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Mainstream medicine is often dismissive of orthomolecular medicine: the leading mainstream guide to alternative medicine says "Scientific research has found no benefit from orthomolecular therapy for any disease." <ref name="cassileth"> Cassileth BR. Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W.W.Norton & Co., 1998:67.</ref><ref name="bccancer"></ref><ref name="qw"/> Supporters claim that some aspects of orthomolecular medicine, and in particular the optimal nutrition subset, have support in mainstream scientific research in a variety of areas: Mainstream medicine is often dismissive of orthomolecular medicine: the leading mainstream guide to alternative medicine says "Scientific research has found no benefit from orthomolecular therapy for any disease." <ref name="cassileth"> Cassileth BR. Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W.W.Norton & Co., 1998:67.</ref><ref name="bccancer"></ref><ref name="qw"/> Supporters claim that some aspects of orthomolecular medicine, and in particular the optimal nutrition subset, have support in mainstream scientific research in a variety of areas:


*Reducing the incidence of cancers<ref>''Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study''. Giovannucci E, Stampfer MJ, Colditz GA, Hunter DJ, Fuchs C, Rosner BA, Speizer FE, Willett WC; Ann Intern Med" 1998 Oct 1;129(7):517-24 PMID: 9758570 Long-term use (>15 years) of folate-containing multivitamin supplements produced an almost 5-fold reduction in the incidence of colon cancer.</ref><ref>''Are dietary factors involved in DNA methylation associated with colon cancer?'' Slattery ML, Schaffer D, Edwards SL, Ma KN, Potter JD in Nutr Cancer 1997;28(1):52-62 PMID: 9200151 </ref><ref>''Dietary intake of folic acid and colorectal cancer risk in a cohort of women''. Terry P, Jain M, Miller AB, Howe GR, Rohan TE in Int J Cancer 2002 Feb 20;97(6):864-7 PMID: 11857369</ref><ref name="se15">Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. Clark LC, Combs GF Jr, Turnbull BW, Slate EH, Chalker DK, Chow J, Davis LS, Glover RA, Graham GF, Gross EG, Krongrad A, Lesher JL Jr, Park HK, Sanders BB Jr, Smith CL, Taylor JR. ''JAMA 1996 Dec 25;276(24):1957-63'' PMID: 8971064 200ug/d of selenium for 4.5 years resulted in a 17% reduction of totality mortality by over 11 years (in total), due to a 50% reduction of (all) cancer mortality, 37% reduction in (all) cancer occurrence </ref><ref name="se71a">Reduction of cancer mortality and incidence by selenium supplementation. Combs GF Jr, Clark LC, Turnbull BW in ''Med Klin 1997 Sep 15;92 Suppl 3:42-5.'' PMID: 9342915/ref><ref name="se71b">Reduction of cancer risk with an oral supplement of selenium. Combs GF Jr, Clark LC, Turnbull BW in ''Biomed Environ Sci 1997 Sep;10(2-3):227-34 '' PMID: 9315315 </ref> *Reducing the incidence of cancers<ref>''Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study''. Giovannucci E, Stampfer MJ, Colditz GA, Hunter DJ, Fuchs C, Rosner BA, Speizer FE, Willett WC; Ann Intern Med" 1998 Oct 1;129(7):517-24 PMID: 9758570 Long-term use (>15 years) of folate-containing multivitamin supplements produced an almost 5-fold reduction in the incidence of colon cancer.