| | What is Orthomolecular Medicine? | |
Maimonedes Molecules
Orthomolecular Medicine is a strategy for the maintenance of health
and the treatment of disease by varying the amounts of substances
normally found in the body, such as vitamins and minerals. Orthomolecular
medicine is nutritional biochemistry applied to understanding
health and treating disease. Other ortho-molecules are also included
in this new approach to medical practice: amino acids, fatty acids,
nucleic acids, enzymes, hormones and numerous metabolic intermediate
molecules. Laboratory tests can measure all of these natural substances
and their health effects are becoming increasingly well understood.
Chemical and pharmaceutical companies supply pure and reliable
forms of these substances for therapeutic use at the doctor's
discretion. Orthomolecular medicine accesses a vastly expanded
information data base and utilizes a more varied and powerful
array of therapies than is otherwise available to the orthodox
medical practitioner. This is truly a new horizon of orthomolecular
or, if you please, nutrimolecular medicine.
The word, orthomolecular, was introduced by Dr. Linus Pauling
in 1968 and it launched a storm of controversy over the role of
nutrition in medicine. Why the fuss? Because the medical community
was convinced that deficiency disease was all but extinct, conquered
by the vitamin D fortification of milk and the enrichment of flour
by the addition of vitamins B1, B2, B3 and iron. This left doctors
with a simplifistic and anachronistic strategy of medical practice
based on a 19th century model, the germ theory. To this day, orthodox
medicine is still looking for infectious organisms behind every
disease. Nutrition was and secretly is passe' and vitamins widely
believed insignificant in causing or preventing heart attacks
and cancer. Nutrition has been considered so unlikely a cause
of illness that medical schools did not teach it and doctors did
not take it seriously until very recently. If patients inquire
about vitamins most doctors are unprepared be authoritative. Instead
too many doctors still give vague warnings; while others reveal
their ignorance with such condescending pap as: "Well, it won't
hurt." or "Go ahead, it will just give you expensive urine."
But when Dr. Pauling, winner of two Nobel Prizes and widely considered
to be the greatest all-around scientist of the 20th Century, published
his treatise, elevating nutrition to the status of a science,
by calling it "orthomolecular," the medical world felt betrayed
and threatened. Betrayed because Pauling is known as the father
of molecular biology for his ground-breaking researches into the
molecular structure of proteins, of hemoglobin, of sickle cell
anemia, of anesthesia, of antigen and antibody, the triple helix
of collagen and much basic work paving the way for the Watson
and Crick concept of the nucleic acid double helix at the core
of the gene.
Pauling's advocacy of vitamins and nutrient therapy had an enormous
following and many medical leaders felt threatened. They were
caught up in pursuit of miracle drugs, along the lines of the
antibiotics and tranquilizers. After all, these were the breakthrough
products that transformed medical prescribing after the Second
World War. And now there was a medical war going on, Nixon's War
on Cancer, a multi-billion dollar search for a cancer virus. Not
easy for the nutrition upstart to compete with that kind of power.
Most of all, the nutrition movement challenged the image of medical
doctors: they were not ready to get involved with vitamin therapies,
which had long since been handed over to the chiropractors, quacks
and health food stores?
Did Pauling's research on vitamin C against viral diseases, such
as the Common Cold and the Flu prevail? Did his later research
into the use of vitamin C against cancer win support? You may
be surprised to hear that the answer is affirmative. Pauling,
proven correct in all of his scientific predictions and recommendations.
He got a standing ovation at a conference on antioxidants in medicine
sponsored by the National Institute of Health in 1990 and the
publications that have come from that symposium have made 'antioxidant'
a buzzword to the health professions, much as vitamin C, the premier
antioxdant., has been a household word the past 20 years.
No, vitamin C does not prevent the Common Cold but it does help
to minimize symptoms and megadoses, from 365 mg up to bowel tolerance,
depending on the clinical situation, do confer benefits greater
than the government recommended dose of 60 mg. This is what Dr.
