Orthomolecular Medicine: A Unique Medical Specialty

Orthomolecular Medicine

Orthomolecular medicine, as conceptualized by double-Nobel laureate Linus Pauling, aims to restore the optimum environment of the body by correcting imbalances or deficiencies based on individual biochemistry, using substances natural to the body such as vitamins, minerals, amino acids, trace elements and fatty acids. The term “orthomolecular” was first used by Linus Pauling in a paper he wrote in the journal Science in 1968. The key idea in orthomolecular medicine is that genetic factors affect not only the physical characteristics of individuals, but also to their biochemical milieu. Biochemical pathways of the body have significant genetic variability and diseases such as atherosclerosis, cancer, schizophrenia or depression are associated with specific biochemical abnormalities which are causal or contributing factors of the illness. Want to learn more? The following essays give a more detailed overview of the nature, efficacy and history of orthomolecular medicine.

 

Principles That Identify Orthormolecular Medicine: A Unique Medical Specialty

by Richard A. Kunin, M.D.

In 1969 Linus Pauling coined the word “Orthomolecular” to denote the use of naturally occurring substances, particularly nutrients, in maintaining health and treating disease. At that time megadose niacin therapy for schizophrenia and dietary treatment of “hypoglycemia7 were the major focus of the movement. Since then Orthomolecular psychiatry and medicine have emerged as a distinct and important specialty area in medical practice.

In the meantime, other medical movements have sprung up out of the public demand for Hope in the face of a worsening epidemic of cancer, heart attacks and mental illness and in response to the outcry against adverse effects of modern medical treatments and invasive diagnostic and intensive care procedures. Alternative therapies have come forward to fill the vacuum left by modern Medicine, which failed to provide effective treatments for the major epidemic diseases and in protest against Medicine’s over-reliance on pharmacology, for the drug treatments seem to have fostered the epidemic of drug-dependence which is the major epidemic of our time. The public majority were ready for a new medicine based on nontoxic, non-invasive, “natural” medicines to go with the re-discovered “natural foods”.

Holistic medicine became a rallying point for the New Medicine by putting nutrition, exercise and meditation ahead of surgery, radiation and drugs. It was an answer to the adverse effects of MegaMedicine, the cut burn and poison approach to “health”. And, since holistic medicine did not focus on basic science data, it did not force a paradigm shift in the medical establishment.

Orthomolecular, on the other hand, because it is identified with Linus Pauling, our greatest living scientist, and because it rests on vast body of research in the basic and clinical sciences, does force a major revision in medical thinking. Nutrition, which has been the stepchild of medicine and generally considered a dead issue in medicine, suddenly is at the crux of this new medical movement. No wonder then, that Orthomolecular became a buzzword to the medical establishment, who saw it only as megavitamins and judged it as quackery. By contrast, the word, Holistic became the subject of numerous symposia, journal articles, welcomed by editors eager to promote the image of modern medicine as a progressive and responsive institution. But as it gained supporters, Holistic Medicine also gained additional theories and practices, some of dubious value, some downright unscientific, Even the most broad-minded and liberal-minded editor had to recoil from permitting such things as psychic healing and kinesiology within the pages of a refereed journal.
Soon the word “Alternative, came to replace Holistic in the medical journals. Now the establishment could pick and choose individually between the various therapies that had gathered under the holistic umbrella; nutrition, biofeedback, chiropractic, acupuncture, herbalism, homeopathy, massage, hypnosis, iridology, kinesiology, astrology, psychic healing and other intuitive therapies, to name a few.
The orthomolecular movement was faltered with identity confusion and, in fact, many of our own members seem to have chosen Holistic as their preferred badge-word. This is good for the short run, I agree: it is attractive to patients and profitable while being non-controversial and safer professionally as well. In the long run, however, I think Holistic Medicine has no future. It has already lost its identity, except as a clearing house for medical novelty. Most important, because it does not identify strongly with science it has lost reliability. Meantime, Orthomolecular Medicine retains scientific reason for being: its basic science foundations of nutrition, biochemistry and clinical nutrition have grown at a prodigious rate. Megavitamin niacin therapy, which was am considered dangerous and controversial in treating schizophrenia, is now the standard of care in the hyperlipidemias. What began as megavitamin therapy now employs a broad data base and a variety of therapies applicable to numerous medical and psychiatric conditions. It is ironic that this positive growth of orthomolecular science and therapy has actually clouded the identity of the Orthomolecular movement. On the one hand we are confused with Holistic Medicine; on the other we are seen only as the avant garde of orthodox medicine In hopes of defining our true identity let me update the concept of Orthomolecular Medicine as anew medical specialty.

