by Jacob Schor, ND, FABNO
The College of Naturopathic Doctors of Alberta (CNDA) asked me to lecture at their June 2018 conference and dictated my topic would be “Back to Basics.” This sounded easy enough when first suggested, nearly a year before, as in theory I wouldn’t have to read and learn new information. I could just stick with basic stuff that we already all know. It would be preaching to the choir, I thought, a piece of cake, as they say. Yet, preparing this lecture turned out to be more challenging than I thought it would be and likely more controversial than I really want it to be. Mind you, I do not shy away from controversial ideas, curmudgeon that I am, but even I worry that colleagues may stop talking to me.
To speak about basic naturopathy, it was apparent that I needed a clear definition of what naturopathy is. To point my audience backwards in the direction of basic naturopathy necessitates accurately defining what naturopathy is. As I began to think about this and plan the lecture in my mind, it became apparent that the definitions we rely on are inadequate, not just for my purpose but for a range of other things such as legislation, public relations, and education.
A good definition describes the meaning of a word so that it expresses the essential nature of the thing; a good definition gives a clear outline of the subject in question, marking its border so it stands out and is distinguishable from other similar things. A definition defines; it draws a line around the thing.
My usual first step to understanding the meaning of a term is usually to look at the root words it derives from. So “naturo,” is probably from the Latin word natura, to which the Greek suffix “-pathy” is tagged on. The suffix “-pathy” derives from pathos, meaning “suffering or disease.” The same suffix is used in loads of terms such as myopathy (muscle disease), neuropathy (nerve disease), or even sympathy (suffering together).1
Thus, naturopathy might have two possible meanings. First it might mean, “nature-disease” or “suffering nature.” If so, then climate change or drought might be examples of naturopathy. Or perhaps naturopathy could mean “suffering caused by nature,” perhaps an example would be frostbite. My lecture audience is, after all, going to be Canadians. The roots of the word “naturopathy” seem insufficient to define naturopathic medicine.
Many websites tell us that Dr. John Scheel patented the term “naturopathy” in 1895, and that Lust purchased the rights from him. My search through the patent records has so far failed to locate this patent. I had hoped Scheel might have described what he meant by the term in his patent application.
The definition of naturopathy that is often quoted in the legislative arena to carve out a scope of practice is originally from the federal Dictionary of Occupational Titles published in 1931:
Doctor, Naturopathic (medical services) 079.101-014 A Naturopathic physician, diagnoses, treats and cares for patients, using a system of practice which bases treatment of physiological functions and abnormal conditions on natural laws governing the human body: utilizes physiological, psychological and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechano-therapy, natural processed foods and herbs and nature’s remedies. Excludes major surgery, therapeutic use of x-ray and radium and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance and life.2*
During the process of winning licensure, naturopathic medicine was defined by the individual state licensing statutes, but these definitions were legal scope-of-practice definitions, often conflicting with each other, reflecting different standards of practice in different places; they just told us the limits of what we could do legally, not what we were doing. In 1965, the US Department of Labor’s Dictionary of Occupational Titles became the formal and widespread definition because it was federal and superseded state definitions. The definition was controversial as it primarily reflected a nature cure perspective:
Diagnoses, treats and cares for patients using a system of practice that bases treatment of physiological function and abnormal conditions on natural laws governing the human body. Utilizes physiological, psychological and mechanical methods such as air, water, light, heat, earth, phytotherapy, food and herbs therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial therapy, mechanotherapy, naturopathic corrections and manipulations, and natural methods or modalities together with natural medicines, natural processed food and herbs and natural remedies. Excludes major surgery, therapeutic use of x-ray and radium, and the use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and physiologically compatible to body processes for the maintenance of life.
We rarely use this definition when describing who we are and what we do in public. I cannot name any “natural laws governing the human body” aside from gravity.
The current definition the American Association of Naturopathic Physicians (AANP) uses is as follows:
Naturopathic medicine is a distinct primary health care profession, emphasizing prevention, treatment, and optimal health through the use of therapeutic methods and substances that encourage individuals’ inherent self-healing process. The practice of naturopathic medicine includes modern and traditional, scientific, and empirical methods.3
This implies a single self-healing process shared by all individuals. That feels rather vague to this reader. So does the word distinct. A good definition should distinguish between primary health care professions and tell us how naturopathic medicine is distinct.
The Canadian Association of Naturopathic Doctors (CAND) definition reads as follows:
Naturopathic medicine is a distinct primary health care system that blends modern scientific knowledge with traditional and natural forms of medicine. The naturopathic philosophy is to stimulate the healing power of the body and treat the underlying cause of disease. Symptoms of disease are seen as warning signals of improper functioning of the body, and unfavourable lifestyle habits. Naturopathic medicine emphasizes disease as a process rather than as an entity.
