Essentials of Complementary and Alternative Medicine (June 1999)

USE OF THE SYSTEM FOR TREATMENT
Homeopathic physicians are often asked what homeopathy is “good for” and what conditions respond well to this approach. Most classically trained homeopaths will 
respond that homeopathy does not treat diagnoses, but treats people who are sick. A patient with almost any condition can be helped by homeopathy, whether it be 
an upper respiratory infection, attention deficit disorder, or cancer. Whether, given specific circumstances, it is cost-effective or the most appropriate approach, or 
whether there are data to support the use of homeopathy in a given condition is another matter. There are relatively few conditions for which homeopathic treatment 
has been studied in a rigorous manner. Until data have been accumulated, the following guidelines may be helpful.
Homeopathy stimulates the body's functional capacities. Functional illnesses that have not progressed to the point of irreversible tissue change are more amenable to 
the influence of homeopathic medicines than those with fixed pathology. A diabetic who has no islet cells, or a patient with advanced Alzheimer's or Parkinson's 
disease in which neuronal elements have been destroyed, would not be expected to respond significantly. However, a patient with Type II diabetes, a patient with 
ulcerative colitis, or a patient with mild traumatic brain injury each has functional disturbances with reversible tissue changes and may respond well to homeopathy. 
When the body can heal, homeopathy can play a role.
The urgency of the situation, the availability of specific treatments with known efficacy, and the risk of using or foregoing the use of conventional therapies are other 
factors that influence the decision to use homeopathy. A child with acute bacterial meningitis should be treated with the appropriate antibiotic, whereas a child with 
viral meningitis could be helped by homeopathy. Furthermore, the choice does not need to be “either/or.” Homeopathic medicines can be used in conjunction with 
conventional medical treatment. Whereas the substitution of homeopathy for conventional medicines in cases such as attention deficit disorder or asthma may be 
disastrous, simultaneous use of the appropriate homeopathic medicine may eventually lead to improved function and often to a reduction or even discontinuation of 
conventional medicines. The simultaneous use of two therapeutic systems should involve professionals versed in both systems.
ORGANIZATION
Training
There is growing interest in homeopathic training among conventional physicians, especially among the primary care specialties (
28
). The Council for Homeopathic 
Education (CHE), founded in 1982, accredits homeopathic training programs. The CHE currently lists more than 30 programs that offer some training and education in 
homeopathy. Most are postgraduate programs, offering didactic instruction with additional supervised clinical experience. The only undergraduate programs are part 
of the three naturopathic colleges, which are in Seattle, WA, Portland, OR, and Phoenix, AZ. Training and education necessary for a primary care physician to use 
homeopathic medicines confidently in acute situations in practice would be about 60 to 100 hours; for a specialist, 1000 hours with an additional supervised clinical 
experience.
Licensure
Most physicians practice homeopathy under their conventional license and are accepted within their community as an important resource. A small number of 
physicians have been harassed by their licensing board for using homeopathy. Connecticut, Nevada, and Arizona have separate homeopathic medical boards. 
Alaska, New York, North Carolina, and Washington have laws prohibiting censure of a physician solely because he or she practices an unconventional therapy. In 
North Carolina, this law was passed in response to a decision of the North Carolina Board of Medicine to prohibit a physician from practicing homeopathy. The courts 
upheld the Board's right to make this decision. The legislature overrode the Board after public protest.
Other professions also practice homeopathy. Many professional groups have been licensed to diagnose and prescribe within guidelines that arise from the scope of 
training of the specific profession. Medical and osteopathic physicians, podiatrists, dentists, chiropractors, acupuncturists, naturopaths, oriental medical doctors, 
nurse practitioners, and physician's assistants have been given power by states to prescribe homeopathic medicine. In most states, pharmacists (and, in some, 
