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Alternative medicine / fringe therapies
Claims Health effects of dietary supplements, particularly vitamin megadoses.
Related fields aturopathy
Original proponents !inus "auling #coined term$
Orthomolecular medicine,-.,/. is a form of complementary and alternative
medicine aimed at maintaining health through nutritional
supplementation and based on the assertion that there is an optimum
nutritional environment in the body and that diseases reflect
deficiencies in this environment.
0reatment for disease, according to this vie1, calls for the "correcting of
imbalances or deficiencies based on individual biochemistry" by use of
substances natural to the body, such as vitamins, minerals, amino acids,
trace elements and fatty acids.,2.,+.,3. Fe1 medical or scientific e4perts support
this approach5,6.,*. even the accuracy of calling the orthomolecular approach a form of
medicine has 7een 8uestioned since the -)*(s.,9.
0he approach is sometimes referred to as megavitamin therapy,-.,/. 7ecause its practice
evolved out of, and in some cases still uses, doses of vitamins and minerals many times
higher than the recommended dietary intake. Orthomolecular practitioners may also
incorporate a variety of other styles of treatment into their approaches, including
dietary restriction, megadoses of non-vitamin nutrients and mainstream
pharmaceutical drugs. Proponents argue that non-optimal levels of certain
substances can cause health issues beyond simple vitamin deficiency and see
balancing these substances as an integral part of health.
!he term "orthomolecular" "as coined by #inus Pauling to mean "the
right molecules in the right amounts" $ortho is %ree& for "right"'.,--.
"roponents of orthomolecular medicine hold that treatment must 7e 7ased on each
patient:s individual 7iochemistry.,-/.,-2.
0he scientific and medical consensus is that the 7road claims of efficacy advanced 7y
advocates of orthomolecular medicine are not ade8uately tested as drug therapies.,6. ;t
has 7een descri7ed as a form of food faddism and even 8uackery.,-+. "roponents point to
mainstream sources that have pu7lished research supporting the 7enefits of nutrient
supplementation,-3.,-6. and to instances 1here conventional medicine uses vitamins as
treatments for some diseases.
Ho1ever, some vitamins have 7een linked to increased risk of cancer and death.,-*.,-9.
,-). 0he scientific consensus vie1 is that for normal individuals, a 7alanced diet contains
all necessary vitamins and minerals, and that routine supplementation is not necessary
a7sent specific diagnosed deficiencies.,/(.
- History and development
2 Orthomolecular psychiatry
6 %edical and scientific reception
6./ <ie1s on safety and efficacy
6.2 =4ample> vitamin =
6.+ ?se in A;'&
6.+.- 'eaths resulting from illegal vitamin trials in &outh Africa
6.3 Alleged institutional 7ias
* &ee also
) Further reading
-( =4ternal links
History and development,edit.
;n the early /(th century, some doctors hypothesised that vitamins could cure disease,
and supplements 1ere prescri7ed in megadoses 7y the -)2(s.,/-. 0heir effects on health
1ere disappointing, though, and in the -)3(s and 6(s, nutrition 1as de@emphasised in
standard medical curricula.,/-. Riordon:s organiAation cite figures from this period as
founders of their movement,,//. although the 1ord BorthomolecularB 1as coined 7y
!inus "auling only in -)6*.
Amongst the individuals descri7ed posthumously as orthomolecularists are %a4 Cerson,
1ho developed a diet that he claimed could treat diseases, 1hich the American %edical
Association:s -)+) Council on "harmacy and Chemistry found ineffective5,/2. and the
&hute 7rothers, 1ho attempted to treat heart disease 1ith vitamin =.,/+. &everal concepts
no1 cited 7y orthomolecularists, including individual 7iochemical variation,-2. and
in7orn errors of meta7olism,,/-.,/3.,/6. de7uted in scientific papers early in the /(th
;n -)+9, William %cCormick theoriAed that vitamin C deficiency played an important
role in many diseases and 7egan to use large doses in patients.,/*. ;n the -)3(s, Fred R.
