History of Orthomolecular Psychiatry

A. HOFFER, M.D., Ph.D. 1

Definition of Orthomolecular Psychiatry foodstuff and as supplements to it. They also Many physicians have contributed towards include a consideration of foods from the point the concept of Orthomolecular psychiatry, of view of its beneficial aspects and from the but the entire work was coordinated into a point of view of its toxic aspects, that is, the medical science by the definition proposed by propensity of some food to be allergogenic for Dr. Linus Pauling (1968), who defined it as some people. follows: Orthomolecular psychiatric therapy is the treatment of mental disease by the How Dr. Linus Pauling Got Involved provision of the optimum molecular Dr. Pauling has been interested in the environment for the mind, especially the relationship of molecules to medicine for many optimum concentrations of substances years. This interest was greatly accentuated by normally present in the human body. This his discovery of the abnormal molecule present definition allowed many physicians who in sickle cell anemia. He had also investigated were working in allied areas to come together the molecular basis of certain mental diseases, and work toward a common goal. The range especially mental deficiency. However, his of Orthomolecular psychiatry extends from interest was rekindled after he retired at age of some of the neurological conditions like 65. About this time he saw a copy of our book multiple sclerosis to the most clear-cut entitled, How To Live With Schizophrenia psychiatric condition such as schizophrenia. (1966). This renewed his interest, and he went The treatments required to optimize the back to work at the University of California in molecular environment for the cells, San Diego. After a careful examination of all especially the brain, include vitamins and the literature he concluded that the criticism of minerals, both as components of the megavitamin approach was not founded upon scientific data, and for this reason he and 1 1201 CN Towers, First Avenue South, Saskatoon, his staff began Sask., Canada. S7K 1J5 223 ORTHOMOLECULAR PSYCHIATRY, VOLUME 3, NUMBER 4, 1974, Pp. 223-230 to examine it more carefully. The paper extension into the general field of which he subsequently published in 1968 in psychiatry. Science is now a classic. It provides a Today it seems to me almost inevitable that theoretical formulation for the requirement as soon as the price of these materials came for excessive quantities of vitamins for down and as soon as major research grants certain people. He also showed how an became available some independent and organism could drop the machinery necessary curious physicians would be interested in trying to the synthesis of very important vitamins out larger than recommended quantities for even though less than adequate quantities various diseases of unknown etiology. There might be present in that individual's diet. His were in fact several papers in the literature importance in the field of Orthomolecular where up to 1 to 11/2 grams per day of nicotinic psychiatry has therefore been immense, not acid or nicotinamide were given to a group of only because he placed his scientific so-called depressives. There was a substantial reputation behind the work that we had done, response. Since it is well known that a number but also because it provided a theoretical of people diagnosed depression are in fact rationale for some of the research we are schizophrenic, it is amply clear that they were engaged in now. the first to see the response of some schizophrenics to megavitamin B3 therapy. Roots However, the first person to systematically 1. Megavitamin Therapy (a) Practical use larger quantities was Dr. William The early pellagrologists, that is, experts Kaufmann (1949) who used 3 to 4 grams of in the treatment of pellagra, used small nicotinamide per day for the treatment of quantities of vitamins. It occurred to some of various forms of arthritis. By 1949 he had them that higher doses might be of some published a couple of volumes in which he value, but they were still astonished when described on a large number of cases the they found that some chronic pellagrins beneficial effects of this vitamin. This work required as much as 600 mg of nicotinic acid was ignored because it had to compete with the per day to prevent recurrence of their pellagra introduction of the wonder drug, cortisone, symptoms. It is undoubtedly true that they which had an ample budget for its promotion. must have gone up to as high as 1 or even No one was interested in the promotion of 1 1 /2 grams per day in running their tests. It is vitamins. It was about this time Dr. Osmond well known that the earlier experiments were and I began to use 3 grams per day and more of conducted in mental hospitals where it was nicotinic acid for the treatment of acute and practically impossible to distinguish between subacute schizophrenic patients. This led to the the chronic schizophrenics and the chronic use of vitamin B3 for many of our acute and pellagrins who might be in the same ward, subacute schizophrenic patients. It also led to and some of these patients