For the past several months I’ve been contrasting the advice from naturopaths against the scientific evidence, in a series I’ve been calling “naturopathy versus science”. In past posts I’ve looked at the naturopathic perspectives on fake diseases, infertility, prenatal vitamins, vaccinations, allergies and even scientific facts themselves. From a blogging perspective, naturopathy is a fascinating subject to scrutinize, as there is seemingly no end of conditions for which naturopaths offer advice that is at odds with the scientific evidence. As a health professional, I want to encourage the best use of health resources, and support patient autonomy and decision-making by providing credible, evidence-based information. Given repeated calls for naturopathy to be “integrated” with conventional medicine, I’ve spent a lot of time reading what naturopaths have to say about different medical conditions. What I’ve found is concerning. Naturopaths describe themselves a health professionals capable of providing primary care, just like medical doctors. And they’re increasingly seeking (and obtaining) physician-like privileges from governments. Yet there is a lack of evidence to show that naturopathy offers anything distinctly useful or incrementally superior to science-based medicine.
Defining the scope of “naturopathic” treatment is difficult. Naturopaths offer an array of disparate health practices like homeopathy, acupuncture and herbalism that are only linked by the (now discarded) belief in vitalism – the idea we have a “life force”. From this philosophy can sometimes emerge reasonable health advice, but that has little to do with the science or the evidence. As long as it’s congruent with the naturopathic belief system, it’s acceptably “naturopathic”. One of the signs that naturopathy isn’t medicine is that it needs a prefix. Notice how there isn’t a “pharmacy medicine” or “nursing medicine” that’s distinct from science-based medicine. It’s just “medicine” – health professionals base their practices on scientific evidence and principles that reach across professions. Naturopathy doesn’t share the same evidence base as medicine, and in some cases, disagrees with its basic scientific principles. It needs to be qualified as distinct, and hence: “naturopathic medicine”. Notice how Rexall makes it easier to find the non-evidence-based products:
This week an advertisement was passed to me that promoted naturopathy at a Toronto public school:
The Learning Disabilities Association is pleased to present this Workshop for Parents and Professionals:
ADHD and LD Naturally
Guest Speaker: Dr. Joseph Steyr
Do you want to know more about natural treatments for ADHD and Learning Disabilities? Dr. Steyr is a Naturopathic Doctor and also has been diagnosed with a Learning Disability since he was a young child. His talk will start with a short introduction to what is Naturopathic Medicine and continue to a discussion of the biology of ADHD/LD. Using that foundation of understanding we will then go over ideas of how nutrition, herbal and homeopathic medicine is used to help support and treat people living with ADHD or LD.
Naturopaths using homeopathy is nothing new (it’s a “clinical science” within their practice, and hence overlap in the photo above), but this bulletin was distributed by the Toronto District School Board, the largest school board in Canada. As a Toronto resident [full disclosure: I have family members in TDSB schools] I’ve always understood that the TDSB was large enough to manage children with special needs and learning disabilities appropriately. It’s a big board with the capacity to offer specialized, focused care. So I was disappointed to see the school board describing homeopathy as “medicine”, and permitting a naturopath to speak. This is especially concerning given that Toronto Public Health notes that some Toronto public schools have up to 40% of students with “exemptions” from the vaccination schedule. Given naturopathy as a practice is antagonistic to vaccination, I wondered if this naturopath shared the perspective of his peers. What I found was troubling. I’ve been reading far too much this week about how how alternative medicine and its purveyors can harm children, so it’s frustrating to see poor thinking about science promoted by academic and charitable organizations that should know better. What’s even more alarming than naturopathy for ADHD and learning disabilities is the naturopathic approach to autism, a condition that naturopaths claim is caused by vaccines, and can be treated with naturopathy.
Autism is related to vaccination only because of a manufactroversy that the two are related, a link that was never based on any credible evidence. Autism is also the unfortunate target of a cornucopia of quackery, all claiming to offer benefit in areas where science-based medicine may not offer satisfactory answers or treatments. The problems with the “naturopathic” approach to autism become clear with an understanding of the science of the disease. Autism can be described as a spectrum of neurodevelopmental cognitive disorders and delays, with variable effects on communication and socialization. There’s no known single cause, and while the disease seems to be strongly influenced by genetics there are a number of factors that are hypothesized to contribute, which include environmental components. While the scientific understanding of autism continues to grow, there are still maddening gaps in the evidence base. There is no cure for autism, but there are evidence-based approaches that can be effective.
