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{{short description|Form of alternative medicine}}
'''Orthomolecular medicine''' or '''optimum nutrition''' emphasizes the use of natural substances found in a healthy diet such as ]s, ]s, ]s, ]s, ]s, ]s, ] and intestinal short chain ] (SCFA) in the prevention and treatment of diseases. Orthomolecular medicine focuses on the role of proper nutrition in relation to health. Optimum nutrition asserts that many typical diets are insufficient for long term health. ] comes first in orthomolecular medical diagnoses and treatment, drug treatment is used only for specific indications.
{{Infobox alternative medicine|
| name = Orthomolecular medicine
| image =
| image_size =
| alt =
| caption =
| claims = Health effects of dietary supplements, particularly ]s.
| topics = Naturopathy
| origyear =
| origprop = ] (coined term)
| laterprop =
| seealso =
| MeshID = D009974
}}
{{Alternative medicine sidebar |fringe}}
'''Orthomolecular medicine'''<ref name="isbn1-59120-226-4">{{cite book|author1= Saul AW |author2= Hoffer A|title= Orthomolecular Medicine For Everyone: Megavitamin Therapeutics for Families and Physicians|publisher= Basic Health Publications|location= Laguna Beach, California|year= 2008|isbn= 978-1-59120-226-4|oclc= 232131968|ol= 16944688M|author-link1= Andrew W. Saul|author-link2= Abram Hoffer}}</ref><ref name="pmid7207301">{{cite journal|author= McMichael AJ|title= Orthomolecular medicine and megavitamin therapy|journal= ]|volume= 1|issue= 1|pages= 6–8|date= January 1981|pmid= 7207301|doi= 10.5694/j.1326-5377.1981.tb135275.x|s2cid= 27461422}}</ref> is a form of ] that claims to maintain ] through nutritional ]. It is rejected by evidence-based medicine. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as ], ], ], trace elements and ].<ref name=Hoffer2000>{{cite book|vauthors= Hoffer A, Walker M |year= 2000|title= Smart Nutrients|publisher= Avery|isbn= 978-0-89529-562-0}}</ref><ref name="SkinnerP" /><ref name="orthomed">{{cite web|url= http://www.orthomed.org/|title= Orthomolecular medicine|publisher= orthomed.org|access-date= |archive-url= https://web.archive.org/web/20110827215048/http://orthomed.org/|archive-date= 2011-08-27|url-status= dead}}{{Verify source|date= April 2011}}</ref> The notions behind orthomolecular medicine are not supported by sound ], and the therapy is not effective for chronic disease prevention;<ref name=Aaronson2003/><ref name=NIH_CSSS2006>
{{cite journal|title= NIH state-of-the-science conference statement on multivitamin/mineral supplements and chronic disease prevention|journal= NIH Consens State Sci Statements|volume= 23|issue= 2|pages= 1–30|year= 2006|pmid= 17332802}}</ref> even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.<ref name="APA">
{{Cite document |vauthors= Lipton M, etal | title = Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry | publisher = American Psychiatric Association | year = 1973}}</ref>


The approach is sometimes referred to as ],<ref name="isbn1-59120-226-4"/><ref name="pmid7207301"/> because its practice evolved out of, and in some cases still uses, doses of vitamins and minerals many times higher than the recommended ]. Orthomolecular practitioners may also incorporate a variety of other styles of treatment into their approaches, including ] restriction, megadoses of non-vitamin nutrients and mainstream ].<ref name="isbn1-59120-226-4" /><ref name="Braverman">{{cite journal|author= Braverman Eric|title= Orthomolecular Medicine and Megavitamin Therapy: Future and Philosophy|journal= Journal of Orthomolecular Medicine|volume= 8|issue= 4|pages= 265|year= 1979|url= http://www.orthomolecular.org/library/jom/1979/pdf/1979-v08n04-p265.pdf}}</ref> Proponents argue that non-optimal levels of certain substances can cause health issues beyond simple ] and see balancing these substances as an integral part of health.<ref name=Singh2008>{{cite book |last1= Singh |first1= S |last2= Ernst | first2 = Edzard |author-link2= Edzard Ernst |year= 2008 |title= Trick or Treatment: The Undeniable Facts About Alternative Medicine |publisher= ] |isbn= 978-0-393-06661-6|url= https://books.google.com/books?id=5m6CKTEr3I0C | page = 320|author-link= Simon Singh}}</ref>
Orthomolecular medicine is defined as the provision of the optimum molecular constitution, especially the optimum concentration of substances that are normally present in the body, for the purposes of treating disease and preserving health.


American chemist ] coined the term "orthomolecular" in the 1960s to mean "the right molecules in the right amounts" (''ortho-'' in Greek implies "correct").<ref name=pauling1968 /> Proponents of orthomolecular medicine hold that treatment must be based on each patient's individual biochemistry.<ref name=Baumel2000>{{cite book|author= Baumel Syd|date= August 2000|title= Dealing with depression naturally : complementary and alternative therapies for restoring emotional health|edition= 2nd|location= Los Angeles|publisher= McGraw-Hill|isbn= 978-0-658-00291-5|oclc= 43641423|url-access= registration|url= https://archive.org/details/dealingwithdepre0002baum}}</ref><ref name="autogenerated1">{{cite book|author-link= Roger J. Williams|author= Williams RJ|year= 1998|title= Biochemical individuality: the basis for the genetotrophic concept|edition= 2 |location= New Canaan, Connecticut|publisher= Keats|isbn= 978-0-87983-893-5|oclc= 38239195}}</ref>
] proposed the term "orthomolecular medicine" in ] in the journal ]. <ref> at www.orthomed.org Accessed June 2006. </ref> Orthomolecular treatments are utilized in both ] fields and, to a lesser degree, in conventional medicine. The field of ] deals with the use of orthomolecular medicine to treat psychiatric problems.


The ] holds that the broad claims of efficacy advanced by advocates of orthomolecular medicine are not adequately tested as drug therapies.<ref name=Aaronson2003/> It has been described as a form of ] and as ].<ref>{{cite journal |author= Jarvis WT |title= Food faddism, cultism, and quackery |journal= Annu. Rev. Nutr. |volume= 3 |pages= 35–52 |year= 1983 |pmid= 6315036 |doi= 10.1146/annurev.nu.03.070183.000343 }}</ref> There are specific narrow applications where mainstream research has supported benefits for nutrient supplementation,<ref> {{webarchive|url=https://web.archive.org/web/20130411202134/http://lpi.oregonstate.edu/fw09/tablecont.html |date=2013-04-11 }}. Linus Pauling Institute. Cites research by Gesch summarized in ''Science'' magazine's .</ref><ref name="Gesch">{{cite journal |vauthors= Gesch CB, etal | year = 2002 | title = Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners. Randomised, placebo-controlled trial | journal = The British Journal of Psychiatry: The Journal of Mental Science| volume = 181 | pages = 22–28 | doi=10.1192/bjp.181.1.22 | pmid=12091259| doi-access = free }}</ref> and where conventional medicine uses vitamin treatments for some diseases.
==Method==
In orthomolecular medicine, diseases are assumed to originate from multiple nonspecific causes, congenital and acquired. These causes give rise to biochemical aberrations, the accumulation of which results in symptoms and signs, from which the perception of a disease state follows. Clinically-apparent diseases may be described as fuzzy sets of biochemical anomalies. Clearly, it is advantageous for physicians to recognize and to correct patients’ small sets of biochemical anomalies at an early stage, before expansion of the anomalies results in recognizable diseases.


Some vitamins in large doses have been linked to increased risk of ], ] and death.<ref name="AmJEpidem2009">{{cite journal |vauthors= Satia JA, Littman A, Slatore CG, Galanko JA, White E |title= Long-term Use of β-Carotene, Retinol, Lycopene, and Lutein Supplements and Lung Cancer Risk: Results From the VITamins And Lifestyle (VITAL) Study |journal= Am. J. Epidemiol. |volume= 169 |issue= 7 |pages= 815–28 |date= April 2009 |pmid= 19208726 |doi= 10.1093/aje/kwn409 |pmc=2842198}}{{unreliable medical source|date= February 2014}}</ref><ref name="nyt-vitamin-e">{{cite news | work= ] | title= Extra Vitamin E: No Benefit, Maybe Harm | first= Jane | last= Brody | author-link= Jane Brody | date= March 23, 2009 | access-date= March 24, 2009 | url= https://www.nytimes.com/2009/03/24/health/24brod.html}}</ref><ref name="bbc-vitamin-e">{{cite news | work= ] | title= High dose vitamin E death warning | date= November 11, 2004 | access-date= March 24, 2009 | url= http://news.bbc.co.uk/1/hi/health/3998847.stm}}</ref> The scientific consensus view is that for normal individuals, a ] contains all necessary vitamins and minerals and that routine supplementation is not necessary outside of specific diagnosed deficiencies.<ref>
In practice, the orthomolecular doctor relies heavily on laboratory testing. In addition to standard clinical chemistries, orthomolecular doctors now employ a wide range of sophisticated laboratory analysis, including those for amino acids, organic acids, vitamins and minerals, functional vitamin status, hormones, immunology, microbiology, and gastrointestinal function. Many of the newer tests have not been accepted by conventional medicine.
Duff, Roberta Larson: American Dietetic Association Complete Food and Nutrition Guide, {{ISBN|0470912073}}
</ref>


==History and development==
Orthomolecular therapy consists in attempting to provide optimal amounts of substances normal to the body, most commonly by oral administration. In the early days of orthomolecular medicine, this usually meant high-dose, single-agent nutrient therapy. However, some ailments require the withholding of normal substances. Thus, "optimal" is a matter for clinical judgment. Most often, the orthomolecular practitioner employs multiple vital substances--amino acids, enzymes, non-essential nutrients, hormones, vitamins, minerals, etc.--in a therapeutic effort to restore those (or derivative substances) to levels statistically normal for healthy young persons.
In the early 20th century, some doctors hypothesised that vitamins could cure disease, and supplements were prescribed in megadoses by the 1930s.<ref name="Menolascino"/> Their effects on health were disappointing, though, and in the 1950s and 1960s, nutrition was de-emphasised in standard medical curricula.<ref name="Menolascino"/> Riordon's organization cite figures from this period as founders of their movement,<ref name="OMHistory">
{{cite web |url=http://www.orthomolecular.org/history/index.shtml |title=History of orthomolecular medicine |publisher=riordonclinic.org |access-date=26 August 2013}}</ref> although the word "orthomolecular" was coined by Linus Pauling only in 1967.