Process? Entity? I admit I don’t think I’ve ever thought about this. I’ll have to ask those Canadians about this. That lecture in Calgary I am committed to giving is only a few weeks off as I write this.
Benedict Lust’s 1905 definition also attempted to distinguish the profession by claiming it is distinct but then claims ownership of osteopathy and chiropractic under the heading naturopathy:
Naturopathy is a distinct school of healing, employing the beneficent agency of Nature’s forces of water, air, sunlight, earth power, electricity, magnetism, exercise, rest, proper diet, various kinds of mechanical treatment such as massage, Osteopathy and chiropractic, and mental and moral science.”4
If you want to read more of these definitions, the white paper Iva Lloyd, ND, wrote for the World Naturopathic Federation lists over a dozen different definitions of naturopathy.5
We don’t pay much attention to these definitions anymore as our profession backed away from striving for a clear definition of naturopathy about 30 years back and instead substitutes a list of principles that supposedly underlie naturopathic medicine. Here is the short version copied from Bastyr University’s website, though most naturopathic doctors know them by heart:
The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic medicine recognizes the body’s inherent ability to heal itself…
Identify and Treat the Causes (Tolle Causam) …
First Do No Harm (Primum Non Nocere) …
Doctor as Teacher (Docere) …
Treat the Whole Person…
Prevention…
Wellness….6
How did we come to these principles? The credit goes to Drs. Pam Snider and Jared Zeff. Actually, some of the credit for this switch in focus from definition to principles should be shared with Roger Fisher and William Ury. These two guys wrote a book called Getting to Yes that was published in 1981.
Naturopathy aims to trigger adaptive responses that lead to healing.
For those of you too young to remember, there was an optimistic period in the 1980s when conflicts were considered resolvable by a “getting to yes” idea, promoted in that book. The premise was that when negotiating, rather than focusing on points of disagreement, instead to focus on common goals or points of agreement.7 This simple idea changed the dynamics of many an argument and gave us hope that other conflicts could be resolved. (I recall one of our lobbyists forcing me to read it before taking the Colorado ND Association on as a client.) These ‘getting to yes’ tactics were so popular that one did not need to have read the book to ask, “Let’s find what we can agree on to move forward and each get what we need instead of arguing.”
This is in essence what the AANP did in the late 1980s.8 Jared Zeff described the challenges back then:
In 1985 or so, when the AANP began, we knew we needed to accomplish 5 things to reestablish our profession. We needed a national professional organization, we needed our schools accredited, we needed a national standard/national licensing examination, we needed a peer-reviewed journal, and we needed a useful definition for legal, educational, and other purposes. The extant definition was the US Department of Labor, Dictionary of Occupational titles definition, which was strictly a modality-based definition: “Naturopaths treat the sick with diet, earth, air, water, etc.” This was not useful to us legislatively, and we would tend to argue about whether it should include or exclude this or that. I was given the job of developing a useful definition, along with Pamela [Snider].
We were to lead an open session at the Alderbrook Convention in 1986, our second AANP conference, to begin the process of developing the definition. We knew what would happen and had a secret plan to implement. We had a room full of naturopaths: older, younger, men, women, students, US and Canadians. Any time this had been done in the past, the argument broke out about what should be included. And that is how this meeting began, with arguments about modalities. After a while of the arguments, I posed a question; ‘Is there anything about which we do agree?’ I knew the answer in advance. It was that we all agreed that there was a philosophy that underlay the medicine. Once the room acknowledged that we agreed that there was a naturopathic philosophy, then we proposed that we determine what that was. What were the tenets of that philosophy? Certainly, Vis Medicatrix Naturae, Do No Harm, and what else? … the process we went through to answer that question, … took three years, and resulted in the definition we now use. We built into the process a review every 5 years to make sure we did not leave something out, etc. It has gone through 2 reviews since the initial unanimous adoption, and has not yet been changed.
…The first time there was a proposal for the consideration of 3 new tenets to add to the 6-tenet definition. They were: Least Force, Ease Suffering, and one other that escapes me. These were written, proposed to the House [of Delegates, AANP], debated, and defeated.9
Dr. Pam Snider remembers a similar process: “The Committee wrote the first draft and presented it at Alderbrook. There was an open mike, more revising over the weekend, the first draft was published for the profession to comment on, and Jonathan Wright had also solicited a lot of input from old and new docs, students etc. in a booklet he pulled it all together in and sent to me and Jared. A 1988 bound report to AANP has a lot of input reported in it…this went on for 3 more years.”10
This method helped our profession resolve what could have been an impossibly contentious process given how opinionated and set in their beliefs some of my colleagues may at times be. However, it was a temporary fix, meant to further our ability to pass legislation legalizing our profession. It was meant to evolve over time. The results no longer serve as an adequate definition. This is because they do not demarcate what naturopathy is and how it differs from other schools of medicine.
