Food as medicine?

In the summer before starting at Bastyr University, I met a naturopath at a Dave Matthews concert. She recently graduated from Bastyr and was excited to meet someone who was about to embark on their own naturopathic journey.

“One of three things will happen to you while at Bastyr,” she joked. “You will either get pregnant, become a lesbian, or become vegan.”

This turned out to be a known joke among the students, because the learning environment at Bastyr promoted experimentation, and we all took part. We completed medical experiments on ourselves and on each other to learn modalities like IV therapy, chiropractic adjustments, and colon hydrotherapy, and we experimented in our personal lives.

My Bastyr experiment involved food.

I brought The Deegan Diet into the world: a naturopathic perpetual motion machine of psychological distress, guaranteed to make you lose a little weight, become anemic, and break out.

Classroom experiments

First-year naturopathic students at Bastyr University took courses on naturopathic history and philosophy. During the spring quarter, students completed a project called “Cultivating the Conditions of Health and Wellness.”

With a classmate, we were to identify a specific health related behavior or habit that we thought could be adjusted to live healthier. One was supposed to make a positive health-related change in his or her life, like starting meditation or yoga, or cutting back on an unhealthy habit, like smoking, drinking, etc.

My health project was to overhaul my eating. I had previously experimented with my diet to help control my psoriasis, and now that I was a naturopathic student, I thought I should focus on applying this seemingly unique medical approach. I was also suffering from what I considered terrible acne.

As discussed in my post, first-year naturopathic students were required to seek naturopathic care at Bastyr’s teaching clinic (BCNH). I considered these appointments a perfect opportunity to address my skin problems with the type of doctor I was set to become.

My naturopath was a very nice resident at BCNH. My first appointment was a fairly standard naturopathic appointment: my vital signs were taken, and then we reviewed my health and family history, my complaints, and medications I was taking. We then spent a great deal of time talking about food, especially the use of food as medicine.

I fell in love with the concept of food as medicine. Later, as a practicing naturopath, I used this theory with patients frequently. (I even designed an entire naturopathic detoxification program around the concept that food could be poison or food could be medicine, which is really interesting now when I look at other detox programs.)

It was easy for me to understand that my diet may be causing my acne because of my experiences “controlling” my psoriasis in high school and college. I do not really know if reducing processed foods in my diet improved my skin, but I believed that it did. As a result, this priming effect led to me being able to concede that virtually any food could play a pathological role in any disease. In other words, my perception of cause and effect was set up to positively evaluate dietary changes to my visible health conditions.

When my naturopath suggested severe dietary restrictions, I embraced them wholeheartedly and cultivated them into my own nutritional monster.

I was to avoid all dairy, eat more protein, and eliminate refined sugars. I was warned about the high sugar content of hemp milk and hidden sugar in condiments like ketchup. I was sent home with numerous handouts on eating healthy, eating mindfully, and avoiding sugar. I dutifully followed the recommendations without complaint–I wanted to be a good naturopathic patient!

At my follow-up appointment weeks later, the ND noted I had lost a few pounds. I remember her exuberant compliments about following the restrictions so well that I had lost weight. I remember standing on the scale and feeling like I was doing a good job!

To this day, her comment about my weight sticks with me. I was not heavy, and I was not trying to lose weight. I wonder if she just misspoke, as inexperienced clinicians do, but I also wonder if she wanted me to lose weight or even for me to be more aware of my weight. I took her comment to mean, “Good job, you’re losing those extra pounds!”

The Deegan Diet

Over the next months, I began setting up facades to make my progressively restrictive diet socially and clinically acceptable. I had used the ideas of detoxification and food elimination diets to make sense of what I was doing to myself in the context of diving deeper into my naturopathic training. Under the guise of healthy eating, I made my pernicious relationship to food socially reinforced by my naturopathic peers. The real purpose of my naturopathic diet plan, though, was to lose as much weight as possible.

By the time spring quarter rolled around, I was fully submerged in naturopathic dietary chaos. I had made the Deegan Diet, which was actually quite impossible to describe because it was constantly evolving. I actively searched for more naturopathic diet advice, and my skin was not improving.

It was just a matter of willpower. Right?

With that intention in mind, I also decided to eliminate all forms of sugar including honey, agave syrup, fructose, dextrose, maltodextrin, and sugar derivatives. I came up with this idea after listening to a naturopath describe acne as “diabetes of the skin.” The theory was that acne was a form of glucose dysregulation.

Inflammation was involved, of course. So, most pro-inflammatory foods needed to go.

The Deegan Diet restricted:

  • all dairy including yogurt, cheese, and milk
  • all sugar including honey and agave syrup,
  • all red meat and poultry,
  • most grains (quinoa and brown rice allowed)
  • most “inflammatory” nightshades including white potatoes, bell peppers, and eggplant

I continued to eat tomatoes, eggs, and fish occasionally. Sometimes I made exceptions for the perceived “anti-inflammatory” foods, such as lamb. As you can imagine, I ate a large amount of soy, fruit, nuts, and vegetables, and I was often very very hungry.

I remained “sugar-free” for about three years and continued to follow some version of The Deegan Diet for many years thereafter. To do this, I avoided condiments and salad dressings with unknown ingredients, ambiguously labeled drinks, indulged only sugar-free chocolate bars and coconut bliss gelato. And I certainly never ate candy. Exceptions did occur, but these occasions were rare.

Over time, my friends and peers complimented my dedication to my health. I continued to lose weight and my acne continued to worsen. We started jokingly referring to my future book, The Deegan Diet and all of its health benefits, which so far included iron-deficiency anemia, worsening acne, and weight loss.

The everything-but-the-kitchen-sink naturopathic treatment approach

My attempt to “cure” myself did not end with diet changes. I took digestive enzymes including pepsin and bromelain between meals to help break down dietary amino acids that escaped from my “leaky” digestive tract. I don’t remember if I was diagnosed with “leaky gut” or if I inferred this condition based on my training at Bastyr and perceived sense of my nutrition and health complaints. (It is important to note that “leaky” gut is not a real medical condition. Naturopathic schools teach this condition as increased permeability of the intestines causing food antigens to escape into the bloodstream, which is detectable with IgG allergy testing.)

I took tablespoons of cod liver oil religiously and many probiotic supplements. From time to time, I added in various antioxidants like vitamin E and selenium, milk thistle to help my liver detoxify, dandelion to help my kidneys, and anything else I could get my hands on. I drank protein powders that contained herbs and nutrients for phase 1 and 2 detoxification. I completed many detoxification diets that included water fasting, juicing, eating nothing but quinoa for days, colon hydrotherapy, constitutional hydrotherapy treatments and peat baths. I had intravenous therapy treatments to help detoxify and supply my body with nutrients that I believed I could not absorb from my diet due to my “leaky” gut.

I addressed possible “hormone imbalance” with another set of supplements and herbs to help clear excessive estrogen out of my system. I diligently avoided plastic, microwaves, parabens, sodium lauryl sulfate, and other “toxins.”

I read books about my blood type and wondered if I should stop eating avocados because my blood type is O positive. Yea, right! I read about the importance of detoxifying the liver and did everything I could, including castor oil packs placed onto my abdomen to help my liver conjugate and eliminate toxins.

For my acne, I topically applied bovine colostrum, exfoliated with dry skin brushes, and sometimes used an old Retin-A prescription. I was desperate and willing to try anything, except medical treatment.

I believed that any failure of naturopathic treatments was not a failure of the treatment, but a failure of mine to implement the therapy correctly. Maybe the gluten in that beer I drank last night caused my break out? Maybe I needed to cut out eggs too? Maybe my gut was so “leaky” that the benefits of treatment will take months to years?

These questions were actively discussed in my naturopathic care at BCNH with the residents and considered reasonable explanations about why my acne was not improving.

what to eat?

The skin-gut connection

My naturopath liked to explain the connection between the skin and the gut. I learned about this connection in school as well. A simplified version of the theory is acne is a manifestation of digestive problems, usually a “leaky” gut.

The Deegan Diet actually seemed to cause symptoms consistent with irritable bowel syndrome. My bowels were alternating between constipation and diarrhea and I had consistent abdominal pain, bloating, and gas.

My new IBS symptoms just corroborated the naturopath’s theories about my skin.

My ND would ask, “How are your bowels?”

I would detail every movement, including any bloating, pain, and constipation and anything else that I thought seemed relevant.

Her response seemed to always be some form of the following: “hmmm…. that makes sense given the skin-gut connection.” I was given new supplements and herbs depending on what the resident thought was churning about in my leaking gut.

I was also led to IgG food allergy testing to make sure I was not eating a food that was the “root” cause of my acne.

You can imagine everyone’s surprise when the results showed I had no IgG food allergies. None. Not even any mild to moderate IgG reactions. I became convinced that the results were false negatives and gained new resolve to stay on The Deegan Diet.

There was literally nothing else to be taken out of my diet.

Giving up

It was not until I had virtually exhausted every naturopathic treatment plan (even a constitutional homeopathy appointment!) that I decided to seek real medical care.

