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Frequently Asked Questions, Answered.

Re-published, courtesy of the American Association of Naturopathic Physicians.

Naturopathic Medicine FAQs: A Service for Consumers

A service for consumers from the American Association of Naturopathic Physicians (AANP) and the Institute for Natural Medicine (INM).

The AANP and the INM would like to acknowledge the Association of Accredited Naturopathic Medical Colleges (AANMC) for its contributions to the content of this FAQ. The AANMC was established in 2001 to advance the naturopathic medical profession by actively supporting the academic efforts of accredited naturopathic medical schools.

View the printable PDF version.

FAQ #1: How are naturopathic doctors educated, trained, and licensed?

Accredited naturopathic medical schools are four-year, in-residence, hands-on medical programs consisting of a minimum of 4,100 hours of class and clinical training. During naturopathic medical school, students are educated in the biomedical sciences as well as the latest advances in science in combination with natural approaches to therapy. They also study disease prevention and clinical techniques.

In addition to a standard medical curriculum, schools require their graduates to complete four years of training in disciplines such as clinical nutrition, acupuncture, homeopathic medicine, botanical medicine, physical medicine, and counseling. For at least the final two years of their medical program, naturopathic medical students intern in clinical settings under the close supervision of licensed professionals.

Given the importance of hands-on, clinical experience for naturopathic medical students, the accrediting body for naturopathic medical colleges does not recognize degrees from online programs of study.

Differences between how MDs and DOs and naturopathic doctors are trained

The general educational structure for naturopathic doctors is comparable to that of conventional medical doctors (MDs) and osteopathic doctors (DOs). In all three medical programs, the first year emphasizes biomedical sciences such as anatomy and biochemistry. Second year classes focus on the diagnostic sciences, including areas such as evidence-based medicine and physiological assessment. All programs progressively increase students’ problem-based learning and integrated coursework, enabling students to learn how different concepts affect one another.

After the first two years, the curricula of the three medical programs focus on applying medical knowledge to real-life situations with simultaneous classroom studies supporting this training. During these later years, the education of MDs and DOs begins to differ from those of naturopathic doctors. For example, students of conventional medical complete clerkships, which are courses in various medical specialties. Although MD students see patients during these clerkships, their roles are primarily observational: they are not primarily responsible for patient care.

Third- and fourth-year naturopathic medical students have more opportunities for hands-on clinical training and practice, often at their schools’ teaching clinics and off-site clinics. This period of clinical training is essential to these students’ education—so much so that clinical training is now being introduced during the first and second years of education at several AANMC-member schools. As a result, naturopathic medical students graduate with experience in diagnosing and treating patients, even before they begin formal practice.

A major difference between the training of the MDs and naturopathic doctors is medical residencies. MD residencies are mandated and regulated by conventional medical schools. As a result, many opportunities for residencies exist at a wide variety of medical facilities and are funded by the federal government.

Naturopathic medical residencies are not nearly as common because they are not yet required by most states (Utah is an exception) or funded by the federal government. In place of a residency, many new naturopathic doctors choose to practice with or shadow an experienced doctor before setting up their own practices.

Like MDs, a growing number of naturopathic doctors choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology. In addition, while practicing Family Medicine, many naturopathic doctors choose an area of focus based on a therapeutic, condition, or population subset.

Prerequisites

Prior to admission into an accredited naturopathic medical school, the typical entering student has completed three years of pre-medical training and earned a bachelor of science degree. Students are expected to have completed courses in English and the humanities as well as math, physics, and psychology, with a strong emphasis on chemistry and biology. In addition to prerequisite course work, prospective students must demonstrate appropriate observational and communication skills, motor function, intellectual-conceptual abilities, integrative and quantitative abilities, and behavioral and social maturity.

Accredited schools

There are currently seven accredited schools with eight campus locations in the United States and Canada. A degree from an accredited medical school is required for licensure or certification by a state.

The following accrediting institutions provide accreditation services for naturopathic medical schools:

College accreditation is issued by the U.S. Department of Education (ED). All AANMC member schools have been accredited or are in candidate status for accreditation by an ED-approved regional accrediting agency.

Programmatic accreditation is issued by the Council on Naturopathic Medical Education (CNME). All AANMC member schools have also been accredited—or are candidates for accreditation—by the CNME, the recognized accrediting body for naturopathic medical programs in North America.

