Sweeteners 101: The Naturopathic Kitchen

Sugar is one of the oldest commodities, and has at times been so valued that it was kept under lock and key in a sugar safe! The domestication of sugar cane occurred around 8,000BC in New Guinea. Nautical trade routes were responsible for the expansion of sugar throughout Southeast Asia, China, and India. Eventually, sugar cane cultivation made its way to Europe and westward to the New World. Today, sugar production exceeds 190 million metric tons each year – that’s one sweet industry!1

In modern culinary application, sugar is responsible for much more than adding sweetness. It is used to facilitate the caramelization processes, balance acidity in foods, and contributes to the appearance, flavor, and viscosity of liquid food items like glazes, sauces, and marinades. There are many types of sugar and sweeteners. Choosing the right one is important in achieving the desired end product. When it comes to sugar and other sweeteners, there is such a thing as too much of a good thing. Consumption of sugar, particularly in excess, is linked to development of a number of chronic degenerative health conditions such as obesity, heart disease, diabetes, liver disease, and cancer.2 The American Heart Association recommends no more than 150 calories (about 9 teaspoons or 36 grams) of added sugar per day for men and no more than 100 calories (about 6 teaspoons or 24 grams) for women.Depending on energy expenditure, age and physical conditions, sugar consumption may be recommended at as close to zero as possible. The food market is home to a number of different sweetener options, each with different properties, strengths, and weaknesses.

White Sugar

Standard white table sugar is primarily made from sugarcane but sugar beets may also be used. This kind of sugar is highly refined and is often the type that comes to mind when people think of sugar. Sugarcane resembles bamboo and is a tropical plant that grows well in warm states like Louisiana, Texas, Florida, and Hawaii. The plant makes sugar in its large leaves then sends that sugar to the stalk/cane for storage.

Once the sugarcane is harvested it is transported to a factory where it undergoes a mastication process to extract the juice. Next, the juice is purified, filtered, and evaporated into golden brown, raw sugar crystals. The golden color is due to the presence of a thin layer of molasses. The raw sugar is then sent to a refinery where the molasses and sucrose are separated resulting in white sugar. The most common form of white sugar is the granulated form but other types such as turbinado, brown, and confectioners are also available.

Nutritional/Health Considerations

Although refined sugar is considered a nutritive sweetener due to its 4 calories per gram caloric content, it is highly processed and does not provide any additional benefits such as antioxidants or minerals. However, the darker varieties such as brown sugar and turbinado sugar do retain some nutrients such as iron, potassium, and magnesium due to their molasses content.

Brown sugar is a moist, packable granulated cane sugar that has molasses added back to it. It can be purchased in both light and dark forms. Dark brown sugar has a stronger flavor and more molasses.

Turbinado sugar, also called “raw” sugar, is the result of the first pressing of the sugar cane. The syrup derived from the first pressing of the sugarcane is boiled to form crystals that are then spun to remove any remaining liquid. Turbinado sugar crystals are coarser, darker, and more well-rounded in flavor than granulated or brown sugar because they are less refined. Because it is less refined, turbinado retains more of the natural flavors and molasses than refined sugar does.

Tips for Use

White sugar can be used in baking and as a sweetener for drinks, though standard granulated sugar may be challenging to dissolve in cold drinks. Because turbinado sugar contains more molasses, it can lead to a more grainy and crumbly texture so it may not be the best substitution in baked goods. Brown sugar contains a greater liquid fraction so recipes may need to have the liquid input adjusted to compensate.

Powdered Sugar

Also known as “confectioners sugar,” powdered sugar is simply white sugar that has been ground into a fine powder with a bit of corn starch added to prevent clumping. Powdered sugar can be found in various levels of fineness that range from an XX to a 14X with 14X being the finest. The type most commonly found in supermarkets is the 10X grind.

Nutritional/Health Considerations

Although powdered sugar is considered a nutritive sweetener due to its 4 calories per gram caloric content, it is highly processed and does not provide any additional benefits such as antioxidants or minerals.

Tips for Use

The 10X variety is commonly used to make frosting, whipped cream, candy, and as a dusting powder for finishing cakes, pastries, and other desserts. The superfine 14X variety is the most dissolvable and is frequently used in cocktails, particularly rum-based beverages like mojitos. It is also used as a sweetener for non-alcoholic drinks like iced tea and coffee as well as in baking.


Stevia is an herbal extract from a plant that is a member of the chrysanthemum family. It has become a widely used calorie-free sweetener. There are a number of species of stevia, some of which are native to southwestern US, but the one most common sweetener is Stevia rebaudiana. This variety is native to Paraguay and Brazil and its leaves have been used to sweeten food for hundreds of years.

Despite its long history of use, in the US, the FDA has not approved whole stevia leaves nor “crude stevia extracts” for use in foods. However, an isolated chemical extract form stevia known as Rebaudioside A has been approved for use in food and beverages.4

Nutritional/Health Considerations

Stevia has no calories, and it is 200 times sweeter than sugar in the same concentration. Because only the extract is used, there are no additional phytonutrients found in US products. There have been studies to suggest that stevia could have therapeutic benefits for a number health conditions including: anti-hyperglycemic, anti-hypertensive, anti-inflammatory, anti-tumor, anti-diarrheal, diuretic, and immunomodulatory actions.5

Tips for Use

Though the stevia plant itself is associated with little aftertaste, Rebaudioside A extracts can have some. The level of aftertaste can vary significantly from one product to the next so trying multiple brands to find the most personally palatable may be necessary. Flavored (vanilla, orange, mint, berry, etc.) stevia extracts are also available.


The relationship between humans and honey can be traced back to cave paintings from 9,000 years ago. Honey was so valued by the ancient Romans that it was used instead of gold to pay taxes. Honey is familiar to most as the thick, golden, sweet liquid that bees make from flower nectar. Honey comes in a variety of colors and flavors both of which stem from the source of the nectar. As a general rule, the darker the color, the stronger the flavor. Liquid honey is the most popular way that honey is sold, but it can also be found still in the chewy and edible wax-like comb.

Nutritional/Health Considerations

Natural honey is around 82% carbohydrate consisting of around 40% fructose, 30% glucose, and 12% other sugars. It also contains a number of bioactive compounds including, flavonoids, polyphenols, vitamins, minerals, enzymes, and organic acids, all of which play an important role in its nutritional and medicinal qualities.6 It was used by ancient civilizations for its antibacterial, antioxidant, anti-tumor, anti-inflammatory, and antiviral properties.7 Honey was also used as a remedy for acute conditions such as ear infections, coughs, and sore throat.8 In particular, Manuka honey is treasured for its medicinal properties.

Note: Honey should never be fed to infants under the age of 12 months as their digestive systems are immature and more susceptible to infant botulism, an illness that may originate from spores found in honey that have no effect on older children or adults whose digestive and immune systems are more developed.

Tips for Use

Honey is considered a supersaturated sugar solution, and since the water in honey contains more sugar than it should naturally hold, it has a tendency to crystallize. It is natural for honey to crystallize and though many people incorrectly believe that the presence of crystals means that it is spoiled, the crystallization process has no effect on the honey other than color and texture. Although all raw honey will crystallize over time, there are several steps that can be taken to slow the crystallization process:

  1. Store honey at room temperature or warmer. Crystallization happens much faster at lower temperatures so not store it in the refrigerator or an unheated area.
  2. Store honey in a glass container. Plastic is more porous than glass and can allow excess moisture to seep in overtime which will increase the crystallization process.
  3. Honey that is higher in glucose such as lavender, clover, and dandelion crystallize faster. Acacia, sage, and tupelo honey are all higher in fructose and much less likely to crystallize.

If honey does crystallize, simply placing it in a container of warm water will melt the crystals and return it to its original consistency.


Agave is a succulent plant and member of the Amaryllis family whose native growth spans from regions of southwestern US all the way down to parts of South America. Agave grow in large rosettes of long, strong, fleshy leaves with sharp “teeth” down the sides. Agave take a very long time to reach maturity, and has been distilled to make tequila since the 1500s.