It was quickly determined that I had excessive testosterone and dihydrotesterone. The medical doctor explained that these androgens were binding to receptors in my skin, causing cystic acne. Also, the lack of food wasn’t helping my skin either. I was prescribed a low dose of spironolactone, and my acne quickly improved.

What strikes me about my story is how my experiences with naturopathic medicine, as a patient, led me down a road of perpetual failed treatments. Furthermore, not only did the treatments fail, but they also induced IBS symptoms and caused a great deal of stress in my personal life, all under the rouse of “food as medicine.”

I am bothered by many aspects of my story. I am astonished by my own lack of critical thinking throughout my experiences as a patient. As a naturally curious person, I am disappointed in myself for never fact-checking the naturopathic theories that constituted the basis for all my treatments given how utterly inconsistent they were. They quite literally were based on an ideology without any input of new clinical information. I am further surprised, and still somewhat baffled, by how I even tried homeopathy before “giving up” and going to see dermatologist.

The nutritional training of NDs

Even by critics, naturopaths are often acknowledged for having training in nutrition. At Bastyr, students do receive a great deal of nutritional education as part of the naturopathic program. When I was at Bastyr, naturopathic students received 143 hours in didactic nutritional education and even more in clinical science classes where diet is used as a part of disease management.

However, the nutritional training is wrapped up in pseudoscience, which makes it difficult to tease apart what is real and what is fake. For example, naturopaths often make dietary recommendations based on applied kinesiology tests, unvalidated blood tests, or far-fetched medical explanations. A commonly prescribed, but unproven, naturopathic diet theory is the elimination of nightshades to reduce the symptoms of inflammatory diseases, especially arthritis.

One such bogus test I often used in practice was an IgG food allergy test. As a first step in treatment for many conditions, such as asthma, infertility, or migraines, I would order an IgG food allergy panel and then discuss the results with patients in the context of an elimination diet treatment plan. Sometimes I would also recommend supplements such as probiotics and l-glutamine to “heal the gut.”

But as Scott Gavura discusses in his 2012 post on IgG Food Intolerance Tests: What does the science say? the scientific consensus has concluded that these tests have no clinical value, are not validated, and most importantly, “should not be performed.”

Naturopathic educators are ignoring the scientific consensus, teaching their students to utilize this test anyway and to clinically act on them to the extent permitted by state law. Furthermore, the clinical training is not even good enough for a naturopathic resident to recognize obvious eating disorders.

The harm of naturopathic diet advice

I am also surprised by how no one, including myself at the time, recognized my disordered eating or least openly discussed it with me.

At my thinnest, I weighed 115 lbs. At 5’6’’, I was carefully walking the line making sure I didn’t fall below this number, which for some inexplicable reason represented the boundary between skinny enough and too skinny.

Yet, there were blatant negative health effects of weighing so little that every naturopath I visited failed to observe. I stopped ovulating. My hair fell out. I was moody, depressed, and anemic. I was often hypoglycemic. I suffered from terrible abdominal pain, bloating, and gas. Also, my acne worsened. These are all common signs seen in young women with Anorexia nervosa.

Sadly, I misinterpreted the above symptoms as leaky gut syndrome, and not due to disordered eating. Even worse, my naturopaths corroborated this fallacious thinking. We discussed how I was clearly addicted to sugar, making it that much more essential that I completely eliminate it. We also talked about how certain food reactions come in the form of mental and emotional reactions, such as irritability and depression. I would then discuss this reasoning with my classmates, who invariability all agreed. In hindsight, I was just hangry and malnourished.

I don’t think that naturopathic diet advice caused my eating disorder. I do think, though, these naturopathic diet recommendations helped trigger my predisposition for disordered eating, mainly by clinical suggestions that gave causality to events that have no causal relationship. In this sense, I do not think I am alone. Self-deception is common.

Through naturopathic dietary advice, I started to believe any two events could be causally related.  The fear of breaking out, or any side effects induced by food, became so powerful that I was obsessed with eating foods that I perceived to be healthy.

This “unhealthy obsession with eating only healthy foods” has been coined orthorexia, by Stephen Bratman, MD. In his book Healthfood Junkie, he describes his own obsessions with healthy eating and describes a new, third category of disordered eating called orthorexia nervosa. My disordered eating encompassed a naturopathic triad of anorexia, bulimia, and orthorexia called The Deegan Diet.

121 Replies to “Food as medicine?

    1. He’s a good writer. I learned of the other book just today when referencing his orthorexia book, which is also a good read. I am looking forward to reading it.

        1. Is that like homeopathic commenting, where less is supposedly more?

          Seems homeopathic comments are no more effective than actual (non-real) homeopathy.

          1. lol “homeopathic comments,” I love it. Best euphemism for drive-by trolling ever.

      1. Britt: Thanks for the kind words! It means a lot to me.

        You are trying to hoe a tough row. Not only is alternative medicine powered by a religious – like faith making it difficult to crack, there are two other main problems. (1) Science, especially in the form of double-blind studies, provides non-intuitive results, and most people (including, or even especially, trained physicians of all persuasions) have trouble accepting results that disagree with what they think is plainly obvious. It takes a long and painful intellectual journey to understand that when it comes to healthcare, one can’t trust one’s own eyes. (2) Conventional medicine is itself so flawed that its opponents gain automatic shine by opposing it. This is logically incorrect but emotionally persuasive. (My summation of the evidence would be that only about 25% of conventional medicine is evidence-based, whereas .0001% of alternative medicine has any real foundation. My personal suspicion is about 50% of conventional medicine works, as opposed to about .0001% of alternative medicine.)

        Maybe connect offline?

        Steve Bratman

    2. Orthorexia? Thats quite a bit of a reach you silly goat. There’s eating healthy and then there’s obsessive behavior.

      Get your head out of the sand and stop generalizing.

      1. These things are not mutually exclusive. Can there not also be obsession with what is perceived as “healthy” eating that is self-destructive and dangerous?

        And how exactly is she “generalizing?” Generalizing in what way and about what?

        1. If you are expecting that poster to use language in a precise or carefully defined manner I suspect you will be disappointed. What you are reading appears to be an emotional response caused by an unfamiliar and uncomfortable contact with critical thinking directed at her belief system. The actual words she uses are incidental, and have no meaningful content.

          1. Seriously. The poster probably doesn’t know she’s doing a good job of illustrating Britt’s points about the attitudes, lack of real knowledge, and cult mentality of the altie movement.

          2. You’re almost certainly correct but I thought I’d give him/her a shot at making sense anyway. Guess I’m just a sap like that. 😛

    3. Linda,

      Thank you for your kind words! Especially the part about how the book was entertaining.

      The problem with being a “quackbuster” is that alternative medicine is (almost entirely) a field of dreams, and on that job one becomes a professional dream crusher. I try to balance the inherent negativity of the role with a sense of humor.

  1. This was a tough read(emotionally). I cannot believe other people encouraged the diet even though it was producing such terrible side effects. Also I am a bit surprised that Naturopaths do not know much about nutrition considering it is one of the ways they promote themselves as superior to MDs.

  2. I’ve been continually impressed by your brave and detailed writings Britt. Keep up the phenomenal work.

  3. Sadly, I misinterpreted the above symptoms as leaky gut syndrome, and not due to disordered eating. Even worse, my naturopaths corroborated this fallacious thinking.

    Yes. This was the thought that loudly banging around in my head as I read this post with increasing horror. An obsessive controlling attitude towards food and eating, the increasing restriction, the preoccupation with “will power” and accompanying self blame when the diet doesn’t “work” as it’s supposed to, the idea of losing more weight as being inherently praiseworthy being reinforced by someone who’s supposed to be a healthcare provider. What you are describing sounds like an entire community where obvious red flags for eating disorders are not only normalized and enabled but praised and encouraged by people trusted as experts. How much damage would a person have to do to their body before they would be referred to the help that they desperately need?

    Maybe it’s the fact that I work with kids (and have especially worked with a lot of pre-teen and teen girls) that made this post especially terrifying to me but, wow, I need more than two hands to be able to do the facepalm that befits it.

  4. Jennifer, It has come to my attention that you, and the other pseudonyms sitting in the spam folder you tried to post as earlier, are posting from the same IP address (in Lombard, IL- home of National University of Health Sciences’ ND and DC programs.) Please pick one name, and stick with it, or be banned from commenting.

    1. That sounds an awful lot like… could it be someone by the name of Nancy? Who calls herself an nutritarian? >.< one of the worst.

      Britt, thank you for sharing your journey. I had so many 'aha's' as I read it. I'm 32 years into anorexia and bulimia but it became clinically severe around age 18, when I went down the rabbit hole into the same kind of thinking and searching that you described. And it was reinforced, just like for you, by people who should have known better!

      In the medical world, your clinician reinforcing what was actually openly making you more and more unwell would have been called malpractice. Somehow these natural therapists get away with so much.

      Are you in recovery now? I am still struggling but determined. It sounds like you will make great contributions to helping people really look past the misinformation and get well, really well, not just more and more sucked in.

      Thank you.

