A guest article from former naturopathic doctor Britt Marie Hermes.
What is a licensed naturopath?
Licensed naturopaths attend four-year post-graduate naturopathic programs. There are seven programs in North America, two of which are in Canada. The Boucher Institute of Naturopathic Medicine is located in British Colombia and the Canadian College for Naturopathic Medicine is located in Toronto. All seven North American naturopathic programs are accredited by the Council on Naturopathic Medical Education (CNME).
Naturopathic programmatic accreditation means that procedural and operational standards related to organizing and running an academic program have been approved by the CNME. The CNME is not affiliated with the North American organization that sets the standards for conventional medical schools. The naturopathic curriculum is not evaluated by government organizations.
As of 2016, 18 U.S. states and five Canadian provinces have regulated naturopathic practitioners. The registered provinces include British Colombia, Alberta, Saskatchewan, Manitoba, and Ontario. In a licensed jurisdiction, naturopaths may call themselves naturopathic doctors (N.D). In unlicensed jurisdictions, naturopaths are not permitted to practice medicine or call themselves doctors or physicians.
There are considerable legal risks for naturopaths practicing without a license.
The naturopathic belief system
Naturopaths believe that the forces of nature can cure disease. Naturopaths refer to this power as the “vis,” which they claim resides inside the human body. Other systems of pre-modern medicine have similar ideas about healing energies. In traditional Chinese medicine, it is called qi. In Ayurvedic medicine, it is called prana.
In naturopathy, the vis is manipulated using treatments that are based on food, water, plants, minerals, and physical contact. The mainstay naturopathic therapies are nutrition, hydrotherapy, herbal medicine, spinal manipulation, homeopathy, and traditional Chinese medicine. Some naturopaths utilize methods and substances that are more familiar to modern medicine, including intravenous injections and pharmaceutical drugs.
Naturopathic training is commonly described as being “similar to medical doctors.” This phrasing can be misleading to patients who are not familiar with modern medical training.
Naturopathic students complete a minimum of 850 hours in a naturopathic clinic and see at least 450 patients. This training primarily takes place in a clinic affiliated with a naturopathic program. Naturopathic clinics are out-patient clinics, which means patients are not hospitalized. Emergency medicine and urgent care are not offered in naturopathic clinics.
A residency is not required for naturopaths to practice. After a naturopathic student graduates, he or she may move directly into practice after passing two licensing exams that primarily focus on testing knowledge about naturopathic therapies and philosophy, such as homeopathy and herbs.
In comparison, medical doctors (MDs) complete the majority of their clinical training in a university hospital. Medical students are exposed to thousands of patients across specialty areas. This exposure ensures a comprehensive medical education. Medical students are required to pass three sets of licensing exams, depending on their country of training, including a clinical skills part that tests the clinician’s physical exam and diagnostic skills, in order to become licensed. A medical residency is usually compulsory in order to practice in any field of medicine.
After completing a medical residency, the MD can then choose to become board certified in a specialty, which requires demonstrating clinical expertise and another comprehensive specialty exam. The average physician has completed about 20,000 hours of clinical training and has seen tens of thousands of patients during his or her medical education.
Naturopathic training in cancer care
Naturopathic students take one lecture course (about 20 classroom hours) in cancer care. In my course at Bastyr University, I was taught that no natural substance has been proven to cure cancer.
Most naturopaths start practicing directly after passing their licensing exams and can immediately go on to consider themselves cancer specialists. Some naturopaths choose to complete a voluntary residency program in naturopathic oncology. These residency positions are typically two years long, and are sponsored by clinics that provide alternative cancer therapies to patients in an out-patient setting.
Residents in naturopathic cancer care learn practices that are delivered independent of, or alongside, modern medical care. They do not learn how to prescribe or use radiation, surgery, or chemotherapy.
After completing a residency in cancer care, a naturopath can take a certification exam administered by the American Board of Naturopathic Oncology to become a fellow and place “FABNO” after his or her name. Those who have not completed a residency may also sit for the exam if they have many years of experience practicing naturopathic cancer care. Thus, not all naturopaths with the FABNO title have completed naturopathic residency training, and not all naturopathic “oncologists” have the FABNO credential.
What is naturopathic cancer care?