There are a number of subspecies of agave, but the one most commonly used to make agave syrup is Agave tequilana the Blue Agave plant. Once the plant reaches maturity (approximately 7-10 years), the leaves are removed from the plant and the central core (known as the “pina” because it resembles a pineapple) is all that remains. The discarded leaves are left behind to restore the soil and reduce erosion. The pina can be quite large, weighing between 50-150 pounds.9 Next, the sap is extracted from the pina. This sap is filtered then heated at a low temperature. The heating process helps break down the natural carbohydrates into sugars. The resulting nectar is then filtered and it is this filtering process that determines the color and flavor of the final agave syrup. Thus, the light Blue Agave syrup is simply more filtered than its raw and amber counterparts.

Nutritional/Health Considerations

Agave syrup contains small amounts of vitamin C, B vitamins, and several common minerals. It is quite similar in color and flavor to honey and is 1.5 times sweeter than sugar (which means less can be used to achieve the same level of sweetness) but it is often thinner in texture. Agave contains more fructose than glucose which means it is less likely to cause a spike in blood sugar, but more likely to negatively impact metabolism and insulin sensitivity.10 Certain bioactive compounds in agave have been shown in research to serve important antioxidant and protective roles in the brain.11

Tips for Use

Agave syrup is a very free flowing and fast dissolving sweetener making it a great choice for cold drinks like cocktails or iced tea. Darker varieties are also used directly from the bottle as a syrup for pancakes, French toast, or waffles. Agave is sold in several varieties including light, amber, dark, and raw. Both the light and raw types have a mild, nearly neutral flavor, the amber variety provides a medium-intensity, caramel flavor, and the dark types have the strongest caramel flavor.

Coconut Sugar

Coconut sugar, also called coconut palm sugar, is the traditional natural sweetener in South and Southeast Asia. It is made from the sap of the coconut palm tree via a natural two-step process. First, a cut is made in the flower bud through which the liquid sap is collected. The sap is a sugary fluid that circulates inside the plant.

Next, the sap is retained under low heat conditions until the liquid fraction has evaporated leaving behind a light brown, granulated substance that appears similar to raw sugar but with a smaller and more varied particle size. It is often mistaken for palm sugar (a similar sugar product made from a different type of palm tree). During the evaporation phase, the sap is stored at temperatures around 100F for a couple of hours, allowing the natural enzymes to remain intact as well. Other manufacturers boil the sap to crystallize the sugar which destroys the natural enzymes found in the plant. Because the coconut palm tree can continue to produce enough sap to harvest for about 20 years and does not require a lot of resources compared to other types of sweetener like cane sugar, coconut sugar has been named the most sustainable sweetener in the world.12

Nutritional/Health Considerations

Coconut sugar is considered a nutritive sweetener containing about 15 calories and 4 grams of carbohydrate per teaspoon (the same as table sugar). Because the production of coconut sugar does not include any refining processes it retains many of its vital nutrients. Coconut sugar contains small, but measurable amounts of potassium, calcium, zinc, magnesium, B-vitamins, polyphenols, and boasts a good amino acid profile as well as short chain fatty acids and a special prebiotic fiber known as inulin. Inulin is rather unique in that it is not digested in your upper intestinal tract, but rather serves as a source of nourishment for the bacteria in the lower digestive tract. Clinical research has shown that prebiotics like inulin can yield many health benefits including, gastrointestinal health, colon cancer prevention, blood sugar and lipid metabolism, bone mineralization, fatty liver disease, obesity, and immunity.13 Coming in at around 45% fructose, coconut sugar is also lower in fructose than other sweeteners such as agave (90% fructose) and high fructose corn syrup (55% fructose). Fructose has a striking tendency to be converted directly to fat so consuming lower amounts can have significant health benefits.

Tips for Use

Coconut sugar has an earthy flavor profile similar to brown sugar. It is gaining popularity and is easy to use in baking because it does not impact the flavor or texture of the food (but it does turn the batter/dough brown so that may not always be ideal).

Monk Fruit

Monk fruit known in Chinese culture as “luo han guo” or the “Buddha Fruit” is a small round fruit native to Southeast Asia. It was first used by Buddhist monks in the 13th century and has been used as part of Traditional Chinese Medicine for hundreds of years, but only became approved by the FDA in 2010.13,14 The sweetener is made from the dehydrated juice of the monk fruit.

To begin the process, the seeds and skin of the fruit are removed, then the fruit is crushed, releasing the juice. The juice is collected and dried to form a concentrated powder. Monk Fruit sweetener is also called “monk fruit extract” and is up to 250 times as sweet as sugar.14 It is often mixed with other compounds like inulin or erythritol (a sugar alcohol) to balance the intensity of the sweetness.

Nutritional/Health Considerations

The monk fruit itself contains calories and sugars in the form of fructose and glucose. However, monk fruit extract does not contain any calories nor any actual sugars. The intensity of the sweetness of monk fruit is due to the presence of a unique group of antioxidant molecules known as mogrosides. During processing of the monk fruit, the mogrosides are separated from pressed juice leaving the natural fruit sugars in the juice and making monk fruit extract calorie and sugar free. Mogrosides have been classified as GRAS or “generally recognized as safe” by the FDA.14 Monk fruit extracts have been shown to have various biological activities including antioxidative, anti-inflammatory, and anti-diabetic action.15 Monk fruit extracts are also known to benefit a number of health conditions such as hypertension, constipation, and aiding in relief of cough.15

Tips for Use

Monk fruit extract is available in liquid, granule, and powder forms. It is regarded as safe for all people including children, as well as pregnant and breastfeeding mothers.14 Because monk fruit is often combined with other sweeteners, this may impact the nature of the end product as well as the nutritional profile. Monk fruit has a somewhat fruity taste that may not be appreciated by everyone and has been reported by some as having an unpleasant aftertaste. Because of the intensity of sweetness in Monk fruit extract, for use in cooking and baking, substantially less volume is required to achieve the same level of sweetness. The sweetness of an entire cup of white sugar can be replaced by less than a teaspoon of Monk fruit extract.16 it is important to note that because of the considerable reduction in volume between the amount of sugar and the amount of Monk fruit extract needed in recipes, the consistency, number of servings, and size of the finished product may be impacted by making the substitution.

Maple Syrup

Maple syrup is made from the xylem sap of several types of maple trees, chiefly the sugar, red, or black varieties. In northern latitudes, these trees store starches in their roots and trunks before winter which are then converted to sugars that form in the late winter and early spring months. The basic process of producing maple syrup involves drilling a hole into the tree trunk and collecting the sap that drips out then processing that sap by boiling it to evaporate off much of the water content leaving behind the sweet syrup we all know and love. The origins of maple syrup date back well before the settling of North America by Europeans. However, it is not known which tribe first discovered it since a number of tribes pass down a similar legend surrounding its use and availability.17

Many legends center around the theme that a God or demigod discovered that people were becoming lazy from drinking the syrup directly from the tree rather than working and hunting and foraging for their food. As such, legend has it that the deity then added water to the syrup necessitating its processing by boiling before consumption. Other legends involve the use of the sap in cooking as the means to the first discovery.18 Indigenous tribes collected maple sap through a v-shaped incision into the bark of the tree and placement of a wedge at the bottom that lead the sap to drip into a wooden bucket placed at the base of the tree. When European colonists arrived, they learned about tapping maple trees from the Native Americans but they used a hole drilled with an auger that was plugged with a wooden spout. A bucket was hung from the spout to catch the sap as it poured out the spout. During the 1800s, many technological innovations, such as flat pans (instead of the formerly used iron kettles), improved the ease of processing maple sap. In modern times, there are many further innovations that make the process faster, easier, and cheaper including the use of tubing that transports the sap directly from the tree to the sugar shack where the processing takes place. If the sap is over boiled and most of the water is removed, all that is left is a solid sugar known as maple sugar. Maple sugar was actually the preferred form for Native Americans because it had a long shelf life and could easily be transported.

