By John Kriz
Interest in so-called alternative, or integrative, medicine has been on the rise, especially post-COVID. This approach to healthcare includes a sharper focus on diet and nutrition, lifestyle, exercise, and employing a wider range of less common therapies and tests that are not only targeted at treating acute and chronic illness, but especially at avoiding chronic illness.
Naturopathic medicine, a decades (if not centuries) old medical discipline, is one of the more prominent, and many say effective, types of alternative medicine. In a nutshell, its philosophy of care is: Find the root cause and treat it – don’t just treat the symptoms. And do this by always focusing on a comprehensive understanding of the patient’s wellness — mind, body, spirit.
So what is naturopathic medicine, what does it focus on, and what can it do for you? Read on.
LICENSING & SCOPE
Naturopathic doctors (NDs), or naturopaths, are licensed physicians in Connecticut, similar to medical doctors, or MDs. The scope of naturopaths’ license is different, however. For example, they cannot prescribe the types of drugs you get from a pharmacist, or order imaging, such as an X-ray or MRI. NDs can meet and examine patients, prescribe supplements and order blood tests. (In some states, NDs have the same scope of license as MDs.)
To get licensed in Connecticut, an ND must attend a post-college four-year accredited naturopathic medical school, and pass two board exams. They are also required to take ongoing training. Dr. Sylvia Cimoch ND, L.Ac who practices in Stamford and Milford (www.drcimoch.com), notes that many NDs at her medical school were“eclecticpeoplewithreally interesting backgrounds that allowed them to be actually great practitioners.” Many NDs practice as primary care providers with a general focus on family medicine or internal medicine, while others specialize in such areas as in oncology, female fertility or Lyme disease.
POST-COVID CHANGES
Since the start of the COVID pandemic, many patients have searched for healthcare providers with outside-the-box thinking, and this has led to many NDs seeing an uptick in patient inflow. Dr. Minna Kim ND, who comes from a medical family and practices in Stamford with her husband, a classic osteopathic physician, (www. ifmct.com) says that, pre-COVID, “the majority of patients who would seek me already had their foot in the door into alternative medicine.” Now, however, although new patients are more interested in naturopathy and alternative medicine, they often have “a lot of skepticism, a lot of questions, and they will almost always double check with Dr. Google and their own PCP [primary care physician]. They don’t know. They never learned about it.” Why is this? “The messageaboutmedicineandhealth always goes out to the people from the mainstream.” This typically means conventional, or allopathic, physicians, and hospitals, insurance companies and federal health agencies.
Dr. Raquel Harrison MD of New Canaan (www.acute2root. com), who is Board certified in lifestyle medicine, a former Yale School of Medicine assistant professor and emergency room physician at Bridgeport Hospital, and now is a consultant and public health advocate, notes that, post- COVID, there’s “an increasing frustration with the way medicine is currently done.” She cites “the ‘sick care model’ where we’re only really seeking help when we’re ill and that when we are ill, there’s only one way to seek care. And I think people are questioning that with increasing frequency.”
(Lifestyle Medicine is a relatively new medical specialty. According to the American College of Lifestyle Medicine, “Certification in lifestyle medicine indicates that the individual has mastered the science of preventing, treating, and reversing chronic disease in an evidence-based manner.” It is based on six pillars: a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections. It bears some common basic healing philosophies with naturopathic medicine.)
Dr. Laura Futterman ND (www.stamfordnaturalhealth.com) notes that people are taking their health more seriously post-COVID, and are especially interested in strengthening their immune systems. Also, “the medical model has shifted so much so that patients do not feel heard or listened to because the medical model now does not allow to even talk about more than one particular topic. They have to keep scheduling appointments and it’s very hard to get in to see conventional doctors and then they only get a very limited time with them.”
WHY ADD A NATUROPATH?
Should a patient add an ND to her/his medical team? Dr. Kim says that MDs are terrific at treating acute ailments, most of it driven by pharmaceuticals. But the underlying idea is that you have an ailment, you get it treated, and come off the meds. But chronic disease?
