place of acknowledgement of our own lack of power against nature, at the inevitability of our own mortality. However, if we refuse to acknowledge these truths, we close ourselves off to entire systems that can teach us to truly heal ourselves, to work with the body’s wisdom and to embrace the forces of nature that surround us. The stories that follow are not capital T truths, however, they can enrich the singular story that we in the west have perpetuated for so long surrounding healing.
The body cannot be separated into systems. Rather than separating depression and diarrhea into psychiatry and gastroenterology, respectively, natural medicine acknowledges the interconnectivity between the body’s systems, none of which exist in a vacuum. When one system is artificially manipulated, others are affected. Likewise, an illness in one system may result in symptoms in another. There have been years of documentation about the gut-brain connection, which the medical model has largely ignored when it comes to treatment. The body’s processes are intricately woven together; tug on one loose thread and the rest either tightens or unravels.
We, as products of nature, may never achieve dominion over it. Pharmaceutical drugs powerfully alter the body’s natural physiology, often overriding it. Since these drugs are largely manmade, isolated from whole plants or synthesized in a lab, they are not compounds found naturally. Despite massive advances in science, there are oceans of what we don’t know. Many of these things fit into the realm of “we don’t know what we don’t know”—we lack the knowledge sufficient to even ask the right questions. Perhaps we are too complex to ever truly understand how we are made. Ian Stewart once wrote, “If our brains were simple enough for us to understand them, then we’d be so simple that we couldn’t.” And yet, accepting this fact, we synthesize chemicals that alter single neurotransmitters, disrupting our brain chemistry, based on our assumption that some people are born in need of “correcting” and we have knowledge of how to go about this corrective process. Such is the arrogance of the medical model.
There are always more than two variables in stories of disease and yet the best studies, the studies that dictate our knowledge, are done with two variables: the drug and its measured outcome. Does acetaminophen decrease pain in patients with arthritis when compared to placebo? A criticism of studies involving natural medicine is that there are too many variables—more than one substance is prescribed, the therapeutic relationship and lifestyle changes exert other effects, a population of patients who value their health are different than those who do not, the clinical experience is more attentive, and so on. With so many things going on, how can we ever know what is producing the effect? However, medicine is limited in effect if we restrict ourselves to the prescription of just one thing. This true in herbalism, where synergy in whole plants offers a greater effect than the sum of their isolated parts. By isolating a single compound from a plant, science shows us that we may miss out on powerful healing effects. Like us, plants have evolved to survive and thrive in nature; their DNA contains wisdom of its own. Stripping the plant down to one chemical is like diluting all of humanity down to a kidney. There is a complexity to nature that we may never understand with our single-minded blinders on.
Studies are conducted over the periods of weeks and, rarely, months, but very rarely are studies done over years or lifetimes. Therefore, we often look for fast results more than signs of healing. This is unfortunate because, just as it takes time to get sick, it takes time to heal. I repeat the previous sentence like a mantra so patients who have been indoctrinated into a medical system that produces rapid results can reset expectations about how soon they will see changes. Sometimes a Band-Aid is an acceptable therapy; few of us can take long, hard looks at our lives and begin an often painful journey in uncovering what hidden thought process or lifestyle choices may be contributing to the symptoms we’re experiencing. However, the option of real healing should be offered to those who are ready and willing.
When we study large masses of people, we forget about individuality. When we start at the grassroots level working with patients on the individual level, we familiarize ourselves with their stories, what healing means to them. In science, large studies are favoured over small ones. However, in studies of thousands of people, singular voices and experiences are drowned out. We lose the eccentric individualities of each person, their genetic variability, their personalities, their preferences and their past experiences. We realize that not everyone fits into a diagnostic category and yet still suffers. We realize that not everyone gets better with the standard treatments and the standard dosages. Starting at the level of the individual enables a clinician to search for methods and treatments and protocols that benefit each patient, rather than fitting individuals into a top-down approach that leaves many people left out of the system to suffer in silence.
It is important to ask the question, “why is this happening?” The root cause of disease, which naturopathic medicine claims to treat is not always evident and sometimes not always treatable. However, the willingness to ask the question and manipulate the circumstances that led to illness in the first place is the first step to true and lasting healing; everything else is merely a band-aid solution, potentially weakening the body’s vitality over time. No drug or medical intervention is a worthy substitute for clean air, fresh abundant water, nutritious food, fulfilling work and social relationships, a connection to a higher purpose, power or philosophy and, of course, good old regular movement. The framework for good health must be established before anything else can hope to have an effect.
The system of naturopathic medicine parallels in many ways the system of conventional pharmaceutical-based medicine. We both value science, we both strive to understand what we can about the body and we value knowledge unpolluted by confusing variables or half-truths. However, there are stark differences in the healing philosophies that can’t be compared. These differences strengthen us and provide patients with choice, rather than threatening the establishment. The time spent with patients, the principles of aiming for healing the root cause and working with individuals, rather than large groups, offer a complement to a system that often leaves people out.
