Misplaced Pages

Orthomolecular medicine

Article snapshot taken from Wikipedia with creative commons attribution-sharealike license. Give it a read and then ask your questions in the chat. We can research this topic together.

This is an old revision of this page, as edited by Michael C Price (talk | contribs) at 01:09, 14 August 2006 (→History and Development). The present address (URL) is a permanent link to this revision, which may differ significantly from the current revision.

Revision as of 01:09, 14 August 2006 by Michael C Price (talk | contribs) (→History and Development)(diff) ← Previous revision | Latest revision (diff) | Newer revision → (diff)

Template:Totallydisputed

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 complementary and alternative medicine fields and rarely in mainstream medicine. 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, however, argue that recent mainstream nutritional studies provide support for their theories.

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" 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 mainstream and non-mainstream researchers. Despite thus it still is often closely associated by the public with Pauling's advocacy of multi-gram doses of vitamin C for optimal health.

An example of a recent mainstream researcher is nutrition researcher Bruce Ames although he does not use the term itself. However his research deals with nutrition and specific genetic disease conditions (as indeed did Pauling's original article which defined the term "orthomolecular"). Ames' research includes investigating the effects of large doses of, for example, the nutrients alpha-lipoic acid (a coenzyme precursor) and the carnitine (an amino acid complex) on restoring metabolic health, and in particular mitochondrial function, in animal models Ames has also investigated the role of high dose B-vitamin therapy in alleviating approximately 50 defective co-enzyme binding affinities, of which one, at least, every human suffers from (example of one genetic disease condition: Over 40% of the population is hetro- or homo-zygous with the thermolabile variant of 5,10-methylenetetrahydrofolate reductase and as a result requires extra riboflavin ).

Ames has, based on his research, developed a supplement for human use.

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 claimed in 1998: "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 suggesting that folic acid and selenium reduce the incidence of cancers
  • Studies suggesting that Vitamin C and Vitamin E reduce coronary disease mortality
  • Studies suggesting that niacin and zinc reduce overall mortality rates
  • Bruce Ames's studies on the effects of vitamins on genetic diseases and biochemical aging processes, and his advocacy of one-a-day multivitamins in cancer prevention

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 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 headaches, depression, learning disabilities, retardation, mental and metabolic disorders, skin problems, and hyperactivity." Proponents argue that these claims come from clinical observation often from physicians with a lifetime of general practise.