Pauling said in the first place: that the optimal intake of vitamin
C had not been determined. He drew a clear distinction between
the minimal amount of the vitamin to prevent death by scurvy,
and the optimal amount for the best of health.
That is the key point: Orthomolecular medicine is identified with
the search for optimum dosage for health and the therapeutic
dose for the most effective treatment of disease. And of course,
as physicians we are always concerned about identifying the toxic
dose.
If nutrition were accepted by now into the mainstream of medical
practice, there would be no need for a specialty of orthomolecular
medicine. Orthomolecular nutrition should be an established part
of general medical research and practice and one of the first
missions of such a development would be to find answers for the
above three categories of response to all the nutrients: the optimal,
therapeutic and toxic doses.
I predict that someday this will happen. Nutrient therapy will
be the first step in primary care, before drugs or surgery. This
is already the case in Sweden but not yet in America. We are still
a country that talks about nutrition in simplistic terms, as if
cholesterol and saturated fat were the only things one needs to
know in order to maintain good health. The medical media message
hasn't really changed much since I graduated medical school in
1955: saturated fat and cholesterol are still the twin villains
and low fat diets are promoted as the next thing to salvation.
But vitamins and minerals are beginning to gain respect though
their use is generally limited to dietary advice: increased intake
of fruits and vegetables.
Increased intake of fruits and vegetables is a good idea, almost
certain to improve the national health. In fact the national health
has improved already: a 30 percent drop in the number of heart
attacks, strokes and back surgeries since 1970. It seems unlikely
that this is because of such widely touted recommendations as
margarine in place of butter or increased vegetable fats and decreased
animal fats. Quite the contrary, the media has finally awakened
to the fact that trans fats in margarine raise cholesterol and
curtail cellular energy. And the public are beginning to realize
that vegetable oils (other than olive oil) are dangerous, especially
when used for cooking, and should be eaten sparingly if at all.
On the other hand the very real improvement in our national health
statistics is certainly not an accident. In fact it coincides
with an era of widespread health consciousness, a return to whole
grain breads and cereals, a major decline in the popularity of
smoking and a remarkable acceptance of vitamins by Americans.
Think of it: approximately half of us now take vitamin pills regularly
and most of us do it without telling our personal doctor about
it. Does that mean that Americans are foolish or that their doctors
are backwards and ignorant on this subject.
I hate to say it but I do believe the latter answer is the more
correct. And that is why it is important to convey to the American
people and their doctors that orthomolecular medicine is an already
established strategy for putting Nutrition First™ in medical diagnosis
and treatment. Vitamins and minerals can be measured and for the
most part treated in direct relation to the test results. This
represents a fundamental advance in medical practice.
Consider the case of Ann Baker, a 50 year old physician's wife,
who was chronically ill and disabled for almost 10 years despite
every available conventional treatment. The onset of her symptoms
came a few months post-partum: insomnia, irritability, palpitations,
generalized muscle pains and persistent fatigue. Because she was
evaluated and treated by numerous consultants for over a decade,
this case bears out the differences between orthodox and orthomolecular
medicine.
After a decade of persistent aches and pains, particularly in
the lower back, she hardly mentioned the pervasive fatigue that
accompanied it, though the fatigue by itself was enough to make
anyone depressed. She had been treated with analgesics, muscle
relaxants, anti-depressants and tranquilizers but obtained minimal
relief. Psychotherapy was inspirational but failed to relieve
her symptoms.
She had gradually gained 60 pounds in weight, tried a low fat
reducing diet and developed gallstones as a complication of this
type of diet. Her gall bladder was removed surgically 4 years
ago and her digestion has been accompanied by much gas ever since.
She avoids animal products, especially meats and eggs. She was
exposed to mercury when she worked as a dental assistant 30 years
ago and was also exposed to lead when she painted her house 4
years ago. Tests of hair and blood did not find significant amounts
of either. She also was exposed to pesticide sprays 3 times a
year outside her home but pesticide testing was not ordered because
the time frame did not fit her illness.