received these the discovery of the beneficial effect of quantities. nicotinic acid in lowering cholesterol levels and It is easy to understand why they would later triglyceride levels. There has been a recent not give very many people high quantities of expansion of this work, as you will hear at this vitamins for a long time because in those conference, into the treatment of other days, that is during the depression, they were conditions. Nicotinic acid and nicotinamide are extremely expensive and there were few very fascinating molecules because of their research budgets which would permit many remarkable properties. One of the more physicians to try these vitamins. However, remarkable properties may be their they were able to demonstrate the value of antihistaminic effect, which may be why these vitamins for the typical pellagra psychosis. There was then a gradual 224 HISTORY OF ORTHOMOLECULAR PSYCHIATRY

this vitamin has some value in the treatment of asthmatics and other allergic conditions with cerebral allergies even though it may not lead to this combination. So far there have been no other final recovery. publications supporting his work, but there are Ascorbic acid has had three main individuals many of us who have been using the treatment who promoted its use in larger than average with success. The pioneers in the parenteral use quantities. The first is Dr. Klenner (1973), who of vitamins have been Dr. Jonathan Could in has been using this vitamin in dosages up to 50 England who began to use parenteral vitamins - 60 grams per day for particularly dangerous for many conditions about 1955, and more conditions for perhaps the past 30 years. He has recently Dr. Allan Cott who popularized this summarized his work in a volume and has treatment especially for Orthomolecular recently written articles for the medical physicians. journals. This work was referred to by Dr. Irwin (b) Theoretical Stone (1972) in his excellent summary of the There are two main theoretical roots, the properties and therapeutic potential of ascorbic first one developed by Dr. Linus Pauling who acid, and of course it was finally popularized by took an evolutionary point of view and described Dr. Linus Pauling (1970) when he published his how it would be beneficial from the point of book, Vitamin C and the Common Cold. You view of energy consumption for the cells of the will recall the tremendous attack upon Dr. body to utilize the essential nutrients available in Pauling for having published this work and for their food rather than to have to synthesize them. having summarized the medical literature. This provides a rational basis not only for the However, just about every control study which need of high quantities of vitamins for. certain has come out since that time has been people but also for some of the individual supportive to one or another of the claims made variations between various people. Dr. Pauling's by Dr. Linus Pauling based upon his careful assistant, Dr. Robinson, working with Dr. examination of the literature. Pauling has taken a turn away from searching Vitamin E has had an equally difficult time only for toxic chemicals which might be the in getting itself established. The pioneers have cause of certain conditions and has been looking been Wilfred and Evan Shute (1969) who have for abnormal patterns of normal metabolites. been using it for the past 30 years on thousands This seems to be a sensible approach and may of cases of cardiovascular disease with success. indicate a new direction for research. However, the attack upon the use of vitamin E Dr. Roger Williams (1971) provided the has not abated, and just the other day in a recent second major root in demonstrating, first of all, issue of the Journal of the American Medical the marked individuality of people with respect Association I read a letter by a physician who to their requirements for various nutrients and claimed bluntly that vitamin E was of value also for emphasizing the importance of the only for vitamin E-deficiency states, and of internal environment, that is the importance of course these did not occur which meant that the solution surrounding each cell. They must be vitamin E did not have any clinical value. provided with the optimum quantity of various However, many of us have been using vitamin nutrients if they are to conduct themselves in a E with success. We will have to discount the proper manner. Anyone who is familiar with Dr. criticism by physicians who are not familiar Roger Williams' work must surely understand with what has been going on in this field. the importance of determining the optimum dose The combination of vitamins A and D with for each particular individual. No general bone meal has been developed by Dr. Carl statement of requirement can be of any value Reich who has treated many thousands of whatever since it will certainly exclude a 225 ORTHOMOLECULAR PSYCHIATRY, VOLUME 3, NUMBER 4, 1974, Pp. 223-230 large proportion of the population. kind of advertising about their own drugs they would be quickly hauled into court. However, it 2. Minerals is now likely that Canada at least will change its The pioneer in