If we were to turn these principles into a Venn diagram, they define the category, the group, we might best label “physicians.”
When I asked about the origin of the principles, Pam Snider wrote me that, “Scraps of these ideas are in the nature literature from way back but not as a coherent set of principles within a definition of naturopathic medicine, scope, modalities etc. You can see [them] in old nature and nature doctor writings. Lust’s journals mention many of these concepts, so they certainly derive from a naturopathic medicine lineage.”
My attempts to convince myself that this is true did not met with success. These principles originated with medical doctors and do not specifically describe naturopathic medicine. The fact that the 1986 conference attendees found a consensus about these ideas is more a measure of our desire as second-class practitioners to emulate physicians; we do not own them. Recall at that time we were still naturopaths who practiced naturopathy. Laying claim to them was like our wearing white coats and carrying stethoscopes. It was our saying, “We are physicians too.”
Take the phrases Tolle causam or Vis medicatrix Naturae: these are concepts to which all of us gladly pledge our allegiance and that have a history in medicine that long predates the nature cure movement. Samuel Hahnemann apparently took rather strong exception to both ideas in The Organon.11 In Hahnemann’s thinking, finding the cause of disease was a ludicrous pursuit, “… as it is not perceptible and not discoverable. For as far the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses…”12
Keep in mind that microbes were still unknown at the time of his writing and the cure for scurvy was still being debated. In fact when the term Tolle causam came into use, it was not an exhortation to identify the etiology or mechanism of a disease process (or is it entity?), rather it was a reminder to employ a belief system that explained the disease in order to prescribe what was thought appropriate treatment. Does one purge the patient or bleed the patient? That was probably the question.
Hahnemann also took strong opposition to the notion that there was a healing intelligence within the body that would direct a cure. “In Hahnemann’s sense … the healing endeavors of nature (living power) are considered as completely insufficient and inappropriate, this reproach signifying nothing else than that the therapy of the ‘allopaths’ is partly worthless and partly highly disastrous.”13 Hahnemann lists a range of tasks that any physician might do to aid a patient from setting a bone to lancing a boil, that the healing power of the Vis is incapable of performing.
That our homeopathic-focused colleagues did not take Hahnemann’s side and pursue debate on these principles is perhaps more a measure of the lulling effect of the “getting to yes” process that encourages agreement, rather than a measure of their unfamiliarity with Hahnemann’s actual beliefs. Clearly these precepts are contrary to a homeopathic worldview. Both were terms widely used by allopathic medical doctors.
“Tolle causam” could today serve as a motto for a number of medical and scientific specialties; a list might include epidemiologists and geneticists and could easily be used as a slogan for the Center for Disease Control (CDC). Using it cannot distinguish our school of medicine from others.
We might also extend some forgiveness to our colleagues who in their youthful enthusiasm for our profession laid claim to the term “primum non nocere” as being our own, a concept they thought sounded naturopathic in origin.
I recall being chastised by a member of the Colorado House of Representatives back in 1992 during a late evening legislative hearing. The representative was a nurse, married to a medical doctor. In the middle of my testimony describing naturopathic medicine, just as I mentioned primum non nocere, she could no longer contain herself and interrupted me with an angry tirade that began, “What gives you the right to appropriate a term that our medical professions have been using since the time of Hippocrates….?”
All modern medical practitioners, including naturopathic doctors, strive to adhere to this Hippocratic injunction; we are not unique. Except that this primum thing is not a Hippocratic injunction. The representative’s alluding to primum non nocere as a Hippocratic injunction was not exactly accurate. While the Hippocratic oath, or some version of it, goes back millennia (the earliest version found dates to third century Egypt14), the oath has gradually evolved and changed over time.15
The actual term “primum non nocere” is a rather recent addition to the oath, amended into the British and American versions by either Worthington Hooker in 1847, or Thomas Syndeham in 1860. A French doctor named Auguste Chomel (April 1788 in Paris – April 1858) came up with the primum phrase a few years earlier.16,17 I did not point this out to the already irate Representative during the hearing. (She voted to ‘postpone indefinitely,’ that is kill our ND legislation, as did the majority of that committee, so ending the first, but not the last, legislative attempt to regulate naturopathic medicine in Colorado.)