Nutritional/Health Considerations

The source of maple syrup is of course the sap of several varieties for maple trees. The sap does not contain fat or protein, consisting mainly of sucrose (a disaccharide molecule that is also the chief component of white table sugar containing one molecule of glucose and one molecule of fructose) along with smaller amounts of free glucose and fructose that are created during the boiling process. The free glucose and fructose are responsible for the varying degrees of darkness seen in maple syrup varieties. Nutritionally, maple syrup has about 52 calories per tablespoon. Maple syrup contains significant amounts of manganese and vitamin B2 (riboflavin) as well as moderate amounts of zinc. It is a moderate antioxidant, rivaling the protective capabilities of carrots. It also contains trace amounts of magnesium, calcium, and potassium.18  Maple has a very distinct flavor and although it is unknown exactly what compounds are responsible for creating it, it is believed that the primary contributors are furanone, strawberry furanone and maltol.19 Maple syrup contains a wide variety of phytochemicals which may impart benefits to human health.20 It has a much lower glycemic index (meaning it causes a slower rise in blood sugar) than honey and is also slightly lower than white sugar.

Tips for Use

Many of the top brands of pancake syrup in the US do not contain any actual maple syrup and rely solely on corn syrup as the main sweetening ingredient. It is important to look at the ingredient list when purchasing to make sure it is pure maple syrup. While maple syrup can be substituted one-to-one for liquid sweeteners like honey, agave, molasses, or corn syrup, some adjustments must be made if substituting for granular sugars like white or brown sugar. To use maple syrup as a white or brown sugar alternative, use 2/3 cup of maple syrup for every cup of granulated sugar, reduce the quantity of liquid ingredients in the recipe (water, milk, juice) by about 1/4 cup and lower the baking temperature by 25° F. Maple sugar can be reused just like cane sugar and has similar performance in baked goods. However, because maple sugar is about twice as sweet as white cane sugar, reducing the amount by a little less than half is recommended to avoid having an overly sweet finished product.

Sugar Alcohols

Although the term “alcohol” is in the name, sugar alcohols are chemically different from (through structurally similar to) alcoholic beverages. More importantly, they do not contain any ethanol. Sugar alcohols occur naturally in foods and come from plant products such as fruits and berries. They are also industrially produced form sugars. Sugar alcohols are sold as white, water-soluble granular solids and look similar to white table sugar. They are used widely in the commercial food industry as bulking agents, thickeners, and sweeteners in place of sugar. Additionally, you can also find them combined with other high-intensity sweeteners to moderate the sweetness level. Most people eat sugar alcohols every day and don’t even know it. Some of the most commonly used sugar alcohols include:21

Mannitol which is found in fruits and vegetables like pineapples, olives, asparagus, carrots, sweet potatoes and even seaweed! Mannitol is less sweet than sugar by about 50-70% meaning that more must be used to provide the same level of sweetness.

Sorbitol is also found naturally in fruits and vegetables such as apples, pears, dried fruits (like raisins, figs, and dates) as well as stone fruits like peaches, nectarines, plums, and cherries. Commercially, it is manufactured from corn syrup. Sorbitol is about half as sweet as table sugar meaning twice as much must be used to exact the same level of sweetness. It is often found in sugar-free gums and candies.
Xylitol is also called “wood sugar” because it was first extracted from wood. It is also found in corn cobs, cereals, mushrooms, fruits and vegetables. Xylitol has about the same relative sweetness as sugar and is often found in chewing gum and toothpaste.
Erythritol was originally discovered by a Scottish chemist in 1848. It is naturally found in fruits like watermelon and pears as well as fermented products like wine, cheese, and soy sauce. Erythritol is 60-70% as sweet as white sugar and is labeled as “non-caloric” (even though it does contain about .2 calories per gram) in some countries like the US and Japan.

Nutritional/Health Considerations

As a sugar substitute, sugar alcohols provide fewer calories (about a half to one-third less calories in most cases) than regular sugar.21 Additionally, they convert to glucose more slowly, have little to no insulin requirements, and are not known to cause spikes in blood sugar. Sugar alcohols have other health benefits as well. Regular use of xylitol for example results in around a 75% reduction in the number of streptococcus mutant bacteria (the main bacteria associated with the development of dental cavities) in the mouth.22 It may also be helpful in both the prevention and treatment of Type II Diabetes as well as reducing fat accumulation in the abdominal area.23 Erythritol has been shown to have potent antioxidant capacity and to have a favorable impact on the vasculature.24 Due to the fact that they are not well absorbed in the digestive tract, sugar alcohols have a tendency to cause gastric distress (nausea, rumbling, diarrhea, reflux, etc.), particularly when  consumed in large quantities. Some sugar alcohols have a greater tendency to cause these effects over others.

NOTE: Some sugar alcohols, particularly xylitol, are toxic to dogs. It is important not to share foods containing xylitol with dogs.

Tips for Use

Most sugar alcohols are less sweet than sugar and require a greater volume to be used to achieve the same level of sweetness. However, xylitol can be used in a one-to-one exchange with sugar. Sugar alcohols are sold in a variety of forms with granular versions being among the most popular. Sugar alcohols may change the taste of the finished product slightly so it may take some experimentation to determine appropriate amounts.

Artificial Sweeteners (i.e. sucralose, saccharin, aspartame and high fructose corn syrup)

Sold under trade names like Splenda, Nutri-Sweet, Equal, and Sweet-N-Low, these sweeteners are readily available in any restaurant, coffee shop, convenience store, or grocery store. High fructose corn syrup is chemically similar to sugar, but results in the addition of unnatural amounts of fructose to the system. The human body has limited capabilities for metabolizing fructose and when overloaded, the excess is converted to triglycerides which are then stored as body fat.25 All of them have been approved by the FDA but their use is controversial due to their potential for deleterious health effects. These products are synthetic, unnatural chemicals and their consumption can lead to a number of deleterious health effects. 26, 27 Their use should be avoided.

The food market is home to a number of different sweetener options, each with different properties, strengths, and weaknesses. With the information above you can make in an informed decision on which sweetener is best for your overall health and baking purposes.

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Dr. Kaley Burns – NUHS

“There is magic in medicine that does not derive solely from technology or diagnostic aptitude; but rather from our interactions with patients.”

Laying the groundwork to become an ND

Like many naturopathic doctors, Dr. Kaley Burns discovered her passion through her own healing journey. After visiting multiple physicians and specialists with no success, Dr. Burns’ mother suggested she see a naturopathic doctor. Accustomed to conventional medicine, she was aware of naturopathic medicine misconceptions, but also believed that medicine could provide more. Naturopathic medicine gave her the healing results that she long desired. A then-physical therapy aide with dreams of becoming a physical therapist, Dr. Burns changed career paths and applied to naturopathic medical school, supported by the mentorship of her naturopathic doctor.

“Naturopathic training has helped me transform into a uniquely talented individual with experience, understanding, and strengths.”

NUHS as a springboard

With roots in Minnesota and an undergraduate degree from Wisconsin, Dr. Burns is a self-proclaimed “Midwest girl at heart.” She was attracted to National University of Health Sciences (NUHS) for its location in Illinois, and the collaborative programs. Throughout her schooling, she worked alongside chiropractors, massage therapists, acupuncturists, and other health professionals to expand her knowledge and open doors to integrative care.

Since NUHS is in a pre-licensed state, the limitations in the naturopathic medical scope of practice inspire ND students to develop additional skills for patient care. “I sought training in IV and regenerative injection therapy. Additionally, I contacted clinics and medical professionals for preceptor and observation opportunities to gain an understanding of how I wanted to structure my practice. Furthermore, I worked to advocate for myself, my colleagues and the profession as a whole, with intentions to advance our training and opportunities.”

Dr. Burns also participated in a medical brigade to bring the healing power of naturopathic medicine to an underserved population in Nicaragua. Furthermore, she describes her NUHS clinic rotation at the clinic where she is currently practicing as an integral part of her growth as a naturopathic doctor.

“I am fortunate once again to be part of a comprehensive team, who are all dedicated to bringing the utmost care to patients in the community.”

Finding fulfillment as an ND

Following graduation, Dr. Burns took some time off to reconnect with her loved ones before making the move to her first job at an integrative clinic in Connecticut. Since then, Dr. Burns has moved to Montana and practices full-time at a naturopathic primary care clinic.

“I am passionate about regenerative therapies, specifically injection therapies. As much as we know about the human body, mysteries remain. Moreover, the connections between mind and body become ever more prevalent in medicine. There is vulnerability when someone seeks help. Patients will share things about themselves; as doctors we must listen with open hearts and minds. There is magic in medicine that does not derive solely from technology or diagnostic aptitude; but rather from our interactions with patients.”

