Naturopathy is an unusual chimera.  It is basically a collection of old fashioned medical superstitions presented under a veneer of highly speculative, quasi-scientific assertions.  But given its popularity, it is important, from time to time, to evaluate specific claims made by this particular non-science-based belief system.

A reader informed me that he was advised to seek the advice of a naturopath for treatment of his seasonal allergies.  Since naturopaths claim to be “doctors plus”, I was curious what they would recommend.  Would it be standard allergy treatment with antihistimines and other proven medications along with some sort of vitalistic mumbo-jumbo? It turns out I was half-right.

A visit to a national (US) naturopathic association website is a painful lesson in how naturopathic believers view health and disease.  No unfounded assertion would be complete without a good straw man.  Regarding the difference between real medicine and naturopathy, they say of allergies:

It’s a yearly ordeal for many people, and many others struggle with these symptoms year-round due to molds, dust, and pet dander. Pharmaceutical commercials offer a promise of living clear, but is a life of pills and side effects the only solution?
Far from it, say naturopathic physicians! Allergic symptoms are your immune system’s extreme reaction to substances that are normally found, harmlessly, in your everyday environment. Very often, simple changes of diet, nutritional supplements, and homeopathic remedies can relieve this extreme reaction and the resulting inflammation that triggers most allergy symptoms.

In fact, it’s a bit more complicated than that.  The pathophysiology of environmental allergies is pretty well understood.  Normally harmless antigens are taken in, processed, and presented to the immune system.  Plasma cells then crank out allergen-specific IgE which coats basophils and mast cells.  On re-exposure to the allergen, basophils and mast cells release a soup of mediators of allergic reactions, including substances such as histamine.  After this immediate (and unpleasant) reaction, a later reaction involving other inflammatory mediators kicks in.

The best way to fight allergies is to avoid the offending allergen, but for many of us, this isn’t possible.  Treatments are based on the underlying pathophysiology.  Antihistamines help fight the unpleasant effects of histamine release, including sneezing, itching, and runny nose and eyes.  Unfortunately, they do little to prevent the release of histamine in the first place and some have significant side-effects.  The oldest anti-histamines, such as diphenhydramine (Benadryl) can cause sedation and dry mouth.  Newer antihistamines cause very little sedation and are quite effective.

There are also medications to help prevent degranulation of mast cells, preventing the histamine from being released in the first place.  These “mast cell stabilizers” can be very effective in preventing allergy symptoms, as long as you take it regularly.  Steroids sprayed in the nose can help with many of the symptoms, usually without side effects, and leukotriene inhibitors can also help blunt the immune response and improve symptoms.  These medications are very well-tolerated, safe, effective, and are based on what we know about the pathology of allergies.

The naturopaths offer something else entirely.

Red meat contains a substance called arachadonic acid, which helps to produce the cytokines and leukotrines that cause your immune system to react with allergic inflammation. While you need a small amount of arachadonic acid for your immune system to function, your body can produce this amount naturally. Simply eliminating red meat from your diet can reduce the level of this acid, thus lessening your allergic reactions.

This speculative assertion has no data supporting it.  It is an interesting supposition, but implausible and unproved.  It is unlikely that any dietary modification could reduce a substrate of allergic reactions enough to give relief of allergies.

They also recommend omega-3 fatty acids.  There is very little clinical literature on the topic.  A recent review of the use of omega fatty acids in allergy prevention found that despite some promising in vitro studies, there was no significant clinical benefit.   They also recommend turmeric, papaya, and pineapple, none of which have been shown to be effective treatments for allergies.

There next piece of advice is to toss money away:

For Best Results – Supplement!
A healthy organic diet low in Omega-6 fatty acids and high in vitamin E, Omega-3 fatty acids, and natural anti-inflammatory foods can help to reduce your allergy symptoms. However, your best bet is to supplement your diet with concentrated doses of anti-allergic nutrients such as those listed below:

  • Vitamin C (up to 10 grams/day) is a natural anti-histamine;
  • Vitamin B5 (up to 800 mg/day);
  • Zinc picolinate (up to 150 mg/day); and
  • Cod Liver Oil or other cold-water fish oil (look at the label and use a high quality fish oil product containing from 1000 – 2000 mg of the essential fatty acids EPA + DHA per day).

Once again, none of these assertions is backed up by evidence.  Most of it isn’t even promising enough to bother with.  But they really hit it out of the park with their final recommendations.

Homeopathic remedies involve taking an extremely diluted form of selected allergens in liquid or sugar-pill form sublingually (under the tongue). These miniscule doses serve somewhat like a vaccination, stimulating your immune system to an effective rather than extreme response.

Vaccination is to homeopathy as horseback riding is to unicorn wrangling.  First of all, vaccination, while sometimes used as immunotherapy and immunoprophylaxis, is not used to treat type I hypersenstivity, the cause of seasonal allergies.  Immune desensitization is used.  Desensitization uses small but measurable amounts of allergen to induce tolerance and prevent an allergic reaction.  There is nothing homeopathic about it.

They go on to mention liver detoxification, gut flora “balancing”, and chiropractic as useful treatments for allergies.

Naturopaths, it would seem, are not “medicine plus”, but “everything but.”  Since they do not use proven, effective therapies, the throw unproved, implausible therapies at their patients perhaps hoping that when the allergies relent as a natural course of the disease, they might finally claim credit.  That’s what all the best shamans do.

Posted by Peter Lipson

Peter A. Lipson, MD is a practicing internist and teaching physician in Southeast Michigan.  After graduating from Rush Medical College in Chicago, he completed his Internal Medicine residency at Northwestern Memorial Hospital. He currently maintains a private practice, and serves as a teaching physician at a large community hospital He also maintains appointments as a Clinical Assistant Professor of Medicine at Wayne State University School of Medicine and at Oakland University William Beaumont School of Medicine, the first being a large, established medical school, the latter being a newly-formed medical school which will soon be accepting its first class of students.  He blogs at White Coat Underground at the Scientopia blog network. A primary goal of his writing is to illuminate the differences between science-based medicine and everything else.  His perspective as a primary care physician and his daily interaction with real patients gives him what he hopes is special insight into the current "De-lightenment" in medicine.  As new media evolve, pseudo-scientific, deceptive, and immoral health practices become more and more available to patients, making his job all that much more difficult---and all that much more interesting. Disclaimer: The views in all of of Dr. Lipson's writing are his alone.  They do not represent in any way his practice, hospital, employers, or anyone else. Any medical information is general and should not be applied to specific personal medical decisions.  Any medical questions should be directed to your personal physician.  Dr. Lipson will not answer any specific medical questions, and any emails and comments should be assumed public. Dr. Lipson receives no compensation for his writing. Dr. Lipson's posts for Science-Based Medicine are archived here.