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Orthomolecular medicine and optimum nutrition are a controversial medical approach (which some sources describe as a paradigm) that many diseases and abnormalities result from various chemical imbalances or deficiencies and can be prevented, treated, or sometimes cured, by achieving optimal levels of naturally occurring chemical substances, such as vitamins, dietary minerals, enzymes, antioxidants, amino acids, essential fatty acids, prohormones, dietary fiber and intestinal short chain fatty acids.

Orthomolecular medicine is a minority practice amongst a small proportion of medical practitioners. Orthomolecular treatments are utilized in 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 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.

Orthomolecular proponents argue that recent mainstream nutritional studies provide support for their theories . They also argue that it tends to be intrinsically safe as it only utilises molecules which are normally present in the body through healthy diet or normal metabolism.

History and development

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 within the context of psychiatry" 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."

Since 1968 the orthomolecular field has developed further through the works of researchers. Despite this it is still often closely associated by the public with Pauling's advocacy of multi-gram doses of vitamin C for optimal health.

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 normal diet such as vitamins, dietary minerals, enzymes, antioxidants, amino acids, essential fatty acids, dietary fiber and intestinal short chain fatty acids.

Orthomolecular medicine argues that some diseases reflect biochemical anomalies and that it is advantageous to recognize and to correct these anomalies at an early stage, before they result in recognizable diseases.

The orthomolecular practitioner relies heavily on laboratory testing. In addition to standard clinical chemistries, orthomolecular practitioners now employ a wide range of 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. Thus, "optimal" is a matter of the "clinical judgment" of the orthomolecular practitioner. Most often, the orthomolecular practitioner uses many substances: amino acids, enzymes, non-essential nutrients, hormones, vitamins, minerals etc. in a therapeutic effort to restore those (or derivative substances) to optimum levels 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. However, the leading orthomolecular medicine website, Orthomolecular Medicine Online, run by the Journal of Orthomolecular Medicine, takes the position that orthomolecular medicine is to be considered different from mainstream medicine, which the website refers to as allopathic medicine, a term typically used in a pejorative sense by alternative medicine proponents. Amongst the differences, mainstream medicine attaches great importance to double-blind studies, whereas orthomolecular medicine proponents believes that false-negative results can lead to discarding of good cures; and mainstream medicine discourages use of unproven remedies whereas orthomolecular medicine holds that these are often useful.

In turn, mainstream medicine is often dismissive of orthomolecular medicine: "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:

• Studies finding that greater than RDA of "A, B₆, C and E plus zinc", folic acid and selenium reduce the incidence of cancers
• Studies finding that supplementation of long-chain omega-3 essential fatty acids reduced the incidence of cardiac mortality in secondary prevention trials
• Early studies finding that vitamin E alone and vitamin C & E together reduce coronary disease mortality
• Studies finding that niacin, selenium, zinc, vitamin C alone and vitamin E alone and vitamin C & E together reduce overall mortality rates
• Bruce Ames's studies on the effects of vitamins on genetic diseases and biochemical aging processes
• The advocacy of daily multivitamins in cancer prevention by Bruce Ames and by others in a JAMA review article for "chronic disease prevention in adults"

Many of these studies' findings have not been fully accepted. For example, subsequent randomized clinical trials have consistently found lack of benefit to vitamin E supplementation. Indeed, vitamin E supplementation may increase the risk for congestive heart failure. Reconciling and confirming the conclusions of individual nutritional studies is a subject of ongoing research.

Moreover, these studies all come from mainstream medical sources that do not claim to support orthomolecular doctrine, and in at least some cases, explicitly reject claims of orthomolecular proponents that nutritional supplements are desireable. Ames supports daily USRDA multivitamin supplements as a public-policy solution to the lack of vegetables in United States diets, but has not endorsed global use of megavitamin therapy propounded by orthomolecular medicine.

The skepticism regarding orthomolecular medicine comes in part from some of its proponents making far more sweeping claims than those supported by double-blind controlled studies. Claims have been made that nutrition can cure or treat "alcoholism, allergies, arthritis, autism, epilepsy, hypertension, hypoglycemia, migraine, depression, learning disabilities, retardation, mental and metabolic disorders, skin problems, and hyperactivity."

Criticism

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. 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.

The accumulated evidence of randomized clinical trials with vitamin E have been informative, given the promise initially held for vitamin E based on theoretical and epidemiological grounds. Meta analysis of several randomized clinical trials of antioxidants, including vitamin E, have not shown any benefit to vitamin E supplementation for preventing coronary heart disease. Indeed, vitamin E supplementation may increase the risk for congestive heart failure. A subsequent meta analysis published in 2005 found that "high dose" vitamin E (>=400 units/day) was associated with an all cause mortality risk difference of 39 per 10,000 persons). Furthermore, a significant relationship was seen between dose and all-cause mortality, with increased risk with doses exceeding 150 I.U. per day. This meta analysis, however, was criticized on a number of grounds . A criticism which the authors did not rebutt was that the mortality effect was a confounder resulting entirely from excess mortality in a few studies of combined vitamin E and beta carotene in smokers, a supplement and exposure combination that had theoretical support initially but later shown to be harmful

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 . Japan has different, often more onerous drug approval regulations than the United States Food & Drug Administration.

Notable orthomolecular doctors

• Robert Cathcart
• Glen Dettman
• Abram Hoffer
• Ronald E. Hunnunghake
• Archie Kalokerinos
• Fred R. Klenner
• Matthias Rath
• Hugh D. Riordan
• Julian Whitaker

Orthomolecular scientists

• Irwin Stone
• Linus Pauling
• Steve Hickey

Reference links

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Bibliography

Advocates

• 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

Critics

• Barrie R. Cassileth (1998) Alternative medicine handbook: the complete reference guide to alternative and complementary therapies. New York: W.W.Norton & Co., ISBN 0393045668

See also

• Life extension
• List of life extension related topics
• Metabolomics
• Megavitamin therapy

External links

• Biologically Based Practices: An Overview, National Institute of Health National Center for Complementary and Alternative Medicine
• Linus Pauling Institute website

Support

• Orthomolecular Medicine
• Orthomolecular Medicine Online
• DoctorYourself.com - Personal site of Andrew Saul PhD, Contributing Editor for the Journal of Orthomolecular Medicine.
• Analysis of Megavitamin Therapy

Criticism

• "Vitamin Therapy, Megadose / Orthomolecular Therapy", British Columbia Provincial Health Services Authority 2000
• Orthomolecular Therapy, a critical analysis of orthomolecular medicine by Stephen Barrett MD. 2000
• Faddism and quackery in cancer nutrition, Nutr Cancer. 1984;6(3):196-206.
• Should We "Thank God" for Julian Whitaker?, American Council on Science and Health, 1999
• Recommendations of the NCAHF Task Force on Supplement Abuse (1987)

• Orthomolecular medicine
• Biologically based therapies