What is an ND and how does an ND practice compared to other doctors?

So what even is an ND and how are we different from other holistic providers? I'm going to answer those questions. And I'm going to walk you through an overview of what the training for a naturopathic doctor looks like by walking you through what I learned at the National University of Natural Medicine, which was actually the founding naturopathic medical school in the United States, it's located in Portland, Oregon.

And then I'm going to go through the differences between naturopathic doctors, functional doctors, integrative doctors, and just help you get a handle on what all the differences are so that. If you are looking to bring someone more holistic onto your care team, you'll have some good information to help choose someone who's the best fit for you.

So the first year was definitely a weed out year. It was very difficult. And my now husband and I were long distance, which made it even harder. My first year was a deep dive into anatomy and physiology, which is the structure and function of the body. I still remember walking into the cadaver room and to the cadaver lab and thinking, there's no way I'm going to be able to do this without passing out.

But by the end of that first quarter, we were all going to cadaver lab right after lunch, because that was when I was scheduled to go. And it was no problem. In my second and third years, we dove into each specialty. So cardiology, pulmonology, reading EKGs, reproductive and women's health, gastroenterology, cardiology, pulmonology, hematology, urology, all the ologies of all the parts of the body.

And we even had a whole musculoskeletal block for assessing strains and sprains and reading x rays, learning how to bandage different wounds and what to do to help fractures heal and doing musculoskeletal manipulations (so chiropractors do adjustments, naturopathic doctors learn similar manipulations to pop ribs and things back in place).

My education included not just memorizing what medication and what the medication algorithms were for specific symptoms or for a specific lab results, but actually diving deep into the pharmacology and understanding specifically what receptors and pathways and biochemical pathways that different classes of medications were working on in the body.

So understanding down to the cellular level, what is happening? What are the reactions that are happening? How are different medications and drugs actually working? Lots of time was dedicated to learning about all different types of herbal medicine, when to use certain herbs, how to combine them, how to use them safely, what were the active ingredients and what was essentially the pharmacology, the mechanism of action of those specific herbs on the body.

And I talk in my previous post about how my health started to go downward by year three in medical school. At that point, I was going to all my classes and I was an intern doing clinical rotations. I'd passed the step one board exam. So all doctors take a written step one board exam at the end of year two; naturopathic doctors take the NPLEX, MDs take the USMLE. I was learning how to formulate IVs with all different types of nutrients and how to administer IV injections and how to draw blood. And we practice all of these on each other, by the way.

I passed all of my OSCE exams (those are the performance exams) for each level of internship, as I moved up in my intern status for my clinical rotations. So for those, I had to enter a room with a card listing a single health complaint for me to address with the standardized patient, who was a paid actor, who was sitting in front of me, and I had a very short time to evaluate them with the appropriate physical exams, ask all the appropriate questions and then state what next imaging or labs I would order, give a working diagnosis with my reasoning and then detail out a treatment plan with names and dosages of everything. And we also had to show we're adept at a lung exam, a heart exam, assessing fractures, we do a pap smear and even a testicular exam. Thankfully, those are now on standardized patients!

And so when I completed rotations and graduated. I studied like a full time job to pass our board exam Step Two. So this naturopathic exam includes the standard primary care areas, all those “ologies”-- the cardiology, pulmonology, pediatrics, pharmacology, emergency medicine, but it also included herbal medicine, homeopathy, and a few more areas like therapeutic nutrition, minor surgery, lifestyle and movement and physical medicine, which is similar to orthopedic approaches. 

So after four long years, I was finally officially a licensed naturopathic doctor. I then had the option to practice as a primary care doctor. Or to branch out into a specialty area.

I wrote previously about how I started to get mysterious symptoms and I unknowingly was living in an apartment with mold and it brought out a ton of other infections and illnesses that took specialty labs to diagnose, and a really specialty strategy to recover from. I ended up working for the specialized complex clinic that got me on the path to recovery. We saw patients who hadn't gotten help at Mayo or Cleveland or Stanford and the way we practiced was really a revolutionary way of looking at the chronic inflammation cycle and cellular health and a system called chronic inflammatory response, and CIRS can be triggered by any immune threat.

And the cell danger response goes hand in hand with that. It's a cell reaction to this inflammatory response. So I'll dive into these more in future episodes because these were revolutionary and life changing. And I apply these to everyone that I work with because this is just part of how the human body functions.

And one day I hope that these systems are part of mainstream medicine and everyone gets to benefit from this-- but understanding this, the system of how the body is truly working, it changed my life. I was able to blend this revolutionary inflammation knowledge with all of the foundations of naturopathic medicine, such as hormones and cortisol, which is our stress/energy hormone, blood sugar, getting quality sleep, gut health, and blend all of that with the brain repair exercises and mental health support that had worked for me.

And I used myself as a test subject. I consolidated everything that had gotten me my life back. And I pioneered the comprehensive surviving to thriving method to include all of that together.  So now, as a naturopathic doctor and someone who started out in the humanities and in journalism, I enjoy holding all of these perspectives at once and integrating them together.

Part of why I chose naturopathic school over other routes is because I wanted to know everything about a root cause approach. I wanted to know all about holistic healing, but I also wanted to know how to incorporate the amazing new advances in modern medicine like labs and imaging and pharmaceuticals when serious support for more advanced emergent conditions is needed.

