What patients bring back from the naturopath

The consult

The patient is in their fifties. They've been seeing a naturopath for tiredness, bloating, and "brain fog" for the last six months. They've spent something in the order of $2,000 on testing and supplements. They've come to you today with a folder of results — a 96-food IgG panel, a hair mineral analysis, a stool microbiome map, a hormone saliva test — and a small organic chemistry's worth of bottles. Their naturopath wants you to order a homocysteine, a fasting insulin, and an iodine load test, and is wondering if you'd write a referral for a private functional medicine specialist.

How you handle the next ten minutes shapes the next ten years of this person's clinical care, including whether they ever come back.

This is one version of the naturopath consult. There are others — the patient taking St John's Wort alongside their SSRI; the patient who has stopped methotrexate to "let her body detox"; the well 35-year-old taking a sensible probiotic and a fish oil and asking if you have any objection. The right response depends on what's in the folder, not on what we think of naturopathy in general.

The regulatory landscape, briefly

In NZ, naturopaths are not regulated under the Health Practitioners Competence Assurance Act 2003 [1]. Eighteen health professions are regulated under the Act — medicine, nursing, dentistry, pharmacy, chiropractic, osteopathy, acupuncture and Chinese medicine among them — but naturopathy is not one of them [1,2]. There is a voluntary professional body, Naturopaths and Medical Herbalists of New Zealand (NMHNZ), which sets a scope of practice and continuing education requirements for its members [3]. But anyone in NZ may legally call themselves a naturopath, set up practice, and offer treatments. The title is not protected; the qualifications behind it vary substantially.

Two practical implications follow. First, when a patient mentions "their naturopath", that practitioner could be an NMHNZ-registered medical herbalist with several years of formal training, or someone who completed a six-week online course. The label tells you very little. Second, the Health and Disability Commissioner's Code of Health and Disability Services Consumers' Rights does apply to all health and disability service providers in NZ regardless of registration status [4] — but the absence of a registering authority means there is no professional body with the power to investigate competence concerns or remove the right to practise.

A rough taxonomy

It helps to think about naturopathic recommendations in three buckets, rather than a single "alternative medicine" lump.

Things with reasonable evidence for specific indications. Some products genuinely have an evidence base, even where the framing is sometimes oversold. Specific probiotic strains for antibiotic-associated diarrhoea or IBS-D [5]; omega-3 fatty acids for hypertriglyceridaemia [6]; vitamin D supplementation for documented deficiency; folate in pregnancy. Most of these appear in conventional guidelines too. The naturopathic vocabulary — "supporting the gut microbiome", "anti-inflammatory" — often attaches to underlying actions that are also clinically reasonable.

Things that lack evidence but are unlikely to harm. A long list, varying with circumstance. Most herbal teas, most multivitamins in healthy adults, most lifestyle and dietary advice that emphasises whole foods and home cooking, most relaxation and stress-reduction practices. The clinical rule of thumb: if the patient is well, the substance is benign, and the cost is bearable, the right answer is usually to leave it alone.

Things with no evidence, or with active potential for harm. This is where the careful work happens.

Tests that don't do what they claim

IgG food intolerance panels. The most common thing you'll see. The Australasian Society of Clinical Immunology and Allergy (ASCIA) is unambiguous: there is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms [7]. The same position is held by the American (AAAAI), European (EAACI), and Canadian (CSACI) allergy bodies [7,8,9]. The biology is straightforward: IgG to a food is a marker of exposure and immune tolerance, not pathology — healthy adults will have detectable IgG to foods they eat regularly [7]. The clinical risk isn't only the cost of the test. It is unnecessary dietary restriction, sometimes severe, occasionally leading to nutritional deficiency, and — most concerningly — the false reassurance for patients who actually have IgE-mediated allergy that may not show on the IgG panel [8].

Hair mineral analysis. Repeated samples from the same person, sent to different laboratories, return substantially different results. The test is not validated for clinical decision-making and is not used in mainstream toxicology outside specific forensic contexts [10].

Live blood analysis. A microscope demonstration with no correlation to any validated clinical parameter. Not a diagnostic test in any meaningful sense.

