…they looked at me confused.”
…they told me not to bother with that nonsense.”
…they insisted I stop seeing you.”
Since most of my patients notice marked improvement in lab values, the way they feel, and the way they look after starting care at our practice, it comes as a surprise to me that my patients still sometimes get flak from family members, or worse - their other doctors, for seeing a naturopath or functional medicine doctor. If I were to guess, I’d say they’re mostly disturbed by the “naturopathic” part. There are a handful of reasons this is probably the case in any given instance:
They have zero clue what it is that I do because they aren’t familiar with our education, training and practice style,
They have had a negative experience with a naturopath (or someone who calls themselves a naturopath) in the past,
They’ve heard only scary and dangerous things about “natural” therapies and supplements,
Their brain cannot structurally absorb the idea that someone might be able to achieve a positive outcome using an alternative method and the brain subsequently threatens to implode.
Okay - #4 is a bit of a stretch. But I do think misconceptions and naivete regarding our background and expertise plays a role in our patients being at times inundated with unsolicited negative feedback about their healthcare choices. So let’s go through these points:
Issue #1 - Lack of familiarity with our background:
To be able to practice medicine as a naturopathic doctor, you need to accomplish a few things first: 1) Go to university and earn a minimum of a bachelor’s degree prior to applying to medical school. 2) Apply, get accepted, and go to an accredited, 4-year naturopathic medical school (of which there are currently 5 campuses in the United States). 3) Complete all four-years of didactic course-work plus clinical rotations. 4) Pass your first set of board exams after 2 years of medical school. 5) Pass your second set of board exams after 4 years of medical school. 6) Apply for licensure in the state where you decide to practice.
Our medical training is robust: It includes 2 full years of “basic sciences” that is outlined very similarly both in depth and in number of hours to those of our conventional (MD/DO) colleagues. We then undergo a minimum of 5 blocks in each naturopathic modality: physical medicine, botanical medicine, clinical nutrition and orthomolecular medicine, TCM and acupuncture, environmental medicine, classical homeopathy, and mind-body medicine. In addition to this coursework, we fulfill a minimum of one-year in-depth pharmacology study, minor surgery, and systems biology courses along with all the necessary complementary labs/clinical hands-on training to go with each course. Our second and final two years of the program is not only in the classroom fulfilling these outlined courses, but is also packed with clinical rotations. These rotations are mainly located in out-patient, primary care ND settings (though the types of rotations and ability to specialize can vary a bit depending on the program). This along with our coursework in natural and nutritional therapies (which doesn’t exist in MD training) is probably the biggest contrast from our MD colleagues who do most of their clinical work in hospital and hospital-affiliated settings. Side note - I actually think it would be great to have NDs rotate in hospitals as part of their training, but that’s a different topic.
There is, of course, more nuance to how our approach is different from the conventional approach. If you are a patient of mine, you already understand that we don’t simply “sub out” drugs for natural alternatives. Rather, we operate from the stand-point that your body is pretty intelligent and if given the right resources, it often times can correct the problems it has developed. Because of that logic, we utilize diet, exercise, stress management and mind-body therapies as the foundation of the treatment plan. Any supplements that we prescribe are actually secondary and have the purpose of facilitating a positive biochemical or physiologic change in an organ or organ system that a health-promoting lifestyle will also be addressing.
Anyone who does not understand this core piece is going to have a very hard time understanding why you would see a naturopath. Believe me, if we were only trained to try and sub out drugs for herbs, we would not be nearly as successful, and I would quit my job.
Issue #2 - They had a previous bad experience, or read about a bad experience somewhere:
Naturopathic doctors are licensed to practice in 22 U.S. states . We are not federally licensed. This means that in a whole bunch of states, there aren’t tight laws and regulations around the term “naturopathic doctor”. You may, in those states, find a “naturopath” or “naturopathic doctor” with no medical training whatsoever simply because the terms are not legally protected in that state. As you can imagine, this means that those of us who have earned professional degrees in medicine and have passed rigorous board exams are nonetheless glumped into a mish-mash of public perception/media coverage with those who have not. Yes, you are correct: that is frustrating.
Even among medically-trained naturopathic doctors, there is variability in the ways they treat and the therapies they use. There are certainly differences in personality as well, though that’s of course true in any form of medicine. The variability in treatment approach and therapies used serves as a big challenge for patients and outside healthcare providers. I get it. That’s super tough. How do you know which one to send your patient or a loved one to? We may have the same medical and clinical training, but we may use it very differently.