First of all, the orthomolecular data base rests strongly on the following areas of scientific knowledge: 1. nutrition, 2. biochemistry, 3. Cell biology, 4. physiology, 5, general medicine, immunology, 7. allergy, 8. endocrinology, 9. pharmacology, 10. toxicology, 11. gastroenterology, 12, parasitology, 13. nephrology, 14. physical medicine and manipulation therapies, 15. dentistry, 16. veterinary science, 17. food science, 18, agriculture, 19. climatology, 20. medical politics.

The following therapeutic modalities fit the definition of orthomolecular: 1. vitamins, 2. minerals 3. amino acids, 4. essential fatty acids 5, fiber, 6. enzymes, 7. antibodies, 8. antigens, 9. cell therapy, 10. chelation therapy, 11. dialysis, 12. plasmapharesis, 13. hydrotherapy, 14. thermal therapy, 15. phototherapy, electrotherapy (including electroconvulsive therapy), 17. air ion therapy, 18. light therapy, 19. solar therapy, 20. acupuncture, 21. massage, 22. exercise, 23. biofeedback 24. hypnotherapy and other psychotherapies.

All of the orthomolecular practice rests on a foundation of basic science advances in biochemistry, biophysics, physiology, psychophysiology and ecology. We do not eschew drug therapy or pharmacology; but we do recognize their limitations and their potential for toxicity. Orthomolecular knowledge gives greater choice of benefits for our patients id with less risk of adverse affects.

Aside from these areas of interest, there are by now some well defined beliefs and principles that also distinguish the orthomolecular practitioner from orthodox health practitioners. These principles actually are an important part of our professional identity. Just as knowledge of science and therapeutics might be thought of as our Ego, these principles makeup our professional conscience or Superego, The desire to be in the avant garde of medical progress, to share the excitement of discovery, no doubt, is a major source of our motivational energy or libido, our medical Id, as it were. No, the love of our grateful patients, those we are privileged to heal and comfort, this must be the ultimate motive. At any rate, I think you will agree that the orthomolecular professional is a different personality, with different beliefs and values than most present-day practitioners of medical orthodoxy. Of course all physicians do cherish our Hippocratic oath, but the orthomolecular identity confers upon us additional values and beliefs. Hippocrates first rule was: “Primum non nocere,” i.e. “first, do no harm”. We in orthomolecular practice have less need for the primacy of that rule, for it is already implicit in the essence of Orthomolecular practice, which is: “put nutrition first”.

THE PRINCIPLES

Here is a list of 15 principles that identify the spirit” of Orthormolecular Medicine:

1. Orthomolecules come first in medical diagnosis and treatment. Knowledge of the safe and effective use of nutrients, enzymes,     hormones, antigens, antibodies and other naturally occurring molecules is essential to assure a reasonable standard of care in     medical practice.

2. Orthomolecules have a low risk of toxicity. Pharmacological drugs always carry a higher risk and are therefore second choice if     there is an orthomolecular alternative treatment.

3. Laboratory tests are not always accurate and blood tests do not necessarily reflect nutrient levels within specific organs or     tissues, particularly not within the nervous system. Therapeutic trial and dose titration is often the most practical test.

4. Biochemical individuality is a central precept of Orthomolecular Medicine. Hence, the search for optimal nutrient doses is a     practical issue. Megadoses, larger than normal doses of nutrients, are often effective but this can only be determined by     therapeutic trial. Dose titration is indicated in otherwise unresponsive cases.

5. The Recommended Daily Allowance (RDA) of the United States Food and Nutrition Board are intended for normal, healthy     people. By definition, sick patients are not normal or healthy and not likely to be adequately served by the RDA.

6. Environmental pollution of air, water and food is common. Diagnostic search for toxic pollutants is justified and a high “index     of suspicion” is mandatory in every case.

7. Optimal health is a lifetime challenge. Biochemical needs change and our Orthomolecular prescriptions need to change based     upon follow-up, repeated testing and therapeutic trials to permit fine-tuning of each prescription and to provide a degree of     health never before possible.

8. Nutrient related disorders are always treatable and deficiencies are usually curable. To ignore their existence is tantamount to     malpractice.

9. Don’t let medical defeatism prevent a therapeutic trial. Hereditary and so-called ‘locatable disorders are often responsive to     Orthomolecular treatment.

10. When a treatment is known to be safe and possibly effective, as is the case in much 0 Orthomolecular therapy, a     therapeutic trial is mandated.

11. Patient reports are usually reliable, The patient must listen to his body, The physician must listen to his patient.

12. To deny the patient information and access to Orthomolecular treatment is to deny the patient informed consent for any     other treatment.

13. Inform the patient about his condition; provide access to all technical information and reports; respect the right of freedom     of choice in medicine.

14. Inspire the patient to realize that Health is not merely the absence of disease but the positive attainment of optimal function     and well-being.

15. Hope is therapeutic and orthomolecular therapies always are valuable as a source of Hope. This is ethical so long as there is     no misrepresentation or deception.

The following tabulation further clarifies the role of Orthomolecular Medicine in relation to medical orthodoxy.

 

The essentials boil down to 7 cardinal rules:1. Nutrition comes first in medical diagnosis and treatment.2. Drug treatment is used only for specific indications and always with an eye to the potential dangers and adverse effects.3. Environmental pollution and food adulteration are an inescapable fact of modern life and are a medical priority.4. Biochemical individuality is the norm in medical practice; therefore stereotyped RDA values are unreliable nutrient guides.5. Blood tests do not necessarily reflect tissue levels of nutrients,6. Nutrient diagnosis is always defensible because nutrient related disorders are usually treatment responsive or curable,7. Hope is an indispensable ally of the physician and an absolute right of the patient.Finally, let me repeat, that our rallying point and badge-word must be “Orthomolecular”, a landmark concept that conveys the genius of Dr. Pauling, who saw the need to resurrect nutrition and put it first, not last, in our science of health and disease.

Orthomolecular Medicine Revisited

by Ray C. Wunderlich, Jr., M.D.’

Orthomolecular treatment of clinical conditions amounts to only a small percentage of total medical care rendered in North America. Persons with health disorders who seek treatment from their physicians are li kely to receive a wide variety of drugs. “The use of pharmaceutical agents has not only become a reflex for most allopathic physicians, it has become a standard upon which judgements are made about “proper doctoring”. In recent years, however, a concerned citizenry, uneasy, perhaps, about the ready use of powerful drugs, has increasingly sought alternatives to drug therapy for medical disorders, Largely as a result of population pressure; nutritional education, prudent eating, and physical fitness are fast becoming first-line measures within and without the medical fraternity.

Despite this strong trend, however, the toximolecular approach (the use of xenobiotics, substances foreign to the body) remains strong whenever patients consult physicians for illness. Persons with hypertension are usually given antihypertensive drugs. Infected patients usually receive anti-infectious drugs. Hyperactive and attention-deficit children usually receive Ritalin or similar drugs. Peptic ulcer patients nearly always receive Zantac or Tagamet, Neurotic, psychotic, and character-disordered patients usually receive tranquilizers (neuroleptics) of one sort or another.We are privileged to live at a time when effective medications are available for crisis-care and some longterm conditions. The calcium-channel blocking drugs appear to be clinically effective agents and are helpful in promoting understanding about basic cellular physiology. Nevertheless, alternative methods of nutritional and orthomolecular disease management are available, “These methods are employed by orthomolecular physician CD The components of these treatments include dietary manipulation, nutrition supplementation, herbal remedies, homeopathic treatments, detoxification, hype bane oxygen, intravenous chelation, a lergy management, attitude adjustment ecological manipulation, and safe forms of megavitamin therapy. Newer method of treatment such as ozone therapy, intravenous hydrogen peroxide therapy, magn o therapy, and the like may be utilized but must be considered experimental at this time.Scientific discovery employs the scientific method and has been responsible for accurate scientific information for hundreds
of years. Although double-blind studies are an important part of the scientific endeavor to find the truth, so, too, are observations. The scientific achievements of the 20th century have been based upon the successful descriptive work of the 19th century. Then, too, in a broad sense science incorporates philosophy. Some point out that science, too, must recognize that experiments once observed by a observer, become changed by the act of observation. The character of scientific procedures places restriction on the relevance of results. Philosophers of science are obliged to consider not merely nature in isolation but also the manner in which man, himsel perceives and interprets facts. Recognizing that the problems posed by the interaction of man and nature are complex, we may conclude that all information can be valuable when placed in proper perspective. Despite the limitations of anecdotes accepted science, they are quite valuable a means of communicating to others how some of us get people well. Accordingly, anecdotal reports can be a valuable didactic tool. In this spirit, a number of clinic anecdotes will now be presented. The subject matter is Orthomolecular Medicine.

Hypertension
A 50-year-old man had a history of elevated blood pressure for at least 10 years, Thorough medical evaluation had disclosed no evident cause for the hypertension. He was not overweight. He had been treated with antihypertensive medications with “moderately good control” of the blood pressure. The man sought orthomolecular treatment because of medication side effects that he had experienced through the years. Body chemical analysis identified low levels of most minerals, especially magnesium, He was placed on mineral supplements with particular attention to magnesium. He was also treated with an herbal mixture that had been formulated specifically for hypertension.Within a 6-month period, without change in diet or exercise, the man was free of prescription medications and his blood pressure remained entirely in the normal range.

Middle-Aged Depression
A 45-year-old executive had become restless during the day. His attention wandered, He couldn’t sleep at night and was constipated. His thinking was beset by notions of inferiority and disillusion. His physicians had treated him with antidepressant drugs for several years with moderately good results. He sought another treatment option.The man was placed on a program consisting of L-tryptophan at bedtime (1000 mgms.) and L-phenylalanine (1000 mg.) in the a.m. At noon he took phosphatidyl choline (1200 mg.) along with supporting vitamins and minerals. Among these were 6 grams of vitamin C and 150 mgms. of niacin daily.
The man remained on this regimen for a year with good results. With good sleep at night and markedly improved bowel pattern, his days were no longer restless and he was able to focus on his work. Furthermore, his thoughts became distinctly “upbeat” and his self-confidence greatly improved.

Teenager with Low Blood Sugar
Suzy was flagging in high school. She had difficulty staying awake in the afternoon despite obtaining 8 hours of sleep at night. She often awoke in the morning with suboccipital headaches. Suzy described her thoughts as fuzzy or spacey most of the time. Her weight was increasing at an abnormal rate.
Because of her symptoms along with a positive family history of diabetes mellitus, a 6-hour glucose tolerance test was ordered. The values were:

Fasting 62 mg present
1/2 hour 80 mg present
1 hour 76 mg present
2 hours 74 mg present
3 hours 64 mg present
4 hours 34 mg present
5 hours 48 mg present
6 hours 58 mg present

The glucose tolerance curve was abnormal (low, flat curve with abnormally low 4 hour nadir). The diagnosis of low blood sugar was established. Suzy was placed on a microalgae supplement and treated with glucose tolerance factor derived from yeast. She was instructed in proper diet and commenced eating fish, shellfish, vegetables, whole grains, and some fresh fruits. In between meals she snacked on soy cheese, tofu and brown rice wafers, seeds, or nuts.
She promptly ceased gaining weight and soon was losing weight at the rate of 1-2 pounds per week. She became more alert, lost her afternoon somnolence and had no further headaches. Whenever she ace sweets or missed meals she noted a return of “brain fog”. After 6 months, however, she was able to consume an occasional sweet without adverse effects.

Jekyll-and-Hyde Child (Mood Swings)
A 4-year-old boy was incorrigible. The mother called him a Jekyll and Hyde. One day he was an angel – cooperative – the next, a devil – destructive. At his worst he stuck out at others, threw things, held his breath, and was defiant to everyone, Sleep habits were very poor. He either prowled all night or rocked back and forth “incessantly”. Laboratory testing of hair showed high levels of lead and cadmium. Blood mineral analysis indicated low levels of calcium, magnesium, and zinc and corroborated an excess of lead. No evident source of heavy metals was able to be found in the environment.Supplements of calcium, magnesium, and zinc were administered. Vitamin C, administered by means of a buffered, neutral pH powder, was increased in dosage gradually to bowel tolerance. The lad was able to consume 5 grams daily. Other supporting vitamins were also taken. A prompt improvement in the youth’s behaviour occurred. Fewer bad days were noted and on those days the boy was able to be dealt with by his parents whereas previously there was no control. As time passed, the mood swings abated. Six months after the institution of treatment, follow up tests showed improved levels of calcium, magnesium and zinc. Lead excess was found again but the levels of lead were only half of the original levels. Cadmium was not found to be excessive at this time.Continued supplementation was carried out. The source of heavy metal excess was never found but the boy’s behaviour was steady at a good level as long as he took his supplements.

Teen-Age Menstrual Cramps
An 18-year-old girl came to me to placate her mother. The girl had no particular complaints except severe menstrual cramps. She did, however, admit to poor eating habits and irritability one week before each menstrual period. Her mother added that her daughter was indecisive, hypersensitive, chronically fatigued and insecure. All her symptoms were improved, the mother noted, whenever the teenager consumed a good breakfast.Nutritional laboratory testing documented abnormally low levels of vitamin A A and deficits of many minerals including iron. When appropriate nutrient supplements were taken she lost her irritable nature. She herself agreed that life was better. Her menses became much more comfortable. She became amenable to dietary counsel. ling whereas previously she had eaten as she wished according to no particular guidelines, often skipping meals.

Depression
A 38-year-old woman felt that the world was closing in on her. Although happily married with 2 children, she had become progressively depressed over the past few years. She performed her household chores in a perfunctory manner and engaged in her sexual marital obligations with no enthusiasm, to say the least. She dragged through each day and offered little in the way of conversation with her family. She preferred to be alone. In an attempt to lift her spirits she consumed copious quantities of coffee on a daily basis. Laboratory testing revealed multiple abnormalities of body chemistry, Deficit minerals included calcium, magnesium, manganese, chromium, and cobalt. Levels of vitamin B12 and folic acid were depressed and vitamin B1 was also low.Treatment was commenced with intravenous vitamin C, 12 1/2 grams, with added calcium, magnesium, B complex, and B,,. Intravenous treatments were rendered daily for 5 days then 3 times the next week, and gradually less thereafter. Oral supplements of B complex, B, and minerals were taken.The response to treatment was prompt and gratifying. The woman “came alive”. Her energy returned. Gradually she reduced her consumption of coffee and eventually was able to function very well with no dietary source of caffeine. She became a responsive family member. Her sexual interest and responsivity grew as she became less and less depressed.From time to time, whenever the “pressures of life” became too great for her, a booster treatment consisting of intravenous vitamin C, B vitamins, and minerals was necessary. For the most part, however, the previously depressed woman was happy and fulfilled.

Panic-Anxiety
A 14-year-old boy was overcome by nervousness and panic attacks. His parents withdrew him from school because he could not face the demands of the school day. He had seen a number of psychiatrists and had been treated with Navane, Haldol, and Mellaril. The mother disliked the side effects of the drugs and desired an orthomolecular approach to treatment.The lad was “afraid of his shadow”. He frequently ran to his parents, wringing his hands, trembling inside, crying or whining, and afraid of some morbid occurrence. Due to low finances, laboratory investigation was curtailed. He was placed on an orthomolecular program consisting of niacinamide, vitamin C, pantothenic acid, and vitamin B, A substantial multiple vitamin was given, too.Within 3 months, the parents reported good gains. The boy was now attending school and had begun to participate in some social affairs. Addition of glutamic acid appeared to accelerate the progress.He has now graduated from high school and holds down a job. His treatment regimen currently consists of a highpotency multiple vitamin each day.

Seizures-Carnosinuria
A 1 1/2-year-old boy sustained a grand mal seizure. There had been no head trauma and there was no known illness and no high fever. CAT scan examination of the brain was normal. The history revealed that the boy was hyperactive with a short attention span. He had required very little sleep since birth. He was considered to eat normally and consumed all foods.A metabolic investigation was carried out. Abnormal protein metabolism was identified. Levels of the amino acid, cystine, were very low in the blood and urine. Ta urine was also low. Two toxic peptides, carnosine and anserine, were considerably elevated. Treatment was commenced with a diet restricting the dietary sources of carnosine and anserine, predominantly red meat. Careful survey of iron stores was carried out. Since the enzyme subserving carnosine and and serine is zinc-dependent, he was placed on supplemental zinc. Cystine and taurine were given,
No further seizures occurred. He is now 6-years old. Through the years, the lad became hyperactive or attention deficit when he consumed meat. His intellect is normal, Follow up laboratory testing shows minimal elevation of carnosine and and serine with no other abnormalities.

Reading Disorder
A fourth-grade boy was evaluated due to severe reading problems characterized as poor comprehension. He was 11/2 grade levels behind in reading comprehension. Psychological testing showed depressed verbal score and normal performance score.Despite an enormous appetite for food, the lad’s weight was low for his age and his rate of gain was slow. The stools were described as large and bulky with chronic offensive odour. The dietary history showed a “normal” intake of protein foods, that is, he ate eggs, hamburgers, milk, cheese, and other foods of the culture.Biochemical testing revealed very low levels of amino acids in the blood and urine. A urine indican test was strongly positive indicative of incomplete digestive proteolysis with absorption of toxic chemicals. Stool samples were sent for detailed exam (Comprehensive Digestive Stool Analysis). Undigested protein fibers were found in the stool along with excessive amounts of undigested fat.The boy was considered to have a chronic digestive and absorptive disorder. He was placed on nutritional supplements including amino acids and digestive enzymes. Within a few months his school performance advanced. Within a year’s time, he was performing at grade level in reading. Moreover, the boy had gained several pounds of weight. He displayed an enhanced level of self-confidence and a heightened self-image that contrasted sharply with his former passive, retiring self.

Discussion
For better or worse, today, the “me” generation has become increasingly aggressive about the pursuit of that which it is convinced is important, Thus we witness progress in civil rights, personal rights, and environmental causes. In some quarters, individuals are willing to spend considerable time and energies in the pursuit of particular diets or exercise regimens. As the media have become more responsible in conveying information about favourable lifestyles, awareness has been fostered that alternatives in medical care may be desirable. The likelihood is that Orthomolecular Medicine will increasingly be utilized as a primary method of health care, as the potential hazards and high costs of toximolecular medicine become more apparent to an increasing number of persons.

Hopefully, the physician of the future will first use orthomolecular concepts to influence his patients to make longterm investments in health. Such a physician may need to utilize pharmaceutical drugs for some persons some of the time. However, when orthomolecular concepts are initially invoked the longterm use of drugs will grow progressively less as the years go on. In contrast, initial use of pharmaceutical drugs may create dependence upon such drugs for the maintenance of normal behaviour (the tranquilizer syndrome, for example, may create a permanent state of drug dependency and Tender recovery unlikely). When physicians come to know the full range of therapeutic options, careful assessment of the risk/benefit ratio will indicate the desirability of Orthomolecular Medicine. When sophisticated high-tech diagnosis married with the selective use of drug treatment, radiation, and surgery, and on a background of Orthomolecular Medicine, the prospects for truly enlightened patient care become most probable.

References
1.Nourishing Your Child by Ray C, Wunderlich, Jr., M.D., and Dwight K. Kalita, Ph.D Keats Pub., Inc., New Canaan, CT, G684 1984.
2.Common Questions on Schizophrenia at Their Answers by Abram Hoffer, MD, Ph.D., Keats Pub., Inc., New Canaan, C- 0 06840,1987,
3.Orthomolecular Nutrition by Abram Hoffer,M.D., PhD, and Morton Walker, D.P.M Keats Pub., Inc., New Canaan, CT, 06840, 1978

 

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