Nor can we claim “docere” as a uniquely naturopathic precept; not only is the term in the Hippocratic oath that all physicians use, but we have to remember that people trained in the healing arts have been referred to as doctors for a long, long time. The Hippocratic oath requires doctors to be teachers and pass on their art.18 We translate it as meaning we are supposed to teach our patients. In recent years, the docere concept has been expanded, at least in allopathic medicine, to include ‘truth telling’ or informed consent.19 We could claim that we place greater or different emphasis on these principles, but neither of these phrases, tolle causam, primum non-nocere, nor docere defines naturopathy as distinct from other schools of medicine. All doctors lay claim to these ideas, and these other schools of medicine have longer held claims to these principles.
What we are doing is kind of like defining “hummus” as a smooth, creamy, edible suspension, but not telling how it differs from pudding, mayonnaise, or ketchup.
At some point I had to admit that our guiding principles do not define naturopathic medicine as clearly as I needed for my lecture. The principles did not provide the compass bearing that would allow me to do a 180-degree about face that would lead us back to the origins of naturopathy, back to basics. The principles were a temporary compromise that allowed our profession to move forward during a period of need; they provided a necessary requirement, a point of agreement, but they are not the solution.
Actually, I should write, they were a brilliant maneuver by Zeff and Snider, a group of ideas all of us could more or less say yes to; a composite agreed upon by our diverse congress of practitioners is not easily come by. This was about getting to yes and it worked.
That was then, this is now. If I am going to talk about the basics of naturopathy, I need to come up with a definition that I feel comfortable with. While time is short, there is no pressure. These were Canadians I was going to speak to and for them, “It’s a ‘process’ not an ‘entity.” Perhaps that is what I will say about my definition?
But how would I define naturopathy?
Our family subscribes to the print version of the Denver Post. My habit is to unlock our front door at 5:00 am every morning to retrieve the paper. Half awake I never bother to put on shoes.
This past February, with five inches of fresh snow on our front sidewalk and the temperature hovering at -4 degrees F (-20 C), I followed this routine (my wife reported that she heard me whimpering when I got back inside). A few hours later when she shoveled the sidewalk, my bare footprints were still visible where the snow had melted beneath my hot feet and refrozen to the concrete. Those iced impressions remained for days.
“Why didn’t you put your shoes on?” she asked over breakfast tea.
“Because I’m a naturopath.”
There’s a famous line attributed to US Supreme Court Justice Potter Stewart. In a court opinion he wrote in 1964, in a case that attempted to define “hard-core” pornography, Justice Stewart wrote, “… I know it when I see it…”20
Naturopathy, thus, is in a way like pornography: ‘We know it when we see it.’
Let us wipe the slate clean of all of these principles and old definitions and attempt to start afresh and actually define what it is we believe and do in a way that sets our profession of naturopathic medicine apart from other schools of medical practice. We are looking for a definition that can serve as a yardstick with which we can take a measure of any given therapy and ask ourselves if this is naturopathy or not.
In my thinking, any definition should ideally define my walking barefoot in snow as naturopathy.
Give me a little space here because I am exploring territory where we do not wander often. This is a process. There are a few basic ideas that I think must be included.
The first is that we naturopathic physicians put great value on nature; we value exposure to nature and the essence of nature that resides in the elements that come from nature. We place high value on the unadulterated, natural world, and we assume mere exposure to it has a healing action, that exposure to water, air, sunlight, and the other aspects of nature, is essential to health and restoration of health. I would go so far to claim that nature nourishes our souls. Or at least the opposite; in environments deprived of exposure to nature, our souls suffer a deficiency, that they starve for something essential.
We have evidence of these deficiency effects in the modern scientific literature. (Kurt Beil, ND, has written extensively and beautifully on this topic in his numerous pieces in the Natural Medicine Journal.) By extension we believe that our living environment, the water we drink, and the food we eat should be ‘natural’ as opposed to processed and synthetic. Yet this belief in itself does not demarcate us from all other schools of medicine. There is little doubt that we put greater value on a natural hot spring than a hot tub, a pristine lake than a swimming pool, a fresh wind than a blow dryer. Or at least my generation of doctors did, and I assume younger doctors still do. How do we put this into words? We put great emphasis on the healing elements that we borrow from nature?
Elements of a definition:
1. Nature and natural elements have a healing effect.
My second assumption is that our therapies all have something in common; they attempt to trigger a reaction in which the body fixes the problem. We give the body or the organism a shove, a stimulus, and this triggers a healing response, a healing crisis if the shove is hard enough. Our therapies serve more as catalysts for change rather than controlling forces. We catalyze healing rather than force change. I recall the late Wade Boyle, ND, speaking how naturopathic herbs tonify or strengthen their target organs and that this is how we differed from the allopaths; they prescribed an herb (or drug) to control their targets to either suppress or turn on action.