      1. Hi Fiona, I guess I am in recovery. My weight is healthy and I usually do not obsess over food, binge, and there is never any purging. One simple little trick helped: There will always be more food/ candy/ ice cream/ whatever available. I can have some now, and some tomorrow, and some the next day too, if I want. Reminding myself that I am “allowed” to eat x,y,z whenever I wanted, and not according to rule helped. For me, there is no longer any such thing as a diet, and no such thing as cheating on a diet. Thank you for reading my blog. Stay determined!

  5. I knew naturopathy to be pseudoscience-based, but I had no idea the delusional depths to which these people can/will go. They willfully ignored facts directly in front of them, which is a hallmark of pseudoscience. And using disproven testing techniques while doing it is quackery at its finest.

    I continue to applaud your attempts at bringing all this to light.

  6. I learned of your blog from Science Based Medicine. I applaud your very courageous efforts here and at SBM. Thank you so much for your perspective and extremely clear, well-written entries.

    I am also studying to work in the biomedical field, and I am very curious about your experiences studying in Germany. Would you be interested and willing to discuss your program?

    I look forward to more insightful, interesting entries here and at SBM!

  7. “leaky” gut is not a real medical condition. Naturopathic schools teach this condition as increased permeability of the intestines causing food antigens to escape into the bloodstream, which is detectable with IgG allergy testing.

    There is such a thing as having a tendency to increased intestinal permeability.
    The medical researcher Dr. Alessio Fasano gave an interesting interview on the subject.
    He wrote an article in Scientific American on this – I think it’s this one.
    But Dr. Fasano also mentions in that interview that “leaky gut syndrome” became an explanation for a wide range of problems, with no good evidence.
    However, testing for IgG antibodies is unlikely to be diagnostic for food hypersensitivities, except that testing for IgG antigliadin antibodies is part of the blood tests for celiac.
    And the issue with increased intestinal permeability may not be antigens getting into the bloodstream, but just (as Dr. Fasano explains) antigens getting to where they can cause an immune reaction.
    The article Food allergy: separating the science from the mythology has great diagrams showing various feedback loops in the regulation of immune reactions to food, and what happens with a damaged intestinal barrier.
    It sounds the thinking in your naturopathic training was that some foods were “inflammatory” because they were allergens.
    But, the more modern thinking as I understand it, is that exposure to food allergens tends to encourage desensitization.
    Strict food avoidance tends to be the psychology of laypeople, doctors not so much.

    1. I am skeptical of Alessio Fasano. I have spoken to him on the phone and once considered applying to his graduate program but changed my mind. In the discussion of leaky gut, his name is the only one that ever comes up. It seems few people in the community recognize it as a condition. Also, i met an RD at a conference once who seems to worship him. The whole dynamic just sends up red flags to me….

      I could be wrong and I need to make time to investigate this….

      1. Oh, if you look, “intestinal permeability” aka “leaky gut” is elevated in a wide range of conditions.
        Of course celiac disease is associated with higher intestinal permeability, but in a quick Medline search I came across research showing higher intestinal permeability in other conditions as well.
        From an article Alterations in intestinal permeability by other authors:

        increased intestinal permeability is observed in association with several autoimmune diseases. It is observed prior to disease and appears to be involved in disease pathogenesis

        Dr. Fasano is a major researcher on this sort of thing, that’s why his name comes up a lot.
        His SciAm article is probably worth reading.

      2. It seems few people in the community recognize it as a condition.

        It was the alt-med people who came up with “leaky gut syndrome”.
        Having a “leaky gut” is a feature of various different diseases, not considered a disease in itself, in mainstream medicine.

      3. Most likely, the genesis of “leaky gut syndrome” is that someone back then read some research articles in which disruption of the intestinal barrier was mentioned as a likely cause for developing immune reactions to a food, and perhaps various other diseases …
        So they latched onto this nugget, and embroidered it with a wide range of symptoms that many people have, turning it into “leaky gut syndrome” – one of the things someone might get diagnosed with by a naturopath. And treatments were developed …
        I don’t know if the wide range of symptoms that are “leaky gut syndrome” are actually associated with a leaky gut, or not.

        1. If you want to investigate the origins of “leaky gut” I would suggest you check out Metchnikoff’s work and his “autointoxication” theory.

          The theory was shown to be incorrect, but we are now finding that certain features have some actual basis in physiology.

          Increased intestinal permeability can- in fact- allow antigenic material to gain broader access to the host, thus setting the stage for immune reactions. (And no, IgG does not appear to be a reliable method for assessing this.)

          Another issue here is recirculation of conjugated metabolites. In particular secondary to increased presence/activity of beta-glucuronidase secondary to microbiota changes.

  8. Thanks, Britt, for your insights into naturopathic attitudes and practice. Although I’ve had limited contact with naturopaths myself, I have a few friends and colleagues who use them. Your writings give me a behind-the-scenes look at the profession and a better understanding about what the advice these people receive is based on.

    And I’m in awe at your willingness to examine, in detail and in public, your own experiences!

  9. It was such a relief to read this, as I’ve had a very similar experience. In the midst of my struggle with anorexia, I had gone to see a naturopath (I was very anti-medicine at the time and wasn’t on medication for my bipolar disorder yet), who somehow managed to not recognize that I blatantly had an eating disorder. I was 5’8″ and 110 pounds and she instructed me to do things such as “eat more pumpkin seeds” and try out her cottage cheese smoothie concoction. I was 16 and sick and naive and I honestly thought I was improving when I ate that small amount of recommended all-natural dairy everyday after. I still hold a lot of anger towards the fact that she led me on for multiple $100+ appointments (in Canada, where all of my mental health treatment is free) and never once suggested that I may have a mental illness. Thankfully, a few months after I stopped seeing her, I started seeing my family physician again. I finally gave into the fact that I would have to be on medication and have to be admitted to the hospital, and I don’t know where I would be if I didn’t accept that. I’m now 19 and realize that medication is something I have to be on. Bipolar disorder and anorexia aren’t things that can be cured by eating more pumpkin seeds. It’s definitely taken some time to figure out where “healthiness” fits into my life; eating too much sugar and caffeine can absolutely trigger my anxiety, and exercise can be a great way to boost my mood, but healthiness will never ever be a cure for my illness, and is definitely not a one size fits all sort of thing like it’s made out to be.

    1. Andrea, this is a great comment. Thank you so much for sharing such a difficult experience with all of us. I will be talking about bipolar disorder and naturopathy in the future and I hope you will find the post helpful. Best, Britt

      1. I look forward to that post also. I live in Arizona. My favorite (sad) thing I heard this past year was a woman in Trader Joe’s grocery store using a motorized cart who had just had bunion surgery. She told the cashier who asked about her foot what was going on. And she proceeded to tell him that she didn’t usually trust conventional medicine, so she was using homeopath and and her naturopath to recover from the surgery. I found you via your first post on SBM. I look forward to hearing more from you. I could tell more stories. I will just say that I have a friend that works at Canyon Ranch, where they seem to believe that anything can be managed with enough exercise and eating clean. Keep doing what you do here and on SBM.

  10. Frightening but high quality post as usual. Thanks for all your effort and also thanks for calling out “Jennifer”

    I think I found a mistake:

    “who invariability all agreed”

  11. I don’t think that naturopathic diet advice caused my eating disorder. I do think, though, these naturopathic diet recommendations helped trigger my predisposition for disordered eating

    Alt-med practitioners seem to be popular partly because they don’t threaten the patient’s ideas, and they are pleasant, agreeable, “nice” people.
    And maybe they also tend to avoid pointing out psychological issues that might be threatening, like having an eating disorder – as part of being “nice” and nonthreatening.
    If someone has an eating disorder or is psychological vulnerable to developing one, this can easily turn into enabling and perpetuating it.
    A guy told me once that his naturopath had diagnosed his food allergies – only, he was supposedly allergic to certain combinations of foods, not to the foods by themselves!
    So he had been given a mild eating disorder – but an eating disorder that he could live with, because the foods weren’t actually off-limits.

  12. Hi Britt-

    The story you share here is both heartbreaking and appalling. However- I’m not sure what the heck is/was going on at Bastyr- but the “treatment” you received is most definitely not consistent with the training I received at SCNM.

    I’ve read your posts here, and on SBM, and I feel you bring up some very real issues that desperately need to be addressed within the broader ND community. Not the least of which is (in my opinion) not simply an “anything goes” attitude with respect to treatment strategies, but a general failure to disclose to patients that a proposed treatment plan is largely experimental, and may be heavily skewed by a given practitioner’s personal biases.

    However I am curious- after you were given a proper workup for steroid hormone levels… did the MD you see inform you that spironolactone for acne is an off-label use of the medication, and an atypical first-line therapy for acne? I’m just wondering if everybody is being held to the same standard of disclosure in your opinion, or if the “real” MD is given a free pass to experiment with you because of their credential.

    I LOVED that you mentioned “orthorexia” as I fully agree that there appear to be many naturopaths suffering from this “condition.” I of course put condition in quotes, because, after all, it is currently recognized as a real diagnosis. Just like “leaky gut” is not currently recognized as a real diagnosis. But of course you knew that, right? I’m just wondering because you appeared to be very critical about the use of the first term and not of the other.