Amongst the individuals described posthumously as orthomolecularists are ], who developed a diet that he claimed could treat diseases, which the American Medical Association's 1949 Council on Pharmacy and Chemistry found ineffective;<ref name='AMA_Council'>
Often supplementation with relatively large doses of vitamins is given and the name megavitamin therapy has become popularly associated with the field. ] is the administration of large amounts of vitamins, often many times greater than the ] (RDA). Short chained fatty acids are produced by fermentation of ] in the colon, then absorbed and utilized, often aided with a combination of ], ] and "]" added to the diet.
{{cite journal |title=Report of the council: cancer and the need for facts |journal=JAMA |date=January 8, 1949 |author=AMA Council on Pharmacy and Chemistry |volume=139 |issue= 2|pages=93–98 |doi=10.1001/jama.1949.02900190023007 }}</ref> and ] and his brother, who attempted to treat heart disease with ].<ref name="Shute">
{{cite web |url=http://orthomolecular.org/hof/2004/ewshute.html |work=Hall of Fame |title=Evan Shute & Wilfrid Shute |publisher=Riordonclinic.org |access-date=2013-08-26}}</ref> Several concepts now cited by orthomolecularists, including individual biochemical variation<ref name="autogenerated1" /> and ],<ref name="Menolascino">
{{cite journal |vauthors=Menolascino FJ, Donaldson JY, Gallagher TF, Golden CJ, Wilson JE |title=Orthomolecular therapy: its history and applicability to psychiatric disorders |journal=Child Psychiatry Hum Dev |volume=18 |issue=3 |pages=133–50 |year=1988 |pmid=2898324 |doi=10.1007/BF00709727 |s2cid=38354755 }}</ref><ref>{{cite journal |author=Mason SF |url=http://oregonstate.edu/dept/spc/subpages/ahp/overview/entirearticle.htm |title=The science and humanism of Linus Pauling (1901–1994) |journal=Chemical Society Reviews |volume=26 |issue=1 |year=1997 |access-date=2009-02-16 |doi=10.1039/cs9972600029 |pages=29–39 |archive-url=https://web.archive.org/web/20090515124732/http://oregonstate.edu/dept/spc/subpages/ahp/overview/entirearticle.htm |archive-date=2009-05-15 |url-status=dead }}</ref><ref>
{{cite book |author=Magner Lois N |title=A history of medicine |publisher=Taylor & Francis |location=Washington, DC |year=2005 |edition=Second |isbn=978-0-8247-4074-0 |oclc=142979953 }}</ref> debuted in scientific papers early in the 20th century.


In 1948, William McCormick theorized that ] deficiency played an important role in many diseases and began to use large doses in patients.<ref name="McCormick">
The substances may be administered by changing the diet to emphasize certain elements high in nutrients, dietary supplementation with tablets, or intravenous injection of nutrient solutions.
{{cite journal |author=McCormick WJ |title=Vitamin C in the prophylaxis and therapy of infectious diseases |journal=Arch Pediatr |volume=68 |issue=1 |pages=1–9 |date=January 1951 |pmid=14800557 }}</ref> In the 1950s, ] also tried ] megadosage as a therapy for a wide range of illnesses, including ].<ref>
{{cite journal |url=http://www.doctoryourself.com/klennerbio.html |title=Hidden in plain sight: the pioneering work of Frederick Robert Klenner, M.D |author=Saul AW |journal=] |year=2007 |volume=22 |issue=1 |pages=31–38 |access-date=2009-02-16}}</ref> ] stated that organisms that do not synthesise their own vitamin C due to a loss-of-function mutation have a disease he called "hypoascorbemia".<ref>
{{cite journal |author=Stone I |title=The genetic disease, hypoascorbemia. A fresh approach to an ancient disease and some of its medical implications |journal=Acta Genet Med Gemellol |volume=16 |issue=1 |pages=52–62 |date=January 1967 |pmid=6063937|doi=10.1017/S1120962300013287 |s2cid=41252990 |doi-access=free }}</ref> This term is not used by the medical community, and the idea of an organism-wide lack of a biosynthetic pathway as a disease was not endorsed by Stone's contemporaries.<ref>
{{cite journal |author=Chatterjee IB |title=Evolution and the biosynthesis of ascorbic acid |journal=Science |volume=182 |issue=4118 |pages=1271–2 |date=December 1973 |doi=10.1126/science.182.4118.1271 |pmid=4752221 |bibcode = 1973Sci...182.1271C |s2cid=26992098 }}</ref>


In the 1950s, some individuals believed that vitamin deficiencies caused mental illness.<ref name="Menolascino"/> Psychiatrists ] and ] gave people having acute ] episodes high doses of ],<ref>
==Criticism==
{{cite journal |vauthors=Hoffer A, Osmond H, Callbeck MJ, Kahan I |title=Treatment of schizophrenia with nicotinic acid and nicotinamide |journal=Journal of Clinical and Experimental Psychopathology |volume=18 |issue=2 |pages=131–58 |year=1957 |pmid=13439009 }}</ref> while William Kaufman used ]. While niacin has no known efficacy in psychiatric disease, the use of niacin in combination with ] and other medical therapies has become one of several medical treatments for cardiovascular disease.<ref name=ACS>
Some health professionals see orthomolecular medicine as an encouragement for individuals to dose themselves with large amounts of vitamins and other nutritients in an unsupervised way, which can be damaging to health. Frequent risks include ], ], ] or sponaneous ] in case of pregnancy, ] or ].
{{cite web | url=http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Orthomolecular_Medicine.asp?sitearea=ETO | title=Orthomolecular medicine | access-date=2008-04-04 | work=Making treatment decisions | publisher=] | date=2007-06-19 | url-status=dead | archive-url=https://web.archive.org/web/20080329160117/http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Orthomolecular_Medicine.asp?sitearea=ETO | archive-date=2008-03-29 }}</ref><ref>
<ref></ref>
{{cite journal |author=Guyton JR |title=Niacin in cardiovascular prevention: mechanisms, efficacy, and safety |journal=Current Opinion in Lipidology |volume=18 |issue=4 |pages=415–20 |year=2007 |pmid=17620858 |doi=10.1097/MOL.0b013e3282364add|s2cid=1647629 }}</ref>
<ref></ref>
<ref></ref>


In the late 1960s, ] introduced the expression "orthomolecular"<ref name=pauling1968>
BC Cancer Agency of Canada gives this summary description of orthomolecular treatments: <ref></ref>
{{cite journal |author=Pauling L |title=Orthomolecular psychiatry. Varying the concentrations of substances normally present in the human body may control mental disease |journal=] |volume=160 |issue=3825 |pages=265–71 |date=April 1968 |pmid=5641253 |doi=10.1126/science.160.3825.265 |bibcode=1968Sci...160..265P|s2cid=20153555 }}</ref> to express the idea of ''the right molecules in the right amounts''.<ref name=pauling1968/> Since the first claims of medical breakthroughs with vitamin C by Pauling and others, findings on the health effects of vitamin C have been controversial and contradictory.<ref>
{{cite journal |vauthors=Chen Q, Espey MG, Sun AY, etal |title=Pharmacologic doses of ascorbate act as a prooxidant and decrease growth of aggressive tumor xenografts in mice |journal=] |volume=105 |issue=32 |pages=11105–11109 |date=August 2008 |pmid=18678913 |doi=10.1073/pnas.0804226105 |pmc=2516281|bibcode = 2008PNAS..10511105C |doi-access=free }}</ref><ref>
{{cite journal |vauthors=Heaney ML, Gardner JR, Karasavvas N, etal |title=Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs |journal=] |volume=68 |issue=19 |pages=8031–8 |date=October 2008 |pmid=18829561 |doi=10.1158/0008-5472.CAN-08-1490 |pmc=3695824 }}</ref> Pauling's claims have been criticised as overbroad.<ref>
{{cite web | first=SJ | last=Barrett | author-link=Stephen Barrett | title=The dark side of Linus Pauling's legacy | publisher=] | url=http://www.quackwatch.org/01QuackeryRelatedTopics/pauling.html | access-date=2008-04-04 | date=2001-05-05}}</ref>


Later research branched out into nutrients besides niacin and vitamin C, including ]s.<ref name=Kidd2007>
:''Megavitamin and orthomolecular therapies are unproven methods considered dangerous by mainstream scientists. "Scientific research has found no benefit from orthomolecular therapy for any disease." (Cassileth)''
{{cite journal |author=Kidd PM |title=Omega-3 DHA and EPA for cognition, behavior, and mood: clinical findings and structural-functional synergies with cell membrane phospholipids |journal=] |volume=12 |issue=3 |pages=207–27 |date=September 2007 |pmid=18072818 }}</ref>


==Popularity== ==Scope==
According to Abram Hoffer, orthomolecular medicine does not purport to treat all diseases, nor is it "a replacement for standard treatment. A proportion of patients will require orthodox treatment, a proportion will do much better on orthomolecular treatment, and the rest will need a skillful blend of both."<ref name="huemer"/> Nevertheless, advocates have said that the right nutrients at the optimum dose for the individual concerned can prevent,<ref>{{cite journal |url=http://www.genengnews.com/news/bnitem.aspx?name=23587988 |title=Clinical data shows vitamin C may reduce risks of cancer, heart disease and variety of other health disorders |journal=Genetic Engineering & Biotechnology News |date=September 24, 2007 |volume=3 |issue=1 |pages=25–35 |author=Moyad Mark A |access-date= |edition=reporting on seminars in preventive and alternative medicine |url-status=dead |archive-url=https://web.archive.org/web/20071121151355/http://www.genengnews.com/news/bnitem.aspx?name=23587988 |archive-date=2007-11-21}}</ref> treat, and sometimes cure a wide range of medical conditions. Conditions for which orthomolecular practitioners have claimed some efficacy are: ],<ref>
A <ref> </ref> survey released in May 2004] by the ] focused on who used ] (CAM), what was used, and why it was used in the United States by adults age 18 years and over during 2002. According to this recent survey, mega-vitamin therapy was the 9th most commonly used CAM therapy (2.8%) in the United States during 2002 <ref> table 1 on page 8 </ref>. Consistent with previous studies, this study found that the majority of individuals (54.9%) used CAM in conjunction with ] (page 6). "The fact that only 11.8% of adults sought care from a licensed or certified CAM practitioner suggests that most individuals who use CAM self-prescribe and/or self-medicate." (page 6).
{{cite journal |author=Leung Lit-Hung |url=http://orthomolecular.org/library/jom/1997/articles/1997-v12n02-p099.shtml |title=A stone that kills two birds: how pantothenic acid unveils the mysteries of acne vulgaris and obesity |journal=J Orthomol Med |volume=12 |issue=2 |year=1997 |pages=99–114 |issn=0834-4825 |oclc=15726974}}</ref> ],<ref>
{{cite book |title=Bill W. : a biography of Alcoholics Anonymous cofounder Bill Wilson |author=Francis Hartigan |oclc=42772358 |year=2000 |location=New York |publisher=Thomas Dunne Books |pages=204–209 |isbn=978-0-312-20056-5}}</ref> ], ], ], ]s, ], ], ],<ref name=Pauling>
{{cite journal |year=1976 |title=Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer |journal=Proceedings of the National Academy of Sciences |volume=73 |pages=3685–9 |author1=Cameron Ewan |author2=Pauling Linus |doi=10.1073/pnas.73.10.3685 |pmid=1068480 |issue=10 |pmc=431183 |bibcode=1976PNAS...73.3685C|doi-access=free }} (self published)</ref><ref>
{{cite book |author1=Cameron Ewan |author2=Pauling Linus |title=Cancer and vitamin C : a discussion of the nature, causes, prevention, and treatment of cancer with special reference to the value of vitamin C |publisher=Norton |location=New York |year=1979 |isbn=978-0-393-50000-4 |oclc=5788147 |url=https://archive.org/details/cancervitaminc00came }}</ref> the ], ], ], ], ], ], ], acute ], ], ], ], ], ], ], ] and ],<ref>Princeton Brain Bio Center. Brochure, distributed to patients. Skillman, New Jersey, 1983, The Center.</ref> ], ], ], ] & ] (including ]), ],<ref>
{{Cite journal| pmid = 15771560| year = 2005| last1 = Plaza | first1 = S. M.| last2 = Lamson | first2 = D. W.| title = Vitamin K2 in bone metabolism and osteoporosis| volume = 10| issue = 1| pages = 24–35| journal = Alternative Medicine Review}}</ref> ], a hypothesised condition called "pyroluria", ], ], ], ],<ref name="SkinnerP">
{{cite web |url=http://findarticles.com/p/articles/mi_g2603/is_0000/ai_2603000096 |author=Skinner Patricia |title=Gale encyclopedia of alternative medicine: holistic medicine |publisher=Thomson Gale |year=2004}}</ref> ], ] problems, ], ], ] and ].<ref name=Klenner1971>
{{cite journal |author=Klenner FR |year=1971 |title=Observations on the dose and administration of ascorbic acid when employed beyond the range of a vitamin in human pathology |journal=J Appl Nutr |volume=23 |pages=61–88}} as reprinted with edits in {{cite journal |title=Observations on the dose and administration of ascorbic acid when employed beyond the range of a vitamin in human pathology |editor=Hoffer A |url=http://orthomolecular.org/library/jom/1998/pdf/1998-v13n04-p198.pdf |journal=J Orthomol Med |year=1998 |volume=13 |issue=4 |pages=198–210 |issn=0834-4825 |oclc=15726974}} (self published)</ref>