Take cardiac health. A patient has high cholesterol or high blood pressure, but no cardiovascular disease or cardiac incidents. Such patients are usually put on beta blockers and/or statins, but never come off them. Dr. Kim cautions that, “there are side effects to these things,” and patients can end up with a ‘polypharmacy’ to address such side effects. She stresses that patients have other options. “Try dietchanges,lifestylemodification, nutraceuticals and supplements. I can have them on and off of supplements within six months when the diet, lifestyle changes having taken hold. I can release them in a much, much healthier way with no cardiovascular disease on the horizon for them.”
Dr. Harrison concurs, noting that “typically there’s not an encouragement to get people off medications. The other thing that contributes to that is the way a lot of primary care doctors are reimbursed because it’s not value-based care. The way a lot of algorithms with insurances work is based on the number of medications people take, which determines their complexity, which then determines billing.” Under a value-based care model, physicians would be reimbursed for better health markers in patients – keeping them healthy in the first place. But, as Dr. Harrison concludes, “right now, things aren’t set up that way in the traditional western medicine perspective.”
Dr. Futterman notes that naturopathic physicians receive “extensive training in nutrition, herbs,” and are “also trained in more of the healing modalities. So it’s always nice to have someone who could help with just healthier lifestyle things and to prevent medications, hopefully, and surgeries and more invasive treatments.” It boils down to working with patients to create and maintain healthier lifestyles, and supporting the body’s innate healing abilities. Dr. Futterman goes on to say that the “majority of the patients that I see, usually I’m doctor number twenty in line,” and that “usually people are like, ‘you’re my last resort.’”
From a patient’s point of view, quality care means co-ordinated care. In addition, post-COVID, Dr. Cimoch notes that more patients are “forcing them (PCPs) to learn more about holistic medicine,” which is “an uplifting thing to see.” Dr. Kim says she is “always impressed when I reach out to an MD to coordinate care for a patient and they are open-minded and can actually take a time out to do that for a patient.” NDs will refer patients to specialists if that’s what’s best for the patient, and receive referrals from PCPs and specialists.
Dr. Kim also notes that, “We’re whole care rather than specialized care. We’re root care rather than symptom care. We give personalized treatment plans.” In addition, “test results are generally reviewed line by line with a patient, ensuring that the patient really understands what the tests are and what they mean for their health.”
Dr. Cimoch agrees, noting that “being able to sit with a holistic practitioner who actually is going to go through comprehensively, head to toe, obviously any concerns, but also look at all the basic things like how’s your digestion, how your sleep, how’s your mood? It’s a much, much more comprehensive view on health.”
Dr. Futterman says she has “had a lot of MDs refer to me, and so we have a good relationship that way because they understand they have the limitations that they do, and they know that the patients that we have in common do get better. So it’s nice to have a team-building sort of situation like that because at the end of the day it’s about getting the patient better.” Dr. Harrison notes that co- ordination “reflects differences among individuals and individual practitioner perspectives to different approaches.”
INITIAL INTAKE AND FOLLOW UP
What’s a first-time meeting with an ND like? After completing a comprehensive medical history questionnaire, and submitting recent test results, you sit with the naturopath and discuss your health history, status, goals and test results for 60 – 90 minutes. Yes, you read that right – an hour or more, one-on-one with an ND. Are patients surprised? “Shocked” isamoreaccurateterm,according to Dr. Kim, who goes on to note that a patient with serious health issues who has been through the round with other physicians and “sits with me and is able to tell their full story, but not only that they’re hearing back that they’re understood and that the doctor, in fact, thinks they may know why this is happening, it’s usually tears.”
Follow-up visits last 30-45 minutes. During these visits, the ND will not only ask about any particular ailments being treated, but inevitably return to ‘square one’: How are you feeling? How’s the family? How’s work? Any trips or big events planned? How’s your sleep, digestion, mood? What exercise are you getting? What’s your energy level? Anything else going on? And if you are being treated for an ailment: Any side effects from the treatment? Do you feel progress is being made?