    In any case… we can find ample references to both “orthorexia nervosa” and “leaky gut” in the literature so it’s fair enough for us to talk about them, in my opinion.

    But yes, I find it quite atrocious that these practitioners would project their eating disorders on to you. That’s really bad medicine, and those practitioners should be ashamed and embarrassed with themselves.

    1. Hi Confused,

      Yes, the MD gave me informed consent. And yes, I was aware that spironolactone is not a first line therapy and off-label. This was all discussed with me. Off-label does not mean without evidence. I don’t say orthorexia is a real diagnosis or accepted as such by the medical community or by naturopaths. I say it is a novel category of disordered eating, coined by an MD, that resonated with me.

      1. Off-label does not mean without evidence

        People keep on comparing off-label or non-standard treatments that an MD might do, with alternative medicine, and suggesting that they’re equivalent.
        I see a couple differences, though.
        – Even the off-label and non-standard treatments by mainstream MD’s tend to have much better evidence than alt-med treatments. Not always – I saw a doctor a few times who loved to reel off lists of herbs she thought would be useful, and I would look them up later and find no evidence for them at all. I guess she just liked herbs.
        – Even if an alt-med treatment has a kernel of truth, it’s liable to be decorated with a lot of stuff for which there isn’t evidence. That decoration seems to be a sales tactic, and it gives the treatment a definite fishy aura.
        For example, acupuncture for some applications seems to have some effectiveness. But, it’s decorated with ideas about “qi”, elaborate charts of acupuncture points, etc.

        1. Beth-

          I won’t attempt to speak on behalf of all naturopathic doctors, or the profession in general.

          What I will say is that I consider myself to be more akin having a type of specialty that encompasses diet (including supplements), lifestyle, and herbal medicines.

          I see my role as a practitioner to recommend those therapies which I perceive to have the *best* scientific evidence available within the context of what they are.

          Dietary interventions will never have that “A” grade level of evidence we would like, simply due to the nature of scientific inquiry. We just can’t control for diet as neatly as a drug.

          Where herbs are concerned- there is ample evidence out there along with sound rationale for their use by one who is trained in pharmacognosy. Of course- this whole drug/herb dichotomy is a false one, although I will not deny that many NDs play into this… so do many MDs.

          There’s a lot of fishy stuff that goes on in “alt-med” and also a lot of fishy stuff that goes on in “plain-vanilla-med” (Overprescription of antibiotics comes immediately to mind… something which we have been hearing warning bells about for decades now.)

          I think we should be calling out fishy practices wherever they occur. That’s my stance. I am embarrassed and chagrined at some of the practices of my colleagues… but I’m also increasingly concerned at the apparent lack of willingness by any within the SBM camp to acknowledge that there are many reputable practitioners who ARE science-based and who ARE ethical with our patients.

          If I dare say… we’d love to be welcomed into the fold and contribute what we have to contribute to the body of medicine at large. We’re not all idiots and kooks, you know.

          1. Dietary interventions will never have that “A” grade level of evidence we would like, simply due to the nature of scientific inquiry.

            There is lots of good research about dietary interventions. I’ve read a lot of the research on food hypersensitivity.
            With the herbs, I was speaking of a particular doctor who reeled out a long list of particular herbs for a particular condition. I would look up these herbs later and find there was no evidence they were effective for the particular condition.

            I’m also increasingly concerned at the apparent lack of willingness by any within the SBM camp to acknowledge that there are many reputable practitioners who ARE science-based and who ARE ethical with our patients.

            As primary care providers, no.
            Dr. Peter Lipson issued some Primary Care Challenges that illustrated that.

          2. @Confused ND
            What are your diagnostic methods for food sensitivities, if you do diagnose them?

            1. RE: Primary care- This push started while I was in ND school in the early aughts and, I feel, a misguided approach to attract more students, and therefore revenue.

              For one thing, I don’t think that NDs and MDs are necessarily talking about the same thing when they use the term “primary care” which is unfortunate, and embarrassing.

              What I think (again, just my opinion) a lot of ND practitioners *mean* when they say “primary care” is utilizing things like lifestyle, diet, supplements, and herbs as primary interventions for presenting complaints, provided that a workup does not indicate a potentially life-threatening condition.

              A big challenge I face in my practice is that so many people are coming to me as a means of last resort… after years and sometimes decades of deteriorating conditions.

              Now… after all other resources are exhausted, they come to me hoping upon hope that I have some mystical, magical diet or supplement pill that is going to miraculously cure them of all their woes.

              I lose a fair amount of patients by my refusal to entertain such expectations.

              Nobody (I mean NOBODY) talked to them about their diet, about their lifestyle and exercise habits, about stress management and social support network, etc.

              And any mention of herbs or supplements- even those fairly established in the literature- were at best poo-pooed, and at worst met with warnings and admonitions about how “dangerous” these things could be.

              (They CAN be dangerous, but what the docs really should have disclosed is that they do not have the knowledge, training, or experience, to use these things, rather than just playing scare tactics on their patients.)

              So the idea with “naturopathic primary care” is that practitioners like us should be seeing patients *early on* in their disease course- when things like diet, exercise, herbs, and supplements stand a more reasonable chance of actually being of help, rather than ignored and poo-pooed and then used as a desperate last measure.

              1. @Confused ND
                Do people like the patients in Dr. Lipson’s Primary Care Challenges rely on you to decide their medications, whether to refer them, etc.?
                In that case, do you feel that knowledge of herbs, diet, lifestyle interventions, etc. is adequate?
                Or are these people relying on MD’s for their primary care?

              2. Beth-

                I think we may have reached the bottom of the chain for responding, so my apologies if this appears out of order.

                Regarding the “naturopath challenge” … no I don’t typically see that kind of patient because I don’t do “primary care.” However- considering the patient’s history, along with being hyperglycemic and hypertensive, my guess is uncontrolled diabetes and maybe some peripheral vascular disease. Is this a trick question?

                In any case… this is what I am talking about. A ND should have seen this patient long ago- in my opinion he is probably too far gone to manage with lifestyle, diet, and supplements alone.

                Since I do not have prescribing rights in my state, I would refer this patient back to a cardiologist. My advice would be to get on meds to get these things under control, and co-manage with diet, lifestyle and a couple of supplements if his finances permit.

                If the numbers normalize and remain stable for six months, AND the patient is compliant with my recommendations, after six months we would have a conversation about seeing if he could try to sustain the improvements without the meds.

                But I wouldn’t be too hopeful about it at this point. He’s probably too far gone.

              3. @Confused ND
                What do you mean, you “don’t do primary care?”
                Do you only take patients by referral from an MD?

            2. RE: Food sensitivities. I’m not satisfied with any test for food sensitivities. In my opinion, food sensitivities in general are a moving target and I’m not much of one for chasing test results around as it is.

              I’d rather work to diversify food sources, rather than restrict them, and attempt to address factors which might be leading to hypersensitivities in the first place.

              If all that fails, a focused elimination-challenge test is the gold standard in my book. Tedious, but unambiguous.

              1. Yes, a hypoallergenic elimination diet followed by food challenges is the gold standard right now for diagnosing food sensitivities.
                However, an elimination diet should be gluten-free among other things, and people need to get tested for celiac disease before going gluten-free.
                The reason is that one needs to be on a gluten-loaded diet for the CD tests to be valid; and once having stopped eating gluten, it may cause severe problems to go back to eating gluten for a diagnosis.
                I’m glad to hear you aren’t a believer in the many fishy food allergy diagnostic tests. A lot of naturopaths use very fishy allergy testing, it seems.
                Researchers try different kinds of diagnostic tests for food sensitivity – basophil activation test, ultrasound, endomicroscopy, atopy patch tests.

              2. I’d rather work to diversify food sources, rather than restrict them, and attempt to address factors which might be leading to hypersensitivities in the first place

                Except for gluten and perhaps dairy, that sounds good.
                If somebody has celiac disease, they’re running a risk of GI tract cancer, lymphoma etc. if they keep on eating gluten.

              3. Except for gluten and perhaps dairy, that sounds good.

                I take that back, it’s much too general. I don’t know whether continuing to eat various kinds of food that someone has a reaction to, might cause them harm.
                The reason I said “that sounds good” is that with food allergies of the kind that cause respiratory symptoms or anaphylaxis, oral immunotherapy is promising.
                And generally, the idea that avoidance isn’t the best way to deal with food allergies, seems to be gaining traction.

              4. I thought we were talking about food sensitivities, not food allergies. Two different things.

              5. As well as someone possibly having celiac disease, they might have a food allergy that shows up on skin tests or blood tests and could be dangerous.
                How would you know, if you aren’t doing such testing?
                Or an eosinophilic disorder, etc. etc.
                Maybe a food-sensitive person should see an allergist or a gastroenterologist, rather than a naturopath.

              6. I thought we were talking about food sensitivities, not food allergies. Two different things.

                By “food allergy” I suppose you mean, a food allergy that shows up on skin or blood tests for IgE-mediated allergy.
                However, some food sensitivities actually have a lot in common with such “classical” food allergies. They may be IgE-mediated, but localized in the gut.