==Orthomolecular psychiatry==
==Relation to conventional medicine==
{{Main|Orthomolecular psychiatry}}
Orthomolecular medicine claims an evolving nutritional pharmacology that overlaps between natural medicine and conventional medicine. The International Society for Orthomolecular Medicine has many conventionally trained doctors among its members and authors.
Hoffer believed that particular nutrients could cure ]. In the 1950s, he attempted to treat schizophrenia with niacin, although proponents of orthomolecular psychiatry say that the ideas behind their approach predate Hoffer.<ref>
{{cite journal |last=Reiter |first=PJ |title= Behandlung von Dementia praecox mit Metallsalzen a. m. Walbum. I. Mangan|journal= Zeitschrift für die Gesamte Neurologie und Psychiatrie|volume=108 |pages=464–80 |year=1927 |doi=10.1007/bf02863975|s2cid=163595385 }} as cited in {{cite journal |last1=Pfeiffer |first1=C |last2=LaMola |first2=S |title=Zinc and Manganese in the Schizophrenias |journal=Journal of Orthomolecular Psychiatry |volume=12 |issue=3 |year=1983 }}</ref><ref>
{{cite book |author=Kay Lily E |title=The molecular vision of life: Caltech, the Rockefeller Foundation, and the rise of the new biology |publisher=Oxford University Press |location=Oxford |year=1993 |isbn=978-0-19-511143-9}}</ref> According to Hoffer and others who called themselves "orthomolecular psychiatrists", psychiatric syndromes result from biochemical deficiencies, allergies, toxicities or several hypothetical contributing conditions which they termed ], ] and ]. These purported causes were said to be found during an "individual biochemical workup" and treated with ] and dietary changes including ].<ref name=Edelman>
{{cite book |author=Edelman Eva |title=Natural healing for schizophrenia: and other common mental disorders |publisher=Borage |year=2001 |isbn=978-0-9650976-7-3 }}</ref> These diagnoses and treatments are not accepted by evidence-based medicine.<ref name=QW />


==Principles==
However, many conventional medical physicians regard most orthomolecular therapies as insufficiently proven for clinical use. Proponents contend that many conventional doctors have little familiarity with the detailed concepts and clinical background of orthomolecular medicine. Conventional medicine disputes the validity of most orthomolecular therapies based on the lack of authoritative studies and the results from some disputed studies. Proponents note that the disputed studies used much lower doses, frequencies, duration or assimilable forms than they recommend or other special conditions, contamination, populations or statistical treatment often not clearly published in the documentation.
According to Abram Hoffer, "primitive" peoples do not consume processed foods and do not have "degenerative" diseases.<ref>
{{cite book |author=Weston Price |year=2008 |title= |publisher=Price Pottenger Nutrition |edition=8th |isbn=978-0-916764-20-3}}</ref> In contrast, typical "Western" diets are said to be insufficient for long-term health, necessitating the use of megadose supplements of ]s, ]s, ]s, ]s, ]s, ], ], ], ], short and long chain ], ], systemic and ]s, other digestive factors, and prohormones to ward off hypothetical ] anomalies at an early stage, before they cause disease.<ref name="huemer">
{{cite journal |author=Huemer RP |title=A theory of diagnosis for orthomolecular medicine |journal=J Theor Biol |volume=67 |issue=4 |pages=625–35 |date=August 1977 |pmid=904336 |doi=10.1016/0022-5193(77)90250-8 |bibcode=1977JThBi..67..625H }}</ref>


Orthomolecularists say that they provide prescriptions for optimal amounts of ] after individual diagnoses based on blood tests and personal histories.<ref name=Hoffer2000 /><ref name=Baumel2000 /> Lifestyle and diet changes may also be recommended. The battery of tests ordered includes many that are not considered useful by medicine.<ref name = QW/>
The relationship of conventional medicine to Orthomolecular proponents has been sometimes technically adversarial. Sometimes proponents claim partisan politics, pharmaceutical industry influence, and competitive considerations to be significant factors.{{fact}} Some other orthomolecular therapies have been long recognized and officially sanctioned within Europe and Japan.{{fact}}


==Prevalence==
Orthomolecular medicine is practiced by few medical practitioners.<ref name="cassileth">
{{cite book |author=Cassileth Barrie R |title=The alternative medicine handbook: the complete reference guide to alternative and complementary therapies |publisher=W.W. Norton |location=New York |year=1999 |pages= |isbn=978-0-393-31816-6 |oclc=40880206 |url=https://archive.org/details/alternativemedic00barr/page/67 }}</ref><ref name="wund">
{{cite web |url=http://www.orthomolecular.org/library/jom/1988/pdf/1988-v03n04-p159.pdf |title=Orthomolecular Medicine Revisited |author=Wunderlich RC |publisher=Orthomolecular Medicine Online |access-date=2009-03-02}}</ref>


A survey released in May, 2004 by the ] focused on who used ], what was used, and why it was used in the United States by adults age 18 years and over during 2003. The survey reported uses in the previous twelve months that include orthomolecular related uses: Nonvitamin, nonmineral, natural products 18.9%, Diet-based therapies 3.5%, Megavitamin therapy 2.8%.<ref name=NCCAMsurvey>
==Orthomolecular doctors==
{{cite journal |vauthors=Barnes PM, Powell-Griner E, McFann K, Nahin RL |title=Complementary and alternative medicine use among adults: United States, 2002 |journal=Adv Data |issue=343 |pages=1–19 |date=May 2004 |pmid=15188733 |url=https://www.cdc.gov/nchs/data/ad/ad343.pdf}}</ref>
*]
*]
*]
*]
*]


Another recent CAM survey reported that 12% of liver disease patients used the antioxidant ], more than 6% used vitamins, and that "in all, 74% of patients reported using CAM in addition to the medications prescribed by their physician, but 26% did not inform their physician of their CAM use."<ref>
==Orthomolecular scientists==
{{cite journal |vauthors=Strader DB, Bacon BR, Lindsay KL, etal |title=Use of complementary and alternative medicine in patients with liver disease |journal=Am J Gastroenterol |volume=97 |issue=9 |pages=2391–7 |date=September 2002 |doi=10.1111/j.1572-0241.2002.05993.x |pmid=12358262 |s2cid=23079537 }}</ref>
*]
*]


Even though the health benefits are not established, the use of high doses of vitamins is also common in people who have been diagnosed with cancer.<ref name=Velicer>
{{cite journal |vauthors=Velicer CM, Ulrich CM |title=Vitamin and mineral supplement use among US adults after cancer diagnosis: a systematic review |journal=J Clin Oncol |volume=26 |issue=4 |pages=665–73 |year=2008 |pmid=18235127 |doi=10.1200/JCO.2007.13.5905}}</ref> According to ], cancer patients should always seek professional advice before taking such supplements, and using them as a substitute for conventional treatment "could be harmful to health and greatly reduce the chance of curing or controlling cancer".<ref name=cuk>{{cite web|url=http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/complementary-alternative/about/harm/the-safety-of-vitamins-and-diet-supplements|title=The safety of vitamins and diet supplements|date=30 August 2017|publisher=]|access-date=|archive-date=11 September 2013|archive-url=https://web.archive.org/web/20130911230604/http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/complementary-alternative/about/harm/the-safety-of-vitamins-and-diet-supplements|url-status=dead}}</ref>


==Medical and scientific reception==
==References==
<references/>


===Methodology===
Orthomolecular therapies have been criticized as lacking a sufficient evidence base for clinical use: their scientific foundations are too weak, the studies that have been performed are too few and too open to interpretation, and reported positive findings in observational studies are contradicted by the results of more rigorous clinical trials.<ref name="cassileth"/><ref>
{{cite web |url=http://www.canstats.org/readdetail.asp?id=542 |title=Vitamin C for SARS? |publisher=Canadian Statistical Assessment Service |date=June 12, 2003|archive-url = https://web.archive.org/web/20050925010741/http://www.canstats.org/readdetail.asp?id=542 |archive-date = September 25, 2005}}</ref> Accordingly, "there is no evidence that orthomolecular medicine is effective". Proponents of orthomolecular medicine strongly dispute this statement by citing studies demonstrating the effectiveness of treatments involving vitamins, though this ignores the belief that a normal diet will provide adequate nutrients to avoid deficiencies, and that orthomolecular treatments are not actually related to ].<ref name=Singh2008/> The lack of scientifically rigorous testing of orthomolecular medicine has led to its practices being classed with other forms of alternative medicine and regarded as unscientific.<ref>
{{cite journal |author=Leibovici L |title=Alternative (complementary) medicine: a cuckoo in the nest of empiricist reed warblers |journal=BMJ |volume=319 |issue=7225 |pages=1629–32 |year=1999 |pmid=10600974 |pmc=1127092 |doi=10.1136/bmj.319.7225.1629}}</ref><ref name=Sampson2005>
{{cite journal |vauthors=Sampson W, Atwood K |title=Propagation of the Absurd: demarcation of the Absurd revisited |year=2005 |journal=Med J Aust |volume=183 |issue=11–12 |pages=580–1 |url=https://www.mja.com.au/public/issues/183_11_051205/sam10986_fm.pdf | pmid=16336135|doi=10.5694/j.1326-5377.2005.tb00040.x |s2cid=43272637 }}</ref><ref>{{Cite web |author1=Task Force on Complementary |author2=Alternative Medicine; Burch T |publisher=Legislative Research Commission |location=] |title=Report on complementary and alternative medicine |year=2000 |url=http://www.lrc.ky.gov/lrcpubs/Rm491.pdf |display-authors=etal |access-date=2008-08-14 |archive-date=2009-05-12 |archive-url=https://web.archive.org/web/20090512060437/http://www.lrc.ky.gov/lrcpubs/Rm491.pdf |url-status=dead }}</ref> It has been described as ] and ], with critics arguing that it is based upon an "exaggerated belief in the effects of nutrition upon health and disease."<ref name="autogenerated3">
{{cite journal |author=Jarvis WT |title=Food faddism, cultism, and quackery |journal=Annu Rev Nutr |volume=3 |issue=1 |pages=35–52 |year=1983 |pmid=6315036 |doi=10.1146/annurev.nu.03.070183.000343}}</ref><ref name=Jukes1990>{{cite journal | author=Jukes TH | year=1990 | title=Nutrition science from vitamins to molecular biology | journal=Annual Review of Nutrition | volume=10 | issue=1 | pages=1–20 | doi=10.1146/annurev.nu.10.070190.000245 | pmid=2200458| doi-access=free }} A short summary is in .</ref><ref name="autogenerated2">
{{cite journal | author=Braganza SF |author2=Ozuah PO | year=2005 | title=Fad therapies | journal=Pediatrics in Review | volume=26 | issue=10 | pages=371–376 | doi=10.1542/pir.26-10-371 | pmid=16199591}}</ref> Orthomolecular practitioners will often use dubious diagnostic methods to define what substances are "correct"; one example is ], which produces spurious results when used in this fashion.<ref name=Singh2008/>


