NPRI's Mission, Vision, Values

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The Naturopathic Physicians Research Institute (NPRI) is a group of academic and community clinicians, clinical researchers and other health scientists whose aim is to increase the amount of original data and analysis on the practice of naturopathic medicine for the purposes of its documentation and improvement, the discovery of potentially generalizable health applications, and to inform policy.  Its focus is primarily on licensed and registered naturopathic medicine practiced in the US and Canada, but it attends to naturopathic practice globally and welcomes collaboration with all interested parties. NPRI was incorporated in Oregon in June 2010 and is a public charity designated as an exempt organization under IRS 501c3.

The mission of the Naturopathic Physicians Research Institute is to stimulate, organize, fund, conduct and disseminate research on the clinical practice and outcomes of naturopathic physicians in order to improve practice and the health of their patients and communities. 

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There are many thousands of studies and published articles on aspects of natural medicine, natural products and complementary and alternative medicine that are incorporated in naturopathic practice. Studies cataloged here are those which are publications which examine components of naturopathic care in North America: a therapeutic or preventive intervention, a diagnostic method, a theory or approach to a health condition. To be included, studies should closely reflect naturopathic care as demonstrated by clinical direction, framing of research questions, and participation in methods development for the study by naturopathic physician-researchers licensed in the US or Canada.  The publication should include original data or analyses on the issues addressed.  Systematic reviews are included but literature reviews without described methods are not. 

This listing below is incomplete.  Please inform us of published studies that meet the criteria above that are not included here by sending a citation and abstract to the Executive Director.


Complement Ther Clin Pract. 2011 Aug;17(3):157-61. Epub 2011 Mar 17.

CAM: naturopathic dietary interventions for patients with type 2 diabetes.

Oberg EB, Bradley RD, Allen J, McCrory MA.

Bastyr University Research Institute, Kenmore WA 98128, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

OBJECTIVE:  To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietaryintervention in patients with Type 2 diabetes.  METHODS:  Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care.  RESULTS:  HbA1c improved in all participants (n = 12); mean - 0.4% +/- 0.49% SD, (p = 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p = 0.05). Specific nutritional behavior modification included: days/week consuming ≥5 servings of fruit/vegetables (p = 0.01), attention to fat intake (p = 0.05), and -11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and self-management also improved significantly.  CONCLUSION:  A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted.

PMID:21742282   PMCID: PMC3136887 [Available on 2012/8/1]



Int J Naturopathic Med 2009 4(1):5-11

Cortisol patterns and DHEA levels of patients with obesity, prediabetes, and Type 2 Diabetes: A Chart Review in a Naturopathic Primary Care Clinic.

Chinnock JA, Zwickey HL, Connelly E, Calabrese C

In healthy individuals, cortisol levels exhibit a circadian pattern, peaking in the morning and decreasing the rest of the day. Studies are inconclusive as to the relationship between high total cortisol levels and obesity, prediabetes, and type 2 diabetes. Since cortisol levels are circadian, many naturopathic physicians use a salivary test performed at four time points during the day to measure the overall pattern of secretion, rather than relying upon a blood draw from a single time point. Some physicians hypothesize that a dysregulated pattern of cortisol is more indicative of diabetes risk than a high mean cortisol level. A retrospective chart review was performed on obese, prediabetic, and type 2 diabetes patients in order to test this theory. The goals of this study were to determine whether people with, or at risk for, type 2 diabetes have abnormal circadian cortisol patterns and dehydroepiandrosterone (DHEA) levels. The chart review demonstrated four patterns of cortisol secretion, one of which is circadian, in this population.

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BMC Clin Pharmacol. 2009 Oct 23;9:17.

Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results.

Adams JB, Baral M, Geis E, Mitchell J, Ingram J, Hensley A, Zappia I, Newmark S, Gehn E, Rubin RA, Mitchell K, Bradstreet J, El-Dahr J.

Southwest College of Naturopathic Medicine

BACKGROUND: This study investigated the effects of oral dimercapto succinic acid (DMSA) therapy on the behavioural symptoms of children with autism spectrum disorders (ASD) ages 3-8 years. METHODS: Phase 1 involved 65 children with ASD who received one round of DMSA (3 days). Participants who had high urinary excretion of toxic metals were selected to continue on to phase 2. In phase 2, 49 participants were randomly assigned in a double-blind design to receive an additional 6 rounds of either DMSA or placebo. RESULTS: The groups receiving one round and seven rounds of DMSA had significant improvements on all the assessment measures. For the seven round group, the degree of improvement on the assessment measures could be partially explained by a regression analysis based on excretion of toxic metals and changes in glutathione (adjusted R2 of 0.28-0.75, p < 0.02 in all cases). One round of DMSA had nearly the same benefit as seven rounds. The assessment measures correlated reasonably with one another at the beginning of the study (r = 0.60-0.87) and even better at the end of the study (r = 0.63-0.94). CONCLUSION: Overall, both one and seven rounds of DMSA therapy seems to be reasonably safe in children with ASD who have high urinary excretion of toxic metals, and possibly helpful in reducing some of the symptoms of autism in those children.

PMID: 19852790

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BMC Clin Pharmacol. 2009 Oct 23;9:16.

Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results.

Adams JB, Baral M, Geis E, Mitchell J, Ingram J, Hensley A, Zappia I, Newmark S, Gehn E, Rubin RA, Mitchell K, Bradstreet J, El-Dahr J.

Southwest College of Naturopathic Medicine

BACKGROUND: This study investigated the effect of oral dimercapto succinic acid (DMSA) therapy for children with autism spectrum disorders ages 3-8 years. METHODS: Phase 1 involved 65 children who received one round of DMSA (3 days). Participants who had high urinary excretion of toxic metals were selected to continue on to phase 2. In phase 2, 49 participants were randomly assigned in a double-blind design to receive an additional 6 rounds of either DMSA or placebo. RESULTS: DMSA greatly increased the excretion of lead, substantially increased excretion of tin and bismuth, and somewhat increased the excretion of thallium, mercury, antimony, and tungsten. There was some increase in urinary excretion of essential minerals, especially potassium and chromium. The Phase 1 single round of DMSA led to a dramatic normalization of RBC glutathione in almost all cases, and greatly improved abnormal platelet counts, suggesting a significant decrease in inflammation. CONCLUSION: Overall, DMSA therapy seems to be reasonably safe, effective in removing several toxic metals (especially lead), dramatically effective in normalizing RBC glutathione, and effective in normalizing platelet counts. Only 1 round (3 days) was sufficient to improve glutathione and platelets. Additional rounds increased excretion of toxic metals.

PMID: 19852789

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Evid Based Complement Alternat Med. 2009 Sep;6(3):297-304. Epub 2007 Dec 5.

Cost effectiveness of natural health products: a systematic review of randomized clinical trials.

Kennedy DA, Hart J, Seely D.

The Canadian College of Naturopathic Medicine

Health care spending in North America is consuming an ever-increasing share of Gross Domestic Product (GDP). A large proportion of alternative health care is consumed in the form of natural health products (NHPs). The question of whether or not NHPs may provide a cost-effective choice in the treatment of disease is important for patients, physicians and policy makers. The objective of this study was to conduct a systematic review of the literature in order to find, appraise and summarize high-quality studies that explore the cost effectiveness of NHPs as compared to conventional medicine. The following databases were searched independently in duplicate from inception to January 1, 2006: EMBASE, MEDLINE, CINAHL, BioethicsLine, Wilson General Science abstracts, EconLit, Cochrane Library, ABI/Inform and SciSearch. To be included in the review, trials had to be randomized, assessed for some measure of cost effectiveness and include the use of NHPs as defined by the Natural Health Products Directorate. Studies dealing with diseases due to malnutrition were excluded from appraisal. The pooled searches unveiled nine articles that fit the inclusion/exclusion criteria. The conditions assessed by the studies included three on postoperative complications, two on cardiovascular disease, two on gastrointestinal disorders, one on critically ill patients and one on urinary tract infections. Heterogeneity between the studies was too great to allow for meta-analysis of the results. The use of NHPs shows evidence of cost effectiveness in relation to postoperative surgery but not with respect to the other conditions assessed. In conclusion, NHPs may be of use in preventing complications associated with surgery. The cost effectiveness of some NHPs is encouraging in certain areas but needs confirmation from further research.

PMID: 18955290

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J Alzheimers Dis. 2009 Jan;16(1):93-8.

Ascorbic acid and rates of cognitive decline in Alzheimer's disease.

Bowman GL, Dodge H, Frei B, Calabrese C, Oken BS, Kaye JA, Quinn JF.

Oregon Health & Science University

The brain maintains high levels of ascorbic acid (AA) despite a concentration gradient favoring diffusion from brain to peripheral tissues. Dietary antioxidants, including AA, appear to modify the risk of Alzheimer's disease (AD). The objective of this study was to test the hypothesis that neurodegeneration in AD is modified by brain levels of AA. Thirty-two patients with mild to moderate AD participated in a biomarker study involving standardized clinical assessments over one year. Cerebrospinal fluid (CSF) and serum were collected at baseline for AA and albumin content. Cognitive measures were collected at baseline and one year. CSF and plasma AA failed to predict cognitive decline independently, however, CSF: plasma AA ratio did. After adding CSF Albumin Index (an established marker of blood-brain barrier integrity) to the regression models the effect of CSF: plasma AA ratio as a predictor of cognitive decline was weakened. CSF: plasma AA ratio predicts rate of decline in AD. This relationship may indicate that the CSF: plasma AA ratio is an index of AA availability to the brain or may be an artifact of a relationship between blood-brain barrier impairment and neurodegeneration.

PMID: 19158425

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J Altern & Comple Med Jul 2008; 14(6): 707-13.

Effects of Bacopa monnieri on cognitive performance, anxiety and depression in the elderly.

Calabrese C, Gregory WL, Leo M, Kraemer D, Bone K, Oken B.

Helfgott Research Institute, National College of Natural Medicine

OBJECTIVES: Study aims were to evaluate effects of Bacopa monnieri whole plant standardized dry extract on cognitive function and affect and its safety and tolerability in healthy elderly study participants. DESIGN: The study was a randomized, double-blind, placebo-controlled clinical trial with a placebo run-in of 6 weeks and a treatment period of 12 weeks. Setting/location: Volunteers were recruited from the community to a clinic in Portland, Oregon by public notification. SUBJECTS: Fifty-four (54) participants, 65 or older (mean 73.5 years), without clinical signs of dementia, were recruited and randomized to Bacopa or placebo. Forty-eight (48) completed the study with 24 in each group. INTERVENTIONS: Standardized B. monnieri extract 300 mg/day or a similar placebo tablet orally for 12 weeks. OUTCOME MEASURES: The primary outcome variable was the delayed recall score from the Rey Auditory Verbal Learning Test (AVLT). Other cognitive measures were the Stroop Task assessing the ability to ignore irrelevant information, the Divided Attention Task (DAT), and the Wechsler Adult Intelligence Scale (WAIS) letter-digit test of immediate working memory. Affective measures were the State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression scale (CESD)-10 depression scale, and the Profile of Mood States. Vital signs were also monitored. RESULTS: Controlling for baseline cognitive deficit using the Blessed Orientation-Memory-Concentration test, Bacopa participants had enhanced AVLT delayed word recall memory scores relative to placebo. Stroop results were similarly significant, with the Bacopa group improving and the placebo group unchanged. CESD-10 depression scores, combined state plus trait anxiety scores, and heart rate decreased over time for the Bacopa group but increased for the placebo group. No effects were found on the DAT, WAIS digit task, mood, or blood pressure. The dose was well tolerated with few adverse events (Bacopa n = 9, placebo n = 10), primarily stomach upset. CONCLUSIONS: This study provides further evidence that B. monnieri has potential for safely enhancing cognitive performance in the aging.

PMID: 18611150



JAMA. 2008 Jun 11;299(22):2633-41.

Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial.

Weber W, Vander Stoep A, McCarty RL, Weiss NS, Biederman J, McClellan J.

School of Naturopathic Medicine, Bastyr University

CONTEXT: Stimulant medication can effectively treat 60% to 70% of youth with attention-deficit/hyperactivity disorder (ADHD). Yet many parents seek alternative therapies, and Hypericum perforatum (St John's wort) is 1 of the top 3 botanicals used. OBJECTIVE: To determine the efficacy and safety of H. perforatum for the treatment of ADHD in children. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial conducted between March 2005 and August 2006 at Bastyr University, Kenmore, Washington, among a volunteer sample of 54 children aged 6 to 17 years who met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria for ADHD by structured interview. INTERVENTION: After a placebo run-in phase of 1 week, participants were randomly assigned to receive 300 mg of H. perforatum standardized to 0.3% hypericin (n = 27) or a matched placebo (n = 27) 3 times daily for 8 weeks. Other medications for ADHD were not allowed during the trial. MAIN OUTCOME MEASURES: Performance on the ADHD Rating Scale-IV (range, 0-54) and Clinical Global Impression Improvement Scale (range, 0-7), and adverse events. RESULTS: One patient in the placebo group withdrew because of an adverse event. No significant difference was found in the change in ADHD Rating Scale-IV scores from baseline to week 8 between the treatment and placebo groups: inattentiveness improved 2.6 points (95% confidence interval [CI], -4.6 to -0.6 points) with H. perforatum vs 3.2 points (95% CI, -5.7 to -0.8 points) with placebo (P = .68) and hyperactivity improved 1.8 points (95% CI, -3.7 to 0.1 points) with H. perforatum vs 2.0 points (95% CI, -4.1 to 0.1 points) with placebo (P = .89). There was also no significant difference between the 2 groups in the percentage of participants who met criteria for improvement (score < or = 2) on the Clinical Global Impression Improvement Scale (H. perforatum, 44.4%; 95% CI, 25.5%-64.7% vs placebo, 51.9%; 95% CI, 31.9%-71.3%; P = .59). No difference between groups was found in the number of participants who experienced adverse effects during the study period (H. perforatum, 40.7%; 95% CI, 22.4%-61.2% vs placebo, 44.4%; 95% CI, 25.5%-64.7%; P = .78). CONCLUSION: In this study, use of H. perforatum for treatment of ADHD over the course of 8 weeks did not improve symptoms. TRIAL REGISTRATION: Identifier: NCT00100295.

PMID: 18544723



Alt Therapies in Health & Med, 2007 Sep-Oct;13(5):18-20, 22-4

Survival in HIV-1 positive adults practicing psychological or spiritual activities for one year.

Fitzpatrick AL, Standish LJ, Berger J, Kim JG, Calabrese C, Polissar N.

Bastyr University Research Institute

OBJECTIVE: To investigate associations between survival and use of psychological and spiritual activities practiced over 1 year in HIV-positive (HIV+) patients. METHOD: Nine hundred one HIV+ adults living in the United States using at least 1 form of complementary and alternative medicine (CAM) completed a questionnaire 3 times between 1995 and 1998. Information on specific mind-body therapies included psychotherapy (group therapy, support groups, individual therapy) and spiritual therapies (self-defined "spiritual" activities, prayer, meditation, affirmations, psychic healing, visualizations). Subsequent death was ascertained from the National Death Index (NDI). Cox proportional-hazards regression assessed risk of death through 1999. RESULTS: Use of any psychological therapy reported in both the 6-month and 12-month follow-up questionnaires (1 year continuous use) was associated with a reduced risk of death (hazard ratio [HR]: 0.5, 95% CI: 0.3-0.9) adjusted for income, clinical acquired immune deficiency syndrome, CD4 count, smoking, alcohol use, and use of antiretroviral therapy or highly active antiretroviral therapy (HAART). The relationship between spiritual activities and survival was modified by use of HAART, which may reflect severity of illness. Individuals not currently using HAART and who participated in spiritual activities over the previous year were found to be at a reduced risk of death (HR: 0.4, 95% CI: 0.2-0.9) compared to those not practicing spirituality. CONCLUSIONS: Participation in spiritual and psychological therapies may be related to beneficial clinical outcomes in HIV+ individuals, including improved survival. Due to the self-selection of therapies in this observational cohort, it is not possible to distinguish use of the therapies from other characteristics or activities of the people participating in them.

