Orthomolecular Medicine for Everyone. Abram Hoffer, M.D., Ph.D.
of acquired dependency arose from an “experiment” conducted in World War II, when Allied members of the armed forces were Japanese prisoners of war for several years. The Canadian soldiers suffered from a deficiency of protein, fat, calories, vitamins, and minerals. A combination of serious diseases arising from a deficiency of calories and nutrients, combined with severe psychological stress, produced a clinical syndrome characterized by accelerated aging. These soldiers were made vitamin B3 dependent and recovered only after they were given large doses of niacin, and they remained well only if they continued to take these large dosages. It is possible they developed multiple nutrient dependencies, but because nearly all these veterans improved so significantly by taking niacin, it is likely their dependency on vitamin B3 was the main one. One year in captivity aged each prisoner the equivalent of five normal years of aging. That is, a veteran at age sixty, having been a prisoner for four years, would be as old physically and mentally as an eighty-year-old who had not been in these prisons.
Sixty-five years ago, nutritionists observed that a few chronic pellagrins did not recover on the usual low-dose niacin treatment. To their surprise, the patients needed 1,000 mg per day; on a smaller dose, their pellagra symptoms did not go away. They could not explain this discrepancy between theory and observation, but it is now clear that chronic pellagra caused a vitamin B3 dependency. Experiments with dogs support this conclusion. Dogs given black tongue (canine pellagra) were cured by small doses of B3 if they were given the vitamin soon after pellagra developed. If black tongue was allowed to remain for one-third of their life span, they required much larger amounts to become well. Thus, the evidence is strong for vitamin B3, and we have no doubt that other vitamin dependencies are also caused by chronic deficiencies.
In addition, intakes required to prevent dependency disorders are higher than those required to prevent index diseases. The concept of vitamin-dependent disease changes the emphasis from simply dietary manipulation to consideration of the endogenous needs of the organism.11 The differentiation between deficiency and dependency is dose. Every patient who was ever helped by high-dose nutrient therapy lends support to the concept of vitamin dependency. By the same token, symptoms resulting from inappropriate and abrupt termination of large doses of nutrients provide equally good evidence for vitamin dependency. While deprivation of low doses of vitamin C causes scurvy, abrupt termination of high-maintenance doses may cause its own set of problems. Called “rebound scurvy,” this includes classical scorbutic symptoms, as well as a predictable relapse of illness that had already responded to high-dose therapy.
In short, the body only misses what it needs—that is dependency. The destructive consequences of alcohol and other negative drug dependencies are taught in elementary schools. At the same time, the consequences of ignoring our positive nutrient dependencies go largely undiscussed, even in medical journals. Vitamin dependencies induced by genetics, diet, drugs, or illness are most often regarded as medical curiosities. The idea that schizophrenics are dependent on large doses of niacin remains a psychiatric heresy.
This is not a total surprise. It took decades for medical acknowledgment that biotin and vitamin E are actually essential to health. Simple cause-and-effect micronutrient deficiency, a doctrine long enamored of by the dietetic profession, is not always sufficient to explain persistent physician reports of megavitamin cures of a number of diseases outside the classically accepted few. Perhaps it is a law of orthomolecular therapy that the reason one nutrient can cure so many different illnesses is because a deficiency of one nutrient can cause many different illnesses.
If nutrient deficiency is basically about inadequate intake, then dependency is essentially about heightened need. As a dry sponge soaks up more milk, so a sick body generally takes up higher vitamin doses. The quantity of a nutritional supplement that cures an illness indicates the patient’s degree of deficiency. It is therefore not a megadose of the vitamin, but rather a megadeficiency of the nutrient that we are dealing with. Orthomolecular practitioners know that with therapeutic nutrition, you don’t take the amount that you believe ought to work—rather, you take the amount that gets results. The first rule of building a brick wall is that you have got to have enough bricks. A sick body has exaggeratedly high needs for many vitamins. We can either meet that need or else suffer unnecessarily. Until the medical professions fully embrace orthomolecular treatment, “medicine” might well be said to be “the experimental study of what happens when poisonous chemicals are placed into malnourished human bodies.”
SUBCLINICAL VITAMIN DEFICIENCY SYNDROMES
The classical deficiency syndromes are rare in technologically advanced nations, but these syndromes—scurvy, pellagra, etc.—were so striking and so devastating that they still remain the main theme of professors of biochemistry who teach medical students. Because they are so infrequently seen, most physicians would fail to recognize them. These deficiency states arise from monotonous diets with very few varieties of food, such as the corn diet that causes pellagra, or from starvation. One deficiency may be predominant but many more are present. The only examples of pure deficiency states may be those produced in experiments on humans and animals and in individuals who are vitamin dependent. Thus, a person who is vitamin B3 dependent on a good diet may have ample quantities of every nutrient except vitamin B3 because he or she requires so much. Some acute schizophrenics may have such a pure deficiency (dependency) state, but the mental changes are much more prominent and the obvious physical changes of pellagra are missing.
Marginal vitamin deficiency is a middle ground between health and frank deficiency. As there are no specific symptoms, this in-between state is not apparent. Vitamin deficiency comes on slowly. During a preliminary stage, body stores of vitamins and minerals are slowly depleted. The second stage, the biochemical stage, occurs when these micronutrients are depleted. Enzymes whose activity depends on having adequate amounts of vitamins work less efficiently, but the individual still appears well in growth and appearance. The third stage is the physiological stage—now enzyme activity is sufficiently impaired to cause personality and behavioral changes. These are nonspecific, including anorexia, depression, irritability, anxiety, insomnia, and somnolence. The final stage is the classical deficiency, a stage near death; the clinical and anatomical changes are now clear. The first three stages comprise the gray area—marginal deficiency or subclinical area, the first term used seventy years ago.
Inadequate intakes of specific nutrients may produce more than one disease. While amyotrophic lateral sclerosis (ALS), progressive muscular atrophy, progressive bulbar palsy, and primary lateral sclerosis are not all the same illness, they and the other neuromuscular diseases may have a common basis: unacknowledged, untreated, long-term vitamin dependency. Therefore, each may respond to an orthomolecular approach such as that successfully used by Dr. Frederick R. Klenner for multiple sclerosis and myasthenia gravis, half a century ago.12
Subclinical vitamin deficiencies produce a variety of symptoms and signs that can mimic an amazing variety of medical and psychiatric syndromes, which may be due to other diseases, such as infections, immune deficiencies, etc. Physicians confronted with these syndromes consider them to be manifestations of these diseases. When they do not respond to treatment, they tend to give them up as psychiatric. Many physicians do not think of any possible connection to nutritional problems. A proper examination of patients’ diets would provide the essential diagnostic clues. When these patients do recover on vitamins they have selected on their own or which have been recommended by others, the recovery is ascribed to faith, to a placebo reaction, or to a natural remission. Nutritional therapy has the remarkable effect of suddenly enhancing the “placebo effect.”
Nutritional deficiencies affect all cells and all organs of the body. With the cells operating at subnormal levels, the whole body must be suffering. Systemic or general symptoms include fatigue, inertia, tension, generalized pain, and muscle irritability. In addition, organs operating at subnormal efficiency will add symptoms and signs unique to that organ. In thinking of the causes of discomfort, physicians should remember that in the absence of readily recognized diseases (such as hyperthyroidism), infection, the presence of fatigue, anxiety, and depression should suggest