Tuesday, July 2, 2013

Naturopathic Heart Care Brings Major Gains in Study of Canadian Postal Workers

A leading research journal publishes study supporting naturopathic care for high-risk heart patients.

Canada Post mailbox
The study was the largest randomized clinical trial ever published on naturopathic medicine. Photo: Christopher Cotrell*

Out-of-shape Canadian postal workers found a significant drop in their risk of heart disease after receiving care from naturopathic doctors, according to a new clinical trial.

The study found that workers who received naturopathic care in addition to typical care lost weight and lowered their blood pressure, compared with a group of workers who received only conventional care.

It's the largest randomized clinical trial ever published on naturopathic medicine, a field of primary care that emphasizes the healing power of nature and treating the root causes of disease. The study appeared in the Canadian Medical Association Journal (CMAJ), a top 10-ranked medical research journal.

"This study is significant because prevention is one of the core principles of naturopathic medicine," says coauthor Ryan Bradley, ND, MPH, associate director of the Bastyr University Research Institute. "This is the first clinical research that's evaluated the effectiveness of naturopathic doctors at preventing disease, and it clearly demonstrated a reduction in risk factors."

BradleyMore than 200 postal workers in Toronto, Vancouver and Edmonton were screened for risk of heart disease, then randomly assigned to a control group or a naturopathic care group. The naturopathic group met seven times over the course of a year with a licensed naturopathic doctor (ND). They received counseling on nutrition, exercise and stress, along with common naturopathic supplements such as fish oil. Like the control group, they also received usual care from a family physician.

After a year, the naturopathic care group was 17 percent less likely to have metabolic syndrome, an indicator of heart risk based on factors such as high blood pressure, high cholesterol and obesity. The group also scored 3 percent better on the 10-year Framingham risk algorithm, a widely used method for measuring the risk of future heart attacks or strokes.

Mainstream Attention

Those results were strong enough for publication in the peer-reviewed CMAJ, considered the 8th-most influential medical journal by impact factor, an approximate measurement of a journal's prestige. The journal added an editorial saying it expected pushback for the study but wanted to promote the project's scientific rigor. The publication has drawn attention from conventional medicine along with the naturopathic world.

Sarah Speck, MD, MPH, FACC, a cardiologist at the Swedish Heart and Vascular Institute in Seattle, says the study validates the naturopathic approach of focusing on lifestyle changes before turning to pharmaceuticals.

Sarah Speck, MD, in exercise room"Naturopathic medicine has a strong role in the prevention of heart disease," says Dr. Speck, medical director of cardiac rehabilitation and prevention services at Swedish. "Since there is an epidemic of heart disease, this study clearly shows the benefits of naturopathic medicine should be more widely recognized and more widely used."

Most doctors understand the importance of lifestyle changes to improve nutrition, exercise and stress, says Dr. Speck. The challenge for patients is figuring out how to make those changes — and make them stick.

"The process of therapeutic lifestyle change is not easy, or we'd all be thin and fit and not have any heart disease," Dr. Speck says.

NDs, with their emphases on doctor-as-teacher and longer patient visits (typically 30 to 90 minutes), are well-equipped to facilitate those changes, she says.

Real-World Design

Lead investigator Dugald Seely, ND, FABNO, director of research at the Canadian College of Naturopathic Medicine, arranged the study with Canada Post, which has collaborated on past studies on naturopathic care for back pain and anxiety. His research team has been open about limitations of the study, many of which were intentional.

Dugald Seely, ND

For example, researchers did not tell doctors exactly what treatment to provide, instead giving them a portfolio of naturopathic therapies and leaving them room to customize the care for each patient. That made it impossible to isolate exactly which therapies were most effective — a task for future studies. In other words, the study doesn't show whether patients gained most by taking fiber supplements, learning how to eat more vegetarian meals, having time to discuss anxiety, or another therapy.

But the multipronged treatment regimen better resembles real-world naturopathic practice, says Dr. Bradley, who has helped develop new methods of patient-focused research.

"For studies to actually represent real practice, the intervention needs to have multiple modalities," he says. "Our research has demonstrated that patients really can listen and change multiple behaviors at the same time. They don't get overwhelmed. In fact, they're eager to get information on how to reduce their own risk."

The trial did not use methods or supplements that would be unfamiliar to NDs. That, too, is a strength of the study, says Jane Guiltinan, ND, dean of the School of Naturopathic Medicine at Bastyr University.

"It's not anything we haven't already been doing for a long time," she says. "The study should give naturopathic doctors more confidence that their approach is effective. It adds to a growing evidence base showing naturopathic medicine can be effective for reducing risk factors for chronic diseases."

Because the study measured naturopathic care alongside conventional medicine, it lends support to more integrative partnerships, Dr. Seely says.

"I think this shows that physicians in cardiovascular disease can see naturopathic doctors as allies to provide better care for their patients," he says.

See the full study: Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial

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Learn more about Bastyr University's naturopathic medicine degree program and research training programs.

*Photo credit: Christopher Cotrell via Creative Commons.

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