PMID: 17900038



Cancer Epidemiol Biomarkers Prev. 2007 Aug;16(8):1601-9.

A pilot and feasibility study on the effects of naturopathic botanical and dietary interventions on sex steroid hormone metabolism in premenopausal women.

Greenlee H, Atkinson C, Stanczyk FZ, Lampe JW.

Mailman School of Public Health, Columbia University

Naturopathic physicians commonly make dietary and/or dietary supplement recommendations for breast cancer prevention. This placebo-controlled, parallel-arm, pilot study tested the effects of two naturopathic interventions over five menstrual cycles on sex steroid hormones and metabolic markers in 40 healthy premenopausal women. The intervention arms were as follows: combination botanical supplement (Curcuma longa, Cynara scolymus, Rosmarinus officinalis, Schisandra chinensis, Silybum marinum, and Taraxacum officinalis; n = 15), dietary changes (3 servings/d crucifers or dark leafy greens, 30 g/d fiber, 1-2 liters/d water, and limiting caffeine and alcohol consumption to 1 serving each/wk; n = 10), and placebo (n = 15). Early-and late-follicular phase serum samples from cycles 1 and 5 were analyzed for estrogens (estrone, estrone-sulfate, total estradiol, and free estradiol), androgens (dehydroepiandrosterone, dehydroepiandrosterone-sulfate, androstenedione, total testosterone, and free testosterone), sex hormone-binding globulin, and metabolic markers (insulin, insulin-like growth factor-I, insulin-like growth factor binding protein-3, and leptin). Serum samples collected during the mid-luteal phase of cycles 1 and 5 were analyzed for total estradiol, free estradiol, and sex hormone-binding globulin. Urine samples collected during the late follicular phase of cycles 1 and 5 were analyzed for 2-hydroxyestrone and 16alpha-hydroxyestrone. During the early follicular phase, compared with placebo, the botanical supplement decreased dehydroepiandrosterone (-13.2%; P = 0.02), dehydroepiandrosterone-sulfate (-14.6%; P = 0.07), androstenedione (-8.6%; P = 0.05), and estrone-sulfate (-12.0%; P = 0.08). No other trends or statistically significant changes were observed. When comparing dietary changes with placebo, no statistically significant differences were observed. Overall, in this pilot study, the naturopathic interventions had no substantial effects on estrogen measures. Early-follicular phase androgens decreased with the botanical supplement.

PMID: 17684134

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Dig Dis Sci. 2006 Dec;51(12):2134-44. Epub 2006 Nov 1.

Efficacy of probiotics and nutrients in functional gastrointestinal disorders: a preliminary clinical trial.

S Kim L, Hilli L, Orlowski J, Kupperman JL, Baral M, F Waters R.

Southwest College of Naturopathic Medicine

The purpose of this study was to evaluate the efficacy and safety of commonly used probiotics and nutrients available for functional gastrointestinal disorders (FGID). Five different combinations of probiotics and nutrients, or placebo, were taken daily over 12 weeks. In this randomized controlled clinical trial, men and women 21 to 72 years of age with FGID symptoms of indigestion, bloating, and abdominal discomfort were assigned to one of six groups, 12 patients per group. Gastrointestinal Quality of Life Index (GIQLI) and visual analogue scale (VAS) for GI symptoms, SF-36, lactulose and mannitol test (LMT), and urine indican levels were evaluated. GIQLI, VAS scores, and LMT did not change significantly (P > 0.05). There were clinically notable improvements in two of the combination formulations. While the nonsignificant improvements in GI symptoms could suggest that combination probiotics and nutrients may be beneficial in conditions such as FGID, no conclusive evidence was found in this pilot trial. Further investigations to explore the findings are discussed.

PMID: 17078006



J Altern Complement Med. 2006 Nov;12(9):881-5.

A single-center, double-blinded, randomized controlled study to evaluate the relative efficacy of sublingual and oral vitamin B-complex administration in reducing total serum homocysteine levels.

Yazaki Y, Chow G, Mattie M.

College of Naturopathic Medicine, University of Bridgeport

OBJECTIVE: Reports correlating total homocysteine (tHcy) concentrations with arteriosclerosis have become a matter of interest amongst healthcare professionals and the public. Several commercial preparations of vitamin B complexes have been marketed as supplements intended to reduce elevated levels of tHcy. Among these preparations are those that have been specifically designed for sublingual administration. This study is designed to evaluate the relative efficacy of sublingually versus orally delivered vitamin B complex in reducing serum tHcy levels. DESIGN: Forty-one (41) subjects, between the ages of 50 and 80 years with total serum tHcy concentrations exceeding 11 micromol/L, were treated with a six-week regimen of vitamin B complex. Each B complex consisted of 1000 microg vitamin B12 (as methylcobalamin), 400 microg folate (as folic acid), and 5 mg vitamin B6 (as pyridoxine HCl). Participants in the study were randomized into two groups designated, retrospectively, as SL and PO. Members of group SL were given a sublingually delivered vitamin B complex and a matching orally delivered placebo. Members of group PO were given an orally delivered vitamin complex and a matching sublingually delivered placebo. A statistically significant reduction in tHcy values was observed in both groups upon completion of the 6-week protocol. RESULTS: There was no statistically significant difference in serum tHcy concentrations between SL and PO groups either before or after treatment, substantiating the idea that there is no difference in efficacy between the two methods of vitamin complex delivery.

PMID: 17109579



Can J Clin Pharmacol. 2006 Fall;13(3):e257-61. Epub 2006 Nov 3.

Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation.

Dugoua JJ, Seely D, Perri D, Koren G, Mills E.

Canadian College of Naturopathic Medicine

BACKGROUND: There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation. OBJECTIVES: To systematically review the literature for evidence on the use, safety, and pharmacology of black cohosh focusing on issues pertaining to pregnancy and lactation. METHODS: We searched 7 electronic databases and compiled data according to the grade of evidence found. RESULTS: Black cohosh, alone or in combination with other medicinal herbs as "mother's cordial", has a long traditional use and is frequently used by midwives as a uterine stimulant and labour-inducing aid. Low-level evidence based on theory and expert opinion shows the following concerns with respect to black cohosh use during pregnancy: 1) labour-inducing effects, 2) hormonal effects, 3) emmenagogue properties and, 4) anovulatory effects. During lactation, there is low-level evidence from theoretical and expert opinion of black cohosh having hormonal properties. CONCLUSIONS: Black cohosh should be used with caution during pregnancy, particularly during the first trimester where its purported labour-inducing effects could be of concern, and during lactation. Black cohosh should undergo rigorous high quality human studies to determine its safety in pregnancy and lactation.

PMID: 17085773

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Can J Clin Pharmacol. 2006 Fall;13(3):e268-76. Epub 2006 Nov 3.

Safety and efficacy of St. John's wort (hypericum) during pregnancy and lactation.

Dugoua JJ, Mills E, Perri D, Koren G.

Canadian College of Naturopathic Medicine

BACKGROUND: There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation. OBJECTIVES: To systematically review the literature for evidence on the use, safety, and pharmacology of St. John's wort focusing on issues pertaining to pregnancy and lactation. METHODS: We searched 7 electronic databases and compiled data according to the grade of evidence found. RESULTS: There is very weak scientific evidence based on a case report that St Johns wort is of minimal risk when taken during pregnancy. There is in vitro evidence from animal studies that St John's wort during pregnancy does not affect cognitive development nor cause long-term behavioral defects, but may lower offspring birth weight. There is weak scientific evidence that St. John's wort use during lactation does not affect maternal milk production nor affect infant weight, but, in a few cases, may cause colic, drowsiness or lethargy. There is weak scientific evidence that St John's wort induces CYP450 enzymes, which may lower serum medication levels below therapeutic range; this may be of concern when administering medications during pregnancy and lactation. CONCLUSIONS: Caution is warranted with the use of St John's wort during pregnancy until further high quality human research is conducted to determine its safety. St John's wort use during lactation appears to be of minimal risk, but may cause side effects. Caution is warranted when using medications along with St John's wort.

PMID: 17085775

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Can J Clin Pharmacol. 2006 Fall;13(3):e277-84. Epub 2006 Nov 3.

Safety and efficacy of ginkgo (Ginkgo biloba) during pregnancy and lactation.

Dugoua JJ, Mills E, Perri D, Koren G.

Canadian College of Naturopathic Medicine

BACKGROUND: There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines used in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation. OBJECTIVES: To systematically review the literature for evidence on the use, safety, and pharmacology of ginkgo focusing on issues pertaining to pregnancy and lactation. METHODS: We searched 7 electronic databases and compiled data according to the grade of evidence found. RESULTS: There is some very weak scientific evidence from animal and in vitro studies that ginkgo leaf has antiplatelet activity, which may be of concern during labour as ginkgo use could prolong bleeding time. Low-level evidence based on expert opinion shows that ginkgo leaf may be an emmenagogue and have hormonal properties. The safety of ginkgo leaf during lactation is unknown. Patients and clinicians should be aware of past reports of ginkgo products being adulterated with colchicine. CONCLUSIONS: Ginkgo should be used with caution during pregnancy, particularly around labour where its anti-platelet properties could prolong bleeding time. During lactation the safety of ginkgo leaf is unknown and should be avoided until high quality human studies are conducted to prove its safety.

PMID: 17085776

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Osteoarthritis Cartilage. 2006 Mar;14(3):286-94. Epub 2005 Nov 23.

Efficacy of methylsulfonylmethane (MSM) in osteoarthritis pain of the knee: a pilot clinical trial.

Kim LS, Axelrod LJ, Howard P, Buratovich N, Waters RF.

Southwest College of Naturopathic Medicine

OBJECTIVE: Osteoarthritis (OA) is the most common form of arthritis and the second most common cause of long-term disability among middle-aged and older adults in the United States. Methylsulfonylmethane (MSM) is a popular dietary supplement used as a single agent and in combination with other nutrients, and purported to be beneficial for arthritis. However, there is paucity of evidence to support the use of MSM. METHODS: A randomized, double-blind, placebo-controlled trial was conducted. Fifty men and women, 40-76 years of age with knee OA pain were enrolled in an outpatient medical center. Intervention was MSM 3g or placebo twice a day for 12 weeks (6g/day total). Outcomes included the Western Ontario and McMaster University Osteoarthritis Index visual analogue scale (WOMAC), patient and physician global assessments (disease status, response to therapy), and SF-36 (overall health-related quality of life). RESULTS: Compared to placebo, MSM produced significant decreases in WOMAC pain and physical function impairment (P<0.05). No notable changes were found in WOMAC stiffness and aggregated total symptoms scores. MSM also produced improvement in performing activities of daily living when compared to placebo on the SF-36 evaluation (P<0.05). CONCLUSION: MSM (3g twice a day) improved symptoms of pain and physical function during the short intervention without major adverse events. The benefits and safety of MSM in managing OA and long-term use cannot be confirmed from this pilot trial, but its potential clinical application is examined. Underlying mechanisms of action and need for further investigation of MSM are discussed.

PMID: 16309928



J Altern Complement Med. 2005 Dec;11(6):1021-6.

Echinacea purpurea for prevention of upper respiratory tract infections in children.

Weber W, Taylor JA, Stoep AV, Weiss NS, Standish LJ, Calabrese C.

Bastyr University

OBJECTIVE: The aim of this study was to determine whether Echinacea purpurea given to children for the treatment of acute upper respiratory tract infection (URI) was effective in reducing the risk of subsequent URI. DESIGN: This was a secondary analysis of data from a randomized, double-blind, placebo-controlled trial of Echinacea for the treatment of URI in children. SETTING: The study was conducted as a joint project between the Puget Sound Pediatric Research Network (Seattle, WA) and Bastyr University (Kenmore, WA). PARTICIPANTS: A total of 524 children ages 2 to 11 years were enrolled in the study. INTERVENTION: Children were monitored for URIs over a 4-month observation period during the fall/winters of 2000-2001 and 2001-2002. At entry the children were randomized to receive Echinacea or placebo to treat acute URIs during the observation period. MAIN OUTCOME MEASURES: The occurrence of a second URI and the number of days between the end of the first URI and the start of the second URI was ascertained. Survival and Cox regression analyses were used to determine whether children who took Echinacea for their URIs were less likely to develop subsequent URIs. RESULTS: Among the 401 children with at least one URI treated with study medication, 69.2% of those receiving placebo developed a second URI versus 55.8% of those who received Echinacea. Use of Echinacea was associated with a 28% decreased risk of subsequent URI (p = 0.01, 95% confidence interval 8%-44% decreased risk). CONCLUSIONS: Echinacea purpurea may be effective in reducing the occurrence of subsequent URIs in children. However this finding needs to be replicated in a URI prevention trial.

PMID: 16398593



BMC Cardiovasc Disord. 2005 Nov 1;5:32.

EDTA chelation therapy for cardiovascular disease: a systematic review.

Seely DM, Wu P, Mills EJ.

Canadian College of Naturopathic Medicine

BACKGROUND: Numerous practitioners of both conventional and complementary and alternative medicine throughout North America and Europe claim that chelation therapy with EDTA is an effective means to both control and treat cardiovascular disease. These claims are controversial, and several randomized controlled trials have been completed dealing with this topic. To address this issue we conducted a systematic review to evaluate the best available evidence for the use of EDTA chelation therapy in the treatment of cardiovascular disease. METHODS: We conducted a systematic review of 7 databases from inception to May 2005. Hand searches were conducted in review articles and in any of the trials found. Experts in the field were contacted and registries of clinical trials were searched for unpublished data. To be included in the final systematic review, the studies had to be randomized controlled clinical trials. RESULTS: A total of seven articles were found assessing EDTA chelation for the treatment of cardiovascular disease. Two of these articles were subgroup analyses of one RCT that looked at different clinical outcomes. Of the remaining five studies, two smaller studies found a beneficial effect whereas the other three exhibited no benefit for cardiovascular disease from the use of EDTA chelation therapy. Adverse effects were rare but those of note included a few cases of hypocalcemia and a single case of increased creatinine in a patient on the EDTA intervention. CONCLUSION: The best available evidence does not support the therapeutic use of EDTA chelation therapy in the treatment of cardiovascular disease. Although not considered to be a highly invasive or harmful therapy, it is possible that the use of EDTA chelation therapy in lieu of proven therapy may result in causing indirect harm to the patient.

PMID: 16262904

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J Altern Complement Med. 2005 Jun;11(3):483-9.

A pilot study to examine a combination botanical for the treatment of menopausal symptoms.

Smolinski D, Wollner D, Orlowski J, Curcio J, Nevels J, Kim LS.

