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orthomolecular medicine or therapy

What is called orthomolecular medicine (OM) or orthomolecular therapy (OT) is not a type or branch of medicine but is rather a set of beliefs regarding the role of nutrition and supplements in human health and disease, beliefs that are generally not accepted by the majority in the scientific medical community.

The popularity of OM has led to excessive confidence in the health and medicinal benefits of vitamin, mineral, and other supplements, as well as in foods that are organic, natural, unprocessed, or deemed 'health foods.' In its broadest use, orthomolecular medicine refers to the belief that poor nutrition is the cause of most disease and the cure is good nutrition. In its narrowest use, orthomolecular medicine refers to using mega doses of supplements to treat diseases. The term originated, however, in the context of treating mental illness.

Linus PaulingThe term 'orthomolecular' seems to have originated with Linus Pauling in his 1968 Science paper "Orthomolecular Psychiatry." (In 1973, Pauling co-authored a book of that title with David Hawkins, who went on to promote a pseudoscinece known as applied kinesiology.) Prior to Pauling's use of the term, 'nutritional psychiatry' was commonly used by psychiatrists who believe that mental disorders such as schizophrenia are caused by nutritional deficiencies. Pauling used the term 'orthomolecular' "to refer to the practice of varying the concentration of substances normally present in the body to prevent and treat disease."* Literally, the term means 'right molecules.' Today, 'molecular therapy' is often interchangeable with 'nutritional therapy,' and includes the idea that large doses of vitamins are good for your health. However, "orthomolecular/nutritional therapy' is, in the words of Dr. David Gorski, "a parody of nutritional science." Pauling, for example, became an ardent advocate of mega doses of vitamin C to prevent colds. During the 1970s, Pauling advocated vitamin C for cancer patients. In 2015, there is still no strong evidence in support of any megavitamin therapy, including vitamin C cancer therapy.*

More than a decade before Pauling gave his support to the notion that mental illness might be due to a vitamin deficiency, psychiatrist Abram Hoffer (1917–2009) was promoting the idea that vitamin C and niacin supplements could be used to effectively treat schizophrenia. The idea that severe mental illness is due to a vitamin deficiency is no longer taken seriously in science-based medical circles. The belief in diet and supplementation as the cause and cure of diseases such as cancer continues to be believed by many people, though the evidence for this belief is next to nil. The evidence consists mainly of anecdotes (many in the form of case studies), laboratory studies involving tissues in petri dishes, tests on rodents or other animals, or speculations based on chemicals present in foods or lacking in the bodies or excreta of diseased persons. What large-scale studies there are on the effects of diets or supplementation do not support the basic beliefs of the OM folks. The only exception I've seen has been a large study that found multivitamin supplementation "modestly but significantly" reduced the risk of "total cancer" (which I take to mean "any kind of cancer"). Few people are aware that dietary supplements send more than 23,000 people to the ER each year or that vitamin supplements may actually increase one's chances of dying from cancer.

diseases caused by poor nutrition and dietary deficiencies

There are, of course, many diseases that are caused by poor nutrition and are treatable with food or supplements. Iodine deficiency, for example, causes thyroid problems. The body does not produce iodine, so it must be ingested.

Before the 1920s, iodine deficiency was common in the Great Lakes, Appalachian, and Northwestern U.S. regions and in most of Canada. Treatment of iodine deficiency by the introduction of iodized salt has virtually eliminated the “goiter belt” in these areas. However, many other parts of the world do not have enough iodine available through their diet and iodine deficiency continues to be an important public health problem globally. Approximately 40% of the world’s population remains at risk for iodine deficiency.*

Certain foods are good sources of iodine, e.g., turkey breast, dried seaweed, shrimp, cod, potatoes, eggs, lobster, milk, strawberries. Most people in the industrialized world should be able to get whatever vitamins and minerals they need from food. Supplements are not necessary unless one suffers from a specific deficiency. For example, some people may need a vitamin D, vitamin B12, or folic acid supplement.