On physical examination she looked tired and depressed but there
was nothing diagnostic. Laboratory tests of blood count, urinalysis
and multiple chemistry panel, were normal and so were the vitamin
and mineral panel tests --all except vitamin B1: the red blood
cell transketolase test activated over six times normal when vitamin
B1 was added in the test tube. She was either vitamin deficient
or her transketolase enzyme was defective and needed extra stimulation
in order to reach full activity.
Therapeutic injections of B1 were dramatically effective: her
pain subsided, her mood improved and she became a cheerful and
active person again--for half a year until she stopped her nutrient
regimen and went on a program of six homeopathic remedies at the
recommendation of a "psychic nutritionist" who blamed her illness
on low copper and low stomach acidity. When the pain and fatigue
relapsed she came back to me. The transketolase test was again
abnormal, indicating only 50 percent recovery of vitamin B1 activity.
She resumed treatment by weekly injections but fatigue remained
a problem.
Since she was not eating meat, I suspected carnitine deficiency
might be involved; however her urine carnitine test was in the
normal range. Nevertheless she improved on supplemental carnitine,
and was able to chair a dinner meeting that she otherwise would
have been too weak too attend. Therapeutic doses of vitamins can
be effective even without deficiency. For example there is good
evidence that supplemental carnitine can increase energy availability
in people with normal carnitine levels but poor blood circulation1.
The extra carnitine increases the amount that is available in
the cells.
Up until then, she was content to think that a single factor,
the vitamin B1, could account for her chronic illness. She had
actually not returned for follow-up visits with me because she
expected a single diagnosis. Her attitude was a reflection of
her orthodox medical background: one disease, one cause--and one
treatment.
I reviewed her medical history in detail once again and noticed
that she actually had a significant number of intestinal symptoms.
Excess gas after meals, constipation and food sensitivities had
been a problem for 20 years. I ordered antibody tests and she
was positive for gliadin, indicative of wheat intolerance. She
was also positive for toxoplasmosis and amoebiasis and she recalled
now that the onset of her fatigue and muscle pain coincided with
swollen lymph glands and stiff neck over a dozen years ago. She
even had to wear a neck collar for a few months. In retrospect
now it seems likely that she had an acute toxoplasmosis infection
at that time.
Antibody testing also was positive for three types of fungi and
in retrospect the fact that her white blood cells were often double
the normal 5000 per ml seemed significant. Candida albicans was
one of them and probably represents a complication of her chronic
intestinal irritation from wheat and recurrent amoeba infections,
which also may explain her recent bout of arthritis of her knees.
A urine test of organic acids, a variety of end-products of metabolism,
reveal by-products of intestinal bacteria, ie. phenol groups 2
to 5 times greater than normal, a 5 fold increase in by-products
of citric acid, suggesting an inefficient use of carbohydrate
fuels. and high lactic acid, giving further confirmation of the
block in carbohydrate metabolism that goes with a vitamin B1 disorder.
Thus, orthomolecular testing has opened the way to an understanding
of this otherwise undiagnosed illness.
With so much going for it, why is not orthomolecular medicine
more widely appreciated? Orthomolecular medicine is mainstream;
it shares the same information, the same research database. But
it is a matter of belief also: the orthomolecular physician believes
in putting nutrition first and in keeping up with advances in
nutrition research so that patients don't have to wait 10 or 20
years for therapies that are available now.
For example, the research that I reviewed last month, regarding
the benefits of Vitamin E in preventing heart attacks, as published
in the New England Journal, showing over 40 percent fewer heart
attacks in men and women taking over 100 units daily of the vitamin
for over 2 years. It is characteristic of medical journal editors
to insist that researchers end their reports, even those showing
the most positive findings, with cautionary statements such as:
"this research does not call for taking extra vitamin E."
It is the very nature of science that research is always incomplete
and proof is never final. The practical strategy of the nutrition
physician is: a therapeutic trial is indicated so long as the
treatment might help and won't cause harm. That is the beauty
of nutrient therapy: it is remarkably safe. As the Spanish physician
Maimonedes wrote some 700 years ago: "Let nothing which can be
treated by diet be treated by any other means."
©2000 Richard A. Kunin, M.D.
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