This is the best and worst thing, in my opinion, about naturopathic medicine. It’s great because it allows patients freedom of choice in finding a doctor that they work well with. It’s not-so-great because you can transfer care from one naturopath to another and get pretty different care. This also tends to be the problem we have with our conventional colleagues. They may be wary of trusting me simply because they don’t know how I personally run my practice. It makes sense to me why many MDs/DOs are confused or even alarmed since they themselves walk a very tight rope clinically. Most clinical decisions they make and certainly the treatment options they are able to provide are extremely tightly controlled.
I get it. They are providers and they care tremendously about you, their patient, and they want you to be safe. I welcome any doctor to write or call me for information about a patient’s care plan, and even to weigh-in on the care provided.
Another way to differentiate one ND from another would be to look at their additional training and certifications. For example, I am also certified to practice functional medicine through IFM. This is a standardized method of applying naturopathic principles in a methodical and evidence-based way. I know that if I sent a patient to another IFMCP (functional-medicine-certified) naturopathic doctor, they would likely practice very similarly to me. Other NDs may carry a FABNO after their name to indicate that they can practice naturopathic oncology. Some may have certifications to do stem cell therapy, IV nutrition, be “lyme-literate” through ILADS, so on and so fourth.
Issue #3 - The scary land of natural therapies and supplements:
Fact: The “supplement industry” is one of the most despicably unregulated industries out there. There is horrifically poor oversight, low standards for quality control and efficacy, and questionable enforcement of even those low standards.
This is why in my practice I only use professional brands that go eons above the set standards. Our companies of choice test their products at every stage including at growing, cultivation and harvest, manufacturing and shelf life for accuracy of labeling, contamination, source quality and potency. They also test their products for bioavailability to ensure your body is able to absorb the contents. Several our key company partners perform clinical studies with their products and engage in research with prominent research bodies to ensure efficacy of their formulas.
If you are using off-the-shelf , over-the-counter supplements from a commercial store, it is very unlikely that you are getting this level of quality.
That makes the generic, dubiously-sourced-online products potentially dangerous. Granted, even considering the gravest of case reports out there, deaths and serious injury from supplements are far outnumbered by deaths and serious injury from pharmaceuticals. Nonetheless, it’s still extremely important that you take it seriously. Work with a qualified clinician to source your supplements as well as ensure appropriate dosing. A qualified clinician (like a naturopathic doctor) is well-versed in drug-nutrient-herb interactions and has subscriptions to the necessary databases to stay up-to-date on herb/nutrient safety and prevent interactions with other supplements or medications you are taking. Yes, harm is absolutely possible if these steps are not taken.
Our MD colleagues, while brilliant at what they do, have zero education in herbs, orthomolecular/nutritional supplements or homeopathy. Therefore, they cannot weigh-in on how to use them, if is it safe to use them, when to use them, how much of them to use or where to source them. They can either: tell you that they don’t know and refer you back to the prescribing doc, contact the doctor to discuss the protocol and their concerns, or tell you generically that it’s dangerous and “unproven” because they themselves have not been trained in it. Unfortunately, some of our colleagues use the latter option. Most, in my experience, will take the first option. Makes sense. If a patient asks me a question about their neurologist’s reasoning in doing XYZ, I will generally refer that patient to their neurologist to inquire, or I will reach out to him or her myself to ask.
Issue #4 - Risk of sudden brain fritz
I’m not going to spend much time on this topic because it’s mostly in jest that I wrote it. 90% of doctors and nurses are super caring, super intelligent, wonderful humans who work incredibly hard to make sure their patients are getting great care. They also are typically professionals who understand ethics and boundaries as well as patient autonomy. Those great and fantastic docs may think what I do is super weird and they may even be against it. But, usually they reserve their opinions and rhetoric for after the patient leaves. And that’s all that matters.
If they don’t behave in a professional way to you the patient… maybe give them the benefit of the doubt that they just woke up on the wrong side of the bed that morning. If it continues, maybe suggest that they contact your naturopathic doctor directly to discuss their concerns about the treatment program in a more productive way.
I love what I do and find that most people are generally positive and/or curious about it - at least in front of me :). I also think that word is getting out that lifestyle medicine and many of our naturopathic principles are effective at addressing many of the chronic debilitating conditions that plague our friends and family members. By working together, we can improve the line of communication among docs and individuals so that we can create robust healthcare teams and take on bigger health challenges.
Have a healthy day!
Dr. Otto