Dlenner also tried vitamin C megadosage as a therapy for a 1ide range of illnesses,
including polio.,/9. ;r1in &tone stated that organisms that do not synthesise their o1n
vitamin C due to a loss@of@function mutation have a disease he called Bhypoascor7emiaB.
,/). 0his term is not used 7y the medical community, and the idea of an organism@1ide
lack of a 7iosynthetic path1ay as a disease 1as not endorsed 7y &tone:s contemporaries.
;n the -)3(s, some individuals 7elieved that vitamin deficiencies caused mental illness.
,/-. "sychiatrists Humphry Osmond and A7ram Hoffer gave people having acute
schiAophrenic episodes high doses of niacin,,2-. 1hile William Daufman used
niacinamide. While niacin has no kno1n efficacy in psychiatric disease, the use of niacin
in com7ination 1ith statins and other medical therapies has 7ecome one of several
medical treatments for cardiovascular disease.,2/.,22.
;n the late -)6(s, !inus "auling introduced the e4pression BorthomolecularB,--. to
e4press the idea of the right molecules in the right amounts.,--. &ince the first claims of
medical 7reakthroughs 1ith vitamin C 7y "auling and others, findings on the health
effects of vitamin C have 7een controversial and contradictory.,2+.,23. "auling:s claims
have 7een criticised as over7road.,26.
!ater research 7ranched out into nutrients 7esides niacin and vitamin C, including
essential fatty acids.,2*.
According to A7ram Hoffer, orthomolecular medicine does not purport to treat all
diseases, nor is it Ba replacement for standard treatment. A proportion of patients 1ill
re8uire orthodo4 treatment, a proportion 1ill do much 7etter on orthomolecular
treatment, and the rest 1ill need a skillful 7lend of 7oth.B,29. evertheless, advocates
have said that nutrients can prevent,,2). treat, and sometimes cure a 1ide range of
medical conditions, including> acne,,+(. alcoholism,,+-. allergies, arthritis, autism, 7ee
stings, 7ipolar disorder, 7urns, cancer,,+/.,+2. the common cold, depression, drug
addiction, drug overdose, epilepsy, heart diseases, heavy metal to4icity, acute hepatitis,
herpes, hyperactivity, hypertension, hypoglycemia, influenAa, learning disa7ilities, mental
and meta7olic disorders,,++. migraine, mononucleosis, mushroom poisoning, neuropathy
E polyneuritis #including multiple sclerosis$, osteoporosis,,+3. polio, an hypothesised
condition called BpyroluriaB, radiation sickness, Raynaud:s disease, mental retardation,
schiAophrenia,,+. shock, skin pro7lems, snake7ite, spider 7ite, tetanus to4in and viral
%ain article> Orthomolecular psychiatry
Hoffer 7elieved that particular nutrients could cure mental illness. ;n the -)3(s, he
attempted to treat schiAophrenia 1ith niacin, although proponents of orthomolecular
psychiatry say that the ideas 7ehind their approach predate Hoffer.,+*.,+9. According to
Hoffer and others 1ho called themselves Borthomolecular psychiatristsB, psychiatric
syndromes result from 7iochemical deficiencies, allergies, to4icities or several
hypothetical contri7uting conditions 1hich they termed pyroluria, histadelia and
histapenia. 0hese purported causes 1ere said to 7e found during an Bindividual
7iochemical 1orkupB and treated 1ith megavitamin therapy and dietary changes
including fasting.,+). 0hese diagnoses and treatments are not accepted 7y evidence@7ased
According to A7ram Hoffer, BprimitiveB peoples do not consume processed foods and do
not have BdegenerativeB diseases.,3-. ;n contrast, typical BWesternB diets are said to 7e
insufficient for long@term health, necessitating the use of megadose supplements of
vitamins, dietary minerals, proteins, antio4idants, amino acids, F@2 fatty acids, F@6 fatty
acids, medium@chain triglycerides, dietary fi7er, short and long chain fatty acids,
lipotropes, systemic and digestive enAymes, other digestive factors, and prohormones to
1ard off hypothetical meta7olism anomalies at an early stage, 7efore they cause disease.