              7. I thought we were talking about food sensitivities, not food allergies.

                Some food sensitivities have a lot in common with food allergies that are positive in skin and blood tests for IgE-mediated allergy.
                Food sensitivities may also be IgE-mediated, but local to the gut so they don’t show up in standard allergy testing.

              8. @Confused ND
                If a naturopath makes it quite clear to patients that they aren’t a primary care provider, and that they aren’t equipped or trained to diagnose diseases or to recognize emergencies OR to know when to refer people – as a family doctor is trained – then, their lifestyle / diet counseling could be very useful.
                *Anyone* who sees a naturopath should also consult a primary care MD/DO about the problem. The naturopath can’t know when a referral is needed – so everyone should be referred.
                That includes people with food sensitivities, BEFORE they get treated with an elimination diet or whatever.
                For example – if you don’t refer people for celiac disease testing before telling them to go on a gluten-free diet, that is causing harm. Going gluten-free without getting tested for CD is a diagnostic trap that many people have fallen into.
                People with food sensitivities should perhaps be referred to a good local allergist, as well as a primary care MD.

              9. Beth-

                I’m also not sure why you keep harping on celiac disease- but it’s kind of ironic because back when I was in ND school 15 years ago, we DID learn how to diagnose celiac. Back then, we were getting scoffed at and poo-pooed by the MDs because we were running too many “unnecessary and expensive” tests for celiac.

                Back in those days- anybody who spoke of non-IgE-mediated food sensitivities was just a crank. 😉

                I’m curious to know- what are your credentials, and when did you receive them?

              10. @Confused ND
                How do you diagnose celiac disease, then?
                And do you test for celiac disease before suggesting a gluten-free diet?

              11. @Confused ND
                The underdiagnosis of celiac disease is a major concern, because people who have celiac disease are at risk of cancer and many other problems if they continue to eat gluten. They need to be strictly gluten-free for life.
                When people who see an alternative practitioner go on a gluten-free or low-gluten diet and they feel better, they may just think vaguely that they have “some kind of wheat allergy” and they don’t realize they need to strictly avoid gluten – so they don’t.
                There are millions of people in the USA with celiac disease. It’s much more diagnosed than it used to be, but still underdiagnosed.
                The preventable colon cancer, lymphoma, etc. that results is not a minor problem.
                That’s why my concern: do you tell people to get celiac blood tests or a biopsy BEFORE they go on a gluten-free diet?

              12. Beth-

                *I* don’t diagnose celiac disease because I don’t have the authority to diagnose here. But if I *did* diagnose celiac, I would order the serologic tests, followed by a biopsy- but like anybody else. And yes- it’s pretty common knowledge that one must he eating gluten in order to get a diagnosis.

                Have you encountered people who saw an ND who didn’t follow standard of care in celiac diagnosis?

              13. *I* don’t diagnose celiac disease because I don’t have the authority to diagnose here.

                Then, you should refer patients who report food sensitivities, or who you think might have food sensitivities, to an MD – finding a good local allergist would be a good idea. Or maybe a primary care doc could do it. BEFORE suggesting a diet without gluten.
                Besides the reasons I’ve mentioned, people with celiac disease also often have sensitivities to non-gluten foods. If someone tells you they have food sensitivities, they are more likely to have celiac disease for that reason.

                Have you encountered people who saw an ND who didn’t follow standard of care in celiac diagnosis?

                I have encountered MANY people who avoid wheat or perhaps gluten in general, who have symptoms suggestive of celiac disease, who have never been tested for it.
                I don’t know what kinds of alternative practitioners they see.
                It seems to be very common that people go on a wheat-free or gluten-free diet, they feel better, various symptoms go away – and they may well have celiac disease and they should strictly avoid gluten – but they don’t! They eat it now and then and get sick; they eat a low-gluten diet rather than a no-gluten diet …
                If they had a solid diagnosis of celiac disease, they be told to take being gluten-free very seriously.
                This is the diagnostic trap you are risking if you suggest somebody try a diet that doesn’t have gluten in it.
                You say that you know your limits and are science-based. Relative to a lot of naturopaths, that seems to be true.
                But, you still seem to be practicing way beyond your expertise.

            3. Beth-

              My patients find me all on their own. They generally fall into three broad categories.

              1. (The largest group.) Is already seeing an MD (or more typically has seen several MDs.) They already have a diagnosis but aren’t satisfied with their treatment and looking for ways to augment it.

              2. This group are the self-diagnosers and self-prescribers who have used Dr. Google or Dr. Facebook and ended up thoroughly confusing themselves. They finally came around and realized they would benefit from some professional advice with respect to diet and supplements.

              3. This group is generally scared or antagonistic toward MDs. More often than not- I encourage them to go get a thorough workup with their MD, since their insurance is going to pay for the MD and not me. More often than not, they don’t come back.

              As I’ve stated before- I present myself as a specialist consultant on lifestyle, diet, herbs and supplements. Some of my patients are more adventurous in terms of how deeply they would like to dive into these things. It’s all done with informed consent.

              I utilize interventions that I believe have the best available evidence-base within the context of the above.

              Like any ethical practitioner, I recognize the limits of my own training and experience as well as my own biases. If I feel I am out of my element, I refer.

      2. We talked about orthorexia all the time during my tenure at ND school. But I was in the subculture of students who were more science-driven and who also believed that moderation with diet was the more sensible approach. We also drank alcohol and *gasp* smoked cigarettes.

        Sounds to me like you may have quickly fallen in with the “orthorexic” group due to your predisposition to that particular kind of ideology.

        Just be sure to keep in mind as you continue to share your anecdotes here… they are just anecdotes. It’s not accurate or fair to attempt to generalize to the entire profession based on your personal experience.

        That being said… do keep sharing. I think it’s high past time for naturopathic medicine to do some house-cleaning and- in particular- do address this unhealthy obsession with health, overly restrictive diets, and presenting experimental therapies as “tried-and-true” or evidence-based.

        1. If you truly were more “science-driven” as you claim you would have dropped out of ND school and applied to MD/DO schools. To the majority of us (real medical students (MD/DO)) it is clear how ND, DC and acupuncture are very far from what is considered science.

          1. Just to clarify, osteopathic medicine was initiated by courageous and innovative individuals like A.T. Still. He was at first regarded as a quack in the medical community. Manipulation has now been wildly accepted as a valid medical therapy. Some in the medical community however still regard them as substandard to MDs. Rather than ridicule other health professions we should work together to raise each other up to be the best we can be. Interprofessionalism is the future, and calling something unscientific is not only rude but uneducated. There is a science to everything. Cosmology, nutrition, physics, chemistry, and of course health all come to mind for me, but basically anything is scientific so long as it is researched and studied. Theories, experiments, and trials are keys to understanding something. There is no reason to think that there isn’t a science to the natural elements that surround us in this world. I mean many of our most effective historical therapies are naturally based, this article was reviewed by an MD. There are thousands of other resources that support the use of natural remedies and approaches to illness in articles, medical journals, and even thesis papers. Of course pharmaceutical companies are more profitable for the parties involved than natural approaches so there will always be backlash to anything that threatens their fortress. However, as dirty as this empire has become, medication and pharmaceutical advancements are necessary to healthcare because there are very obvious circumstances that cannot be treated without them. That being said we come full circle to the fact that ultimately for full scale patient care professionals need to understand that they don’t know everything and that they are all limited to their specialties. But the goal should be to bring all specialties together for the sake of the patient.

            1. Manipulation as a valid medical therapy? No. It’s not. Stating chiropractic manipulation, astrology, homeopathy, and other pseudosciences are not based in science is honest, not rude. Sometimes the truth hurts.

            2. “anything is scientific so long as it is researched and studied.”

              What about unicorns, leprechauns, and fairies? Does “research” and “study” make them “scientific”?

              I think you forgot the most important part — the part where you throw out the failed hypothesis.

            3. “There is no reason to think that there isn’t a science to the natural elements that surround us in this world.”

              In fact, there is: it’s called chemistry.

  13. Britt, following your blog over the last few weeks has been enlightening and terrifying.

    The more I have reflected on the state of play of nutritionism and the naturalistic fallacies abundant in paleo/naturopathy/raw veganism, the more I see these sick sociological and cultural ties to the religious sexual purity movement that was especially prominent in GWB’s reign. The idea that the body is only one mouthful – or one sexual partner – away from total depravity and corruption is as harmful as it is scientifically unjustified, and it seems to be having the biggest harm on young women.

    1. Bec- That is an interesting observation you have made. I was in ND school during the GWB reign and witnessed that same “You’re either for us, or you’re against us.” attitude coming from the leadership. Personally- I tried to sound the alarm on many of these issues that Britt is raising but was edged out and effectively silenced by those in charge. And not just me… there was a fairly large exodus of instructors- some really good ones- who were shown the door when they refused to cowtow to the leadership.

      I suspect many of the issues that are being raised here have more to do with politics than anything else. Naturopathic medicine desperately needs a “changing of the guard” with respect to leadership, in my opinion.