The exam required to qualify for naturopathic doctor licensure is administered by the North American Board of Naturopathic Examiners (NABNE). The Naturopathic Physicians Licensing Examinations (NPLEX) is a two-part examination. Only students and graduates from accredited or candidate naturopathic programs are eligible to sit for the NPLEX. Passing the NPLEX is required before a doctor of naturopathic medicine can be licensed by a state.

Licensure and certification

Licensure and certification are the highest forms of regulation. They are designed to protect the public by ensuring that certain minimum competency requirements are met. They also set standards for the profession.

Currently 19 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands offer licensure or certification for naturopathic doctors. The American Association of Naturopathic Physicians maintains a list of states and territories that license or certify naturopathic doctors.

FAQ #2: What is Naturopathic Medicine

View the printable PDF version. | View the editable Word version for use in your practice.

Naturopathic medicine is a distinct practice of medicine that emphasizes prevention and the self-healing process to treat each person holistically and improve outcomes while lowering health care costs.

Naturopathic doctors are educated and trained in accredited naturopathic medical colleges. They diagnose, prevent and treat acute and chronic illness, restore and establish optimal health by supporting the person's inherent self-healing process. Rather than just suppressing symptoms, naturopathic doctors work to identify underlying causes of illness, and develop personalized treatment plans to address them. Their Therapeutic Order™, identifies the natural order in which all therapies should be applied to provide the greatest benefit with the least potential for damage.

  1. Remove Obstacles to Health. Health, the “natural state” of one’s body, is disturbed by obstacles that lead to disease. The first step in returning to health is to remove the entities that disturb health such as: poor diet, digestive disturbances, inappropriate and chronic stress levels, and individual disharmony. Naturopathic doctors construct a healthy regimen based on an individual’s “obstacles to health” to change and improve the terrain in which the disease developed. This allows additional therapeutics to have the most beneficial effects possible.
  2. Stimulate the Self-Healing Mechanisms. NDs use therapies to stimulate and strengthen the body’s innate self-healing and curative abilities. These therapies include modalities such as clinical nutrition, botanical medicines, constitutional hydrotherapy, homeopathy, and acupuncture.
  3. Strengthen Weakened Systems. Systems that need repair are addressed at this level of healing. Naturopathic doctors have an arsenal of therapeutics available to enhance specific tissues, organs or systems including: lifestyle interventions, dietary modifications, botanical medicine, orthomolecular therapy (use of substances that occur naturally in the body such as vitamins, amino acids, minerals), and homeopathy.
  4. Correct Structural Integrity. Physical modalities such as spinal manipulation, massage therapy, and craniosacral therapy are used to improve and maintain skeletal and musculature integrity.
  5. Use Natural Substances to Restore and Regenerate. Naturopathic medicine’s primary objective is to restore health, not to treat pathology. However, when a specific pathology must be addressed, NDs employ safe, effective, natural substances that do not add toxicity or additionally burden the already distressed body.
  6. Use Pharmacologic Substances to Halt Progressive Pathology. NDs are trained in pharmacology and how to use pharmaceutical drugs when necessary. If their state license permits, they can prescribe these agents themselves or if not, refer to a conventional medical colleague.
  7. Use High Force, Invasive Modalities: Surgery, Radiation, Chemotherapy. When life, limb, or function must be preserved, NDs refer patients to MDs who are expertly trained in these arenas. At the same time, NDs use complementary or supportive therapies to decrease side effects and increase the effectiveness of these invasive procedures.

While many naturopathic doctors are trained in primary care, like conventional medical doctors (MDs), some choose to specialize or focus their practices. Specialty associations currently exist for Endocrinology, Environmental Medicine, Gastroenterology, Parenteral Therapies, Pediatrics, Primary Care Physicians, Psychiatry, and Oncology.

Naturopathic medical education curricula include certain areas of study not covered in conventional medical school. At the same time, aspiring naturopathic doctors receive training in the same biomedical and diagnostic sciences as MDs and osteopathic doctors (DOs). The result is a comprehensive, rigorous, and well-rounded scientific medical education that is both comparable and complementary to that of MDs and DOs. For more information on how naturopathic doctors are educated, trained, and licensed, see FAQ#1 in this service, available here.

Working in working out

  You know how sometimes, you can plan for something, work at it a bunch, and still have it fall flat on its face?

That was me this time last year.

