Whole-System Naturopathic Care Trials: What They Found and What They Could Not Show

This page is information only and does not replace care from a doctor. For chest pain, signs of a stroke, a severe allergic reaction or thoughts of suicide, get urgent help first: in the United States call 911, or call or text 988 for a mental health crisis.

What "whole-system" research means

Most naturopathic research tests one thing at a time, such as a single herb or diet. Whole-system research tests the package a practice actually delivers: counseling, diet advice, supplements, botanical medicine and other measures, chosen for the individual. A 2019 scoping review of this research counted a study only if two or more naturopathic modalities were delivered by naturopathic clinicians. [1] That makes the studies closer to real practice. It also makes it hard to say which part of the package did what.

The trials, side by side

The heart-risk, back-pain and anxiety trials all list authors at the same naturopathic school, the Canadian College of Naturopathic Medicine. [2][3][4] The back-pain and anxiety papers state that no competing interests exist. [3][4] Affiliation does not make a result wrong. It is one reason these findings need testing by other groups.

What the wider review found

The 2019 scoping review covered 33 studies with 9,859 participants. [1] Most were observational: 12 prospective and 8 retrospective cohort studies, 11 clinical trials and 2 case series. [1] The authors' summary was that the studies predominantly showed evidence of efficacy for the conditions and settings studied. [1]

The same paper lists its own limits. Comparison groups were used in only 4 of 12 prospective studies. [1] The nine randomized trials had low risk of bias except for blinding of participants and personnel, with moderate bias for allocation concealment. [1] The authors also wrote that no specific analysis of the effectiveness of naturopathic treatment was conducted. [1] They noted that most studies were positive, which raises a publication bias concern. [1] Their conclusion was that there is a distinct lack of well-conducted pragmatic trials of the whole package. [1]

What these designs could not show

• Which part worked. Counseling, diet changes, supplements and acupuncture were bundled together. The anxiety authors themselves called for a closer look at individual components. [4]
• Effect beyond attention. Extra visits and a supportive clinician can improve how people feel on their own. See placebo, context and the therapeutic relationship.
• Real-world events. The heart trial measured an estimated 10-year risk and the prevalence of metabolic syndrome, not actual heart attacks or strokes. [2]
• Long-term results. Follow-up ran 12 weeks to 1 year in these trials. [3][2]
• Blinded comparisons. Counseling and diet advice are hard to mask, so participants know which group they are in.

Where to read more

This page asks what whole-system trials found. For the condition-by-condition detail see anxiety and depression and back and musculoskeletal pain. For the wider debate see naturopathy and science, and for study-reading tips see how to read a study.