Southwest College of Naturopathic Medicine

OBJECTIVE: Hormone replacement therapy has become a controversial treatment for symptoms of menopause, leading many women and their physicians to search for safer, effective alternatives. Certain botanicals are known to contain phytoestrogenic activity, which may be helpful in alleviating menopausal symptoms. We report the results of a study using a combination botanical supplement to treat menopausal symptoms. DESIGN: Prospective pilot study. SETTING/LOCATION: Family practice medical center, Phoenix metropolitan area. SUBJECTS: Eight (8) women with moderate vasomotor and somatic symptoms of menopause. INTERVENTION: Combination botanicals daily for 3 months. OUTCOME MEASURES: Modified Kupperman Index (KI), daily hot flashes severity, and overall quality of life (QoL) using the SF-36 index, which were collected at enrollment, during treatment, and at the end of treatment. RESULTS: Mean KI total symptoms decreased from 30.3 +/- 7.5 to 22.9 +/- 8.4 (95% CI, 25-34), p = 0.0028. Daily hot flashes decreased from 68.1 +/- 14.3 to 39.6 +/- 9.7 (95% CI, 38-46), p = 0.0003, and the overall QoL also improved at the end of treatment. CONCLUSIONS: This pilot study demonstrates the potential benefit of a combination botanical for improving moderate menopausal symptoms in women. The efficacy and role of combination botanicals for long-term use to reduce menopausal symptoms requires further exploration.

PMID: 15992234



Integr Cancer Ther. 2005 Jun;4(2):144-55.

The effects of green tea consumption on incidence of breast cancer and recurrence of breast cancer: a systematic review and meta-analysis.

Seely D, Mills EJ, Wu P, Verma S, Guyatt GH.

Canadian College of Naturopathic Medicine

BACKGROUND: Green tea is widely used by women for the prevention and treatment of breast cancer. The authors aimed to determine the efficacy of green tea ingestion on the risk of breast cancer development and the risk of breast cancer recurrence. METHODS: The authors conducted a systematic review and meta-analyses of observational studies from systematic searches of 8 electronic data sources and contact with authors. They included studies assessing breast cancer incidence and recurrence. RESULTS: Results: The pooled relative risk (RR) of developing breast cancer for the highest levels of green tea consumption in cohort studies was 0.89 (95% confidence interval [CI], 0.71-1.1; P= .28; I(2)= 0%), and in case control studies, the odds ratio was 0.44 (95% CI, 0.14-1.31; P= .14; I(2)= 47%). The pooled RR of cohort studies for breast cancer recurrence in all stages was 0.75 (95% CI, 0.47-1.19; P= .22; I(2)= 37%). A subgroup analysis of recurrence in stage I and II disease showed a pooled RR in cohort studies of 0.56 (95% CI, 0.38-0.83; P= .004; I2= 0%). Dose-response relationships were evident in only 3 of the 7 studies. CONCLUSION: To date, the epidemiological data indicates that consumption of 5 or more cups of green tea a day shows a non-statistically significant trend towards the prevention of breast cancer development. Evidence indicates that green tea consumption may possibly help prevent breast cancer recurrence in early stage (I and II) cancers. However, conclusions as to the potential therapeutic application of green tea are currently impossible to make due to the small number of studies conducted, the lack of any clinical trial evidence, the lack of a consistent dose-response relationship, and the potential for interaction with standard care.

PMID: 15911927



Nutr J. 2005 Jan 26;4:3.

The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature.

Prousky J, Seely D.

The Canadian College of Naturopathic Medicine

BACKGROUND: Migraine and tension-type headaches impose a tremendous economic drain upon the healthcare system. Intravenous and oral niacin has been employed in the treatment of acute and chronic migraine and tension-type headaches, but its use has not become part of contemporary medicine, nor have there been randomized controlled trials further assessing this novel treatment. We aimed to systematically review the evidence of using intravenous and/or oral niacin as a treatment for migraine headaches, tension-type headaches, and for headaches of other etiologic types. METHODS: We searched English and non-English language articles in the following databases: MEDLINE (1966-February 2004), AMED (1995-February 2004) and Alt HealthWatch (1990-February 2004). RESULTS: Nine articles were found to meet the inclusion criteria and were included in this systematic review. Hypothetical reasons for niacin's effectiveness include its vasodilatory properties, and its ability to improve mitochondrial energy metabolism. Important side effects of niacin include flushing, nausea and fainting. CONCLUSION: Although niacin's mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches. Adequately designed randomized trials are required to determine its clinical implications.

PMID: 15673472

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BMC Complement Altern Med. 2004 Sep 15;4:13.

Harpgophytum procumbens for osteoarthritis and low back pain: a systematic review.

Gagnier JJ, Chrubasik S, Manheimer E.

Department of Health Policy Management and Evaluation, University of Toronto

BACKGROUND: The objective of this review is to determine the effectiveness of Harpagophytum procumbens preparations in the treatment of various forms of musculoskeletal pain. METHODS: Several databases and other sources were searched to identify randomized controlled trials, quasi-randomized controlled trials, and controlled clinical trials testing Harpagophytum preparations in adults suffering from pain due to osteoarthritis or low back pain. RESULTS: Given the clinical heterogeneity and insufficient data for statistical pooling, trials were described in a narrative way, taking into consideration methodological quality scores. Twelve trials were included with six investigating osteoarthritis (two were identical trials), four low back pain, and three mixed-pain conditions. CONCLUSIONS: There is limited evidence for an ethanolic Harpagophytum extract containing less than <30 mg harpagoside per day in the treatment of knee and hip osteoarthritis. There is moderate evidence of effectiveness for (1) the use of a Harpagophytum powder at 60 mg harpagoside in the treatment of osteoarthritis of the spine, hip and knee; (2) the use of an aqueous Harpagophytum extract at a daily dose of 100 mg harpagoside in the treatment of acute exacerbations of chronic non-specific low back pain; and (3) the use of an aqueous extract of Harpagophytum procumbens at 60 mg harpagoside being non-inferior to 12.5 mg rofecoxib per day for chronic non-specific low-back pain (NSLBP) in the short term. Strong evidence exists for the use of an aqueous Harpagophytum extract at a daily dose equivalent of 50 mg harpagoside in the treatment of acute exacerbations of chronic NSLBP.

PMID: 15369596



JAMA. 2003 Dec 3;290(21):2824-30.

Efficacy and safety of echinacea in treating upper respiratory tract infections in children: a randomized controlled trial.

Taylor JA, Weber W, Standish L, Quinn H, Goesling J, McGann M, Calabrese C.

University of Washington and Children's Hospital and Regional Medical Center

CONTEXT: Echinacea is a widely used herbal remedy for treatment of upper respiratory tract infections (URIs). However, there are few data on the efficacy and safety of echinacea in treating URIs in children. OBJECTIVES: To determine if Echinacea purpurea is effective in reducing the duration and/or severity of URI symptoms in children and to assess its safety in this population. DESIGN, SETTING, AND PARTICIPANTS: Randomized, double-blind, placebo-controlled trial of healthy children 2 to 11 years old recruited from a regional practice-based network and an alternative medical center in 4-month periods from 2000 through 2002. INTERVENTIONS: Study patients were randomized to receive either echinacea or placebo for up to 3 URIs over a 4-month period. Study medication was begun at the onset of symptoms and continued throughout the URI, for a maximum of 10 days. MAIN OUTCOME MEASURES: Primary outcomes were duration and severity of symptoms and adverse events recorded by parents; secondary outcomes included peak severity of symptoms, number of days of peak severity, number of days of fever, and a global assessment of severity of symptoms by parents of study children. RESULTS: Data were analyzed on 707 URIs that occurred in 407 children, including 337 URIs treated with echinacea and 370 with placebo. There were 79 children who completed their study period without having a URI. The median duration of URIs was 9 days (95% confidence interval, 8-10 days); there was no difference in duration between URIs treated with echinacea or placebo (P =.89). There was also no difference in the overall estimate of severity of URI symptoms between the 2 treatment groups (median, 33 in both groups; P =.69). In addition, there were no statistically significant differences between the 2 groups for peak severity of symptoms (P =.68), number of days of peak symptoms (1.60 in the echinacea group and 1.64 in the placebo group; P =.97), number of days of fever (0.81 in the echinacea group vs 0.64 in the placebo group; P =.09), or parental global assessment of severity of the URI (P =.67). Overall, there was no difference in the rate of adverse events reported in the 2 treatment groups; however, rash occurred during 7.1% of the URIs treated with echinacea and 2.7% of those treated with placebo (P =.008). CONCLUSIONS: Echinacea purpurea, as dosed in this study, was not effective in treating URI symptoms in patients 2 to 11 years old, and its use was associated with an increased risk of rash.

PMID: 14657066

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BMC Clin Pharmacol. 2003 Nov 13;3:4.

The safety of over-the-counter niacin. A randomized placebo-controlled trial [ISRCTN18054903].

Mills E, Prousky J, Raskin G, Gagnier J, Rachlis B, Montori VM, Juurlink D.

Department of Research, Canadian College of Naturopathic Medicine


BACKGROUND: Niacin is widely available over the counter (OTC). We sought to determine the safety of 500 mg immediate release niacin, when healthy individuals use them as directed. METHODS: 51 female and 17 male healthy volunteers (mean age 27 years SD 4.4) participated in a randomized placebo-controlled blinded trial of a single dose of an OTC, immediate-release niacin 500 mg (n = 33), or a single dose of placebo (n = 35) on an empty stomach. The outcomes measured were self-reported incidence of flushing and other adverse effects. RESULTS: 33 volunteers on niacin (100%) and 1 volunteer on placebo (3%) flushed (relative risk 35, 95% confidence interval (CI) 6.8-194.7). Mean time to flushing on niacin was 18.2 min (95% CI: 12.7-23.6); mean duration of flushing was 75.4 min (95% CI: 62.5-88.2). Other adverse effects occurred commonly in the niacin group: chills (51.5% vs. 0%, P <.0001), generalized pruritus (75% vs. 0%, P = <.001), gastrointestinal upset (30% vs. 3%, P =.005), and cutaneous tingling (30% vs. 0%, P = <.001). Six participants did not tolerate the adverse effects of niacin and 3 required medical attention. CONCLUSION: Clinicians counseling patients about niacin should alert patients not only about flushing but also about gastrointestinal symptoms, the most severe in this study. They should not trust that patients would receive information about these side effects or their prevention (with aspirin) from the OTC packet insert.

PMID: 14614780

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J Altern Complement Med. 2001 Apr;7(2):175-85.

The safety of low-dose Larrea tridentata (DC) Coville (creosote bush or chaparral): a retrospective clinical study.

Heron S, Yarnell E.

OBJECTIVE: To determine whether internal use of low doses of Larrea tridentata tincture or topical applications of this traditional herbal medicine are safe. DESIGN: Retrospective review of all people prescribed Larrea for internal or for topical use over a 22-month period. SETTING/LOCATION: A general naturopathic practice in Sedona, Arizona. SUBJECTS: Thirteen patients were identified for whom Larrea tincture for internal use was prescribed. An additional 20 female and 3 male patients were identified for whom an extract of Larrea in Ricinus communis (castor) oil for topical use was prescribed. No patient had any history of liver disease. INTERVENTIONS: Larrea was prescribed as part of the usual care of each patient. In all cases it was given as either part of a complex herbal formula individualized for each patient containing less than 10% Larrea tincture or as an extract in Ricinus oil for topical use. OUTCOME MEASURES: Serum liver enzyme levels as well as blood urea nitrogen and creatinine levels, glucose levels, electrolytes, bilirubin levels, iron levels, ferritin levels, lipid levels, and complete blood count (CBC) were available for analysis in four patients; general clinical history and physical examination findings were relied on in all other cases. RESULTS: The four patients with complete before and after blood chemistry panels and CBC had no indication of liver damage from use of Larrea. This included one patient who was taking medications with significant potential for hepatotoxicity. No patient in the study, whether using Larrea for short term or long, internally or externally, showed any sign of organ damage during the period of follow-up. CONCLUSIONS: Relatively small intakes of Larrea tincture, or topical application of extracts in Ricinus oil, are safe when prescribed by a clinically trained botanical prescriber. Larrea should be used with caution in persons with a history of previous, or current, liver disease. It may be preferable to avoid the use of Larrea capsules because they have been associated with potentially dangerous overdosing.

PMID: 11327523



Altern Med Rev. 2000 Oct;5(5):455-62.

The use of ascorbigen in the treatment of fibromyalgia patients: a preliminary trial.

Bramwell B, Ferguson S, Scarlett N, Macintosh A.

National College of Naturopathic Medicine

Twelve female fibromyalgia syndrome (FMS) patients were given 500 mg per day of a blend containing 100 mg ascorbigen and 400 mg broccoli powder in a preliminary, one-month, open-label trial. This group of patients showed a mean 20.1 percent (p=0.044) decrease in their physical impairment score and a mean 17.8 percent (p=0.016) decrease in their total fibromyalgia impact scores as measured by the Fibromyalgia Impact Questionnaire. The mean physical impairment score two weeks post-treatment showed a significant return to near pre-treatment level (p=0.028). Analysis of ten of the patients' mean threshold pain levels at the 18 possible tender points obtained before and at the end of treatment showed a strong trend toward an increase in the mean threshold pain level (p=0.059). The reduced sensitivity to pain and improvement in quality of life measured in this study appear to be clinically relevant and a larger, double-blind study is warranted.

PMID: 11056415

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Phytother Res. 2000 Aug;14(5):333-8.

A phase I trial of andrographolide in HIV positive patients and normal volunteers.

Calabrese C, Berman SH, Babish JG, Ma X, Shinto L, Dorr M, Wells K, Wenner CA, Standish LJ.

Bastyr University

A phase I dose-escalating clinical trial of andrographolide from Andrographis paniculata was conducted in 13 HIV positive patients and five HIV uninfected, healthy volunteers. The objectives were primarily to assess safety and tolerability and secondarily to assess effects on plasma virion HIV-1 RNA levels and CD4(+) lymphocyte levels. No subjects used antiretroviral medications during the trial. Those with liver or renal abnormalities were excluded. The planned regimen was 5 mg/kg bodyweight for 3 weeks, escalating to 10 mg/kg bodyweight for 3 weeks, and to 20 mg/kg bodyweight for a final 3 weeks. The trial was interrupted at 6 weeks due to adverse events including an anaphylactic reaction in one patient. All adverse events had resolved by the end of observation. A significant rise in the mean CD4(+) lymphocyte level of HIV subjects occurred after administration of 10 mg/kg andrographolide (from a baseline of 405 cells/mm(3) to 501 cells/mm(3); p = 0.002). There were no statistically significant changes in mean plasma HIV-1 RNA levels throughout the trial. Andrographolide may inhibit HIV-induced cell cycle dysregulation, leading to a rise in CD4(+) lymphocyte levels in HIV-1 infected individuals.

PMID: 10925397



Altern Ther Health Med. 2000 Jul;6(4):70-6.

The effects of a short program of detoxification in disease-free individuals.

MacIntosh A, Ball K.