I picked the Tillamook Burn Trail Race as my first 50K distance race.  It's beautiful, or rather....brutiful.  With over 7000 ft elevation gain and loss over 30 miles of lush old growth forest, I really had my work cut out for me when I found out I had gotten a spot from the waitlist for this race.

I toed the line last spring, started strong, but then a few hours in, the terrain started to eat me alive.

I realized around mile 16 that my finish was in jeopardy.  With each mile completed, it actually started to feel like the finish line was moving away from me.  There was a 5pm cutoff for the race.  I was dangerously close to going over time.  The final 1450ft ascent before the finish, I knew it was over for me.  They let me through the last aid station so I could complete the distance and cross the finish line.  My family was waiting there for me, and it didn't matter to them that I missed the official time by 14 minutes.  It really only mattered to me.

Turns out it mattered to me a LOT.  Way more than I understood until the past few weeks.

I took the fitness attained from training for that race and churned it into the next race, and the race after that.  I volunteered at other races and got inspired.

I went to grown up up running camp and highlighted my areas of weakness so I could hone those skills and become a better athlete.

I cross-trained when I could (read: grabbing those 5-10 minute slots to kettlebell, stretch, squat, handstand, lunge, or whatever!).  I ran in the rain, the mud, the snow, the ice, the numerous mini-landslides, in jeans, pajamas, snow gear...to make it happen.  For me.

I studied the Tillamook Burn course this year and chunked it down into 8 sections.  I set time goals for each checkpoint.

Do you know what?  It worked.  I finished 38 minutes faster this year, and the day was a pure joy.  365 days and a lot of work later, I finished that bad boy.

Set goals, huge goals, and work towards them every day.  Work it into your day.  Stay focused. It's important to me that my kids see me doing this valuable self-care, even though I'm balancing parenting them and seeing my patients.  Be patient.  Do many small things.  I promise, it's worth it.

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The sweetest finishes sometimes take a long time to get to.

 

 

 

Green space exercise

There are a growing number of articles that show a clear connection between increased mental wellbeing, stress relief and even immune system activation. when exercise is conducted in forested green spaces. In the UK and Japan, they study this phenomenon extensively, citing active components that are directly responsible for all these positive effects.  That fresh pine smell, for example, is actually alpha and beta pinene.  These naturally occurring volatile aromas increase Natural Killer cells, which help us battle things like viruses and tumor cells.

You don't have to smell the woods, to get the benefit though.  In the UK, researchers found that just looking at peaceful, natural scenery while exercise increased several health parameters.

So, exercise in nature if you can, but also consider switching from zoning out with a TV show on the treadmill to treating yourself to some seriously beautiful views instead.

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Li Q1Kobayashi MWakayama YInagaki HKatsumata MHirata YHirata KShimizu TKawada TPark BJOhira TKagawa TMiyazaki Y. Effect of phytoncide from trees on human natural killer cell function. Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4):951-9.

Li Q1, Kobayashi MInagaki HHirata YLi YJHirata KShimizu TSuzuki HKatsumata MWakayama YKawada TOhira TMatsui NKagawa T. A day trip to a forest park increases human natural killer activity and the expression of anti-cancer proteins in male subjects. J Biol Regul Homeost Agents. 2010 Apr-Jun;24(2):157-65.

Humpel N., Owen N., Iverson D., Leslie E., Bauman A. Perceived environment attributes, residential location and walking for particular purposes. Am. J. Prev. Med. 2004;26:119–125. doi: 10.1016/j.amepre.2003.10.005. [PubMed] [Cross Ref]

De Vries S., Verheij R.A., Groenewegen P.P., Spreeuwenberg P. Natural environments—Healthy environments? An exploratory analysis of the relationship between greenspace and health. Environ. Plan A. 2003;35:1717–1731.

Pap happy.

Guess what?  The guidelines have changed for Pap smears!  I know that coming in for your annual exam is about as fun as going to the dentist for a filling, but I am proud when you ladies come in and take care of business.  I like checking in with you each year.  However, the guidelines have changed, and it means we won't be seeing eachother quite as often. To summarize: Under Age 21: no pap smear, no HPV testing Age 21-29 Pap every 3 years Age 30-65 Pap + HPV every 5 years

Here's a nice article written by a colleague, Aviva Jill Romm, MD.  This is a great summarization of the new guidelines.

If you want more info from the U.S. Preventive Services Task Force, click here.