this work is Dr. Carl Pfeiffer, direction in public education. I look forward to who fortunately is with us today. He has the time when citizens can expect honest and emphasized and provided data to support his accurate nutritional information from their claims that it is important to have optimum governments. quantities of minerals, that having too much The American government, especially mineral, for example, copper, lead, iron, through the F.D.A., has had a very cadmium, and so on, can be very toxic for some pernicious effect in the area of food education. people, but on the other hand having too little They have attempted to suppress those of the essential elements like zinc, manganese, nutritionists and other people interested in good calcium, magnesium, and iron can be equally nutrition by ad hominem attacks. For devastating. This work is only in its infancy, example, physicians who recommended that and undoubtedly over the next 10 to 20 years patients should be treated with adequate or there will be major advances. supernutrition were promptly labeled as quacks, 3. Major Foodstuffs and people who developed certain food We have a very curious situation in North habits because they discovered that on this America and perhaps in the rest of the world. particular kind of food they themselves felt Over the past 100 years, especially in the better were promptly labeled as food faddists. industrial nations, there has been a remarkable They have been particularly severe on health drift downward in the nutritional quality of our food operators. It is true that many so- food. It is true that sanitation has improved, but called food faddists have gone overboard the availability of good nutritious food has simply because they themselves came to the gotten worse, and today it is very difficult even erroneous conclusion that a diet which had been in the larger supermarkets for a person, unless beneficial to them ought to be beneficial for he is exceptionally intelligent, to obtain a everyone else. This counters the basic arguments variety of food that can nourish him properly. put forward by Dr. Roger Williams. Recently the Canadian government published However, we must recognize the fact that evens the results of Canada's nutrition survey (Sabry, the food faddists may be correct for a small 1973) which I think every person interested in number of people if only they would realize-that nutrition ought to read. Their conclusions are they ought not to promulgate these ideas very pessimistic. They report that a large for everyone or at least recognize that other proportion of the population sampled were people have different requirements. suffering from one or more nutritional However, governments who have been attacking deficiencies. Examination of their data shows them have made more grievous errors since they that the proportion deficient tends to increase lumped all these people together as food faddists with age, so that it is rare for a person over age without paying any attention to their message. I 65 not to be deficient in one or more factors. have always been amused by the amazement and For many years the governments of United anger of the doctors when they discover that States and Canada have been depending upon people read books on nutrition and begin to their so-called daily requirements and health treat themselves by nutritional techniques. They rules or food rules to educate the public with seem to have forgotten that many intelligent respect to nutrition. In general the education has people can read, can understand, and can been misinformed and has been of such a nature practice the science of nutrition perfectly well that if drug companies were to issue the same provided they are given 226 HISTORY OF ORTHOMOLECULAR PSYCHIATRY accurate guides. pioneer is Dr. Allan Cott, who has brought over 4. The Saccharine Diseases The major change the fasting techniques from Russia which have in the development of current foodstuff is to led to the present interest in the various food process the natural foods into what is allergies, which are easily diagnosed,by a four- considered to be either more desirable day fast. Dr. Cott has also pioneered the use of or more palatable. We have seen the megavitamins for children and the use of major effects of processing by which single parenteral administration of the vitamins. I elements of the food are extracted and made should also refer to Dr. Jack Ward and Dr. available in pure form. This includes Robert Meiers who have done a good deal of the primarily fats and carbohydrates. As a result basic work relating the hypoglycemias to schizo- it is now possible to obtain large quantities of phrenia and other conditions. Dr. Carl Pfeiffer fat and single carbohydrates; for example, sugar has already been mentioned in connection with which is not being consumed as a portion of the the minerals. He has also done pioneer research whole original food has many undesirable in developing accurate laboratory tests for consequences. The excessive consumption of diagnosing. I need only refer to Dr. Bernie fats can lead to a large number of conditions Rimland who has done the most effective