Elements of a definition:
1. Nature and natural elements have a healing effect.
2. Naturopathic therapies act as catalysts to trigger healing response.
Our profession evolved from the European Nature Cure Movement of the 1800s to which some decidedly American and Canadian elements have been added over the last century. Clearly, Vincenz Priessnitz was a major influence on our early thinking, and his influence lingers.
We naturopaths all know the story how, as a child, Vincent witnessed an injured deer immerse itself in a cold mountain stream after being injured, seemingly with the intent to heal itself. Vincent imitated this behavior later in his own life when he was himself injured and had apparent success. He imitated this process with many ‘patients’ over the years.21 There were several aspects to these treatments. Priessnitz employed natural elements, in particular, cold water and exercise, rougher versions of clothing, and simpler coarser foods than people might choose of their own volition. The patients were made uncomfortable. Patients were also removed from their ‘modern environment,’ a lifestyle that had become increasingly toxic. We still carry reservations about modern lifestyles and have an underlying faith that living simpler lives closer to nature is associated with better health.
So third, we have a lasting belief that harmful substances either in the environment or in our bodies are to blame for much of modern illness. (We might now include endotoxins generated within the body in this list.)
Elements of a definition:
1. Nature and natural elements have a healing effect. Exposure to harsher elements is beneficial.
2. Naturopathic therapies act as catalysts to trigger healing response.
3. Toxic exposure causes many illnesses.
We have to remember that while we complain about environmental pollution today, toxic exposures in 19th century Europe could be far worse. One example was the wallpaper craze of the midcentury. In the early 1800s, chemists had invented green pigments from a combination of arsenic and verdigris.22 Variations of these chemicals also produced yellow, green, and blue pigments, and these new colors inspired a wallpaper craze that lasted nearly a century. If you lived in a Victorian home in England, Europe, or even the United States in the 19th century, you wall papered. William Morris who started the British Arts and Crafts movement became the foremost wallpaper designer and seller of the era, and the owner of England’s largest arsenic mine. Beautiful as these wallpapers were, they released arsenic as a gas, enough to poison a house’s occupants over time. By 1874, Britain produced 32,000,000 rolls of arsenic impregnated wallpaper per year and apparently a significant portion of their population was afflicted by what was called ‘witch fever.’23 Getting out of the house for some fresh air, and getting outside into nature had a salubrious effect to a degree that is hard for us to imagine today.
Granted this is a historic detour, but let’s put this into context with our nature cure movement. Getting outside from Victorian wallpapered houses was associated with a reduction in a wide range of symptoms. The benefits were so clear that the theory that being outdoors improved health did not require randomized controlled trials. Getting outside for fresh air back then was profound and became foundational to nature cure and by inheritance, to naturopathy.
Is there an innate self-repair mechanism hardwired within the body that Priessnitz was able to trigger with his mix of cold-water exposure and other therapies? Our assumption is yes. This could be the “inherent self-healing process” talked about in the AANP definition? Is this the same self-healing intelligence that Samuel Hahnemann so doubted because it wasn’t capable of lancing a boil or setting a fracture?
Elements of a definition:
1. Nature and natural elements have a healing effect.
2. Naturopathic therapies act as catalysts to trigger healing response.
3. Toxic exposures cause many illnesses, and reducing toxic burden improves health.
Adaptive Responses
Two concepts that this writer considers fundamental to defining naturopathic medicine are the ideas of homeostasis and adaptive response. What we now call homeostasis, that there is some sort of harmonic equilibrium “…among bodily humors dates back to the pre-Hellenic thinkers and was converted into medical suggestions by the Hippocratic school. This concept was handed down to posterity by the several schools of Medicine before being resumed by the great naturalist Jean-Baptiste Lamarck in purely physical terms.” Walther Cannon is given credit for formulating the rules that transformed this general concept into a paradigm in the 1920s.24
What nature cure and most of naturopathic medicine does, when successful, is to restore a body to homeostasis, a state that we might equate to as health. These ‘therapies’ do so in a manner that may define our medicine. Naturopathic therapies initially push the organism further away from homeostasis, and this triggers an adaptive response that restores function closer to the homeostatic normal. Reliance on this sort of adaptive response may distinguish what we do from allopathic medicine. Reading this over, what I’ve written doesn’t sound quite correct. The very nature of our biology is to seek to restore this equilibrium; naturopathy may give it a nudge, but it is nature that ‘heals.’
Elements of a definition:
1. Nature and natural elements have a healing effect.
2. Naturopathic therapies, by pushing the organism away from homeostasis, trigger adaptive responses that act as catalysts to trigger healing response.
3. Toxic exposures cause many illnesses, and reducing toxic burden improves health.
Hormesis
Triggering adaptive responses might be better defined as employing hormetic responses, from the term “hormesis.” Hormesis describes dose effects, specifically the idea that the effects on biological systems may shift with dose size. In fact, the effect may vary as doses increase from good to bad, bad to good, or positive to negative, or visa versa. The simplest dose response, of course, would be a straight line. Effects of a drug often simply increase with dose.