dieticians and cosmetologists, too) may also administer prescribing advice for over-the-counter homeopathic products.
Certification
The current certification in homeopathy for physicians is available at two levels: a Primary Care Certificate in Homeotherapeutics, and a Diplomate in 
Homeotherapeutics (DHt). A primary care certificate in homeopathy can be obtained through study at either a postgraduate or graduate level, integrated into other 
primary care teaching programs. This certification requires 60 to 100 hours of training in homeotherapeutics and a written exam. Training and certification at the level 
of a diplomate in homeotherapeutics is required for treatment of chronic disease or complex pathology. Certification at the diplomate level requires proof of 
comprehensive didactic and clinical training, as well as 3 years of clinical practice. Both exams offered by the American Board of Homeotherapeutics were developed 
according to international standards for certification of homeopathic specialists. Naturopathic physicians are certified by the Homeopathic Association of Naturopathic 
Physicians (DHANP). All other homeopathic practitioners can be certified by the Council for Homeopathic Certification.
Other than in the three naturopathic colleges, graduate programs in homeotherapeutics do not exist at this time. Most practicing homeopathic physicians are already 
certified in a primary care specialty (e.g., family practice, internal medicine, pediatrics) or a subspecialty. For them, homeopathy represents a second specialization 
that complements their existing training. Comprehensive homeopathic training programs take from 1 to 4 years to complete, usually on a part-time basis. Most 
candidates obtain clinical supervision during their early years of training and practice.
Legal Status
The Homeopathic Pharmacopoeia of the United States was included in the 1938 Food and Drug Act and is referenced in the definition of  drugs in every state. 
Homeopathic medicine is part of the 1965 Medicare Act. Practitioners use homeopathy within the scope of their conventional license. The over-the-counter status of 
the medicines has spurned an active self-help study group network supported by the National Center for Homeopathy.
A recent deluge of articles in the medical press has criticized homeopathy to the point of suggesting it be banned. Most of these articles come from authors who are 
members of the National Council Against Health Fraud. Frustrated by the FDA's lack of response to their petition requesting review of the regulations governing the 
dispensing of homeopathic products, they used the media to make their point. This group has further directed their frustration to the courts, bringing law suits against 
both dispensing and manufacturing pharmacies, claiming fraudulent advertising of homeopathic products.
The heart of the criticism is that homeopathic products are being allowed on the over-the-counter market with labels that suggest efficacious treatment for a variety of 
complaints, ranging from restless children to immune dysfunction. The critics claim this situation represents a double standard within the over-the-counter 
market—i.e., homeopathic products are not required to demonstrate clinical efficacy whereas conventional drugs are. The homeopathic defense is that homeopathic 
products, unlike conventional medical products, are safe, have been used successfully for 200 years, and that the public should be free to choose as long as there is 
no risk.
The FDA, by providing waivers for Phases One and Two studies of the homeopathic medicines used in an NIH-funded clinical trial on mild traumatic brain injury, 
accepted the clinical safety of homeopathic medicines. Researchers were permitted to go directly to a Phase Three, or efficacy, trial. Within the homeopathic 
community, many professionals share the concerns about products being marketed with labeling that suggests efficacy for clinical syndromes, without the support of 
at least Phase Four clinical trials. Equally inappropriate is the labeling of single homeopathic medications with indications. These conditions imposed by the FDA stem 
from a lack of appreciation of homeopathic principles.
Reimbursement Status
Most insurance companies reimburse homeopathic physician services as they would any other conventional physician. Recent correspondence between the American 
Institute of Homeopathy and various Medicare carriers has confirmed that physicians may be reimbursed for homeopathic services if coded within the standard 
evaluation and management codes. Some insurance companies, including Champus and several state Medicaid or Blue Shield plans, have refused to pay for 