Proponents of orthomolecular medicine contend that, unlike some other forms of alternative medicine such as ], their ideas are at least biologically based, do not involve ],<ref name=Lindeman2000>
* Abram Hoffer (1998) Putting It All Together: The New Orthomolecular Nutrition, McGraw-Hill, ISBN 0879836334
{{cite journal |vauthors=Lindeman M, Keskivaara P, Roschier M | title=Assessment of magical beliefs about food and health | date= April 1, 2000 | journal=Journal of Health Psychology | volume=5 | issue=2 | pages=195–209 | doi=10.1177/135910530000500210| pmid=22049010 | s2cid=23255517 }}</ref> and are capable of generating testable hypotheses.<ref name=Jonas1999>
* Abram Hoffer, M.D. with Linus Pauling (2004) Healing Cancer: Complementary Vitamin & Drug Treatments, CCNM Press, ISBN 1897025114
{{Cite journal | author=Jonas WB | year=1999 | title=Magic and methodology: when paradigms clash | journal=The Journal of Alternative and Complementary Medicine | volume=5 | issue=4 | pages=319–21 | doi=10.1089/acm.1999.5.319 | pmid=10471010}}</ref> ''Orthomolecular'' is not a standard medical term, and clinical use of specific nutrients is considered a form of chemoprevention (to prevent or delay development of disease) or chemotherapy (to treat an existing condition).<ref name=Martinez2008>
* Pauling, Linus (1986) How to Live Longer and Feel Better, W. H. Freeman and Company, ISBN 0-380-70289-4
{{cite journal |vauthors=Martínez ME, Marshall JR, Giovannucci E |title=Diet and cancer prevention: the roles of observation and experimentation |journal=Nature Reviews Cancer |volume=8 |issue=9 |pages=694–703 |year=2008 |pmid=19143054 |doi=10.1038/nrc2441 |s2cid=376975 }}</ref>
* Roger J. Williams, Dwight K. Kalita (1979) Physician's Handbook on Orthomolecular Medicine, Keats Publishing, ISBN 0879831995

* Melvyn R. Werbach, Jeffrey Moss (1999) Textbook of Nutritional Medicine, Third Line Press, ISBN 0961855096
Despite a lack of evidence for its efficacy, interest in intravenous high dose vitamin C therapy has not been permanently extinguished, and some research groups continue to investigate whether it has an effect as a possible cancer treatment.<ref name="cancer1">{{Cite journal | last1 = Ohno | first1 = S | last2 = Ohno | first2 = Y | last3 = Suzuki | first3 = N | last4 = Soma | first4 = G | last5 = Inoue | first5 = M | title = High-dose vitamin C (ascorbic acid) therapy in the treatment of patients with advanced cancer | journal = Anticancer Research | volume = 29 | issue = 3 | pages = 809–15 | year = 2009 | pmid = 19414313}}</ref><ref name="LevinePadayatty2011">{{cite journal|last1=Levine|first1=M.|last2=Padayatty|first2=S. J.|last3=Espey|first3=M. G.|title=Vitamin C: A Concentration-Function Approach Yields Pharmacology and Therapeutic Discoveries|journal=Advances in Nutrition|volume=2|issue=2|year=2011|pages=78–88|issn=2156-5376|doi=10.3945/an.110.000109|pmid=22332036|pmc=3065766}}</ref>
* Joseph E. Pizzorno, Jr., Michael T. Murray (November 2005) Textbook of Natural Medicine, 3rd edition, Churchill Livingstone, ISBN 0443073007 · 2368pp

===Views on safety and efficacy===
In general, the vitamin megadoses advocated by orthomolecular medicine are unsupported by scientific consensus.<ref name=ACS/> Some vitamins such as vitamins ADEK are toxic in high doses,<ref name=NutCom1990>
{{cite journal |author1=Nutrition Committee |author2=Canadian Paediatric Society | date= January 1, 1990 | title=Megavitamin and megamineral therapy in childhood. Nutrition Committee, Canadian Paediatric Society | journal= Canadian Medical Association Journal | volume=143 | issue=10 | pages=1009–13 | pmc=1452516 | pmid=1699646 }}</ref> including ] (B<sub>3</sub>),<ref>{{cite encyclopedia|url=https://www.nlm.nih.gov/medlineplus/ency/article/002409.htm|title=Niacin|encyclopedia=MedlinePlus Encyclopedia|author=National Library of Medicine|date=March 2009|access-date=2010-04-28|publisher=National Library of Medicine|quote=Large doses of niacin can cause liver damage, peptic ulcers, and skin rashes. Even normal doses can be associated with skin flushing. It can be prescribed as a treatment for elevated total cholesterol and other types of lipid disorders, but it should only be used with medical supervision due to its potential for severe side effects.}}</ref> ] (D)<ref>{{cite encyclopedia|url=https://www.nlm.nih.gov/medlineplus/ency/article/002405.htm|title=Vitamin D|encyclopedia=MedlinePlus Encyclopedia|author=National Library of Medicine|date=March 2009|access-date=2010-04-28|publisher=National Library of Medicine|quote=Vitamin D deficiency can lead to osteoporosis in adults or rickets in children. Too much vitamin D can make the intestines absorb too much calcium. This may cause high levels of calcium in the blood. High blood calcium can lead to calcium deposits in soft tissues such as the heart and lungs. This can reduce their ability to function. Kidney stones, vomiting, and muscle weakness may also occur in someone who has too much vitamin D.}}</ref> and ] (E).<ref>{{cite encyclopedia|url=https://www.nlm.nih.gov/medlineplus/ency/article/002406.htm|title=Vitamin E|encyclopedia=MedlinePlus Encyclopedia|author=National Library of Medicine|date=March 2009|access-date=2010-04-28|publisher=National Library of Medicine|quote=In November, 2004, the American Heart Association stated that high amounts of vitamin E can be harmful. Taking 400 IU per day, or higher, may increase the risk of death. Taking smaller amounts, such as those found in a typical multivitamin, was not harmful.}}</ref> The view of the medical community is that there is no evidence for the efficacy of Orthomolecular medicine as a treatment for cancer,<ref name=Aaronson2003>
{{cite book |vauthors=Aaronson S, etal |title=Cancer medicine 6 |editor1=Frei Emil |editor2=Kufe Donald W |editor3=Holland James F |publisher=BC Decker |location=Hamilton, Ontario |year=2003 |pages= |isbn=978-1-55009-213-4 |chapter=Cancer medicine |chapter-url=https://www.ncbi.nlm.nih.gov/books/bv.fcgi?call=bv.View..ShowTOC&rid=cmed6.TOC&depth=2 |quote=There is no evidence that megavitamin or orthomolecular therapy is effective in treating any disease. |url=https://archive.org/details/cancermedicine60002unse |url-access=registration }}</ref> and that high vitamin doses may&nbsp;&ndash; on the contrary&nbsp;&ndash; increase overall mortality.<ref name=incmort>{{cite journal|last1=Bjelakovic|first1=G|last2=Nikolova|first2=D|last3=Simonetti|first3=RG|last4=Gluud|first4=C|title=Antioxidant supplements for preventing gastrointestinal cancers.|journal=The Cochrane Database of Systematic Reviews|date=16 July 2008|issue=3|pages=CD004183|pmid=18677777|doi=10.1002/14651858.CD004183.pub3}}</ref> Nutritional treatments are not generally accepted as being helpful for psychological health.<ref>
{{cite journal |author=Miller M |title=Diet and psychological health |journal=Altern Ther Health Med |volume=2 |issue=5 |pages=40–8 |year=1996 |pmid=8795935 }}</ref> Its claims have been criticized by most medical organizations, including the ], the ], the ],<ref name=QW>
{{cite web |url=http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html |title=Orthomolecular therapy |last=Barrett |first=Stephen |author-link=Stephen Barrett |publisher=] |date=2000-07-12 |access-date=2008-01-02}}</ref> the ],<ref>
{{cite journal |url=http://pediatrics.aappublications.org/cgi/content/abstract/72/5/707 |title=Vitamin and mineral supplementation in Down's syndrome |journal=Pediatrics |volume=72 |issue=5 |pages=707–713 |first=Forrest C |last=Bennett|date=November 1983 |doi=10.1542/peds.72.5.707 |pmid=6226926 |s2cid=1888682 }}</ref> ], and the ]. The ] describes as "myths" the ideas that adequate nutrition is not readily achievable with normal food, all food grown with pesticide is poisonous, all food additives are poisonous, vitamin and mineral deficiencies are common, that the cause of most disease is poor diet, which can be prevented by nutritional supplements.
<ref name=ama-diet-myth>{{cite web |url=http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml |title=Report 12: Alternative medicine |author=Council on Scientific Affairs |date=June 1997 |access-date=2009-02-18 |publisher=] |archive-date=2009-06-14 |archive-url=https://web.archive.org/web/20090614085504/http://www.ama-assn.org/ama/no-index/about-ama/13638.shtml |url-status=dead }}</ref>

Similarly, the ] comments that the current scientific evidence does not "support use of orthomolecular therapy for most of the conditions for which it is promoted." Some supplements have exhibited benefits for specific conditions, while a few have been confirmed to be harmful; the consumption of nutritious foods is the best recognized method to obtain vitamins, minerals, and nutrients crucial for good health.<ref name="ACS"/> ], an adviser on alternative medicine to the ], stated that "scientific research has found no benefit from orthomolecular therapy for any disease,"<ref name="cassileth"/> and medical textbooks also report that there is "no evidence that megavitamin or orthomolecular therapy is effective in treating any disease."<ref>
{{cite book |author1=Frei Emil |author2=Kufe Donald W |author3=Holland James F |title=Cancer medicine 6 |chapter=20.76. Complementary and alternative cancer therapies |publisher=BC Decker |location=Hamilton, Ontario |year=2003 |pages= |isbn=978-1-55009-213-4 |chapter-url=https://www.ncbi.nlm.nih.gov/books/bv.fcgi?highlight=orthomolecular&rid=cmed6.section.18479&WebEnv=0MnZPX94hO0XD2ugCELLkbhpkV5QLNBinRc8fAJ1IwDvCVoCzamY2zTpsFeeRiEdbTVTXzrZpQLqXt%40263F77C978AD3D40_0136SID&WebEnvRq=1#18482 |access-date=2008-04-04 |url=https://archive.org/details/cancermedicine60002unse |url-access=registration }}</ref>