Dr. Burns enjoys spending time with family and friends as well as building connections in the community. She also values an active lifestyle and recently summited Mount Kilimanjaro.

Advice for aspiring NDs

Naturopathic medicine is rewarding career with many paths. “I encourage prospective students to embark on this journey because you believe whole-heartedly that there is a better way to help patients, a better method of healthcare. The infinite tools and meticulous training of naturopathic physicians allow us to truly treat each patient uniquely.” To learn more about career paths in naturopathic medicine, click here.

Learn more about Dr. Burns:


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NUHS Integrative Care Focus, Business Education Lead to Success

By offering programs in naturopathic medicine, chiropractic medicine, acupuncture, oriental medicine and massage therapy on one campus, National University of Health Sciences (NUHS) students have the unique option to earn a second or third degree in less time — saving money and starting their careers sooner.

Jane Drobin (pictured to the right) grew up in Elizabethtown, PA., with parents who were interested in alternative medicine. But it wasn’t until she started researching natural lifestyles for herself that she discovered naturopathy.

“The naturopathic philosophy aligned with my personal interests,” Drobin said. The opportunity to earn both a doctor of chiropractic and doctor of naturopathic degree in less time than earning them separately at different schools led her to NUHS.

Naturopathic students are also drawn to NUHS in Lombard, IL., because it is dedicated solely to science and health care careers. The ability to learn and work with students and faculty in other natural health care disciplines gives NUHS naturopathic students a competitive edge.

“NUHS does a good job of exposing you to everything, and you can decide what you love,” Drobin said. For example, after finding acupuncture students to be great resources, she added 100 hours of acupuncture instruction to her curriculum. “I’ll be able to refer my patients for acupuncture treatment because of the knowledge I now have,” she noted. She also plans to offer cupping in her practice.

With more hospitals and specialty clinics providing integrative health care options, NUHS graduates are trained to work with MDs, DOs, DCs and other medical specialists, co-managing patient cases as part of an integrative medical team.

Integrative Clinic Experience

Naturopathic students at NUHS spend a full year in the clinical internship program in one of its integrative medical clinics, learning to collaborate with professionals in other natural medical specialties. Students may also intern at the Salvation Army Adult Rehabilitation Center, gaining experience treating a wide range of pathology while meeting the needs of an underserved population. They also have unique opportunities for clinical observations in other specialties such as homeopathy, with an on-campus clinical observation experience and a clinical rotation at the Center for Integrative Health.

Rigorous, Science-Based Curriculum

A rigorous curriculum with a strong foundation in basic and clinical sciences is important to naturopathic doctors’ success. Students learn anatomy and physiology through full-cadaver dissection in its gross anatomy laboratory. While the basis of the program is in the naturopathic philosophy of looking for underlying imbalances and determining what is necessary to support the natural healing process, NUHS takes students deep into naturopathic clinical theory, which equips them with models for case analysis and treatment, and helps them to apply the principles in action. This comprehensive approach prepares NUHS graduates to be exceptional diagnosticians and physicians.

Experience a Hydrotherapy Suite

In 2017, the Lombard clinic opened a new hydrotherapy suite with state-of-the-art equipment. Hydrotherapy is an important healing modality in traditional naturopathic medicine.

It employs the therapeutic benefits of water at various temperatures applied in one of several ways to promote a specific outcome in a patient’s treatment plan. In NUHS’s hydrotherapy suite, students have the opportunity to experience the use of Constitutional Treatments, Russian Steam Baths (pictured to the left), Peat Immersion Baths, Far-Infrared Sauna and Colon Hydrotherapy.

Learn to Manage Your Career, Run Your Business

Naturopathic doctors need to be both excellent practitioners and knowledgeable businesspeople. National University’s business program gives graduates the confidence and real-world skills to succeed in what they want to do in today’s health care marketplace. Instructors in the business program are successful doctors who know the demands of the professional world.

Students learn about the many career choices they have and receive guidance in how to find the right fit for them. Those who go into private practice gain the knowledge needed to successfully managing their own businesses and develop a business plan for their private practice before graduation.

NUHS understands and supports every naturopathic student’s educational journey with their goal to have a successful career in mind. To learn more, follow the real-time year in the life of an NUHS naturopathic student by subscribing to the Naturopathic Student Blog. Keep up with the latest developments in naturopathic and other complementary and alternative medical fields on The Future of Integrative Health blog for aspiring professionals.

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Naturopathic Approaches to IBS

With a worldwide prevalence of 10-20%, irritable bowel syndrome (IBS) is an exceedingly common functional bowel disorder.1 Diagnosis is complex because IBS is typically made as a diagnosis of exclusion. This means that all other potential causes need to be ruled out before the diagnosis is confirmed. Symptoms of IBS can include: abdominal pain, irregular bowel habits, alternating constipation and diarrhea, gas, and bloating.2 Often times, these symptoms can be quite restricting to an individual’s quality of life. People who suffer from IBS report having to limit their activity levels about 20% of the time, and also experience a poor health-related quality of life.3 Pharmaceutical-based treatment options are minimal, with only two strongly recommended drugs available.4 An IBS diagnosis can also result in significantly increased medical costs. IBS patients incur around 50% more health care costs than those without IBS.1 In the US alone, IBS costs are estimated at some $20 billion annually.5 The combination of loss of quality of life, limited medical treatment options, and elevated costs of treatment lead many to seek out other means of treatment, including naturopathic medicine.

“IBS is a disorder with a complex set of triggers, none of which would be individually sufficient to produce symptoms, but may do so when combined. Food sensitivities, unbalanced flora, and improper fermentation can set up a condition in the gut that then only takes a trigger, like emotional or physical stress or a dose of sensitive food, to cause reactions and symptoms. Natural treatment is based on the concept of ‘The Four Rs’: Remove, Replace, Re-inoculate, and Restore.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

IBS can be a frustrating condition to manage, with at least half of sufferers turning to therapies outside of conventional allopathic medicine. In one survey, approximately 10% of individuals who used alternative medicine for a gastrointestinal complaint reported using naturopathy.6 The systematic approach and individualized care provided by naturopathic physicians involves the integration of modern medical knowledge with natural treatment options. Research confirms that naturopathic approaches to IBS are distinct from those offered in a conventional medical setting.1

“When I see a new patient, I give them a very detailed digestive health questionnaire that helps me to understand their risk factors for various GI conditions, their current symptoms picture and what kinds of things trigger their symptoms. I then spend about an hour speaking with them, going over their history and performing a physical exam to make sure I fully understand the picture. If I find that additional testing or referrals are necessary, I may also order these at the first visit.”

Lela Altman, ND, LAc

Graduate, Bastyr University

“Most patients who visit my practice have tried eliminating foods from their diets, seen many providers, performed numerous GI tests and still don’t have answers for why they don’t feel well. IBS generally does not start over night. So, I try to determine, what has brought the patient to this point? I like to consider myself trained as a detective as well as a naturopathic doctor to understand the why this person has developed IBS. An initial patient visit should be extensive. I cover a thorough time line of health history, evaluate past health records, document treatments tried and understand who my patient is as a person. It’s my goal to think outside of the box for events that could have led to the development of IBS. Once I have an understanding of the most likely reason for their distress, I systematically start there, while working through other possibilities.”

Crane Holmes, ND

Graduate, National University of Natural Medicine

“I take a complete history, including other systems that may be disturbed by the digestive imbalance. I look at dental history, NSAID and antibiotic use, other allergies and diagnoses, immune and liver function and microbiome condition. When necessary I will order lab tests, food sensitivities and allergy panels, SIBO breath tests, flora and stool analysis, micronutrient assays, as well as any indicated standard testing. The aim is to find which set of symptoms that the patient is showing and to tailor an individualized treatment plan to meet the root cause.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Though not all treatments work for all individuals, there are a number of means by which naturopathic medicine addresses the underlying functional imbalance associated with IBS.