work ranging from obesity to cardiovascular in introducing the Orthomolecular approach to disease. The excessive consumption of the vast group of children with learning and carbohydrates, especially alcohol and sugar, behavioral disorders. can lead to a whole host of conditions from 6. Cerebral Allergies diabetes mellitus to the anxiety states I want to refer to the current interest in and depressions commonly diagnosed as cerebral allergy which has been in the medical having relative hypoglycemia. The literature since Dr. Rinkel began to do his work. deficiency of fiber leads to a large The greatest contribution has been made by Dr. number of bowel conditions including Randolph who was interested in the general diverticulitis, appendicitis, and cancer. effects of allergy on physical diseases but had, Processing also greatly increases the over 10 years ago, accumulated 500 mental sodium content of foods and tends to decrease patients who were also sick because of their the potassium content, thus producing an allergies. This work has recently been expanded inverted ratio compared to what is required. by Dr. Marshall Mandell, by Dr. W. H. Philpott The effect of excessive sugar has been who fortunately is here today, and you will hear documented by Professor Yudkin (1972) and his work. This work has led to the diagnosis of will be referred to later on. The total effect of allergies by using fasts of various durations, by consuming highly processed foods which using elimination diets, by using rotation diets, include sugar, alcohol, and the cereal grains has and eventually by using diets which eliminate been well described by Dr. Cleave, Campbell, the toxic foods and also by various forms of and Painter in their book called, “The desensitization. You will hear some of these Saccharine Disease," which also will be described here today by one of Canada's referred to later on. foremost allergists, Dr. I. Claisher, and by Dr. 5. General Glen Green, the rediscoverer of the condition There have been general contributions to the subclinical pellagra. Orthomolecular approach, especially by Dr. David Hawkins who has shown how to involve Orthomolecular Approach the community on a massive level. He has The Orthomolecular approach therefore works shown that the skillful use of tranquilizers and within the framework of the medical model, antidepressants in combination with megavita- which has been described very clearly by Dr. mins has been extremely helpful. Another Osmond 227 ORTHOMOLECULAR PSYCHIATRY, VOLUME 3, NUMBER 4, 1974, Pp. 223-230 and his colleagues and includes the use of our public and high schools and our supernutrition, preferably not containing those governments and Departments of Health will foods to which that particular patient is allergic. issue accurate information about nutrition. It includes a proper consideration of vitamins Inadequate foods may still be available on the and megavitamins if necessary. It also must market, but when this is the case they will have take into account the proper use of minerals. If to be properly labeled with a cautionary warning necessary, tranquilizers are used. It may well be such as: "Warning - this food does not make any that the tranquilizers work either because of useful contribution to your daily health." their antihistamine effect or because they (c) Consideration will have to be given to increase the quantity of coenzyme 1 in the specific needs, for example, those people who body. It is well known that tranquilizers are are allergic, those people who require special rather weak antihistamines, but perhaps they vitamins, and those people who require special are effective because they can be given in large minerals. A special investigation will have to be quantities whereas the standard antihistamines determined to find out why there is a significant produce too much sedation. The treatment also increase in the number of people who are includes antidepressants which have recently allergic as it may well be that malnutrition been shown to be curative for pellagra, perhaps carried on over a number of years might be because they make tryptophan more available. responsible for a number of these allergic ECT may have an antihistamine effect as has reactions. The fact that a number of vitamins been suggested by Dr. Philpott. have anti-allergy and antihistaminic properties However, the final aim of Orthomolecular suggests this is an area worth searching. therapy is to have a normal person without the need for either tranquilizers or antidepressants, An Alternative Future but there is certainly no reason why they should Every species of animal is adapted to its not be used as long as they are necessary. environment. The interplay of genotype and Future environment has produced the very variable (a) The future must include accurate phenotype — the human species. When the diagnosis both based upon clinical examination environment is changed, whether or not man is and upon accurate laboratory tests. I think that responsible for the change, there is a gradual we are just at the beginning of this, and I look adaptation to the newer environment and a new forward over the