  14. Heartbreakingly honest post, thank you. Your experience with more and more restrictive diets and all of the allergy and sensitivity rigmarole tracks very closely with the anecdotes of a friend who was in treatment with a naturopath for digestive issues. The practitioner put her through all kinds of tests, proclaimed many sensitivities, and put her on a very restrictive diet (she was, like you, quite slender and fit and could not afford to lose much weight.) I think I may have helped her by pointing out how unlikely it was that she was allergic to wheat, eggs and oranges throughout her life, but had just noticed it recently. The real cause of her gastric problems were, I believe, the stress related to being a high-achieving grad student.

    Thanks again for this blog. It cheers me to know that some people find their way out of the alt medicine fog!

    1. how unlikely it was that she was allergic to wheat, eggs and oranges throughout her life, but had just noticed it recently

      People can have problems caused by food(s), yet not associate it with the particular food(s).
      Many people with celiac disease went undiagnosed for decades – never knowing that gluten grains were the cause of their problems.
      Once they’re on a gluten-free diet, they tend to get quite sick if they accidentally get gluten. Their body did its best to suppress the reaction while they were eating gluten often.
      Similar things happen with other allergies (using the term “allergy” loosely).
      So while the naturopath may well have misdiagnosed your friend, it’s not true that a food reaction must be obviously associated with the food.

    2. The practitioner put her through all kinds of tests, proclaimed many sensitivities, and put her on a very restrictive diet

      If her diet was gluten-free and this was after 2003, there’s no excuse for a naturopath to not tell someone to get tested for celiac disease before going gluten-free!

  15. Britt, I was also made aware of your brave step by Science Based Medicine and would like to acknowledge the difficulty you must have faced/continue to face.

    All of my personal involvement with Naturopathy (and those who espouse it) aligns eerily with what you have just mentioned. I was once dragged to see a Naturopath* by a somewhat deluded acquaintance when it was completely pointless and irresponsible as I was suffering from an SBO whilst recovering from abdo. surgery.

    This woman’s “approach” was the same for all who walked through her door – an incredibly strict “Elimination Diet”. I was given the spiel about having “leaky gut syndrome” which unfortunately confused me initially as I had recently had a resection reversed! The reliance upon a Vega Testing Machine & a LOT of Science-y words used in circular arguments, however, alerted me to the intrinsic BS. This was reinforced by a) happening to meet with several other young women with obvious eating disorders who were using the cloak of “but I was put on this Elimination Diet – by a Naturopath!” and b) the fact that when I was queuing to pay at the Reception desk, the Receptionist didn’t even glance up at my <35 kg at 5 ft 2 frame before asking "Oh, you'll be on the Weight Reduction Protocol, then?".**

    *ND isn't a recognized term in Australia, nor are Naturopaths subsidized as Primary Care Professionals under Federal funding

    **To be fair, the majority of the Practice's demographic were there to either lose weight &/or treat problems exacerbated by excess weight in middle age, and it probably wouldn’t have done most of the older women in the waiting room a great deal of harm in & of itself in the short term…

  16. Confused ND
    Just curious… Does your herbal specialty include homeopathy?

    Thank you for another thoughtful post. The title of this post “Food as Medicine” struck a nerve. The concept of food as medicine permeates a lot of the alternative medicine culture. Food as medicine is often a euphemism for cancer prevention. As a long time member of the cancer gulag I always cringe at the meme that you can prevent cancer by eating the “right” diet. Granted some foods could be linked to cancer like too much meat and not enough fiber could cause or aggravate colon cancer. Blaming cancer patients for not eating the right supplements or ‘super’ foods is just victim blaming. The implication is that I must have been eating a whole lotta sh– food to have gotten cancer. I wish the hypotheses of the origin of cancer and it’s prevention were that simple.

    1. Mike-

      I don’t use homeopathy in my practice, and I am certainly not the only ND who doesn’t. Honestly, I’m not sure how homeopathy became part of the standard naturopathic curriculum, but as the SBM folks love to point out, it certainly is the bane of the profession.

      I am very sorry to hear that you have encountered those types of ignorant attitudes regarding your cancer diagnosis. I can assure you that it is certainly not taught in naturopathic school that diet alone can prevent, cure, or treat cancer. And if licensed NDs are out there claiming as such, they should be held accountable for their actions.

  17. One big problem with MD’s is not keeping up with medical research.
    But from what I’ve noticed of alternative practitioners, they tend to be much, much worse at keeping up with research.

    1. Keeping up with research is difficult for anybody, due to the sheer volume. Then there’s all the shoddy research out there to contend with. Then there’s the pay-to-play journals. Then there’s flat-out research fraud. It’s really all quite a mess, as I’m sure anybody can tell you. And if you follow research yourself, you would already know this.

      With medicine in general, it’s not fair or accurate to paint the picture in black or white terms between MDs and “alternative” practitioners. There’s somewhat of a false dichotomy there.

      Medicine is medicine. It’s whatever works, and can be proven to work. When we get into the evidence-basis for medicine, there is not a level playing field between drugs and non-drug therapies like lifestyle, diet, herbs and supplements. Part of the reason is because it’s a lot more difficult to perform high quality studies on some of these things. Another part of the reason is because there’s a lot less financial incentive to do so. Another part is because of a long-standing bias among many MDs against anything that isn’t drugs or surgery.

      It’s really kind of a mess all around. In my opinion, rather than standing around shouting at each other about who’s to blame, we need to all work together in order to improve outcomes. That’s the bottom line.

      1. it’s not fair or accurate to paint the picture in black or white terms between MDs and “alternative” practitioners.

        The alternative practitioners are much, much worse at keeping up with current research, so far as I’ve seen. The things you’ve said so far haven’t made you seem like an exception to that.

      2. And the solution is definitely NOT allowing pseudoscience, quackery, in other words, Naturopathic Doctors have the same scope of practice as MDs or DOs. I, for one, would love to see what your biochem/medical genetics/physiology classes look like – I’m willing to bet it’s all surface and that you don’t delve as far into the subjects as MD/DO students do…

        1. Cruz-

          I think you are likely right to assume that the instruction in basic sciences that an MD/DO receives is more rigorous than that of an ND. But I also don’t think that what an ND receives is as shallow as you might believe.

          In my opinion, chest-pumping about who is more science-y is kind of a red herring.

          After all- pick any quack remedy that an ND might use- including homeopathy- and I could find plenty of examples of MDs who also use that same quack remedy.

          But perhaps a more poignant question is… how much science does a physician require to know that prescribing antibiotics for what is most likely a viral infection is a really bad idea for public health? I’m guessing a 10th grade level of biology would be required.

          The point is, more science alone does not make for better physicians.

          1. Letting “ND”s practice this quackery “because some MDs do” doesn’t seem like a solution. Rather, those MDs who allegedly practice this voodoo should be called out on it.

          2. “After all- pick any quack remedy that an ND might use- including homeopathy- and I could find plenty of examples of MDs who also use that same quack remedy.”

            But will you also find that training in those quackeries are an integral part of the training of all MDs, as is the case with naturopaths? Or that MDs are tested on their mastery of those quackeries on their licensing exams, as i the case with the NPLEX exam for NDs? Will you find all other MDs uniformly accepting their embrace of these quackeries, or taking them to task for it?

            1. Hi JGC-

              If it were up to me, I’d perform an excision of homeopathy from naturopathy. I’m not sure how or why it became part of the curriculum. I’m guessing political reasons or some “behind the scenes” dirty financing. (That’s all speculation.)

              It irks me to no end that homeopathy and naturopathy have been conflated. I cringe every time somebody calls our office asking about “homeopathy” even though the word is mentioned only one place on my website, when we state that we DO NOT use homeopathy in our office.

              The homeopaths were always a little clique within the larger ND community. Just like the “orthorexics” that Britt laments about in her post.

              The points you raise are valid concerns about naturopathy in general, but in my opinion do not really address what I was saying to Cruz. Allow me to restate:

              Chest-pumping about who is more science-y is a red herring.

              All the scientific training, examination, and credentialing in the world does not prevent against somebody going the way of the Anatids. Scientific and medical history is full of examples of this, as I’m sure you know.

              On the flip side, no amount of homeo-babble ever caused me- or many other NDs- to believe that administering increasingly infinitesimal dilutions of various substances is going to have some kind of biochemical effect on the recipient.

              1. I don’t think it’s accurate to characterize ND’s who embrace homeopathy as being a minor clique within naturopathy–it seems to me that it’s instead people like yourself who eschew and/or condemn its use who represent a small minority.

                As I noted in a previous response to John O’Malley, I’ve yet to find a I’ve yet to find a professional naturopathy association that doesn’t embrace homeopathy and acupuncture.

              2. All the scientific training, examination, and credentialing in the world does not prevent against somebody going the way of the Anatids

                So the training of MD’s in evidence-based medicine has no influence on how they practice?
                That would be strange … what’s your evidence for that assertion?
                Also, an MD who doesn’t follow the standard of care would likely be successfully sued.

          3. chest-pumping is not chest-pumping if it is a fact… You can call whatever irks you a red herring, it does not take away from the fact that you received many hours of utter bullshit (hydrotherapy, homeopathy, and the other sh*t modalities you have studied). The organization that represents you, AANP chest-pumps all the time with false-equivalency charts how much more NDs study science as compared to MDs/DOs;


            and now students interested in the ND course to nowhere, are also falsely assured of how ‘sciencey’ and ‘rigorous’ an ND education is –

            Good luck in your continued swim in the lake of cognitive dissonance!

