Addition of Naturopathic Medicine Boosts CV Risk Reduction

Shelley Wood

April 29, 2013

TORONTO — The addition of naturopathic care on top of usual care significantly reduced the 10-year risk of cardiovascular disease among adults with an increased risk for CVD, a small randomized, controlled trial has found [1].

 

In the study, 10-year risk, based on the Framingham algorithm, was 7.74% among subjects randomized to the add-on naturopathic medicine approach over a 52-week period, as compared with 10.81% in the usual-care group (p<0.001).

The study, led by naturopathic physician Dr Dugald Seely (Canadian College of Naturopathic Medicine, Toronto, ON) is published online today in CMAJ.

"Future investigation of the potential for complementary naturopathic care to support general practice in preventing chronic diseases, including cardiovascular disease, is warranted," the authors conclude.

Cardiologists who reviewed the study for heartwire acknowledged there can be resistance among members of their specialty toward complementary approaches.

Calling the study "very timely," Dr Tracy Stevens (St Luke's Health System, Kansas City, MO) pointed out that naturopathic physicians reinforce many of the same messages to patients that cardiologists are saying but typically spend more time with patients to individualize that message.

"We should all keep our minds open. We are all in this epidemic, which is only going to get worse, and we know that if there are means to encourage our patients to take ownership of their health, that's great. It's easy for us as cardiologists just to write a prescription, but it's hard work to do a lot of the other things that we are recommending. Just being open-minded to suggestions by a credible naturopathic healthcare provider is the key."

Likewise, Dr Nathan Wong (University of California, Irvine) told heartwire , "It is great to see these positive benefits on CVD risk resulting from naturopathic physicians counseling on lifestyle. The results are not surprising, given we know multiple lifestyle sessions as was used in this study can reduce cardiovascular risk factors and would be superior to the generally poor state of 'usual care.' "

Higher-Risk Subjects Sought for Study

Seely et al's study invited postal workers aged 25 to 65 in three Canadian cities to participate in the study. All invited subjects, at baseline screening, were found to have high total-/HDL-cholesterol ratios.

In all, 246 subjects were randomized to advice to follow up with their family physician or to family physician follow-up plus seven individualized counseling sessions with a naturopathic doctor (ranging in time from 30 minutes to one hour) focused on health promotion, nutritional medicine, or dietary supplementation. Body weight and waist circumference and lipid, blood-pressure, and fasting-glucose levels were all measured in both groups three times during the year of study. In the naturopathic group, therapies included specific dietary and lifestyle recommendations, plus prescription of natural health supplements including omega-3 fatty acids, soluble fiber, coenzyme Q10, and plant sterols.

Of the 207 subjects who concluded the study, those in the naturopathic group had CVD risk levels by Framingham that were 3% lower than those in the usual-care group. Prevalence of metabolic syndrome was also lower in the naturopathic group (31.6% vs 48.5%, p=0.002).

To heartwire , Seely stressed that the naturopathic approach is not merely the prescription of supplements but a holistic and individualized approach.

"I agree we can't tease out what component is delivering what aspect of benefit there," he acknowledged. "There is really a health coaching element that goes into naturopathic care and a certain amount of time that patients spend with clinicians that really allows them to focus on the key lifestyle issues. . . . So not just supplementation, for sure, although some of the ones we used have evidence for use in and of themselves, and when combined with a lifestyle and dietary changes, then they can really add up to have a more pronounced impact."

Stevens commented: "We all have to be careful of the supplement hype that's out there, and this isn't just with naturopathic meds, it's from watching Dr Oz or from whatever company is trying to sell you their products, but that's not necessarily a reflection of naturopathic medicine."

What "makes sense with supplements," she added, is supplementing those a patient is deficient in, but not others. "I think the naturopathic doctors, those who are acknowledged as being trained from a naturopathic college, do have good credibility with recommendations."

Focused Counseling Key

Wong pointed out that the study supports a role for the kind of focused counseling studied in the trial. "It is likely similar results could be obtainable by a combination of counseling sessions by dietitians and exercise physiologists or nurse case managers, but such interventions should be compared with the naturopathic physician intervention that was used in this study."

Stevens made the point that people who seek out care from a naturopathic physician tend to be a group who are already more proactive about their health, so this approach may not work for everyone.

Asked about the skepticism some "Western" medicine physicians may feel toward complementary approaches, Seely stressed that the profession and its approaches are regulated. Also, he noted, naturopathic physicians are also trained in physiology and pharmacology and often know more about adverse reactions and interactions than cardiologists.

The relationship between Western-trained physicians and naturopathic practitioners "is a partnership to be supported, ideally, and it's the risk of that sort of gut reaction on the part of physicians saying to patients, 'Don't do anything complementary or naturopathic' that leads people to self-censure," or, worse, take steps without any guidance from a regulated health practitioner, Seely said.

Seely and colleagues also have a cost-effectiveness analysis pending publication; to heartwire , Seely noted that the approach tested in this study, "showed a dramatic impact" in terms of the societal cost savings.

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