Light on Revealing causes and solutions from an orthomolecular perspective

Abram Hoffer,MD, PhD

With contributions from James Greenblatt, MD Jonathan Prousky, ND, MSc Paul Demeda, CNP Light on Schizophrenia © 2020 The International Society for Published by The International Society for Orthomolecular Medicine www.ISOM.ca All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the written permission of the publisher. It is recommended that treatment of all health concerns be undertaken in consultation with a qualified health care professional. This book should not be regarded as a substitute for professional medical advice.

ISBN 978-0-2288-3556-1 eBook ISBN 978-0-2288-3557-8

Cover art by Dušan Petričić, commissioned for the Abram Hoffer Memorial Poster in 2009. About this book...

This publication is an update to Dr. Abram Hoffer’s book Orthomolecular Treatment for Schizophrenia and other Mental Illness, A Guide for Practitioners, originally published in 2007. Its purpose is to support and validate Dr. Hoffer’s work, and add information that he might write about if he were alive today. Dr. James Greenblatt and Dr. Jonathan Prousky have provided content segments for this update. Both doctors have extensive knowledge and clinical experience, acquired from many years of research and work with schizophrenia patients. Their contributions are invaluable additions to this publication. This book is meant to be a useful introduction and resource for understanding schizophrenia from an orthomolecular perspective.

Much of the content of the original book is included in this update. To keep the legacy of Dr. Hoffer’s original writing, the text of his original book exists alongside the updated content and is displayed in a contrasting typeface.

Dr. Hoffer’s writing looks like this: The original content is displayed throughout the book in this typeface.

Updated content looks like this: The additional content from the various contributors is displayed in this typeface. Table of contents

Preface. 1 Orthomolecular treatment for Schizophrenia...... 66 Introduction...... 4 Expanding Hoffer’s orthomolecular Contributing factors treatment of schizophrenia...... 68 for schizophrenia...... 9 Schizophrenia psychosis ...... 9 and the tranquilizer psychosis. 68 Allergic or sensitivity reactions. 9 Recovery is possible with integrative Celiac disease and gluten orthomolecular treatment...... 69 ...... sensitivity 11 Amino acid therapies...... 70 Gliadorphin and casomorphin...... 16 Broad-spectrum micronutrient Glutathione insufficiency...... 17 treatment. 73

Histadelia . 17 Hormonal therapies ...... 74

Histapenia . 19 Improving the current situation. 77

Homocysteine...... 19 Putting it all together . 77

Hypothyroid ...... 20 In conclusion. 78

Kynurenine pathway. 23 Legacy chapter...... 81 Oxidative stress and inflammation . . . .23 Common questions about Pyroluria ...... 24 schizophrenia treatment...... 81 The microbiome Relapses and orthomolecular and the gut-brain axis ...... 27 therapy. 82 Toxic metals ...... 30 Orthomolecular treatment for other mental illnesses...... 84 Modulators of schizophrenia. 38

Niacin...... 39 Conclusion...... 91

Vitamin B6 (pyridoxine)...... 46 Biographies...... 92 C (ascorbic acid)...... 47 Dr. Abram Hoffer...... 92 Vitamin D...... 49 Dr. James Greenblatt. 96 Folate (folic acid)...... 50 Dr. Jonathan Prousky...... 97 Vitamin B12...... 52 Paul Demeda. 98 Lithium ...... 54