Orthomolecularists say that they provide prescriptions for optimal amounts of
micronutrients after individual diagnoses 7ased on 7lood tests and personal histories.,2.
,-/. !ifestyle and diet changes may also 7e recommended. 0he 7attery of tests ordered
includes many that are not considered useful 7y medicine.,3(.
Orthomolecular medicine is practiced 7y fe1 medical practitioners.,3/.,32.
A survey released in %ay, /((+ 7y the ational Center for Complementary and
Alternative %edicine focused on 1ho used complementary and alternative medicine
#CA%$, 1hat 1as used, and 1hy it 1as used in the ?nited &tates 7y adults age -9 years
and over during /((/. 0he survey reported uses in the previous t1elve months that
include orthomolecular related uses> onvitamin, nonmineral, natural products -9.)G,
'iet@7ased therapies 2.3G, %egavitamin therapy /.9G.,3+.
Another recent CA% survey reported that -/G of liver disease patients used the
antio4idant silymarin, more than 6G used vitamins, and that Bin all, *+G of patients
reported using CA% in addition to the medications prescri7ed 7y their physician, 7ut
/6G did not inform their physician of their CA% use.B,33.
=ven though the health 7enefits are not esta7lished, the use of high doses of vitamins is
also common in people 1ho have 7een diagnosed 1ith cancer.,36. According to Cancer
Research ?D, cancer patients should al1ays seek professional advice 7efore taking such
supplements, and using them as a su7stitute for conventional treatment Bcould 7e harmful
to ,their. health and greatly reduce the chance of curing or controlling ,their. cancerB.,3*.
%edical and scientific reception,edit.
Orthomolecular therapies have 7een criticiAed as lacking a sufficient evidence 7ase for
clinical use> their scientific foundations are too 1eak, the studies that have 7een
performed are too fe1 and too open to interpretation, and reported positive findings in
o7servational studies are contradicted 7y the results of more rigorous clinical trials.,3/.
,39. Accordingly, Bthere is no evidence that orthomolecular medicine is effectiveB.
"roponents of orthomolecular medicine strongly dispute this statement 7y citing studies
demonstrating the effectiveness of treatments involving vitamins, though this ignores the
7elief that a normal diet 1ill provide ade8uate nutrients to avoid deficiencies, and that
orthomolecular treatments are not actually related to vitamin deficiency.,-(. 0he lack of
scientifically rigorous testing of orthomolecular medicine has led to its practices 7eing
classed 1ith other forms of alternative medicine and regarded as unscientific.,3).,6(.,6-.
;t has 7een descri7ed as food faddism and 8uackery, 1ith critics arguing that it is 7ased
upon an Be4aggerated 7elief in the effects of nutrition upon health and disease.B,6/.,62.
,6+. Orthomolecular practitioners 1ill often use du7ious diagnostic methods to define
1hat su7stances are BcorrectB5 one e4ample is hair analysis, 1hich produces spurious
results 1hen used in this fashion.,-(.
"roponents of orthomolecular medicine contend that, unlike some other forms of
alternative medicine such as homeopathy, their ideas are at least 7iologically 7ased, do
not involve magical thinking,,63. and are capa7le of generating testa7le hypotheses.,66.
Orthomolecular is not a standard medical term, and clinical use of specific nutrients is
considered a form of chemoprevention #to prevent or delay development of disease$ or
chemotherapy #to treat an e4isting condition$.,6*.
'espite a lack of evidence for its efficacy, interest in intravenous high dose vitamin C
therapy has not 7een permanently e4tinguished, and some research groups continue to
investigate 1hether it has an effect as a possi7le cancer treatment.,69.,6).
<ie1s on safety and efficacy,edit.