A 1973 task force of the American Psychiatric Association unanimously concluded:
<blockquote>This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment", to be deplorable.<ref>
{{Cite book |vauthors=Lipton M, etal |title=Task force report on megavitamin and orthomolecular therapy in psychiatry |location=Washington DC |year=1973 |publisher=]}}; as cited in {{cite web |url=http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html |title=Orthomolecular Therapy |last=Barrett |first=Stephen |author-link=Stephen Barrett |publisher=] |date=2000-07-12 |access-date=2008-01-02}}</ref></blockquote>

In response to claims that orthomolecular medicine could cure childhood psychoses and learning disorders, the ] labelled orthomolecular medicine a "]" in 1976.<ref name="pmid995522">
{{cite journal |author=American Academy of Pediatrics Committee on Nutrition |title=Megavitamin therapy for childhood psychoses and learning disabilities |journal=Pediatrics |volume=58 |issue=6 |pages=910–2 |year=1976 |doi=10.1542/peds.58.6.910 |pmid=995522|s2cid=58766636 }}</ref>

Proponents of orthomolecular medicine counter that some vitamins and nutrients are now used in medicine as treatments for specific diseases, such as megadose ] and fish oil for ]s, and megavitamin therapies for a group of rare ].<ref name="Menolascino"/> A review in the '']'' concluded that while some therapies might be beneficial, others might be harmful or interfere with effective medical therapy.<ref>
{{cite journal |vauthors=Eisenberg DM, Cohen MH, Hrbek A, Grayzel J, Van Rompay MI, Cooper RA |title=Credentialing complementary and alternative medical providers |journal=Ann Intern Med |volume=137 |issue=12 |pages=965–73 |date=December 2002 |pmid=12484712 |doi=10.7326/0003-4819-137-12-200212170-00010|s2cid=7780006 }}</ref> A recent study of over 161,000 individuals provided, in the words of the authors, "convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women."<ref name=pmid19204221>
{{cite journal |vauthors=Neuhouser ML, Wassertheil-Smoller S, Thomson C, etal |title=Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts |journal=Arch Intern Med |volume=169 |issue=3 |pages=294–304 |date=February 2009 |pmid=19204221 |doi=10.1001/archinternmed.2008.540|pmc=3868488 }}</ref> A recent ] in '']'' suggested that supplementation with combinations of antioxidant vitamins (], ], and ]) may increase mortality, although with respect to beta-carotene this conclusion may be due to the known harmful effect in smokers.<ref>
{{cite journal |vauthors=Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C |title=Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis |journal=JAMA |volume=297 |issue=8 |pages=842–57 |year=2007 |pmid=17327526 |doi=10.1001/jama.297.8.842}} See also the to ] by Philip Taylor and ] and the by the authors of the original paper.
</ref>

====Safety====
In the United States, pharmaceuticals must be proven safe and effective to the satisfaction of the ] before they can be marketed, whereas ]s must be proven ''unsafe'' before regulatory action can be taken.<ref>
{{cite web |url=https://www.fda.gov/opacom/laws/dshea.html |title=Dietary Supplement Health and Education Act of 1994 | publisher=] |date=1994-10-25 |access-date=2008-04-04 }}</ref> A number of orthomolecular supplements are available in the US in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are regulated as pharmaceuticals. The US regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests. Proponents of orthomolecular medicine argue that supplements are less likely to cause dangerous side-effects or harm, since they are normally present in the body.<ref name="orthomed"/> Some vitamins are toxic in high doses<ref name=NutCom1990 /> and nearly all (with the possible exception of Vitamin C<ref>{{Cite journal | last1 = Padayatty | first1 = S. J. | last2 = Sun | first2 = A. Y. | last3 = Chen | first3 = Q. | last4 = Espey | first4 = M. G. | last5 = Drisko | first5 = J. | last6 = Levine | first6 = M. | editor1-last = Gagnier | editor1-first = Joel Joseph | title = Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects | doi = 10.1371/journal.pone.0011414 | journal = PLOS ONE | volume = 5 | issue = 7 | pages = e11414 | year = 2010 | pmid = 20628650 | pmc =2898816 | bibcode = 2010PLoSO...511414P | doi-access = free }}</ref>) will cause adverse effects given high levels of overdosing for prolonged periods as recommended by orthomolecular practitioners.<ref name=Singh2008/> Forgoing medical care in favor of orthomolecular treatments can lead to adverse health outcomes.<ref name=Aaronson2003 />

Health professionals see orthomolecular medicine as encouraging individuals to dose themselves with large amounts of vitamins and other nutrients without conventional supervision, which they worry might be damaging to health. Potential risks<ref>
{{cite web | url=http://www.emedicine.com/emerg/topic638.htm | title=Toxicity, vitamin | date=2007-12-12 | access-date=2008-04-04 | last=Rosenbloom | first=M | publisher=]}}</ref> of inappropriate vitamin and supplement regimes include an increased risk of ],<ref name="pmid9193380">
{{cite journal |vauthors=Rapola JM, Virtamo J, Ripatti S, etal |title=Randomised trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction |journal=Lancet |volume=349 |issue=9067 |pages=1715–20 |year=1997 |pmid=9193380 |doi=10.1016/S0140-6736(97)01234-8|s2cid=54392389 |url=https://zenodo.org/record/1259825 }}</ref> ], ], ], ], ] effects, ], ], ], ], ], ]s, and ].<ref name="NIH_CSSS2006"/><ref name="AmJEpidem2009"/><ref name=Huang2006>
{{cite journal |vauthors=Huang HY, Caballero B, Chang S, etal |title=The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference |journal=Ann Intern Med |volume=145 |issue=5 |pages=372–85 |date=September 2006 |pmid=16880453 |url=http://www.annals.org/cgi/pmidlookup?view=reprint&pmid=16880453 |doi=10.1001/archinte.145.2.372}}</ref><ref name="pmid3153129">
{{cite journal |author=Arroyave G |title= |language=es|journal=Arch Latinoam Nutr |volume=38 |issue=3 |pages=589–98 |year=1988 |pmid=3153129}}</ref><ref>
{{cite journal |author=Blair KA |title=Vitamin supplementation and megadoses |journal=Nurse Pract |volume=11 |issue=7 |pages=19–26, 31–6 |year=1986 |pmid=3737019 |doi=10.1097/00006205-198607000-00003}}</ref><ref name="pmid7885163">
{{cite journal |author=Roberts HJ |title=Vitamin E |journal=Lancet |volume=345 |issue=8951 |pages=737 |year=1995 |pmid=7885163 |doi=10.1016/S0140-6736(95)90913-3 |last2=Roberts |first2=H|s2cid=5410582 }}</ref><ref>
{{cite journal |vauthors=Bégin M, Kaegi E |title=Unconventional therapies and cancer |journal=Canadian Medical Association Journal |volume=161 |issue=6 |pages=686–7 |year=1999 |pmid=10513271 |url=http://www.cmaj.ca/cgi/reprint/161/6/686 |format=PDF |pmc=1230613}}</ref> In their book '']'', ] and ] conclude that "The concepts of orthomolecular medicine are not biologically plausible and not supported by the results of rigorous clinical trials. These problems are compounded by the fact that orthomolecular medicine can cause harm and is often very expensive."<ref name=Singh2008/>

===Example: vitamin E===<!-- This section is linked from ] -->
Orthomolecular proponents claim that even large doses of ] pose no risk to health and are useful for the treatment and prevention of a broad list of conditions, including heart and circulatory diseases, diabetes and nephritis.<ref>{{cite web | url = http://www.orthomolecular.org/resources/omns/v01n01.shtml | title = Vitamin E: Safe, Effective, and Heart-Healthy | publisher = Orthomolecular Medicine News Service | date = 2005-03-23 }}</ref> Initial hopes for the usefulness of vitamin E in orthomolecular medicine were based on ] studies suggesting that people who consumed more vitamin E had lower risks of chronic disease, such as ].<ref>
{{cite journal |author=Traber MG |title=How much vitamin E?... Just enough! |journal=] |volume=84 |issue=5 |pages=959–60 |date=November 2006 |pmid=17093143 |doi=10.1093/ajcn/84.5.959|doi-access=free }}</ref> These ] could not distinguish between whether the higher levels of vitamin E improved health themselves, or whether ]s (such as other dietary factors or exercise) were responsible.<ref>
{{cite journal |author=Gaziano JM |title=Vitamin E and cardiovascular disease: observational studies |journal=] |volume=1031 |issue=1 |pages=280–91 |date=December 2004 |pmid=15753154 |doi=10.1196/annals.1331.028|bibcode = 2004NYASA1031..280G |s2cid=26369772 }}</ref><ref>
{{cite journal |vauthors=Hemilä H, Miller ER |title=Evidence-based medicine and vitamin E supplementation |journal=] |volume=86 |issue=1 |pages=261–2; author reply 262–4 |pmid=17616790 |date= July 1, 2007 |doi=10.1093/ajcn/86.1.261 |doi-access=free }}</ref> To distinguish between these possibilities, a number of ]s were performed and ] of these controlled clinical trials have not shown any clear benefit from any form of vitamin E supplementation for preventing chronic disease.<ref name="viv">
{{cite journal |vauthors=Vivekananthan DP, Penn MS, Sapp SK, Hsu A, Topol EJ |title=Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis of randomised trials |journal=] |volume=361 |issue=9374 |pages=2017–23 |year=2003 |pmid=12814711 |doi=10.1016/S0140-6736(03)13637-9|s2cid=41982547 }}</ref><ref>
{{cite book |author=Stocker R |title=Dietary Supplements and Health |chapter=Vitamin E |volume=282 |pages=77–87; discussion 87–92, 212–8 |year=2007 |pmid=17913225 |doi=10.1002/9780470319444.ch6 |series=Novartis Foundation Symposia |isbn=978-0-470-31944-4}}</ref><ref>
{{cite journal |vauthors=Cherubini A, Vigna GB, Zuliani G, Ruggiero C, Senin U, Fellin R |title=Role of antioxidants in atherosclerosis: epidemiological and clinical update |journal=] |volume=11 |issue=16 |pages=2017–32 |year=2005 |pmid=15974956 |doi=10.2174/1381612054065783}}</ref><ref name=Kline>
{{cite book |vauthors=Kline K, Lawson KA, Yu W, Sanders BG |title=Vitamin E |chapter=Vitamin E and cancer |journal=Vitam Horm |volume=76 |pages=435–61 |year=2007 |pmid=17628185 |doi=10.1016/S0083-6729(07)76017-X|series=Vitamins & Hormones |isbn=9780123735928 }}</ref> Further clinical studies show no benefit of vitamin E supplements for cardiovascular disease.<ref>
{{cite journal |vauthors=Sesso HD, Buring JE, Christen WG, etal |title=Vitamins E and C in the Prevention of Cardiovascular Disease in Men: The Physicians' Health Study II Randomized Trial |journal=] |volume=300 |issue=18 |pages=2123–33 |date=November 2008 |pmid=18997197 |doi=10.1001/jama.2008.600 |pmc=2586922}}</ref> The current position of the American ] is that there is no convincing evidence that vitamin E supplements can prevent or treat any disease.<ref>{{cite web |url=http://ods.od.nih.gov/factsheets/vitamine.asp |title=Vitamin E |publisher=National Institutes of Health |year=2009}}</ref>