next 20 years to a remarkable phenotype evolves. Man has adapted at least accuracy in diagnosing and treating. twice to major food environmental shifts and is (b) Treatment of the future will make now forcing himself to adapt to a third. The last sure that supernutrition is easily available for 10,000 years or so have witnessed a major anyone who wishes it. This will be done by change from a hunting, foraging species to an making available natural foods which are not agricultural society. The development of grains contaminated by additives of which sugar, is a has been one of the main factors in the enormous prime example, or which are not emasculated increase in world population, in the development by taking out of them various of cities, in short, in the development of our components. If the foods are processed they culture. will be carefully labeled in such a way that any Ten thousand years is not long in the history person can easily determine whether that food of evolution. Over the past 50 years, and this has is either good or bad for him. There will be a accelerated dramatically in the past 20 years, we good and effective educational program, and have exposed 228 HISTORY OF ORTHOMOLECULAR PSYCHIATRY ourselves to the third major change, i.e., the is to sum the percentages of our population utilization of processed foods. I am suffering from those chronic illnesses apt to be convinced many of us are casualties of this examples of nutritional deficiencies. These are newer development. shown in Table 1. There are no statistics available to I would assume that between 21/2 and 20 determine what proportion of our population percent of our population suffer from chronic suffers from malnutrition, which is directly malnutrition. They are the result of tampering attributable to this change. There are no with our food. The proportion will grow surveys where any attempt has been made to rapidly as more and more people attain the get this data. This in itself is an indication of status of 20 years of malnutrition or more. our lack of interest in this problem. It is Many of the saccharine diseases appear after possible, however, to obtain an estimate of 20 years of excessive sucrose consumption. the prevalence of malnutrition arising from Evolution will undoubtedly produce a excessive use of processed foods. species of man able to assimilate sucrose and I have approached this problem from two other refined foods or a species of man whose directions. I consider the saccharine diseases appetite for sweets will be so altered they will which I will describe later as diseases of no longer consume anything but the malnutrition. The other diseases are the unprocessed foods of our distant ancestors. avitaminosis, the vitamin dependencies, and Those of us who do not adapt will be replaced the mineral deficiencies or excesses. Perhaps and in the process will suffer from a variety of it will be shown that the allergies may also diseases of malnutrition. The costs will be a turn out to be forms of malnutrition. One can burden on the rest of society which remains add up the number of patients discharged well by virtue of a remarkable biochemical from hospitals from any region which are constitution able to utilize the processed foods, probably due to malnutrition. This will or because of their superior nutritional provide a gross underestimate since not every intelligence, or because of an inherited dislike chronic patient is admitted every year. for all junk foods. In 1973, 220,000 patients were discharged The relation of corn and man provides an from hospitals in Saskatchewan. Of this interesting example of intelligent nutrition and group 10 percent, in my opinion, are its impact on people. There are two general examples of chronic malnutrition. They ways of preparing corn for food. It can be include diseases of circulation, diseases of incorporated directly into food, or it can first digestion, nutritional deficiencies, and so on. be treated with alkali, preferably calcium. If these diseases of malnutrition had not Corn, untreated, is not a high-quality food. occurred, our hospital costs could have been Corn meal deprived of its embryo and outer decreased by 10 percent. About 21/2 percent layers (pericarp and aleurone) is even worse. of Saskatchewan population is ill enough The nicotinamide is in a fixed form and not from malnutrition to require admission to absorbed in the intestine, and there is hospital. Another approach TABLE 1 Percent of Population III

Senility 2% This may be much too low. About 50% of all people in Canada over 65 have various avitaminosis. Arthritis 5% Diabetes mellitus 2% Alcoholism 5% Schizophrenia 2% All other conditions including cancer 4% TOTAL 20% 229 ORTHOMOLECULAR PSYCHIATRY, VOLUME 3, NUMBER 4, 1974, Pp. 223-230 too much leucine compared to isoleu-cine. CLEAVE, T.L., CAMPBELL, G.D., and PAINTER, N.S.: Diabetes, Coronary Thrombosis and the Saccharine Disease. John Wright and Sons, Ltd., Bristol, 1969. Leucine increases the loss of vitamin B3 in COTT, A.: The parenteral use of vitamins in the treatment of schizophrenia. the urine, while isoleucine prevents this. Schizophrenia 2, 177, 1970.