There are as many stories of healing and medicine as there are patients. Anyone who has ever consulted a healthcare practitioner, taken a medicine or soothed a cold with lemon and honey, has experienced some kind of healing and has begun to form a narrative about their experience. Anyone with a body has an experience of illness, healing or having been healed. Those of us who practice medicine have our own experience about what works, what heals and what science and tradition can offer us in the practice of our work. Medicine contains in its vessel millions of stories: stories of doubt, hopelessness, healing, practitioner burnout, cruises paid for my pharmaceutical companies, scientific studies, bias, miracle cures, promise, hope and, most of all, a desire to enrich knowledge and uncover truth. Through collecting these stories and honouring each one of them as little truth droplets in the greater ocean of understanding, we will be able to deepen our appreciation for the mystery of the bodies we inhabit, learn how to thrive within them and understand how to help those who suffer inside of them, preferably not in silence.
In most service industries, there are certain guarantees. If you go to a restaurant, your soup is guaranteed. At the GAP, you will get a pair of chinos, guaranteed. In lots of instances, you get what you are paying for and in most cases, you get to see if before you hand over your credit card—a coffee, a massage. In many cases, if you’re not satisfied, you can get your money back—guaranteed.
This is not the case in medicine. We cannot legally guarantee results. There are no guarantees.
Everybody and every body is different. Contrary to what it might seem like in our age of paralyzing fear of uncertainty, no one has all, or even most, of the answers.
Dr. Google makes it seem like we do, though.
When I see a new patient who is worried about their health and their future, I want to be able to promise them. I want nothing more than to say, “these breathing exercises will eliminate your anxiety, just like you asked for: poof! gone.”
I want to guarantee things.
I want to tell someone that, if they follow my instructions, they’ll never have another hypertensive emergency again. I want to, but I can’t. No one can. And our job is not to guarantee. It is to serve.
A $10,000 bag of chemotherapy pumped into your arm will not guarantee that the cancer goes into remission no matter how many studies show it has an effect. I can’t promise you’ll get pregnant, even though I’m doing my best, you’re doing your best and science is doing its best.
That’s all I can guarantee: that I will try my very best.
I can be your researcher, teasing out the useful scientific information from a sea of garbage and false promises—false guarantees from those who have no business guaranteeing anything. I can provide my knowledge, culminated from years of study and practice and life. I can sit with you while you cry and hear you share your story. I can let you go through your bag of supplements, bought in a whirlwind of desperation, and tell you what is actually happening in your body—something that doctor didn’t have time to explain. I have time to spend with you. We can have a real conversation about health. I can also make recommendations based on my clinical experience, research and millenia of healing practices. These recommendations will certainly help—virtually everyone sees some kind of benefit—but I can’t guarantee that either.
I watched a webinar on probiotics recently. The webinar sent me into a spiral of existential probiotic nothingness. I’ve been prescribing probiotics for years. I’ve seen benefits from them with my own eyes. Patients have reported great things after taking them and I feel better when I take them: my stomach gets flatter, things feel smoother, my mood gets lighter. Probiotics are wonderful. However, according to the research that was being presented by this professional, which he’d meticulously collected and organized, many things we thought about probiotics aren’t true. I’d have to change my whole approach when it came to probiotics, prescribing certain strains for certain conditions where they’d seen benefit. I remember feeling hard-done by by the supplement companies and the education I’d gotten at my school. How could we be so off base on this basic and common prescription?
At the same time, some skeptics were harassing me on Twitter, telling me that I’d wasted 4 years, that naturopathic medicine is useless and doesn’t help people. Besides having helped numerous people and having been healed myself, their words got to me. What if everything I know is as off-base as my previous knowledge on probiotics was?
The very next day, I called a patient to follow up with her. She’d kind of fallen off the radar for a while. She was happy to hear from me. I asked her how she was feeling, if she’d like to rebook. “I don’t need to rebook,” She told me, excitedly, “I’m completely better!”
After one appointment.
I was astounded and intrigued. Of course, we expect people to get better, but it takes time to heal, and I rarely go gung-ho on the first appointment, there was still lots left in my treatment plan for her. She’d been experiencing over seven years of digestive pain, debilitating fatigue, life-changing and waist-expanding cravings for sugar. It takes a while to reverse seven years of symptoms. It takes longer than a couple of weeks. But her symptoms were gone. She felt energized, her mood was great and she’d lost a bit of weight already. She no longer had cravings.
And she’d just started on one remedy.
Which was, you guess it, probiotics.
Sure, you might think. Maybe it wasn’t the probiotics, maybe she would have just gotten better on her own. Possible, but unlikely. She’d been suffering for years.