The body does not produce vitamin C, but it is available from many food sources. Dr. James Lind (1716-1794) discovered a relationship between citrus fruit and scurvy, a disease that killed many more sailors than died of battle wounds in the 18th century. We now know that scurvy is caused by a vitamin C (ascorbic acid) deficiency.

Rickets, beriberi, and pellagra are nutritional diseases, but orthomolecular medicine, unlike science-based medicine, is not interested in the kind of nutritional deficiency that is known to cause disease. Rather, the OM folks focus on such things as foods and diets that cause or prevent cancer, or megavitamin treatments to cure cancer or treat mental illness.

vitamin C in cancer treatment

Ron Hunninghake, M.D., defends intravenous vitamin C infusion to treat cancer and much more.

Intravenous vitamin C also does more than just kill cancer cells. It boosts immunity. It can stimulate collagen formation to help the body wall off the tumor. It inhibits hyaluronidase, an enzyme that tumors use to metastasize and invade other organs throughout the body. It induces apoptosis to help program cancer cells into dying early. It corrects the almost universal scurvy in cancer patients. Cancer patients are tired, listless, bruise easily, and have a poor appetite. They don't sleep well and have a low threshold for pain. This adds up to a very classic picture of scurvy that generally goes unrecognized by their conventional physicians.*

Memorial Sloan Kettering provides a different, perhaps more balanced view of the benefits of vitamin C:

The purported effects of vitamin C have been examined in many clinical and epidemiologic studies. Regular intake of vitamin C supplements may reduce the duration and severity of common cold. However, the effect is minimal except in people exposed to acute severe physical stress (2). Vitamin C is believed to promote cardiovascular health but findings are inconsistent. Previous studies suggest that intake of dietary vitamin C, not supplements, may reduce the risk of coronary heart diseases (3). However, two large scale randomized trials did not find any benefits (4) (5). Furthermore, supplementation with vitamins C and E increased risk of mortality and nonfatal myocardial infarction in patients with coronary artery disease (6). Data on vitamin C’s effect in reducing blood pressure are also conflicting (7) (8)....

The role of vitamin C in cancer prevention is unclear. Studies indicate that vitamin C reduces oxidative stress (18). High plasma level of vitamin C is associated with lower gastrointestinal cancer incidence probably due to its protective effects against dietary carcinogenic nitroso compounds (19). Intake of vitamins A, C, or E reduced risk of cervical cancer (20), but they do not prevent gastrointestinal (21), prostate (22), lung cancers (23) and other cancer incidence or affect cancer mortality (24). Further, vitamin C supplementation is associated with increased risk of liver cancer, although this effect is not observed with vitamin C from dietary sources (25).

High-dose vitamin C has been long been used as an alternative cancer treatment (26) based on the hypothesis that the formation of new collagen resists malignant infiltration (27). Early reports using parenteral plus oral ascorbic acid showed promising results (28). But subsequent randomized, placebo-controlled trials in advanced cancer patients using 10g per day of oral vitamin C did not demonstrate any significant benefits (29) (30). This lack of effect is explained by the finding of pharmacokinetic study that ascorbic acid can only reach a limited plasma concentration through oral administration (31). A higher pharmacologic concentration, achieved only via intravenous injection, had selective cytotoxic effects on cancer cell lines (32) (33). Ascorbic acid is postulated to act as a carrier of hydrogen peroxide to the extracellular fluid (32) where it generates free radicals against tumor cells (33). High-dose IV ascorbic acid up to 1.5g /kg/day appears to be well-tolerated (34), may improve the quality of life of terminal cancer patients (35), and reduce chemotherapy-associated toxicity in patients with ovarian cancer (67).  This led to a renewed interest in studying high-dose IV vitamin C as an anticancer treatment (34) (36). However, it should be regarded as an investigational drug and used only in a clinical trial setting.

