Naturopathic doctor vs medical doctor: training, licensing and evidence

You are holding a bottle of a supplement a friend recommended, with one appointment waiting with your medical doctor and another penciled in with a naturopath. The question of the day is whom to call first, and the answer depends on what is going on: if you have a symptom that has lasted weeks, or high blood pressure or blood sugar, waiting to try the bottle is the part that gets expensive.

A licensed medical doctor practices conventional medicine, with a medical degree and a license to practice. A naturopathic doctor practices naturopathy, a separate system of care. The two titles sound alike and people often treat them as interchangeable. They are not. What each can legally do, and how strong the science behind it is, is what you need to know before deciding whom to see.

The medical doctor (MD). Attends medical school, completes supervised clinical training and passes licensing exams. You can verify a physician’s license online.

The licensed naturopathic doctor (ND or NMD). Per NCCIH, typically completes a four-year graduate program at a North American naturopathic medical school accredited by the Council on Naturopathic Medical Education, and passes national board exams to be licensed where licensing exists.

The “traditional naturopath.” NCCIH notes that people trained in non-accredited programs, which vary widely in length and content, are not eligible for licensing. If someone calls themselves a naturopath, ask which of the two they are.

NCCIH also reminds readers that a license or certificate does not by itself guarantee safe, effective treatment, whether the provider is conventional or complementary. A license tells you what someone is authorized to do; it does not tell you whether each recommendation has good evidence.

A licensed medical doctor can diagnose, order tests, prescribe medicine and refer to specialists within their license. This is the clinician who coordinates care for conditions that need a medical diagnosis and treatment.

For naturopathic doctors, NCCIH explains that licensing requirements vary by state and territory, and that where a license exists the licensed doctor can diagnose and treat patients, unlike a traditional naturopath. What they may prescribe or order varies by jurisdiction. We do not list where they are licensed here, because it changes; before seeing a naturopathic doctor, check with the relevant board what license they hold and what it allows.

One question that works with any clinician: “What license do you hold, who issues it, and what are you authorized to diagnose or prescribe?” A good clinician answers it without offense.

No single answer fits, because naturopathy bundles many different tools, which can include herbs and supplements, homeopathy, manipulative therapies or “detox” programs. Each has its own research base, and they do not all stand up equally well.

Stronger support. Sleeping well, staying active, eating a varied food pattern, avoiding tobacco and managing stress are widely recommended as part of general health. These habits complement medical care for a disease; they do not replace it.

Limited or mixed evidence. For many supplements and herbs, research is small, uneven in quality or mixed.

“Cleanse” products. The scientific support is limited, and they do not replace anything your doctor prescribes; check before using them, especially if you take medicines.

Dietary supplements are not approved to treat, cure or prevent disease. If you take any prescribed medicine, ask your doctor or pharmacist before starting or changing any supplement.

With any clinician, ask: what is the evidence for this, what could it do to me, and what would we change if it does not work?

It is a fair question, and you do not have to choose one or the other. A medical doctor can look for the cause of what you feel with an assessment and, when needed, lab work; a habit or a supplement cannot tell you what is going on. And “natural” is not the same as “no risk”: some herbs and supplements change how blood-pressure, diabetes, blood-thinner and antidepressant medicines work, and dose and product quality matter too.

If you prefer a natural or complementary approach, tell your doctor. A good doctor takes it into account, tells you honestly what the evidence is and helps everything work together instead of competing.

Dr. Diana Nieves Castro is a licensed general practice physician in Puerto Rico. Her care is medical care: she evaluates, diagnoses and treats; if needed, she gives you a lab order for a lab near you, and if appropriate, she prescribes and the prescription is sent to your pharmacy. She is not a naturopath; she is a medical doctor.

Tell her everything you take, including supplements, herbs and teas, so she can consider it when she assesses you. If you already use complementary practices, she can tell you honestly what the evidence is and how to coordinate them with your care.

Online visits are for people who are physically in Puerto Rico. If you want a general medicine visit, you can request an online visit. In an emergency, call 911.

If you are interested in an in-person wellness program, it does not replace medical care: read about the THI retreat, which is held in English.

See a medical doctor promptly, rather than continuing to try remedies on your own, if you have symptoms that have not improved over weeks, unexplained weight loss, blood in your stool or urine, a fever that will not go away, a new lump, excessive thirst and urination, or high blood pressure or blood sugar that has been detected. With warning signs such as chest pain or shortness of breath, do not wait: call 911.

If sadness, anxiety or thoughts of harming yourself are getting the better of you, call or text 988 or the Línea PAS at 1-800-981-0023, available 24 hours.