      3. there is not a level playing field between drugs and non-drug therapies like lifestyle, diet, herbs and supplements.

        There are tons of research studies on health effects of various foods.
        Research suggests that coffee has a lot of anti-cancer properties, for example.
        And every time I’ve looked up an herb on Medline, I’ve found a lot of studies on it.
        There’s a risk that the idea that lifestyle, diet etc. aren’t well researched will be used to encourage people to hope that a new diet or whatever will take care of whatever health problems they have.

        1. beth, I’m not finding your link directing me to evidece that coffee has anti-cancer properties. In fact, the only study offered at the coffee informer website that came close was the last study which ound that 2 mM caffeine may increase cisplatin-induced apotosis in cancer cells grwon in vitro.

          1. Coffee and oral cancer
            Coffee and uterine cancer Another study on coffee and uterine cancer.
            Coffee and prostate cancer
            Coffee and brain cancer
            Coffee and colon cancer. However, other studies found that coffee raised risk of colon cancer.
            Coffee and breast cancer
            Coffee and liver cancer
            Coffee may actually increase the risk of lung cancer.
            Coffee and skin cancer
            From a 2010 review of epidemiological studies:

            For hepatocellular and endometrial cancers, there appears to be a strong and consistent protective association [with coffee]; for colorectal cancer, the direction of association is borderline protective. … Risk of bladder cancer appears to be associated with heavy coffee consumption in some populations and among men.

            More recently:

            Epidemiological studies have reported coffee drinking to be inversely associated with mortality as well as incidence of type 2 diabetes, Parkinson’s disease and cancers of the liver, endometrium, colon and skin.

            Anyway, there’s plenty of research to keep a lifestyle consultant busy reading!

          2. the only study offered at the coffee informer website that came close was the last study which ound that 2 mM caffeine may increase cisplatin-induced apotosis in cancer cells grwon in vitro

            That’s not true. Some of the links were broken, but other worked and were to epidemiological studies.
            Anyway I posted a list of links on coffee and cancer which hopefully will appear later.

            1. I think we’re suffering a problem of terminology–to my mind “having antivancer properties” denotes having the property of selectively killing or inhibiting proliferation of cancer cells, where it’s now clear you’re using it to denote being associated with a reduced risk of developing cancer.

              1. “Anti-cancer” is not the best way to put it.
                I don’t know of anything a naturopath could do that would actually treat cancer.

              2. Other than refer their client to a board-certified oncologist, I’d agree.

                That doesn’t seem to stop many of them from trying, however.

  18. @Confused ND

    I don’t have the authority to diagnose here.

    But you treat people. How do you treat people without diagnosing them?

    1. Beth-

      I’m pretty sure I’ve told you this already. The vast majority of people I see *already* have a diagnosis, and I am consulting with them about diet, lifestyle, herbs, and supplements which could help them.

      1. When you see people who haven’t been evaluated by mainstream medicine for their problem, how do you avoid being in a primary care role with them?
        How would you treat those people, without a diagnosis?

        1. Beth- I am feeling at this point either I am being a lot less clear with my communication than I think I am, or you are being intentionally selective about reading what I write. Or possibly that you are employing personal incredulity and loaded questions some type of argumentative tactic.

          I’ve already answered the above questions. I think our conversation here has passed the point of further utility. Thanks for the chat.

          I’ve already answered your

          1. I’ve already answered the above questions

            You haven’t so far as I can tell.

        1. The more “rational” style of naturopathy – avoiding obvious charlatanry – could be more dangerous to some. It’s more plausible – so it might induce cancer patients to avoid chemotherapy, for example, and try herbs and supplements instead. People who respect science might go to a naturopath who claims to be science-based.

  19. Hi Britt,
    I admire your devotion and persistence in pursuing your various eating regimens. I also can understand your disappointment and criticisms of the advice you received. I don’t know how skilled and experienced the clinicians were who were advising you.
    Nutrition, like medicine itself is an art; a high art. I’ve been practicing clinical nutrition for 40 years now. Food still seems to me to be one of the most powerful of all medicines.
    I would encourage you to not give up on how beneficial it can be to you. Eating is a way to express love to yourself. And, like thinking and movement, there is no escaping its impact, for better or for worse.
    Further, eating cannot be separated from your thoughts, emotions and relationships.
    There is nothing more important than the guidance of a skilled practitioner in guiding you in this.
    I hope you can recover your trust in your power to nourish and Heal yourself through your ways of eating and living.
    Bless you, sister.

    1. Healthy eating is important.
      But what makes you think people in general need a “skilled practitioner” to tell them how to eat healthy?
      And if they do – what’s your evidence that naturopaths are better at getting someone to eat healthy than MD’s or RD’s?

      1. To be fair, my MD told me that there’s vitamin D in broccoli… And also, RDs are more likely to have restrictive eating disorders than the general population, which could have a negative influence on his or her recommendations.

        1. Mushrooms can make vit D – only non-animal food source I know of. When exposed to ultraviolet light they make vit D, similarly to how vit D is made in human skin.
          Fun (and maybe useful) fact 🙂

          1. Plant foods do have Vitamin D2, but the human body cannot utilize it without Vitamin D3 (from sunlight and/or meat).

  20. I could really relate to some of the comments. I had an experience similar to Andrea’s. I had C. diff, and I was calling my ND’s office about diarrhea (as that was who last prescribed antibiotics, and I knew the risks, and this was something different than I’d had before) and they were telling me to eat coconut. Coconut for C. diff, yes. It was undiagnosed at this time, but they should have known I didn’t call between appointments for minor stuff. And then I’m calling back saying it’s helping only a little, and they’re saying, keep on doing the coconut. But if you feel in danger, go to Urgent Care. So I did. And I lived to tell the tale. Because of some of my MDs, and saline IVs in ER.

    I’m kind of done with NDs now. They listen better, but they can’t help much. Not that the MDs can help, either, but at least I’m not spending money on supplements continually that aren’t doing much, and discussing whether I will do yet another unscientific diet plan (Eat Right 4 Your Type, Weston A Price, yeast suppressing, whatever).

    But I hope someone figures out a cure for food sensitivities & allergies. Adding foods back rarely works for me.

    1. I hope someone figures out a cure for food sensitivities & allergies

      People mean different things by food sensitivities & allergies, so I don’t know exactly what you mean.
      But I’ve been trying to desensitize my own delayed-reaction food allergies, with the help of my allergist, and I’ll tell you what I’m doing.
      By delayed-reaction, I mean I start to feel hazy about half an hour after eating the food, the reaction comes on fully about 4-5 hrs after eating. Similar to late phase of an inhalant allergic reaction.
      Oral cromolyn 1/2 hr before meals, decreases the food reaction. I get it in powder form from a compounding pharmacy, it’s much less expensive that way.
      For foods I’m trying to reintroduce, I eat a tiny amount with a meal, once every 4 days. I take loratadine and singulair in addition to the cromolyn, 2 hrs before eating that tiny amount. Those also help some with the food reaction.
      After months of doing this, the reaction diminishes somewhat. I’ve been able to slowly increase the amount that I eat. I haven’t been able to go back to eating any food in normal quantities though.
      Also – the kind of delayed-reaction food allergy that I have, happens mostly to people who are otherwise allergic – allergic rhinitis, asthma, etc. For that reason and others, I suspect these allergies are antibody-mediated (maybe mediated by IgE, maybe free light chains).
      I have horrible inhalant allergies and I’m getting allergy shots.
      Allergy shots with the food might help with delayed-reaction food allergies, but this isn’t done.
      But I hope that allergy shots will help with my delayed-reaction food allergies anyway, because allergy shots over several years tend to turn one’s body away from antibody-mediated immunity.

      1. Beth,

        “Delayed food sensitivities” is not a recognized medical condition. Feeling “hazy” hours after a meal is sufficiently vague to be an extremely pliable symptom and therefore very prone to observational bias. Nor does it sound in any way related to a mast cell mediated allergic response, so your Cromolyn, loratadine, and singulair do not have a rational basis for use, nor do they have an evidence base for use. And if you want to start blaming IgG food allergy, T-cell responses or other cellular mediators, then you are getting even further into the muck and away from science based evidence.

        Your “allergist” is not practicing from a foundation of evidence. If you really believe that a given food is making you sick, and provided it is not a major staple such as milk, wheat, corn etc, then fine, pull it from your diet and everyone is happy. If you have a long list of alleged food allergies/sensitivities, and your life revolves around what you are and are not eating, stressing your budget and social relationships, then you need to see a competent allergist who will set you up with some blinded food challenges to help you establish the veracity of your alleged food sensitivities.

        An elimination diet or rotation diet as utilized by naturopaths is generally not blinded. As such, this approach can be unreliable, to say the least, in the diagnosis of food allergy. Confirmation bias is an enormous factor with self diagnosed food sensitivities. It needs to be removed from the equation by using blinded food challenges.