National College of Naturopathic Medicine

CONTEXT: Removal of toxins from the body is an integral part of Ayurvedic, yogic, and naturopathic medicine. Symptoms of poor health in people free from diagnosed disease may be related to toxin buildup. OBJECTIVE: This study investigates whether a 7-day program of detoxification can improve well-being and enhance the activity of liver detoxification pathways. METHODS: In this pilot, patient-outcome-focused, noncontrolled clinical intervention, 25 disease-free participants were recruited. Pre- and postmeasures were taken using the Metabolic Screening Questionnaire (as a subjective assessment of well-being) and drug challenge tests to assess hepatic detoxification capacity. RESULTS: A statistically significant (47%) reduction in the Metabolic Screening Questionnaire scores resulted. This improvement in patient-assessed health occurred concurrently with a 23% increase in liver detoxification capacity, as reflected by the caffeine clearance measure. There was an increase in the urinary sulfate-to-creatinine ratio after treatment, indicating a trend toward improved liver function. DISCUSSION: In disease-free adults, a 7-day course of detoxification may produce improvements in subjective health reports. This simple, short-term intervention may be appropriate for disease-free individuals without specific toxin exposure, for the purpose of enhancing health and preventing the development of disease. CONCLUSIONS: A simple 7-day detoxification program resulted in a significant reduction in participant symptomology. The tendency toward improvement in liver detoxification measures is consistent with the hypothesis that improved liver detoxification capacity may contribute to well-being.

PMID: 10895516



Alternative Medicine Review; 4(1):23-8, 1999.

A cross-over study of the effect of a single oral feeding of medium chain triglyceride oil vs. canola oil on post-ingestion plasma triglyceride levels in healthy men.

Calabrese C, Myer S, Munson S, Turet P, Birdsall TC.

Bastyr University Research Institute

Due to its unique absorption and metabolism characteristics, medium chain triglyceride (MCT) oil, consisting of fatty acids with 8-12 carbons, has been used therapeutically since the 1950s in the treatment of fat malabsorption, cystic fibrosis, epilepsy, weight control, and to increase exercise performance. Medium chain triglycerides are easily hydrolyzed in the intestines and the fatty acids are transported directly to the liver via the portal venous system, in contrast to long-chain fatty acids (LCFAs), which are incorporated into chylomicrons for transport through the lymphatic system or peripheral circulation. Medium chain fatty acids (MCFAs) do not require carnitine to cross the double mitochondrial membrane of the hepatocyte, thus they quickly enter the mitochondria and undergo rapid beta-oxidation, whereas most LCFAs are packaged into triglycerides in the hepatocyte. In this single-blind, randomized, cross-over study, 20 healthy men ingested a single dose of either 71 g of MCT oil or canola oil. Blood samples were taken at baseline and at hours one through five post-ingestion to compare the effect of a single oral dosing of MCT oil versus canola oil on post-ingestion plasma triglyceride levels. Mean triglyceride values after canola oil increased 47 percent above baseline (p <0.001), while mean triglyceride values after MCT oil decreased 15 percent from baseline (p <0.001), which is consistent with several other studies involving short- and longer-term feeding with MCT oil. The effect of long-term usage of MCT oil on triglycerides is yet to be established.

PMID: 9988780

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Planta Medica, 59(5):394-7, 1993.

Report of the results of a double-blind, randomized, single-dose trial of a topical 2% escin gel versus placebo in the acute treatment of experimentally-induced hematoma in volunteers.

Calabrese C, P Preston.

Bastyr College

The efficiency of topically applied 2% escin gel in reducing tenderness to pressure on experimentally induced hematoma is demonstrated. A double-blind, randomized signal dose trial versus placebo in healthy volunteers was used.

PMID: 8255928



J Naturopathic Medicine, 2(1):33-6, 1991.

Intestinal candidiasis, L. acidophilus supplementation and Crook's questionnaire.

Blair DM, CS Hangee-Bauer, C Calabrese.

Twenty-six subjects with positive stool cultures for Candida albicans were prospectively studied in a double-blind controlled trial to determine the effect on intestinal Candida of supplementation with Lactobacillus acidophilus.  Subjective evaluation and follow-up stool cultures demonstrated no significant differences between the treatment and control groups.  We did however notice a positive correlation between stool culture results and score average on Crook’s questionnaire.  The limitations of this study are discussed with recommendations for future studies.  A correlation is observed between stool cultures and scores from Crook’s questionnaire.



Planta Med. 1990 Feb;56(1):44-7.

Randomized, double-blind study of freeze-dried Urtica dioica in the treatment of allergic rhinitis.

Mittman P.

National College of Naturopathic Medicine

Ninety-eight individuals took part in a double-blind randomized study comparing the effects of a freeze-dried preparation of Urtica dioica (stinging nettles) with placebo on allergic rhinitis. Sixty-nine individuals completed the study. Assessment was based on daily symptom diaries, and global response recorded at the follow-up visit after one week of therapy. Urtica dioica was rated higher than placebo in the global assessments. Comparing the diary data Urtica dioica was rated only slightly higher.

PMID: 2192379


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The clinical studies catalogued in the following abstracts are those in which the study clinicians are allowed access to the therapeutic and diagnostic tools within the naturopathic scope of practice or a range of tools which model relevant whole practice in the US and Canada. They are pragmatic studies of practitioner activities in which broad responses to presenting health conditions are a part of the intervention.  Given that individualized combinations of modalities and remedies are generally the rule in naturopathic medicine and that their selection is guided by the system’s own principles and guidelines, evaluation of the whole practice is most likely to reveal its potential health benefit.  Whole practice clinical studies represent good model fit to everyday practice and as such provide evidence on the effectiveness of a practitioner class.  The studies are classified here as 1) randomized trials, 2) comparative non-randomized studies, 3) single group prospective studies and 4) retrospective studies.  If you know of studies not listed here that meet the criteria above, please This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

We performed a systematic review of naturopathic whole practice clinical studies and presented the preliminary results as a poster at the International Research Congress on Integrated Medicine and Health in Portland, Oregon on May 16, 2012. The poster may be seen here.


1.  Randomized whole practice trials

PLoS One. 2009 Aug 31;4(8):e6628.

Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974.

Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely D.

Department of Research and Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, Canada.

BACKGROUND: Anxiety is a serious personal health condition and represents a substantial burden to overall quality of life. Additionally anxiety disorders represent a significant cost to the health care system as well as employers through benefits coverage and days missed due to incapacity. This study sought to explore the effectiveness of naturopathic care on anxiety symptoms using a randomized trial. METHODS: Employees with moderate to severe anxiety of longer than 6 weeks duration were randomized based on age and gender to receive naturopathic care (NC) (n = 41) or standardized psychotherapy intervention (PT) (n = 40) over a period of 12 weeks. Blinding of investigators and participants during randomization and allocation was maintained. Participants in the NC group received dietary counseling, deep breathing relaxation techniques, a standard multi-vitamin, and the herbal medicine, ashwagandha (Withania somnifera) (300 mg b.i.d. standardized to 1.5% with anolides, prepared from root). The PT intervention received psychotherapy, and matched deep breathing relaxation techniques, and placebo. The primary outcome measure was the Beck Anxiety Inventory (BAI) and secondary outcome measures included the Short Form 36 (SF-36), Fatigue Symptom Inventory (FSI), and Measure Yourself Medical Outcomes Profile (MY-MOP) to measure anxiety, mental health, and quality of life respectively. Participants were blinded to the placebo-controlled intervention. RESULTS: Seventy-five participants (93%) were followed for 8 or more weeks on the trial. Final BAI scores decreased by 56.5% (p<0.0001) in the NC group and 30.5% (p<0.0001) in the PT group. BAI group scores were significantly decreased in the NC group compared to PT group (p = 0.003). Significant differences between groups were also observed in mental health, concentration, fatigue, social functioning, vitality, and overall quality of life with the NC group exhibiting greater clinical benefit. No serious adverse reactions were observed in either group. RELEVANCE: Many patients seek alternatives and/or complementary care to conventional anxiety treatments. To date, no study has evaluated the potential of a naturopathic treatment protocol to effectively treat anxiety. Knowledge of the efficacy, safety or risk of natural health products, and naturopathic treatments is important for physicians and the public in order to make informed decisions. INTERPRETATION: Both NC and PT led to significant improvements in patients' anxiety. Group comparison demonstrated a significant decrease in anxiety levels in the NC group over the PT group. Significant improvements in secondary quality of life measures were also observed in the NC group as compared to PT. The whole system of naturopathic care for anxiety needs to be investigated further including a closer examination of the individual components within the context of their additive effect. TRIAL REGISTRATION: ISRCTN78958974.

PMID: 19718255

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Arthritis Rheum. 2009 Aug 15;61(8):1037-45.

Naturopathic treatment of rotator cuff tendinitis among Canadian postal workers: a randomized controlled trial.

Szczurko O, Cooley K, Mills EJ, Zhou Q, Perri D, Seely D.

Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada.

OBJECTIVE: To explore the effectiveness of naturopathic care (NC) on rotator cuff tendinitis using a prospective randomized clinical trial design. METHODS: Canadian postal workers with rotator cuff tendinitis for a duration of >6 weeks were randomized to receive NC (n = 43) or standardized physical exercises (PEs; n = 42) over 12 weeks. Participants in the NC group received dietary counseling, acupuncture, and Phlogenzym (2 tablets 3 times/day). The PE intervention group received passive, active-assisted, and active range of motion exercises and matched placebo. The primary outcome measure was the Shoulder Pain and Disability Index (SPADI), and secondary outcomes were the pain visual analog scale (VAS), Short Form 36 (SF-36), Measure Yourself Medical Outcomes Profile (MYMOP), and shoulder maximal range of motion. Participants and assessors were blinded to group and placebo allocation. RESULTS: Seventy-seven participants (87%) completed >or=8 weeks of the trial. Final total SPADI scores decreased by 54.5% (P < 0.0001) in the NC group and by 18% (P = 0.0241) in the PE group. Between-group differences in changes to SPADI scores showed statistically significant decreases in shoulder pain and disability in the NC group compared with the PE group (P < 0.0001). Significant differences between groups were also observed in the pain VAS, MYMOP, SF-36, and shoulder extension, flexion, and abduction, with the NC group showing superiority in each outcome. No serious adverse reactions were observed. CONCLUSION: NC and PE provided significant improvements, with greater improvement in shoulder function in the NC group compared with the PE group. Statistically significant improvements in quality of life measures were observed in the NC group as compared with the PE group.

PMID: 19644905



J Altern Complement Med. 2008 Jun;14(5):475-87.

A pilot whole systems clinical trial of traditional Chinese medicine and naturopathic medicine for the treatment of temporomandibular disorders.

Ritenbaugh C, Hammerschlag R, Calabrese C, Mist S, Aickin M, Sutherland E, Leben J, Debar L, Elder C, Dworkin SF.

Department of Family and Community Medicine, The University of Arizona, Tucson AZ

OBJECTIVES: To assess the feasibility and acceptability of studying whole systems of Traditional Chinese Medicine (TCM) and Naturopathic medicine (NM) in the treatment of temporomandibular disorders (TMD), and to determine whether there is indication to support further research. DESIGN: A pilot study using a randomized controlled clinical trial design of whole system TCM and NM versus state-of-the-art specialty care (SC). SETTING/LOCATION: Kaiser Permanente Northwest (KPNW), and practitioner offices in Portland, Oregon. SUBJECTS: One hundred and sixty (160) women 25-55 years of age attending a KPNW TMD specialty clinic. INTERVENTIONS: Whole system TCM and NM, and KPNW TMD clinic SC; the intervention protocols were designed to model the individually tailored type of community care offered in alternative medicine practices in Portland and in the KPNW TMD clinic, using protocols that enhanced similarities among practitioners within each system and permitted full descriptions of the treatments provided. OUTCOME MEASURES: TMD was ascertained using the Research Diagnostic Criteria/TMD; outcomes were self-reported worst and average facial pain and interference with activities (scaled 0-10 where 10 is worst). RESULTS: Of 948 consecutive eligible patients, 160 were randomized to one of three arms; 128 provided endpoint data. TCM and NM demonstrated significantly greater in-treatment reductions for worst facial pain compared to SC (adjusted regression analysis; higher negative values indicate greater improvement, = -1.11 +/- 0.43, p = 0.010 and -1.02 +/- 0.45, p = 0.025 for TCM and NM, respectively, compared to SC) and at 3 months post-treatment (-1.07 +/- 0.51, p = 0.037 and -1.27 +/- 0.54, p = 0.019 for TCM and NM versus SC, respectively). Additionally, TCM provided significantly greater decreases in average pain than SC; NM provided significantly greater decreases than SC or TCM in TMD-related psychosocial interference. CONCLUSIONS: These alternative medicine approaches each resulted in significantly greater reduction of pain and psychosocial interference than SC. Further research on the potential benefits of traditional whole systems of medicine for TMD appears warranted.

PMID: 18564953

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J Altern Complement Med. 2008 Jun;14(5):489-96.

A randomized pilot study of naturopathic medicine in multiple sclerosis.

Shinto L, Calabrese C, Morris C, Yadav V, Griffith D, Frank R, Oken BS, Baldauf-Wagner S, Bourdette D.

Department of Neurology, Oregon Health & Science University, Portland, OR 97239-3098, USA. 

BACKGROUND: Complementary and alternative medicine (CAM) use is high in people with multiple sclerosis (MS), yet there are limited reports on safety and effectiveness of CAM in MS. Naturopathic medicine encompasses a broad range of CAM modalities and may improve quality of life in patients with MS. OBJECTIVE: To assess quality of life in MS subjects who received interventions designed to "model" the "whole practice" of naturopathy. DESIGN: A pilot, randomized, controlled study with a 6-month intervention period. PARTICIPANTS: Participants who met criteria for clinically definite MS. INTERVENTIONS: The 3 intervention arms were usual care, naturopathic medicine plus usual care, and MS education plus usual care. OUTCOME MEASURES: The primary outcome measure was quality of life (36-item short form health survey [SF-36]). Secondary outcome measures included fatigue (Modified Fatigue Impact Scale); depression (Beck Depression Inventory); cognition battery (Stroop test and Paced Auditory Serial Addition Test 3), and neurologic impairment (Expanded Disability Status Scale [EDSS] and Multiple Sclerosis Functional Composite). Adverse event reporting and laboratory measures were used to assess safety. RESULTS: Forty-five (45) participants (15 per group) were randomized and all completed the 6-month intervention. There were no significant differences between groups on any outcome measure. There was a trend in favoring the naturopathic group in the General Health subscale of the SF-36 (p = 0.11), Timed Walk (p = 0.11), and neurologic impairment (EDSS) (p = 0.07). There was a trend favoring the Education group in the Stroop attention test (p = 0.07). There was no difference between groups in adverse events or laboratory changes. CONCLUSIONS: Naturopathic medicine combined with usual care for MS showed a trend in improvement in the General Health subscale of the SF-36, Timed Walk, and neurologic impairment. Evaluation of naturopathic medicine, as a multimodality regimen, warrants further investigation.

PMID: 18532899



PLoS One. 2007 Sep 19;2(9):e919.

Naturopathic care for chronic low back pain: a randomized trial.

Szczurko O, Cooley K, Busse JW, Seely D, Bernhardt B, Guyatt GH, Zhou Q, Mills EJ.

Division of Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada.

