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After experiencing blurry vision and excessive thirst, Mr. R visits his primary care doctor, who tests him and diagnoses diabetes and high lipid levels. Mr. R is placed on hypoglycemic and statin medications and sent to a dietitian for nutritional advice, but he is confused about to how to shop and cook according to the new recommendations. In the next weeks, he experiences dangerous blood glucose swings and inadequate improvement in his LDL level. His primary care doctor refers him to an endocrinologist, but the next available appointment is three months away. What now?
Treatment of diabetes is widely recognized as complex, requiring management not only of medications, but also of nutrition, exercise, stress levels, and more. Although mass use of blood glucose- and cholesterol-lowering medications has produced good results for some, related patient education and compliance monitoring are often inadequate. Patients may be sent to multiple professionals to address various aspects of care, and lack of coordination between these professionals may result in confusing or conflicting instructions, less than optimal compliance, and, thus, less than optimal results. Patients bear the burden of reconciling information received from various sources, but may lack the education and support to make beneficial decisions on their own behalf. As a consequence, potentially dangerous consequences like Mr. R's are not uncommon.
What if there were a "one-stop shop" for diabetes management: a licensed medical professional skilled in diagnosis, medication, and nutrition and lifestyle management, as well as patient education? What if that same professional took a holistic approach, partnering with patients to effectively monitor all aspects of their health to prevent the onset of the long-term complications of diabetes?
Meet the naturopathic physician
With diabetes on the rise and a shortage of endocrinologists, diabetes educators, and primary care physicians with adequate training and time, naturopathic physicians are a much needed resource. As medical experts in nutrition and lifestyle as medicine, naturopathic physicians are an excellent match for the wide-ranging demands of diabetes management. Trained in four-year accredited postgraduate medical programs1 and certified under national board examinations, naturopathic physicians spend the clinical years of their training in outpatient settings rather than in hospitals, focusing on primary care medicine and chronic conditions such as diabetes while becoming skilled at triaging emergencies to urgent-care settings. Naturopathic physicians are currently licensed by 15 states2, the District of Columbia, Puerto Rico, and the Virgin Islands.
Naturopathic medicine differs from conventional Western medicine in its deep grounding in a set of philosophical tenets, foremost among them a profound trust in the body's ability to heal itself. Symptoms are viewed as signals that various stressors are overwhelming the body's innate self-healing design, and naturopathic treatment is oriented towards removing the causes of such imbalance and restoring the body's self-healing mechanisms using the safest effective means. As causes of illness are addressed and the self-healing mechanisms restored, not only do symptoms disappear, but future occurrences are also prevented. Along the way, naturopathic physicians execute two other charges from their philosophical grounding: to treat each patient as an individual and to educate each patient about what promotes his or her optimal health. The result is people empowered to maintain themselves at a high level of overall wellness.
To fulfill this broad scope of care, naturopathic physicians typically provide visits that are longer than those with conventional physicians. A first visit will often last from sixty to ninety minutes, fulfilling the American Association of Naturopathic Physicians' description of its members as "physicians who listen." The history-taking portion of the visit usually includes a detailed discussion of diet, exercise, and stress management in addition to physical symptoms and current medications.
Like their conventional counterparts, naturopathic physicians make use of physical examination and laboratory testing to assess each patient's condition, but some are also versed in diagnostic methods from other medical traditions, such as pulse, tongue, or iris assessment. Likewise, naturopathic treatment methods combine the best of modern science and time-honored therapies, such as herbal medicine, various forms of physical manipulative therapy, and hydrotherapy (the use of contrasting hot and cold water applications to stimulate circulation and immune function).
To effectively and safely apply such a wide range of therapies, naturopathic physicians are well-trained in potential interactions between medications and nutritional or herbal remedies. However, such interactions are rarely seen in patients who comply with physician recommendations. The great advantage of such a diverse toolbox of therapies is the ability to finely tailor treatment to each individual patient. This feature of naturopathic care is often the key to successful outcomes for patients who don't respond satisfactorily to conventional medical treatment.
For people with type 2 diabetes who are willing to become proactive in self-care with their physician's support, the naturopathic approach often results in an eventual return to a day-to-day non-diabetic state with minimal to no reliance on prescription drugs. Dr. Patrick Chapman, an Oregon naturopathic physician who works with many people with diabetes, has come to expect such outcomes for his type 2 patients. Key to his approach is selection of an appropriate dietary regimen for each patient. "With dietary changes alone, I've seen amazing results," he claims. "One patient who came in undiagnosed, weighing 300 pounds and medicated for a number of other health issues, was able to reduce his A1c from 7.6% to a non-diabetic level and lose 80 pounds within a few months, simply by adopting the right diet, which, in his case, was gluten- and casein-free. Now he feels good, his lipids are normal, and he takes many fewer medications." Such changes, Dr. Chapman claims, are quite sustainable given patient compliance with individualized lifestyle recommendations.
For type 1 diabetics, the goal of naturopathic treatment is optimizing insulin/carbohydrate management in order to mimic normal physiologic function as closely as possible. By spending enough time with patients to ensure their understanding of the insulin/carbohydrate dance, and by providing targeted nutritional and herbal support to prevent accumulation of sorbitol and other factors that accelerate long-term complications, naturopathic physicians enable type 1 patients to live at a high state of wellness. Patients do their part by holding themselves accountable for self-monitoring and compliance and by requesting support as needed. The naturopathic physician also explores and treats the autoimmune aspect of type 1, warding off associated autoimmune conditions such as Hashimoto's thyroiditis. "The goal is the health of all organ systems and, thus, the prevention of complications and the ability to live a fulfilled life," says Dr. Chapman.
With their focus on prevention, attention to each patient's uniqueness, and empowerment of people to make beneficial choices for themselves, naturopathic physicians are often an excellent choice as partners in diabetes care. To find a naturopathic physician in your area, visit www.naturopathic.org.
Shani Fox, ND, is a naturopathic physician in Portland, Oregon, who serves people with cancer and chronic concerns such as diabetes. She frequently writes and speaks on the joy and mystery of natural medicine, and she envisions the day when all Americans have access to the life-affirming benefits of naturopathic care. She can be contacted at firstname.lastname@example.org.
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1 Accredited programs in naturopathic medicine are currently offered at National College of Natural Medicine in Portland, OR, Bastyr University near Seattle, WA, Southwest College of Naturopathic Medicine in Phoenix, AZ, and the University of Bridgeport in Bridgeport, CT.
2 States currently licensing naturopathic physicians are Alaska, Arizona, California, Connecticut, Hawaii, Idaho, Kansas, Maine, Minnesota, Montana, New Hampshire, Oregon, Utah, Vermont, and Washington. The District of Columbia, Puerto Rico, and the Virgin islands also provide licensure. Naturopathic physicians who practice in as-yet unlicensed states typically hold licensure from one of the licensing states and practice to the extent permitted by their state's medical practice laws.
6 comments - Jul 24, 2009
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