Ok, then, you say, maybe it was a placebo effect. Maybe it wasn’t the actual probiotics. Again, it’s possible. She’d tried other therapies before, which hadn’t worked, however and she “believed” in them just as much as the probiotic. And the probiotic made her better.
The point is this: we don’t know. Science is magical. People are magical. Medicine, which combines science with people, is the most magical of all. There are no guarantees.
The point is that anything can make anyone feel better: a good cry, a $10,000 bag of chemotherapy, journalling for 12 weeks or popping a probiotic. Some things have more research behind them. Some things we’ve studied and so we know some of the mechanisms for why things work. But we still have a lot of why’s and we always will. Everybody and every body is different. No two people or two conditions should receive the exact same protocol or supplement or IV bag or journalling exercise or cry-fest. We have no guarantees what will work or what will make you feel better. Just some research papers, some experience, maybe the odd dash of intuition or interpersonal connection and a firm resolve to want our patients to get better. And that’s a guarantee.
Sigh… I just finished reading a rather annoying article in the Globe and Mail (don’t even bother to click and add more Google street-cred, seriously) that doesn’t really warrant a response but… here we go. It’s my day off.
The article was written by one Carly Weeks, who doesn’t seem to have a very positive view of naturopathic doctors. I don’t know Carly and have no idea about her health history, but I’m going to take a shot in the dark and imagine she hasn’t suffered from chronic eczema.
Let me know how that steroid cream works out for ya, Carly!
But, ad hominem aside, her issue with naturopathic doctors this week(s)—pun intended, aren’t I hilarious—is, what else: we’re a bunch of quacks who use nothing but false therapies and smooth-talking to coax our patients into thinking they feel better. Well, if that worked, I wonder why more healthcare practitioners don’t try copying those moves too. It might save the government some money, which is what, coincidently, naturopathic medicine is already doing and it’s not by false therapies and smooth-talking. (But we do make time for a lot of talking).
The Globe piece begins with a story about how physicians (not naturopaths, for the record) prescribed radioactive water in the 1920’s. It’s a cute and tragic story about limited safety profiles. And other than its juxtaposition in an article about NDs, I’m not sure what the writer’s point was. We don’t use radioactive water to treat anyone. If you want radiation, which is a therapy, a cancer treatment, then you must see an oncologist. Talk about throwing out babies and bathwater.
The article is largely about how naturopathic doctors are moving under a new regulatory board, under the Regulated Health Practitioners Act. This limits our scope compared to that of provinces like BC or certain US states, where naturopathic doctors have been prescribing drugs and even performing minor surgeries safely where it’s warranted.
Here are some facts:
Naturopathic medicine is incredibly safe. We are trained in conventional diagnosis, anatomy, physiology, physical exams, including gynaecological exams, breast exams and digital rectal exams. We have the ability to perform acupuncture in Ontario and give intramuscular injections. With additional training we can provide IV treatments. We are trained to order and interpret labs and to take blood. I will not deny that conventional medicine and pharmaceuticals have saved millions of lives. However, we know that 10,000 yearly deaths in Canada (and 100,000 in the US) are due to pharmaceuticals alone. A year ago I wrote a post talking about the off-label birth control pill Diane-35. Let’s not start comparing safety profiles here.
Naturopathic doctors are highly trained and educated: We have completed a 4-year very rigorous program that includes a 12-month internship where we treat patients in an out-patient facility. In our training we performed over 100 practical and written examinations. After our second and fourth year we complete two licensing exams, which span a course of 5 full days of examinations combined. Ask anyone I know if what I did was easy. Trick question: they wouldn’t know because they didn’t hear from me for the past 5 years–I was studying the WHOLE time. It’s ok, though, because now I know a lot.
Naturopathic medicine is a regulated profession: In order to practice in Ontario naturopathic medical graduates who have passed both licensing exams, must pass a series of board examinations that are both written and practical. We then must enter into a month-long application process, which includes a police background check and character reference check. If I try to delay treatment of an emergent condition or treat an emergent condition with something like homeopathy or acupuncture (effective treatments for other conditions, but not emergent, life-threatening ones), which is something we are often accused of potentially doing, my licence will be removed. It’s not something we do—it’s that simple. We are held accountable and have a lot of responsibility to deliver safe care.
Naturopathic doctors are health experts: In order to complete the naturopathic medical program we complete 1200 hours of clinical training and 3000 hours of classroom training. This does not include study time for our board exams and pursuit of side interests or continuing education credits that are required to maintain licensure. We are trained in nutrition, which many medical professional, including medical doctors, are not. Naturopathic doctors often see patients that have been failed by the conventional medical system, which means we deal with complex cases on a regular basis. This demands that we keep our skills sharp and our knowledge current.