</ref><ref>''Are dietary factors involved in DNA methylation associated with colon cancer?'' Slattery ML, Schaffer D, Edwards SL, Ma KN, Potter JD in Nutr Cancer 1997;28(1):52-62 PMID: 9200151 </ref><ref>''Dietary intake of folic acid and colorectal cancer risk in a cohort of women''. Terry P, Jain M, Miller AB, Howe GR, Rohan TE in Int J Cancer 2002 Feb 20;97(6):864-7 PMID: 11857369</ref><ref name="se15">Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. Clark LC, Combs GF Jr, Turnbull BW, Slate EH, Chalker DK, Chow J, Davis LS, Glover RA, Graham GF, Gross EG, Krongrad A, Lesher JL Jr, Park HK, Sanders BB Jr, Smith CL, Taylor JR. ''JAMA 1996 Dec 25;276(24):1957-63'' PMID: 8971064 200ug/d of selenium for 4.5 years resulted in a 17% reduction of totality mortality by over 11 years (in total), due to a 50% reduction of (all) cancer mortality, 37% reduction in (all) cancer occurrence </ref><ref name="se71a">Reduction of cancer mortality and incidence by selenium supplementation. Combs GF Jr, Clark LC, Turnbull BW in ''Med Klin 1997 Sep 15;92 Suppl 3:42-5.'' PMID: 9342915</ref><ref name="se71b">Reduction of cancer risk with an oral supplement of selenium. Combs GF Jr, Clark LC, Turnbull BW in ''Biomed Environ Sci 1997 Sep;10(2-3):227-34 '' PMID: 9315315 </ref>
*Reducing coronary disease mortality <ref name="vitCE"> Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. Losonczy KG, Harris TB, Havlik RJ in Am J Clin Nutr 1996 Aug;64(2):190-6 PMID: 8694019 34% reduction in total mortality over 9 years from vitamin E use (47% reduction coronary disease mortality; 42% reduction in total mortality over 9 years from) vitamin C & E use (53% reduction in coronary disease mortality)</ref><ref></ref> *Reducing coronary disease mortality <ref name="vitCE"> Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. Losonczy KG, Harris TB, Havlik RJ in Am J Clin Nutr 1996 Aug;64(2):190-6 PMID: 8694019 34% reduction in total mortality over 9 years from vitamin E use (47% reduction coronary disease mortality; 42% reduction in total mortality over 9 years from) vitamin C & E use (53% reduction in coronary disease mortality)</ref><ref></ref>
*Reducing overall mortality rates <ref name="se15"/><ref name="vitCE"/><ref name="niacin27g">Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W in ''J Am Coll Cardiol 1986 Dec;8(6):1245-55 '' PMID: 3782631 "With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004)." Dose used = 2g 3g/day for 6 years. The drop in mortality was only evident after 6-8 years.</ref><ref name="znb">Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study: AREDS Report No. 13. AREDS Research Group (Authors: Traci E. Clemons, PhD; Natalie Kurinij, PhD; Robert D. Sperduto, MD.) in ''Arch Ophthalmol. 2004 May;122(5):716-26.'' PMID: 15136320 "Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89)."</ref> *Reducing overall mortality rates <ref name="se15"/><ref name="vitCE"/><ref name="niacin27g">Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W in ''J Am Coll Cardiol 1986 Dec;8(6):1245-55 '' PMID: 3782631 "With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004)." Dose used = 2g 3g/day for 6 years. The drop in mortality was only evident after 6-8 years.</ref><ref name="znb">Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study: AREDS Report No. 13. AREDS Research Group (Authors: Traci E. Clemons, PhD; Natalie Kurinij, PhD; Robert D. Sperduto, MD.) in ''Arch Ophthalmol. 2004 May;122(5):716-26.'' PMID: 15136320 "Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89)."</ref>

