Orthomolecular Medicine: Can vitamins help those that medications have failed?
By Paul Forsyth
Reprinted with permission from Schizophrenia Digest, Spring 2008
Nearly 40 years ago, Tom Krampf felt there was no hope.
It was the late 1960s, and Krampf's life was on a downward spiral. The New York writer and his engineer wife, Francoise, had moved to France, and Krampf—who would later be diagnosed with schizophrenia—was already troubled by symptoms of the disorder and took a large overdose of prescribed drugs.
In the hospital, he was put in a room next to a window on the fourth ﬂoor. "I actually stepped out the window," he says.
He fell four storeys and was badly injured. He returned in a body cast with his wife to New York City and began a long physical rehabilitation.
But his physical injuries were only a fraction of his problems; back in the Big Apple, he had another breakdown and was hospitalized. "My illness got increasingly worse," he says.
Krampf saw psychiatrists who prescribed a powerful ﬁrst-generation antipsychotic. The side effects were terrible, and Krampf—a poet—was unable to write because the drug put him in an almost catatonic state.
"I'm a writer, but I couldn't create," he recalls. But without the medication, Krampf was wracked by terrifying hallucinations.
"I couldn't even walk down the street. I saw blood running from people's mouths, and skeletons."
And the advice he got from psychiatrists gave him little hope: "I was told I would never be well again," he says. "I was telling my wife she should separate from me."
An alternative approach
Things changed for Krampf, now 73, when he hooked up with the late psychiatrist William Douglas Hitchings, MD, a Canadian doctor working in New York. Hitchings was a believer in orthomolecular psychiatry, a controversial ﬁeld of medicine that proposes mental abnormalities can be treated by correcting imbalances or deficiencies among naturally occurring biochemical constituents of the brain— most notably vitamins and other micronutrients.
Typically, orthomolecular treatment includes taking mega-doses of vitamins, often much more than the recommended daily dose, along with such things as amino acids. Dietary changes are also frequently part of treatment.
Advocates of orthomolecular medicine insist it is a superior option to taking antipsychotic medications alone, but for decades mainstream science has remained skeptical, saying claims of its efﬁcacy come in a vacuum of controlled, scientiﬁ c studies into the effectiveness and safety of such treatments.
Krampf started a regimen of high doses of Vitamin C, E, and niacin, and began researching how diet can contribute to mental illness. Other doctors he spoke with dismissed the connection.
"They just laughed," he says. "They said it would never work."
The vitamin treatments, along with a modiﬁed diet, which excluded high levels of sugar and processed white flour, progressively alleviated Krampf's hallucinatory symptoms, he says, leading him to believe that those symptoms were the end result of wildly ﬂuctuating glucose levels in his blood that played havoc with his organs—such as his pancreas—which in turn messed with his brain chemistry.
"The effect of the treatment was the closest thing to a miracle you could ﬁnd," Krampf says. "If I went back to eating the way I used to, I'd probably end up in hospital again."
The term "orthomolecular" was coined in 1968 by Nobel prize-winning U.S. scientist Linus Pauling, PhD, who worked with Victoria, British Columbia, physician Abram Hoffer, MD, PhD, to promote vitamins, amino acids, and minerals as treatment for mental illness. Pauling died in 1994, but Hoffer says that over the past 50-plus years, he has helped thousands of people with schizophrenia recover through orthomolecular medicine.
Yet the skepticism that set in early among the broader medical community has endured, in large part because of what is seen as a lack of placebo-controlled studies, such as those used to test new medications before they are approved by the U.S. Food and Drug Administration (FDA) and Health Canada.
In 1973, an American Psychiatric Association task force found that in the few studies that have been conducted on orthomolecular treatment, there were numerous methodological ﬂaws. Likewise, the Canadian Psychiatric Association has taken the position that there is "no good scientiﬁ c evidence" that mega-vitamin therapies are effective, and that high doses of some vitamins can actually have toxic side effects.
"The drugs they give people with mental illnesses would make a well person sick."
The Royal Australian and New Zealand College of Psychiatrists issued a position statement in 2004, warning that orthomolecular treatment involving vitamin doses of up to 600 times the recommended daily allowance can result in dangerous side-effects, such as convulsions and blood circulation problems.
"There is no scientiﬁc substantiation of the therapeutic (effectiveness) of orthomolecular psychiatry in the treatment of psychiatric disorders," the College wrote.