OBJECTIVE: Chronic low back pain represents a substantial cost to employers through benefits coverage and days missed due to incapacity. We sought to explore the effectiveness of Naturopathic care on chronic low back pain. METHODS: This study was a randomized clinical trial. We randomized 75 postal employees with low back pain of longer than six weeks duration to receive Naturopathic care (n = 39) or standardized physiotherapy (n = 36) over a period of 12 weeks. The study was conducted in clinics on-site in postal outlets. Participants in the Naturopathic care group received dietary counseling, deep breathing relaxation techniques and acupuncture. The control intervention received education and instruction on physiotherapy exercises using an approved education booklet. We measured low back pain using the Oswestry disability questionnaire as the primary outcome measure, and quality of life using the SF-36 in addition to low back range of motion, weight loss, and Body Mass Index as secondary outcomes. RESULTS: Sixty-nine participants (92%) completed eight weeks or greater of the trial. Participants in the Naturopathic care group reported significantly lower back pain (-6.89, 95% CI. -9.23 to -3.54, p = <0.0001) as measured by the Oswestry questionnaire. Quality of life was also significantly improved in the group receiving Naturopathic care in all domains except for vitality. Differences for the aggregate physical component of the SF-36 was 8.47 (95% CI, 5.05 to 11.87, p = <0.0001) and for the aggregate mental component was 7.0 (95% CI, 2.25 to 11.75, p = 0.0045). All secondary outcomes were also significantly improved in the group receiving Naturopathic care: spinal flexion (p<0.0001), weight-loss (p = 0.0052) and Body Mass Index (-0.52, 95% CI, -0.96 to -0.08, p = 0.01). CONCLUSIONS: Naturopathic care provided significantly greater improvement than physiotherapy advice for patients with chronic low back pain. TRIAL REGISTRATION: ISRCTN41920953.

PMID: 17878954

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2.  Comparative non-randomized studies

BMC Complement Altern Med. 2012 Apr 18;12(1):44.

Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year

Bradley R, Sherman K, Catz S, Calabrese C, Oberg E, Jordan L, Grothaus L, Cherkin D

Background. Several small, uncontrolled studies have found improvements in self-care behaviors and reductions in clinical risk in persons with type 2 diabetes who received care from licensed naturopathic physicians. To extend these findings and determine the feasibility and promise of a randomized clinical trial, we conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC) in primary care patients with inadequately controlled type 2 diabetes.

Methods. Forty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c) values between 7.5-9.5% and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight). Standardized instruments were administered by telephone to collect outcome data on self-care, self-efficacy, diabetes problem areas, perceived stress, motivation, and mood. Changes from baseline scores were calculated at 6- and 12-months after entry into the study. Six and 12-month changes in clinical risk factors (i.e., HbA1c, lipid and blood pressure) were calculated for the ANC cohort, and compared to changes in a cohort of 329 eligible, non-participating patients constructed using electronic medical records data. Between-cohort comparisons were adjusted for age, gender, baseline HbA1c, and diabetes medications. Six months was pre-specified as the primary endpoint for outcome assessment.

Results. Participants made 3.9 ANC visits on average during the year, 78% of which occurred within six months of entry into the study. At 6-months, significant improvements were found in most patient-reported measures, including glucose testing (P=0.001), diet (P=0.001), physical activity (P=0.02), mood (P=0.001), self-efficacy (P=0.0001) and motivation to change lifestyle (P=0.003). Improvements in glucose testing, mood, self-efficacy and motivation to change lifestyle persisted at 12-months (all P<0.005). For clinical outcomes, mean HbA1c decreased by -0.90% (P=0.02) in the ANC cohort at 6-months, a -0.51% mean difference compared to usual care (P=0.07). Reductions at 12-months were not statistically significant (-0.34% in the ANC cohort, P=0.14; -0.37% difference compared to the usual care cohort, P=0.12).

Conclusions. Improvements were noted in self-monitoring of glucose, diet, self-efficacy, motivation and mood following initiation of ANC for patients with inadequately controlled type 2 diabetes. Study participants also experienced reductions in blood glucose that exceeded those for similar patients who did not receive ANC.  Randomized clinical trials will be necessary to determine if ANC was responsible for these benefits.

PMID: 22512949  

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3.  Single group prospective studies

Complement Ther Clin Pract. 2011 Aug;17(3):157-61. Epub 2011 Mar 17.

CAM: naturopathic dietary interventions for patients with type 2 diabetes.

Oberg EB, Bradley RD, Allen J, McCrory MA.

Bastyr University Research Institute, Kenmore WA 98128, USA. 

Objectve: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes.

Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care.

Results: HbA1c improved in all participants (n = 12); mean - 0.4% +/- 0.49% SD, (p = 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p = 0.05). Specific nutritional behavior modification included: days/week consuming ≥5 servings of fruit/vegetables (p = 0.01), attention to fat intake (p = 0.05), and -11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and self-management also improved significantly.

Conclusion: A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted.

Copyright © 2011 Elsevier Ltd. All rights reserved.

PMID: 21742282   PMCID: PMC3136887 [Available on 2012/8/1]



J Altern Complement Med. 2004; 10(3): 506- 513.

Implementation of outcome measures in a complementary and alternative medicine clinic: evidence of decreased pain and improved quality of life.

Secor ER, Blumberg JH, Markow MJ, MacKenzie J, Thrall RS.

Objectives: The purpose of this study was twofold: (1) to design and implement a practical data collection sys- tem capable of obtaining pain and quality-of-life outcome measures in a complementary and alternative medicine (CAM) outpatient clinic and (2) to evaluate changes in patient status over time using these objective measures.

Design: A prospective study was carried out in an outpatient practice based setting. Scannable forms were designed utilizing Cardiff’s TELEform® system (Cardiff Software, Inc., Vista, CA) for data collection.  Setting/location: This study was conducted at Special Care Holistic Wellness Connection, an urban-based, hospital-affiliated, CAM clinic in Connecticut.  Subjects: Inclusion criteria consisted of: a starting pain level of 2 or more, subjects receiving 3 or more treatments in a specific modality, and a completed SF-12v2® Health Survey (Quality Metric Inc., Lincoln, RI). A total of 94 subjects were evaluated for acupuncture, chiropractic, or naturopathy.  Outcome measures: The Numeric Pain Analogue Scale and SF-12v2® Health Survey were used for subject evaluations and were compared from the first to the last treatments. International Classification of Disease codes were utilized to correlate and track the diagnosis.  Results: An outcome measures data management system was successfully implemented into a CAM outpatient clinical setting. Significant decreases in pain were observed in subjects receiving acupuncture, chiropractic, or naturopathy. In addition, improvements in various subscales of the SF-12v2® Physical and Mental Health categories were observed for each CAM treatment modality studied.  Conclusions: This study established that a practical data collection system could be implemented in a CAM clinic utilizing several treatment modalities. In addition, outcome measures demonstrated both a significant reduction in pain and improvement in quality of life for subjects who utilized acupuncture, chiropractic, or naturopathy treatments.  

PMID: 15253855



4.  Retrospective studies

eCAM, doi:10.1093/ecam/nep219, Jan 2010

Observed Changes in Risk during Naturopathic Treatment of Hypertension

Bradley R, Kozura E, Kaltunas J, Oberg EB, Probstfield J, Fitzpatrick AL.

Bastyr University, Kenmore, WA 98028

Few outcome assessments are published from complementary and alternative medicine (CAM) practices. We aimed to describe patient and practice characteristics of ND care for hypertension (HTN), quantify changes in blood pressure (BP), and evaluate the proportion achieving control of HTN during care. A retrospective, observational study of ND practice in HTN was per- formed in an outpatient clinic in WA State. Eighty-five charts were abstracted for the final analysis. At initiation of care, the mean patient age was 61years, with 51% having stage 2 HTN, despite common use of anti-hypertensive medications (47%). Patients with both stage 1 and stage 2 HTN appeared to improve during care, with stage 2 patients achieving mean reductions of 26mmHg (P<0.0001) and 11mmHg (P<0.0001) in systolic BP (SBP) and diastolic BP (DBP), respectively. The proportion of patients achieving control (<140/90mmHg) in both SBP and DBP was increased significantly from 14 to 44% (P<0.033), although the statistical significance was not maintained upon correction for mul- tiple comparisons. BP appears to improve during ND care for HTN, in a high-risk population. Randomized trials are warranted.

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J Altern Complement Med. 2009 Jun;15(6):633-8.

Description of clinical risk factor changes during naturopathic care for type 2 diabetes.

Bradley R, Kozura E, Kaltunas J, Oberg EB, Probstfield J, Fitzpatrick AL.

Bastyr University Research Center, 14500 Juanita Dr NE, Kenmore, WA 98028, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BACKGROUND: Survey findings report that 48% of people with type 2 diabetes use complementary and alternative medicine (CAM) practice. Publications suggest a high incidence of health promotion counseling in naturopathic practice, yet clinical data on risk factor changes are not available in the literature. OBJECTIVES: The primary aim of this study was to describe clinical risk factor changes during the utilization of naturopathic CAM services in patients with type 2 diabetes. DESIGN: A retrospective, observational study design was used to describe naturopathic care. SETTING: Abstracted medical charts were from patients of the Bastyr Center for Natural Health in Seattle, WA. PARTICIPANTS: The patients in this study had type 2 diabetes and received naturopathic care between 2001 and 2006. OUTCOMES: Abstracted data included patient demographics, duration of care, number of visits, laboratory values for hemoglobin A1c (HbA1c), low density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol, triglycerides (TAG); and systolic/diastolic blood pressure (SPB, DBP). RESULTS: Thirty-seven (37) patient records met inclusion criteria and were abstracted in detail. Mean and median duration of care were 27 and 20 months, respectively. The mean number of visits was 11. Significant mean changes in clinical laboratory risk factors over the duration of care were: -0.65% for HbA1c (p = 0.046), -45 mg/dL for TAG (p = 0.037), -7 mm Hg in SBP (p = 0.02), and -5 mm Hg in DBP (p = 0.003). Mean changes for cholesterol did not reach statistical significance. The percentage of patients who reached new control, had clinically significant risk factor improvements, or had any improvement was: 26%, 42%, and 68% for HbA1c, 7%, 28%, and 62% for LDL, 0%, 25%, and 39% for HDL, 14%, 38%, and 52% for TAG, 16%, 51%, and 86% for SBP, and 27%, 54%, and 70% for DBP. COMMENTS/CONCLUSIONS: These preliminary outcomes suggest that risk factor improvements occur during naturopathic care for diabetes, although the contribution of naturopathic care to these changes cannot be determined. Effectiveness and generalizability of naturopathic approaches in treating type 2 diabetes should be evaluated in controlled prospective studies in representative populations or randomized trials.

PMID: 19500011


Altern Med Rev. 2006 Mar;11(1):30-9.

Naturopathic medicine and type 2 diabetes: a retrospective analysis from an academic clinic.

Bradley R, Oberg EB.

Bastyr University, Kenmore, Washington, USA.

Accurate descriptions of naturopathic medicine as a whole system of medical practice are rare in the literature and non-existent for type 2 diabetes. METHODS: Using retrospective analysis of medical records at an academic naturopathic outpatient clinic, data was abstracted to investigate patterns of patient status, details of treatment recommendations, and levels of evidence. RESULTS: Most naturopathic medical care for type 2 diabetes is adjunctive, although naturopathic physicians are qualified to fill the role of primary care providers. Glycemic control and other vital statistics in patients receiving naturopathic care are comparable to published national averages. Naturopathic physicians prescribe comprehensive therapeutic lifestyle change recommendations supported by a high level of evidence - 100 percent received dietary counseling, 69 percent were taught stress reduction techniques, and 94 percent were prescribed exercise. Patients additionally received prescriptions for botanical and nutritional supplementation, often in combination with conventional medication. Analysis of individual supplement effects was not performed due to inadequate records. Components of treatment recommendations are often evidence-based, with varying evidence quality. CONCLUSION: Naturopathic medicine as a whole medical system supplies evidence-based lifestyle recommendations as suggested in management guidelines for diabetes, hypertension, and hyperlipidemia set forth by the respective national organizations - the American Diabetes Association (ADA), the Joint National Committee on Hypertension (JNC-7), and the National Cholesterol Education Program results of the third Adult Treatment Panel (NCEP ATP-III). Increased research effort to determine the safety and efficacy of combinations of supplements or medications and supplements is warranted. Education of other health care providers, patients, and health policy makers regarding the value of the naturopathic approach in the treatment and prevention of type 2 diabetes is warranted, yet prospective data on efficacy must be collected.

PMID: 16597192     Free article 


J Altern Complement Med. 2003 Aug;9(4):529-38.

Is naturopathy as effective as conventional therapy for treatment of menopausal symptoms?

Cramer EH, Jones P, Keenan NL, Thompson BL.

BACKGROUND: Although the use of alternative medicine in the United States is increasing, no published studies have documented the effectiveness of naturopathy for treatment of menopausal symptoms compared to women receiving conventional therapy in the clinical setting. OBJECTIVE: To compare naturopathic therapy with conventional medical therapy for treatment of selected menopausal symptoms. DESIGN: A retrospective cohort study, using abstracted data from medical charts. SETTING: One natural medicine and six conventional medical clinics at Community Health Centers of King County, Washington, from November 1, 1996, through July 31, 1998. PATIENTS: Women aged 40 years of age or more with a diagnosis of menopausal symptoms documented by a naturopathic or conventional physician. MAIN OUTCOME MEASURES: Improvement in selected menopausal symptoms. RESULTS: In univariate analyses, patients treated with naturopathy for menopausal symptoms reported higher monthly incomes ($1848.00 versus $853.60), were less likely to be smokers (11.4% versus 41.9%), exercised more frequently, and reported higher frequencies of decreased energy (41.8% versus 24.4%), insomnia (57.0% versus 33.1%), and hot flashes (69.6% versus 55.6%) at baseline than those who received conventional treatment. In multivariate analyses, patients treated with naturopathy were approximately seven times more likely than conventionally treated patients to report improvement for insomnia (odds ratio [OR], 6.77; 95% confidence interval [CI], 1.71, 26.63) and decreased energy (OR, 6.55; 95% CI, 0.96, 44.74). Naturopathy patients reported improvement for anxiety (OR, 1.27; 95% CI, 0.63, 2.56), hot flashes (OR, 1.40; 95% CI, 0.68, 2.88), menstrual changes (OR, 0.98; 95% CI, 0.43, 2.24), and vaginal dryness (OR, 0.91; 95% CI, 0.21, 3.96) about as frequently as patients who were treated conventionally. CONCLUSIONS: Naturopathy appears to be an effective alternative for relief of specific menopausal symptoms compared to conventional therapy.

PMID: 14499029



Altern Med Rev. 2000 Aug;5(4):355-71.

Hepatitis C; a retrospective study, literature review, and naturopathic protocol.

Milliman WB, Lamson DW, Brignall MS.

Naturopathic Medicine Program, Bastyr University, Kenmore, WA, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

The standard medical treatment of hepatitis C infection is only associated with sustained efficacy in a minority of patients. Therefore, the search for other treatments is of utmost importance. Several natural products and their derivatives have demonstrated benefit in the treatment of hepatitis C and other chronic liver conditions. Other herbal and nutritional supplements have mechanisms of action that make them likely to be of benefit. This article presents comprehensive protocol, including diet, lifestyle, and therapeutic interventions. The authors performed a retrospective review of 41 consecutive hepatitis C patients. Of the 14 patients with baseline and follow-up data who had not undergone interferon therapy, seven had a greater than 25-percent reduction in serum alanine aminotransferase (ALT) levels after at least one month on the protocol. For all patients reviewed, the average reduction in ALT was 35 U/L (p=0.026). These data appear to suggest that a conservative approach using diet and lifestyle modification, along with safe and indicated interventions, can be effective in the treatment of hepatitis C. Controlled trials with serial liver biopsy and viral load data are necessary to confirm these preliminary findings.

