Megavitamin Therapy for Childhood Psychoses and Learning Disabilities

AMERICAN ACADEMY OF PEDIATRICS

Vitamins have long beell recognized for their dantoin sodiuni (Dilantin), they need increased unique role ill human nutrition. s1ost of these folic acid aild vitamin Finally, there are a low-molecular weight, organic substances are ilulliber of rare inborn errors of metabolism precursors of coenzymes, and adequate amounts affecting the apoenzme at the cofactor 1)mding to nieet the known Ilutritiollal needs of healthy site or involving the metabolism of the vitamin persons of all ages have been defined by the Food itself to its biologically active derivative.3 In these and Nutrition Board of the National Academy of so-called dependency syndromes, the metabolic Sciences as the “Recommended Dietary Allow- defect may completely or partially be overcome ances (RDA). The consistent opinion of the by greatly increasing vitamin or cofactor avail- Coninlittee OIl Nutrition of the Anlerican Acade- ability. lily of Pediatrics has been that normal children Set against a background of wide public belief receiving a normal diet do not need vitamin 111 the benefits of vitamins, the accounts of supplementation’ over alld above RDA levels. dramatic amelioration of deficiency states, the However, there are a variety of clinical entities easy and relatively inexpensive availability of in which the daily intake of vitamins needs to be these substances, and tile occasional, remarkable significantly increased. This is true, for example, benefit of large doses (both in the dependency with the fat-soluble vitanhillS A, D, E, and K in the syndromes and ill certain other clinical situa- steatorrhoeas and in the autosomallv recessive tions), it is Ilot surprising that a cult developed in selective malabsorption of vitamin B12. Rarely, the use of large doses of water-soluble vitamins to children treated with isoniazid require increased treat a wide spectrum of disease states. In particu- pridoxine: and, when treated with diphenlhv- lar, “megavitamin” therapy came to be applied to

Downloaded from www.aappublications.org/news by guest on September 24, 2021 910 PEDIATRICS Vol. 58 No. 6 December 1976 the use of large amounts of nicotinic acid or these conditions is justified, and it is reasonable to nicotinamide in the treatment of schizophrenia. expect that other conditions of this type will be Pauling, in 1968, coined the term “orthomolecu- identified. In contrast, megavitamin therapy as a lar medicine,” meaning the treatment or preven- treatment for learning disabilities and psychoses tion of diseases by altering body concentrations of in children, including autism, is not justified on certain normally occurring substances. Pauling’s the basis of documented clinical results. term now encompasses the additional use of nicotinamide adeinine dinucleotide (NAD), ribo- flavin, ascorbic acid, pyridoxine, calcium pantho- COMMITTEE ON NUTRITION tenate, vitaillin B19, folic acid, and trace minerals LEwIs A. BARNESS, M.D., in doses considerably in excess of the RDA for a Chairman wide range of problems including arthritis, ALVIN M. MAUER, M.D., neuroses, geriatic problems, hyperlipidemia, and Vice-Chairman depression. ARNOLD S. ANDERSON, M.D. This “orthomolecular” approach has been used PETER R. DALLMAN, M.D. in children primarily in the treatment of nonspe- GILBERT B. FomEs, M.D. cific mental retardation, psychoses, autism, AMES C. HAWORTH, M.D. hyperactivity, dyslexia, and other learning disor- J MARY JANE JESSE, M.D. ders reminiscent of an earlier advocacy of large CHARLES R. SCRIVER, M.D. doses of glutamic acid for Down’s syndrome. 1 MYRON WINICK, M.D. The substantially anecdotal evidence of thera- Consultants peutic benefit in these and other conditions WILLIAM C. HEIRD, M.D. should be viewed with skepticism until vigorous 0. L. KLINE, PH.D. evidence of benefit has been obtained and DONOUGH O’BRIEN, M.D. published in peer reviewed journals. Technical Advisory Group As an example of this approach, Cott’1 reports RUDOLPH M. TOMARELLI, PH.D., giving niacin (1 to 2 glll/24 hr), ascorbic acid (1 to Chairman 2 gm/24 hr), pyridoxine (200 to 400 mg/24 hr), DUANE A. BENTON, PH.D. and calcium pantothenate (400 to 600 mg/24 hr) IVY M. CELENDER, D.SC. to more than 500 children with psychoses and GEORGE A. PURvI5, PH.D. learning disabilities. The author claims that the SIDNEY SAPERSTEIN, PH.D. treatment shows promise and is sometimes ROBERT E. SMITH, PH.D. dramatic; however, no precise data are given on Liaison Representatives which any objective assessment of results can be BETTY E. ANDERSON made. MYRTLE L. BROWN, PH.D. Although no comparable evaluation has been MARGARET CHENEY, PH.D. carried out on children for autism and learning JOGINDER CHOPRA, M.D. disabilities, the claims of orthomolecular psychia- WILLIAM J. DARBY, M.D., PH.D. trists in the treatment of adult schizophrenia have MARY C. EGAN recently been carefully examined in a report to J. MICHAEL LANE, M.D. the An#{238}erican Psychiatric Association by a Task HAROLD T. MCLEAN Force on Vitamin Therapy in Psychiatry.1211 MERRILL S. READ, PH.D. Their conclusions were emphatic that orthodox, HERBERT P. SARETT, PH.D. properly controlled, and well-standardized trials L. J. TEPLY, PH.D. found nicotinic acid therapy to be without value. PHILIP L. WHITE, SC.D. Moreover, there is some evidence that long-term administration of high doses of nicotinic acid in man may lead to persistent skin erythema, pruri- tis, tachycardia, liver damage, hyperglycemia, REFERENCES and uml4 1. Committee on Nutrition: Proposed changes in Food and There are a number of situations in pediatric Drug Administration regulations concerning formu- la products and vitamin-mineral dietary supple- practice where a specific vitamin deficiency can ments for infants. Pediatrics 40:916, 1967. be demonstrated by biochemical tests and 2. Silverman A, Roy CC, Cozzetto FJ: Pediatric Clinical increased amounts of vitamins can be shown to Gastroenterologv. St. Louis, CV Mosby, 1975, resolve these conditions. Vitamin therapy under p 514.