Manage Mental and Emotional Stress

The gut is home to the “enteric nervous system” also known as the ‘second brain’.7 This intricate neuronal network allows us to feel the inner world of the gut and its contents. Digestion is the main duty of this system, which includes breaking down ingested foods, absorbing nutrients, and eliminating wastes, and the synchronized muscular contractions that move it all along. As many experience, digestion can be intimately related to an emotion or stressor. It is very common for chronic digestive issues to be connected to an emotional or stress component. Those with IBS often present with accompanying disorders including those impacting the mental/emotional state. Studies have shown that patients with IBS report an average of five (four physical and one mental-emotional) additional conditions.8  Researchers went on to note that specific diagnoses, such as generalized depression, anxiety, insomnia, and tension headaches, were associated with decreased quality of life, greater impairments to mental and physical function, distress, more severe symptoms of IBS, and worse pain symptoms.8 Developing a strategic program to help manage stress and realign the balance of the nervous system can be integral to managing chronic digestive disturbances. Implementing activities such as mindful breathing, yoga, earthing, qigong, tai chi, journaling, and many other techniques can be helpful in reducing stress and reconnecting with the body.

“I ask the patient to keep a diet diary that includes symptoms, bowel movements, and self-care, like meditation and exercise. This serves as an educational tool for them to become aware of what they are eating and how it relates to their digestive health.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Dietary Considerations

The use of food as medicine is as old as the practice of medicine itself. When it comes to IBS, food plays a central role in that many people with IBS note significant association between the foods they eat and the appearance or exacerbation of their symptoms. More than 60% of patients with IBS report the onset or worsening of symptoms after meals, alterations happened within 15 minutes in 28% and within three hours in 93% of these patients.9

“Identification and elimination of food sensitivities and allergies is the first thing that should be addressed. I commonly use an elimination/challenge diet because it is diagnostic and therapeutic at the same time, but some patients prefer lab testing. We also need to eliminate foods and habits that irritate the gut alone, like alcohol, coffee, smoking and not coping well with stress. The basis of the diet for this period of time should be whole food, plant centered, and properly prepared (cooked), to provide rest for the digestive system.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Some examples of dietary considerations that may be helpful in IBS management include:

Assess and address food sensitivities, intolerances, and allergies

Although it can be extremely difficult to identify single, specific food items that are causing a reaction, a staggering 84% of IBS patients report consumption-related symptomatology to at least one food item.9 A food intolerance is a nonimmune-mediated adverse reaction to food that can be caused by any (non-protein) food component, and is much more common than food allergy. 10 Studies have shown that those with IBS will try to extrapolate which foods cause them the most issues, revealing that 62% of IBS patients limit or exclude foods from their diet.11 Among the most common methodologies for determining adverse food reactions is an elimination and challenge trial. This is typically a multi-phase protocol that involves short term (typical time frames are three to six weeks but it can be longer) elimination of a specific food, category of foods, or even several categories of foods then consuming the suspected foods again one at a time to monitor for potential reactions. The impact of elimination diets can be very profound. One study of IBS patients who underwent an elimination diet demonstrated statistically significant improvements in stool frequency, pain, and quality of life scores.12

Increase fiber Intake

Inadequate fiber intake is extremely common in modern society with less than 5% of people actually getting the recommended basic 19-38 grams daily.13 Fiber is well known to improve a number gastrointestinal complaints, and is among the most often suggested dietary interventions in primary care.9 Fiber helps to support normal bowel function and elimination habits. A note of caution however, in some instances fiber may cause an increase in gas and bloating due to bacteria in the digestive tract producing gas as they metabolize the fiber. In these instances, balancing gut bacteria with adequate probiotics can be helpful.

Special diets

Food elimination through various dietary protocols provides structure and can help patients identify and remove food allergies or sensitivities. Examples of dietary systems that include an elimination component include gluten free, Paleo and low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol better known as low-FODMAP. Patients who reduce their FODMAP intake have noted improvement in abdominal pain, bloating, and flatulence. Some studies have reported that a gluten-free diet reduces diarrhea as well as abdominal pain and bloating.10

The standout therapy when it comes to managing IBS is the low-FODMAP diet. This dietary system was developed by Drs. Peter Gibson and Susan Shepherd of Monash University. FODMAPs are short chain polysaccharides that are limited in small intestine absorption but are highly fermentable by the bacteria in the small intestine to form short-chain fatty acids.14 The low-FODMAP diet has been shown in at least 10 randomized trials to result in a positive clinical response in 50%-80% of patients with IBS, with improvements in bloating, flatulence, diarrhea and global symptoms being among the most notable.15  A low-FODMAP diet involves three stages.16 Stage one is classified as an elimination phase, which lasts between three and eight weeks and involves strict elimination of all high-FODMAP foods. Stage two is the re-introduction phase where high-FODMAP foods are reintroduced one at a time for cycles of three days each. This phase allows an individual to both determine which selective FODMAPs they are sensitive to (since it is uncommon to be sensitive to all of them) and how much FODMAP they can tolerate. In stage three, a long-term personalized FODMAP protocol is implemented based on the findings from stage two. This final stage is important for supporting long term compliance through dietary variety and flexibility, which are linked to improvements in both quality of life and overall gut health.17

Supplements and Herbal Options

It is always the goal in naturopathic medicine to find and remove the cause of disease, however in some chronic conditions, this can take time and patience. While naturopathic therapies are at work, supplements and botanicals may be used to manage and decrease the expression of symptoms.

“I will often prescribe herbs to help the gut heal and restore to proper function. The goal of botanical medicine in this is always aimed at restoring function and reminding the body to heal itself. The herbal combinations are chosen for the individual’s symptoms. Demulcent herbs like Deglycyrrhizinated licorice and slippery elm coat and soothe the mucosa layer, allowing the underlying cells to heal. Glutathione directly feeds the gut cells.  Anti-microbial herbs like mahonia (Oregon grape root) and hydrastis (goldenseal) to help balance yeasts and bacterial overgrowth. Enteric coated peppermint or valerian root can address cramping and spasm in the bowel. Fiber sources like flax, chia and psyllium pull double duty as fiber and mucilage.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

The use of herbs and other supplements can help relieve symptoms. The following herbs/supplements have been shown to help manage IBS:

Probiotics: Probiotics have long been a go-to therapy for intestinal conditions, and IBS is no exception. There is a growing body of scientific evidence connecting the response to changes in the enteric microenvironment to IBS symptoms, suggesting that strategies that modulate the gut microbiome could be beneficial in IBS. Additional studies delineating the role of gut bacteria in influencing function such as gut motility, intestinal and colonic barrier integrity, visceral sensation, as well as reciprocal actions between the gut and the brain further support the role of the micro biome in IBS.18 People with IBS can have a variant composition of commensal gut bacteria including Bacteriodes spp., Bifidobacterium spp., Lactobacilli spp. and others compared to healthy controls.19 Improving the balance of gut bacteria with probiotics can help modulate IBS symptoms via multiple mechanisms. Because microbes in the intestinal microbiome compete for both nutrients and space, probiotics can limit the availability of both to pathogenic bacteria. Probiotics also leave fewer binding sites for pathogenic bacteria and secures substances that create an inhospitable environment for pathogenic microbes.19 Probiotics have also been demonstrated to enhance and protect gut barrier function as well as produce an anti-inflammatory effect.19 There is ample evidence to suggest that probiotics would benefit those with IBS.