        For state of the art in diagnosing food allergy, see :

        There is some anecdotal evidence that allergy shots to pollens can help with Oral Allergy Syndrome (AKA the Fruit-Pollen syndrome). Otherwise, you should not expect aeroallergen shots to help your food issues.

        Good luck

  21. How awful. 🙁 I had annorexia or EDNOS (not sure what I would have been diagnosed with at the time, but my BMI was underweight and I lost my period), and none of the ND’s or MD’s I went to caught it for what it was. But my worst experiences were with ND’s who wanted me to cut even more foods out of my restricted diet, or who were pleased that I was eating “healthy.”

    I will tell you my worst ND story. Well, to be fair, she was not a registered ND, but she had written a book about how that didn’t really matter. Anyway, when on her theraputic diet, which I went on for mental health reasons (she claimed it would cure me), I lost 30 pounds in 1.5 months. When I called her and told her I was worried because I had used to have a restrictive eating disorder and it had taken me so much work to gain the weight I’d just lost, she raised her voice asking, “do you want this or not?” I was desperately mentally ill, and I wanted to be better. But I now see her response was egotistical and irresponsible.

    When her diet didn’t do what was claimed, and my teeth started to erode due to my lack of nutrition, I gave up on ND’s completely. Shortly thereafter I found the website Your Eatopia, which saved me.

    Many ND’s are ignorant and harmful. But so are some MD’s. The best ND I have ever been to, uses all the appropriate blood testing, and ever perscribes antibiotics when necessary. It’s helpful to be a concious healthcare consumer,and not just take everything a professional said as gospel.

  22. Thank you for this. The food as medicine/food purity thing that has always rubbed me the wrong way and the more I read about cleanses and specialized diets to deal with myriad issues, the more I see them as the opposite of what they claim. They are not the “path to wellness”. More often they are a path to obsessive thinking about food or one that leads to yo-yo dieting under the guise of health.

  23. As a pharmacist I get the use of medications helps us with symptoms at least, sometimes it helps cure the underlying condition too. I see people often that have “tried everything” the doctor has written a prescription for and they still don’t feel better. Sometimes they do feel better with the first choice of therapy. I have seen patients needlessly and completely write off a good doctor because they couldn’t help them. It’s called throwing the baby out with the bath water. I get the sense that this background you’ve described has soured you to all “alternative therapies”, or maybe I am reading too much into that. From my own personal pharmacy career I can assure
    You that sometimes the therapies you claim are baseless actually do work. Sometimes they don’t. It’s important to filter out the garbage for sure. I have had patients come to me for acne related issues that have had nothing to do with their testosterone levels or testosterone to estrogen ratio. Some of them did. I have had patients go
    Their entire life using benzoyl peroxide without caring what the cause of their acne was. The food sensitivity test you speak of does not result in a positive treatment all the time, but some of the time it does work. It takes patience and time
    To weed through information when some of it doesn’t apply and some of
    It does with that one patient in front of you. After your experience I can see why you’d want to throw whatever they taught you at the ND school into the lake, but when you realize that it isn’t an all or nothing choice, you actually can find some useful information in what you are now completely against. Sometimes stuff works and sometimes it doesn’t. Modern medicine or alternative. I can assure you I see this every day in my job. I actually had a patient come off of nightshade and she came off of an arthritis medication, but not all patients. Does she care if some would call that hogwash? Nope. She thanks me every time
    I see her though.

    1. Do you realize that your anecdotal experiences you are describing are a big part of the reason this blog exists. This is the whole point of double blind randomized control trials so people like you (who should know better if you have science training) do not attribute improvement or lack thereof to a single treatment point in time Because my uncle john said his wife finally got pregnant because he ate ravioli before sex, doesn’t mean that ravioli is a cure for infertility. Pharmacist, your post is infuriating.

      1. I love your metaphor, David. And yes, you are exactly right. Anecdotes like this are a large motivation for this blog. Anecdotal evidence as robust scientific evidence is far too pervasive in the ND community.

  24. Actually I haven’t discussed any of the therapies I use at all so how can you be against them? This is the danger here: being against someone that implies that something that is shown in small studies and therefore all they do is wrong. This is
    The baby and the bath water reference . I am not sure what infuriates
    You when there are no specifics
    To refer to? I am not into homeopathy, I do not practice naturopathic medicine , and I invite
    You to walk into my village and ask around their opinion if my overall healthcare approach and their experience of it overall. I would be happy to have a coffee someday and discuss with you
    What I do for
    My patients so you will know exactly what it is I do to help them improve; not
    The least
    Which is withdrawing sugary beverages from my store, offering one on one FREE consultations for anything my patients want, offering nutritional counseling on top of conventional prescription therapies, I offer quality of life in palliative care patients in pain, I help obese patients to healthy weights that add years in their life, improve cardiac outcomes with evidence based therapies, I help accelerate wound healing in bed ridden patients when conventional therapies fail and am consulted regularly by physicians of all backgrounds to successfully treat patients that fall outside of the bell curve of your “evidence based medicine” that frustates the average medical community.
    This infuriates you?

  25. I notice when i eat well I don’t get as sick. Also I’ve been eating fresh pineapple every day to keep sinus infections away(it works) and I haven’t seen a dr. for a sinus infection in over a year. Whereas before I would have to go once a month to get antibiotics for sinus infections. I have asthma and it makes me more prone to them.

  26. You continue to have articles with NO evidence or proof of what you’re saying. Im very convinced you’ve been paid money to advocate against natural medicine!

  27. Hmmm….it sounds like you had some bad experiences. From what I’ve
    gathered from your story is that you created your own diet…and I
    wonder if you were paying attention in nutrition classes? I know
    that you’re studying biochemistry now, but did you take the chemistry
    prerequisites before naturopathic medical school? I am getting a
    Bachelor of Science in Human Biology (and considering going to Naturopathic medical school). I’ve taken a nutrition class taught by a
    biochemist at my University, and it was extremely science-based. Did their nutrition
    classes at Bastyr cover the details of each macro and micro-nutrient? It seems that they would considering the prerequisites for attending the school. However, Bastyr is not my top choice anyway…NCNM is my top choice, because of their qigong and tai chi program.

    Life experiences can change one’s perspective, and you may have just been going through some crises at that time in your life, and I’m just not sure if I should believe you….. I’ve gone through my own dietary stuff as well, and timing in life events really does matter. Although, it is truly awful if the naturopaths knew of your messed up diet and did not mention it (but again, I don’t know if I believe you).

    The best thing I ever found for my facial acne was the Oil Cleansing Method, which is a mixture of 2 oils that I wash my face with every night. It is literally the best natural remedy that I have ever found. (Yes, I do keep the sugar cane to a minimum, but I of course eat fruit that contains natural sugars).

    1. You may have missed Britt’s point about her clinical experiences with the ND resident and “doctors” at the Bastyr clinic enabling an eating disorder by seemingly trying anything and everything under the sun to treat her complaints. Obviously they were not finding the root cause and just chasing symptoms, which were making her problems worse. Basically, they put her on a restricted diet which gave her problems and then tried to fix those problems with more restrictions, which are unproven. There is nothing science-based about that! You should really reconsider your career as a naturopath, you might really save yourself a lot of time and money. Read Britt’s posts on the cost and career prospects. Of course you won’t get honest information from any ND school. They want your loan money!

      1. Yah, I saw that. I’m not sure why they wouldn’t have checked her BMI and decided that it was unhealthy. And why wouldn’t they have checked her nutrient levels, such as iron, as she mentioned? She needed to be eating a balanced diet to acquire all of her nutrients. But she also mentioned that she came up with her own diet, which sounded unhealthy to me anyway and didn’t seem to follow nutritional guidelines, whether as an omnivore or a vegetarian….

        It seems plausible that not everyone who studies naturopathic medicine should be practicing it….perhaps they’re not good at it.

        And I have had troubles with allopathic doctors as well, so can she really blame all naturopathy for her troubles?? Sometimes a doctor (no matter if they’re allopathic or naturopathic) can not figure out their patients problems and how to treat it, so they send them to a different doctor….that’s what they should have done for her. I almost died when I was 4 because my mom’s allopathic doctor could not figure out that I had appendicitis. After days and days of his false diagnoses, my mom took me to the hospital, and they saved my life…I would have died that day. Also, as a teenager, I was depressed, and the allopathic doctor prescribed me anti-depressants. He didn’t even ask about my nutrition or if I was getting enough sunlight, which I found out about later after quitting therapy and all anti-depressants.

        So I don’t think that blaming a naturopathic or an allopathic doctor for all of your problems is the right approach. They all mess up. That’s why they have insurance to cover themselves if they mess up. And they’re not all going to be good at their practice. It probably takes talent.

        I still believe in natural medicine, but I also believe in allopathic medicine when needed. All medicine comes from plants anyway….

        It sucks that she had such a terrible experience, but what would be cool is if she could use her knowledge of biochemistry to understand how medicinal plants work.

  28. Did you even pay attention in nutrition classes?
    It all makes sense now. You’re obviously just not very bright and also got given shitty advice.
    Hahaha serves you right

Comments are closed.