Downloaded from www.aappublications.org/news by guest on September 24, 2021 AMERICAN ACADEMY OF PEDIATRICS 911 3. Bell NI, Ilarries JT, Wolff OH, et al: Familial selective 10. Rimland B: Megavitamin treatment in children. In, malal)sorption of vitamin B .Arc h Dis Child Hawkins D, Pauling L (eds): Orthomolecular 48:896, 1973. Psychiatry. San Francisco, WH Freeman Co, 4. Christiansen C, Rodbro P. Nielsen CT: latrogenic osteo- 1973. malacia in epileptic children: A controlled thera- 1 1 . Cott A: Megavitamins: The orthomolecular approach to peutic trial. Acta Pediatr Scand 64:219, 1975. behavioral disorders and learning disabilities. Acad 5. Scriver CR: Vitamin-responsive inborn errors of metab- Ther 7:245, 1972. olism. Metabolism 22:1319, 1973. 12. Megavitamin and Orthomolecular Therapy in Psychia- 6. Pauling L: Orthomolecular pschiatr. Science 160:265, try: Task Force Report No. 7. Washington DC: 1968. American Psychiatry Association, 1973. 7. Green G: Subclinical pellagra, its diagnosis and treat- 13. Megavitamin and orthomolecular therapy in psychiatry: ment. Schizophrenia 2:70, 1970. Excerpts from the Report of the Task Force on 8. Hoffer A: Treatment of hperkinetic children with Vitamin Therapy in Psychiatry. Nutr Rev 32:44, nicotinamide and pridoxine. Can Med Assoc J 1974. 107:111, 1972. 14. Winter SL, Boyer JL: Hepatic toxicity from large doses 9. Hoffer A: Vitamin B-3 dependent child. Schizophrenia of vitamin B3 (nicotinamide). N EngI J Med 3:107, 1971. 289:1180, 1973.

Downloaded from www.aappublications.org/news by guest on September 24, 2021 912 MEGAVITAMIN THERAPY Megavitamin Therapy for Childhood Psychoses and Learning Disabilities Lewis A. Barness, Alvin M. Mauer, Arnold S. Anderson, Peter R. Dallman, Gilbert B. Forbes, James C. Haworth, Mary Jane Jesse, Charles R. Scriver, Myron Winick, William C. Heird, O. L. Kline, Donough O'Brien, Rudolph M. Tomarelli, Duane A. Benton, Ivy M. Celender, George A. Purvis, Sidney Saperstein, Robert E. Smith, Betty E. Anderson, Myrtle L. Brown, Margaret Cheney, Joginder Chopra, William J. Darby, Mary C. Egan, J. Michael Lane, Harold T. McLean, Merrill S. Read, Herbert P. Sarett, L. J. Teply and Philip L. White Pediatrics 1976;58;910

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Downloaded from www.aappublications.org/news by guest on September 24, 2021 Megavitamin Therapy for Childhood Psychoses and Learning Disabilities Lewis A. Barness, Alvin M. Mauer, Arnold S. Anderson, Peter R. Dallman, Gilbert B. Forbes, James C. Haworth, Mary Jane Jesse, Charles R. Scriver, Myron Winick, William C. Heird, O. L. Kline, Donough O'Brien, Rudolph M. Tomarelli, Duane A. Benton, Ivy M. Celender, George A. Purvis, Sidney Saperstein, Robert E. Smith, Betty E. Anderson, Myrtle L. Brown, Margaret Cheney, Joginder Chopra, William J. Darby, Mary C. Egan, J. Michael Lane, Harold T. McLean, Merrill S. Read, Herbert P. Sarett, L. J. Teply and Philip L. White Pediatrics 1976;58;910

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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 1976 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397.

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