Naturopathic cancer therapies are not a part of standardized medical protocols that are set by evidence-based guidelines, common medical practice, or scientific consensus.
Naturopathic cancer care comes in a variety of packages and flavors. There is no such thing as a typical naturopathic treatment plan. Since naturopathic protocols are not standardized, plans are fluid, usually picking up and eliminating various therapies as treatment is underway.
Patients often visit their naturopath for treatment two to three times per week, for stretches as long as twelve months, or even several years. When conventional cancer treatments have ended, naturopaths often recommend that patients still receive naturopathic therapies a few times per month, indefinitely. Most naturopaths believe these treatments are necessary to prevent cancer recurrence.
Common language used to describe naturopathic cancer treatments
Naturopaths tend to use an attractive set of phrases to describe natural cancer care. When looking at naturopathic clinic websites, you will likely read statements like these:
It is important to remember that no natural treatment has been scientifically proven to effectively treat cancer [1,2].
What does science say about some of the most common naturopathic treatments?
The cancerous process is very complex, and involves the breakdown and dysregulation of many molecular processes simultaneously . Sometimes cancer is related to a heritable genetic defect . Other times, it is just bad luck .
Common naturopathic therapies include strict diet changes, intravenous injections with high-dose vitamin C, injections with the herbal substance Mistletoe, and treating your blood with ozone gas.
Strict Diet Changes
The most ubiquitous naturopathic recommendation for cancer is a strict diet to reduce or eliminate foods that are believed to promote cancer growth or weaken the body’s immune system. Example diet recommendations include:
The most common diet recommendation is to avoid sugar. This recommendation is based on a belief that sugar “feeds” cancer cells . This is based on laboratory experiments that showed cancer cells “take-up” more sugar compared to healthy cells, as cancer cells have a higher metabolic rate than the average healthy cell .
Excessive sugar intake does have negative health consequences, namely, obesity . There is an increased risk of cancer due to obesity, which is a complex process that is caused by multiple behavioral, environmental, and genetic risk factors . There have been no conclusive studies directly linking sugar intake to increased cancer risk, and no studies have shown that sugar-free diets are associated with increased survival rates in cancer patients [10,11].
Following a strict diet can have negative consequences. Chemotherapy often results in significant weight loss. A diet that makes it difficult to eat typical meals may exacerbate muscle loss and wasting. Patients adhering to restrictive diets sometimes report a decrease in their quality of life from stress related to adhering to the diet [12,13]. There may be an increased cost of food associated with special diets . Patients may also feel unable to participate in social gatherings, due to their diet restrictions, which can translate to feelings of depression, isolation, and loneliness .
It is generally recommended to eat a well balanced diet, rich in fruits and vegetables, and to follow specific instructions from your medical doctor.
Intravenous High-Dose Vitamin C (IVC)
Vitamin C, also called L-ascorbate or L-ascorbic acid, is used by naturopaths for all types of cancers. It is injected intravenously in order achieve very high doses in the blood that are not attainable through oral supplementation .
Naturopaths believe high-dose vitamin C has many therapeutic actions, including:
These claims are based on the understanding of how vitamin C normally functions in the body. At low or moderate levels, vitamin C is an anti-oxidant and is essential for the production of collagen .
At high doses, vitamin C no longer works like an anti-oxidant. Instead, it makes reactive oxygen species, including hydrogen peroxide . In laboratory experiments and studies on rodents, this hydrogen peroxide has been shown to kill cancer cells, but safety and effectiveness has not been demonstrated in human trials [19-23]
Justification for using high-dose vitamin C in cancer patients is based predominately on case studies and trials that have not been controlled . These types of studies are considered weak forms of evidence and their findings should be taken with a grain of salt.
The evidence for improving a patient’s quality of life is limited; further studies are needed to know for certain what the effect of high-dose vitamin C has on a patient’s well-being 
High-dose vitamin C has also been shown to decrease the effectiveness of certain chemotherapy agents [25-28]. It is essential to inform your medical oncologist if you are receiving high-dose vitamin C while undergoing chemotherapy or radiation.
High-dose vitamin C is generally well-tolerated by patients . From my experience, common side effects include dehydration and increased thirst, pain and redness at the injection site, and feeling tired.