An example of a straight-line dose response is the change in forced expiratory volume in asthmatics based on increasing amounts of albuterol given. In a hormetic response, increasing doses increase response initially but then at higher doses the response decreases, and actually shifts to negative.
Anyone who has graphed biological data will recognize these u-shaped curves, but this concept has been controversial and until recently ignored. What we are seeing in hormetic responses are over-compensatory adaptive responses. Let me back up and cover some history.
Although Rudolph Virchow is technically credited with writing the first published description of a hormetic response, the actual concept of hormesis is generally credited to Hugo Schulz, a German pharmacologist, who in the mid-1880s came up with the concept through his experiments using disinfectants to kill yeast: “…. Schulz observed an unexpected biphasic dose–response in which high doses were toxic and suppressed metabolism, while the opposite seemed to occur at low doses.”25 Low doses stimulated growth.
This was an era when scientists were hunting for ‘laws’ to describe the universe, and Schultz teamed up with Rudolf Arndt and together, in 1888, they proposed a ‘law’ to be used in toxicology: “For every substance, small doses stimulate, moderate doses inhibit, large doses kill.” While this ‘law’ was an interesting idea at the time, a forward-thinking progressive idea, it was ignored. Not only ignored, but the very idea was actively campaigned against by the scientific establishment. This is because Arndt and Schulz tried to use it to justify homeopathy. But that’s another story.
About 20 years ago Edward Calabrese, a professor of toxicology, risk assessment, and environmental health at the University of Massachusetts, Amherst, became interested in this concept of hormesis and began researching and writing about it. He has since almost single handedly revived and advanced this concept. There are few modern papers related to hormesis that don’t have his name on them as an author. He has successfully pushed hormesis into a scientifically valid and accepted phenomenon:
Hormesis is an adaptive response characterized by biphasic dose response of generally similar quantitative features with respect to amplitude and range of the stimulatory response that are either directly induced or the result of compensatory biological processes following an initial disruption in homeostasis.26
The ill reputation of the Arndt-Schulz law and its association with homeopathy forced many researchers to call hormesis by other names. PubMed articles on hormesis are often camouflaged under euphemistic terms, including beneficial effects of low doses, intermediate disturbance hypothesis, and subsidy-stress gradient; and dose responses get described as U-shaped, J-shaped, biphasic, stimulatory-inhibitory, facilitation-inhibition, reverse, bidirectional, dual, bell-shaped, compensatory, and as paradoxical, usually without mention of the term hormesis.
Using these search terms, we realize that a wide range of supplements we use in naturopathic practice, probably most of them, exhibit these sorts of U-shaped dose responses characteristic of hormetic responses.
An appealing example is chocolate.27 Steinhaus et al suggested in 2017 that eating chocolate regularly is associated with a decreased incidence of heart failure (HF) (n= 31,917). Compared with guys who never eat any chocolate, eating just one-to-three servings of chocolate per month lowers risk by about 12% and eating one-to-two servings per week lowers risk even more, 17%. The greatest reduction in risk, 18% below the guys who never ate chocolate, was for men eating three-to-six servings a week. Eating any more chocolate than this backfires; with one or more servings of chocolate per day, risk of heart failure increased to 10% higher than for those who never ate chocolate.28
Similar patterns of dose response have been seen in studies on coffee and risk of stroke,29 or cognitive decline,30 and depression.31 The benefits of vitamin D also display a hormetic response including against cardiovascular disease,32 fracture risk,33 and prostate cancer (in which the ideal dose was reported to be between 18-28 ng/ml),34 and overall mortality risk.35
Consumption of fish or fish oil shows a similar pattern. The right dose helps depression but too much worsens it.36 Risk of psychosis decreases with the addition of some fish oil and then increases with higher doses.37 The right dose of curcumin helps wound healing, too much hinders it.38
This hormetic dose-response that results from apparent compensatory biologic processes is so common to naturopathic therapies that I cannot help but wonder if this reliance on hormetic responses does not in part define our profession?
While we may not think about it, we often choose therapies that disrupt homeostasis; and it is the adaptation by the patient’s body that compensates to this disruption that restores or at least nudges us closer to a homeostatic balance. Curcumin, berberine, and resveratrol are neurotoxins, at least to insects and mild neurotoxins in humans. Exposure to them triggers neuroprotective pathways in humans. That’s why they are helpful to protect cognition.
