According to the NCCAM study, only one-third of the out-of-pocket costs that adults spend on alternative complementary medicine went to practitioners such as naturopaths. The other two-thirds went to "self-care" purchases of alternative medicine products, which include classes such as yoga and nonvitamin, nonmineral, natural products such as fish oil, glucosamine and echinacea.
Despite the widespread acceptance of alternative medicine in recent years, some naturopaths say they are worried about self-care purchases of supplements.
"The use of them is very complex. There is a lot of science that goes into choosing the right one," said Marnie Loomis, N.D., a director of professional formation at the National College of Natural Medicine in Portland, Ore.
"There are so many people out there thinking that natural equals safe, and that's not true," Loomis said.
Naturopathic doctors are recognized as licensed health care providers in 15 states, up from just a handful a few years ago.
The association of accredited naturopathic medical colleges defines naturopathy as a do-no-harm holistic approach to medicine that "combines many methodologies, such as acupuncture, massage, chiropractic adjustment, homeopathy and herbal cures, along with sensible concepts such as good nutrition, exercise and relaxation techniques."
Loomis said in states where they are licensed, patients' care is almost uniformly coordinated with a mainstream doctor. But, her patients consistently say their dissatisfaction with their current doctor was the reason they chose to come to her.
"From my personal experience in my practice, the phrase I heard most often was 'this is what I thought a doctor's office should look like,'" said Loomis.
"The visits are long, we talk about their entire health history as well as their lifestyle, what food they're eating, what are their exercise habits," she said. "Of the diseases out there -- cancer, diabetes, obesity -- they [patients] keep hearing that lifestyle is part of it, but they don't know how to do it. It is a learned skill."
Loomis said about two-thirds of her patients say extra attention to lifestyle was what motivated them to try her office. Anecdotally, some people who have lost their health insurance come to Loomis for a cheaper alternative.
But one-third comes out of frustration with their current treatment plans. Paul Mittman, N.D., president of South West College of Naturopathic Medicine and Health Sciences in Tempe, Ariz., said he's heard the occasional bristling against mainstream medicine.
"There are some people who come in with a mistrust of medicine, and it's often ironic because they expect to have a sympathetic ear, then I'll tell them, 'I think you need to go ahead and have that surgery,'" said Mittman, who noted four medical doctors who work alongside naturopaths at his institution.
"That's one of the myths that persist, that it has to be oppositional," he said. "Integrating health care, integrating naturopathic medicine into patients' care is really the best way to practice."