homeopathic medicine although they will pay for physician services. Managed care networks and HMOs have generally not included homeopaths on their rosters as 
specialists. Whereas physicians in HMOs routinely refer patients to homeopaths, the HMO rarely reimburses patients for those services. Recent state laws (e.g., in 
Washington) forcing insurance companies to include naturopathic physicians as primary care providers have led to local experiments by insurers to pay for 
homeopathic care.
PROSPECTS FOR THE FUTURE
Preliminary research into the efficacy and cost effectiveness of homeopathy suggests that this system of therapy will be increasingly used in the primary care setting 
and as a referral for many chronic complaints in which effective conventional medical treatment does not exist or in which adverse effects make alternatives attractive. 
For example, experts in infectious disease are seeking to learn more about homeopathy in conditions such as otitis media, in which it is known that antibiotics are 
overprescribed and antibiotic resistance is becoming a significant public health risk. Recent research into the treatment of mild traumatic brain injury suggests that 
homeopathy may play a significant role in the recovery from neurologic trauma, an area in which conventional therapies have limited efficacy.
Advocates believe that homeopathy should be included in the prescribing skills of all primary care professionals. Its low cost, absence of adverse effects, applicability 
to self-care, and potential to improve the health of patients make it the therapy of choice in most common primary care problems. The recognition of homeopathy will 
increase with quality clinical research and education of primary care physicians about the value of homeopathy in both acute and chronic disease.
C
HAPTER
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EFERENCES
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Coulter HL. Divided legacy: a history of the schism in medical thought. Volume III. Science and ethics in American medicine. Washington, DC: McGrath Pulishing Co., 1973:1800-1914.
3.
Kent JT. Lectures on homeopathic philosophy. Memorial edition. Chicago: Ehrhart & Karl, 1929.
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Kent JT. Lectures on homeopathic materia medica. 4th ed. Philadelphia: Boericke & Tafel, 1956.
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Kent JT. In: Kunzli von Fimmelsberg J, ed. Kent's rerporium genrale. Berg, Germany: Barthel & Barthel Publishing, 1987.
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Allen, TF. The encyclopedia of pure materia medicia. A record of the positive effects of drugs upon healty human organism. Indian edition. New Delhi: B. Jain Publishers, 1982.
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Hering C. The guiding symptoms of our materia medica. Indian Edition. New Delhi: B. Jain Publishers, 1972.
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Ernst E, Kaptchuk T. Homeopathy revisited. Arch Intern Med 1996;159:2162-2164.
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Rothstein WG. American physicians in the 19th century. Baltimore, MD: Johns Hopkins University Press, 1984.
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Eisenberg DM, Kesser RC, Foster C, et al. Unconventional medicine in the United States. New Engl J Med 1993;328:4,246–252.
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Homeopathy in the USA, 1995–1996. The American Homeopathic Pharmaceutical Association, Box 174, Norwood, PA 10974.
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Social Security Statistics, CNAM 61, French Government Report, 1/91.
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Ullman D. Discovering homeopathy: medicine for the 21st century. Berkeley, CA: North Atlantic Books, 1991.
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Jacobs J, Crothers D, Chapman E. A comparison of practice patterns between physicians practicing homeopathic medicine and a national survey of conventional physicians. Survey by the 
American Institute of Homeopathy, 1992.
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Linde K, Clausius N, Ramirez G, et al. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 1997;350:834–843.
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Reilly DT, Taylor MA, McSharry C, Atkinson T. Is homeopathy a placebo response? Controlled trial of homeopathic potency, with pollen in hayfever as model. Lancet 1986;2:881–885.
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Demangeat JL, Demangeat C, Gries P, et al. Modifications des temps de relaxation RMN a 4MHz du solvant dans les tres hautes dilutions salines de silice/lactose. J Med Nucl Biophy 
1992;16:135–145.
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Lo SY. Anomalous state of ice. Modern Physics Letters B 1996;10(19):909–919.
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Poitevin B, Davenas E, Benveniste J. In vitro immunological degranulation of human basophils is modulated by lung histamine and apis mellifica. Br J Clin Pharmacol 1988;25:439–444.
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Jacobs J, Jimenez ML, Gloyd SS, et al. Treatment of acute diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994;93(5):719–725.
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Sampson W, London W. Homeopathic treatment of diarrhea. Pediatrics 1995;96:961–964.
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Letters. Pediatrics 1996;97(5):776–779.
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Linde K, Jonas W, Melchart D, et al. Critical review and meta-analysis of serially agitated dilutions in experimental toxicology. Hum Exp Toxicol 1994;13:481–492.
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Riley D. Homeopathic drug provings. J Am Inst Homeopathy 1996;89(4):206–210.
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Warkentin D. MacRepertory. Fairfax, CA: Kent Homeopathic Associates, 1988.
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Sankaran R. The substance of homeopathy. Bombay, India: Homeopathic Medical Publishers, 1994:171.
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Berman B, Singh BK, Lao L, et al. Physicians' attitudes towards complementary or alternative medicine: a regional survey. J Am Board Fam Pract 1995;8(5):361–366.
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CHAPTER 29. N
UTRITIONAL
 B
IOTHERAPY
Essentials of Complementary and Alternative Medicine
CHAPTER 29. N
UTRITIONAL
 B
IOTHERAPY
Keith I. Block
Introduction
History and Background of Nutritional Medicine
Principal Concepts of Nutritional Biotherapy
 
