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Why GPs should be concerned about naturopathy

Professor Edzard Ernst considers a new textbook covering this 'eclectic' system of healthcare

Professor Edzard Ernst considers a new textbook covering this 'eclectic' system of healthcare

Naturopathy is ‘an eclectic system of healthcare that uses elements of complementary and conventional medicine to support and enhance self-healing processes' [1].

The main concepts of naturopathy include the notion that ill health is at least partly caused by unhealthy lifestyles and that it can be improved by stimulating the body's own healing power. All this sounds quite rational, but is it?

Others before me have pointed out that the main text naturopaths learn their trade from is full of misunderstandings, exaggerations and simplistic notions [2].

This also applies to the ‘flagship' US textbook entitled ‘The Textbook of Natural Medicine' [3].

This being so, I was pleased to see a new ‘textbook' being published by a British naturopath: ‘The Textbook of Modern Naturopathy' [4]. Perhaps, I thought, naturopathy is evolving and becoming more grounded in evidence, science and rational thought?

One of the first things I noted with great delight and considerable surprise was that the new book had something to say about ‘red cell rigidity'.

This rather exotic subject happens to be the topic of my PhD thesis. Having conducted many years of research into blood rheology, I was fascinated and excited. Here is what the ‘textbook' tells us:

‘When the diet contains too much saturated fat and not enough essential polyunsaturated oils, cell membranes, (including those of the red blood cells) begin to incorporate saturated fat into their structure. This makes red blood cells rigid, whereas to squeeze through narrow capillaries they need to be very flexible and deformable.

‘Red cell rigidity can cause red cells to become stuck in the capillaries, cutting off parts of the microcirculation.

‘Research has shown that some children with hearing problems improve when the fat in their diet is reduced.

‘This may be because the circulation to their ears has improved. The cochlea of the ear is nourished by many small blood vessels.

‘According to Dr. Majid Ali (, micro-clots are frequently due to mitochondrial malfunction, much energy has to be obtained anaerobically by the process of glycolysis.

‘Dr Ali says that this raises acidity levels, thus causing the blood to begin congealing. Primordial life forms such as yeasts (Candida) then clump with the resulting microclots.

‘Dr Ali says that this state is also found in many patients with chronic degenerative diseases.

‘Microclots also block the microcirculation, and are likely to have substantial effects on sensitive tissues such as eyes, ears and brain.'

My fascination thus quickly changed into utter bewilderment: without going into all the boring details, I can affirm that this is complete nonsense.

In case you don't accept my word and want to learn for yourself what red cell rigidity is all about, I recommend reading a book that we published many years ago[5].

Much more relevant for GPs is what this modern ‘textbook' of naturopathy tells students about a clinical subject closer to GP's hearts such as vaccination.

Naturopaths have a long history of being against immunizations [6]. Essentially they claim that natural treatments are much better preventatives, and some suggest that infections are important milestones for a child's mental and physical development.

I was therefore anxious to see where the author of the new book stood. Here are two paragraphs from the ‘textbook' [4]:

‘It is wise for parents to avoid a direct confrontation with the doctor or other health professional. Delay, on the grounds that they prefer to have the child vaccinated later, might create less resentment than an outright refusal and will give them more time for deliberation.

‘If the child is unwell, a delay would not be unreasonable. If a parent is unhappy about the combined MMR jab, doctors can, on a "named patient" basis, request single vaccines against measles, mumps and rubella to be administered separately, though not all doctors will comply with such a request.

‘When making a decision about a specific vaccination, parents should remember to consider the age and constitution of the child, the reputation of the vaccine and any special considerations such as travel abroad.'

‘In addition to good nutrition, homeopathic vaccinations, which are taken by mouth, are well worth considering. Some people known personally to the author, who work with animals, find that homeopathic vaccinations are very effective and can prevent infection in an animal which is exposed to an outbreak of a disease among pharmaceutically-vaccinated animals.'

At this point I could, of course, rest my case and simply conclude that this textbook cannot be recommended, particularly not to students of naturopathy or other CAM practitioners.

But, I think, there are important, more general lessons to be learnt here. These include the following:

• If students of naturopathy are taught potentially dangerous nonsense, their practice is likely to turn out to be potentially dangerous nonsense as well. And, in some instances, this can even be a threat to public health.

• Those optimists who think, as I did, that naturopathy is progressing towards an evidence-based discipline seem to be mistaken.

• After having read many similar texts, not just by naturopaths but also by other types of alternative practitioners, I do see a pattern emerging. Authors like to write about (basic) research thus giving their books a veneer of science which, to the non-expert or CAM practitioner, may look authorative.

• The flair of authority is nevertheless exploited by those authors to give practical advice which is not based on evidence (to put it mildly).

• Naturopaths and other CAM practitioners thus find themselves often in a schizophrenic situation where they reject science as much as they thrive to emulate it.

• Hardly anyone of those professionals who are in a position to disclose the absurdity of such texts ever raise their voices and object openly.

• Thus menacing myths are perpetuated and progress is prevented.

My conclusion is simple: that we must speak out against the dissemination of such rubbish – not to show how clever and well-trained we are but to prevent harm. We need to persuade publishers not to print healthcare-related nonsense, and we need to persuade colleagues to abstain from teaching it.

If we don't do this, who will? And if nobody does it, how will we ever make progress?

Professor Edzard Ernst is professor of complementary medicine at Peninsula Medical School

Professor Edzard Ernst

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