Berberine: Berberine is not an actual herb, but an alkaloid compound derived from plants such as Oregon Grape, Barberry, and Goldenseal. It has a long history of use in both traditional Chinese and ayurvedic medicine. Berberine is available in extract form as a dietary supplement. Traditional use of berberine has been proven to have many pharmacological effects, including antimicrobial, anti-tumor, anti-inflammatory and blood glucose–lowering effects.20 Studies examining the use of berberine in patients with IBS found that berberine was well tolerated. It also reduced the frequency and urgency of bowel movements as well as the frequency of abdominal pain. Non-digestive quality of life measures such as anxiety and depression also showed improvement trends.21

Peppermint Oil (Mentha piperita): Peppermint is a carminative herb. It prevents the formation of gas or promotes expulsion of gas from the intestines. Reduced ability to expel intestinal gas with consequent gas trapping and bowel distension may contribute to abdominal discomfort/pain and bloating associated with IBS.22 Peppermint oil has a broad range of medicinal properties that may be relevant in treating the IBS patient including acting as an antispasmodic, antimicrobial, anti-inflammatory, and antioxidant as well as having immunomodulating and anesthetic activity.23 A double blind study of enteric coated peppermint oil revealed a 40% reduction in total IBS symptom scores compared to baseline.23 Additional studies confirm the benefit of peppermint oil for statistically significant treatment of abdominal symptoms of IBS. 24,25

Artichoke (Cynara scolymus): Cynara scolymus is a plant native to the Mediterranean region and is a member of the thistle group of the sunflower family.26 Artichoke has been used as an herbal medicine since ancient times and has a number of beneficial properties. It is well known for its use as a digestive support- aiding in the formation and secretion of bile which helps support the digestion of fats. It also has antioxidant, anti-inflammatory, liver protective and cholesterol lowering properties.27 Interestingly, although we eat the flower bud of the plant as food, the compounds associated with its medicinal qualities are concentrated in the leaves rather than the favored bud.28 Cynara scolymus leaf extract has also demonstrated both curative and preventive roles when it comes to management of IBS. In a study of individuals who suffered digestive disturbance, but were otherwise healthy, treatment led to a 26.4% decrease in IBS incidence and a 41% decrease in IBS type digestive symptoms.29 This included a significant shift in bowel habits to a more regular pattern versus the oscillating diarrhea and constipation that is common in IBS. Additional studies of artichoke leaf extract in individuals diagnosed with IBS revealed that over a six week treatment period, there was a significant reduction in the severity of symptoms with 96% of participants rating artichoke leaf extract as equal or better than previously administered therapies.29

Move that body!

Exercise is an essential part of a healthy lifestyle. The benefits of exercise for systems such as the cardiovascular system are well-known. Perhaps lesser known are the benefits to the digestive system. One study revealed that after six weeks of treadmill-based aerobic exercise, there was a significant improvement in the severity of IBS symptoms and quality of life scores compared to a control group as well as compared to before and after exercise intervention.30 Additional studies have confirmed the benefit of exercise on both IBS symptomatology as well as quality of life measures such as emotion, sleep, energy, physical functioning, and social and physical role were significantly improved in IBS sufferers who exercised regularly.31

NDs share IBS patient success stories

“I have a 28-year-old female patient who is in a master’s program and enjoys spending time working outside raising animals. She had a history of IBS associated with heavy, painful menses but otherwise normal GI health. After foreign travel, increased stress and some general illnesses, she developed urgent IBS-d. This urgent diarrhea greatly affected her daily life, making tending animals and leaving the house for school difficult. She had tried multiple food eliminations, herbal teas, probiotics and other supportive therapies she could find online without much improvement. Her main strategy was to avoid eating which could prolong her day away from a restroom until she was home at night.

Homeopathic podophyllum provided immediate relief for the explosive, urgent diarrhea which allowed her to feel more comfortable leaving the house. Further work revealed issues with GI dysbiosis and pancreatic insufficiency. After a few different herbal and pharmaceutical treatments to correct the dysbiosis, discovering the right pancreatic enzyme and focusing on stress reduction/sleep improvement, one year later she is having one-two non-urgent, well-formed stools per day while maintaining a healthy diet.”

Crane Holmes, ND

Graduate, National University of Natural Medicine

“A 38-year-old male patient presented with symptoms of IBS which included abdominal pain and distension. These symptoms were relieved with bowel movements that were urgent, frequent, and loose. He had been experiencing these symptoms for six months, and his quality of life was slowly deteriorating. He stopped going to restaurants with his family, as he felt extreme anxiety at the thought of being unable to control his pain and bowel movements. He traveled for work frequently, and would not eat meals with his colleagues, surviving on ginger ale, nut bars and Imodium. When he came to see me, his anxiety was heightened as his wife was asking for a separation. After gathering a full history and completing a physical exam, the assessment of IBS was made. I recommended dietary changes, botanicals and supplements to control his anxiety and GI symptoms, and counseling was provided to help him grieve the end of his relationship. After three months, his symptoms were better controlled, and while he was still struggling with the divorce, his quality of life had improved, he had started his own business, was relying less on Imodium. He was able to travel and control his IBS and anxiety with botanicals and supplements. Today, he is in a new relationship, and although his IBS symptoms flared up briefly when he started dating, he enjoys his life, eats a variety of foods, and travels without anxiety. This case really helped me understand the gut-brain axis and its influence on the balance of health.”

Poonam Patel, BSc, ND

Graduate, Canadian College of Naturopathic Medicine

“A female in her mid-40s presented with a six-month history of abdominal pain, loose stools and nausea.  Her symptoms started around the same time that the she had undergone significant stress with work and family. She was diagnosed with IBS-D and recommended to take Imodium as needed for the loose stool and to reduce stress. She did this, however the symptoms never really resolved which brought her in to see me. I gave her a gut healing protocol with glutamine, herbs and digestive enzymes which helped a little, but also did not resolve her symptoms. It became clear that her symptoms were worse with some meals so we investigated food intolerances and found that she reacted to wheat, dairy and eggs. She eliminated these from her diet and her symptoms improved slightly more, but not completely. At this I ordered a small intestinal bacterial overgrowth (SIBO) breath test, which was positive. Of note, the only risk factor she had for SIBO was stress.  I treated her SIBO and all her GI symptoms resolved. While she still had mild reactions to wheat, dairy and tomatoes, she was able to tolerate them much better after SIBO treatment.

Depending on the study, somewhere between around 60-80% of patients with IBS test positive for SIBO. This may be what is causing all their digestive symptoms and, in my opinion, is important to consider when determining treatment approaches. If SIBO is present, it is the first thing I work. If SIBO is missed, you won’t generally get very far with the IBS treatment until it is addressed.”

Lela Altman, ND, LAc

Graduate, Bastyr University

“I had a patient that had been treated for years for IBS exclusively with medications, to little effect. She had what she called ‘unpredictable’ gas and stool urgency, with many loose bowel movements a day, constant cramping, and bloating after meals. She also suffered from headaches and depression, insomnia and fatigue, and had different medications for each. She was told she would have to deal with the symptoms, and that they would likely get worse as time went on. She called me in what she saw as a last-ditch attempt to get some relief. She was on a diet of mostly processed foods; particularly wheat-based. I convinced her to do a basic elimination for two weeks, focusing on eliminating wheat and increasing vegetables. We also addressed the daily stress she was under and gave her some good ways to deal with it in a healthy way.

She left hopeful for the first time in years. A month later she reported having had solid bowel movements consistently through the weeks, and significant improvement in gas and bloating. She was sleeping better and hadn’t had a headache since the second week. She even found the energy to start an exercise routine. She had seen the immediate effect from removing offending foods, and using enzymes and probiotics, and found it was worth the effort. At six months she was thriving for the first time in decades and had become a vocal advocate for gut health. She even led a meditation group for her stress-filled office in an effort to improve her surroundings.”

Wm. Thor Conner, ND

Graduate, National University of Health Sciences

Due to the complexities of IBS and the intricacies of the workings of the human digestive tract, a single treatment is unlikely to be fully beneficial for managing IBS symptoms effectively. Using a multi-pronged approach that takes advantage of the various approaches available is more likely to result in adequate symptomatic control and management of the condition long term.

For questions about how naturopathic doctors treat patients with conditions like IBS, click here to find an ND near you in the United States or Canada. The Gastroenterology Association of Naturopathic Physicians (GastroANP) is also a great resource!

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Chocolate 101: The Naturopathic Kitchen

Welcome back to The Naturopathic KitchenAs always, our focus is to learn more about bringing new, fun, and healthy foods into our home kitchens. Today we will take a closer look at a flavorful favorite, chocolate!

Chocolate 101

Though today most people associate chocolate with candy, desserts, and other sweet treats, this was not always the case. For most of its 4000-year history, chocolate was consumed as a bitter drink. Evidence of ancient civilizations’ use of chocolate has been dated back to 1900BC.1 The Mayans made a concoction that was a combination of crushed cocoa beans, chili peppers, and water. They heated it and then repeatedly poured it from one vessel to another until a layer of frothy foam developed on the top.2 There was no sugar in the region at the time so the concoction was quite bitter. In fact, it is believed that the word chocolate comes from the Mayan word, “xocolatl” which means “bitter water.”2 Chocolate also had other uses in society. For both the Mayans and Aztecs, money really did grow on trees, as both civilizations used cocoa beans as a form of currency.2 It is believed that the famous Aztec King, Montezuma II, drank upwards of 50 cups of chocolate per day!