So how does an ND compare to other providers? And I'm saying N. D. as in naturopathic doctor. So, obviously there's no direct comparison, because I believe the helpfulness of each provider is going to come down to how much they care, their willingness to keep learning, their bedside manner, so how, you know, what's their rapport with you, are they showing empathy, are they engaging with you, how good is their communication, and then their individual approach.

But there are some fundamental differences to be aware of that I think can be helpful. So let's back out and start with conventional medicine.  Conventional medicine is mostly a sick care model that follows an algorithm to address a symptom or lab result that is showing a sickness.  So take diabetes, for example, conventional medicine, you know, it's becoming more holistic overall, but for the longest time, if someone's hemoglobin A1c or blood sugar level showed that it was high enough for, you know, pre diabetes, just one point away from being considered fully diabetic, then no treatment was started until they caught bad enough to officially cross into diabetes territory.

Um, and an MD, so medical doctor's toolbox mostly includes drugs and surgery.  Now let's look at functional medicine. Functional medicine doctors go to four years of conventional medical school. So they're an MD or do the regular med school route. And then after they take a course in functional medicine after graduation.

So functional medicine means taking into account how the body is operating on a deeper level and starting to treat the root cause of disease. Nurse practitioners and PAs can also receive post grad functional medicine certifications. DOs can, you know, can receive this as well. It's not just MDs.  DOs used to be more alternative, but the profession streamlined to gain the same practicing and surgery privileges as MDs.

Um, so some DOs may have a more holistic outlook, um, Because their school might show a few more things about, you know, structure and how that can impact the body. And their curriculum does tend to have an added focus on spinal manipulation, hence the osteopathic medicine part of their name.  An integrative doctor, on the other hand, they also went to conventional, regular med school.

Then they do a residency that is still under the purview of the conventional medical system, but it has a little bit more holistic lens. And this area considers how symptoms might be connected and refers patients to many different forms of therapy to improve wellness. So they can be the central point for directing people to acupuncture, body work, yoga, meditation, things like that.

Now, on the other hand, naturopathic doctors go to four years of entirely holistic medical school and learn a wellness model. So not a sick care model, but a wellness model of foundational wellness. with prevention instead of only correcting once disease has progressed and already happened. A side note here is that what's confusing is that you might hear the term naturopaths, or even here are some people calling themselves board certified naturopathic doctors, who did not go to medical school.

So these are certified traditional naturopaths, which is a type of health coach. In most states, calling yourself a doctor without having a medical degree is not allowed, but because naturopathic doctors who've gone to medical school, because they're not licensed in all U. S. states yet, there aren't any clearly defined regulatory agencies in every state or federally that would regulate that term.

So I understand why people are confused by the term, which is why I like to clarify all of my training and credentials to my patients and my clients.  Another term that can be confusing is integrative health practitioner. Practitioner is actually not a regulated term. So these are health coaches who get a certification and a root cause health approach. This is a type of more advanced health coach.

And remember any provider or coach can be helpful if they're a good fit for the person that they're working with.

And then moving on to a dietitian, this is someone who's trained in the calorie breakdown and you know, what are some of the therapeutic diets that people can use for things like diabetes, for example. To be called a dietitian, they have passed licensing exams.

However, these licensing exams are based on a conventional medical approach. So dieticians tend to be more conventional. They might follow the government food pyramid with grains being the largest group, things like pasta and cereal and bread. Nutritionists may be more likely to have a more root cause holistic approach, but the term nutritionist is more unregulated.

So the trick is finding someone who has a master's degree or an equivalent program instead of someone who is a self-declared nutritionist. Nutrition programs typically do not cover anything outside of food. They don't cover anything that would require a medical background for safety reasons.

And some dietitians, you know, they also call themselves nutritionists.It can be used interchangeably, kind of like a rectangle square analogy here. And some dietitians do have a more holistic approach. So it's very individual when it comes to working with a dietitian or a nutritionist. 

And last, some chiropractors act similarly to functional medicine doctors or even naturopathic doctors. It really depends on what school they went to. Chiropractic schools vary tremendously and it depends on what state they're in. As the schooling curriculum varies state by state and the practicing laws vary state by state as well. So some chiropractors can act similar to a primary care provider and some chiropractors are just doing manipulations, helping pop ribs back in place, that kind of thing. 

So always use discretion when seeking out any health providers. There are some amazing conventional providers, coaches, and some terrible functional and naturopathic doctors out there. So definitely do your research. I have a network of people that I can refer my patients and clients to because I understand that it can be hard to navigate through all of these credentials and alphabet soup on your own.

And because of my extensive training, I can understand where different practitioners are coming from and why they're making the decisions that they are, but I like to give my clients all of the options so that they can fully understand what they are agreeing to and how the path that they're going down will help them. Some options might be more naturopathic and other options that we do might be more conventional. So the important thing is that it is your choice.  My hope is to always blend all types of medicine. I want to best help my patients and clients, and I truly care about the people I work with, and I understand how they feel with everything that they're going through, and I think having options so that you can feel empowered and informed, and having options so that you can choose your course of healing.

I think that that is super important and that's part of the healing process in itself.  And my experience with chronic illness, personal experience, and most importantly, my holistic doctorate degree as a naturopathic doctor, these are what make me a unique provider and why I'm a great fit, according to a lot of my clients and patients.

I hope that you can find someone who you feel like is a good fit and really understands you. And if you are looking for someone to add to your care team and you feel like you haven't found that yet, feel free to reach out. I'm always happy to chat with you, do a free phone call chat and get to know you a little bit more!

Sincerely,

Dr. Rachel