Magnesium ...... 54 Acknowledgements...... 99 Zinc. 55

Essential fatty acids...... 56

Amino acids . 57

Medications...... 59 2017). Many developing societies assign Preface theocentric or supernatural responsibil- ity for mental illness, either exalting or James Greenblatt, MD Medical Director, Redefined Chief Medical ostracizing those with Western-defined Officer, Walden Behavioral Care schizophrenia symptoms. Some psy- chologists and philosophers have even proposed that schizophrenia is an Schizophrenia may be the most complex, advancement in evolutionary human mysterious, and misunderstood psychi- biology, a theory that has gained favor atric condition that has perplexed and among some genetic researchers (Scarr, frustrated clinicians over the past several Udawela, & Dean, 2018). decades. Despite ongoing research and efforts to improve its definition, diagno- Beyond taxing medical systems, schizo- sis, and treatment, schizophrenia retains phrenia brings untold costs to prisons a stubborn presence in society. and homeless shelters, where hundreds of thousands go undiagnosed and lack Most recently defined in the Diagnostic proper care (Torrey, Zdanowicz, & Ken- and Statistical Manual of Mental nard, 2014). Disorders (DSM-V) as a chronic disorder characterized by visual and auditory hal- In addition to a 5 to 10% greater risk of lucinations, cognitive deficits, delusional death by suicide, individuals with schizo- beliefs, incoherent speech, and inappro- phrenia face a significantly shorter life priate behavior, schizophrenia can arise expectancy, estimated at double to triple abruptly or gradually (McCutcheon, the risk of early death compared to typi- Marques, & Howes, 2019). cal American adults (McCutcheon, 2019). The World Health Organization currently The conventional treatment of schizo- estimates that schizophrenia affects at phrenia has relied almost exclusively on least 23 million individuals worldwide, an array of antipsychotic medications representing a prevalence rate of roughly that offer moderate control of symptoms 1%. In addition to a higher incidence in some patients but deliver debilitating in young adults, statistics also indicate side effects in many (Chien & Yip, 2013). that schizophrenia occurs more often in Whether through ignorance, apathy, or men and is associated with ethnic, racial, arrogance, it is clear that the medical and economic minorities. The latter system has failed schizophrenia patients. evidence suggests a strong psychoso- Beyond unproductive diagnoses and cial contribution to the etiology and ineffective treatments, most clinicians prognosis of the disease (World Health have neglected to comprehend the full Organiz­ation, 2019). picture of care needed to address the Interestingly, cultural interpretations of physical, psychological, functional, and schizophrenia symptoms differ widely, sociological ramifications of schizophre- to the extent that the global preva- nia, and support recovery of the patient lence rate is likely much higher (Morrill, as a whole person.

Preface 1 Without ignoring its biological aspects, A paragon of scientific inquiry, Hoffer schizophrenia is clearly a disease of so- searched existing information, compared cioeconomics: mounting data strongly and questioned data, developed and link low income status at birth with tested new hypotheses, reported honest lifetime risk of schizophrenia, a relation- results, and adjusted his views and theo- ship strengthened by enduring poverty ries according to new discoveries. and chronic stress (Hakulinen, Webb, Furthermore, Hoffer never denied that Pedersen, Agerbo, & Mok, 2019). antipsychotic medications were often Notwithstanding the degree of knowl- necessary and effective when used appro- edge, effort, and persistence required, priately and moderately, only empha- patients deserve better, especially when sizing that pharmacotherapy should be multiple underexplored and underuti- one aspect rather than the entirety of lized treatment approaches exist. treatment. Regardless, his experimen- tal methods and clinical practices were Dr. Abram Hoffer’s chief contributions repeatedly called into question and re- to orthomolecular psychiatry began jected by the medical establishment. in 1952 when he performed the first The American Psychiatric Association double-blind therapeutic trials treating and National Library of Medicine delib- schizophrenia patients with high-dose erately ostracized Hoffer and dismissed , after recognizing the remarkable his research and case histories as non- similarities between psychosis and the “evidence-based medicine”, publishing neurological symptoms of pellagra. opposing data based on dissimilar and Through his experiments with high-dose irrelevant study designs in patients with vitamin therapy, Hoffer demonstrated severe, irreversible damage. dramatic improvements in recovery and Hoffer was ahead of his time in devel- discharge rates in schizophrenia patients. oping a biological model of a mental Furthermore, he exhibited a holistic disorder, but arguably his greatest con- model of ethical care, removing sources tribution is the example he set for doing of physical and emotional stress by pro- whatever he could to find the answers viding comfortable shelter, adequate needed to improve the treatment of nourishment, and personal respect to schizophrenia patients and maintained each patient. hope that their lives could be better. Hoffer’s prolific career produced over five Hoffer’s goal with each patient was com- hundred scientific papers, two dozen plete recovery, including the absence books, and numerous collaborations of symptoms, familial and social har- with like-minded renegade experts, mony, and productive contribution to working tirelessly until the end of his society (Hoffer, 2007). He was willing life to leave a clear and imitable legacy to exercise patience and accept small worthy of more than a second glance. improvements as successful progress toward these goals.