It wasn’t until the 1500s that chocolate made its way to Europe.1 The exact origins of chocolate in Europe are not clear, but it is generally agreed upon that it first appeared in Spain where it quickly became a favorite of the Spanish court. Soon, other European countries such as France and Italy were importing chocolate. The Europeans began combining chocolate with sugar, spices, and other flavorings, and soon trendy chocolate houses began popping up in major European cities as a place for the wealthy to indulge.

Today, chocolate is enjoyed by people of all socioeconomic levels, mostly as sweet confections rather than in liquid form. Although some famous chocolatiers maintain a commitment to ingredient purity, in most cases, modern chocolate is highly refined and mass produced. A staggering 90% of the world’s cocoa supply is grown on family farms by about six million farmers who support their families by growing and selling cocoa beans.3 The work is hard and they are often paid very little for their efforts. Some estimate that 40% of cocoa is slave grown.4 With demand for cocoa rising and prices of cocoa beans falling, the owners of cocoa farms struggle to meet the demands of production. Some have turned to low-wage and even slave labor, sometimes involving child slaves acquired through human trafficking, as a means of meeting demands and staying competitive. As such, the standards of fair trade chocolate were developed.

Cocoa products that are “fair trade” bear a label marking them as such. This means that certain criteria such as non-use of GMO plants or harmful agrochemicals, submitting to and passing regular inspections, and guaranteed payment of a fair wage for their products have been met.5 Being paid a fair wage means that farmers can avoid cost cutting practices that undermine the quality of the product and negatively impact the lives of laborers as well as lead to destruction of the environment.

Where does chocolate come from? Where can I find it?

Chocolate is available everywhere, but it is important to seek out chocolate that is produced under fair trade standards. Fair trade cocoa is typically shade grown and organic. Fair trade cocoa products can often be found in traditional supermarkets but health food stores are also an excellent resource.

The contemporary version of chocolate begins with the fruit (beans) of the tree known as Theobroma cacao. Once harvested from their pods, the cocoa beans are fermented, dried, roasted and ground. During the refining process, varying amounts of cocoa butter, chocolate liquor, sugar, and other ingredients are combined to create different forms of chocolate. Chocolate can be purchased in a number of different forms from powder, to solids, to liquid. To be labeled chocolate, the FDA mandates that chocolate must contain at least 35% cocoa solids. Lack of regulation surrounding sugar content can blur the lines between the different types. Commercially available chocolate varieties can include:

Baking Chocolate: Baking chocolate is also known as “bitter” or “unsweetened” chocolate. It looks and smells like chocolate but has a bitter taste if eaten on its own. It provides a rich chocolate flavor in baked goods where it’s bitterness can be countered with the addition of sugar.

Dark Chocolate: Dark chocolate contains between 30-90% cocoa solids. It is a combination of sugar, cocoa butter, chocolate liquor, and an emulsifier like lecithin. Semi-sweet and bittersweet also fall into this category.

Sweet Dark Chocolate: Sweet dark chocolate is technically classified as “dark chocolate” because it does not contain milk solids, but it does have a higher percentage of sugar and in some cases only 20-40% cocoa solids.

Semi-sweet Chocolate: Originally popularized in reference to branded semi-sweet chocolate chips, semi-sweet chocolate is a term mainly used in America.

Bittersweet Chocolate: Bittersweet chocolate typically contains 50-80% chocolate liquor. It should have a deeper and more bitter flavor than sweet dark or semi-sweet.

Milk Chocolate: Milk chocolate not only contains cocoa butter and chocolate liquor; it also contains some type of milk in the form of condensed milk or dry milk solids. Milk chocolates are often much sweeter than dark chocolate, lighter in color and have a more mild chocolate flavor.

White Chocolate: White chocolate contains only cocoa butter with no chocolate liquor or any other cocoa products. By law it must contain at least 20% cocoa butter as well as at least 14% milk solids, and no more than 55% sugar. It does not have any characteristic chocolate flavor. There are products available that use vegetable fat instead of cocoa butter. These products are technically not “white chocolate” at all and should be avoided.

How does chocolate help my health?

Although highly processed chocolate used in the average candy bar is not considered healthy, dark chocolate has been shown to be abundant in heart-healthy antioxidants.6 A number of experimental and clinical studies have indicated a protective role of chocolate against oxidative stress, inflammation, endothelial dysfunction, and development of plaque in the arteries.6 Chocolate intake is associated with decreased risks of coronary heart disease, stroke, and diabetes. Consuming chocolate in moderation (six servings or less per week) may be optimal for preventing these disorders.7

What medical conditions/symptoms is chocolate good for?

When should chocolate be avoided?

Aside from an outright allergy to chocolate, chocolate can be enjoyed in moderation by everyone- except your dog. Chocolate contains a compound called theobromine that is highly toxic to dogs because their physiologic mechanisms for breaking down theobromine work very slowly allowing it to build to toxic levels in their system. Theobromine toxicity can result in muscle tremors, seizures, irregular heart rate, internal bleeding and heart attacks. Among the initial symptoms is severe hyperactivity.

Let’s try out chocolate with these delicious and nutritious recipes!

Charred Cauliflower and Peppers with Picada Sauce


1 head organic cauliflower, trimmed, halved, and cut into 1 1⁄2″ wedges
2 T plus 3/4 c olive oil
Kosher salt and freshly ground black pepper, to taste
8 cloves garlic, roughly chopped
1 c olive oil, for frying
12 shishito or anaheim peppers
1⁄2 c whole almonds, toasted and roughly chopped
1 c plus 1 T roughly chopped parsley
1 T finely grated dark chocolate
2 t sherry


  1. Heat oven broiler.
  2. Arrange cauliflower in a single layer on a baking sheet.
  3. Brush both sides with 2 tablespoons of olive oil and season with salt and pepper; broil, flipping once, until charred and tender, about 15 minutes.
  4. Meanwhile, heat remaining olive oil and the garlic in a 12″ skillet over medium. Cook until garlic is golden, 4–6 minutes; transfer to a bowl and let cool.
  5. Wipe skillet clean and heat olive oil over medium-high; fry peppers until blistered and slightly crisp, 4–6 minutes.
  6. Transfer peppers to paper towels to drain; season with salt.
  7. Stir almonds, 1 cup parsley, the chocolate, sherry, salt, and pepper into reserved garlic oil; spread onto a serving platter. Top with cauliflower; garnish with fried peppers and remaining parsley.

A special thank you to Saveur.com for the amazing recipe!

Double Chocolate Avocado Cookies


1 ripe organic avocado, pitted and peeled
1 large organic egg
1 t vanilla
1/2 c coconut sugar
1/4 t salt
1 t baking soda
1/2 c organic whole wheat pastry flour
1/2 c fair trade cocoa powder
1/4 c fair trade mini chocolate chips


  1. Preheat the oven to 350.
  2. In a food processor or blender, combine the avocado, egg, vanilla, and sugar. Blend until the avocado chunks are smooth.
  3. Stir in the salt, baking soda, flour, and cocoa.
  4. Add in the mini chocolate chips.
  5. Lightly grease a cookie sheet and drop rounded tablespoons of cookie dough onto the sheet. They won’t spread much so you don’t need much room in between.
  6. Bake for 8-10 minutes.
  7. Remove from the oven and let them cool for a few minutes before removing from the pan.

Thank you to IHeartVegetables for this wonderful recipe!

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Therapeutic Benefits of Pets

We all know that eating fruits and vegetables, exercising, controlling stress, and getting enough sleep each night are vital components to overall health and longevity. But what if you found out you could further reduce your risk of heart disease and death without limiting carbs or taking another supplement? What if the same thing could reduce the risk of your kids developing environmental allergies, and improve mental health and well-being? Interested? Then it may be time to check out a local pet adoption event because these benefits (and more) are all associated with pet ownership!

“I can’t imagine life without pets. Animals provide unconditional love and acceptance. There is no way to describe all that these wonderful companions give to us.”