Naturopathic medicine provides the public with an amazing service that patients are willing to pay for: We spent up to two hours at time with our patients, educating them on any topic of their health picture: the medications they’re on that their doctors don’t have time to discuss with them, their health conditions, their prognosis and what else they can do about it. I spent half an hour talking about an STI a patient of mine had been diagnosed with. She’d seen two doctors and a specialist. None of them had talked to her about it. Patients have told me their doctors no longer perform physicals. Well, we do. And, it turns out, people pay for excellent care. Naturopathic medicine provides the much-needed service of patient education, human-centred care and prevention of disease. It’s an excellent complement to an effective whole-person healthcare strategy.
Naturopathic medicine works: I could say more on this but let’s keep it brief: if it didn’t work, people wouldn’t pay for it. The Globe and Mail, more than anyone should know to “let The Market speak.” (Amiright?) I lied, I will say more. If you don’t think naturopathic medicine works, then call my patients who no longer have chronic pain or allergies or chronic constipation. Ask my patient who couldn’t conceive how her daughter is doing. Blah blah, we help people.
Naturopathic doctors prefer to work in collaboration with other healthcare professionals: Ideally each patient should be managed by a healthcare team. When I start seeing a new patient I immediately establish a relationship with his or her medical doctor. I refer out for labs and to specialists if necessary. Medicine should be integrative, not alternative. Patients shouldn’t be forced to choose.
In addition to accusing us of being a bunch of unsafe quacks, the author writes, “Ontario should have created a regulatory system based on the principle of evidence first.” So, there you have it. Only medicine that is based in evidence should be regulated by the province.
Wow, what a ridiculous statement made by someone who I imagine knows little to nothing about how medicine and so-called “evidence” works.
Firstly, there is more than one type of evidence. In fact, evidence is a hierarchy. At the bottom we have things like clinical case reports or expert opinion, what my friends the skeptics love to call “anecdotal evidence.” Sigh. If you’ve seen something work, you keep doing it. It’s not the best evidence we have, but it’s still evidence. The better forms of evidence, randomized control trials, are being done on naturopathic therapies and naturopathic therapies have been found to hold steady. Actually, many of the therapies we prescribe are done precisely because there is evidence to support it: fish oil for depression and bipolar disorder? Inositol for fertility in patients with PCOS? Evidence, evidence, evidence.
Secondly, only 10% of medical guidelines are based on the type of “evidence” that our friend Carly Weeks is likely referring to: the Randomized Control Trial, which involves comparing two groups: a treatment group to an inactive group that gets something like a placebo. Well, it turns out, we just don’t have that much “evidence” of this sort to dictate what happens in medicine. A tourniquet for a bleeding wound? Using general anesthetic rather than nothing? These things haven’t been compared against placebo. What is the other 90% of medicine based on? Expert opinion: a nice mixture of clinical expertise, intuition, common-sense, “what the heck, might as well try it it couldn’t hurts” and research. I don’t see Carly questioning the use of SSRI for mild and moderate depression or beta-blockers to prevent cardiac events as a result of high blood pressure, both of which have “no evidence” to support their use. Nope, just crickets when it comes to those topics.
Thirdly, the father of EBM, or Evidence Based Medicine, himself, Dave Sackett, said, “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannized by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient.” (Emphasis mine). Individual clinical expertise from both modern and traditional medicine, the best available external evidence and tailoring treatments to individuals patients needs and preferences? Sound like naturopathic medicine to me.
Naturopathic medicine is safe and effective. We have a patient-centred approach and offer wonderful service for the cost, which is often covered by insurance benefits. Naturopathic doctors take the time to listen to your story and educate you on what is happening in your own body. We treat the root cause of your condition, rather than masking symptoms. We are highly-trained healthcare professionals and we are regulated. Soon we will be moving to different regulation. However, the government will be removing some of the rights we’ve had, which include ordering certain lab tests that we’ve safely ordered for years. If you use or support naturopathic medicine, please click the link to sign the petition to maintain the current naturopathic scope of practice in Ontario and support safe and effective natural healthcare for all Ontarians.
My family waste no time making illusions about their lack of acceptance of my form of medicine. If left unchecked, dinner table conversation can quickly lead to arguments about the efficacy of the flu shot, why Cold FX is unnecessary and whether “eating in moderation” includes microwave pizza. Lately I’ve decided it’s not worth the bother to champion my cause; I now simply remain silent, keeping my eyes on my gluten-free toast. Having a family that is not well-versed in natural medicine, however, is educational. It removes me from the naturopathic medicine bubble of my colleagues and ex-classmates and brings me back to reality. The truth is that many people don’t know or can’t appreciate what we naturopathic doctors do. There are several myths I’ve been confronted with, ranging from critically negative to unknowingly innocent, that need to be destroyed.