PMID:10956381    Free article


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There is little published descriptive data on naturopathic practice. Yet, as Coulter aptly put it, “It would be difficult to exaggerate the importance of the descriptive studies for CAM. Until we know more about the practice, scope of practice, patient characteristics, utilization rates, and patient numbers, it is difficult to design appropriate studies or to even know which issues are worth studying.“(1). The published studies listed here are those with recent data descriptive of naturopathic practice in the US or Canada and include work on patient characterisitics and numbers, physician characteristics and surveys, practice settings and workflow.  The list below is not complete and we solicit readers' submissions of additional studies that meet inclusion criteria for this section.

1. Coulter ID, Khorsan R. Is health services research the Holy Grail of complementary and alternative medicine research? Altern Ther Health Med. 2008 Jul-Aug;14(4):40-5.


Can J Public Health. 2010 Nov-Dec;101(6):475-80.

Naturopathic medicine and aboriginal health: an exploratory study at Anishnawbe Health Toronto.

Walji R, Weeks L, Cooley K, Seely D.


Department of Research & Clinical Epidemiology, The Canadian College of Naturopathic Medicine, Toronto, ON.


To explore the experiences and perceptions of providing and receiving naturopathic care within the Aboriginal community served by community health centre Anishnawbe Health Toronto.


This is an exploratory study using a descriptive qualitative approach to enable better understanding of the care provided to Aboriginal patients by naturopathic interns and clinician supervisors at Anishnawbe Health Toronto (AHT). We conducted semi-structured interviews with 3 naturopathic supervisors, 7 naturopathic interns, and 7 Aboriginal patients to gain an in-depth understanding of participants' experiences and perceptions of naturopathic medicine at AHT. We also conducted 3 confirmatory interviews with Naturopathic Doctors practicing in other Aboriginal communities.


Naturopathic medicine is perceived to fit with health care philosophies in Aboriginal communities, as it emphasizes spiritual, mental and emotional aspects of health. Specifically, strengths of naturopathic medicine within the Aboriginal community relate to the philosophical suitability of naturopathic medicine, the ability to meet a wide range of health needs, the lack of power imbalance in the patient-practitioner relationship, and the cultural sensitivity of the practitioners. While AHT is highly regarded by patients and practitioners, certain limitations at the local setting regarding privacy and inter-professional communication were evident. Further, to facilitate trust, naturopathic interns require enhanced training in specific health issues that face the Aboriginal population to allow them to better engage with the culture and practices of the Aboriginal community.


The naturopathic clinic at AHT contributes to positive patient outcomes and satisfaction and helps address unmet health needs in this population. Naturopathic medicine may be well suited to address Aboriginal health care needs through its holistic and respectful approach to care and a foundation of traditional knowledge and research evidence for treatment of a person's mind, body and spirit.

PMID: 21370784



J Womens Health (Larchmt). 2009 Aug;18(8):1133-43.

Preventive screening of women who use complementary and alternative medicine providers.

Downey L, Tyree PT, Lafferty WE.

Department of Health Services, School of Public Health and Community Medicine, University of Washington

BACKGROUND: Many women use complementary and alternative medicine (CAM). Although CAM use has been associated with reductions in conventionally recommended pediatric preventive care (e.g., vaccination), little is known about associations between CAM use and receipt of recommended preventive screening in women. METHODS: Using Washington State insurance data from 2000 to 2003, the authors generated clustered logistic regression models, examining associations between provider-based CAM use and receipt of screening tests for Chlamydia trachomatis, breast cancer, and cervical cancer: (1) contrasting women who used CAM providers only (alternative use) and women who used both conventional and CAM providers (complementary use) with women who used conventional care only and (2) testing associations between screening and use of four specific CAM provider types-naturopathic physicians, chiropractors, massage therapists, and acupuncturists. RESULTS: Both alternative and complementary use was associated with reduced Chlamydia screening. Cancer screening increased with complementary use but decreased with alternative use of CAM. Use of naturopathy was associated with decreased mammography, whereas all four CAM therapies were positively associated with Papanicolaou testing. CONCLUSIONS: When used in conjunction with conventional care, use of provider-based CAM may signal high interest in various types of health-promoting behavior, including cancer screening. Negative associations between CAM and Chlamydia screening and between naturopathy and mammography require additional study. Interventions with CAM providers and their patients, aimed at improving rates of conventionally recommended screening, might encourage greater focus on preventive care, an important task when CAM providers serve as women's only contact with the healthcare system.

PMID: 19630554



Vaccine. 2008 Jul 30.

Attitudes towards vaccination among chiropractic and naturopathic students.

Busse JW, Wilson K, Campbell JB.

Department of Clinical Epidemiology and Biostatistics, McMaster University

We have investigated the attitudes towards vaccination of undergraduate chiropractic and naturopathic students in the two major complementary and alternative medicine colleges in Canada. While the majority of the students were not averse to vaccination, we found in both colleges that anti-vaccination attitudes were more prevalent in the later years of the programs. Reasons for this are discussed, and we provide suggestions for strategies to address the situation.

PMID: 18674581



J Altern Complement Med. 2008 May;14(4):445-8.

Interest of naturopathic physicians in pediatric research.

Weber W, McCarty RL.

School of Naturopathic Medicine, Bastyr University

OBJECTIVES: Naturopathic physicians' interest in participating in pediatric observational studies or clinical trials is unknown. Complementary and alternative medicine research may need to be conducted in the settings where these therapies are commonly used to fully understand their effects. Optimally, naturopathic physicians will participate in the research of naturopathic medical practice. A survey was conducted to ascertain naturopathic physicians' interest in participating in pediatric research studies and characteristics of those most interested. DESIGN, SETTING, AND SUBJECTS: In July 2004, a survey designed to assess pediatric research interests and a one-dollar incentive was mailed to all Washington state-licensed naturopathic physicians with in-state mailing addresses (n = 513). A second survey and one-dollar incentive were sent to nonresponders in November 2004. Surveys were collected through January 2005. RESULTS: From the 499 surveys delivered as addressed, 251 completed surveys were returned (50.3%). Of the 204 naturopathic physicians in current practice who completed surveys, 59 (28.9%) indicated they would not recommend or advertise an observational, open-label, or placebo-controlled trial to their pediatric patients, and 85 (41.7%) indicated they had no interest in being involved with research studies themselves. Of the 204 respondents in practice, 83 (40.7%) would recommend placebo-controlled trials to their pediatric patients, and 52 (25.5%) were willing to recruit for such a trial in the office. CONCLUSIONS: Characteristics of naturopathic physicians most interested in active pediatric research involvement included fewer years in practice, greater number of pediatric patients treated per week, and having shared office space.

PMID: 18435598

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BMC Complement Altern Med. 2008 May 31;8:24.

Attitudes towards fibromyalgia: a survey of Canadian chiropractic, naturopathic, physical therapy and occupational therapy students.

Busse JW, Kulkarni AV, Badwall P, Guyatt GH; Medically Unexplained Syndromes Study Group.

Department of Clinical Epidemiology and Biostatistics, McMaster University

BACKGROUND: The frequent use of chiropractic, naturopathic, and physical and occupational therapy by patients with fibromyalgia has been emphasized repeatedly, but little is known about the attitudes of these therapists towards this challenging condition. METHODS: We administered a cross-sectional survey to 385 senior Canadian chiropractic, naturopathic, physical and occupational therapy students in their final year of studies, that inquired about attitudes towards the diagnosis and management of fibromyalgia. RESULTS: 336 students completed the survey (response rate 87%). While they disagreed about the etiology (primarily psychological 28%, physiological 23%, psychological and physiological 15%, unsure 34%), the majority (58%) reported that fibromyalgia was difficult to manage. Respondants were also conflicted in whether treatment should prioritize symptom relief (65%) or functional gains (85%), with the majority (58%) wanting to do both. The majority of respondents (57%) agreed that there was effective treatment for fibromyalgia and that they possessed the required clinical skills to manage patients (55%).Chiropractic students were most skeptical in regards to fibromyalgia as a useful diagnostic entity, and most likely to endorse a psychological etiology. In our regression model, only training in naturopathic medicine (unstandardized regression coefficient = 0.33; 95% confidence interval = 0.11 to 0.56) and the belief that effective therapies existed (unstandardized regression coefficient = 0.42; 95% confidence interval = 0.30 to 0.54) were associated with greater confidence in managing patients with fibromyalgia. CONCLUSION: The majority of senior Canadian chiropractic, naturopathic, physical and occupational therapy students, and in particular those with naturopathic training, believe that effective treatment for fibromyalgia exists and that they possess the clinical skillset to effectively manage this disorder. The majority place high priority on both symptom relief and functional gains when treating fibromyalgia.

PMID: 18513441

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Complement Ther Clin Pract. 2008 May;14(2):98-104. Epub 2008 Jan 4.

Survey of parents on the use of naturopathic medicine in children--characteristics and reasons.

Leung B, Verhoef M.

Department of Community Health Sciences, University of Calgary

This cross-sectional study assessed the sociodemographic characteristics of families whose children used naturopathic medicine, the reasons for use, and whether naturopathic and conventional medicine were combined in treating children's conditions. Data were collected in British Columbia, Alberta and Ontario, Canada. Ninety-eight completed questionnaires were analyzed. The results showed that participants (parents) were most likely to be females, university educated, had household income >$60,000, and also saw a naturopathic doctor for themselves. The most common conditions for which children saw a naturopathic doctor included allergies, digestive problems and skin problems, and the most important reasons for use included using all possible options and having a more holistic approach to care. Most parents reported combining naturopathic and conventional care for their children. Study limitations, in particular, selection bias, were discussed.

PMID: 18396253



Pediatrics. 2007 Jul;120(1):e142-6.

Frequency and characteristics of pediatric and adolescent visits in naturopathic medical practice.

Weber W, Taylor JA, McCarty RL, Johnson-Grass A.

School of Naturopathic Medicine, Bastyr University

OBJECTIVES: This work sought to identify naturopathic physicians in Washington State who frequently provide pediatric care and to describe the conditions treated and therapies recommended for children. PATIENTS AND METHODS: A mailed survey of licensed naturopathic physicians residing in Washington State collected demographic information and practice descriptions. For naturopathic physicians treating > or = 5 pediatric patients per week, data were collected on the conditions seen and treatments provided to children during a 2-week period. RESULTS: Of 499 surveys delivered to providers, 251 surveys were returned (response rate: 50.3%). Among the 204 naturopathic physicians currently practicing, only 31 (15%) saw > or = 5 children per week. For these pediatric naturopathic physicians, pediatric visits constituted 28% of their office practice. Pediatric naturopathic physicians were more likely to be licensed midwives (19.4% vs 0.6%) and treated significantly more patients per week (41.6 vs 20.2) than naturopathic physicians who provided less pediatric care. Eighteen of the 31 pediatric naturopathic physicians returned data on 354 pediatric visits; 30.5% of the visits were by children < 2 years old, and 58.5% were by those < 6 years old. The most common purpose for presentation included health supervision visits (27.4%), infectious disease (20.6%), and mental health conditions (12.7%). Pediatric naturopathic physicians provided immunizations during 18.6% of health supervision visits by children < 2 years old and 27.3% of visits by children between the ages of 2 and 5 years. CONCLUSIONS: Although most naturopathic physicians in Washington treat few children, a group of naturopathic physicians provide pediatric care as a substantial part of their practice. Based on the ages of children seen and the conditions treated, pediatric naturopathic physicians may provide the majority of care for some children. Efforts should be made to enhance collaboration between naturopathic physicians and conventional providers so that optimal care can be provided to children.

PMID: 17606541

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Soc Sci Med. 2006 Jul;63(2):409-17. Epub 2006 Feb 17.

The scope of naturopathic medicine in Canada: an emerging profession.

Verhoef MJ, Boon HS, Mutasingwa DR.

Department of Community Health Sciences, The University of Calgary, Alta., Canada.

In Canada, naturopathic medicine is an emerging profession that is gaining formal recognition, including provincial/territorial regulation. While naturopathic medicine has undergone significant growth and legitimization, it still faces substantial challenges to acceptance as a full-fledged health care profession within the Canadian health care system. For example, professionalization theories indicate the importance of clear professional boundaries as well as the need for 'new' groups to find a place in the system of professions. This has been problematic for naturopathic practitioners who continue to practice within a broad scope of practice that encompasses many different therapeutic modalities. Development of statutory regulation also requires delineation of a specific, well-defined scope of practice. The purpose of this study was to describe naturopathic practitioners' perception of their training and their current scope of practice. Two thirds (n = 315) of all licensed Canadian naturopathic practitioners responded to the survey. The results showed that naturopathic practitioners are trained in, and practice, a wide range of therapeutic modalities and diagnostic procedures. Practitioners disagreed about their scope of practice, as 57% thought it was too restrictive, 31% felt it was about right and 13% thought it was too broad. A large majority felt there was some or a great deal of overlap with other practitioners' scope of practice. We conclude that multiple challenges are facing naturopathic medicine, including scope of practice, overlap with other professions, social closure, scarcity of vacancies and lack of cohesion. The future of naturopathic medicine will depend on how effectively the profession will use available strategies to overcome barriers to statutory self-regulation.

PMID: 16487639



J Altern Complement Med. 2006 Jan-Feb;12(1):71-7.

Complementary and alternative provider use by insured patients with diabetes in Washington State.

Lind BK, Lafferty WE, Grembowski DE, Diehr PK.

Department of Health Services, University of Washington

OBJECTIVES: The authors investigated whether insurance coverage for complementary and alternative medicine (CAM) providers is associated with increased medical care use among diabetes patients. Predictors of CAM use and how CAM affects health care use and expenditures under insurance coverage were examined. DESIGN: Claims data from two large insurers in Washington State were obtained for 2002. Types of providers used, comorbid medical conditions, number of visits, and expenditures were calculated for the study sample and compared to a nondiabetic matched group. RESULTS: Of the 20,722 adults with diabetes, 3605 (17.4%) had one or more visits to any licensed CAM provider (mostly chiropractors). This was lower than the 20% CAM use in the comparison group. Diabetes patients who used CAM were more likely to have multiple other medical problems than CAM nonusers. CAM users had a higher average number of annual outpatient visits compared to nonusers (28 versus 16), and higher average annual expenditures (8,736 dollars versus 7,356 dollars); however, after adjustment for disease load and other factors, CAM use was not a significant predictor of expenditures. CAM use was <2% of the overall mean medical expenditures for diabetes patients. Quality of conventional care was similar for CAM users and nonusers. CONCLUSIONS: CAM provider usage when covered by insurance is lower among diabetes patients than in adults without diabetes and represents a small proportion of diabetes care costs. Very few CAM visits were related directly to diabetes care. CAM-using patients often have heavy disease burdens and high total expected resource use compared to those not using CAM.

PMID: 16494571



Nutr J. 2005 Jan 26;4:3.

The treatment of migraines and tension-type headaches with intravenous and oral niacin (nicotinic acid): systematic review of the literature.

Prousky J, Seely D.

The Canadian College of Naturopathic Medicine

BACKGROUND: Migraine and tension-type headaches impose a tremendous economic drain upon the healthcare system. Intravenous and oral niacin has been employed in the treatment of acute and chronic migraine and tension-type headaches, but its use has not become part of contemporary medicine, nor have there been randomized controlled trials further assessing this novel treatment. We aimed to systematically review the evidence of using intravenous and/or oral niacin as a treatment for migraine headaches, tension-type headaches, and for headaches of other etiologic types. METHODS: We searched English and non-English language articles in the following databases: MEDLINE (1966-February 2004), AMED (1995-February 2004) and Alt HealthWatch (1990-February 2004). RESULTS: Nine articles were found to meet the inclusion criteria and were included in this systematic review. Hypothetical reasons for niacin's effectiveness include its vasodilatory properties, and its ability to improve mitochondrial energy metabolism. Important side effects of niacin include flushing, nausea and fainting. CONCLUSION: Although niacin's mechanisms of action have not been substantiated from controlled clinical trials, this agent may have beneficial effects upon migraine and tension-type headaches. Adequately designed randomized trials are required to determine its clinical implications.