OFFICE ENVIRONMENT
One common patient comment these NDs get is that their offices seem so cozy. Dr. Kim says “we want you to feel like this is your second home.” And that’s not by accident: De-stressing, soothing the patient is core to the healing protocol. There’s a toy box for kids. Noreceptionistsbehindglasswalls. And patients often encounter white noise machines, aromatherapy and, yes, maybe a crystal or two. Dr. Futterman notes the lack of white coats, and that if a patient wants to take a book from her shelf and page through it, there’s usually a reason that can lead to better understanding that patient’s needs. She tries to make her office environment more serene, so when patients walk in there’s “a sense of calm and peace.”
WHAT YOU’LL OFTEN HEAR FROM AN ND
Nutrition. That’s #1. Many MDs “don’t even get one nutrition class, and yet most of our chronic disease conditions can do a 180 with nutrition alone,” stresses Dr. Kim. Doctors Futterman and Cimoch agree. Dr. Cimoch notes that digestive disregulation, which can affect so many bodily functions, not to mention quality of life, might have any number of root causes. Is there a gluten sensitivity that’s damaging the gastrointestinal (GI) tract, and impairing nutritional uptake? What about heavy metal toxicity?
It is only recently that medical schools have been required to provide more nutritional education, and Dr. Harrison notes that she received “very little nutrition education in my medical school” and had to learn on her own and through certification in Lifestyle Medicine.
Dr. Futterman notes that GI issues are major topics during every patient meeting. She stresses that GI issues relate closely to a patient’s microbiome – that complex colony of bacteria in our GI tract (and elsewhere) that not only helps digest food, but drives much of our immune system, and is closely connected to cognition. Anxiety and depression – even skin ailments – can often be traced to GI problems. This demonstrates why nutrition is “foundational,” according to Dr. Futterman.
Naturopathic doctors begin with flipping the food pyramid on its head: Carbs, such as grains, at the bottom, and healthy fats and animal proteins at the top, along with a rainbow of vegetables and some whole fruit. The low fat craze that started a few decades back has turned out to be bad health policy, they say. “We thought fat was the culprit for heart disease, obesity and diabetes,” says Dr. Kim. It isn’t. And when fat is stripped out of foods, the f lavor comes with it. Solution? Add sugar. “Sugar’s a culprit for everything from heart disease to obesity, diabetes, dementia, cancer. These are all what we call diseases of our metabolic system. And it’s where the majority of what chronic disease is,” notes Dr. Kim.
Dr. Futterman echoes this, calling the amount of processed food and extra sugar that is consumedinAmerica”outrageous.” She goes on to note that “sugar paralyzes the immune system for up to 24 hours, which also feeds cancer.”
But we are cautioned not to take nutrition and diets to an extreme. A balanced diet is best. And healthy animal fats and protein implies healthy animals, which means avoiding industrial meats raised in feedlots, and instead choosing wild fish from clean waters, grassfed, or pasture-fed, animals, and organic fruits and vegetables. Dr. Kim emphasizes that having those balanced meals in the company of friends and family is a big part of healthy eating and overall wellness.
Dr. Futterman, who describes herself as a “recovering vegan,” agrees, stressing that genetically modified food and pesticides “are such endocrine disruptors” that “lead to cancer and other metabolic conditions. And we look at how many children are diagnosed now with Type 2 diabetes and asthma and allergies and all these inflammatory conditions which are totally preventable and reversible. So it’s about educating patients on quality food.”
Supplements. These can be vitamins, so-called nutraceuticals, or herbs, many of which are rarely prescribed by MDs. The goal here could be to address an ailment, or to ensure that the patient is receiving the proper level of nutrition, with too many people overfed and under nourished. Dr. Futterman notes that often people are dissatisfied with supplements because they are “using brands that are cutting corners and they have a bunch of fillers and things that shouldn’t be in there.” So, part of what she and other NDs do is counsel people on good supplement sources that deliver what is promised.