1. Naturopathic Medicine is not scientific.
The main criticism against naturopathic medicine is that it is unfounded and unscientific. “If alternative medicine worked, it would just be called medicine,” once said Tim Minchin, a comedian that skeptics love to quote. While there are several political reasons for the fact that there are not as many studies on natural therapies as there are on conventional medical therapies, the body of evidence that supports natural therapies is growing. Naturopathic doctors use conventional medicine to diagnose, request laboratory tests and perform physical exams on our patients. We follow many conventional medical guidelines, all of which are evidence-based. In naturopathic medical school, we were taught to consult a wide range of scientific journals for developing our treatment plans. Throughout our education we were required to write research reviews and case studies. The Canadian College of Naturopathic Medicine and its affiliate centres such as the Ottawa Integrated Cancer Centre conduct many research studies and offer research residency programs for graduates of the naturopathic medicine program.
Further, the notion that nutrition is unscientific is ridiculous. We know that what we put in our bodies can either improve or diminish our state of health. Herbal remedies and therapies, such as acupuncture, have been used for millennia. Most drugs are derived from the medicinal properties of herbs.
Additionally, there is an increasing number of medical doctors employing natural therapies in their practices; the reasons being that they are safe, gentle and they work.
2. Naturopathic doctors are anti-pharmaceutical, anti-surgery and anti-vaccine.
The practice of naturopathic medicine involves adhering to the Therapeutic Order. This order is a loose guideline for developing a treatment plan that begins with establishing the conditions for health: a healthy diet, lifestyle and environment, and ends with more invasive therapies not performed by naturopathic doctors, such as powerful medications and surgery. For example, if you break your arm, a medical doctor will set the bones back into place, manage your pain and immobilize the bones by using a cast and sling. However, drugs and surgery do not fuse your bone back together. This magical feat is performed by your body, or what we naturopathic doctors term the healing power of nature. Surgery would not work without it. Our job as naturopathic doctors is to help your body do its job of healing, enabling your bones to heal faster.
Like natural therapies, some conventional therapies are better than others. Some heavy medications are necessary for temporarily managing pain or stabilizing life-threatening acute conditions, such as anaphylactic shock. However, preventing these health crises or working alongside conventional medicine to help the body better recover is the job of the naturopathic doctor.
Naturopathic doctors are not anti-vaccine. Some vaccines are more effective than others and, like many therapies, some vaccines carry with them risks, however small. Naturopathic doctors have medical knowledge and time to spend with patients. We believe in taking the time to share our knowledge and research with patients to help them make informed choices about their health and what goes into their bodies, vaccines included.
While vaccines play a critical role in public health, it’s important to acknowledge that, like any medical intervention, they come with potential risks. Some individuals may experience mild side effects, while in rare cases, more serious reactions can occur. It’s crucial for patients to have access to accurate information about these risks so they can make informed decisions about vaccination. Naturopathic doctors are committed to educating patients about both the benefits and potential risks associated with vaccines, allowing individuals to weigh their options carefully.
In cases where someone does experience an adverse reaction, understanding their rights becomes essential. This is where seeking guidance from professionals, such as My Vaccine Lawyer, can be helpful. These experts can provide the necessary legal advice and support for individuals who feel they’ve been harmed by a vaccine. While the occurrence of serious side effects is rare, having access to legal resources ensures that patients are protected and informed throughout their healthcare journey.
3. Patients need to choose between naturopathic and conventional medicine.
There are numerous studies that show that, when practiced together, naturopathic medicine and conventional medicine achieve better outcomes than conventional medicine alone. Naturopathic cancer care, for example, is not about curing cancer with green smoothies; it aims to keep patients feeling healthy and strong while undergoing chemotherapy and radiation so that they can complete their treatment. Many patients with cancer experience negative outcomes because the treatment cannot be completed due to diminishing health or debilitating side effects. For any condition, naturopathic doctors work alongside medical doctors to benefit our patients. The job of the naturopathic doctor is to help strengthen our patients’ health and support their bodies through disease, not compete with medical doctors. Many people term naturopathic medicine Integrative Medicine because it aims to integrate the existing body of medical knowledge, both conventional and natural, to better help patients.
4. You can go to a supplement store; you don’t need a naturopathic doctor.
Natural health products are a complicated issue because, like Advil, they can be acquired without a doctor’s prescription. However, this means that patients become consumers, subject to marketing schemes and misinformation. A naturopathic doctor is a doctor. We take your health history (spending up to 90 minutes doing so) and then spend time developing a comprehensive treatment plan that fits you as an individual. This is far more powerful and effective than simply buying health products on a whim or shooting in the dark. We recommend products at the correct dose and for the appropriate duration. We can also tell you which products have the most evidence behind them. We have studied medicine for 8 years and develop treatment plans, as doctors, to treat your condition. This is vastly different from self-prescribing fish oil because you heard it’s good for you.
