The Positive Side

Fall/Winter 2005 

When Nature Calls

The role of naturopathic medicine for people with HIV

By Diane Peters

IN THE FALL OF 2002, Michael Bell had never felt worse. He’d contracted the Norwalk virus three times, had dropped 60 pounds and could barely get down more than a glass of water and a few soda crackers a day. Diagnosed with HIV in 1993, Bell, 47, had hardly ever been sick. Before contracting Norwalk, he had long been doing well on his HIV meds, was a busy volunteer at a Toronto AIDS organization and was working at his maintenance job.

Never quite having recovered from Norwalk, the following February Bell developed pneumonia and a fever of 109. When he pulled through — just barely — he had less than 50 CD4 cells and a viral load of over one million. “There was nothing the doctors could do for me anymore,” Bell recalls. So he started seeing a naturopathic doctor (ND).

 

NATUROPATHIC CARE has become increasingly popular among people with HIV/AIDS (PHAs). And, more often, PHAs go with the support and even the encouragement of their regular doctors, using naturopathic medicine in combination with their medications. There’s been a new recognition of the power of naturopathic medicine to help PHAs deal with drug side effects, immunity and some HIV-related conditions, which has led to more HIV clinics offering free naturopathic care. For instance, the Positive Living Society of British Columbia  (Positive Living BC) runs a free clinic in Vancouver and Blood Ties Four Directions Centre offers free naturopathic services in Whitehorse.

Bell was lucky enough to live near the largest naturopathic HIV/AIDS specialty clinic in Canada. At the Sherbourne Health Centre Community PHA Naturopathic Clinic in downtown Toronto, interns — under the supervision of licensed NDs — from the Canadian College of Naturopathic Medicine (CCNM) started treating him, first with acupuncture, a form of Traditional Chinese Medicine that uses tiny needles to help the body’s natural energy flow better. When Bell stood up for the first time after having some needles in his pelvis, he felt a tiny shift. “Boy, was I hungry,” he says. “I hadn’t been hungry in months.”

 

ACUPUNCTURE IS JUST ONE one of many types of complementary medicine modalities used by naturopathic doctors. Think of them as the general practitioners of alternative medicine. They go to school for four years after completing an undergraduate degree and study an array of treatments including herbs, supplements, homeopathy, Traditional Chinese Medicine (including herbs and acupuncture), nutrition, lifestyle counseling and manual therapies such as massage. In Canada, licensed NDs are trained at either the Canadian College of Naturopathic Medicine in Toronto or the Boucher Institute of Naturopathic Medicine in New Westminster, British Columbia.

Kenn Luby, a Toronto ND who specializes in treating PHAs and works in the same office as two HIV primary care physicians, says, “A naturopath uses various techniques to tap into the body’s natural ability to heal itself.” To do that, a practitioner looks past surface symptoms — say, a chronic runny nose or fatigue — and finds out about the underlying cause (perhaps inflammation, an imbalance or even something psychological) before planning treatment.

In Bell’s case, one of his biggest problems was all the damage that Norwalk had done to his digestive system: His stomach had shrunk and his bowels and urinary system barely worked, plus he was very dehydrated. Acupuncture, herbs and nutritional supplements encouraged healing, allowing him to start eating and drinking again and to develop smoother digestion. Now, since those underlying problems have been helped, Bell has fewer headaches and a lot more energy and has returned to his volunteer job. He’s still taking highly active antiretroviral therapy (HAART) but has been able to stop taking other medication to help him eat and sleep. His CD4 count is now up to 170 and his viral load is undetectable.

Like Bell, most PHAs benefit the most from naturopathic medicine when it’s combined with effective HIV treatment. Call it the new combination therapy. “We work very closely with medical doctors. We’re not opposed to regular, allopathic medicine,” says Afsoun Khalili, ND, who works at the Sherbourne Clinic. “There’s nothing like the drugs to bring down the viral load and increase the CD4 count.” What naturopathic medicine can do is help keep the body as healthy as possible and help combat some drug side effects so that people are better able to tolerate their meds.

