Naturopathy and diabetes–pure pseudoscience

Let’s be blunt. Naturopathy is pure, unmitigated, undiluted junk medicine (or what many call “woo”). What is naturopathy? It is a form of alternative medicine based on a belief in vitalism, which posits that life has a quality independent of physical and chemical laws. In other words, it is no different than homeopathy (one of the core competencies of naturopathy), both of which rely upon denying the basic laws of physics and chemistry. Life may have some quality independent of physical or chemical laws and theories, but treating anything from a viral infection to a fractured femur to any of the 200 or so types of cancer requires medicines and techniques that depend upon real science, whether physics, chemistry or biology.

Like all pseudosciences, whether it’s creationism, global warming denialism, homeopathy (or any alternative medicine), or anti-vaccines, naturopathy needs to have some manner of peer-reviewed papers to “prove” that it is something more than just plain woo. One of the favorite journals for woo-pushers is the BMC Complementary and Alternative Medicine, an online, open-access, peer-reviewed journal with an impact factor of 2.2, well below standard medical journals such as the Lancet, with an impact factor of 33.63. In other words, the journal isn’t one that would be your “go-to” for information on new medical techniques, or whether naturopathy actually works. Just to be fair, BioMed Central publishes over 100 different online, open-access journals, and many of the scientific publications have respectable impact factors.

My graduate studies were in endocrinology, specifically insulin effects on liver cells (hepatocytes). I keep up on research on metabolic disorders, such as diabetes mellitus type 2, which is characterized by high blood glucose as a result of insulin resistance and relative insulin deficiency. It is mainly caused by lifestyle issues, such as excessive weight, but there is also a genetic component. A small number of cases also may result from the “other” category, which includes certain tumors, pregnancy, side effects of some drugs, and other hormonal effects. In other words, type 2 diabetes has a complex pathophysiology that is not easily treated, depending on the underlying cause. Some can be treated with exercise, weight loss and diet changes, some require pharmaceuticals, and others require insulin management.

During my research, I came across an article in BMC Complementary and Alternative Medicine, entitled Adjunctive naturopathic care for type 2 diabetes: patient-reported and clinical outcomes after one year (full paper, pdf). The authors “conducted a prospective study to measure the effects of adjunctive naturopathic care (ANC) in primary care patients with inadequately controlled type 2 diabetes.” These kind of studies are just silly, since it reads as if there’s just one cause and one kind of type 2 diabetes. So I’m starting off with this article with my skeptical radar on full sensitivity. Let’s just see what else:

  • The study included “forty patients with type 2 diabetes were invited from a large integrated health care system to receive up to eight ANC visits for up to one year. Participants were required to have hemoglobin A1c (HbA1c) values between 7.5-9.5 % and at least one additional cardiovascular risk factor (i.e., hypertension, hyperlipidemia or overweight).” A 40 patient study? The statistical validity of 40 patients has sampling errors of 15-20%. 
  • Moreover, the hemoglobin A1C levels (a marker of long-term blood glucose levels) of the sample group are quite high (7.5-9.5%). We could expect that the numbers would go down even with small changes in weight, diet, and exercise.
  • The two groups (one receiving naturopathic care and the other not) were not randomized nor blinded. Any type of error could be introduced up to and including some sort of placebo effect.
  • The naturopathic group had higher A1c levels, and were on a different drug regimen. So, the naturopathic group actually was worse off (from the perspective of the disease), so had a better chance of actually showing some effect.
  • The study was not powered in a way for us to determine whether the patients were in better compliance with the normal medical treatments (medications, exercise, diet) rather than any change in the vital life force. In fact, I would contend that physicians should spend more time with diabetic patients to teach them the importance of blood testing, diet, medications and exercise. This is called the Hawthorne effect, where the patients by being in the study actually change their behavior. 

The sample size (40 patients), lack of randomization, and no study blinding make the study suspect on many levels. In addition, the bias of the patients makes the results even more suspect.

Of course, the pseudoscience-pushing Huffington Post has published a pro-naturopathy article, How Naturopathic Doctors Are Proving the Value of Integrative Medicine by John Weeks, that trumpets the paper by stating that “naturopathic treatment for diabetes…support the value in the multiple modality, individualized approach.” Except the paper proves no such thing (let alone that it is not a treatment for diabetes, just type 2 diabetes). Once again, alternative medicine, lacking any real data, needs to rely upon poor study design with debatable results.

Unless the average reader takes the time to separate the real science from the pseudoscience, you would assume that naturopaths actually have “cured diabetes”. Which they haven’t. Actually, we can’t prove they’ve done anything. 

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!