Beyond the lack of apparent benefit, a series of three meta-analyses reported that vitamin E supplementation is associated with an increased risk of death; one of the meta-analyses performed by the ] also found significantly increased mortality for the antioxidant vitamins ] and ].<ref name="Cochrane2012">{{cite journal |vauthors=Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C |title=Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases |journal=Cochrane Database Syst Rev |volume=2012 |issue= 3|pages=CD007176 |year=2012 |pmid=22419320 |doi=10.1002/14651858.CD007176.pub2 |pmc=8407395 |hdl=10138/136201 |hdl-access=free }}</ref><ref name="miller">{{cite journal |vauthors=Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E |title=Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality |journal=Ann Intern Med |volume=142 |issue=1 |pages=37–46 |year=2005 |pmid=15537682 |doi=10.7326/0003-4819-142-1-200501040-00110|doi-access=free }}</ref><ref name=Bjelakovic>{{cite journal |vauthors=Bjelakovic G, Nikolova D, Gluud L, Simonetti R, Gluud C |title=Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis |journal=] |volume=297 |issue=8 |pages=842–57 |year=2007 |pmid=17327526 |doi=10.1001/jama.297.8.842}}</ref> A subsequent meta-analysis found no mortality benefit from vitamin E, but also no increase in mortality either.<ref>{{Cite journal | doi = 10.2174/1874609811104020158 | last1 = Abner | first1 = E. L. | last2 = Schmitt | first2 = F. A. | last3 = Mendiondo | first3 = M. S. | last4 = Marcum | first4 = J. L. | last5 = Kryscio | first5 = R. J. | title = Vitamin E and all-cause mortality: A meta-analysis | journal = Current Aging Science | volume = 4 | issue = 2 | pages = 158–170 | year = 2011 | pmid = 21235492 | pmc=4030744}}</ref>

===Use in AIDS===
Several articles in the alternative-medicine literature have suggested that orthomolecular-related dietary supplementation might be helpful for patients with ]/].<ref>{{cite journal |author=Patrick Lyn |title=Nutrients and HIV: part one -- beta carotene and selenium |journal=Altern Med Rev |volume=4 |issue=6 |pages=403–13 |date=December 1999 |pmid=10608913 |url=http://www.thorne.com/altmedrev/.fulltext/4/6/403.pdf |access-date=2008-08-25 |archive-url=https://web.archive.org/web/20081006144539/http://www.thorne.com/altmedrev/.fulltext/4/6/403.pdf |archive-date=2008-10-06 |url-status=dead }}</ref><ref>
{{cite journal |author=Lichtenstein BS |title=Nutrition and HIV |journal=STEP Perspect |volume=7 |issue=1 |pages=2–5 |year=1995 |pmid=11362399}}</ref>
A study using 250&nbsp;mg and 1000&nbsp;mg doses of vitamin C along with other antioxidants to treat people with AIDS did not find any benefit.<ref>{{cite journal |vauthors=Batterham M, Gold J, Naidoo D, etal |title=A preliminary open label dose comparison using an antioxidant regimen to determine the effect on viral load and oxidative stress in men with HIV/AIDS |journal=Eur J Clin Nutr |volume=55 |issue=2 |pages=107–14 |date=February 2001 |pmid=11305623 |doi=10.1038/sj.ejcn.1601124|doi-access=free }}</ref>

A ] in 2010 (updated in 2017 with different results) found that micronutrient supplementation decreased the risk of death and improved outcomes in pregnant women with HIV in Africa.<ref>{{Cite journal|last1=Irlam|first1=James H.|last2=Visser|first2=Marianne Me|last3=Rollins|first3=Nigel N.|last4=Siegfried|first4=Nandi|editor1-first=James H|editor1-last=Irlam|date=2010-12-08|title=Micronutrient supplementation in children and adults with HIV infection|journal=The Cochrane Database of Systematic Reviews|issue=12|pages=CD003650|doi=10.1002/14651858.CD003650.pub3|issn=1469-493X|pmid=21154354}}</ref><ref name=":0" /> A 2017 ] review found no strong evidence to suggest that micronutrient supplementation prevents death or is effective at slowing the progression of disease for adults with HIV.<ref name=":0">{{Cite journal|last1=Visser|first1=Marianne E.|last2=Durao|first2=Solange|last3=Sinclair|first3=David|last4=Irlam|first4=James H.|last5=Siegfried|first5=Nandi|date=18 May 2017|title=Micronutrient supplementation in adults with HIV infection|journal=The Cochrane Database of Systematic Reviews|volume=2017|issue=5|pages=CD003650|doi=10.1002/14651858.CD003650.pub4|issn=1469-493X|pmc=5458097|pmid=28518221}}</ref> It is important for people living with HIV to eat a healthy adequate diet.<ref name=":0" /> For people with HIV that have clinically demonstrated deficiencies in micronutrients or for people who are not able to consume the recommended daily quantities of minerals and vitamins, supplementation is still encouraged.<ref name=":0" /> Vitamin A in children with HIV appears to be safe and beneficial.<ref>{{Cite journal|last1=Irlam|first1=James H.|last2=Siegfried|first2=Nandi|last3=Visser|first3=Marianne E.|last4=Rollins|first4=Nigel C.|date=2013-10-11|title=Micronutrient supplementation for children with HIV infection|journal=The Cochrane Database of Systematic Reviews|issue=10|pages=CD010666|doi=10.1002/14651858.CD010666|issn=1469-493X|pmid=24114375}}</ref> Vitamin A deficiency is found in children with HIV infection who may or may not have symptoms of AIDS. Vitamin A supplementation reduces morbidity and mortality in AIDS symptomatic children, but has no effect on asymptomatic children. It does not prevent HIV infection, cannot treat the chronic HIV infection, and will not cure AIDS.<ref>
{{cite journal |vauthors=Grotto I, Mimouni M, Gdalevich M, Mimouni D |title=Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis |journal=J Pediatr |volume=142 |issue=3 |pages=297–304 |date=March 2003 |pmid=12640379 |doi=10.1067/mpd.2003.116}}</ref><ref>
{{cite book |author1=Mehta Saurabh |author2=Fawzi Wafaie |title=Effects of vitamins, including vitamin A, on HIV/AIDS patients |journal=Vitam Horm |volume=75 |pages=355–83 |year=2007 |pmid=17368322 |doi=10.1016/S0083-6729(06)75013-0 |series=Vitamins & Hormones |isbn=978-0-12-709875-3}}</ref>

====Deaths resulting from illegal vitamin trials in South Africa====
{{Main|Matthias Rath}}
] has been extensively criticized for presenting his vitamin supplements as a treatment for AIDS and for testing them in illegal trials in ].<ref>{{cite journal |author=Kapp C |title=South Africans hope for a new era in HIV/AIDS policies |journal=Lancet |volume=368 |issue=9549 |pages=1759–60 |date=November 2006 |pmid=17120343 |doi=10.1016/S0140-6736(06)69717-1|s2cid=37147734 }}</ref><ref name=Smith/> A former associate of Linus Pauling, Rath has promoted vitamins as a treatment for HIV infection, describing treatment with effective ] as toxic and part of a global conspiracy serving the financial interests of the pharmaceutical industry.<ref name=Rath>{{cite news |author=Boseley Sarah |url=https://www.theguardian.com/world/2005/may/14/southafrica.internationalaidanddevelopment |title=Discredited doctor's 'cure' for Aids ignites life-and-death struggle in South Africa |newspaper=The Guardian |location=Manchester |date=May 14, 2005 }}<br/>*{{cite news |url=http://www.int.iol.co.za/index.php?set_id=1&click_id=6&art_id=nw20070510150555640C886929 |title=Apartheid a pharmaceutical plot - Rath |newspaper=Independent Online |location=Cape Town |date=May 10, 2007 |access-date=August 22, 2008 |archive-date=October 30, 2007 |archive-url=https://web.archive.org/web/20071030041927/http://www.int.iol.co.za/index.php?set_id=1&click_id=6&art_id=nw20070510150555640C886929 |url-status=dead }}</ref> In a lawsuit that found against Rath, the ] blamed his vitamin products for several deaths.<ref name=Smith>{{cite journal |vauthors=Smith TC, Novella SP |title=HIV Denial in the Internet Era |journal=PLOS Med |volume=4 |issue=8 |pages=e256 |date=August 2007 |pmid=17713982 |pmc=1949841 |doi=10.1371/journal.pmed.0040256 |doi-access=free }}</ref><ref>
{{cite journal |author=Watson J |title=Scientists, activists sue South Africa's AIDS 'denialists' |journal=Nat Med |volume=12 |issue=1 |pages=6 |date=January 2006 |pmid=16397537 |doi=10.1038/nm0106-6a|s2cid=3502309 |doi-access=free }}</ref><ref>
{{cite news |url=http://www.iol.co.za/index.php?set_id=1&click_id=15&art_id=nw20080613124210476C691501 |title=TAC hails ruling on Rath |newspaper=Independent Online |location=Cape Town |date=June 13, 2008}}</ref> The ] and two health agencies of the ] also described Rath's advertisements as "wrong and misleading" and "an irresponsible attack on ARV (antiretroviral) therapy."<ref>
{{cite news |author=Reed John |url=https://www.latimes.com/archives/la-xpm-2005-jul-25-ft-aids25-story.html |title=HIV fight focuses on ads |work=Los Angeles Times |date=July 25, 2005}}</ref> The South African ] described the trials as "state sponsored pseudo-science".<ref>{{cite journal |title=Echoes of Lysenko: State-sponsored pseudo-science in South Africa |author=Geffen N |journal=Social Dynamics |volume=31 |issue=2 |pages=183–210 |year=2005 |url=http://www.tac.org.za/documents/wp149.pdf |doi=10.1080/02533950508628713 |hdl=11427/19344 |s2cid=143821379 |hdl-access=free |access-date=2011-05-02 |archive-date=2011-07-26 |archive-url=https://web.archive.org/web/20110726212100/http://www.tac.org.za/documents/wp149.pdf |url-status=dead }}</ref> Rath's trials, conducted with the aid of ] ], were declared unlawful by the ]; Rath, Rasnick and their foundation were barred from conducting further unauthorised clinical trials and from advertising their products.<ref>
{{cite news |url=https://www.reuters.com/article/latestCrisis/idUSL13834914 |title=South African court bans AIDS vitamin trials |date=June 13, 2008 |work=Reuters |access-date=June 20, 2008}}</ref>

===Alleged institutional bias===
Advocates of orthomolecular medicine, including Pauling, Hoffer and ] have claimed that their findings are actively suppressed by the medical and ]. Hoffer wrote "There is no conspiracy led and directed by a single person or by a single organization. There is no Mafia in psychiatry. However, there is a conspiracy led and directed by a large number of professionals and their associations who have a common aim to protect their hard-earned orthodoxy, no matter what the cost to their opponent colleagues or to their patients."<ref>
{{cite journal |author=Hoffer A |year=1987 |url=http://www.orthomolecular.org/library/jom/1987/pdf/1987-v02n03-p158.pdf |title=Is there a conspiracy? |journal=J Orthomol Med |volume=2 |issue=3 |pages=158 }}</ref><ref>
{{cite book |author=Thomas Hager |title=Force of nature: the life of Linus Pauling |publisher=Simon & Schuster |location=New York |year=1995 |isbn=978-0-684-80909-0 |url=https://archive.org/details/forceofnaturelif00hage }}</ref>