5. You should only visit a naturopathic doctor if you’re willing to make drastic lifestyle changes.
There was a time when naturopathic doctors put all of their patients on an extreme diet, such as the Anti-Candida Diet or some facsimile. While many people felt better on this diet – it eliminated many noxious foods such as fast food, processed foods and sugar – it served to intimidate many who didn’t feel ready for such a drastic change. Fortunately for patients, those days are over. While the practice style of the naturopathic doctor can vary, my personal style is to start slowly and not overwhelm. The treatment plan your naturopathic doctor prescribes you will depend on your readiness for change; you will not be pushed into doing anything you are unready for. Naturopathic doctors are also trained in counselling and are able to assess your readiness for change and help motivate you to make health changes at a pace that you feel comfortable with. We are also trained to support you through the process of making changes, ensuring your success and health outcomes.
6. Naturopathic medicine is for the rich.
It is an unfortunate truth that naturopathic visits are not financially accessible for all Canadians. I charge between $95 to $150 for a visit and, even if the visit lasts 90 minutes, this is certainly not cheap. However, the cost of medicine is not cheap, even if it is covered by the government. There is evidence to show that naturopathic medicine saves the individual and the tax payer money; it is far cheaper to prevent disease than treat it. The average patient at my clinic spends $500 a year on naturopathic visits, most or all of which is covered by extended health benefits. In 2014 the Ontario government removed the need to charge HST for naturopathic visits, slightly reducing the cost of naturopathic medicine. Lastly, while supplements and therapies need to be paid for out of pocket, naturopathic doctors tailor their supplement recommendations to your treatment plan and are trained to take your financial situation into consideration when designing a treatment plan.
When we consider all of the things we channel our money towards, I believe that we as a country could afford to dedicate a little more of our salaries to our health. The average Canadian woman spends $1200 a year on cosmetics and personal care products. However, real beauty comes from being healthy—cultivating a healthy glow from the inside out. Health is your greatest asset; perhaps we should invest in it if we have the means. For those who simply cannot afford naturopathic medicine there are free satellite clinics staffed by interns and cost-effective options such as community acupuncture that provide natural medicine at a more affordable price.
7. Naturopathic medicine is for granola-munching hippies.
Even though my website and business cards are covered in flowers (flowers are beautiful!), naturopathic medicine aims to include everyone, no matter what their value system is. Naturopathic medicine is for people who value their health. It is for those who believe that healing is more than suppressing symptoms and remaining medicated for the rest of their lives. Naturopathic medicine offers an option to anyone who wonders how their lifestyle and diet may be affecting their health. We believe in empowering people to lead healthier lives and to take a more active role in how they feel mentally and physically. We use science, clinical experience and traditional therapies to help people feel better. You don’t need to be a vegan to appreciate what good health is worth.
What other natural health myths have you heard that require destroying?
Rosalind Franklin: She might have been left out of the Nobel, but at least she gets the honoured spot as the featured image of this post. Lucky her. (Sorry, readers, just a little inside joke for the molecular biologists out there). Image source: wikipedia.org
“Do you find yourself easily able to bounce back from emotionally-charged situations?” Dr. Emily Fitzgerald, ND, asked while sitting across from me at her white desk. “The fact that this part of the gene is present and not deleted means that you are the ‘cool and collected’ type, the ‘Wolf of Wall Street’, if you will.” She went on, “We find here through our testing that most naturopathic doctors have the other version of this gene.”
Great, I thought, I was genetically unfit to practice naturopathic medicine; it was like something out of the movie GATTACA. I couldn’t help but feel let down by my genetic coding. I had always thought of myself as an empathetic and caring person and yet science was telling me the opposite. Wolf of Wall Street? Seriously? I hated the movie. In fact, I felt more at home sharing a collective vegan lunch with protesters occupying Wall Street than bidding on stock options. Surely this doctor must be mistaken. But alas, it wasn’t her fault. She was simply a messenger, reading out to me what was clearly spelt out in my nucleic acid.
Genes are funny things. We inherit one set from our mothers and another from our fathers. They don’t change throughout our lives and they are responsible for coding all of the proteins, enzymatic reactions and cellular structures that make up our beautiful bodies. However, I once read that interpreting the human body through genetic code is analogous to interpreting Shakespeare’s works by studying the alphabet; it’s not even a recipe, but a mere grocery list.
Dr. Mohammed, the CEO of YouNique Genomics, a Canadian lifestyle genomics company, will also assert that “genes aren’t everything.” Our environment has a lot to do with how they are expressed and this simple fact can explain why, despite the fact that I am missing part of the “emotional gene”, I am still able to regard my patients with positivity, appreciate literature and cry at sappy love stories.
Despite the Nature vs. Nuture debate, there is still a lot that can be garnered from looking at genetic coding. By studying my expression of SNPs (single nucleotide polymorphisms), or small variations in DNA, on only 14 of my 23,000 genes, Dr. Fitzgerald was able to tell me that I am a passionate person, I am capable of regulating my emotions when confronted with difficult situations, I can drink espressos after dinner without affecting my sleep and the Paleo Diet will only lead me to overeat. She told me how dopamine is metabolised in my brain, how my liver detoxifies and how my body digests cholesterol and lipids, giving me information about my long-term risk for heart disease. And she did all of this without looking at her crystal ball, not even once.
I previously associated genetic testing with detecting the risk for diseases such as early-onset Alzeimer’s or breast cancer. I had always thought that knowing one’s genetics was dis-empowering. After all, you’re born with your genetic code; what is the use of learning about something that you can’t change? It seemed to me as useful as tying yourself to a set of train tracks, powerless to stop yourself from being crushed under the freighter speeding towards you.
My mind changed when I learned about functional genomic testing like the kind offered at YouNique. Functional, or lifestyle, genomics don’t predict disease risk but rather only test for genes whose expression can be affected by lifestyle. The test I received was called the SNaP Shot. It looks at 14 genes, including those that code for dopamine metabolism, liver detoxification, methylation pathways and cardiovascular health.
One of the noteworthy pieces of information I learned was that my detoxification pathways are like a leaky faucet with a clogged drain. The enzymes that run Phase I liver detoxification, which make many toxins more toxic, are over-expressed, meaning that they work better than the average person’s. However, I have less than optimal Phase II detoxification, which is responsible for neutralizing these toxins and allowing them to be safely eliminated from the body. This means that I need to start supporting my liver and increasing my production of glutathione, an important antioxidant. If I don’t do this? It’s written in my DNA, and perhaps that stars, that my risk of cancer from toxin exposure could be higher than normal. I bought a bottle of milk thistle the next day.
I also learned that my body has a 30% reduced ability to use folate, meaning that I need to increase my intake of this vitamin or else risk problems with inflammation, which has wide-spread affects. I also found out that I respond poorly to saturated fat intake: it makes me hungrier by stimulating ghrelin, the appetite hormone, and can lead to weight-gain if my diet is uncontrolled. This is relevant in the natural health world because the Paleo Diet involves eating a diet high in saturated fats to achieve the exact opposite aim: controlling hunger. Genetic testing is the future!
What was the immediate result of the information I received by donating a vial of blood and an hour’s consultation time to YouNique? I learned that I need to support my liver (hence the milk thistle) and increase my folate intake. The truth of my long-term disease risk is there, written in my genome, which won’t change, that much is true. What I hadn’t considered, however, is our power to rewrite the future, by using naturopathic medicine to work with the building blocks we inherit. Our genes will always be the same but what we learn about how they are expressed will continuously evolve. Genomic testing, as Dr. Mohammed pointed out, is a living and breathing test. With the same test results, our treatment plans can evolve as our knowledge in the area grows. The more science learns about how lifestyle affects our genes, the more we can work with what we’ve got.
To end off, Dr. Mohammed told me a story in which he was examining a rather unfavourable genetic report before meeting the patient it belonged to, a naturopathic practitioner. When the ND entered the room, Dr. Mohammed was taken aback. Surely this healthy, spry, attractive individual was not the same person whose genes indicated an increased risk of obesity, inflammation, toxic exposure and heart disease? However, this individual had chosen to “walk the talk”, as we say in the field, and live his life in a healthy and holistic way. And, by doing so, he was able to change the course of his own personal health history; a great novel whose prologue began being written moments after his conception but whose conclusion he will be able to co-write. Shakespeare was given the alphabet. We are given a crazy combination of four nucleotides. Shakespeare wrote Hamlet. Through lifestyle genomics, I’ve come to realize that what we write with the information we’re given just might be up to us.
To learn more about lifestyle genomic testing and how it can help you affect your own health, contact me.
I am a naturopathic physician. On a Facebook page hosted by some peers in my profession, a young naturopathic doctor expressed distress at having her attempt to forge ties with one of her patients’ medical doctor thwarted. Needing her patient to obtain the diagnostic testing covered under provincial insurance only when ordered by a medical doctor, she wrote a letter to the patient’s MD, explaining the case, her assessment, the natural treatments that the patient was taking and her reasons for asking for diagnostic testing to be done. She expressed her hope to work collaboratively with this professional in order to provide better care for their mutual patient.
The response was less than ideal. The MD wrote a short, snappy letter, making clear his disinterest in “working collaboratively” with “alternative health practitioners”. He told her, bluntly, that he would not welcome further communications regarding their mutual patient.
Rookie mistake.
