CAM: Naturopathic dietary interventions for patients with Type 2 diabetes Erica B. Oberg a, * , Ryan D. Bradley a , Jason Allen a , Megan A. McCrory b a Bastyr University Research Institute,14500 Juanita Dr., Kenmore WA 98128, United States b Department of Foods and Nutrition, Department of Psychological Sciences, and the Ingestive Behavior Research Center, Purdue University, West Lafayette, IN, United States Keywords: Diabetes mellitus, type 2 Naturopathy Complementary therapies Self-efficacy Self-care Diet therapy abstract Objective: To test feasibility, acceptability, and preliminary effectiveness of a naturopathic dietary intervention in patients with Type 2 diabetes. Methods: Prospective observational pilot study evaluating the change in clinical and patient-centered outcome measures following a 12-week individualized and group dietary education program delivered in naturopathic primary care. Results: HbA1c improved in all participants (n ¼ 12); mean - 0.4% þ/ 0.49% SD, (p ¼ 0.02). Adherence to healthful eating increased from 3.5 d/wk to 5.3 d/wk (p ¼ 0.05). Specific nutritional behavior modifi- cation included: days/week consuming 5 servings of fruit/vegetables (p ¼ 0.01), attention to fat intake (p ¼ 0.05), and 11.3% carbohydrate reduction. Measures of physical activity, self-efficacy and self- management also improved significantly. Conclusion: A naturopathic dietary approach to diabetes appears to be feasible to implement among Type 2 diabetes patients. The intervention may also improve self-management, glycemic control, and have influences in other domains of self-care behaviors. Clinical trials evaluating naturopathic approaches to Type 2 diabetes are warranted. Ó 2011 Elsevier Ltd. All rights reserved. 1. Background Clinical risk factor control is poor in patients with Type 2 dia- betes (T2DM) in the United States. According to 1999e2004 National Health and Nutrition Examination Survey (NHANES) data, only 52.2% of adults with T2DM met the American Diabetes Asso- ciation (ADA) goal for HbA1c control (<7.0%). 1 Increasingly complex pharmaceutical strategies are contributing minimally; only 32% of patients on triple oral therapy (TZD, sulfonylurea, and metformin) have an HbA1c less than 7%. 1 The prevalence of risk factors for diabetic complications, such as hypertension, obesity, and physical inactivity are also high. In 2007 67.0% of U.S. adults with diabetes reported having hypertension, 83.5% were overweight or obese, and 38.2% reported being physically inactive. 2 It is well established that adoption of a healthy lifestyle, espe- cially good nutrition, is the cornerstone of diabetes treatment yet it is not frequently delivered and can be challenging for patients to understand and stay motivated. 3,4 Delivery of healthy lifestyle advice by primary care providers is low, even for diabetes. A 2002 study of primary care found nutrition counseling addressed in 45% of visits for diabetes,with the duration of counseling averaging just 55 seconds (<20 s to >6 min). 5 Data from the 2000 National Ambulatory Medical Care Survey revealed that among patients with diabetes, diet counseling was provided in 37% and physical activity counseling in 20% of visits. 6 Complementary and alternative medicine (CAM) may offer novel approaches to addressing lifestyle behavior change for prevention and control of chronic diseases such as diabetes. Naturopathic medicine is of greatest interest as it is a whole-system of CAM most closely resembling conventional primary care in scope of practice, but with greater delivery of healthy lifestyle counseling. According to observational studies, healthy lifestyle interventions are routine in naturopathic clinical care for T2DM, with diet, physical activity, and stress management counseling incorporated into the majority of clinical encounters (80e100%). 7,8 Use of CAM has been associated with engaging in positive health behaviors and self-care, however these findings may only apply to uniquely motivated patients. 9e11 Thus rigorous evaluations of the effective- ness of naturopathically delivered healthy lifestyle interventions are needed in more generalized patient populations. The objective of this study was therefore to examine the feasi- bility and effectiveness of a naturopathic dietary intervention on clinical and patient-centered outcome measures in patients with T2DM. * Corresponding author. Tel.: þ1 425 602 3267; fax: þ1 425 602 3240. E-mail address: eoberg@bastyr.edu (E.B. Oberg). Contents lists available at ScienceDirect Complementary Therapies in Clinical Practice journal homepage: www.elsevier.com/locate/ctcp 1744-3881/$ e see front matter Ó 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.ctcp.2011.02.007 Complementary Therapies in Clinical Practice 17 (2011) 157e161