The '']'', founded in 1967 as the ''Journal of Schizophrenia'', is a major publication of orthomolecular medicine. As ] wrote:
:We had to create our own journals because it was impossible to obtain entry into the official journals of ] and medicine. Before 1967 I had not found it difficult to publish reports in these journals, and by then I had about 150 articles and several books in the establishment press.<ref name="hoffer">
{{cite journal |author=Hoffer Abram |title=History |journal=J Orthomol Med |url=http://www.orthomed.org/jom/jomhist.htm |archive-url = https://web.archive.org/web/20071101114000/http://www.orthomed.org/jom/jomhist.htm |archive-date = 2007-11-01}} (via archive.org) archived on November 1, 2007</ref>

Other members of the medical community deny the existence of such an institutional prejudice.<ref name=Razzouk2003>
{{Cite journal |vauthors=Razzouk N, Seitz V | year=2003 | title=Marketing to the heart: a practical approach to dealing with health care quackery | journal=Clinical Research and Regulatory Affairs | volume=20 | issue=4 | pages=469–478 | doi=10.1081/CRP-120026128 | s2cid=73219671 | url=http://www.informaworld.com/index/713622947.pdf }}</ref><ref>
{{cite journal |author=Weitzman S |title=Alternative nutritional cancer therapies |journal=Int J Cancer Suppl |volume=11 |pages=69–72 |year=1998 |issue=S11 |pmid=9876483 |doi=10.1002/(SICI)1097-0215(1998)78:11+<69::AID-IJC20>3.0.CO;2-7|s2cid=20633344 |doi-access=free }}</ref> A review in the '']'' denied that physicians collude against unconventional treatments.<ref>
{{cite journal |vauthors=Gertz MA, Bauer BA |title=Caring (really) for patients who use alternative therapies for cancer |journal=J Clin Oncol |volume=21 |issue=9 Suppl |pages=125s–128s |date=May 2003 |pmid=12743218 |doi=10.1200/JCO.2003.01.195}}</ref> Claims of conspiracy were limited to the now defunct Linus Pauling Institute of Science and Medicine. In its current iteration, the ] derives a significant amount of funding from the ] and other federal sources.<ref name="Frei">{{cite journal |author=Frei, Balz |title=From the Director |journal=LPI Research Newsletter |issue=Spring 2006 |date=June 2006 |url=http://lpi.oregonstate.edu/ss06/director.html |access-date=2006-09-21 |archive-url=https://web.archive.org/web/20110919163020/http://lpi.oregonstate.edu/ss06/director.html |archive-date=2011-09-19 |url-status=dead }}</ref>


==See also== ==See also==
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* ]
* ]
* ] * ]
* ]
* ] * ]
* ] * ]
* ]
* ]
* ]
* ]
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{{colend}}

==Citations==
{{Reflist|30em}}

==Further reading==

* {{cite book |title=Healing cancer : complementary vitamin & drug treatments |author1=Hoffer Abram |author2=with Pauling Linus |year=2004 |location=Toronto |publisher=] |isbn=978-1-897025-11-6 |oclc=56682217 }}
* {{cite book |title=The health robbers : how to protect your money and your life |author=Barrett Stephen |author-link=Stephen Barrett |year=1980 |edition=Second |pages= |location=Philadelphia |publisher=] |isbn=978-0-89313-023-7 |oclc=6994138 |url=https://archive.org/details/healthrobbers00gfst/page/52 }}
* {{cite book|title=Alternative medicine handbook: the complete reference guide to alternative and complementary therapies|author=Cassileth Barrie R |author-link=Barrie R. Cassileth |year=1998 |publisher=] |location=New York |isbn=978-0-393-04566-6 |oclc=36727947}}
* {{cite book |title=Nutritional biochemistry of the vitamins |author=Bender David A |author-link=David A. Bender |year=2003 |edition=Second |pages=230 |location=Cambridge; New York |publisher=] |isbn=978-0-521-80388-5 |oclc=50948594}}
* {{cite book |title=Terrors of the table: the curious history of nutrition |author=Gratzer Walter B |author-link=Walter Gratzer |year=2005 |pages= |location=Oxford; New York |publisher=] |isbn=978-0-19-280661-1 |oclc=60837725 |url=https://archive.org/details/terrorsoftablecu0000grat/page/210 }}


==External links== ==External links==
* {{Webarchive|url=https://web.archive.org/web/20090109020533/http://nccam.nih.gov/health/backgrounds/biobasedprac.htm |date=2009-01-09 }}, ] ]
*

*
{{DEFAULTSORT:Orthomolecular Medicine}}
* - Personal site of Andrew Saul PhD, Contributing Editor for the Journal of Orthomolecular Medicine.
]
*
]
* , a critical analysis by ]
]
] ]
]
]
]

Latest revision as of 16:59, 8 December 2024

Form of alternative medicine
Orthomolecular medicine
Alternative medicine
ClaimsHealth effects of dietary supplements, particularly vitamin megadoses.
Related fieldsNaturopathy
Original proponentsLinus Pauling (coined term)
MeSHD009974
Part of a series on
Alternative medicine
General information
Fringe medicine and science
Controversies
Classifications
Traditional medicine
Alternative diagnoses

Orthomolecular medicine is a form of alternative medicine that claims to maintain human health through nutritional supplementation. It is rejected by evidence-based medicine. The concept builds on the idea of an optimal nutritional environment in the body and suggests that diseases reflect deficiencies in this environment. Treatment for disease, according to this view, involves attempts to correct "imbalances or deficiencies based on individual biochemistry" by use of substances such as vitamins, minerals, amino acids, trace elements and fatty acids. The notions behind orthomolecular medicine are not supported by sound medical evidence, and the therapy is not effective for chronic disease prevention; even the validity of calling the orthomolecular approach a form of medicine has been questioned since the 1970s.

The approach is sometimes referred to as megavitamin therapy, because its practice evolved out of, and in some cases still uses, doses of vitamins and minerals many times higher than the recommended dietary intake. Orthomolecular practitioners may also incorporate a variety of other styles of treatment into their approaches, including dietary restriction, megadoses of non-vitamin nutrients and mainstream pharmaceutical drugs. Proponents argue that non-optimal levels of certain substances can cause health issues beyond simple vitamin deficiency and see balancing these substances as an integral part of health.

American chemist Linus Pauling coined the term "orthomolecular" in the 1960s to mean "the right molecules in the right amounts" (ortho- in Greek implies "correct"). Proponents of orthomolecular medicine hold that treatment must be based on each patient's individual biochemistry.

The scientific and medical consensus holds that the broad claims of efficacy advanced by advocates of orthomolecular medicine are not adequately tested as drug therapies. It has been described as a form of food faddism and as quackery. There are specific narrow applications where mainstream research has supported benefits for nutrient supplementation, and where conventional medicine uses vitamin treatments for some diseases.

Some vitamins in large doses have been linked to increased risk of cardiovascular disease, cancer and death. The scientific consensus view is that for normal individuals, a balanced diet contains all necessary vitamins and minerals and that routine supplementation is not necessary outside of specific diagnosed deficiencies.

History and development

In the early 20th century, some doctors hypothesised that vitamins could cure disease, and supplements were prescribed in megadoses by the 1930s. Their effects on health were disappointing, though, and in the 1950s and 1960s, nutrition was de-emphasised in standard medical curricula. Riordon's organization cite figures from this period as founders of their movement, although the word "orthomolecular" was coined by Linus Pauling only in 1967.

Amongst the individuals described posthumously as orthomolecularists are Max Gerson, who developed a diet that he claimed could treat diseases, which the American Medical Association's 1949 Council on Pharmacy and Chemistry found ineffective; and Evan Shute and his brother, who attempted to treat heart disease with vitamin E. Several concepts now cited by orthomolecularists, including individual biochemical variation and inborn errors of metabolism, debuted in scientific papers early in the 20th century.

In 1948, William McCormick theorized that vitamin C deficiency played an important role in many diseases and began to use large doses in patients. In the 1950s, Fred R. Klenner also tried vitamin C megadosage as a therapy for a wide range of illnesses, including polio. Irwin Stone stated that organisms that do not synthesise their own vitamin C due to a loss-of-function mutation have a disease he called "hypoascorbemia". This term is not used by the medical community, and the idea of an organism-wide lack of a biosynthetic pathway as a disease was not endorsed by Stone's contemporaries.

In the 1950s, some individuals believed that vitamin deficiencies caused mental illness. Psychiatrists Humphry Osmond and Abram Hoffer gave people having acute schizophrenic episodes high doses of niacin, while William Kaufman used niacinamide. While niacin has no known efficacy in psychiatric disease, the use of niacin in combination with statins and other medical therapies has become one of several medical treatments for cardiovascular disease.

In the late 1960s, Linus Pauling introduced the expression "orthomolecular" to express the idea of the right molecules in the right amounts. Since the first claims of medical breakthroughs with vitamin C by Pauling and others, findings on the health effects of vitamin C have been controversial and contradictory. Pauling's claims have been criticised as overbroad.

Later research branched out into nutrients besides niacin and vitamin C, including essential fatty acids.

Scope

According to Abram Hoffer, orthomolecular medicine does not purport to treat all diseases, nor is it "a replacement for standard treatment. A proportion of patients will require orthodox treatment, a proportion will do much better on orthomolecular treatment, and the rest will need a skillful blend of both." Nevertheless, advocates have said that the right nutrients at the optimum dose for the individual concerned can prevent, treat, and sometimes cure a wide range of medical conditions. Conditions for which orthomolecular practitioners have claimed some efficacy are: acne, alcoholism, allergies, arthritis, autism, bee stings, bipolar disorder, burns, cancer, the common cold, depression, drug addiction, drug overdose, epilepsy, heart diseases, heavy metal toxicity, acute hepatitis, herpes, hyperactivity, hypertension, hypoglycemia, influenza, learning disabilities, mental and metabolic disorders, migraine, mononucleosis, mushroom poisoning, neuropathy & polyneuritis (including multiple sclerosis), osteoporosis, polio, a hypothesised condition called "pyroluria", radiation sickness, Raynaud's disease, mental retardation, schizophrenia, shock, skin problems, snakebite, spider bite, tetanus toxin and viral pneumonia.

Orthomolecular psychiatry

Main article: Orthomolecular psychiatry

Hoffer believed that particular nutrients could cure mental illness. In the 1950s, he attempted to treat schizophrenia with niacin, although proponents of orthomolecular psychiatry say that the ideas behind their approach predate Hoffer. According to Hoffer and others who called themselves "orthomolecular psychiatrists", psychiatric syndromes result from biochemical deficiencies, allergies, toxicities or several hypothetical contributing conditions which they termed pyroluria, histadelia and histapenia. These purported causes were said to be found during an "individual biochemical workup" and treated with megavitamin therapy and dietary changes including fasting. These diagnoses and treatments are not accepted by evidence-based medicine.

Principles

According to Abram Hoffer, "primitive" peoples do not consume processed foods and do not have "degenerative" diseases. In contrast, typical "Western" diets are said to be insufficient for long-term health, necessitating the use of megadose supplements of vitamins, dietary minerals, proteins, antioxidants, amino acids, ω-3 fatty acids, ω-6 fatty acids, medium-chain triglycerides, dietary fiber, short and long chain fatty acids, lipotropes, systemic and digestive enzymes, other digestive factors, and prohormones to ward off hypothetical metabolism anomalies at an early stage, before they cause disease.

Orthomolecularists say that they provide prescriptions for optimal amounts of micronutrients after individual diagnoses based on blood tests and personal histories. Lifestyle and diet changes may also be recommended. The battery of tests ordered includes many that are not considered useful by medicine.

Prevalence

Orthomolecular medicine is practiced by few medical practitioners.