Consumer stool microbiome reports. The science of the gut microbiome is real and developing. The clinical usefulness of consumer microbiome reports for individuals — what species you have, what supplements should follow — is currently very limited. Reports rarely change management in any evidence-based direction.

Saliva hormone testing for "adrenal fatigue". Adrenal fatigue is not a recognised endocrine diagnosis. A 2016 systematic review concluded the construct is not supported by the available evidence [11]. Real adrenal insufficiency is diagnosed quite differently and treated very differently.

The right response to these tests is not to dismiss them — the patient has paid for them and brings them in good faith — but to gently explain what each test does and doesn't measure, and to focus on the symptoms that prompted the testing in the first place.

Things that can cause real harm

Three categories worth being explicit about.

Herb–drug interactions. The most clinically significant interaction in routine practice is St John's Wort, which induces CYP3A4 and reduces serum concentrations of many drugs including the combined oral contraceptive pill, warfarin, digoxin, certain anticonvulsants, and some antiretrovirals; combining it with an SSRI raises the risk of serotonin syndrome [12]. Other interactions worth keeping an eye on include garlic and ginkgo with anticoagulants and antiplatelets (potential bleeding), high-dose vitamin K with warfarin, and the routinely-forgotten one — grapefruit juice and CYP3A4 substrates [12]. The practical step is simple: ask, on every medication review, what supplements and herbal products the patient takes, and run them through an interaction checker if there's any doubt.

Treatment delay or cessation in serious illness. The most concerning scenario is a patient with cancer or another serious condition who substitutes naturopathic treatment for, or in addition to, conventional care. Cohort studies of patients who decline conventional cancer treatment in favour of alternative approaches show consistently and substantially worse outcomes, including a roughly two-fold increase in five-year mortality risk after adjustment for stage and other variables in one widely-cited analysis [13]. The right approach is rarely an ultimatum (which usually loses the patient entirely). It is to maintain the relationship, document the conversation clearly, and keep the door open.

Heavy-metal "detox" chelation in the absence of documented poisoning. Chelation therapy has narrow legitimate indications — lead poisoning with documented elevated levels, for example. Its use for non-specific symptoms or as part of a "detox" programme is not evidence-based, can cause electrolyte disturbance and renal injury, and has been associated with deaths, including paediatric deaths from inappropriate disodium-EDTA administration [14].

Why patients go

It is worth pausing on this, because the response to the naturopath consult depends partly on understanding it.

People go to naturopaths for predictable, often legitimate reasons. They feel unheard by short consultation times in conventional general practice. They have chronic symptoms — fatigue, bloating, low mood, brain fog — that do not have neat conventional answers and have not improved despite multiple visits. They want a longer consult. They want a practitioner who takes a detailed dietary and lifestyle history. They want someone to tell them their symptoms are real, that there is something they can do, and that the path forward is not just "your bloods are normal".

Many of these wants are reasonable. Many are not well served by the way GP consultations are currently structured and funded in NZ. The fact that the alternatives offered in the naturopathic encounter are often unsupported by evidence does not change the fact that the underlying needs are real, and partly produced by gaps in conventional care.

This shouldn't slide into clinical relativism. A test that doesn't work doesn't work whether or not the patient feels listened to. But the response that maintains the relationship is to acknowledge what the patient is seeking, explain plainly what the evidence does and doesn't support, and offer what conventional medicine actually can do — which, in the right hands and with adequate time, is more than the cynical version of this story suggests.

In the consult

A few practical postures.

Always ask what supplements and herbal products they're taking. Routine. Don't wait for the patient to volunteer; many won't think to mention them.

Don't dismiss the test results in front of the patient — translate them. "This test measures whether you've been exposed to these foods, not whether they're causing you harm — that's why it's positive for everything you eat regularly." That works much better than: "That's pseudoscience."

Address the underlying symptoms. If the patient has brain fog and fatigue, consider B12, ferritin, TSH, HbA1c, sleep, mood, alcohol, screen exposure. Make a plan that's about their symptoms, not about the naturopath's tests.

Document the conversation. Especially if you are concerned about herb–drug interactions or treatment delay. Note what you advised, what they decided, and the rationale.