Supplements can also include homeopathic medicines, which come as either small pellets you dissolve under your tongue, or as a tincture, which is a liquid infused with homeopathic medicine you put under your tongue with an eyedropper. Homeopathy, developed in the 1800s by a German physician, aims to cure an acute or chronic condition by stimulating healing responses in the body using substances that mimic the illness, and help the immune system get back in balance.
Diagnostic Tests. Many of the tests NDs will recommend are ones that MDs are often unaware of, or rarely order. These often include functional tests, stool tests and saliva tests that take a “deeper dive into hormones and our metabolic health and our microbiome,” says Dr. Futterman. “There are ones even to look at your vaginal microbiome, your skin microbiome,” plus heavy metals or mycotoxin exposure, glyphosate levels, and how much plastic and parabens are in your system and affecting your health.
Treatments. Naturopaths commonly employ treatments that MDs do not often recommend. Some of these include:
• Acupuncture, which is the insertion of special needles into targeted body points. This treatment discipline can help with stress, pain, sleep, hormonal regulation, constipation and numerous other conditions.
• Cupping, which consists of shot glass-sized cups that are attached to specific areas on the body via suction to help pull in fresh blood, and thus healing, to the area, which helps the immune system kick in. Cupping is especially useful in treating painful injuries.
• Craniosacral therapy, which is a gentle massage technique designed to release tension in the body’s connective tissue, such as fascia. It is often used to treat pain and the side effects of cancer treatments.
Dr. Harrison notes that while MDs typically do not recommend such treatments, they do not discourage them either, the common MD response being that if no harm is anticipated from the treatment, it’d be OK to go ahead.
OTHER ALTERNATIVE MEDICAL DISCIPLINES
Some people associate naturopathic medicine with Traditional Chinese Medicine (TCM) or Ayurvedic medicine. While some NDs and MDs are cross trained in these disciplines, it is more common for a healthcare professional to be specifically trained, and specialized, in these sister disciplines.
INSURANCE
Some NDs in Connecticut do not take insurance, in part because many insurers do not cover naturopaths or their treatments. Or, if insurance does cover the visit, the ND gets “$1.23 for my 45 minute consult,” laments Dr. Kim. Thus, NDs are often private pay. Costs vary, but an initial intake visit can run $400-$600, and a 45 minute follow-up $100-$300. Some NDs have a sliding scale, depending on patients’ circumstances. However, even if the ND is working pro bono, there’s the cost of the supplements to consider, and such are uncommonly covered by insurance.
DOCERE
At its root, the word ‘doctor’ comes from the Latin ‘Docere’ – to teach. Notes Dr. Kim, “doctors are not pill dispensers and we are not surgeons. We are teachers. And we have strayed so far from that that we now live in a society where people are not being taught about their health. People are expected instead to hand over their health into the hands of a doctor and say, ‘Help me. Fix me.’ None of that is teaching. I spend the majority of my time teaching my patients what health is, why they are the way they are.” Dr. Harrison is on the same page, saying we’ve gotten away from the teaching aspect of medicine, continuing to note that “doctors either don’t have the time to do that [teach, discuss] anymore or aren’t equipped, and there’s too much focus on that sick care model, that acute care model.”
In the end, naturopathic medicine mostly seems like old fashioned medicine: Eat well. Exercise. Get outside. Spend time withfamilyandfriends,especially over a meal. Manage stress. Dr. Futterman says “it’s really going back to basics — not reinventing the wheel,” with Dr. Harrison stressing “that there’s not a one size fits all for people.” But above all, do this: Treat the whole patient – and get to know the patient, so you can treat him/her comprehensively. And listen. Really listen.
MORE INFORMATION:
www.naturopathic.org American Association of Naturopathic Physicians
www.cnpaonline.org Connecticut Naturopathic Physicians Association
www.aanmc.org Association of Accredited Naturopathic Medical Colleges
www.anma.org American Naturopathic Medical Association
www.lifestylemedicine.org American College of Lifestyle Medicine
John J Kriz is a 30+ year New Canaan resident. The opinions expressed are his own.
