FAQ #18: What advanced nutrition training do naturopathic doctors receive? 
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The AANP and the INM would like to acknowledge: JoAnn Yanez, ND, MPH, CAE, executive director of the Association of Accredited Naturopathic Medical Colleges (AANMC), Arianna Staruch, ND, interim dean, School of Naturopathic Medicine,Bastyr University, and Taylor Arnold, PhD, RDN, assistant professor, nutrition, Southwest College of Naturopathic Medicine,for their contributions to the content of this FAQ. 

Nutrition is often a pivotal component of an individual’s journey toward optimal health. Poor diet is also the leading preventable risk factor for disability or early death in the United States.[1] However, despite this and rising rates of obesity, diabetes, and other nutrition-related diseases, many U.S. healthcare providers are not adequately trained to address nutrition in a way that could help patients build a stronger foundation of health, or even lessen disease development or progression. Conventionally trained medical doctors receive a nominal amount of nutrition education in medical school.[2] A recent study found that only 12 percent of osteopathic doctors were aware of Dietary Reference Intakes, a key guide to differentiated nutrition requirements.[3]

Naturopathic doctors (NDs) recognize nutrition as a cornerstone of health. During medical school, ND students complete an average of 155 classroom hours of nutrition education. Coursework is similar to that taught to registered dietitians, with a focus on primary outpatient care. NDs’ understanding of food as medicine, passion for nutrition, and rigorous nutrition training enables them to go beyond offering patients dietary guidelines. Naturopathic doctors provide individualized nutrition assessment and guidance utilizing evidence based nutritional recommendations. They tailor nutrition treatment to a patient’s health concerns. They also empower patients to integrate better nutrition to support optimal health.

Nutrition curriculum in naturopathic medical schools is covered in a series of rigorous courses that build upon each other through an ND’s in-residence, four-year, science-based, post-graduate medical education, whose accreditation is recognized by the United States Department of Education. In addition to classroom study, naturopathic medical students refine and apply learnings in various settings including academic teaching kitchens and over 1,200 hours of clinic rotations with patients. Areas of concentration include:

  • Macronutrients (proteins, fats and carbohydrates), their biochemistry, their role in a healthy body, and optimal amounts.
  • Micronutrients (vitamins and minerals), their bodily requirements, recommended daily intakes, food sources, toxicity sources, and how they are processed in the body (from absorption to digestion to storage to elimination).
  • Performing a dietary assessment to determine if an individual is getting enough macro- and micro-nutrients or has nutritional deficiencies, dysfunction, or pathology.
  • Analysis of diet types, including whole foods diets, low carb diets, Mediterranean diets, ketogenic diets, low FODMAP (short chain carbohydrates that are not properly absorbed in the gut) diets, and other evidence-based nutrition therapies.
  • Food attitudes, cultures, socio-economics, and pre-conceptions that impact an individual’s nutrition choices and ability to successfully adopt and maintain healthy nutrition.
  • Clinical nutrition, diet and nutrient (or nutraceutical) therapy, including evidence-based use of vitamins, supplements and diets as integral supports for the health and optimal function of all major body systems. This includes training on how adverse effects related to individual body systems can impact a person’s nutrition status, as well as how nutrition can be applied to optimize the health and performance of each system.
  • Advanced clinical nutrition, including the application of specific evidenced-based diets and nutrients to support treatment for specific conditions, e.g. Irritable Bowel Disease (IBD), heart disease, and more.
  • Supplement-drug interaction, including prescribed drug and nutrient interaction as well as nutrient-botanical interaction.
  • Specialized areas of nutrition including: pediatric nutrition, breast feeding nutrition, sports nutrition, community nutrition, eating disorders, and more.
  • Technology and nutrition, including how to leverage leading and evidence-based websites, applications (apps) and other technology resources to assist patients in nutrition planning and adherence.
  • Collaboration with registered dietitians, as needed.Many health symptoms and conditions have nutrition at the root of the issue. Trained to address root causes, naturopathic doctors are expert at identifying illnesses and conditions with nutritional causes and tailoring treatment to individual patient needs.

NDs understand how difficult it can be for individuals to change their diets, regardless of how medically essential it is. No two patients are alike, and many individual and societal factors impact food choices and nutritional status including family life, finances, time, personal preferences and more. Understanding where the patient is and meeting them there can make or break a patient’s nutritional success.

Naturopathic doctors take the time to investigate and incorporate all of these factors to individualize nutrition assessment and prescription. They work with patients in a step-by-step fashion to implement nutritional changes. By doing so, they empower patients to play an active role in their nutrition. This kind of empowerment can lead to better health outcomes and lower costs.[4]

[1] Murray CJ, Abraham J, Ali MK, et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA. 2013;310:591-608. Medline
[2] https://www.medscape.com/viewarticle/886722_1
[3] https://medicalxpress.com/news/2017-10-medical-students-overconfident-underprepared-nutrition.html
[4] Health Policy Brief: Patient Engagement. Health Affairs. February 12, 2013.

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