The lack of a “cure” for autism hasn’t stopped alternative medicine proponents from bringing forward their own (unproven) treatments. “Autism biomed” is short for biomedical, and is the umbrella term for the interventions used to “treat” autism medically. There are countless “biomedical” treatments for autism, and they’re offered by alternative (and sometimes conventional) practitioners. What proponents of “autism biomed” treatments always have in common is that they proclaim a superior understanding of autism over “conventional” medicine. And with this special insight comes the confidence that their particular biomed treatments are effective. Their entire perspective on autism as a disease may be quite different. Because they believe autism has external triggers and causes, they see autism as something “done” to a child that can therefore be “undone” with the right treatment: biomed. Consequently it’s not uncommon to see biomed practitioners claim that autism is either curable or highly treatable with their treatments. Biomed treatments can range from mild interventions (like modest dietary changes) to the truly horrific, like chemical castration or bleach enemas. Joseph Steyr, the naturopath noted above, is a proponent of autism biomed. Taking a closer look at his website, his description of biomedical treatment neatly encapsulates the biomed belief system:
The Biomedical Approach believes that environmental triggers (infectious agents, vaccines, foods, pesticides, pollutants/heavy metals) accumulate to a threshold point where Autism starts. These factors can trigger Autism on their own, or in conjunction with genetic susceptibilities. Once Autism begins, untreated triggers and nutrition deficiencies will lead to a worsening of the condition. Starting Biomedical Approach treatments, along with Behavioural therapies, as early as possible increases the chances that Autistic behaviours can be reduced or possibly eliminated. Naturopathic medicine offers many treatment options, from therapeutic diets, herbal (botanical) medicines, vitamin and mineral supplements, to homeopathic remedies, hydrotherapy (waterbased therapies such as foot baths and low‐heat infrared saunas) and (needle‐free) acupuncture.
To biomed purveyors like Steyr, autism is “triggered” by products like vaccines. Other naturopaths hold these same beliefs. Hilary Andrews, a naturopath in Portland Oregon claims:
While the measles-mumps-rubella or MMR vaccine has been strongly linked to the onset of autism, I believe that prior vaccinations also play a cumulative role in this disease. Current vaccination schedules overload very young, fragile immune systems with a huge number of viruses. The number of vaccinations administered to children has more than doubled during the last decade. Today, a child receives approximately 33 doses of 10 different vaccines before the age of six.
To naturopaths, vaccines are yet another “toxin” triggering autism spectrum as well as conditions like food allergies and “nutrient sensitivities”. To detoxify your autistic child, Steyr offers useless but probably harmless treatments like homeopathy and foot baths. He also offers treatments with greater risk for harm, like herbalism or the quackery of hyperbaric oxygen. But Steyr is no rogue naturopath. There is no shortage of naturopaths offering biomedical treatments for autism. A comprehensive list of treatments would be impossible – but here are some of the common treatments promoted by naturopaths:
Anke Zimmerman, a naturopath in Victoria, British Columbia, offers Complete Elimination of Autistic Spectrum Expression (CEASE) therapy which uses homeopathy to allegedly rid the autistic child of vaccine toxins. Homeopathy is an elaborate placebo system, with no medicinal effects. Here it is pseudoscience that’s neatly packaged snake oil and promoted to parents of autistic children.
Autonomic Response Testing
Eugene Quan, a Calgary naturopath claims he can cure autism:
We now know that autism is not a psychological disorder. It is biomedical … viruses, bacteria, candida, parasites, and heavy metals cause the behaviours that lead to an autism diagnosis. Once you remove what is causing the symptoms, you can remove the diagnosis … Dr. Quan at Western Naturopathic in Calgary can help your child become autism-free in 1-2 years. Dr. Quan uses Autonomic Response Testing for clear patient assessments, resulting in successful individualized treatment plans. Dr. Quan guides us through a myriad of options, organ-supportive protocols, the vaccine issues, healing the gut, parasites, mould sensitivity, stemming, seizures, speech issues, tonsils, soul awareness, and biofilm elimination. His approach is making a positive difference in the lives of many children and parents searching for options.