Revision as of 13:56, 13 August 2006

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Orthomolecular medicine and optimum nutrition is the theory that mental diseases or abnormalities result from various chemical imbalances or deficiencies and can be cured by restoring proper levels of chemical substances, such as vitamins and minerals, in the body.

Orthomolecular medicine is a minority view held by a small number of medical practitioners. Orthomolecular treatments are utilized in mainstream, complementary and alternative medicine fields. The controversial field of orthomolecular psychiatry deals with the use of orthomolecular medicine to treat psychiatric problems.

The orthomolecular field, although viewed by its supporters as science-based, remains controversial among many mainstream 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, because of unsubstantiated claims, lack of proven benefits, and serious toxic effects.

Origins

Orthomolecular megavitamin therapies, such as "megadose" usage of tocopherols and ascorbates, date back to the 1930s.

The term "orthomolecular" was first used by Linus Pauling in 1968, to express the "idea of the right molecules in the right amounts" and subsequently defined "orthomolecular medicine" as "the treatment of disease by the provision of the optimum molecular environment, especially the optimum concentrations of substances normally present in the human body." or as "the preservation of good health and the treatment of disease by varying the concentrations in the human body of substances that are normally present in the body and are required for health."

The field was developed by others after Pauling coined the term "orthomolecular", but it still is often closely associated by the public with Pauling's advocacy of muti-gram doses of vitamin C for optimal health. However Paulings's definition and use of the term covers a broader range than just vitamin C. It is this broader use of the term orthomolecular, as originally defined, that defines its usage by mainstream researchers such as Bruce Ames.

Method

Orthomolecular medicine posits that many typical diets are insufficient for long term health; thus, orthomolecular medical diagnoses and treatment often focus on use of natural substances found in a healthy diet such as vitamins, dietary minerals, enzymes, antioxidants, amino acids, essential fatty acids, dietary fiber and intestinal short chain fatty acids.

In orthomolecular medicine, some diseases are posited to originate from multiple nonspecific causes, congenital and acquired. These causes are said to give rise to biochemical aberrations, the accumulation of which results in symptoms, from which the perception of a disease state follows. Orthomolecular medicine argues that some clinically-apparent diseases may be described as fuzzy sets of biochemical anomalies and that 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.

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 these tests have not been accepted by mainstream medicine.

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.

Often supplementation with relatively large doses of vitamins is given and the name megavitamin therapy has become popularly associated with the field. Megavitamin therapy is the administration of large amounts of vitamins, often many times greater than the recommended dietary allowance (RDA). Short chained fatty acids are produced by fermentation of dietary fiber in the colon, then absorbed and utilized, often aided with a combination of probiotics, prebiotics and "glyconutrients" added to the diet.

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.

Popularity

A survey released in May 2004 by the National Center for Complementary and Alternative Medicine focused on who used complementary and alternative medicine (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, megavitamin therapy was the twelfth most commonly used CAM therapy (2.8%) in the United States during 2002, though the study did not distinguish between full-scale orthodox orthomolecular medicine and lay use of relatively publicized Vitamin C megadose supplements. . Poor adults were more likely to use megavitamin therapy than non-poor adults.

Relation to mainstream medicine

Orthomolecular medicine claims an evolving nutritional pharmacology that overlaps between natural medicine and mainstream medicine. The International Society for Orthomolecular Medicine has some conventionally-trained doctors among its members and authors.

Mainstream medicine is often dismissive of orthomolecular medicine: the leading mainstream guide to alternative medicine says "Scientific research has found no benefit from orthomolecular therapy for any disease." Supporters claim that some aspects of orthomolecular medicine, and in particular the optimal nutrition subset, have support in mainstream scientific research in a variety of areas:

  • Reducing the incidence of cancers
  • Reducing coronary disease mortality
  • Reducing overall mortality rates

However, these studies (some of which have yet to be fully accepted) all come from mainstream medical sources that neither subscribe to nor claim to support orthomolecular doctrine, and, in at least some cases, explicitly reject claims of orthomolecular proponents that nutritional supplements are desireable.

The skepticism regarding orthomolecular medicine comes in part from proponents making far more sweeping claims than those with support from mainstream studies, including claims that nutrition can cure or treat "alcoholism, allergies, arthritis, autism, epilepsy, hypertension, hypoglycemia, migraine headaches, depression, learning disabilities, retardation, mental and metabolic disorders, skin problems, and hyperactivity." Proponents argue that these claims come from clinical observation.

Criticism

Many mainstream medical physicians regard most orthomolecular therapies as insufficiently proven for clinical use, and criticize leading orthomolecular proponents for making unsubstantiated claims such as Robert Cathcart's claim that Vitamin C is a legitimate treatment for SARS. Proponents contend that many mainstream doctors have little familiarity with the detailed concepts and clinical background of orthomolecular medicine. Mainstream medicine disputes the validity of most orthomolecular therapies based on the lack of authoritative studies and the poor results from the studies that have been done. Proponents dispute the results of mainstream studies, arguing that those studies used much lower doses, frequencies, duration or assimilable forms than they recommend or suffered from other special conditions, contamination, populations or statistical treatment often not clearly published in the documentation.

