Orthomolecular Medicine for Everyone. Abram Hoffer, M.D., Ph.D.
the state of health, we will have to depend on clinical judgment, an awareness of the need for vitamins, and a therapeutic response to determine the optimum quantity. Fortunately, vitamins are so safe that there is hardly any danger to the person in determining the best dose. This is done by increasing the dose slowly until there is no further improvement. Once this has been achieved, the person can test which is the best continuing dose by decreasing the quantity. If he or she remains in good health, the newer dose can be used; if symptoms reappear, the dose can be increased. Each vitamin has unique properties that must be understood, since they are helpful in establishing the correct dose.
A food extract or dried preparation rich in a particular vitamin would also contain minerals, vitamins, and enzymes related to the metabolism of the vitamin, but all would be present in small amounts. For example, a dried powder made from acerola or rose hips will contain some vitamin C, plus the enzymes, minerals, and other vitamins that helped create it and help metabolize it. But for a person needing large doses of vitamin C, too much of the powder would have to be consumed.
Further confusion is generated by current labeling laws. A product may have no synthetic or extracted vitamin in it, yet the label may list a large number of vitamins. For example, yeast tablets contain very small amounts of many vitamins. They are not vitamin tablets but are really a tableted food. Rose hips powder is a relatively poor source of vitamin C and must be reinforced with a lot more to make 100-mg or stronger tablets, and therefore is a mixture of mostly synthetic and very little natural-source vitamin C. It would be better if the catch-all term natural was dropped. The label should simply indicate the source and quantity of each nutrient.
A CLOSER LOOK AT VITAMIN SUPPLEMENTS
Vitamins are organic molecules normally found in living tissue in very small amounts. They are essential for most of the metabolic reactions in the body, wherein they act as catalysts or as portions of catalysts called enzymes. As catalysts, they are used over and over. They do not contribute calories, as do carbohydrates and fats, nor do they contribute to the structural integrity of tissues.
By definition, vitamins cannot be made in the body, but this definition was made before enough was known about vitamins. Some of the vitamins, by this definition, are not vitamins: vitamin D3 is made in the body by the effect of ultraviolet light on the skin; vitamin C is a vitamin only for humans and a few other species and is made in the bodies of most animals in large quantities; vitamin B3 (niacin and niacinamide) is made in the body from the amino acid tryptophan. But these three substances have been classed as vitamins for so long that it is highly unlikely they will be classified as anything else.
Nutritionists have been long concerned about the optimum amount of vitamins the body needs. When vitamins were first identified, it was recognized that very small amounts were needed to prevent the typical terminal or deficiency disease. The vitamins were discovered and identified by measuring the effect of various food fractions on animals, plants, or bacteria that were fed a diet lacking that vitamin. To detect thiamine (vitamin B1), food extracts were fed to pigeons made to suffer beriberi by a specially prepared, thiamine-free diet. Very little thiamine is needed to prevent and cure beriberi; this is also true of other deficiency diseases, such as scurvy and pellagra. Scientists assumed that no additional vitamins were needed if these deficiency diseases were absent. If a patient did not have pellagra, he or she needed no additional vitamin B3. Later on, nutritionists realized that patients had symptoms of deficiency that were not severe enough to be diagnosed as the fully developed disease. Patients were diagnosed with subclinical pellagra—they were not near death, as are pellagrins, but they were not well either, and they did become normal when given additional quantities of vitamins.
Official recommended dietary allowances (RDA or DRI) reflect the view that very minute quantities of vitamins are required, but they also recognize that requirements vary with age, physiological state, and degrees of stress. Nevertheless, the maximum doses recommended in the RDA/DRI tables are little higher than the minimal doses required to prevent classical deficiency diseases. The tables also reflect the quantity of vitamins obtainable from food. They do exclude the use of vitamins for most people to supplement their diet. Supporters of the recommended allowances believe that a balanced and varied diet will be adequate for the vast majority of people. Even if this were true, it still ignores a huge number of people who are not well and who are patients at one time or another. There are no recommended dose tables of vitamins for patients.
Many patients have recovered when treated with large doses of vitamins, doses that are 100 to 1,000 times those recommended to prevent the terminal deficiency diseases. A few patients require 1 mg per day of vitamin B12, which is 1,000 times the average daily dose. To lower cholesterol and triglyceride levels, patients require 3,000 mg (3 g) of niacin per day, which is several hundred times the pellagra-preventive dose. Some schizophrenic patients have needed 30 g (30,000 mg) per day or more. The term megavitamin therapy was developed to describe these larger doses, but the term is not particularly useful because it confuses many into thinking there is something called a “megavitamin.” The term megadose vitamin therapy is better, as it focuses on the use of large quantities.
Physicians using these large doses recognize that individuals have different vitamin requirements and that the range of variation is much greater than had been suspected several decades ago. We now recognize that the range of vitamin needs for optimum health varies from those quantities present in good, whole food, to doses up to a thousand times greater. The main problem for an orthomolecular physician is to determine what that optimum level is.
DEFICIENCY AND DEPENDENCY
Dependency is a fact of life. The human body is dependent on food, water, sleep, and oxygen. Additionally, its internal chemistry is absolutely dependent on vitamins. Without adequate vitamin intake, the body will sicken; virtually any prolonged vitamin deficiency is fatal. Surely this constitutes a dependency in the generally accepted sense of the word. Nutrient deficiency of long standing may create an exaggerated need for the missing nutrient, a need not met by dietary intakes or even by low-dose supplementation.
Deficiency diseases occur when individuals with average vitamin requirements live on food deficient in that vitamin. Usually such a diet contains several vitamin and mineral deficiencies. There is a relative deficiency as the diet fails to provide what is required. When the requirements are so high that even a perfect diet cannot provide it, we find exactly the same relative deficiency, but as the problem is the body’s requirements and not in the diet, it is called a dependency. A dependency is also a relative deficiency. In both deficiency and dependency disease, the net result is the same, although the mechanisms are different.
A dependency may be present at birth or may be acquired. Genetic factors are involved, for no pathology can express itself except in the context of chromosomal needs failing to be met by one’s chemical environment. Genetic factors determine the optimum vitamin requirements. Vitamins have to be delivered to the cells, and this requires the transfer of vitamins across several membranes, through certain tissues, and requires the presence of the correct mechanism, of which the vitamin is a part. If a person has an efficient mechanism for absorbing a vitamin, the consumed optimum dose will be less than for a person with a less efficient mechanism. Individuals develop pernicious anemia because they cannot absorb vitamin B12 efficiently. They must be given this vitamin by injection to bypass the gastrointestinal tract.
Vitamin dependencies can also be acquired, following a prolonged period of deficiency of that vitamin, usually due to severe malnutrition combined with stress. Some people even develop a dependency following a few weeks of stress before, during, and after surgery, when combined with severe malnutrition. Modern hospitals are almost unaware of the importance of special nutrition for their patients. I (A. H.) have seen many elderly men and women who dated their fatigue, tension, and depression from such an episode in a hospital. They had been given intravenous fluids but no food for many days. One was not fed for two weeks, and when food was offered, it was junk—colored gelatin and a soft drink. These patients required large doses of several vitamins before they began to recover.
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