Additionally, in 2006, a 13-member panel of experts in ﬁelds such as biochemistry, human nutrition, disease prevention, and toxicology was appointed by the U.S. National Institutes of Health (NIH) to examine current data on the effectiveness and safety of multivitamins and minerals. The panel said that in light of a lack of data—combined with the fact more than half of Americans take dietary supplements, and the potential for people to ingest too-high levels of supplements—changes in the regulation of dietary supplements are recommended. They include "rigorous, randomized, controlled trials" on supplements and reporting possible side effects on labelling in the same fashion as FDA-regulated drugs.
"Most of the public assumes that the components of… supplements are safe, because many of the ingredients are found in everyday foods and the products are available over-the-counter," the panel wrote.
In response, Hoffer and six other colleagues issued a statement through a group they called the Independent Vitamin Safety Review Panel, calling the NIH panel's ﬁ ndings biased.
Hoffer's panel said the NIH ignored the more than 600 scientiﬁc papers and studies published in the Journal of Orthomolecular Medicine—which Hoffer established decades ago—leading to a "politically predetermined conclusion that vitamins are somehow dangerous."
Hoffer said that in his 50 years of clinical experience, he has not seen any life-threatening side effects nor any deaths from orthomolecular treatment.
"Vitamin supplements are extraordinarily safe and effective," he said. "It is drugs that are dangerous. Perhaps the U.S. Food and Drug Administration is getting tired of all the bad news about drugs, so instead they are going after nutritional supplements."
Actress Margot Kidder, best known for her role as Lois Lane in the 1970s and '80s Superman ﬁlms, is a high-pro-ﬁle advocate of orthomolecular medicine. After suffering from manic depression and years of conventional treatment from psychiatrists (plus a high-proﬁle breakdown in the 1990s), she has been symptom-free for more than 10 years through orthomolecular treatment, she told the Montreal Gazette when she spoke in that city in 2006.
"I ﬁnally realized that drugs were not the answer," she told the Gazette's Donna Nebenzahl. "Listen, the drugs they give people with mental illnesses would make a well person sick."
A confusing debate
It is certainly understandable that consumers are confused by the debate for and against multivitamin therapy for psychiatric disorders.
In a 2003 study published in the journal Schizophrenia Research, researchers from India tested the effect of giving Vitamin C and Vitamin E as well as omega-3 fatty acids— which come naturally from sources such as coldwater ﬁ sh— to people with schizophrenia over a four-month period. The researchers said they witnessed a signiﬁ cant improvement in symptoms that continued even after omega-3 levels in participants returned to pre-treatment levels following the study, leading them to conclude that supplementation could be a very effective treatment.
In 2002, Israeli researchers studied the possible use of Vitamin B6 as an add-on treatment for people suffering from chronic schizophrenia and schizoaffective disorder, noting "anecdotal reports" of a reduction in psychotic symptoms among people who took the vitamin as an add- on treatment. But their study, published in the Journal of on treatment. But their study, published in the Journal of Clinical Psychiatry, found the vitamin was no better than placebo in reducing symptoms.
Studies of dietary supplements for other psychiatric conditions have added to the confusion. In a 2004 study, researchers from Turkey said that because previous studies have suggested a deﬁciency of zinc plays a role in the onset of attention deﬁcit hyperactivity disorder (ADHD), they gave 400 boys and girls diagnosed with ADHD either they gave 400 boys and girls diagnosed with ADHD either zinc sulfate or placebo over 12 weeks. They found zinc sulphate was statistically superior in reducing hyperactive, impulsive, and impaired socialization symptoms, but not in reducing attention deﬁciency symptoms.
In 2001, Wallace Sampson, MD, a former clinical professor of medicine at the prestigious Stanford University School of Medicine in California, wrote in Academic Medicine, the journal of the Association of American Medical Schools, that U.S. schools for doctors fail to present complementary and alternative medicine in a way that encourages "skepticism their curriculum so that young doctors can analyze and as- and critical thinking appropriate for unproven therapies." He called on medical schools to alter their curriculum so that young doctors can analyze and assess the validity of alternative medicine claims.
In the 2004-05 fall/winter issue of the journal Scientific Review of Alternative Medicine, researchers from the Simon Fraser University Department of Psychiatry in Burnaby, British Columbia, presented a study questioning the level of protection for consumers using supplements, citing "lax" regulations in the sale of herbs and vitamin supplements in Canada and the U.S. Many producers of such products provide consumers with "inaccurate and potentially harmful information" on the products, taking advantage of the fact many consumers wrongfully believe such products have been regulated and tested for safety and effectiveness by government agencies, the researchers said.