Linus Pauling has been criticized for making overbroad claims for the efficacy of Vitamin C but has received some support for modified claims in the last few years. Contemporaries of Pauling report that he "frequently" suffered from colds.

The relationship of mainstream medicine to orthomolecular proponents has usually been adversarial, with the latter accusing mainstream medicine of a conspiracy to suppress their discipline. The American Academy of Pediatrics even labelled orthomolecular medicine as a "cult" in 1976. Many 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 may be damaging to health. Risks of megavitamins may include 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. Many physicians express concern that megavitamin and orthomolecular therapies used solely as alternative treatments can create dangerous delays in obtaining their conventional treatments, such as radiation and chemotherapy for cancer. For example, in a highly publicized Canadian case, the chemotherapy treatment of a 13-year-old cancer patient, Tyrell Dueck, was delayed, possibly fatally, because his parents were influenced by claims of orthomolecular cures for cancer. Sustained megadoses of Vitamin C may inhibit the immune system, a particular danger for AIDS and cancer patients resorting to orthomolecular medicine.

Sometimes proponents claim partisan politics, pharmaceutical industry influence, and competitive considerations to be significant factors; on the other hand, prominent orthomolecular proponents sell lines of orthomolecular products, orthomolecular practitioners sell expensive tests of questionable benefit such as hair analysis, and the Linus Pauling Institute's funding comes mostly from Hoffmann-La Roche, the leading manufacturer of Vitamin C supplements. At least one orthomolecular therapy has been officially sanctioned within Japan, which has looser drug approval regulations than the United States Food & Drug Administration