;n general, the vitamin megadoses advocated 7y orthomolecular medicine are
unsupported 7y scientific consensus.,2/. &ome vitamins are to4ic in high doses,,*(.
including niacin #H2$,,*-. cholecalciferol #'$,*/. and tocopherol #=$.,*2. 0he vie1 of
the medical community is that there is no evidence for the efficacy of Orthomolecular
medicine as a treatment for cancer,,6. and that high vitamin doses may I on the contrary
I increase overall mortality.,*+. utritional treatments are not generally accepted as
7eing helpful for psychological health.,*3. ;ts claims have 7een criticiAed 7y most
medical organiAations, including the American Cancer &ociety, the American "sychiatric
Association, the ational ;nstitute of %ental Health,,3(. the American Academy of
"ediatrics,,*6. CHA%"?&, and the Canadian "aediatric &ociety. 0he American %edical
Association descri7es as BmythsB the ideas that ade8uate nutrition is not readily
achieva7le 1ith normal food, all food gro1n 1ith pesticide is poisonous, all food
additives are poisonous, vitamin and mineral deficiencies are common, that the cause of
most disease is poor diet, 1hich can 7e prevented 7y nutritional supplements. ,**.
&imilarly, the American Cancer &ociety comments that the current scientific evidence
does not Bsupport use of orthomolecular therapy for most of the conditions for 1hich it is
promoted.B &ome supplements have e4hi7ited 7enefits for specific conditions, 1hile a
fe1 have 7een confirmed to 7e harmful5 the consumption of nutritious foods is the 7est
recogniAed method to o7tain vitamins, minerals, and nutrients crucial for good health.,2/.
Harrie Cassileth, an adviser on alternative medicine to the ational ;nstitutes of Health,
stated that Bscientific research has found no 7enefit from orthomolecular therapy for any
disease,B,3/. and medical te4t7ooks also report that there is Bno evidence that
megavitamin or orthomolecular therapy is effective in treating any disease.B,*9.
A -)*2 task force of the American "sychiatric Association unanimously concluded>
0his revie1 and criti8ue has carefully e4amined the literature produced 7y megavitamin
proponents and 7y those 1ho have attempted to replicate their 7asic and clinical 1ork. ;t
concludes in this regard that the credi7ility of the megavitamin proponents is lo1. 0heir
credi7ility is further diminished 7y a consistent refusal over the past decade to perform
controlled e4periments and to report their ne1 results in a scientifically accepta7le
fashion. ?nder these circumstances this 0ask Force considers the massive pu7licity 1hich
they promulgate via radio, the lay press and popular 7ooks, using catch phrases 1hich are
really misnomers like Bmegavitamin therapyB and Borthomolecular treatment,B to 7e
;n response to claims that orthomolecular medicine could cure childhood psychoses and
learning disorders, the American Academy of "ediatrics la7elled orthomolecular
medicine a BcultB in -)*6.,9(.
"roponents of orthomolecular medicine counter that some vitamins and nutrients are no1
used in medicine as treatments for specific diseases, such as megadose niacin and fish oil
for dyslipidemias, and megavitamin therapies for a group of rare in7orn errors of
meta7olism.,/-. A revie1 in the Annals of ;nternal %edicine concluded that 1hile some
therapies might 7e 7eneficial, others might 7e harmful or interfere 1ith effective medical
therapy.,9-. A recent study of over -6-,((( individuals provided, in the 1ords of the
authors, Bconvincing evidence that multivitamin use has little or no influence on the risk
of common cancers, cardiovascular disease, or total mortality in postmenopausal
1omen.B,9/. A recent meta@analysis in JA%A suggested that supplementation 1ith
com7inations of antio4idant vitamins #7eta@carotene, vitamin A, and vitamin =$ may
increase mortality, although 1ith respect to 7eta@carotene this conclusion may 7e due to
the kno1n harmful effect in smokers.,92.