Maternity leave for the midwife!

  Hi everyone!  Most of you know that we're expecting our second baby in September, but I wanted to get the word out at any rate.  Next week is my last week at the office before I go into major mama mode and bring our new little one into the world.  I will be out of the office from 9/5/11-10/11/11.  When I come back, I will be in the office on a very part-time basis for the month of October.  I will add more hours in November and December, and will be back to my full schedule in January. While I'm out, Dr. Jenny Maurer (at our clinic) will be covering my practice.  She will be available to see you at the clinic for any of the concerns you would normally see me for.  If you have well-baby, well-child, or adult wellness checkups that are due, she is happy to do those too.  I will be in the office this Tuesday, Wednesday, and Thursday wrapping things up, so please give a ring if you have any questions!

We don't know if our baby is a boy or a girl (YET), but I will post here when the baby is safely born.  See you all this coming fall!!!

Radiation update

So far, only tiny amounts of radiation have been detected in the US.  Science likens it to the amount of radiation a person would be exposed to taking a cross country airplane flight. This article came out today.  Keep checking back for updates.  My recommendations have not changed at this time regarding iodine supplementation (see below)

In health,

Dr. Roe

Radiation conundrum

Hi all, I have been reading the news this week regarding the devastation in Japan, watching some of the impact fall right into our laps here on the West Coast.  Quite a few patients have contacted me this week wondering if they should be taking Potassium Iodide.  The short an answer is, I don't know.

There is very little conclusive evidence available at this time to make a definitive recommendation.  However, I did come across this map that shows the likely flow of the radiation plume from the nuclear power plant.  Many people want and need a plan of action.

What I do know is that it's smart to be prepared.  As a naturopathic doctor and midwife, I can't stress that enough in any realm of health.  What I also know is that I want to protect my patients and my family.  So, for that reason I am recommending that each family get some Potassium Iodide.  I think it's wise to have it on hand at this point.

If your local stores are out of it, I have found some at Amazon.com.  We also got a shipment this afternoon at our clinic of Potassium Iodide drops.  The dosing::ONLY IN THE EVENT OF ACTUAL RADIATION EXPOSURE:: is as follows (from cdc.gov):

  • Adults should take 130 mg (one 130 mg tablet OR two 65 mg tablets OR two mL of solution).
  • Women who are breastfeeding should take the adult dose of 130 mg.
  • Children between 3 and 18 years of age should take 65 mg (one 65 mg tablet OR 1 mL of solution). Children who are adult size (greater than or equal to 150 pounds) should take the full adult dose, regardless of their age.
  • Infants and children between 1 month and 3 years of age should take 32 mg (½ of a 65 mg tablet OR ½ mL of solution). This dose is for both nursing and non-nursing infants and children.
  • Newborns from birth to 1 month of age should be given 16 mg (¼ of a 65 mg tablet or ¼ mL of solution). This dose is for both nursing and non-nursing newborn infants.
  • Pregnant women should take 130mg and immediately evacuate the radiation zone.

Many forms of Potassium Iodide that you will find in stores come in microgram dosages, so make sure to do the appropriate math.  You want to take milligram dosages should we have actual radiation exposure.

In the meantime, we should be focusing on Iodine-rich foods to build our stores up a bit.  I'll be updating this blog as the story develops. So check back.  I'll leave you with this list of yummy foods to munch on:

Asparagus

Dulse

Garlic

Kelp

Lima beans

Mushrooms

Seafood

Sea salt and fortified salt

Seaweed

Sesame seeds

Soybeans

Spinach

Summer squash

Swiss chard

Turnip greens

recipes

From my kitchen (more to come): Healthy Mac N Cheez: Dairy-free, egg-free, gluten-free

Ingredients:

1 package gluten-free pasta of your choice

4 cups fresh chopped cooking greens (spinach, chard, kale, or collards)

1/3 cup nutritional yeast powder

1/4 cup olive oil

2 TBS tamari sauce (this is a good wheat-free alternative to soy sauce)

Directions:

1. Cook pasta as directed.  When through, drain and return pasta to saucepan.

2. Saute greens over medium heat with a little olive oil until tender and bright.

3. Add olive oil and tamari to pasta, mixing thoroughly with pasta

4. Add nutritional yeast and greens to pasta, stirring it all together!

Enjoy hot or cold as a delicious alternative to boxed mixes.