Interestingly, there is contradicting evidence against the use of vitamin C supplements during chemotherapy. In vitro and animal studies found that cancer cells preferentially uptake vitamin C (37) and render some chemotherapy drugs less effective (38). Also, a major concern surrounding use of antioxidants, such as vitamin C, is that they can interfere with the actions of chemotherapy and radiation therapy that rely on the production of reactive oxygen species for their cytotoxic activities (39). However, a clinical study showed that ascorbic acid does not reduce the therapeutic effects of paclitaxel and carboplatin (40). Another study found an increase in chemo-associated adverse effects with inadequate intake of vitamin C in children with acute lymphoblastic leukemia (41).

While the most common "treatment' associated with orthomolecular medicine is with megavitamins or megaminerals, the original idea conceived by Pauling was that mental and physical health are both a matter of having the "right" (ortho) balance of molecules, which would vary from person to person. Pauling's notion was not based on strong empirical evidence but on intuition of such a misguided nature that it led one of the great minds of the twentieth century down the path of irrevocable quackery.

promoters of orthomolecular therapy

1. Journal of Orthomolecular Medicine: "Orthomolecular medicine is defined as the therapeutic use of substances that occur naturally in the body. Originally defined in the context of treating and preventing psychiatric diseases, the intent of orthomolecular therapy is to provide the optimal molecular environment for the brain and other tissues by altering the intake of nutrients such as vitamins (and their metabolites), minerals, trace elements, macronutrients, as well as other naturally occurring metabolically active substances." The magazine was formed because the believers in OM couldn't get their work published in scientific journals. The OM folks claim persecution from parties protecting their interests; those who reject the work of the OM folks claim that the OM work isn't worthy of publication.

2. Orthomolecular.org: These folks look to Linus Pauling in his quack period as their Founding Father, which is somewhat ironic since they define orthomolecular medicine as "the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body." Pauling is mostly known in the popular media for his belief in the miraculous power of vitamin C megasupplementation and his belief that vitamin C could prevent and cure cancer. Vitamin C is not natural to the human body and the notion that 10,000 mg of vitamin C per day is optimal is simply not true.

3. Linus Pauling. The winner of two Nobel prizes descended into some very bad science in his later years. He and Ewan Cameron published a paper claiming to show that mega doses of vitamin C cures cancer.

Unfortunately, as experimental clinical protocols go, this study was a complete mess. Linus Pauling was not a clinician and had no experience in clinical trial design, and it really showed. Even as a retrospective analysis, the paper was a total embarrassment. There was no standardization, no good matching of controls by age, stage of cancer, or performance status; given the terrible design, there was clearly serious selection bias going on at a minimum. The study’s flaws, which were too numerous to mention, rendered its results essentially meaningless. If you want a quote from his original paper that shows this better than anything, here it is: “We believe that the ascorbate-treated patients represent a random selection of all the terminal patients in the hospital, even though no formal randomization process was used.” Suffice it to say that, in a clinical trial, it is not sufficient to “believe” that your groups were properly randomized and matched. You have to show it. Indeed, Dr. William D. DeWys, Chief of the Clinical Investigations Branch of the National Cancer Institute’s Cancer Therapy Program, pointed out that Pauling and Cameron failed at even a rudimentary effort to control for these variables:

Cameron’s patients began getting vitamin C when Cameron judged them “untreatable” and their subsequent survival was compared to that of the control patients from the time they had been labeled “untreatable.”

DeWys reasoned that if the two groups were comparable, the average time from the initial diagnosis to “untreatable” status should be similar for both groups. But they were not. He concluded that many of Cameron’s patients had been labeled untreatable earlier in the course of their disease and would therefore be expected to live longer. DeWys also noted that more than 20% of the patients in the control group had died within a few days of being labeled untreatable, whereas none of Cameron’s patients had died. This, too, suggested that Cameron’s patients had had less advanced disease when they were labeled untreatable.