Whether a patient seeks consult from a naturopathic doctor or not, natural medicine is here to stay. The good news for medical doctors, however, is that naturopathic doctors can help make their lives easier and contribute significant benefits to patient management. Here are some reasons for working with naturopathic doctors:
1. Naturopathic doctors are highly trained.
NDs go through 4 years of undergraduate education, taking prerequisite courses in biochemistry, biology, psychology, physiology and chemistry. Naturopathic medical school consists of an additional 4 years of intense, full-time study that includes the completion of two licensing exams, one board exam, 3 clinical exams and a 12-month clinical internship working with patients in an out-patient setting. NDs are trained in medical diagnostics, physical exams and can perform procedures such as taking blood, injections, pelvic exams and prostate exams. With extra training NDs are being certified in IV therapies, minor surgery and pharmaceutical prescribing.
Naturopathic doctors speak the same language as medical doctors and our training and medical opinions can be trusted.
2. Patients that see naturopathic doctors in addition to medical doctors do better overall.
In a 2013 randomized clinical trial by the Canadian Medical Association Journal, it was found that high-risk patients decreased their risk of heart disease when using both naturopathic medicine and conventional treatments together rather than just conventional medicine alone. NDs have the time to teach patients how to make changes that benefit their long-term health. Adding a naturopathic doctor to your patient’s healthcare team can help decrease their risk of chronic diseases, such as cardiovascular disease, the leading cause of death among Canadians.
3. Naturopathic medicine decreases the burden on the healthcare system.
A colleague of mine practised as a registered nurse in Ontario for several years before deciding to begin studies at the Canadian College of Naturopathic Medicine and become licensed as a naturopathic doctor. When I asked her why she told me that she was tired of the “revolving door.” “The revolving door?” I asked, puzzled. She explained that, as a nurse she would often see the same patients time and time again – patients with diabetes who were having trouble managing their blood sugar and mental health patients, for instance – who would come into the emergency room, receive treatment and leave, only to return again after a short time. There was no one addressing the root cause of these patients’ ailments and, therefore, it was only a matter of time before they returned to the emergency room. Working with a naturopathic doctor helps patients take responsibility for their health, addresses the root cause of disease and assists patient in learning how to manage chronic disease more effectively, freeing up the emergency room for actual emergencies.
4. Naturopathic doctors address family physician shortages.
Many Canadians do not have a family doctor and many medical doctors are far too busy to take on new patients. Referring patients to be co-managed by a naturopathic doctor can reduce their need for doctors visits, reduce medical clinic wait-times and allow medical doctors to take on more patients on their rosters. Also, by focussing on lifestyle changes, finding the root cause of disease and anticipating health issues such as seasonal allergies, colds and flu or traveller’s diarrhea, NDs can help patients prevent disease. We can effectively take on the ailments that are not appropriately treated with pharmaceuticals (viral colds, for instance), freeing up time and space in medical clinics.
5. Naturopathic doctors can take on chronic, long-term cases.
Chronic acne, digestive concerns, musculoskeletal pain, fatigue and mental illness, cardiovascular disease, hormonal imbalances such as uterine fibroids, PMS, PCOS and endometriosis are all chronic conditions, difficult to treat with medications, that benefit hugely from lifestyle changes. Many patients who suffer from these conditions experience immense benefit when treated with gentle, natural therapies and lifestyle changes. Naturopathic doctors excel at treating chronic, long-standing conditions that are upsetting to patients but often aren’t “serious” enough to warrant conventional care or perhaps aren’t responding to conventional care.
6. There is someone managing drug-nutrient or drug-herb interactions.
It is estimated that more than 70% of Canadians have used a natural health product. That number is only increasing as the public recognizes the need for nutritional and herbal supplementation. However, interactions between natural remedies and medications are real. Naturopathic doctors are trained in pharmacology and are prepared to anticipate interactions and avoid products that have the potential to interfere with certain medications and medical procedures. Collaborating with an ND also means that there is a recorded history of all the natural products your patient is taking and your patient is far less likely to self-prescribe remedies that have the potential for harm.
7. NDs excel at providing stress relief.
“My doctor told me it’s just stress,” a family friend told me over dinner. No surprise. What can sound to some patients like a back-handed dismissal is actually a concrete truth; some sources estimate that 90% of physician visits are stress-related. Naturopathic doctors offer a wide range of therapies such as talk therapy, lifestyle counselling, homeopathy, acupuncture, botanical therapy and nutritional supplementation all of which are effective at helping reduce stress and improve the body’s response to stress. As a society we tend to focus on physical health and lifestyle and neglect the importance of mental health. Naturopathic doctors are well-positioned to offer that kind of care.
Dear medical doctor, we naturopathic doctors appreciate everything that you do. We would love the opportunity to work with you as part of a collaborative team for the benefit of our mutual patients. So please, no more of the above-mentioned letters.
In the words of Vanilla Ice, “Stop. Collaborate and Listen.” Your patients will thank you for it.
