Orthomolecular Medicine for Everyone. Abram Hoffer, M.D., Ph.D.
FOR NUTRITIONAL SUPPLEMENTS
A recent (March 26, 2003) and unsuccessful attempt to restrict free public access to vitamin supplements was U.S. Senate Bill S. 722, the “Dietary Supplement Safety Act of 2003.” The proposed law attempted to give the head of the U.S. Food and Drug Administration sole power to decide if and when “the continued marketing of the dietary supplement is disapproved,” based on adverse event reporting so vague that the proposed bill specified that the decision was “without regard to whether the event is known to be causally related to the dietary supplement.”
The intent of S. 722 was to overturn the main provisions of the U.S. Dietary Supplement Health and Education Act of 1994 (DSHEA). The U.S. Congress enacted DSHEA specifically to define vitamins, amino acids, herbs, and other nutritional supplements as foods, not drugs. DSHEA enjoyed tremendous popular support. More citizen letters—2.5 million—were sent to Congress in 1992–1994 in favor of DSHEA than over any other issue in American history. Citizen opposition to S. 722 was also strong. It gathered only four co-sponsors, and failed in committee. The Congress has seen that there is overwhelming public support for ensuring free access to dietary supplements.
Proving Effectiveness
Low-dose vitamin studies are the ones that get negative results. Most vitamin research is low dose. You cannot test the effectiveness of high doses by giving low doses. Any time nutritional research employs inadequately low doses of vitamins, doses that hundreds of orthomolecular physicians have already reported as too small to work, vitamin therapy will be touted as “ineffective.” You can set up any study to fail. One way to ensure failure is to make a meaningless test with the choice to use insufficient quantities of the substance to be investigated. If you shoot beans at a charging rhinoceros, you are not likely to influence the outcome. If you give every homeless person you meet on the street 25 cents, you could easily prove that money will not help poverty.
One reason commonly offered to justify conducting low-dose studies is that high doses of vitamins are somehow dangerous. They are not. There are those who may not believe this next statement, but it is not a matter of belief—it is a matter of fact: there is not even one death per year from vitamin supplements.23 We call for double-blind, placebo-controlled testing of alleged vitamin side effects. And let the opponents of vitamin therapy cite the double-blind, placebo-controlled studies upon which they have based their toxicity allegations. They can’t, because there aren’t any.
It is ironic that critics of vitamins preferentially cite low-dose studies in an attempt to show lack of vitamin effectiveness, yet they cannot cite any credible studies of high doses that show vitamin dangers. This is because vitamins are effective at high doses, and vitamins are safe at high doses.
Patented drugs have parents—pharmaceutical manufacturers—who promote and defend them. Vitamins are not patentable and so have languished as orphans. The use and promotion of vitamins in high doses has depended on the energy and enthusiasm of physicians who have seen what they do, and patients who have been helped when all else failed.
3
Niacin (Vitamin B3)
Most vitamins were recognized biologically and nutritionally before their chemical structure was determined. In chemistry, compounds are named logically once the structure is finally established. When the first vitamin was purified, it was called vitamin B1 (then later, thiamine). The second one was called vitamin B2 (riboflavin). This was followed by the antipellagra vitamin, B3, later recognized to be nicotinic acid (niacin) and nicotinamide (niacinamide).
Nicotinic acid had been synthesized many years earlier but had remained merely one of a large number of chemicals of no biological interest. Once it was found to be vitamin B3, nicotinic acid was renamed niacin, and nicotinamide was renamed niacinamide for medical use. “Nicotinic acid” was too similar to “nicotine,” an association that suggested the detrimental effects of nicotine and frightened a few away from the vitamin. Both niacinamide and niacin are components of the nucleotide cycle, which ensures the continual production of nicotinamide adenine dinucleotide (NAD). This is the active anti-pellagra factor, a component of the respiratory enzyme system. The designation vitamin B3 was revived by Bill W. (Bill Wilson), a cofounder of Alcoholics Anonymous, when he distributed his first Alcoholics Anonymous report to physicians, which was titled “The Vitamin B3 Therapy.” The term is, in fact, very useful, as it includes both niacin and niacinamide.
The major sources of vitamin B3 are whole-grain cereals, legumes, nuts, and meats. Most cereals have been milled (refined) and their bran and wheat germ stripped away. Since this removes most of their vitamin B3, white wheat flour is “enriched” or reinforced with niacinamide. This was a major factor in eliminating the great pandemic of pellagra that raged in many countries, including the United States, until about 1942, when adding the vitamin was mandated. One hypothesis is that the human race is undergoing an evolutionary change and losing the ability to convert the amino acid tryptophan into niacinamide.1 This makes us more dependent on the supply of the vitamin in our food at the same time that our food provides less of this important nutrient. “Enrichment” quantities are low.
Niacin is needed for the health of the digestive system, skin, and nerves. It is essential for obtaining energy from carbohydrate foods. The body’s complex niacin/niacinamide nucleotide cycle is so important and pervasive that it would take a whole book to describe all its other many remarkable uses and properties. Chief among them are niacin’s participation in the manufacture of sex hormones and in repairing our DNA.
CONDITIONS BENEFITED BY VITAMIN B3
Pellagra
Pellagra is one of the classical diseases of Western civilization. It is a niacin-deficiency disease characterized by dermatitis, gastrointestinal disorders, and mental disturbance. It also causes premature aging, brings on neurological conditions, and decreases immunity to a large number of infectious diseases.
As long as populations lived on a variety of whole foods, pellagra was very rare. But when farmers began to grow single crops as the main source of cash and for food, diseases due to single cultured crops (monocultures) became epidemic. Farmers and poor people in the southern United States and in several countries around the Mediterranean Sea (Spain and Italy) began to depend very heavily on corn. Pellagra is the direct result of excessive corn consumption combined with a lack of other foods. This is not due only to a deficiency of vitamin B3 in corn, but rather to the fact that the vitamin is so tightly bound chemically that too little is absorbed by the body. Curiously, natives of Central America discovered several thousand years ago that corn consumed as tortillas did not cause pellagra. They treated the crudely ground whole corn with calcium-rich alkali, which liberated the vitamin.
A number of diseases present such a varied set of symptoms and signs that a study of these diseases is almost a study of medicine itself. Syphilis is one such disease and pellagra is probably the one condition that can mimic a larger number of physical and psychiatric diseases. Deficiency of the essential fatty acids (EFAs) is another, perhaps because one of the main functions of vitamin B3 is to aid in the conversion of EFAs to the hormonelike prostaglandins. Pellagra may be due to a deficiency of EFA substrate in contrast to the corn-induced pellagra.2 Both result in a deficiency of prostaglandins.
Classic pellagra has been characterized by the four Ds: dermatitis, diarrhea, dementia, and death. It is, after all, a preterminal disease. If a vitamin B3 deficiency is diagnosed only after pellagra is obvious, one is playing Russian roulette with the life of the patient.