In 2001, Barry Beyerstein, a professor of psychology and one of the Simon Fraser researchers, wrote in the journal Academic Medicine about why he believes many people turn to dietary supplements despite the fact they haven't been subjected to rigorous scientiﬁc testing.
"When people become sick, any promise of a cure is beguiling," he said.
The British Medical Journal reported that in the Netherlands in 2006, a medical disciplinary tribunal banned one doctor from practicing medicine and suspended two other physicians for prescribing exclusively complementary treatments, such as food supplements and homeopathic medicine, for Dutch actor and comedian Sylvia Millecam, who died of breast cancer. The journal stated that the stiff measures were a warning that doctors must urge patients with serious illnesses to seek conventional treatment.
"Alternate medicine can be combined with—but never replace—regular evidence-based care," said Johan Legemaate, professor in health law at Amsterdam's Free University.
Is there a compromise?
Steven Carter, the executive director of the International Schizophrenia Foundation, based in Toronto, Ontario (of which Hoffer was the founding president), says that orthomolecular advocates aren't necessarily against medication.
Combining orthomolecular treatment with traditional drug treatment can have astounding results, he says. "It's meant to be a companion to medicine."
By correcting balances of essential nutrients in the body, many people with schizophrenia do ﬁne with lower dosages of medication, while roughly half no longer need medication at all, he says.
He believes that resistance from doctors is in large part due to the fact that during their years of training, they get at most eight hours of instruction in nutrition. Their education is almost completely pharmacology-based. "This [drugs] is all they know," he says.
Angela Webster, executive director of the Lotte and John Hecht Memorial Foundation, a Vancouver, British Columbia-based philanthropic organization that, in 2007, named Hoffer a winner of the inaugural Dr. Rogers Prize for excellence in contemporary and alternative medicine, said the 89-year-old Hoffer and others who promote orthomolecular medicine should be applauded for their work. The prize is named after Dr. Roger Rogers, a University of British Columbia professor emeritus who was a champion of complementary and alternative medicine.
When Hoffer was ﬁrst pushing the idea that nutrition is the basis for health and is a good place to look to ﬁnd the causes of disease in the 1960s and '70s, "it was heretical," Webster told the Vancouver Sun. "(It's) now mainstream."
Certainly, a growing number of people have bought into the worth of complementary and alternative medicines: A survey commissioned by British Columbia-based think tank, the Fraser Institute, said Canadians—in a market one-tenth the size of the United States—spent about $7.84 billion in the latter half of 2005 and the ﬁrst half of 2006 on such products, an increase of nearly $2.5 billion over a decade ago.
Carter says many other countries recognize the worth of orthomolecular medicine, too: Japan has 30,000 practitioners, Brazil has 8,000, and Holland and Germany have been training doctors in orthomolecular medicine for 30 years.
He says Krampf is one of "literally tens of thousands of people who have had their lives restored" through orthomolecular psychiatry.
"This is certainly worth investigating," Carter says.
"It's not a fad."
Krampf says the strict dietary rules he follows have allowed him to cope with his disorder for more than 30 years, as well as to follow his calling to write poetry. The western New York State resident will soon have his ﬁfth book of poetry published, he has taught poetry and creative writing, and he reads his work in universities.
And because of his success with orthomolecular treatment, he's concerned that the powerful pharmaceutical industry will ﬁght "tooth and nail" to have over-the-counter vitamins restricted through prescription regulations because, he says, they pose a threat to those companies' prescription medications.
"Alternate medicine can be combined with—but never replace—regular evidence-based care."
He acknowledges that the newer generation of atypical antipsychotics developed since the 1990s help many people and have fewer side effects than the older medications, "but they don't work for everybody."
"I'm not proselytizing for anybody," Krampf says, "but I feel it would be extremely stupid and even highly irresponsible to automatically dismiss the gains and research made in the ﬁeld of orthomolecular medicine.
"I'm not preaching a miracle cure," he continues. "(But) it worked for me and it worked for a lot of other people.
"I feel very lucky for having survived."
Paul Forsyth, a professional journalist for 25 years (and a former editor of Schizophrenia Digest), lives in Niagara Falls, Ontario.
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