Orthomolecular Medicine for Everyone. Abram Hoffer, M.D., Ph.D.
develop after severe and prolonged stress. Such stress is common before, during, and after surgery if patients stay very long in a hospital. This is more common following gastrointestinal complications, severe loss of weight, chronic infection, cancer, and other debilitating diseases.
HOW MUCH OF A VITAMIN IS NEEDED?
With such wide range of vitamin needs among individuals, and even for the same individual throughout life, how do we find out what is the optimum amount? The most effective way is through trial and error, for there are no laboratory tests to help us decide. Is it possible to determine levels of vitamins in body fluids that indicate a deficiency is present or will soon appear? If there is no vitamin B3 or ascorbic acid or thiamine in the urine, it is certain there is very little in the body. But no doctor should wait until these deficiency states develop, for the mortality from these classic deficiency diseases is too great. The same biochemical tests are of less value for individuals who are not suffering from the deficiency disease but who have subclinical variants of these deficiency diseases.
Patients and their physicians can determine what the optimum doses are. We define “optimum dose” as that quantity which restores health without causing either unpleasant or dangerous side effects. This definition also contains the clue to determining the optimum dose: one starts with a dose that long experience has shown is the most effective starting dose for that condition. Once it has been established that there are minimal or no side effects, one continues to see if there is an adequate therapeutic response. If both patient and doctor are satisfied with the rate of improvement, the dose is not increased. If the improvement rate is too slow, the dose is increased slowly, every few weeks or months, until the therapeutic rate is accelerated or until side effects develop.
One of the common side effects of too high a dose of vitamin B3 is nausea. It is possible to take higher doses of niacin, but if nausea does develop, the dose must be reduced or vomiting may develop. Uncontrolled nausea and vomiting can be dangerous, causing dehydration and loss of electrolytes. The optimum dose is the subnauseant dose, 1,000–2,000 mg below the nauseant dose.
Other vitamins have different side effects. Vitamin C, for example, has another end point—it causes intestinal gas (flatulence) and diarrhea. The optimum dose is the sublaxative dose, which is also the therapeutic dose. Usually healthy people require less vitamin C and develop the laxative effect at lower doses than do individuals who are under stress or are ill. Normally, one may require just a few grams of vitamin C per day, but on one occasion, when bitten by sand flies, A. H. took 30 g per day with no laxative effect. A.W. S. has taken as much as 85 g in one day to eliminate a bad cold. Vitamin C can also be used as a laxative, one that is much safer than any commercial laxative probably because it does not interfere with bowel absorption.
The optimum dose required to restore health may be too high once the patient has recovered; maintenance doses may be much lower. They should be determined even if there are no side effects. The health maintenance optimum dose is usually smaller and is that dose required to keep the person healthy. Again, it will have to be determined by trial and error. The dose is decreased very slowly, using lower increments for several months before the next move down is made. If there is any recurrence of symptoms, the dose is raised immediately. Some vitamins have a maintenance dose that should not be reduced. Usually lower doses are not as effective in maintaining health for these vitamins, which will be discussed in the respective vitamin chapters.
Orthomolecular physicians have learned to pay little attention to government-sponsored recommended dietary allowances. But minimal as the RDA/DRI standard is, there is a caveat in any requirement that is intended for almost “all healthy persons in the United States.” This immediately excludes every person who consults a physician, except for those few who seek annual physicals. Arthur M. Sackler points out that most people, many of whom never consult physicians, are not well. Five conditions alone—alcoholism, allergies, arthritis, diabetes, and hypertension—affect over a third of U.S. citizens. Nor is there any meaning in averages as far as patients are concerned, because each patient is unique. A physician who depends only on averages will be a much less than average physician. Sackler concludes: “The common belief that RDAs are generally applicable to all sectors of our population as a standard is a misleading chimera. As standards, they are more often fallacies than facts.”13 The newer DRI (Dietary Reference Intake) standard is even more inadequate.
The RDA/DRI levels should be raised immediately, according to a panel of physicians, academics, and researchers. The Independent Vitamin Safety Review Panel (IVSRP) stated that the government-sponsored nutrient recommendations are “not keeping pace with recent progress in nutrition research.… Inadequate intake, and inadequate standards to judge intake, have resulted in widespread nutrient inadequacy, chronic disease, and an undernourished but overweight population.” Citing a large number of physician reports and clinical studies, the IVSRP called for substantial increases in daily intake of the Bvitamins, vitamins C, D, and E, and the minerals selenium, zinc, magnesium, and chromium. “Clinical and subclinical nutrient deficiencies are among the main causes of our society’s greatest health-care problems. Cancer, cardiovascular disease, mental illness, and other diseases are caused or aggravated by poor nutrient intake. The good news is that scientific evidence shows that adequately high consumption of nutrients helps prevent these diseases.” The new standard, an Optimum Health Requirement, recommends daily adult consumption of nutrients in the following quantities:
• Thiamine (vitamin B1): 25 mg
• Riboflavin (vitamin B2): 25 mg
• Niacinamide (vitamin B3): 300 mg
• Pyridoxine (vitamin B6): 25 mg
• Folic acid: 2,000 mcg
• Cobalamin (vitamin B12): 500 mcg
• Vitamin C: 2,000 mg
• Vitamin D3: 1,500 IU
• Vitamin E (as natural mixed tocopherols): 200 IU
• Zinc: 25 mg
• Magnesium: 500 mg
• Selenium: 200 mcg
• Chromium: 200 mcg
The IVSRP concluded by stating: “People have been led to believe that they can get all the nutrients they need from a ‘balanced diet’ of processed foods. That is not true. For adequate vitamin and mineral intake, a diet of unprocessed, whole foods, along with the intelligent use of nutritional supplements, is more than just a good idea: it is essential.”14
ABOUT “OBJECTIONS” TO VITAMIN MEGADOSES
In massive doses, vitamin C (ascorbic acid) stops a cold within hours, stops influenza in a day, and stops viral pneumonia in two days. It is a highly effective antihistamine, antiviral, and antitoxin. It reduces inflammation and lowers fever. Your doctor may not believe this, but it is not a matter of belief. It is a matter of experience.
Many people therefore wonder, in the face of statements like these, why the medical professions have not embraced vitamin C therapy with open and grateful arms. The reason is this: many studies that claimed to “test” vitamin effectiveness were designed to disprove it. The public and their doctors look to scientific researchers to test and confirm the efficacy of any nutritional therapy. As long as such research is done using insufficient doses of vitamins, doses that are invariably too small to work, megavitamin therapy will be touted as “unproven.”
Probably the main roadblock to widespread examination and utilization of vitamin C therapy is the equally widespread belief that there must be unknown dangers to high doses. Yet, since the time megascorbate therapy was introduced in the late 1940s by Frederick R. Klenner, M.D., right up to today, there has been a surprisingly safe track record. Safety and effectiveness have always been and should always be the benchmark for any therapeutic program.
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