Autonomic Response Testing is a variation of applied kinesiology, where muscles are “tested” to determine “sensitivities” to different products. ART is complete pseudoscience and there’s no scientific evidence that ART or applied kinesiology is anything other than a parlour trick – or in this case, a bogus diagnostic.
Food intolerance testing
Sharon Behrendt, a naturopath in Orleans, Ontario, claims that children with autism are suffering from food allergies:
Many children with ASD have food allergies, due to abnormalities in their digestive and/or immune systems. If food is not broken down and digested, then the partly digested food can pass from the gastrointestinal tract into the bloodstream. The immune system recognizes those foods as foreign to the body, and may launch an immune response to those foods, including brain inflammation. These food allergy reactions are called IgG, or delayed, food reactions, as they can take hours or even a couple of days to occur.
Perhaps not surprisingly, Behrendt wants you to stay away from gluten and milk. She also claims:
Removing allergic foods can result in a wide range of improvements in up to 65% of ASD children, in particular improvements in behavior, focus and concentration.
Citation required. I’ve blogged extensively about how naturopaths do not diagnose or treat allergies according to scientific principles. IgG food testing offered by naturopaths is clinically useless and is not recommended by medical professionals for allergy testing. IgG testing leads to unnecessary and potentially-harmful food restrictions, with no relationship between the IgG test and autism.
Behrendt also recommends juicing (delicious, but medically useless) and B12 injections (useless, unless you’re deficient).
Supplements, supplements, supplements
Marianne Fernance, a naturopath in Brisbane, Australia, recommends detoxification, but also vitamin B12, zinc, and magnesium, as well as essential fatty acids for children with autism. The reality is that many children with autism are placed on (sometimes highly restrictive) diets, which increases the risk of nutritional deficiencies if close attention isn’t paid to nutrient intake. The evidence seems to show that special diets do not work for autism, so unless there is a clear dietary restriction or deficiency, supplementation should not be necessary.
Nicola McFadzean Ducharme, a naturopath in San Diego, California, recommends low-dose naltrexone for autism. Steven Novella has a much longer summary of the lack of evidence that supports LDN. In short, LDN is an opiate antagonist, usually used to treat narcotic overdoses by blocking the drug’s action at the cell receptor. When used at very low doses, there’s no convincing evidence it has any established role in the treatment of autism.
McFadzean Ducharme also advertises chelation, a common pseudoscientific treatment offered by naturopaths:
Heavy metal toxicity is a key component in many children suffering with autistic-spectrum disorders. Whether through exposure via environmental factors such as contaminated food or water, or vaccinations these toxins are detrimental to your child’s health. The detection of toxicity levels of heavy metals is challenging and sometimes difficult to quantify. Tests such as hair analysis (Great Plains or Doctor’s Data) are a good place to start and can give some useful information with regards to the potential of heavy metal poisoning. However, it is important to realize that hair testing is a screening tool and further diagnostics may be necessary to qualify heavy metal toxicity.
Chelation has legitimate uses when it’s part of a protocol for actual heavy metal poisoning. You don’t diagnose heavy metal poisoning with hair testing, however. The hair testing is simply used to give the provider the impetus to recommend useless treatments. When used by alternative medicine providers, chelation is quackery used to remove fictitious “toxins” in the body. There is no credible evidence that supports the use of chelation in autism. What’s concerning about chelation is that the intravenous infusions are not without risks, and chelating children with autism has caused deaths.
Like the other medical conditions they claim to treat, naturopaths do not look at autism from a science-based perspective. Many appear to place a strong emphasis on environmental factors as causes, regularly calling out out vaccines as contributors. Naturopaths offer an array of pseudoscientific treatments they call “biomedical”, with some practitioners claiming that autism biomed can “cure” autism. The reality of autism biomed is quite different than the vision promoted by practitioners. There are countless autism biomed interventions, but there is one universal feature: There is no convincing evidence that autism biomed treatments have any meaningful therapeutic effects on the features of autism. Autism biomed is anecdote driven experimentation. There is no convincing evidence that naturopathy has anything meaningful to offer for the treatment of autism.