Naturopathic Doctors: An Underutilized Resource of Whole Health Delivery in Primary Care.

Naturopathy, recognized by the National Institutes of Health and the World Health Organization as a distinct system of complementary and integrative health care, is an existing model of whole health delivery. Its unifying principles, respect for the interconnectedness of biological systems, and representation globally uniquely positions naturopathy to serve an integral role in addressing the needs of primary health care. In this viewpoint, we aim to 1) highlight key areas and existing literature supporting the use of naturopathy for health promotion and disease prevention of noncommunicable diseases; 2) describe how naturopathy can addresses the mental health needs of today's societies; and 3) discuss the importance of naturopathy in the access and navigation of complementary and integrative health therapies.

Introduction

Naturopathy is categorized as a discipline of traditional, complementary, and integrative medicine by the World Health Organization and a system of complementary and integrative health (CIH) by the National Center for Complementary and Integrative Health of the National Institutes of Health (NCCIH). Herein, we submit naturopathy is most accurately portrayed as an existing model of whole health delivery, defined by its philosophies and predilection for integrating traditional and complementary therapies within the structure and responsibilities of primary care. In the United States, states such as Oregon and Washington where naturopathic doctors (ND) are licensed and regulated as primary care providers, their scope of practice can include evidence-based diet and lifestyle counseling, mind-body therapies, natural products, joint manipulation, physical therapy, minor surgery, pharmaceuticals, and more.[2,3] However, the scope of practice, training, licensure, and professional designations (i.e., naturopathic practitioners (NPs) or naturopaths versus naturopathic doctors) vary by country and state, making the global contribution of naturopathy in healthcare challenging to quantify from a health services perspective. Yet, the unifying principles within naturopathy serve as important frameworks in the delivery of whole health in primary care—treating the whole person, identifying root cause of disease, disease prevention, and health promotion. Given their representation globally, NDs are uniquely positioned to introduce and guide patients through diverse medical modalities, including those considered both “complementary” and “conventional,” in an evidence-based framework, exemplifying a culturally appropriate and holistic model of care.

Implementation and Utilization of Naturopathy in Whole Health

The COVID-19 pandemic has understandably taken precedence in all current aspects of health and medicine, with public health measures such as masking, social distancing, hand washing, and mass vaccination being integral to stopping the spread of SARS-CoV-2. However, it must not be forgotten that the prevalence of noncommunicable diseases such as cardiovascular disease and diabetes significantly compounded the severity of COVID-19 in developed nations like the US, and remain leading causes of morbidity and mortality despite being highly modifiable through lifestyle changes. Although COVID-19 was the third leading cause of death in 2020 and 2021, cardiovascular disease remained the number 1 cause of mortality, and it has been estimated that 63.5% of COVID-19-related hospitalizations were jointly attributable to diabetes mellitus, obesity, hypertension, and heart failure. All 4 of these cardiometabolic disorders are highly prevalent globally and in the United States, affect approximately 13%, 46.6%, 42.4%, and 2.2% of Americans, respectively.[8-10] Much like how vaccines and adherence to basic public health recommendations significantly prevent the spread and downstream healthcare burden of infectious diseases, incorporating naturopathy into a primary care model could enhance the focus on health promotion and disease prevention. Because NDs and NPs frequently address health concerns such as obesity, diabetes, and hypertension in practice, there is potential to reduce the prevalence and risk of society’s most burdensome yet preventable chronic diseases.

According to the 2012 National Health Interviews Survey, 67% of individuals who utilized naturopathy were motivated to make one or more behavioral changes for their health, including smoking cessation, alcohol intake modification, increasing physical activity, and eating organic foods. NDs spend time with patients to endorse evidence-based and pragmatic self-care therapies in addition to standards of care, which contributes to the patient-centeredness of naturopathy and may help to increase adherence to clinical and public health guidelines. Both the 2019 combined American College of Cardiology and American Heart Association’s (ACC/AHA) guideline on the primary prevention of cardiovascular disease and the 2020 United States Preventive Services Task Force recommend physician-directed promotion of healthy diet and physical activity as well as non-pharmacological options to reduce risk of cardiovascular disease.[14,15] Retrospective observation audits of naturopathic practice detail the very high frequency of delivery of health promotion counseling in preventive cardiology visits, and when tested in a randomized trial, naturopathic care added to enhanced standard of care led to significant absolute reduction in 10-year Framingham cardiovascular disease event risk (mean difference, −3.07%; 95% CI: −4.4, −1.9; P < .001), and reduced the prevalence of metabolic syndrome (−16.9%; 95% CI: −29.6, −4.3; P = .002). While the current focus on improving cardiovascular disease risk relies quite heavily on medical advancements in the cardiology specialty, in contrast, in the naturopathic model of care, preventive cardiology is addressed in primary care as a critical and foundational part of whole health.

While the COVID-19 pandemic drew our attention away from some high-priority noncommunicable diseases, it forced many to recognize the desperate need for adequate and accessible mental health care given the experiences of persistent psychological stress, isolation, financial insecurities, and grief attributed to COVID-19. Even prior to the pandemic, the US Burden of Disease Collaborators made an urgent call in 2018 for improved quality of mental health and the prevention of mental health disorders, which contribute to the top twenty-five leading causes of disability-adjusted life-years. Naturopathy emphasizes the interconnectedness of biological systems, so mental and physical complaints are routinely addressed in tandem. NDs often deliver counseling in office, combined with mind-body therapies (e.g., mindfulness-based stress reduction, meditation, yoga). This multisystem approach of naturopathy is well illustrated in the treatment of irritable bowel syndrome, a primarily gastrointestinal disorder that may also influence and be affected by one’s emotional state; thus, NDs routinely consider dietary, microbial, mechanical, and psycho-emotional contributors to health.[17,18]

As recently acknowledged by the American Heart Association, focusing on the role of psychological health as a contributory factor of overall health has been largely overlooked in the conventional model of care. Positive psychological health is associated with a lower risk for cardiovascular disease and greater likelihood of beneficial health behaviors such as increased participation in preventive care measures, smoking cessation, and increases in nutritious food consumption and physical activity. As practitioners trained in both medical and mind-body therapies, NDs are uniquely equipped to deliver a whole health model that simultaneously addresses mental and physical health. Furthermore, the usage rate of meditation and yoga over the last 2 decades has increased dramatically, particularly among younger individuals. As such, younger patients who seek NDs for their expertise in mind-body therapies may receive earlier introductions to other beneficial health promoting behaviors, which might consequently lead to further disease prevention.

Conclusion

Naturopathy, by its philosophical principles and real-world practice, ascribes to a whole health approach to patient care. The COVID-19 pandemic has highlighted the increasingly urgent need for prevention and treatment of noncommunicable diseases, compounding the effects attributed to COVID-19 and other infectious diseases. NDs effectively promote health to reduce risks associated with cardiometabolic disorders, improve mental health and wellbeing through evidence-based mind-body interventions, and are specifically trained to assist patients in navigating the continuum of CIH therapies and general medical services, based on assessment of medical risk, patients’ preferences and determinants of health, and the accessibility of services. We encourage researchers, clinicians, stakeholders, and policymakers to recognize naturopathy as a sophisticated model of whole health delivery in the primary care setting where individual, social, and environmental determinants of health are considered for every patient, and prevention and health promotion are the cornerstones to care.