Gaia Mather, ND

Graduate and Assistant Professor, National University of Natural Medicine

According to a 2018 national survey, 68% of US households own a pet.1 Pet ownership comes with more than just unconditional love and endless entertainment. Additional health and wellness benefits of pet ownership include:

Improved cardiovascular risk and lower mortality

Pets are often responsible for filling their owner’s heart with love, but studies have also demonstrated that owning a pet can have added cardiovascular benefits and may even reduce the risk of death due to cardiovascular disease (as well as other causes). A 12-year long Swedish study involving 3.4 million people aged 40-80 showed that dog owners had a lower risk of death over the course of the study.1 Pet ownership has also been associated in a number of studies with reductions in cardiovascular risk factors such as high blood pressure, improved cholesterol patterns, as well as increased heart rate variability and autonomic function.2

Reduced risk of allergies and stronger overall immune system

The term “immunity” refers to not one specific thing, but a collection of mechanisms employed by the body in an effort to guard against agents in the environment. This includes microorganisms, foods, chemicals, pharmaceuticals, environmental allergens such as pollen and animal hair/dander. Pets can be a great source of a number of these, and interacting with a pet may affect immunity levels. Researchers have hypothesized that pets increase exposure to a greater number of allergens and other microbes. Published research has shown that growing up with a cat or dog can lead to fewer allergies later in life.3 Further research demonstrates that having a pet in the home can actually lower a child’s likelihood of developing related allergies by as much as 33%.4 The Journal of Allergy and Clinical Immunology revealed that children exposed early on to animals tend to develop stronger immune systems overall.4

Enhanced stress management capabilities

Pet therapy is becoming increasingly popular and is used in a variety of ways. Many people rely on animals for support, whether in an official capacity as a trained service animal, or in the role of a house pet or registered emotional support animal.

“I know plenty of people whose lives would be significantly different if they didn’t have their companion animals helping them through life: a woman whose dog would alert her when she was about to have a seizure, and people whose assistance dogs help modulate their anxiety levels to function more fully in the world.”

Gaia Mather, ND

Graduate and Assistant Professor, National University of Natural Medicine

Veterans, children and students are just a few groups who have shown that people can experience less stress when a pet is around. A 12-month study of veterans with PTSD symptoms who were involved in a therapeutic dog ownership program revealed that participants experienced significant reductions in symptoms of post-traumatic stress, perceived stress, isolation, and self-judgment accompanied by significant increases in self-compassion.5

“As someone living with PTSD, animals have been a great source of comfort and truly a gift on my healing journey. I started riding at the age of five and cannot imagine my life without a horse. Just being in the presence of my horses, I feel a sense of peace and tranquility that heals my body, mind and soul. Horseback riding and being in nature allows me to re-balance and reconnect with myself and reduces feelings of depression and anxiety.”

Holly Wurtz, ND

Graduate, National University of Health Sciences

Children often have less developed emotional and physiological responses to stress, as well as reduced cognitive coping mechanisms to self-regulate their stress response.6 In a study of typically developing children between the ages of 7 and 12, it was found that perceived stress during a novel stressor is buffered in the presence of a dog.6 University students are another group who experience a good deal of stress. In a study of pet therapy, students experienced a statistically significant reduction in stress markers, including stress as measured on the state trait anxiety inventory and blood pressure when interacting with therapeutic animals.7

Pet therapy may also benefit the workplace. Stress is a major contributor to employee absenteeism, poor morale and burnout, and results in significant loss of productivity and resources.8 Researchers examined how the presence of dogs impacted worker stress throughout the course of a work day. They found that dogs in the workplace may buffer the impact of stress and make the job more satisfying for those with whom they come into contact.9

For some, time with pets is the ultimate stress reliever. “As a practitioner, business owner and mom, my stress levels are inherently high. Cats make a huge difference in helping me recover from stress, giving me a chance to take a break and be in the present moment.”

Doni Wilson, ND, CNS, CPM

Graduate, Bastyr University

NDs share how they incorporate the therapeutic benefits of animals in patient care

“One of my patients was a depressed mother of two small children. Myself along with her other therapists, suggested that she get a dog.  She rescued a boxer and within a few months, her outlook on life and connection with her children improved significantly.”

Marizelle Arce, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

“A 60-year-old woman who complained of stress and anxiety, especially related to her health, got a cat. In taking care of her cat, her anxiety levels decreased, and she felt a sense of companionship. Many people feel isolated and alone, which actually becomes a stressor and causes further health issues. Having a pet can make a huge difference for these patients.”

Doni Wilson, ND, CNS, CPM

Graduate, Bastyr University

“I ask patients about pet ownership and find that pets often have a significant role in people’s lives.  Many pet owners view their pets as family members.  For example, I saw a patient who was experiencing a high level of stress due to work and a recent divorce. As part of his wellness plan, I suggested that he make time to take his beloved golden retriever to a dog park.  He started going to the dog park on a daily basis and felt more relaxed and better able to cope with life’s circumstances.”

Holly Wurtz, ND

Graduate, National University of Health Sciences

Decreased risk of obesity and augmented activity level

Despite intensive campaigns to promote awareness and lifestyle interventions for obesity, obesity and physical inactivity continue to climb, reaching epidemic proportions. In the US, over 60% of adults are overweight or obese, and fewer than 50% achieve recommended amount of physical activity.2 Studies have found that people who walk dogs tend to have lower incidence of obesity and are 53% more likely to meet recommendations for moderate to vigorous physical activity.2 The benefits are not limited to adults. The US has seen a threefold increase in childhood obesity since 1970 with around 20% of children aged 6-19 being considered obese.10 However, research has shown that for younger children, the odds of being overweight or obese were cut in half for those whose family owned a dog versus those who did not.2

Fosters social interaction

Creating, developing, and maintaining social connections with others is an important part of maintaining our long-term health. However, for many people, this is no easy feat. Social anxiety, communication difficulties, and lack of opportunity can all be challenges in forming social bonds. Pets can be great social networkers, helping to facilitate new connections, building support and rapport with others. A 2015 study found that people who were pet owners were over 60% more likely to meet and get to know the people in their neighborhood.11 Although dog owners were the most likely to make new friends while spending time walking their dogs, other types of pets such as cats, rabbits, and even snakes can support a sense of connection as well.2

NDs share how they’ve become involved in the community because of their love for animals

Dr. Mather has volunteered at the Oregon Humane Society with her niece.  She adopted one of her two cats while volunteering.

Gaia Mather, ND

Graduate ad Assistant Professor, National University of Natural Medicine

Dr. Arce and her husband donate toys and blankets to the Yonkers animal shelter. They also volunteer their time to the Mount Vernon animal shelter and Wildlife SOS in an effort to help people realize the importance of rescuing animals. Dr. Arce and her husband are pictured below with their two dogs, both rescued from North Shore Animal League. They also have two cats which were also rescued.

Marizelle Arce, ND

Graduate, University of Bridgeport School of Naturopathic Medicine

“I have five cats, three dogs and two fabulous horses. My furry companions add to the richness of my life. I have volunteered with pet rescues for over 20 years and currently work with two rescues, FurKeeps Cat Rescue and Adopt a River Cat Rescue. I foster cats and kittens until they can find their forever homes and am very privileged to work with a remarkable group of people in rescue who are dedicated to helping both animals and people. We encounter many situations when working in pet rescue in which people need temporary homes for their animals due to unfortunate circumstances such as illness, job loss, domestic violence or homelessness, for example.  We also connect people with resources in the community to help provide support.  It is very rewarding to be able to help my community and be of service to both animals and people in need.”

Holly Wurtz, ND

Graduate, National University of Health Sciences

“I run a not-for-profit organization called Cat Care. Our mission is to care for feral cats in Port Jefferson on Long Island. We also care for a colony of 25 cats on my property. We also have a dachshund and a snake.”

Doni Wilson, ND, CNS, CPM

Graduate, Bastyr University

In summary, pets can serve a multitude of therapeutic functions in addition to being a loving member of our family. The decision to bring a pet into a home should not be taken lightly, however. Pets are a lifelong commitment – so make sure you research care, temperament and lifespans of the animals you are considering, and adopt from reputable locations or rescue organizations. By picking the right pet for your family, you will not only improve your health, but the health of your pet as well!

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