;n the ?nited &tates, pharmaceuticals must 7e proven safe and effective to the satisfaction
of the F'A 7efore they can 7e marketed, 1hereas dietary supplements must 7e proven
unsafe 7efore regulatory action can 7e taken.,9+. A num7er of orthomolecular
supplements are availa7le in the ?& in pharmaceutical versions that are sometimes 8uite
similar in strength and general content, or in other countries are regulated as
pharmaceuticals. 0he ?& regulations also have provisions to recogniAe a general level of
safety for esta7lished nutrients that can forgo ne1 drug safety tests. "roponents of
orthomolecular medicine argue that supplements are less likely to cause dangerous side@
effects or harm, since they are normally present in the 7ody.,3. &ome vitamins are to4ic
in high doses,*(. and nearly all #1ith the possi7le e4ception of <itamin C,93.$ 1ill cause
adverse effects given high levels of overdosing for prolonged periods as recommended 7y
orthomolecular practitioners.,-(. Forgoing medical care in favor of orthomolecular
treatments can lead to adverse health outcomes.,6.
Health professionals see orthomolecular medicine as encouraging individuals to dose
themselves 1ith large amounts of vitamins and other nutrients 1ithout conventional
supervision, 1hich they 1orry might 7e damaging to health. "otential risks,96. of
inappropriate vitamin and supplement regimes include an increased risk of coronary heart
disease,,9*. hypertension, throm7ophle7itis, peripheral neuropathy, ata4ia, neurological
effects, liver to4icity, congenital a7normalities, spontaneous a7ortion, gouty arthritis,
Kaundice, kidney stones, and diarrhea.,*.,-*.,99.,9).,)(.,)-.,)/. ;n their 7ook 0rick or
0reatment, =dAard =rnst and &imon &ingh conclude that B0he concepts of orthomolecular
medicine are not 7iologically plausi7le and not supported 7y the results of rigorous
clinical trials. 0hese pro7lems are compounded 7y the fact that orthomolecular medicine
can cause harm and is often very e4pensive.B,-(.
=4ample> vitamin =,edit.
Orthomolecular proponents claim that even large doses of vitamin = pose no risk to
health and are useful for the treatment and prevention of a 7road list of conditions,
including heart and circulatory diseases, dia7etes and nephritis.,)2. ;nitial hopes for the
usefulness of vitamin = in orthomolecular medicine 1ere 7ased on epidemiological
studies suggesting that people 1ho consumed more vitamin = had lo1er risks of chronic
disease, such as coronary heart disease.,)+. 0hese o7servational studies could not
distinguish 7et1een 1hether the higher levels of vitamin = improved health themselves,
or 1hether confounding varia7les #such as other dietary factors or e4ercise$ 1ere
responsi7le.,)3.,)6. 0o distinguish 7et1een these possi7ilities, a num7er of randomiAed
controlled trials 1ere performed and meta@analysis of these controlled clinical trials have
not sho1n any clear 7enefit from any form of vitamin = supplementation for preventing
chronic disease.,)*.,)9.,)).,-((. Further clinical studies sho1 no 7enefit of vitamin =
supplements for cardiovascular disease.,-(-. 0he current position of the ational
;nstitutes of Health is that there is no convincing evidence that vitamin = supplements
can prevent or treat any disease.,-(/.
Heyond the lack of apparent 7enefit, a series of three meta@analyses reported that vitamin
= supplementation is associated 1ith an increased risk of death5 one of the meta@analyses
performed 7y the Cochrane Colla7oration also found significantly increased mortality for
the antio4idant vitamins A and 7eta@carotene.,-(2.,-(+.,-(3. A su7se8uent meta@analysis
found no mortality 7enefit from vitamin =, 7ut also no increase in mortality either.,-(6.
?se in A;'&,edit.
&everal articles in the alternative@medicine literature have suggested that orthomolecular@
related dietary supplementation might 7e helpful for patients 1ith H;</A;'&.,-(*.,-(9.