The bottom line was that, for the above reasons and others, Pauling and Cameron’s study was shockingly bad. Undeterred, they published a follow-up study in 1978 that purported to confirm the findings of their 1976 study.*

Like many other quacks before and after him, Pauling didn't do proper studies on vitamin C and cancer, write proper scientific papers on the studies, and submit those papers to a peer-reviewed journal. He started his own institute and went on the lecture circuit to promote his books that promoted his beliefs. One of his more notorious associates, Matthias Rath, did the same thing and is considered one of the leading forces behind the attempt to treat AIDS in South Africa with vitamin supplements.

4. Frederick Robert Klenner (1907–1984). Klenner claimed to have cured many people of many diseases, including polio, with mega doses of vitamin C. He wrote many research papers on cases involving either self-administered vitamin C or of others he claimed to have treated, but he did no studies involving control groups or randomization and his work is largely ignored outside of the orthomolecular world. Linus Pauling was an admirer. Klenner is considered a maverick and a pioneer in the OM world. The medical world considers him a crank or a quack.

While it is obviously true that good nutrition is essential to good health, it is not true that you can cure cancer (or polio) with nutrients. It is true that nutrients are essential to a healthy immune system and a healthy immune system is necessary to prevent cancer, it is not true that a healthy immune system is sufficient to prevent cancer. The idea that natural foods, special diets, various nutrients, or vitamin/mineral supplementation can "boost the immune system" and cure cancer is not supported by the evidence. It is true that some supplements can be harmful to your health and some can interfere with the effectiveness of chemotherapy drugs. If you are on chemotherapy or other drugs for cancer, always let your oncologist know of any herbs or supplements you are taking. You may think you are improving your chances of destroying your cancer by adding to your drugs some substance you read about on the Internet as being a natural cure for cancer, but you may be unintentionally initiating the exact opposite effect. Not everything that by itself isn't likely to harm you is safe when taken with prescribed pharmaceuticals.

See also functional medicine, Gerson therapy, integrative oncology, natural cancer cures, the Nobel disease, and supplements.

further reading

Orthomolecular Therapy by Stephen Barrett, M.D.

High Doses of Vitamin C Are Not Effective as a Cancer Treatment by Stephen Barrett, M.D.

High dose vitamin C and cancer: Has Linus Pauling been vindicated? by David Gorski, Science-Based Medicine, August 18, 2008

Vitamin C strikes (out) again by David Gorski, Science-Based Medicine, October 6, 2008

How do scientists become cranks and doctors quacks? by David Gorski, Science-Based Medicine, June 15, 2009

Beyond the flu shot: A closer look at the “alternatives” by Scott Gavura, Science-Based Medicine, December 5, 2013

A closer look at vitamin injections by Scott Gavura, Science-Based Medicine, May 24, 2013

Orthomolecular Medicine- Big Talk, Little Evidence, Real Risk, August 24, 2009 by skeptvet

Food faddism: a challenge to nutritionists and dietitians’ Lois D. McBean, M.S., R. D., and Elwood W. Speckmann, Ph.D.

Wikipedia article on OM

Recommendations of the NCAHF Task Force on Supplement Abuse (1987)

From The Mayo Clinic: Timothy J. Moynihan, M.D.

Interest in using very high doses of vitamin C as a cancer treatment began when it was discovered that some properties of the vitamin may make it toxic to cancer cells. Initial studies in humans had promising results, but these studies were later found to be flawed.

Subsequent well-designed, randomized, controlled trials of vitamin C and cancer found no such treatment benefit. Despite the lack of evidence, alternative medicine practitioners continue to recommend high doses of vitamin C for cancer treatment.

More recently, vitamin C given through a vein (intravenously) has been found to have different effects than vitamin C taken in pill form. This has prompted renewed interest in the use of vitamin C as a cancer treatment.

There's still no evidence that vitamin C can cure cancer, but researchers are studying whether it might boost the effectiveness of other cancer treatments, such as chemotherapy and radiation therapy. Until clinical trials are completed, it's premature to determine what role, if any, intravenous vitamin C may play in the treatment of cancer.

Last updated 08-Dec-2015

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