These are several of the reasons why corn is COTT, A.: Controlled fasting treatment of schizophrenia in the U.S.S.R. Schizophrenia 3, such a pellagra-producing food, as is millet in 2, 1971. India. Populations which live on corn GOULD, J.: The Use of Vitamins in Psychiatric Practice. Proc. Roval Soc. Med. 47, 215, 1954. therefore suffer from pellagra unless the GREEN, G.: Subclinical pellagra in Orthomolecular psychiatry. Edited by Hawkins, D., vitamin B3 is provided by other foods. This and Pauling, L., W.H. Freeman and Co., San Francisco, 1973. KATZ, S.H., HEDIGER, M.L., and VALLEROY, L.A.: Traditional Maize Processing. may be done by enrichment of flour as in Techniques in the New World. Science 184, 765, 1974.

North America, by use of coffee or bananas KAUFMAN, W.: Common Forms of Joint Dysfunction. E.L. Hildreth and Co., which provide small quantities of vitamin B3. Brattleboro, Vermont, 1949. But many races of men have used large KLENNER, F.R.: Response of Peripheral and Central Nerve Pathology to Megadoses of the Vitamin B Complex and' other Metabolites. J. Applied Nutrition 25, 16, 1973. quantities of corn without suffering from NEWBOLD, H.L., PHILPOTT, W.H., and MANDELL, M.; Psychiatric Syndromes pellagra. These men first treated corn with Produced by Allergies: Ecologic Mental Illness. Orthomolecular Psychiatry 2, 84, 1973. alkali salts, usually lime. This makes the PAULING L.: Orthomolecular Psychiatry. Science 160, 265, 1968. vitamin B3 more available and increases the PAULING, L.: Vitamin C and the Common Cold. W.H. Freeman and Company, San amount of isoleucine. Thus one group of men Francisco, 1970. learned to remain healthy by a simple PFEIFFER, C: Neurobiology of the Trace Metals Zinc and Copper. Internat. Review of modification of their cooking habits, while Neurobiology Supp. 1. Academic Press, New York, 1972. another group continued to suffer pellagra RANDOLPH, T.G.: Ecologic Mental Illness - Levels of Central Nervous System Reactions. The Third World Congress of Psychiatry Vol. 1, 379, 1961. until they discovered alternate supplies. It is clear the people treating the corn with alkali REICH, C: The Vitamin Therapy of Chronic Asthma. J. Asthma Research 9, 99, 1971. RIMLAND, B.: High-Dosage Levels of Certain Vitamins in the Treatment of Children were better nutritionists (Katz, Hediger, and with Severe Mental Disorders. Orthomolecular Psychiatry. Ed. Hawkins, D., and Valleroy, 1974). Pauling, L., W.H. Freeman and Co., San Francisco, page 513, 1973. If we do not heed the lesson to be learned flINKEL, H.J.: The Technique and Clinical Application of Individual Food Tests. Ann. Allergy 2, 504, 1944. from the pellagra sufferers of a century we SABRY, Z.I.: Nutrition Canada. Department Nat. Health and Welfare, Ottawa, 1973. are doomed to suffer the pathology and SHUTE, W.E., and TAUB, H.J.: Vitamin E for Ailing and Healthy Hearts. Pyramid disability of the malnutritions until we too House, New York, 1969. develop a more intelligent nutritional STONE, I.: The Healing Factor. Grosset and Dunlap, New York, 1972. approach. Orthomolecular medicine, of WARD, J.: Glucose Tolerance in Schizophrenia. Orthomolecular Psychiatry 1, 137, which Orthomolecular psychiatry is a 1972. subdivision, represents one of the modern WILLIAMS, R.J.: Nutrition against Disease. Pitman Pub. Corp., New York, 1971. intelligent approaches. YUDKIN, J.: Sweet and Dangerous. Peter H. Wyden, Inc., New York, 1972.