Be willing to hold a position you can defend. If the patient is taking St John's Wort and an SSRI, you say so plainly. If they are using a "detox" in place of chemotherapy, you say so plainly. The relationship is not served by silence on these.

Don't issue ultimatums. "If you keep seeing the naturopath I won't see you" is almost always wrong, and almost always loses you the patient — and usually the only person it punishes is the patient.

A closing thought

There is a temptation, in writing about this topic, to land in one of two unhelpful places. The first is the easy contempt that imagines all naturopathic practice as a confidence trick on credulous patients. The second is the polite fiction that all healthcare modalities have something to offer if we just listen. Neither is true. Naturopathy in NZ is a heterogeneous set of practitioners offering a heterogeneous set of services, some of which are useful, some of which are harmless, some of which are not, and a small but real subset of which are dangerous. The clinical task is to tell the difference, in front of the patient, with the patient, in time you don't have.

Most of the time, with care, you can. The alternative — losing the patient to a system that won't notice the SSRI–St John's Wort interaction or the cancer that's progressing under the elderberry syrup — is worse than the discomfort of the conversation.

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References

1. Health Practitioners Competence Assurance Act 2003 (NZ) [Internet]. Wellington: New Zealand Government [cited 2026 May 2]. Available from: https://www.legislation.govt.nz/act/public/2003/0048/latest/
2. Ministry of Health. Responsible authorities under the Act [Internet]. Wellington: Ministry of Health [cited 2026 May 2]. Available from: https://www.health.govt.nz/regulation-legislation/health-practitioners/responsible-authorities
3. Naturopaths and Medical Herbalists of New Zealand. Scope of practice [Internet]. Auckland: NMHNZ; 2018 [cited 2026 May 2]. Available from: https://naturopath.org.nz/scope-of-practice/
4. Health and Disability Commissioner. Code of Health and Disability Services Consumers' Rights [Internet]. Wellington: HDC [cited 2026 May 2]. Available from: https://www.hdc.org.nz/your-rights/the-code-and-your-rights/
5. World Gastroenterology Organisation. Probiotics and prebiotics: WGO global guidelines [Internet]. Milwaukee (WI): WGO; 2023 [cited 2026 May 2]. Available from: https://www.worldgastroenterology.org/guidelines/probiotics-and-prebiotics
6. Skulas-Ray AC, Wilson PWF, Harris WS, et al. Omega-3 fatty acids for the management of hypertriglyceridemia: a science advisory from the American Heart Association. Circulation. 2019;140(12):e673–91. doi:10.1161/CIR.0000000000000709
7. Australasian Society of Clinical Immunology and Allergy. Position paper: evidence-based versus non evidence-based allergy tests and treatments [Internet]. ASCIA [cited 2026 May 2]. Available from: https://www.allergy.org.au/hp/papers/position-paper-evidence-based-versus-non-evidence-based-allergy-tests-and-treatments
8. Carr S, Chan E, Lavine E, Moote W. CSACI position statement on the testing of food-specific IgG. Allergy Asthma Clin Immunol. 2012;8(1):12. doi:10.1186/1710-1492-8-12
9. Stapel SO, Asero R, Ballmer-Weber BK, et al. Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report. Allergy. 2008;63(7):793–96. doi:10.1111/j.1398-9995.2008.01705.x
10. Seidel S, Kreutzer R, Smith D, McNeel S, Gilliss D. Assessment of commercial laboratories performing hair mineral analysis. JAMA. 2001;285(1):67–72. doi:10.1001/jama.285.1.67
11. Cadegiani FA, Kater CE. Adrenal fatigue does not exist: a systematic review. BMC Endocr Disord. 2016;16(1):48. doi:10.1186/s12902-016-0128-4
12. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777–98. doi:10.2165/11317010-000000000-00000
13. Johnson SB, Park HS, Gross CP, Yu JB. Use of alternative medicine for cancer and its impact on survival. J Natl Cancer Inst. 2018;110(1):121–4. doi:10.1093/jnci/djx145
14. Brown MJ, Willis T, Omalu B, Leiker R. Deaths resulting from hypocalcemia after administration of edetate disodium: 2003–2005. Pediatrics. 2006;118(2):e534–6. doi:10.1542/peds.2006-0858