 

SOME PHAs ALSO USE naturopathic medicine as a form of early treatment to help them delay taking meds. Freida Richler did this back in 1988 when she was first diagnosed. She found a rare health care provider — a general practitioner who was also an ND. “I really didn’t want to take drugs because I’ve always had extreme adverse reactions to them,” Richler says. Dr. Carolyn Dean encouraged her to change her diet (to eat more whole foods and less refined ones) and to take a series of nutritional supplements and vitamins. “For more than 10 years, I relied exclusively on Dr. Dean and other naturopathic doctors.”

Richler, now 47, fared quite well until 1998, when she started running a high fever and lost a lot of weight. After being diagnosed with PCP (Pneumocystis pneumonia) and other complications, she began to take HIV drugs. Although she had a hard time with her initial regimen, she eventually adjusted to a simpler combination that was easier to tolerate. Today she has a CD4 count of 1,524 and an undetectable viral load. “I think I responded so well to the drugs and was able to bounce back to relatively good health because I always took large amounts of nutritional supplements religiously, took time for self-care and was careful about my diet,” Richler says.

Richler started to attend the PHA naturopathic clinic in Toronto run by CCNM shortly after recovering from PCP. During her assessment, she mentioned to the naturopathic intern that she hadn’t had a period in more than three years. The intern treated her with acupuncture; in addition to working on meridian points that help support the immune system, she worked on a couple of points that stimulate the reproductive organs. After one month of daily acupuncture, Richler got her period. “Ever since then I’ve had my period regularly,” she says. “That was five years ago.”

PHAs often have a list of health concerns, including side effects, various discomforts and their immune systems. Using just one modality, or more often a combination of two or more, NDs have had success helping PHAs with diarrhea, appetite loss, fatigue, lipodystrophy, stress, hemorrhoids, fissures, weight loss, frequent colds and many other conditions.

But naturopathic medicine has its limits. The treatments at an ND’s fingertips are not strong enough to stop a powerful infection or fight cancer. And NDs themselves debate its impact on immunity. “There certainly are things that can affect the immune system, like sugar and stress,” says Joanne Leung, a Whitehorse-based ND who works at the Blood Ties Four Directions clinic. She admits there just haven’t been the studies to show that naturopathic medicine can actually impact CD4 count or viral load. But, anecdotally, NDs say that their PHA patients end up not just feeling better but with a stronger immune system after treatment. “I believe that the patients who are seeing me as well as seeing their doctors are doing better than those who are following just a medicine regimen,” Luby says.

Along with a lack of good solid medical studies to show exactly what naturopathic medicine can do for HIV, it has a few other flaws. One is that the various modalities impact people differently. For instance, some people respond very well to homeopathy, while others get no help at all.

 

INTERACTIONS WITH HIV MEDS can also be a problem. “It’s a real challenge, especially since HIV meds change so rapidly,” says Tasleem Kassam, a Calgary ND who treats PHAs. “Research becomes obsolete so fast.” As a result, many NDs avoid things like botanicals and herbs, as they are the most likely to interact with drugs, while homeopathy, acupuncture and dietary changes are much safer. Luby has another reason for avoiding herbs with his PHA patients. “I don’t want to add to the pharmaceutical load in their bodies,” he says. According to Luby, herbs are really just drugs that come straight from nature.

However, according to Hal Huff, ND, chief supervisor of the Sherbourne Health Centre Community PHA Naturopathic Clinic, herbal medicines, when used cautiously, can be helpful in correcting or managing concerns related to HIV. “Although we know that St. John’s wort and probably other botanical medicines can interfere with HAART, other herbs have been used without any apparent interaction in thousands of patients,” he says. “That said, as with any intervention, we are very careful to monitor for viral load changes or any other evidence of herb-drug interactions.” Huff gives the example of milk thistle, an herb used to protect the liver and treat liver damage. “It’s been the subject of negative attention but it appears to have been vindicated,” he says, citing recent studies that show that milk thistle has no significant impact on the efficacy of antiretrovirals.