Notable orthomolecular doctors

Orthomolecular scientists

Reference links

  1. The American Heritage Stedman's Medical Dictionary, 2nd Edition, 2004.
  2. ^ Cassileth BR. Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W.W.Norton & Co., 1998:67.
  3. ^ "Vitamin Therapy, Megadose / Orthomolecular Therapy" British Columbia Provincial Health Services Authority 2000
  4. ^ http://www.quackwatch.org/01QuackeryRelatedTopics/ortho.html
  5. American Cancer Society 2006 "Orthomolecular Medicine has not been scientifically proven to help most of the conditions for which it is promoted. However, vitamins, minerals, and other supplements have been and continue to be studied to see if they can help or prevent many types of illness."
  6. Nutrition Committee, Canadian Paediatric Society. Megavitamin and megamineral therapy in childhood. Canadian Medical Association Journal 143:1009 1013, 1990, reaffirmed April 2000.
  7. New/Old Findings on Unique Vitamin E
  8. AscorbateWeb: Timeline from 1935 to 1939
  9. Orthomolecular psychiatry. Varying the concentrations of substances normally present in the human body may control mental disease,Science 1968 Apr 19;160(825):265-71.(PMID 5641253)
  10. Definition of Orthomolecular medicine at www.orthomed.org Accessed June 2006 and What is Orthomolecular Medicine?, Linus Pauling Inst.
  11. Bruce N Ames, Ilan Elson-Schwab and Eli A Silver (2002). "High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms". American Society for Clinical Nutrition. 75: 616–658. Retrieved 2006-08-12.
  12. NCCAM.NIH table 1 on page 8
  13. Id. p. 4
  14. Multivitamin use, folate, and colon cancer in women in the Nurses' Health Study. Giovannucci E, Stampfer MJ, Colditz GA, Hunter DJ, Fuchs C, Rosner BA, Speizer FE, Willett WC; Ann Intern Med" 1998 Oct 1;129(7):517-24 PMID: 9758570 Long-term use (>15 years) of folate-containing multivitamin supplements produced an almost 5-fold reduction in the incidence of colon cancer.
  15. Are dietary factors involved in DNA methylation associated with colon cancer? Slattery ML, Schaffer D, Edwards SL, Ma KN, Potter JD in Nutr Cancer 1997;28(1):52-62 PMID: 9200151
  16. Dietary intake of folic acid and colorectal cancer risk in a cohort of women. Terry P, Jain M, Miller AB, Howe GR, Rohan TE in Int J Cancer 2002 Feb 20;97(6):864-7 PMID: 11857369
  17. ^ Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. A randomized controlled trial. Nutritional Prevention of Cancer Study Group. Clark LC, Combs GF Jr, Turnbull BW, Slate EH, Chalker DK, Chow J, Davis LS, Glover RA, Graham GF, Gross EG, Krongrad A, Lesher JL Jr, Park HK, Sanders BB Jr, Smith CL, Taylor JR. JAMA 1996 Dec 25;276(24):1957-63 PMID: 8971064 200ug/d of selenium for 4.5 years resulted in a 17% reduction of totality mortality by over 11 years (in total), due to a 50% reduction of (all) cancer mortality, 37% reduction in (all) cancer occurrence
  18. Reduction of cancer mortality and incidence by selenium supplementation. Combs GF Jr, Clark LC, Turnbull BW in Med Klin 1997 Sep 15;92 Suppl 3:42-5. PMID: 9342915
  19. Reduction of cancer risk with an oral supplement of selenium. Combs GF Jr, Clark LC, Turnbull BW in Biomed Environ Sci 1997 Sep;10(2-3):227-34 PMID: 9315315
  20. ^ Vitamin E and vitamin C supplement use and risk of all-cause and coronary heart disease mortality in older persons: the Established Populations for Epidemiologic Studies of the Elderly. Losonczy KG, Harris TB, Havlik RJ in Am J Clin Nutr 1996 Aug;64(2):190-6 PMID: 8694019 34% reduction in total mortality over 9 years from vitamin E use (47% reduction coronary disease mortality; 42% reduction in total mortality over 9 years from) vitamin C & E use (53% reduction in coronary disease mortality)
  22. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W in J Am Coll Cardiol 1986 Dec;8(6):1245-55 PMID: 3782631 "With a mean follow-up of 15 years, nearly 9 years after termination of the trial, mortality from all causes in each of the drug groups, except for niacin, was similar to that in the placebo group. Mortality in the niacin group was 11% lower than in the placebo group (52.0 versus 58.2%; p = 0.0004)." Dose used = 2g 3g/day for 6 years. The drop in mortality was only evident after 6-8 years.
  23. Associations of Mortality With Ocular Disorders and an Intervention of High-Dose Antioxidants and Zinc in the Age-Related Eye Disease Study: AREDS Report No. 13. AREDS Research Group (Authors: Traci E. Clemons, PhD; Natalie Kurinij, PhD; Robert D. Sperduto, MD.) in Arch Ophthalmol. 2004 May;122(5):716-26. PMID: 15136320 "Participants randomly assigned to receive zinc had lower mortality than those not taking zinc (RR, 0.73; 95% CI, 0.61-0.89)."
  24. E.g., Spencer JW, Jacobs JJ. Complementary/alternative medicine: an evidence based approach. Toronto: Mosley, 1999:134,137; The selenium shocker. University of California at Berkeley Wellness Letter 1997;13:8-9; http://www.news.cornell.edu/releases/Jan97/selenium.ssl.html
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  29. The Dark Side of Linus Pauling's Legacy by Stephen Barrett
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  34. emedicine - Toxicity statistics, 2003
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  40. http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colds.html
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  44. http://www.quackwatch.org/01QuackeryRelatedTopics/hair.html
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  46. fibrinolytic activity of nattokinase, Miyazaki Medical College, Japan
  47. Coenzyme Q10, prescribed for CHF in Japan since 1974, AAFP
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Bibliography

  • Barrie R. Cassileth (1998) Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W.W.Norton & Co., ISBN 0393045668
  • Abram Hoffer (1998) Putting It All Together: The New Orthomolecular Nutrition, McGraw-Hill, ISBN 0879836334
  • Abram Hoffer, M.D. with Linus Pauling (2004) Healing Cancer: Complementary Vitamin & Drug Treatments, CCNM Press, ISBN 1897025114
  • Pauling, Linus (1986) How to Live Longer and Feel Better, W. H. Freeman and Company, ISBN 0-380-70289-4
  • 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
  • Joseph E. Pizzorno, Jr., Michael T. Murray (November 2005) Textbook of Natural Medicine, 3rd edition, Churchill Livingstone, ISBN 0443073007 · 2368pp

See also

External links

Support

Criticism

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