PMID: 15673472

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J Altern Complement Med. 2004 Dec;10(6):1001-8.

The effect of mandating complementary and alternative medicine services on insurance benefits in Washington State.

Watts CA, Lafferty WE, Baden AC.

Department of Health Services, University of Washington

OBJECTIVES: Washington was the first state to require insurance companies to cover all categories of licensed providers. The purpose of this paper was to examine the effect of Washington's law on coverage decisions of major health plans. DESIGN: The study uses literature and document review as well as key informant interviews. SETTINGS/LOCATION: The study focuses on legislation and other legal activity in the state of Washington. The key informant interviews are focused on the decisions of three major health plans. RESULTS: Although the law had a major effect on complementary and alternative medicine (CAM) coverage in Washington, the impact on the use of CAM services and expenditures has been bounded by changing market forces. CONCLUSIONS: CAM providers face scientific tests of measurable efficacy and market tests of consumer value. In this economic environment, CAM stakeholders will have to work hard to maintain their political gains.

PMID: 15673994



J Altern Complement Med. 2004 Oct;10(5):891-7.

Complementary and alternative medicine in multiple sclerosis: survey of licensed naturopaths.

Shinto L, Calabrese C, Morris C, Sinsheimer S, Bourdette D.

Oregon Health & Science University

OBJECTIVE: This paper describes the treatments and treatment outcome measures used by licensed naturopathic physicians in the United States who treat people with multiple sclerosis (MS). DESIGN: A cross-sectional mail survey was used. SUBJECTS: The participants were licensed naturopaths who were members of the American Association of Naturopathic Physicians. OUTCOME MEASURES: Outcome measures included practitioner demographics; patient demographics by practitioner report; recommended therapies; perceived effectiveness of treatments for MS; methods for measuring treatment effectiveness. RESULTS: Forty three percent (43%) of the respondents (166/385) had treated at least one patient with MS while 56.9% (291/385) had never treated MS. 63.3% had treated 1-10 patients with MS, 19.9% had treated 11-20 patients with MS, and 16.8% had treated > or =20 patients with MS. Among the naturopaths, 68.1% communicated with an M.D. about their patient(s)' care and the majority of patients with MS were diagnosed by an M.D. (mean % = 96.3). The mean number of therapies recommended for M.S. was 3.91 (standard deviation [SD] =2.01, range 1-10). The most frequently recommended therapies included, diet (52.4%), essential fatty acid supplementation (44.6%), vitamin/mineral supplementation (33.7%), homeopathy (30.7%), botanicals (22.3%), and antioxidants (18.1%). Respondents perceived their treatments as "very effective" for the following stages of MS: early stage (57.2%); middle stage (25.3%); and late stage (3.0%). Respondents perceived their treatments as "very effective" for the following disease-related outcomes: improved quality of life (59.0%); decrease relapse rates (48.2%); decreased symptom severity (45.8%); prevention of disease progression (41.6%). The methods used "most often" for measuring treatment effectiveness included, patient report (88.0%); physical examination (27.1%); medical records/laboratory testing (13.3%). The mean estimated percentage of patients not taking conventional disease-modifying medication was 51.2% (SD = 42.7%). CONCLUSIONS: Naturopaths use both a broad range and multiple complementary and alternative medicine CAM therapies for treating MS and report treatment effectiveness on the following outcomes: quality of life; symptom severity; relapse rates; and disease progression. Further research on single CAM therapies and holistic CAM systems is warranted in MS.

PMID: 15650479



BMC Complement Altern Med. 2004 Oct 20;4:14.

Practice patterns of naturopathic physicians: results from a random survey of licensed practitioners in two US States.

Boon HS, Cherkin DC, Erro J, Sherman KJ, Milliman B, Booker J, Cramer EH, Smith MJ, Deyo RA, Eisenberg DM.

University of Toronto

BACKGROUND: Despite the growing use of complementary and alternative medicine (CAM) by consumers in the U.S., little is known about the practice of CAM providers. The objective of this study was to describe and compare the practice patterns of naturopathic physicians in Washington State and Connecticut. METHODS: Telephone interviews were conducted with state-wide random samples of licensed naturopathic physicians and data were collected on consecutive patient visits in 1998 and 1999. The main outcome measures were: Sociodemographic, training and practice characteristics of naturopathic physicians; and demographics, reasons for visit, types of treatments, payment source and visit duration for patients. RESULT: One hundred and seventy practitioners were interviewed and 99 recorded data on a total of 1817 patient visits. Naturopathic physicians in Washington and Connecticut had similar demographic and practice characteristics. Both the practitioners and their patients were primarily White and female. Almost 75% of all naturopathic visits were for chronic complaints, most frequently fatigue, headache, and back symptoms. Complete blood counts, serum chemistries, lipids panels and stool analyses were ordered for 4% to 10% of visits. All other diagnostic tests were ordered less frequently. The most commonly prescribed naturopathic therapeutics were: botanical medicines (51% of visits in Connecticut, 43% in Washington), vitamins (41% and 43%), minerals (35% and 39%), homeopathy (29% and 19%) and allergy treatments (11% and 13%). The mean visit length was about 40 minutes. Approximately half the visits were paid directly by the patient. CONCLUSION: This study provides information that will help other health care providers, patients and policy makers better understand the nature of naturopathic care.

PMID: 15496231

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Gen Hosp Psychiatry. 2004 May-Jun;26(3):171-7.

Mental health visits to complementary and alternative medicine providers.

Simon GE, Cherkin DC, Sherman KJ, Eisenberg DM, Deyo RA, Davis RB.

Center for Health Studies, Group Health Cooperative

The objective of this study was to examine the characteristics of mental health visits to Complementary and Alternative Medicine (CAM) providers. A representative sample of acupuncturists, chiropractors, massage therapists, and naturopathic physicians in four states reported on 8933 consecutive visits, including demographic characteristics; presenting complaints; referral source; treatments provided; disposition; and other sources of care for the presenting problem. The proportion of visits for a mental health complaint ranged from 7% to 11% for acupuncture, massage, and naturopathic physicians to less than 1% for chiropractors. For acupuncturists, massage therapists, and naturopaths, 69-87% of patients making mental health visits were self-referred. The CAM provider discussed care with a conventional medical provider in 6-20% of cases and was aware of concomitant conventional medical care in an additional 10-30%. Only 1-5% were subsequently referred to conventional providers. For acupuncturists, massage therapists, and naturopaths, the proportion of visits for mental health concerns is similar to that in conventional primary care. Mental health visits to chiropractors are much less common, but this may reflect differences in true prevalence or differences in presentation. Among those seeking CAM care for mental disorders, concomitant treatment by conventional medical providers is common, but communication or coordination of care is rare.

PMID: 15121344



Cancer. 2004 Apr 1;100(7):1522-30.

The use of complementary and alternative medical providers by insured cancer patients in Washington State.

Lafferty WE, Bellas A, Corage Baden A, Tyree PT, Standish LJ, Patterson R.

Department of Health Services, University of Washington

BACKGROUND: Insurance coverage of complementary and alternative medicine (CAM) is expanding. However, to the authors' knowledge, little is know concerning CAM utilization among cancer patients under the insurance model of financing. In this study, the authors evaluated CAM provider utilization by cancer patients in a state that requires the inclusion of alternative practitioners in private, commercial insurance products. METHODS: An analysis was carried out of year 2000 claims data from two large Washington State insurance companies. RESULTS: Of 357,709 claimants, 7915 claimants (2.3%) had a cancer diagnosis. Among cancer patients, 7.1% had a claim for naturopathy, acupuncture, or massage; and 11.6% had a claim for chiropractic during the study year. The use of naturopathy (odds ratio [OR], 2.0; P<0.001) and acupuncture (OR, 1.4; P<0.001) were more common, and the use of chiropractic was less common (OR, 0.9; P<0.001) for cancer patients compared with those without cancer. No significant differences were noted in the use of massage between the two groups. Except in 2 individuals (0.03%), cancer patients also had at least 1 conventional provider claim during the year. Factors associated with nonchiropractic alternative provider use were female gender, the presence of metastatic cancer, hematologic malignancy, and the use of chemotherapy. Increased use of naturopathic physicians accounted for much of this trend. Musculoskeletal pain was the most common diagnosis at the CAM provider visit. Billed amounts for alternative services were <2% of the overall medical bills for cancer patients. CONCLUSIONS: A substantial number of insured cancer patients will use alternative providers if they are given the choice. The cost of this treatment is modest compared with conventional care charges. For individuals with cancer, CAM providers do not appear to be replacing conventional providers but instead are integrated into overall care. Copyright 2004 American Cancer Society.

PMID: 15042688



Can Fam Physician. 2003 Nov;49:1481-7.

Visiting family physicians and naturopathic practitioners. Comparing patient-practitioner interactions.

Boon H, Stewart M, Kennard MA, Guimond J.

Faculty of Pharmacy, University of Toronto

OBJECTIVE: To explore similarities and differences in patient visits with family physicians (FPs) and naturopathic practitioners (NPs). DESIGN: Exploratory study combining quantitative and qualitative methods. SETTING: Southern Ontario. PARTICIPANTS: A purposeful sample of 10 practitioners (five FPs and five NPs matched for age, sex, and number of years in practice): each agreed to recruit three consecutive patients with new complaints to participate in the study. MAIN OUTCOME MEASURES: Patient and visit characteristics; qualitative (content analysis of audiotaped interactions) and quantitative (ie, patient-centred care scores) information was gathered and analyzed. RESULTS: Qualitative analysis revealed that information gathering and treatment planning were very similar whether patients were visiting FPs or NPs. Most important differences were length of interaction (mean 54 minutes for NPs and 16.5 minutes for FPs) and patients' reasons for visits. Naturopathic practitioners were more likely to recommend medications (usually natural health products) than FPs. Quantitative data suggested that patients perceived no differences in patient-centred care from FPs and NPs. CONCLUSION: Overall, there were more similarities than differences in visits to the two types of practitioners.

PMID: 14649987

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J Am Board Fam Pract. 2002 Nov-Dec;15(6):463-72.

Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians.

Cherkin DC, Deyo RA, Sherman KJ, Hart LG, Street JH, Hrbek A, Davis RB, Cramer E, Milliman B, Booker J, Mootz R, Barassi J, Kahn JR, Kaptchuk TJ, Eisenberg DM.

Center for Health Studies, Group Health Cooperative

BACKGROUND: Despite growing popularity of complementary and alternative medical (CAM) therapies, little is known about the patients seen by CAM practitioners. Our objective was to describe the patients and problems seen by CAM practitioners. METHODS: We collected data on 20 consecutive visits to randomly sampled licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians practicing in Arizona, Connecticut, Massachusetts, and Washington. Data were collected on patient demographics, smoking status, referral source, reasons for visit, concurrent medical care, payment source, and visit duration. Comparative data for conventional physicians were drawn from the National Ambulatory Medical Care Survey. RESULTS: In each profession, at least 99 practitioners collected data on more than 1,800 visits. More than 80% of visits to CAM providers were by young and middle-aged adults, and roughly two thirds were by women. Children comprised 10% of visits to naturopathic physicians but only 1% to 4% of all visits to other CAM providers. At least two thirds of visits resulted from self-referrals, and only 4% to 12% of visits were from conventional physician referrals. Chiropractors and massage therapists primarily saw musculoskeletal problems, while acupuncturists and naturopathic physicians saw a broader range of conditions. Visits to acupuncturists and massage therapists lasted about 60 minutes compared with 40 minutes for naturopathic physicians and less than 20 minutes for chiropractors. Most visits to chiropractors and naturopathic physicians, but less than one third of visits to acupuncturists and massage therapists, were covered by insurance. CONCLUSIONS: This information will help inform discussions of the roles CAM practitioners will play in the health care system of the future.

PMID: 12463292



J Am Board Fam Pract. 2002 Sep-Oct;15(5):378-90.

Characteristics of licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians.

Cherkin DC, Deyo RA, Sherman KJ, Hart LG, Street JH, Hrbek A, Cramer E, Milliman B, Booker J, Mootz R, Barassi J, Kahn JR, Kaptchuk TJ, Eisenberg DM.

Center for Health Studies, Group Health Cooperative

BACKGROUND: Despite the growing popularity of complementary and alternative medical (CAM) therapies, little is known about the professionals who provide them. Our objective was to describe the characteristics of the four largest groups of licensed CAM providers in the United States and to compare them with the characteristics of conventional physicians. METHODS: Random statewide samples of licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians living in Arizona, Connecticut, Massachusetts and Washington were interviewed by telephone. Sociodemographic, training, and practice characteristics of CAM providers were elicited and compared with data on conventional physicians published by the American Medical Association. RESULTS: More than 160 providers in each profession were interviewed. Participation rates ranged between 78% and 94% except for Arizona chiropractors (61%). The proportion of female respondents was highest for massage therapy (85%) and acupuncture and naturopathy (almost 60%) and was lowest for chiropractic (about 25%) and conventional medicine (23%). Except for acupuncturists, only 5% of CAM providers were nonwhite. CAM providers were more likely than conventional physicians to practice solo (51%-74% vs 26%, respectively), and less than 10% practiced with medical physicians. Massage therapists saw the fewest patients per week (about 14), and chiropractors and conventional physicians the most (about 100). Chiropractors and conventional physicians saw about 3 patients per hour compared with roughly 1 patient per hour for the other CAM professions. Interstate differences were small. CONCLUSIONS: This characterization of CAM providers will help inform decisions about the future role of CAM providers PMID: 12350060

PMID: 12350060



Altern Ther Health Med. 2002 Sep-Oct;8(5):68-70; 72-5.

Complementary and alternative medical treatment of breast cancer: a survey of licensed North American naturopathic physicians.

Standish LJ, Greene K, Greenlee H, Kim JG, Grosshans C.

Bastyr University Research Institute

CONTEXT: Complementary and alternative medicine (CAM) use is on the rise in the United States, especially for breast cancer patients. Many CAM therapies are delivered by licensed naturopathic physicians using individualized treatment plans. OBJECTIVE: To describe naturopathic treatment for women with breast cancer. DESIGN: Cross-sectional mail survey in 2 parts: screening form and 13-page survey. SETTING: Bastyr University Cancer Research Center, Kenmore, Wash. PARTICIPANTS: All licensed naturopathic physicians in the United States and Canada (N=1,356) received screening forms; 642 (47%) completed the form. Of the respondents, 333 (52%) were eligible, and 161 completed the survey (48%). MAIN OUTCOME MEASURES: Demographics of naturopathic physicians, development of treatment plans, CAM therapies used, perceived efficacy of therapeutic interventions. RESULTS: Of those respondents screened, 497 (77%) had provided naturopathic care to women with breast cancer, and 402 (63%) had treated women with breast cancer in the previous 12 months. Naturopaths who were women were more likely than men to treat breast cancer (P < or = .004). Of the survey respondents, 104 (65%) practiced in the United States, and 57 (35%) practiced in Canada; 107 (66.5%) were women, and 54 (33.5%) were men. To develop naturopathic treatment plans, naturopathic physicians most often considered the stage of cancer, the patient's emotional constitution, and the conventional therapies used. To monitor patients clinically, 64% of the naturopathic physicians used diagnostic imaging, 57% considered the patient's quality of life, and 51% used physical examinations. The most common general CAM therapies used were dietary counseling (94%), botanical medicines (88%), antioxidants (84%), and supplemental nutrition (84%). The most common specific treatments were vitamin C (39%), coenzyme Q-10 (34%), and Hoxsey formula (29%).