A survey released in May, 2004 by the National Center for Complementary and Alternative Medicine focused on who used alternative medicine, what was used, and why it was used in the United States by adults age 18 years and over during 2003. The survey reported uses in the previous twelve months that include orthomolecular related uses: Nonvitamin, nonmineral, natural products 18.9%, Diet-based therapies 3.5%, Megavitamin therapy 2.8%.

Another recent CAM survey reported that 12% of liver disease patients used the antioxidant silymarin, more than 6% used vitamins, and that "in all, 74% of patients reported using CAM in addition to the medications prescribed by their physician, but 26% did not inform their physician of their CAM use."

Even though the health benefits are not established, the use of high doses of vitamins is also common in people who have been diagnosed with cancer. According to Cancer Research UK, cancer patients should always seek professional advice before taking such supplements, and using them as a substitute for conventional treatment "could be harmful to health and greatly reduce the chance of curing or controlling cancer".

Medical and scientific reception

Methodology

Orthomolecular therapies have been criticized as lacking a sufficient evidence base for clinical use: their scientific foundations are too weak, the studies that have been performed are too few and too open to interpretation, and reported positive findings in observational studies are contradicted by the results of more rigorous clinical trials. Accordingly, "there is no evidence that orthomolecular medicine is effective". Proponents of orthomolecular medicine strongly dispute this statement by citing studies demonstrating the effectiveness of treatments involving vitamins, though this ignores the belief that a normal diet will provide adequate nutrients to avoid deficiencies, and that orthomolecular treatments are not actually related to vitamin deficiency. The lack of scientifically rigorous testing of orthomolecular medicine has led to its practices being classed with other forms of alternative medicine and regarded as unscientific. It has been described as food faddism and quackery, with critics arguing that it is based upon an "exaggerated belief in the effects of nutrition upon health and disease." Orthomolecular practitioners will often use dubious diagnostic methods to define what substances are "correct"; one example is hair analysis, which produces spurious results when used in this fashion.

Proponents of orthomolecular medicine contend that, unlike some other forms of alternative medicine such as homeopathy, their ideas are at least biologically based, do not involve magical thinking, and are capable of generating testable hypotheses. Orthomolecular is not a standard medical term, and clinical use of specific nutrients is considered a form of chemoprevention (to prevent or delay development of disease) or chemotherapy (to treat an existing condition).

Despite a lack of evidence for its efficacy, interest in intravenous high dose vitamin C therapy has not been permanently extinguished, and some research groups continue to investigate whether it has an effect as a possible cancer treatment.

Views on safety and efficacy

In general, the vitamin megadoses advocated by orthomolecular medicine are unsupported by scientific consensus. Some vitamins such as vitamins ADEK are toxic in high doses, including niacin (B3), cholecalciferol (D) and tocopherol (E). The view of the medical community is that there is no evidence for the efficacy of Orthomolecular medicine as a treatment for cancer, and that high vitamin doses may – on the contrary – increase overall mortality. Nutritional treatments are not generally accepted as being helpful for psychological health. Its claims have been criticized by most medical organizations, including the American Cancer Society, the American Psychiatric Association, the National Institute of Mental Health, the American Academy of Pediatrics, CHAMPUS, and the Canadian Paediatric Society. The American Medical Association describes as "myths" the ideas that adequate nutrition is not readily achievable with normal food, all food grown with pesticide is poisonous, all food additives are poisonous, vitamin and mineral deficiencies are common, that the cause of most disease is poor diet, which can be prevented by nutritional supplements.

Similarly, the American Cancer Society comments that the current scientific evidence does not "support use of orthomolecular therapy for most of the conditions for which it is promoted." Some supplements have exhibited benefits for specific conditions, while a few have been confirmed to be harmful; the consumption of nutritious foods is the best recognized method to obtain vitamins, minerals, and nutrients crucial for good health. Barrie Cassileth, an adviser on alternative medicine to the National Institutes of Health, stated that "scientific research has found no benefit from orthomolecular therapy for any disease," and medical textbooks also report that there is "no evidence that megavitamin or orthomolecular therapy is effective in treating any disease."

A 1973 task force of the American Psychiatric Association unanimously concluded:

This review and critique has carefully examined the literature produced by megavitamin proponents and by those who have attempted to replicate their basic and clinical work. It concludes in this regard that the credibility of the megavitamin proponents is low. Their credibility is further diminished by a consistent refusal over the past decade to perform controlled experiments and to report their new results in a scientifically acceptable fashion. Under these circumstances this Task Force considers the massive publicity which they promulgate via radio, the lay press and popular books, using catch phrases which are really misnomers like "megavitamin therapy" and "orthomolecular treatment", to be deplorable.

In response to claims that orthomolecular medicine could cure childhood psychoses and learning disorders, the American Academy of Pediatrics labelled orthomolecular medicine a "cult" in 1976.

Proponents of orthomolecular medicine counter that some vitamins and nutrients are now used in medicine as treatments for specific diseases, such as megadose niacin and fish oil for dyslipidemias, and megavitamin therapies for a group of rare inborn errors of metabolism. A review in the Annals of Internal Medicine concluded that while some therapies might be beneficial, others might be harmful or interfere with effective medical therapy. A recent study of over 161,000 individuals provided, in the words of the authors, "convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women." A recent meta-analysis in JAMA suggested that supplementation with combinations of antioxidant vitamins (beta-carotene, vitamin A, and vitamin E) may increase mortality, although with respect to beta-carotene this conclusion may be due to the known harmful effect in smokers.

Safety

In the United States, pharmaceuticals must be proven safe and effective to the satisfaction of the FDA before they can be marketed, whereas dietary supplements must be proven unsafe before regulatory action can be taken. A number of orthomolecular supplements are available in the US in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are regulated as pharmaceuticals. The US regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests. Proponents of orthomolecular medicine argue that supplements are less likely to cause dangerous side-effects or harm, since they are normally present in the body. Some vitamins are toxic in high doses and nearly all (with the possible exception of Vitamin C) will cause adverse effects given high levels of overdosing for prolonged periods as recommended by orthomolecular practitioners. Forgoing medical care in favor of orthomolecular treatments can lead to adverse health outcomes.

Health professionals see orthomolecular medicine as encouraging individuals to dose themselves with large amounts of vitamins and other nutrients without conventional supervision, which they worry might be damaging to health. Potential risks of inappropriate vitamin and supplement regimes include an increased risk of coronary heart disease, hypertension, thrombophlebitis, peripheral neuropathy, ataxia, neurological effects, liver toxicity, congenital abnormalities, spontaneous abortion, gouty arthritis, jaundice, kidney stones, and diarrhea. In their book Trick or Treatment?, Edzard Ernst and Simon Singh conclude that "The concepts of orthomolecular medicine are not biologically plausible and not supported by the results of rigorous clinical trials. These problems are compounded by the fact that orthomolecular medicine can cause harm and is often very expensive."

Example: vitamin E

Orthomolecular proponents claim that even large doses of vitamin E pose no risk to health and are useful for the treatment and prevention of a broad list of conditions, including heart and circulatory diseases, diabetes and nephritis. Initial hopes for the usefulness of vitamin E in orthomolecular medicine were based on epidemiological studies suggesting that people who consumed more vitamin E had lower risks of chronic disease, such as coronary heart disease. These observational studies could not distinguish between whether the higher levels of vitamin E improved health themselves, or whether confounding variables (such as other dietary factors or exercise) were responsible. To distinguish between these possibilities, a number of randomized controlled trials were performed and meta-analysis of these controlled clinical trials have not shown any clear benefit from any form of vitamin E supplementation for preventing chronic disease. Further clinical studies show no benefit of vitamin E supplements for cardiovascular disease. The current position of the American National Institutes of Health is that there is no convincing evidence that vitamin E supplements can prevent or treat any disease.

Beyond the lack of apparent benefit, a series of three meta-analyses reported that vitamin E supplementation is associated with an increased risk of death; one of the meta-analyses performed by the Cochrane Collaboration also found significantly increased mortality for the antioxidant vitamins A and beta-carotene. A subsequent meta-analysis found no mortality benefit from vitamin E, but also no increase in mortality either.

Use in AIDS

Several articles in the alternative-medicine literature have suggested that orthomolecular-related dietary supplementation might be helpful for patients with HIV/AIDS. A study using 250 mg and 1000 mg doses of vitamin C along with other antioxidants to treat people with AIDS did not find any benefit.

A meta analysis in 2010 (updated in 2017 with different results) found that micronutrient supplementation decreased the risk of death and improved outcomes in pregnant women with HIV in Africa. A 2017 Cochrane review found no strong evidence to suggest that micronutrient supplementation prevents death or is effective at slowing the progression of disease for adults with HIV. It is important for people living with HIV to eat a healthy adequate diet. For people with HIV that have clinically demonstrated deficiencies in micronutrients or for people who are not able to consume the recommended daily quantities of minerals and vitamins, supplementation is still encouraged. Vitamin A in children with HIV appears to be safe and beneficial. Vitamin A deficiency is found in children with HIV infection who may or may not have symptoms of AIDS. Vitamin A supplementation reduces morbidity and mortality in AIDS symptomatic children, but has no effect on asymptomatic children. It does not prevent HIV infection, cannot treat the chronic HIV infection, and will not cure AIDS.

Deaths resulting from illegal vitamin trials in South Africa

Main article: Matthias Rath

Matthias Rath has been extensively criticized for presenting his vitamin supplements as a treatment for AIDS and for testing them in illegal trials in South Africa. A former associate of Linus Pauling, Rath has promoted vitamins as a treatment for HIV infection, describing treatment with effective antiretroviral drugs as toxic and part of a global conspiracy serving the financial interests of the pharmaceutical industry. In a lawsuit that found against Rath, the South African Medical Association blamed his vitamin products for several deaths. The World Health Organization and two health agencies of the United Nations also described Rath's advertisements as "wrong and misleading" and "an irresponsible attack on ARV (antiretroviral) therapy." The South African Centre for Social Science Research described the trials as "state sponsored pseudo-science". Rath's trials, conducted with the aid of AIDS denialist David Rasnick, were declared unlawful by the Cape High Court; Rath, Rasnick and their foundation were barred from conducting further unauthorised clinical trials and from advertising their products.

Alleged institutional bias

Advocates of orthomolecular medicine, including Pauling, Hoffer and Ewan Cameron have claimed that their findings are actively suppressed by the medical and pharmaceutical industry. Hoffer wrote "There is no conspiracy led and directed by a single person or by a single organization. There is no Mafia in psychiatry. However, there is a conspiracy led and directed by a large number of professionals and their associations who have a common aim to protect their hard-earned orthodoxy, no matter what the cost to their opponent colleagues or to their patients."

The Journal of Orthomolecular Medicine, founded in 1967 as the Journal of Schizophrenia, is a major publication of orthomolecular medicine. As Abram Hoffer wrote:

We had to create our own journals because it was impossible to obtain entry into the official journals of psychiatry and medicine. Before 1967 I had not found it difficult to publish reports in these journals, and by then I had about 150 articles and several books in the establishment press.

Other members of the medical community deny the existence of such an institutional prejudice. A review in the Journal of Clinical Oncology denied that physicians collude against unconventional treatments. Claims of conspiracy were limited to the now defunct Linus Pauling Institute of Science and Medicine. In its current iteration, the Linus Pauling Institute derives a significant amount of funding from the National Institutes of Health and other federal sources.

See also

Citations

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