Ho1ever, high@dose vitamin C treatments have 7een studied clinically to treat A;'&
patients 1ithout any positive result.,-(). An analysis of fifteen clinical trials of
micronutrient therapies 7y the Cochrane Colla7oration in /((3 found no evidence that
such approaches either reduce symptoms or mortality in H;<@infected adults 1ho are not
malnourished, 7ut found evidence, in one hospital, that giving vitamin A to infants 1ith
H;< may 7e 7eneficial.,--(. <itamin A deficiency is found in children 1ith H;<
infection 1ho may or may not have symptoms of A;'&. <itamin A supplementation
reduces mor7idity and mortality in A;'& symptomatic children, 7ut has no effect on
asymptomatic children. ;t does not prevent H;< infection, cannot treat the chronic H;<
infection, and 1ill not cure A;'&.,---.,--/.
'eaths resulting from illegal vitamin trials in &outh Africa,edit.
%ain article> %atthias Rath
%atthias Rath has 7een e4tensively criticiAed for presenting his vitamin supplements as a
treatment for A;'& and for testing them in illegal trials in &outh Africa.,--2.,--+. A
former associate of !inus "auling, Rath has promoted vitamins as a treatment for H;<
infection, descri7ing treatment 1ith effective antiretroviral drugs as to4ic and part of a
glo7al conspiracy serving the financial interests of the pharmaceutical industry.,--3. ;n a
la1suit that found against Rath, the &outh African %edical Association 7lamed his
vitamin products for several deaths.,--+.,--6.,--*. 0he World Health OrganiAation and
t1o health agencies of the ?nited ations also descri7ed RathLs advertisements as
M1rong and misleadingN and Man irresponsi7le attack on AR< #antiretroviral$
therapy.N,--9. 0he &outh African Centre for &ocial &cience Research descri7ed the trials
as Bstate sponsored pseudo@scienceB.,--). Rath:s trials, conducted 1ith the aid of A;'&
denialist 'avid Rasnick, 1ere declared unla1ful 7y the Cape High Court5 Rath, Rasnick
and their foundation 1ere 7arred from conducting further unauthorised clinical trials and
from advertising their products.,-/(.
Alleged institutional 7ias,edit.
Advocates of orthomolecular medicine, including "auling, Hoffer and =1an Cameron
have claimed that their findings are actively suppressed 7y the medical and
pharmaceutical industry. Hoffer 1rote B0here is no conspiracy led and directed 7y a
single person or 7y a single organiAation. 0here is no %afia in psychiatry. Ho1ever, there
is a conspiracy led and directed 7y a large num7er of professionals and their associations
1ho have a common aim to protect their hard@earned orthodo4y, no matter 1hat the cost
to their opponent colleagues or to their patients.B.,-/-.,-//.
0he Journal of Orthomolecular %edicine, founded in -)6* as the Journal of
&chiAophrenia, is a maKor pu7lication of orthomolecular medicine. As A7ram Hoffer
We had to create our o1n Kournals 7ecause it 1as impossi7le to o7tain entry into the
official Kournals of psychiatry and medicine. Hefore -)6* ; had not found it difficult to
pu7lish reports in these Kournals, and 7y then ; had a7out -3( articles and several 7ooks
in the esta7lishment press.,-/2.
Other mem7ers of the medical community deny the e4istence of such an institutional
preKudice.,-/+.,-/3. A revie1 in the Journal of Clinical Oncology denied that physicians
collude against unconventional treatments.,-/6. 'espite claims of conspiracy, the !inus
"auling ;nstitute:s funding comes primarily from the ational ;nstitutes of Health,,-/*.
and in -))3 some orthomolecular therapies 1ere reported as 7eing sanctioned in Japan.
Health freedom movement
!ist of ineffective cancer treatments
!ist of life e4tension related topics
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Journal of Orthomolecular %edicine, orthomolecular.org
Official 1e7site for the ;nternational &ociety of Orthomolecular %edicine, isom.eu
Orthomolecular %edicine Online
Hiologically 7ased practices> an overvie1, ational ;nstitute of Health ational Center
for Complementary and Alternative %edicine
Food, health and 1ell@7eing in Hritish Colum7ia. HC "rovincial Health OfficerLs Annual
&hould 1e B0hank CodB for Julian WhitakerP, American Council on &cience and Health,
Recommendations of the CAHF task force on supplement a7use #-)9*$
Categories> Orthomolecular medicineFringe science
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