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. ^ Age-associated mitochondrial oxidative decay: improvement of carnitine acetyltransferase substrate-binding affinity and activity in brain by feeding old rats acetyl-L- carnitine and/or R-alpha -lipoic acid. Liu J, Killilea DW, Ames BN in Proc Natl Acad Sci U S A 2002 Feb 19;99(4):1876-81 (PMID 11854488)
  12. ^ Memory loss in old rats is associated with brain mitochondrial decay and RNA/DNA oxidation: partial reversal by feeding acetyl-L-carnitine and/or R-alpha -lipoic acid. Liu J, Head E, Gharib AM, Yuan W, Ingersoll RT, Hagen TM, Cotman CW, Ames BN in Proc Natl Acad Sci U S A. 2002 Feb 19;99(4):2356-61. (PMID 11854529)
  13. ^ Feeding acetyl-L-carnitine and lipoic acid to old rats significantly improves metabolic function while decreasing oxidative stress. Hagen TM, Liu J, Lykkesfeldt J, Wehr CM, Ingersoll RT, Vinarsky V, Bartholomew JC, Ames BN in Proc Natl Acad Sci U S A. 2002 Feb 19;99(4):1870-5. (PMID 11854487)
  14. ^ High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms. Ames BN, Elson-Schwab I, Silver EA in Am J Clin Nutr 2002 Apr;75(4):616-58 (PMID 11916749) Abstract:As many as one-third of mutations in a gene result in the corresponding enzyme having an increased Michaelis constant, or K(m), (decreased binding affinity) for a coenzyme, resulting in a lower rate of reaction. About 50 human genetic dis-eases due to defective enzymes can be remedied or ameliorated by the administration of high doses of the vitamin component of the corresponding coenzyme, which at least partially restores enzymatic activity. Several single-nucleotide polymorphisms, in which the variant amino acid reduces coenzyme binding and thus enzymatic activity, are likely to be remediable by raising cellular concentrations of the cofactor through high-dose vitamin therapy. Some examples include the alanine-to-valine substitution at codon 222 (Ala222-->Val) in methylenetetrahydrofolate reductase (NADPH) and the cofactor FAD (in relation to cardiovascular disease, migraines, and rages), the Pro187-->Ser (DNA: 609C-->T) mutation in NAD(P):quinone oxidoreductase 1 and FAD (in relation to cancer), the Ala44-->Gly (DNA: 131C-->G) mutation in glucose-6-phosphate 1-dehydrogenase and NADP (in relation to favism and hemolytic anemia), and the Glu487-->Lys mutation (present in one-half of Asians) in aldehyde dehydrogenase (NAD + ) and NAD (in relation to alcohol intolerance, Alzheimer disease, and cancer).
  15. (PMID: 15681105)
  16. Riboflavin as a determinant of plasma total homocysteine: effect modification by the methylenetetrahydrofolate reductase C677T polymorphism. Hustad S, Ueland PM, Vollset SE, Zhang Y, Bjorke-Monsen AL, Schneede J in Clin Chem 2000 Aug;46(8 Pt 1):1065-71 PMID: 10926884 The riboflavin-tHcy relationship was modified by genotype (P = 0.004) and was essentially confined to subjects with the C677T transition of the MTHFR gene . CONCLUSIONS: Plasma riboflavin is an independent determinant of plasma tHcy.
  17. Zey.com
  18. NCCAM.NIH table 1 on page 8
  19. Id. p. 4
  20. 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.
  21. 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
  22. 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
  23. ^ 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
  24. 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
  25. 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
  26. ^ 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)
  27. http://www.ajcn.org/cgi/content/full/77/2/279?ijkey=9ab8b23f0bdf45f83af656d8623815f69608ad01&keytype2=tf_ipsecsha
  28. 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.
  29. 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)."
  30. 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.
  31. http://www.juvenon.com/pdfs/june05_ames-prescrip.pdf
  32. http://reason.com/amesint.shtml
  33. 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
  34. http://www.tinussmits.nl/english/dynamic.htm?main=http://www.tinussmits.com/english/autism.htm
  35. http://www.canstats.org/readdetail.asp?id=542
  36. e.g., Princeton Brain Bio Center. Brochure, distributed to patients. Skillman, N.J., 1983, The Center.
  37. Frederick R Klenner M.D. , Ancient History and Homespun Vitamin C Therapies .
  38. Robert F. Cathcart III, M.D. Allergy, Environmental & Orthomolecular Medicine.
  39. Orthomolecular Medicine Revisited Ray C. Wunderlich, Jr., M.D.'
  40. http://www.canstats.org/readdetail.asp?id=542
  41. The Dark Side of Linus Pauling's Legacy by Stephen Barrett
  42. Padayatty SL et al, "Vitamin C Pharmacokinetics: Implications for Oral and Intravenous Use," Ann Intern Med. 2004 Apr 6;140(7):533-7.
  43. Douglas RM, Hemila H (2005). "Vitamin C for preventing and treating the common cold". PLoS Med. 2 (6): e168, quiz e217. PMID 15971944.
  44. James Lowell, Ph.D., Nutrition Forum May 1985.
  45. Committee on Nutrition, American Academy of Pediatrics. Megavitamin therapy for childhood psychoses and learning disabilities. Pediatrics 58:910­912, 1976. PMID: 995522
  46. emedicine - Toxicity statistics, 2003
  47. Rapola JM, et al. Randomized trial of alpha-tocopherol and beta-carotene supplements on incidence of major coronary events in men with previous myocardial infarction. Lancet 1997;349;1715-20.
  48. PMID: 3153129
  49. PMID: 3737019
  50. Roberts HJ. Vitamin E . Lancet 1995 Mar 18;345:737
  51. Kaegi E, on behalf of the Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative. Unconventional therapies to cancer: 5. Vitamins A, C, and E. Canadian Medical Association 1998; 158:1483-88.
  52. http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/colds.html
  53. Vitamin Therapy, Megadose / Orthomolecular Therapy, provincial BC Cancer Agency
  54. http://www.healthwatcher.net/Quackerywatch/Cancer/Dueck/index.html
  55. Eylar E, et al. Sustained levels of ascorbic acid are toxic and immunosuppressive for human T cells. Puerto Rico Health Sciences Journal 1996;15:21-6.
  56. http://www.quackwatch.org/01QuackeryRelatedTopics/hair.html
  57. http://www.quackwatch.org/01QuackeryRelatedTopics/pauling.html
  58. fibrinolytic activity of nattokinase, Miyazaki Medical College, Japan
  59. Coenzyme Q10, prescribed for CHF in Japan since 1974, AAFP
  60. Kaitin, K. I., and Jeffrey Brown. 1995. A Drug Lag Update. Drug Information Journal 29: 361–73.

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

Categories: