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Orthomolecular Medicine

Optimum nutrition and orthomolecular medicine are nutritional health and medical approaches that are based upon the notion that many diseases and abnormalities result from various biochemical and/or chemical imbalances and can be prevented, treated, or sometimes cured by achieving optimum levels of naturally occurring chemical substances, such as vitamins, dietary minerals, enzymes, antioxidants, amino acids, lipotropes, essential fatty acids, prohormones, dietary fibre and intestinal short chain fatty acids. Many of the substances used are essential nutrients.

Orthomolecular medicine is explicitly practiced by relatively few conventional medical practitioners. Orthomolecular treatments are also utilized in complementary and alternative medicine fields, increasingly being integrated into over the counter retail products, naturopathic medical textbooks and mainstream pharmaceuticals. The controversial field of orthomolecular psychiatry deals with the use of orthomolecular medicine to treat psychiatric problems.

The orthomolecular field is based on research in biochemistry, nutrition, medicine, and pharmaceuticals combined with the clinical experience of a number of physicians and physician scientists. Aspects of orthomolecular therapy remain controversial among mainstream medical organizations and physicians, who consider many aspects to be complementary, alternative or integrative medicine. Orthomolecular proponents argue that many mainstream nutritional studies, both recent and historical, provide investigational and clinical support for their treatments and recommendations. They also argue that orthomolecular therapies are intrinsically less likely to cause dangerous side-effects or harm, since they utilize only molecules which are normally present in the body through healthy diet or normal metabolism.

The therapy can help on the treatment of some diseases such as:

• Asthma
• Pneumonia
• Diabetes
• Alzheimer
• Parkinson
• Cancer
• Obesity

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 conventionally-trained doctors among its members and authors. However, the leading orthomolecular medicine website, Orthomolecular Medicine Online, run by the Journal of Orthomolecular Medicine, discusses differences between orthomolecular medicine and current mainstream medicine, which the website refers to as allopathic medicine.

Amongst the differences, mainstream medicine attaches great importance to rigorous double-blind randomized controlled trials to prove a treatment is effective and to exclude the placebo effect. Orthomolecular medicine proponents, on the other hand, believe that such studies overemphasize presupposed minimization of uncertainty in measurement and have instead led to false-negative results from otherwise poorly designed and executed studies that resulted in misrepresented "authoritative" disparagement of nutritional treatments. Mainstream medicine avoids use of new, unproven xenobiotic molecules whose effects are unknown, instead favoring extensively tested, clinically proven drugs, of which 20% may subsequently have unrecognized, serious adverse reactions requiring the later addition of the "black box warning," or withdrawal from market. Orthomolecular medicine holds that natural equivalent molecules, as non-toxic nutritional therapies, are often useful in the interim, before extremely expensive, time-consuming authoritative tests are available.

Individual mainstream medical proponents are sometimes dismissive of orthomolecular medicine, with claims such as "Scientific research has found no benefit from orthomolecular therapy for any disease" despite strong counterexamples such as megadose niacin for dyslipidemias (1955).

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 the RDA of selenium reduce the overall incidence of cancers
• Studies finding that greater than the RDA of vitamin D reduce the overall incidence of cancers; a randomised intervention study involving 1,200 women, published in June 2007, reports that vitamin D supplementation (1,100 international units (IU)/day) resulted in a 60% reduction in cancer incidence, during a four-year clinical trial, rising to a 77% reduction if cancers diagnosed in the first year (and therefore more likely to have originated prior to the intervention) were excluded.
• Studies finding that greater than the RDA of "A, B6, C and E plus zinc," folic acid and selenium reduce the incidence of specific 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"

Some of these findings have been reported as not consistent with other studies. 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 desirable. 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 about orthomolecular medicine comes in part because some of its proponents make claims more broad than those supported by double-blind randomized controlled studies, additionally considering observational studies, clinical and anecdotal experience, single blinded controlled tests, and case histories. Proponents of orthomolecular medicine argue that, despite the extensive and expensive testing of pharmaceuticals, a number of medications have recently been withdrawn after approval due to serious adverse events, and the FDA regulatory methodology and relationship with the pharmaceutical industry has been criticized.

Nutritional supplements, such as those used in orthomolecular medicine, are less regulated than pharmaceuticals in the United States. Pharmaceuticals must be proven safe and effective to the satisfaction of the FDA before they can be marketed, whereas supplements must be proven unsafe before regulatory action can be taken. A number of orthomolecular US supplements are available in pharmaceutical versions that are sometimes quite similar in strength and general content, or in other countries are pharmaceuticals. The US regulations also have provisions to recognize a general level of safety for established nutrients that can forgo new drug safety tests. Proponents of nutritional supplement use have argued that the lower level of regulation results in cost savings for American consumers, pointing to higher supplement prices in Europe, where supplements are more tightly regulated or even unavailable.

The conventional view amongst mainstream medical physicians is that most orthomolecular therapies are insufficiently proven for clinical use, that the scientific foundations are weak, and that the studies that have been performed are too few and too open to disputed interpretation. Orthomolecular proponents, such as Robert Cathcart who predicts that 120+ grams per day intravenous vitamin C should cure SARS and has used up to 250 grams IV vitamin C per day, have been criticised without any conventional medical trials of such intravenous vitamin C treatments.

Proponents of orthomolecular medicine argue that many mainstream physicians are unfamiliar with the concepts and clinical background of orthomolecular medicine. They dispute the interpretation of results of many mainstream studies, arguing that those interpretations or studies are "strawmen," using 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.

The orthomolecular field 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. A number of individuals and organizations contest the claims, benefits, degree of evidence and toxicity. Based on testing with dosages well below orthomolecular recommendations, Linus Pauling has been criticized for making overbroad claims for the efficacy of vitamin C but Paulings' claims have received some support from tests closer to the orthomolecular recommendations during the last few years.

The relationship of mainstream medicine to orthomolecular proponents has often been adversarial; orthomolecular proponents argue that mainstream medical claimants confuse orthomolecular medicine with other, less science based modalities. The American Academy of Pediatrics labelled orthomolecular medicine a "cult" in 1976, in response to claims that orthomolecular medicine could cure childhood psychoses and learning disorders. Conventional health professionals see orthomolecular medicine as encouraging individuals to dose themselves with large amounts of vitamins and other nutritients without conventional supervision, which they worry might be damaging to health. Rare risks of non-orthomolecular "mega" dosages of vitamin relatives, which frequently involved pharmaceutical analogues such as synthetic menadione, unsupervised misuse, deliberate abuse and earlier medical treatments, 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.

Megavitamin proponents point to an almost zero level of deaths caused by vitamins, even with large overdoses, compared to the significant numbers from pharmaceuticals, including a number of over-the-counter items.

FDA-Approved Health Claims:
FDA has approved health claims for some foods and has tentativily identified the active ingredients of those foods, but has not automatically approved the same claim for those compounds in supplement form.

Sources: Wikipedia, the free encyclopedia;
Department of Health and Human Services, Centers for Disease Control and Prevention;
and FDA - Food and Drug Adminstration

Adapted by Editorial Staff, July 2007
Last update, August 2008