What is a Naturopathic Approach to Health?
I studied Naturopathic Nutrition at the College of Naturopathic Medicine. People are interested in this but I am often greeted by a quizzical look about the word naturopathic. So I’m giving you my own take on it here as I compare it to my practice of regular medicine.
At medical school, we study traditional Western Medicine. Broadly speaking, this approach teaches us as doctors to recognize symptoms and signs of disease and how to diagnose. Our approach to treating our patients is mainly based on drugs, intervention and surgery. It serves many people very well. I have been on the receiving end of some of these amazing treatments. Surgery and drugs have helped my family through various stages of ill health over the years and I am very grateful. It is an amazing system to study and practice, but as a GP I have found time and time again that some patients do not get better with what I have to offer, sometimes they seem to get worse.
“Naturopathic Medicine” is a little different. Naturopathy is based on six main principals. Here I am going to discuss these principals and how, as a GP, I have learnt some personal lessons in my studies of them. The NHS is a fantastic institution. I have trained and worked in it for 30 years. But, it does not work for everyone. I know this because I see the frustrated patients time and time again in my surgery. This is a personal reflection upon my own practice as a GP. I think a lot of GPs do practice in a naturopathic way without realising it, but are still ultimately constrained by how the NHS system has grown around them. These are the six naturopathic principals and what I have learned about them. It is my food for thought.
Principal One: Do no harm
Now this is the same as the first principal of standard Western medicine. It is the main principal upheld by the General Medical Council, with whom all doctors are registered. The principal can be expanded to also say, ‘and minimize side effects of treatments’. As a GP I get worried by how much harm we do to our patients unintentionally. Over medicalisation of peoples’ lifestyles is at an all time high. Prescribing rates have gone up by 55% over the last decade. This is not news and doctors know about this. The Academy of the Medical Royal Colleges wrote about it in 2015 and outlined a collective concern over this. These eminent doctors represent over 20 Royal Colleges in England, such as the Royal College of Physicians, the Royal College of Surgeons the Royal College of General Practitioners. Between January 2000 and November 2011 the MHRA (Medicines and Healthcare Products Regulatory Agency), the people responsible for licencing of medicines in the UK, reported 274,123 suspected adverse drug reactions with 12,020 deaths linked to these adverse reactions. That’s quite substantial! And adverse drug reactions are significantly underreported. We know as doctors that over treatment is a concern and tackling antibiotic resistance is now one of the top priorities of the World Health Organisation. But on it goes. I think the system is set up to carry on.
Referring people round the hospital departments to investigate abdominal pain, fatigue, headaches and other complaints difficult to ram into a diagnostic category also generate anxiety and stress in a patient. It is sad for the patient when the doctors finally conclude that ‘nothing is wrong’ despite the patient still being left with the very real symptoms. I know because I have sat and listened to these patients for years. Of course harm can be done by lack of treatment and lack of referral. These are generally the cases which make headline news. As GPs we can become very wary of missing something but I really believe from what I have seen that the pendulum, in general, has swung the other way. We over treat people and medicalise lifestyles rather than address simpler factors. That is the way the NHS machine has evolved to be the easiest way for our population.
Principal Two: Treat the cause
Naturopathy upholds the principal of getting to the root of the problem and not just suppressing symptoms. For example if someone’s asthma flares up doctors are very good at prescribing inhalers but very seldom address why has this condition flared up now? Naturopathic practitioners will consider the soil that a plant is rooted in rather than just looking at the leaves. Now we do this as doctors to a certain extent for sure but sometimes we stop asking why because we don’t see any more benefit. Patients will ask me, why they have an irritating red rash on their abdomen as they take the steroid prescription. Sometimes the answer will be, “Well, we just don’t know..”, followed up by “well, it doesn’t matter. Does it?” But maybe it does matter? Naturopathic practice delves a bit deeper and does a bit more health detective work. What is upsetting the balance in the body for it to react now? This involves taking a holistic approach to all body systems, the mind and lifestyle too. This is more difficult for doctors to do if they have become superspecialists in one part of the body. It becomes easier if you are a generalist looking at the whole person and their own unique story.