Mistletoe (Viscum album) is a naturopathic treatment commonly used as a supportive cancer therapy. Naturopaths claim that mistletoe may increase patient survival and improve one’s quality of life [29,30] In petri dish experiments, mistletoe has shown anti-cancer effects [31-36]. In human experiments, mistletoe has been suggested to increase the activity of the immune system through increasing the number of white blood cells and special immune chemicals called cytokine . Mistletoe is usually delivered in a small injection under the skin .
Mistletoe is popular in European countries, especially Germany and Switzerland. As a result, mistletoe is frequently marketed as a “European” cancer drug . The U.S. FDA does not approve mistletoe for use, even in homeopathic forms. This means it is not legal for medical providers to import mistletoe into the U.S.A. It is possible to receive mistletoe treatments in some Canadian provinces.
Common side effects from mistletoe injections include pain and irritation at the injection site  Flu-like symptoms, fevers, headaches, and chills are often reported .
Since mistletoe is not available for use in the United States, I have limited experience with this therapy. I am aware that American naturopaths import mistletoe from overseas and teach patients how to administer injections themselves at home. If an American naturopath offering this therapy, please be aware that in doing so, the naturopath may be breaking U.S. laws.
Ozone therapy is marketed for just about everything, including all types of cancer. It is most commonly associated with claims related to boosting the activity of the immune system .
Ozone (O3) is a gas made up of three oxygen molecules . Ozone is a very strong oxidizing molecule that can form products known to be damaging to the respiratory system . Ozone is categorized as a toxic gas and environmental hazard .
Ozone is delivered to patients in a variety of ways, including through the nose, ear, mouth, rectum, vagina, and skin, but for cancer treatment, ozone is most often delivered via autohaemotherapy . In this method, blood is taken out of a patient. This blood is then treated with ozone gas. The treated blood is then injected back into the patient [37,41]. Autohaemotherapy carries significant risks; some patients have died from this application, and as a result, autohaemotherapy with ozone has been illegal in Germany since 1984 [37,42].
The rationale for ozone use in cancer is based on a theory from the 1930s that demonstrated cancer cells can live and grow easily in low-oxygen environments inside the body  It is suggested that applying ozone gas to the blood will bring more oxygen to the cancerous tumor, thus causing cancer cells to die. However, tumors are very heterogeneous . While some cancer cells within a tumor potentially prefer a low oxygen environment, others readily thrive in the presence of oxygen .
The U.S. FDA and Health Canada do not allow manufacturers to advertise or sell ozone generators for medical use [45,46].
Editor's note: You can read more about these specific naturopathic compounds, and others, at the U.S. National Cancer Institute Website.
If you are considering naturopathic treatments
Patients should bear in mind that complementary and alternative therapies are not risk-free. There is preliminary evidence showing cancer patients who used complementary and alternative therapies in addition to conventional care experienced a decrease in the quality of their life .
Additionally, patients undergoing complementary and alternative treatments in conjunction with conventional treatments did not live longer compared to cancer patients receiving conventional treatment alone . A 2003 study from Norway reported patients undergoing complementary and alternative treatments died sooner than patients who did not integrate complementary and alternative methods into their cancer care .
In order to help you make an informed decision about naturopathic cancer care, I have compiled a short list of questions to ask your naturopathic provider:
Ask for the above answers to be provided to you in writing.
It is also essential to document your treatment plan. Naturopathic patients are often uncertain about which substances they are receiving. To assist with keeping track of your care, you can do the following:
If your naturopath asks you to keep your care secret, or asks you to stop seeing your oncologist, consider this a red flag for inappropriate treatment and medical misconduct.
Finally, and perhaps most importantly, take your time in deciding to pursue naturopathic cancer care. There should be no rush to implement naturopathic therapies, as no natural therapy has ever been proven to cure cancer.
Today, I no longer consider myself a naturopathic doctor. I left my practice after I discovered my former boss was importing a non-FDA approved substance called Ukrain, and delivering it to terminally ill cancer patients. I retired after I learned more about the lack of evidence and risks associated with naturopathic treatments.
In my former practice, patients would often ask me hypothetically whether I would recommend naturopathic treatment to my family members.
My answer is still “No.”
Read more articles by Britt Marie Hermes on naturopathic medicine at naturopathicdiaries.com