Exercise causes oxidative damage to muscle. We don’t just adapt to handle the damage, we overcompensate and become better at neutralizing oxidative damage. Over-adaptation to stressors is perhaps the common denominator of naturopathic medicine and rare in allopathic medicine. Exercise, fasting, saunas are all examples of this over-adaption response triggered by more physical stressors.
The benefits of walking barefoot in snow might fit into this realm.
Thus, perhaps a fourth aspect of a possible definition of naturopathy is the triggering of hormetic over-adaptation responses, using stimuli and triggers typically from natural elements or natural agents, to restore homeostasis and increase resilience. These triggers selected are often close to a natural state: exposure to water, heat, and light, and ingestion of foods, plants, botanical extracts, and mineral elements.
Elements of a definition:
1. Nature and natural elements have a healing effect.
2. Naturopathic therapies, by pushing the organism away from homeostasis, trigger adaptive responses that act as catalysts to trigger healing response. These are often hormetic responses; the triggering of hormetic over-adaptation responses using stimuli and triggers typically from natural elements or natural agents to restore homeostasis and increase resilience. These triggers selected are often close to a natural state: exposure to water, heat, and light, and ingestion of foods, plants, botanical extracts and mineral elements.
3. Toxic exposures cause many illnesses, and reducing toxic burden improves health.
If this is what nature cure is, I would say a possible definition of naturopathic medicine could be “nature cure in the age of evidence-based medicine.”
Is this list adequate to demarcate naturopathy from other medical treatments? Maybe, maybe not.
Naturopathy’s heyday was in the first half of the 1900s, an era in which identifying essential nutrients and curing diseases caused by deficiency reached a zenith; and we maintain an optimism that more vital nutrients and deficiency diseases exist that might be cured with the correct extract. I do not know that this is a distinguishing characteristic of our profession, but perhaps our continuing belief still in part defines us?
Here is another thought: A number of cancer chemotherapy agents apparently act by causing damage to the gut lining that in turn allows bacterial translocation into the lymph system, which in turn triggers an immune hyperreaction that kills cancer cells. Could we claim chemotherapy as a naturopathic therapy? If it triggers an adaptive response….? Most of us will object to this adamantly, so a definition must retain the notion that we emphasize safety or low toxicity.
Another problem with the idea of using natural substances to stimulate a response, in particular an immune response, are the adjuvant chemicals added to vaccines. These are the small doses of fairly objectionable chemicals added to immunizations to provoke an immune response to the vaccine antigens and that increase the likelihood the patient will develop immunity. This is why mercury, formaldehyde, and other undesirable substances are added. A definition that includes chemotherapy and vaccines may not be acceptable.
In my own thinking, I find that I am often trying to envision ourselves in an evolutionary context and how we might inform our thinking based on what our bodies were ‘designed’ for or evolved to tolerate. Such thinking informs our belief that we need more vitamin D and longer melatonin production at night, that we should get more exercise, relax more, eat more fiber, and so on.
But for the moment let’s look at what I’ve listed:
1. Nature and natural elements have a healing effect.
2. Naturopathic therapies, by pushing the organism away from homeostasis, trigger adaptive responses that act as catalysts to trigger healing response. These are often hormetic responses.
3. Toxic exposure causes many illnesses and reducing toxic burden improves health.
4. Safety of therapy. Green preference.
There are three descriptors of our school of medicine that I think need inclusion: emerging, evolving, and rational. Emerging means we are still new in the medical field and going through developmental stages. Evolving means we are still changing and adjusting to our place in medicine. Rational is a term that goes back to the Hippocratic era. Hippocrates is credited with turning away from divine notions of medicine and using observation of the body as a basis for medical knowledge. Prayers and sacrifices to the gods did not hold a central place in his theories, but changes in diet, beneficial drugs, and keeping the body “in balance” were the key.39 We might call it ‘fact-based medicine.’ This was termed “rational medicine,” and most of us would rather be thought of as rational than its opposite, irrational. These days it may be called evidence-based medicine. Rational, though, is a more Hippocratic term.
(This article is based on the lecture Dr. Schor made to the Canadian Naturopathic Doctors of Alberta in June 2018.)
Naturopathy is an emerging and evolving school of rational medicine, that encourages use of natural substances, and or exposure to nature and its elements, as catalysts to restore homeostasis through triggering adaptive or hormetic responses. Other strategies employed for improving health include lowering toxic burden, providing nourishment in cases of deficiency, or stimulating a healing response. Therapies are viewed as existing on a spectrum of force or potential for harm and are selected conservatively, referentially selecting the least invasive, safest options. Knowledge and discoveries from modern science are translated into ‘greener’ approaches to treatment.
Thus, this is where I am at the moment. But as our medicine is evolving, so should the definition.
I invite suggestions and comments on these thoughts.
