Naturopathic medicine could be a key health care tool for type 2 diabetes, one of the 21st century's costliest public health problems, two new studies suggest.
Conventional medicine has struggled to address the disease, which affects 26 million Americans at an annual cost of $178 billion. Bastyr University researchers Ryan Bradley, ND, MPH, and Erica Oberg, ND, MPH, are building a body of evidence that has the potential to reshape care for the condition.
A new study by Dr. Bradley and the Group Health Research Institute found that diabetes patients who received naturopathic care had steadier blood-sugar levels, better eating and exercise habits, higher moods and a stronger sense of control over their condition than patients receiving conventional care. And a related study led by Dr. Oberg found that diabetes patients who received naturopathic nutrition counseling improved their eating practices and blood-sugar control by significant margins.
Too Much Calorie-Counting
Despite the billions Americans spend on diabetes care, less than 40 percent of patients with diabetes reach recommended blood-sugar targets. Dr. Oberg, an assistant research scientist at the Bastyr University Research Institute, wondered if the problem is the way patients are advised to focus on specific amounts of calories or carbohydrates.
"When people think about diets for diabetes, they think about very formulaic diets," she says. "But it's very difficult to know what '60 percent carbohydrates' or '200 milligrams of sodium' looks like on your plate. Even nutritionists have a tough time estimating those."
She designed a 12-week trial that gave 12 patients one-on-one dietary counseling with naturopathic physicians, combined with group sessions about whole-food nutrition. Those gatherings included potluck meals to create a sense of camaraderie and expose patients to new foods they might be intimidated to cook themselves.
It's Not What You Eat, but How
Rather than focusing only on what macronutrients (fats, protein and carbohydrates) patients consumed, the point was to become mindful to the positive aspects of a meal — social interaction, tastes and smells and a time of nourishment, Dr. Oberg says.
"If we approach those meals as a holistic experience, we can understand that coming together and sharing food is a really healthful experience," she says. "It becomes much less stressful, and people end up eating fewer calories. They also tend not to have negative self-talk about 'I'm not keeping to my diet so I must be a bad person.'"
She and Dr. Bradley are giving a free public lecture Nov. 19, 2011, at Bastyr Center for Natural Health in Seattle on how anyone can learn from this approach, especially for oft-stressful holiday meals.
After learning to fixate less on calories, participants in Dr. Oberg’s study had healthier levels of hemoglobin A1c (a measure of blood-sugar control), exercised more, checked their blood-sugar level more frequently, felt more self-efficacy (or empowerment) over their health and ate more fruits and vegetables and fewer fats and carbohydrates. The results were recently published in the journal Complementary Therapies in Clinical Practice.
"Changing the behavior will ultimately change the composition of the plate, but in a way that people feel good about, not in a way that makes them feel restricted, as diets often do," says Dr. Oberg. "We all have relationships with food. For many people, it's a very unhealthy relationship. Changing the mindset we bring to the table can be a powerful change."
Dissatisfied with Current Care
Dr. Bradley's related study began with a survey of 220 type 2 diabetes patients at Group Health Cooperative, a large Seattle-area health care provider. Health care leaders have long believed that patients who seek naturopathic care are already healthier and more motivated about their health than others. But the survey, conducted with Dan Cherkin, PhD, and the Group Health Research Institute, suggested otherwise.
The team found that patients who were interested in naturopathic care (but had not yet received it) were no more consistent than others in checking their glucose levels or taking medication.Nor did they exercise more or eat healthier diets. A chief difference was their dissatisfaction with their current care.
"That was surprising," said Dr. Bradley, a Bastyr clinical research assistant professor. "No one had previously documented that dissatisfaction with current care was a driving motivator for patients to pursue complementary and alternative medicine."
For the next stage, the research team selected a random sample of 40 patients to receive care from naturopathic physicians, which included counseling on diet, exercise and glucose monitoring. Many also provided stress-management care, herbal supplements and prescription medications. Researchers then created a control group using anonymous electronic medical records of other Group Health patients.
Researching "Whole Systems"
The results, which Dr. Bradley presented at a research symposium hosted by the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) in Los Angeles in October, showed that better self-care, more consistent glucose monitoring, better moods and slightly lower depression rates (a common struggle for diabetes patients) occurred when patients used naturopathic care. Hemoglobin A1c rates were nearly a full percentage point lower for those patients — a significant gain that equals what many medications provide, Dr. Bradley says. Interestingly, most patients went to only four naturopathic visits within the year to achieve these benefits (they were allowed up to eight), an encouraging sign for the cost of care.
The two studies are unique in evaluating a whole practice, instead of looking at one isolated drug or therapy. That's essential for scientifically validating naturopathic medicine, which takes an integrated approach to physical, mental and spiritual health.
"When a patient visits a naturopathic physician, they may get a botanical supplement, but they're also going to have a conversation about how to change their diet, how to manage stress and about what their goals are," says Dr. Oberg. "The holistic approach that naturopathic medicine takes is much better captured with this type of whole-systems research."
Helping patients who feel "stuck"
Dr. Bradley recently applied for a $3.5 million grant from the National Center for Complementary and Alternative Medicine (NCCAM), which funded the two previous studies, for a randomized clinical trial, the next key step. That would help build the case that all patients with diabetes deserve these options.
"My goal is to get naturopathic medicine on the list of options for patients with diabetes," says Dr. Bradley. "We have a huge number of patients who feel stuck in their diabetes care. We know that many of them are motivated to make changes, but our health care system is not set up to serve them. We want to change that."
Learn more about the naturopathic approach to healthier eating at the free Living Naturally lecture by Drs. Bradley and Oberg, “Tips for Healthier Holiday Eating,” from 10:30 a.m. to noon Saturday, Nov. 19, at Bastyr Center for Natural Health, 3670 Stone Way N. in Seattle.