Principal Three: Teach the Principals of Healthy Living
As a GP I think I had about one hours worth of nutrition teaching in my training. Doctors and Nurses are often unhealthy and stressed professionals. Some doctors think it is a contentious issue for them to set an example to patients. There is a lot of evidence to support the fact that non smoking doctors are better at convincing their patients to give up the cigarettes. Some doctors that I speak to think it is too much of an uphill struggle to address healthy eating and living with their patients. In a ten minute consultation they might be right. But if we don’t know the importance of diet and environmental threats to our health how can we advise others who come to us for help? When I was struggling to get pregnant in my 30s I don’t recall anyone asking me what my diet was like. It is so relevant! Naturopathic practitioners are interested in all the things that add up to influence a persons wellness and see everything as a possible clue to try and understand where the person is now and why.
The word doctor arises from the latin word docere, meaning to teach. Naturopaths see teaching people as a fundamental tool in their practice.
Principal Four: Treat The Whole person and offer Individualised treatment
Naturopaths see patients as unique, made up by a combination of genetics, biochemistry, life events and environment. As a GP, my work has become fairly heavily influenced by national protocols and guidelines. For example, a patient is diagnosed with type two diabetes and so we start off with Drug X because that is the way the protocol works. Maybe, if the patient is more worried about their elderly parent dying of cancer or they have such an erratic blood sugar due to poor sleeping that they are craving sweet treats to pick them up in the afternoons we end up going down the wrong route for that person. GPs receive incentives for making sure these protocols are followed. These can be great for a public health team looking at population statistics because for populations as a whole they can be effective. The average person who responds well will do fine BUT, in my experience, individuals have nuances and what works for one person does not work for another. If you are an outlier in the statistics the general way might not work for you. Studying Naturopathy has taught me that if something is not working for someone then stop, try something else and a different approach that might be a deviation from the rigid protocol. If a therapy does no harm, and people have reported benefits from it, listen, consider, it might work. Have an open mind. Evidence Based Medicine is great but is no good if it leads us to become dogmatic.
Principal Five: Emphasise Prevention
The NHS, as great as it, is does not really do ‘check ups’. It has a limited set of screening tools that we judge on principal to use if they do more good than harm to the majority of the population. Like smear tests and breast screening. One the whole, as a doctor, I tend to practice reactively and deal with patients’ problems as they arise. We don’t really proactively seek to optimise a persons’ wellness and vitality. The NHS is geared to do check ups on a population basis rather than geared to the individual. The well meaning might be there but in reality it is very hard to deliver. Again, it can be a one size fits all approach and individuals preferences and situations can be sidelined if they don’t fit into the general model.
Principal Six : Support the Healing Power of the Body
In Western medicine we tend to fight the body and its diseases with drugs. Sometimes these drugs are wonderful and curative and amazing but we would be foolish to think that the drugs work one hundred percent of the time. The Healing power of the body may sound hookie and without an open mind it can be very easy to jump in and dismiss this idea if it doesn’t stack up with big evidence based data. My studies and personal experience have taught me much about this valuable principal. We undervalue how powerful the mind can be. How it can affect our immune system and our healing. We also under appreciate how the right environment in our guts and correct foods, can affect neurotramitters and chemicals in our brains and bodies. I have been lucky enough to get to some exciting conferences on the biosome and healthy gut bacteria this year. It has a huge scientific body of evidence now and research is coming on in leaps and bounds about how vital our guts are to our health. If we give our body a chance, nurture it, look after it and work with it, we can do amazing things. This was once the preserve of alternative way out or hippy views. Now we are gathering more information and more and more interesting science. In my experience, patients are very interested in complementary approaches to feeling well and achieving their goals.
As a doctor, studying the principals of naturopathy I have seen that there are parts in common with how we practice as normal GPs. ‘Do no harm’. But principals we might like to try to think we do, such as emphasising prevention and teaching the principals of healthy living, in reality I think we only apply this to the general population rather than the individual. A lot of doctors lack information about healthy living. I have learned a lot from studying these principals. Applying them to the field of nutrition has opened many interesting doors of thought that I would never have considered before as a regular GP.
I have met some really interesting people along the way with my studies who are open minded and often very keen to discuss their approaches with a doctor and share ideas. These ways of supportive working and thinking have given me a new exciting perspective when it comes to wellness and health. It is nice to be able to appreciate both ways of doing things and discovering the best of both.