References
1. Medical Definition of Pathy. https://www.medicinenet.com/script/main/art.asp?articlekey=6388
2. Von Peters W. Making the Cut: What Exactly Is Naturopathy. http://www.fnun.edu/documents/makingthecut.pdf
3. naturopathic.org . Accessed April 2, 2018.
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5 Hausser T, et al. WNF White Paper: Naturopathic Philosophies, Principles and Theories http://worldnaturopathicfederation.org/wp-content/uploads/2015/12/White-Paper_FINAL.pdf . 2017. Accessed online February 2018.
6. https://bastyr.edu/academics/naturopathic-medicine/about-naturopathic-medicine
7. Latimer H. Book review: Getting to Yes: Negotiating Agreement Without Giving In. http://commonoutlook.com/learning/book-reviews/getting-to-yes-review/
8. email from John Weeks. January 19, 2018.
9. email from Jared Zeff. January 2018.
10. email from Pamela Snider. January 2018.
11. Neuburger M. The Journal of the American Institute of Homeopathy. August 1934; 25(8).
12. “The partisans of the old school of medicine flattered themselves that they could justly claim for it alone the title of “rational medicine”, because they alone sought for and strove to remove the cause of disease, and followed the method employed by nature in diseases. “Tolle causam!” they cried incessantly. But they went no further than this empty exclamation. They only fancied that they could discover the cause of disease; they did not discover it, however, as it is not perceptible and not discoverable. For as far the greatest number of diseases are of dynamic (spiritual) origin and dynamic (spiritual) nature, their cause is therefore not perceptible to the senses; so-they exerted themselves to imagine one, and from a survey of the parts of the normal, inanimate human body (anatomy), compared with the visible changes of the same internal parts in persons who had died of diseases (pathological anatomy), as also from what they could deduce from a comparison of the phenomena and functions in healthy life (physiology) with their endless alterations in the innumerable morbid states (pathology, semeiotics), to draw conclusions relative to the invisible process whereby the changes which take place in the inward being of man in diseases are affected a dim picture of the imagination, which theoretical medicine regarded as its prima causa morbi,(1) and thus it was at one and the same time the proximate cause of the disease, and the internal essence of the disease, the disease itself although, as sound human reason teaches us, the cause of a thing or of an event, can never be at the same time the thing or the event itself. How could they then, without deceiving themselves, consider this imperceptible internal essence as the object to be treated, and prescribe for it medicines whose curative powers were likewise generally unknown to them, and even give several such unknown medicines mixed together in what are termed prescriptions?” Hahnemann S. Organon Sixth Edition http://www.homeopathonline.net/library/Organon%20Of%20Medicine%20–%20Homeopathy%20-%20Hahnemann.pdf
13. “That nature,” states Hahnemann, “whose self-help was alleged by the traditional school of medicine to be the incomparable healing art and the only thing worth imitating, is merely the individual nature of man, is nothing but the instinctive, irrational, unreasoning vital force subject to the organic laws of our body, which is ordained by the Creator to maintain the functions and sensations of the organism in marvelously perfect condition so long as man remains in good health, was not intended nor adapted for the restoration in the best manner of deranged or lost health.
“For should our vital force have its integrity impaired through injurious forces from without, then this force strives instinctively and automatically to free itself by revolutionary processes from the adventitious derangement (disease); but these efforts are themselves disease, they are a second different evil substituted for the original one; it produces, according to the laws of the constitution of the organism, to which it is subject, a disease of another kind, intended to expel the disease by which it was attacked, which it strives to accomplish by pain, metastases, etc., but mostly through evacuations and sacrifice of much of the fluid and solid parts of the body, with difficult, often dubious, injurious and frequently even disastrous results” (Preface to the Fourth Edition of the Organon of Medicine).” It is only the slighter acute diseases which tend when their natural course has expired to terminate quietly in resolution, as it is called, with or without the employment of not very aggressive allopathic drugs; the vital force having regained its powers, then gradually substitutes the normal condition for the derangement of health that has now ceased to exist. But in highly acute and in chronic diseases which constitute by far the greater portion of all human ailments, crude nature and the old school must remain equally powerless; in these neither the vital forces, with their self-aiding faculty, nor allopathy, in imitation of it, can effect a lysis—but at most a mere temporary truce during which the enemy fortifies itself, in order, sooner or later, to recommence the attack with still greater violence” Ibid. (Introduction, page. 281.)”
14. Oxyrhynchus Papyrus 2547
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20. “I shall not today attempt further to define the kinds of material I understand to be embraced within that shorthand description [“hard-core pornography”], and perhaps I could never succeed in intelligibly doing so. But I know it when I see it, and the motion picture involved in this case is not that.” http://caselaw.findlaw.com/us-supreme-court/378/184.html
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