Description of Principal Concepts
Basic Principles in Nutritional Assessment
A Survey of Diets Used in Complementary Medicine
 
High-Fiber, High-Carbohydrate, Low-Fat Diets
 
High-Protein, Low-Carbohydrate Diets
 
Diets of Variable Nutrient Composition
Medical Applications of Nutritional Biotherapy
 
Nutritional Biotherapy for Cancer
 
Nutritional Biotherapy for Hypertension
 
Nutritional Biotherapy for Coronary Artery Disease (CAD)
 
Nutritional Biotherapy for Diabetes
Training and Quality Assurance in Nutritional Biotherapy
Quality Assurance and Professional Competency
Reimbursement Status
 
Impact on Conventional Medicine and Medical Costs
Prospects for the Future
Chapter References
I will apply dietetic measures for the benefit of the sick according to my ability and judgment....
The Hippocratic Oath
INTRODUCTION
Nutritional medicine involves therapeutic application of dietary and nutritional modifications to reestablish bodily harmony. During the twentieth century, an explosion 
of scientific findings on the nutritional influences on disease–from epidemiologic, biochemical, and animal investigations–has occurred. The role and importance of 
dietary fats, proteins, carbohydrates, some minerals, and many vitamins were established in the early part of this century. Recently, many other vitamins, trace 
elements, and accessory factors have been discovered to have important roles in human health. Some of these “non-nutritive” substances, such as fibers and 
phytochemicals, have been identified as bioactive agents or  biological response modifiers (BRMs) from the plant world. These substances modulate key 
disease-related mechanisms, such as immune function, oxidative stress, homeostasis, inflammatory activity, and hormonal balances.
By applying a mechanism-based perspective in nutrition science, researchers have increasingly shown methods for the nutritional exploitation of host mechanisms 
that modulate disease processes. Recognition that disease processes can be modulated through noninvasive biochemical methods has helped the development of 
the complementary medical discipline known as  nutritional biotherapy. Nutritional biotherapy is the clinical use of diet and nutrition to influence host–disease 
relationships as well as the relationships between nutritional biochemistry and standard treatment.
Nutritional biotherapy takes advantage of our rapidly expanding knowledge of the ability of nutrients to modulate key biochemical processes. For example, in classical 
nutrition science, dietary fats are primarily viewed as a rich source of calories and modifier of membrane fluidity. As a biotherapeutic agent, fats modulate 
cell-signaling mechanisms and the synthesis of specific hormones, eicosanoids, and cytokines, all of which modulate immune and cardiovascular functions as well as 
tumor growth-regulatory pathways.
Nutritional biotherapy bridges complementary and conventional care. This emergent field consists of three major areas of clinical application:
1. Prescriptive dietetics: the selective use of foods and diets specifically designed for different diseases, depending on many individual factors.
2. Nutritional pharmacology: the supplemental use of specific vitamins, minerals, phytochemicals, and botanicals (herbal or plant-derived substances), which are 
tailored to the individual.
3. Nutrition support: the use of intravenous, or parenteral, nutrition (e.g., when there is a compromised gastrointestinal tract) or orally modified formulas (enteral 
nutrition), when a general diet cannot be consumed. Nutritional support is primarily aimed at malnourished patients who cannot consume food in its original 
form.
Each dimension of nutritional biotherapy, or some combination thereof, may be incorporated into a complementary treatment plan, depending on the clinical situation. 
In most cases, prescriptive dietetics is the first area of attention for the complementary practitioner and is generally the safest in the context of nutritional assessments 
and monitoring. Nutritional pharmacology has garnered considerable interest from researchers and complementary practitioners in recent years and remains the focus 
of intense debate. Nutritional support has been well accepted by conventional physicians for many years; however, with few exceptions, complementary practitioners 
have rarely delved into this area of nutritional biotherapy.
Prescriptive dietetics and nutritional pharmacology can be delineated further into two general subcategories:  therapeutic strategies and prophylactic strategies.
Therapeutic strategies address biochemical imbalances or physiological disturbances (e.g., the mode of functioning of organs and tissues caused by organic 
diseases). The physical state of the tissues or organs can be either improved or worsened by the particular nutritional biotherapy approach. In some cases, the results 
are palliative rather than curative (e.g., bland, low-protein diets used to alleviate peptic ulcer and inflammatory bowel disorders). In other cases, a complementary 
approach to illness has emerged. For example, after the life-prolonging success of hemodialysis and transplantation, there has been an interest in low-protein diets 
for patients with chronic renal disease. High-fiber regimens are almost routinely recommended for patients who are constipated or overweight. Low-fat and 
nonaromatic foods are now frequently prescribed for patients suffering from nausea.
Prophylactic strategies are aimed at preventing the expression of a particular disease-relatedgenotype and enabling patients to enjoy reasonably good health if they 
select foods and food preparation methods within certain parameters. The concept also applies to preventive therapeutics, referring to the use of noninvasive 
interventions to prolong the success of a standard medical therapy by adding a specific biomodulation effect (e.g., reducing serum cholesterol, lowering blood 
pressure, or enhancing insulin sensitivity) and thus reducing the relapse rate. These strategies may be either specifically tailored to the individual or, as occurs in the 
conventional medical setting, based on general guidelines for health maintenance.
HISTORY AND BACKGROUND OF NUTRITIONAL MEDICINE
The history of nutritional medicine dates back 2,500 years to the medical systems of ancient China and Greece. The oldest of medical texts, Chi Po's  Yellow 
Emperor's Classic of Internal Medicine, recognized food selection and proper cooking as the cornerstone of prevention and relief of illness. In ancient Greece, 
Hippocrates frequently emphasized the primacy of cereal grains and vegetables in  The Book of Nutriment, in which he wrote, “Let food be thy medicine, and medicine 
thy food.” In the twelfth century, the famous Rabbinic scholar and Jewish physician Moses Maimonides formulated a broad dietary philosophy and addressed potential 
therapeutic applications of foods and food combinations, as well as the order of foods eaten in a meal. Each of these recommendations was deemed to have a 
specific health impact, while other points of dietary advice were related to relief of specific disorders.