NDs develop an individualized treatment plan based upon a holistic assessment of the patient in terms of their physical, mental, social and spiritual health. So it’s no surprise that the start of a relationship with an ND begins with a lengthy consultation. At least an hour long, this discussion is about sharing medical information (meds, medical history, side effects, preexisting conditions and the like) and personal information. Emotional health, stress level and family history all play into a person’s treatment. “I end up knowing more about patients than their own mother does,” Kassam says. In the initial assessment, NDs also perform a thorough physical examination.

That’s where naturopathic medicine’s true power lies — in its ability to treat the whole person, not just their disease or their numbers. And that’s very important because naturopathic medicine often takes a lot of effort on the part of the patient. “It’s hard work and it’s not for everyone,” Leung says. To make naturopathic medicine work, a patient must often make dietary changes, take supplements and herbs on a regular schedule, show up for regular appointments and even deal with emotional issues.

PHAs must also be patient with naturopathic medicine: It’s not a quick fix. “It takes time, a lot longer than I thought,” Bell says. He’s still getting weekly acupuncture treatments to keep his health and particularly his digestion strong.

Just as an ND picks a mix of modalities to suit each patient, so must they adapt treatment to what a patient can handle. This is true patient-centred care: No one should have to do acupuncture if they’re really uncomfortable with needles, or be turned away from naturopathic care if they can’t afford the supplements or are unable to make dietary changes. “It fits in where the clients want it to fit in,” Leung says. When an ND and patient work closely together to create a treatment program and it works, it’s worth the effort. “It can be very empowering to make some changes and see some results,” she adds.

As more free naturopathy clinics and services open up for PHAs and as more doctors embrace complementary medicine, more PHAs are benefiting from naturopathic care. It’s a nurturing approach that can help with many problems that cause discomfort and even long-term damage. “I see the future of medicine being naturopaths and conventional doctors working together, especially with HIV but with any condition,” Khalili says. “The two work best together.” Freida Richler adds: “We need more naturopathic doctors who are familiar with drugs and more medical doctors who practice integrative medicine.”

Diane Peters is a Toronto-based writer who has written extensively about health, including HIV/AIDS, for Chatelaine, Reader’s Digest Canada, POZ and Today’s Parent.

For more information, check out CATIE’s Practical Guides to Complementary and Herbal Therapies for People Living with HIV at www.catie.ca or by calling 1.800.263.1638.

Learn the Lingo

Acupuncture: A component of Traditional Chinese Medicine that uses very fine needles inserted into special energy points on the body to encourage the body to heal itself.

Botanicals/herbs: The use of plant remedies in the form of supplements, teas or tinctures to treat conditions.

Homeopathy: A form of treatment that uses common diluted remedies to help the body heal itself. The practitioner takes into account a complete patient profile to select an appropriate remedy.

Hydrotherapy: The use of hot and cold water (usually through towels) on various parts of the body to promote circulation and encourage healing.

Nutritional supplements: The use of vitamins, probiotics (healthy bacteria) and other substances normally found in foods in pill form.

Traditional Chinese Medicine: An ancient approach to healing that includes acupuncture and herbs.

Natural Selection

Want to see a naturopathic doctor (ND)? Here are some tips for making sure you get the best possible treatment:

  • Tell your MD about your ND. Your medical doctor may be able to help you with a referral. Make sure to get a copy of your most recent lab work over to your ND. Your physician should be kept updated on your naturopathic treatments to help monitor for drug interactions and other possible problems.
  • Look for qualifications. Make sure your ND has graduated from a reputable school and has taken either the North American or provincial licensing exams.
  • Ask about HIV. Ideally, find an ND who has treated PHAs before. If that’s not possible, ask your ND to consider talking to a naturopathic HIV expert to help with your treatment.
  • Follow your gut. If you’re not comfortable with your treatment regimen or you fear you’re not getting the right care, trust your instincts to either make suggestions or switch to another practitioner.