NDs and MDs now working together
By Dr. Martin Gleixner, MSc, ND
The face of health care is changing in Canada.
We often hear mostly about the problems…spiralling health care costs, long hospital wait times, drugs side-effects, short patient visit times, increasing occurrences of chronic disease (most notably cancer, diabetes, auto-immune disease), super bugs that are antibiotic resistant, the lack of preventive care, etc...
Despite these challenges facing our current health care system, are there positive changes occurring as well?
Indeed, our health care system is showing signs of improvements and there is hope for upcoming innovations and cooperation.
In Ontario for example, Brampton residents will see their primary care options expand as the Canadian College of Naturopathic Medicine (CCNM) opens the first naturopathic teaching clinic in a hospital setting in Canada. This change reflects the public’s growing interest in integrative, preventative health care.
Closer to home, as a naturopathic doctor practicing in Moncton, I have begun to work closely with a gastroenterology medical doctor (MD) at the George Dumont. This partnership was developed based on the recognition that both naturopathic medicine and conventional medicine have their specialties and strengths.
The debate is no longer whether it’s one or the other, but rather moving forward with the integration of both. Patient care can only benefit from combining the strengths of each form of medicine. Certain elements of this integrated approach has been discussed within four previous columns. Let's review additional reasons for combining both forms of medicines:
Both forms of medicine are accepted forms of medical care in Canada
Naturopathic doctors are regulated health care professionals in Canada who have undergone rigorous medical training and have passed standardized North American Board exams. Naturopathic doctors undergo training similar to MDs (practicing family medicine) plus additional naturopathic disciplines and therapies. Both NDs and MDs are equally trained in the diagnosis of health conditions, in the core medical sciences (anatomy, pathology, physiology, etc…) and in specialty medical fields (pharmacology, gynecology, obstetrics, oncology, geriatrics, etc).
In Canada, legislation regulating the practice of naturopathic medicine exists in six provinces. In our province, members of the New Brunswick Association of Naturopathic Doctors (NBAND) are presently working with the government to achieve that goal. The members of NBAND meet the criteria required for regulation in those jurisdictions that currently regulate the naturopathic profession. Naturopathic doctors that form NBAND maintain a registration with the regulatory colleges in either British Columbia or Ontario and will continue to do so until legislation regulating the profession is passed in New Brunswick.
In 2009, legislation in both British Columbia and Ontario were also amended to grant naturopathic doctors prescribing authority for certain substances including pharmaceutical drugs previously only prescribed by MDs.
Both forms of medicine have treatment options that compliment each other
Although both practitioners have training in pharmacology, MDs dedicate themselves to treating symptoms and disease with drug interventions. NDs on the other hand often focus on treating the root cause of disease and are specialized in naturopathic disciplines including clinical nutrition, botanical medicine, traditional Asian medicine and acupuncture, homeopathic medicine, hydrotherapy, naturopathic manipulation and lifestyle counseling.
An NDs' in-depth training in pharmacology includes recognizing when drug therapy is essential to halt the progression of serious health conditions and also assessing drug interactions with other medications or herbs and supplements, enabling them to trace and treat any potential side-effects.
Let’s use inflammatory bowel disease (ulcerative colitis and Crohn’s disease) as an example. These conditions are well known to include periods of flare-ups and remission. During periods of acute flare-up, inflammation of the intestinal lining can be out of control and drug therapy is often required (along with naturopathic treatments) to prevent further damage. Matching the severity of the disease with the strength of the treatment is paramount. In the case of a colitis or Crohn’s flare-up, we are less concerned with the short-term side-effects of the drugs (e.g. prednisone), because we are doing what we can to prevent what could lead to irreparable damage to the digestive system. The use of naturopathic treatments along side these drugs, such as probiotics and herbal medicines can lessen the duration of the flare-up and decrease the dosage and duration of drug prescriptions.
It is also important for patients to seek out a combined approach when taking drug therapies that can have side-effects and serious long-term consequences. For example, mounting evidence is suggesting that bisphosphonates drugs (including Actonel, Fosamax, Didronel and Aclasta) to treat osteoporosis are associated with rare but risky side-effects such as deterioration of the jawbone or spontaneous femoral factures. Statin medications (e.g. Crestor, Lipitor, etc…) to treat high cholesterol are associated with an increased risk of diabetes. Many anti-depressant medications can cause significant weight gain.
Patients who are motivated to make lifestyle changes and/or with a desire to reduce or eliminate their prescription medications can be supported with naturopathic treatments. This can be done by NDs working with a patient's MD, to adjust drug doses accordingly as their condition improves. The use of specific vitamins or minerals in medicinal doses as well as individualized herbal or homeopathic combinations can address underlying functional or pathological imbalances. As an ND, I have successfully worked with patients to decrease their need for many types of medications, including those for osteoporosis, cholesterol, digestive problems, depression/anxiety and many other conditions.
Both forms of medicine have unique diagnostics tools
If we look at the example of digestive tract disorders, we see that gastroenterologist provide essential diagnostic tools that include: a) laboratory tests to diagnose different conditions (e.g. celiac disease) and presence of certain microbes (e.g. H. pylori that is related to peptic ulcers); b) imaging studies such as abdominal ultrasounds, x-rays, CAT scan, etc; c) endoscopy and colonoscopy to directly visual the inside of the intestines; and d) many others.
As new scientific advances in diagnostic tools take place in North America, our present health care system is often slow to integrate such changes. As naturopathic doctors, we provide many diagnostic tests that fill any gaps in our ability to understand health conditions. For gastrointestinal conditions such as irritable bowel syndrome (IBS), heartburn/reflux (known as GERD), inflammatory conditions (e.g. gastritis, ulcerative colitis, Crohn’s disease, etc), we recognize the need to verify for potential food sensitivities and conduct more specialized testing to assess for the presence of ‘bad’ bugs or the absence of ‘good’ bacteria in the digestive system. IBS can also be caused by small intestinal bacteria overgrowth (SIBO) in which case a hydrogen and methane breath test is required for diagnosis. The value of such tests is becoming known in Moncton, as certain MDs are actively referring to NDs for these tests (note: such tests are available to everyone; via referrals or simply by directly making an appointment with an ND who can assess your health and decide on the most appropriate test).
The IgG food sensitivity test is paramount to address many health conditions by providing a more individualized approach to dietary recommendations. Naturopathic doctor Nicholas Anhorn highlighted this fact in his most recent article related to the book ‘Wheat Belly’.
Skin conditions (such as eczema or psoriasis), digestive concerns and mood disorders are among those most helped and can be cured by avoiding foods that cause inflammation and immune system responses. The IgG food sensitivity blood test is offered at the Moncton Naturopathic Medical Clinic. Although, foods such as grains (especially gluten containing grains), dairy, eggs, corn, nuts and soy can are often important culprits, this test measures blood concentrations of IgG antibodies for a large number of foods; in fact it can test for 96 or 184 different foods (depending on the panel chosen).
The use of naturopathic medicine in conjunction with conventional medicine is an important first step in improving our present health care system. NDs and MDs can work together because their roles in patient care are complementary, and treatments become more effective in resolving a patient's health concerns.
Published by Dr. Gleixner on Thursday May 16th, 2013 in Times & Transcript.
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