Early in the twentieth century, dental surgeon Weston Price performed fieldwork among the Indians of North America, the Eskimos, the Polynesians, and the 
Australian Aborigines. In his 1945 publication  Nutrition and Physical Degeneration, Price reported no trace of various degenerative diseases among these 
populations. During this same period, Drs. Dennis Burkitt and Hugh Tral suggested that diseases common in industrial countries but rare in Africa might be due in part 
to low dietary fiber intake, as Tral documented in  Western Diseases: Their Emergence and Prevention. More recently, biochemist T. Colin Campbell conducted an 
extensive survey of dietary and mortality characteristics of 65 counties in rural China. Campbell's international research team concluded that the higher the intake of 
high-fat, high-protein diets, the higher the incidence and mortality from “Western diseases”; conversely, plant-based diets were strikingly protective against such 
diseases (
1
).
Expert recommendations for health-promoting diets have largely followed suit.  Healthy People 2000, a report issued by the United States Public Health Service and 
22 expert working groups, recommends increasing “complex carbohydrate and fiber-containing foods in the diets of adults to 5 or more daily servings for vegetables 
(including legumes) and fruits, and to 6 or more daily servings for grain products” (
2
). To justify these and other guidelines,  Healthy People 2000 draws substantiation 
from sources such as The Surgeon General's Report on Nutrition and Health (
3
), the National Research Council's Diet and Health (
4
), and the USDA's Dietary 
Guidelines for Americans (
5
). However, these recommendations focus on prevention, not treatment. Nevertheless, dietary prevention guidelines may prove beneficial 
to the long-range management of many chronic diseases, with the exception of cancer. (Malignant diseases as a single group exhibit a far more complex histologic 
and pathological character and thus more personally tailored diet therapy compared with diabetes, heart disease, and other chronic disorders.)
The development of nutritional biotherapy as a complementary medical discipline has been guided by the interplay between nutritional research and the 
clinical–medical communities. This interaction, catalyzed by Linus Pauling, Roger Williams, Max Gerson, Emanuel Revici, Kedar Prasad, Ranjit Chandra, and Jeffrey 
Bland, has expanded the purview of nutritional biotherapy, taking it beyond the correction of nutrient imbalances toward modulating specific disease processes by 
nutritional means.
Biochemist Roger Williams conducted intensive studies of biochemical individuality (
6
). In his 1950 Lancet paper, “The Concept of Genetotrophic Disease,” Williams 
defined genetotrophic disease as
“one in which the genetic pattern of the individual calls for an augmented supply of a particular nutrient (or nutrients), for which there develops, as a result, 
a nutritional deficiency. Partial genetic blocks somewhere in the metabolic machinery are probably commonplace in the inheritance of individuals and 
explain to a considerable degree why each person possesses a characteristic and distinctive metabolic pattern....” (
7
).
Williams' postulation regarding inherited or acquired partial enzymatic blocks, with diminished adaptive competency at the level of enzyme synthesis and regulation, 
explains why the resultant functional defect may raise the body's requirement for a particular food factor or set of factors (
8
). Thus, clinical situations that benefit from 
nutritional modulation may often involve conditional deficiencies of these nutrients–that is, deficiencies triggered by disease or other external factors–despite the 
normal provision of the nutrient that appears deficient.
Currently there is a resurgence of interest in nutritional medicine among physicians throughout the world. The medical community recognizes that successful 
long-range management of chronic disease requires a biologically-based approach that is grounded in an understanding of the biochemical synergisms and 
antagonisms that influence disease progression. Heart disease, diabetes, hypertension, cancer, and obesity are all, to varying degrees, responsive to dietary 
interventions that modulate essential pathological mechanisms. The use of dietary interventions provides a complement to standard medical care. For two decades, 
we have been coupling nutrients, botanicals, and other bioactive agents with standard medical treatments of cancer and other degenerative diseases. This approach, 
although still in an early stage, raises provocative possibilities for diminishing untoward effects and improving the efficacy of standard medical care.