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 What is Orthomolecular Medicine? 
The following is one in an ongoing series of columns entitled Nutritional Medicine & Longevity by . View all columns in series

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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