PMID: 12233805



Focus Altern Complement Ther 2002; 7: 114

The scope of naturopathic practice: an emerging profession

Verhoef MJ, Boon HS, Smith M, Mutasingwa DR

Faculty of Medicine, University of Calgary

Objective: A specific challenge to the professionalisation of naturopathic practitioners is the degree of overlap between their practice and the practice of other therapists. Therefore, we examined naturopathic practitioners’ perspectives and opinions about their scope of practice. Materials and methods: A survey of all (473) licensed naturopathic practitioners in Canada. Data were collected by means of a seven-page mailed questionnaire. Results: The response rate was 63%; 41% were male and the mean age was 42 years (SD 10.9 years). Ninety-seven per cent were in active clinical practice. The most common health problems seen by participants were gastrointestinal complaints, women’s health issues, fatigue and allergies. Out of a list of 35 treatment modalities, 23 were practised by more than 30% of respondents (most commonly botanical medicine, homoeopathy, nutritional counselling and supplementation, and psychological counselling). Seventy-five per cent indicated there were modalities other than the 35 listed that they would like to be able to offer their patients, 56% felt that the scope of practice for naturopathic doctors was too restrictive and 92% identified overlap with the practice of other practitioners. More than 90% of respondents referred to MDs, chiropractors, massage therapists and other naturopathic practitioners.

Discussion: Naturopathic practitioners often deal with chronic, difficult-to-treat conditions, which require multiple modalities. While respondents appeared to be open to referring to other professionals, they generally felt that their scope of practice was too limited. This may pose a major problem in the process of professionalisation, as this type of practice is difficult to codify when seeking regulation.

PMID: 16487639



Can J Clin Pharmacol. 2000 Spring;7(1):45-9.

Attitudes and practices of physicians and naturopaths toward herbal products, including use during pregnancy and lactation.

Einarson A, Lawrimore T, Brand P, Gallo M, Rotatone C, Koren G.

The Motherisk Program, The Hospital for Sick Children, Toronto, Canada.

BACKGROUND: The popularity of complementary therapies continues to grow, and physicians are asked increasingly by their patients for information regarding these modalities. PURPOSE: To assess the impact of these trends on physicians and medical students, and compare their attitudes and practices with those of the naturopaths and their students, with particular interest in the use of herbal products during pregnancy and breastfeeding. MATERIALS AND METHODS: A detailed questionnaire was distributed by a medical student and a naturopathic student to a randomly selected group of physicians, medical students, naturopaths and naturopathic students. They were asked a variety of questions about their background, attitudes and practices concerning herbal products. RESULTS: Thirty-eight per cent of the questionnaires were returned, with a total of 242 respondents. Fifty-four per cent of physicians discussed complementary therapies with their patients, whereas 100% of naturopaths discussed conventional medicines with their patients. The most popular product recommended by both medical doctors and naturopaths was echinacea, followed by St John's Wort. Eighty-six per cent of physicians, 74% of medical students, 66% of naturopaths and 50% of naturopathic students think that complementary medical education should be incorporated into the standard medical curriculum. Only one physician actually recommended a herbal product to a pregnant patient compared with 49% of the naturopaths who felt comfortable doing so. CONCLUSIONS: Complementary medicine has become a reality, and physicians are recommending herbal products to their patients, although on a smaller scale than are naturopaths. However, the two most popular herbal products are the same in each group. Physicians are less likely to recommend herbal products to pregnant and breastfeeding women than are naturopaths.

PMID: 10822213



Arch Pediatr Adolesc Med. 2000 Jan;154(1):75-80.

Homeopathy and naturopathy: practice characteristics and pediatric care.

Lee AC, Kemper KJ.

Center for Holistic Pediatric Education and Research, Children's Hospital, Harvard Medical School

OBJECTIVE: To describe the practice characteristics and pediatric care of homeopathic practitioners (HPs) and naturopathic doctors (NDs). DESIGN: Cross-sectional, descriptive survey. SETTING: Homeopathic and naturopathic practices in Massachusetts. PARTICIPANTS: Homeopathic practitioners (N = 42) and NDs (N = 23) identified from the yellow pages, regional and national society membership lists, schools, magazine advertisements, and by word-of-mouth. The response rate was 55% (23/42) for HPs and 65% (15/23) for NDs. MAIN OUTCOME MEASURES: Demographics, practice characteristics, fee structure, and amount of pediatric care. Practitioners were asked for their approach to childhood immunizations and to treating a febrile neonate. Data were analyzed using simple descriptive statistics. RESULTS: Almost all respondents were white. Among the HPs, 13 (57%) were licensed medical doctors. Naturopathic doctors and HPs reported having an average of only 25 to 40 patient visits per week, but children and adolescents accounted for up to one third of these visits. Nearly all reported treating children, but fewer than half of the practitioners reported any formal pediatric training. Initial patient visits typically lasted more than 1 hour and cost $140 to $150. Follow-up visits were scheduled every 4 to 6 weeks and lasted more than 30 minutes on average. Insurance covered less than one third of the patient visits, and sliding scale payments were offered by less than half of the respondents. Most practitioners reported that they did not actively recommend immunizations and fewer than half of the nonphysician practitioners reported that they would refer a 2-week-old neonate with a fever to a medical doctor or emergency medical facility. CONCLUSIONS: Many patients using homeopathy and naturopathy are children. Visits to these providers are frequent and fees are primarily paid out-of-pocket. Failure on the part of these providers to recommend immunizations or recognize potentially serious illnesses is cause for concern.

PMID: 10632255

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Cancer Prev Control. 1999 Feb;3(1):77-82.

Complementary health practitioners' attitudes, practices and knowledge related to women's cancers.

Gray RE, Fitch M, Saunders PR, Wilkinson A, Ross CP, Franssen E, Caverhill K.

Toronto-Sunnybrook Regional Cancer Centre

OBJECTIVE: To document the attitudes, practices and knowledge of 3 groups of complementary practitioners (naturopathic doctors, chiropractors and massage therapists) regarding women's cancers in general and ovarian cancer specifically. DESIGN: A mailed survey questionnaire was followed by a reminder card and a second mailing of the questionnaire. SETTINGS: National samples were obtained for naturopathic doctors and chiropractors. The massage therapist sample was drawn from Ontario only because of the absence of a national listing of massage therapists. MAIN OUTCOME MEASURES: Practitioners reported response to patients' suspicious symptoms. Practitioners' perceptions of patients' motivations for seeking treatment. Practitioners' satisfaction with interactions with conventional practitioners. Practitioners' perceptions of their role in the care of women at risk of, or diagnosed with, cancer. Practitioners' perceptions of their knowledge regarding women's cancers. Practitioners' knowledge specific to ovarian cancer. RESULTS: A total of 894 completed questionnaires were returned, providing a response rate of 56%. The vast majority of practitioners who saw women with symptoms possibly related to cancer referred them to a family physician or a cancer specialist. Motivations that practitioners most frequently heard expressed by women seeking complementary treatments were "maximizing quality of life," "seeking natural approaches to healing" and "looking to stay well when disease is in remission." Most respondents were dissatisfied with patient-related communication with both family physicians and cancer specialists. The majority of complementary practitioners indicated that they have an important role to play in the postdiagnostic care of women with cancer. Considerable interest was expressed in further education concerning ovarian cancer. CONCLUSIONS: Whereas the professions reached through this survey differ in important ways from each other, they share an interest in being involved in the care of women with cancer, as well as an enthusiasm for the development of continuing professional education programs to help them better serve their clients.

PMID: 10474756



Soc Sci Med. 1998 May;46(9):1213-25.

Canadian naturopathic practitioners: holistic and scientific world views.

Boon H.

Faculty of Pharmacy, University of Toronto

This paper describes naturopathic practitioners with two different world views--holistic and scientific, and explores the relationship of practitioners' socialization experiences and practice patterns with these two world views. Data were gathered by a variety of methods including: (1) a 14-page questionnaire mailed to all 296 naturopathic practitioners licensed in Canada; (2) a participant observation study at the Canadian College of Naturopathic Medicine (CCNM); and (3) open-ended interviews with 16 students attending CCNM and 41 naturopathic practitioners which were audio-taped and transcribed verbatim. Individuals with both holistic and scientific world views entered naturopathic training and none of the practitioners who were interviewed reported a change in world view while at naturopathic college. However, practitioners reported a new-found appreciation of the "other" world view on completion of their training, indicating the occurrence of a socialization effect. Many decisions involved in setting up a practice and seeing patients were affected by the practitioners' world views. For example, there were distinct differences in the way the practitioners with different world views who were interviewed chose treatment modalities. Practitioners with scientific world views reported choosing treatments based on the available "scientific evidence", while practitioners with holistic world views included a careful exploration of the patient's spirituality and their own intuition in their treatment decisions. In addition, practitioners with holistic world views reported significantly longer patient visits than practitioners with scientific world views. The data presented here suggest that one's world view influences one's perceptions of socialization experiences and social situations, and modulates the effects of both on practice patterns.

PMID: 9572611





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Naturopathic medicine is an important laboratory of integrative, complementary and alternative medicine (CAM) research because of the breadth of the practice, its holistic philosophy inclusive of important CAM approaches, and its capacity to interface with conventional medicine in common physiological and psychological outcome measures.  Its practitioners are trained in basic medical sciences and communicate with scientific colleagues interprofessionally.  There is a growing cadre of cross-trained naturopathic physician-researchers.

Given its theoretical foundations and the reality of daily practice, it is challenging to study naturopathic practice in ways which do not distort it or violate its principles to the point of possibly rendering it apparently ineffective.  These problems have been addressed in the Naturopathic Medical Research Agenda (1) and several book chapters (2,3,4).  Biomedical research standards considered the gold standard by the scientific community, notably single agent randomized controlled trials, have typically been developed to provide reliable data on a single therapeutic intervention for a single disease.  These methods have not been designed to assess multifactorial whole practice approaches to disease or to evaluating the support of overall health.  As a result, research using these methods does not fully evaluate naturopathic medicine as practiced. More fundamentally, naturopathic medicine, in common with other complementary and alternative health disciplines, is already extensively used in the community, thus is not most efficiently assessed by the pharmaceutical research and development model which begins with basic sciences to identify mechanisms as drug targets and with therapeutic candidates being evaluated in animals before safety and efficacy studies in humans.  Rather, its use in the community suggests a reversal of this process, with effectiveness being determined in the clinical practice and then disassembling the practice into components for exploration of mechanism.  Health services research has been suggested as appropriate to natural medicine assessment(5) but has its own limitations(6).  Some studies have been done to describe and evaluate naturopathic whole practice and its outcomes and others are currently underway.  There has been little study of overall safety and the fit of naturopathic physicians in the larger health care system. In addition to whole practice studies, many components of care as understood by naturopathic clinicians have been explored by naturopathic physician-scientists.

Studies cited in the collections linked below are those specific to naturopathic medicine (distinguished from other CAM practices) that have been done in the US and Canada with reviews of the international literature to be added at a later date. Our intent is that the studies listed here are either based on original data or analyses or are systematic reviews.  Literature reviews without an identified methodology may be separately categorized at a later date.

The collections are an ongoing effort.  Notice of studies that fit our inclusion criteria but that do not appear here are welcome.

  1. Standish L, C Calabrese, P Snider.  The Naturopathic Medical Research Agenda.  Bastyr University Press, 2005. 
  2. Calabrese C.  Assessing the effectiveness of Naturopathic Medicine.  In: Complementary Medicine in Clinical Practice.  Eds: D Rakel, N Faass.  Jones and Bartlett, 2006
  3. Calabrese C.  Research in Natural Medicine.  In:  The Textbook of Natural Medicine, 3rdEd.  Eds:  J Pizzorno, M Murray.  Elsevier,  2006.
  4. Calabrese, C.  Clinical Research Methods in Naturopathic Medicine.  In Clinical Research in Complementary and Alternative Medicine; G Lewith, W Jonas, H Walach, eds; Churchill Livingstone, 2001.
  5. Herman PM, D'Huyvetter K, Mohler MJ. Are health services research methods a match for CAM? AlternTherHealth Med. 2006 May-Jun;12(3):78-83.
  6. Coulter ID, Khorsan R.  Is health services research the Holy Grail of complementary and alternative medicine research? AlternTherHealth Med. 2008 Jul-Aug;14(4):40-5.
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The listing here is of surveys of naturopathic physicians or patients on topics relevant to naturopathic medicine.  The surveys here are currently active.  The listing may be incomplete; if you know of other active or imminent survey data collection relevant to naturopathic medicine, please contact the NPRI Executive Director to have the survey listed here.


The Naturopathic Physician-guided Research Survey (PGRS)

NDPartner a student group at National College of Natural Medicine with mentoring by C Calabrese is surveying the naturopathic profession in the US and Canada as to research interests and involvement, research capacities and practice characteristics.  NDPartner's members are Dana Waichunas (now Dr. Waichunas), Ann Thiel, Renae Rogers, Jamie Fields, Alana Peters, and Casey Carpenter.  The survey is being issued in phases.  Over 1000 NDs in Oregon and Washington have been solicited for participation with a 22% response rate.  Preliminary results have been presented at research conferences.  If you are a licensed naturopathic physician in the states of Alaska, Arizona, California, Hawaii, Montana, Oregon, Washington and would like to participate in the survey, please contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


Knowledge, Attitudes, and Personal Health Practices of Naturopathic Physicians in Practice and Training

This study is a survey of practicing NDs and ND students investigating health promotion and prevention both personally and professionally. Participants complete an anonymous one-time survey about their own health and their practice/training in health promotion and prevention topics. To participate in this collaboration with Bastyr University and the University of British Columbia, please click here. For more information, contact Dr. Oberg at 425 602 3267 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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The clinical encounter between the patient and the doctor is the heart of all medicine. Case reports provide a unique glimpse into the experience of of the patient and the interaction of the patient and doctor. It is also a rich source of information that can be used to improve healthcare.   The NPRI solicits, collects and analyzes case reports from naturopathic clinicians, and we invite you to submit case reports from your practice to the Naturopathic Physicians Case Reports database. 

A case report (or case study) is the whole picture of one case over time beginning with the patient's presentation, the treatment and outcome, a summary of the doctor’s and patient’s experience over a course of care. It may illustrate an exceptional outcome, a classical presentation, a unique event, or illustrate a clinical point. Case reports can show a therapeutic approach and help other providers understand what they might expect if they follow the same protocol. For more on naturopathic case report writing, see this article by Leung and Seely (2009).  Case reports can be strengthened by including the patient's comments on the events reported.

To submit a case report, click here to complete and upload the submission form to the Case Report system. You may return to the same form to complete later from the same computer and browser with which you started the case report by clicking again on the link in the previous sentence.  Cookies must be enabled for return to the form.

To download a copy of the same form as a word processor worksheet to allow you prepare and review your case submission information off line before submitting, click here

 Thank you for your commitment to documentation and study in the practice of naturopathic medicine.  If you have comments on improving our system of case reporting or the data fields in the form, please let us know by emailing the This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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