2 Light on Schizophrenia Though he did not arrive at all of the References answers in his lifetime, he set forth mul- Chien, W. T., & Yip, A. L. (2013). Current approaches to tiple testable hypotheses for others to treatments for schizophrenia spectrum disorders, part I: an overview and medical treatments. Neuropsychiatric build upon; indeed, to this day Hoffer’s Disease and Treatment, 9, 1311. theories remain topics of research (Pires- Hakulinen, C., Webb, R. T., Pedersen, C. B., Agerbo, E., Minard, 2017). & Mok, P. L. (2019). Association between parental income during childhood and risk of schizophrenia later in life. As Hoffer would attest, optimal mental JAMA Psychiatry. health is not merely the absence of dis- Hoffer, A. (2007).Orthomolecular treatment for schizo- ease, but comprises both a healthy mind phrenia and other mental ilnesses: A guide for practitioners. International Schizophrenia Foundation. and body, autonomy, resilience, and McCutcheon, R. A., Marques, T. R., & Howes, O. D. (2019). a sense of happiness and fulfillment. Schizophrenia—An overview. JAMA Psychiatry, 1-10. Consequently, the integrative care model Morrill, Z. (2017). Psychologists push for new approaches must address each of these areas from to psychosis: Part 1. Mad In America website. https://www. personal, familial, social, and environ- madinamerica.com/2017/10/psychologists-push-new-ap- proach-psychosis-part-1/. Accessed 11 Jan 2020. mental perspectives. Pires-Minard, A. (2017). Is niacin a possible successful The information in this book is the prod- treatment for schizophrenia? McGill University Office for Science and Society. https://www.mcgill.ca/oss/article/ uct of one man’s commitment to making -health-history-you-asked/niacin-possible-success- a difference in patient’s lives: a story ful-treatment-schizophrenia. Accessed 28 Dec 2019. every clinician needs to read, study, and Scarr, E., Udawela, M., & Dean, B. (2018). Changed frontal benefit from the hope and encourage- pole gene expression suggest altered interplay between , developmental, and inflammatory ment found within Hoffer’s words and in pathways in schizophrenia. NPJ Schizophrenia, 4(1), 4. each patient’s testimony. Torrey, E. F., Zdanowicz, M. T., & Kennard, A. D. (2014). The treatment of persons with mental illness in prisons and jails: A state survey. Arlington, Va, Treatment Advocacy Center. World Health Organization. (2019). Schizophrenia. https:// www.who.int/news-room/fact-sheets/detail/schizophre- nia. Accessed 28 Dec 2019.

Preface 3 We are just at the beginning of major Introduction development in orthomolecular treat- ment. This guide is not meant to be a Abram Hoffer, MD Bible or a cook book. It is not “writ in stone”. It is a framework that practi- This guide is a resource for health tioners can use in order to get started practitioners who are interested but each practitioner will add or sub- in obtaining better results treating tract what is appropriate based upon their patients and hope to start using their own experience in treatment and the program. with each patient. It is also written for patients and their As more biochemical information families who are not satisfied with accrues, more specific forms of the the results they are seeing when only disease will be found and, with the drugs are used and want to try a treat- appropriate laboratory tests, much ment which is ultimately safer and more specific treatment will be avail- more effective. able. There is no reason to think that the listed in this guide are The students who have mastered the the only ones. material in this manual should be able to start successful treatment for A large amount of clinical material mentally ill patients. As they continue was published in the medical literature to work with this approach they will beginning with our first publication become more and more enthusias- in 1957. The study was financed by tic and gradually expand their use the Government of Canada. We pub- of nutrients. lished originally in the establishment press until this information was sup- Most often medication is essential pressed by the combined efforts of but orthomolecular physicians use the American Psychiatric Association drugs in optimum doses. When the and National Institute of Mental drugs are combined with the ortho- Health and others. We were forced to molecular approach, the amount of rely on our own journals, the Journal needed is much less and this of Orthomolecular Medicine and its fore- decreases the incidence and the inten- runners and in journals which deal sity of their side effects. with natural healing. These journals I will discuss the important aspects are becoming increasingly popular. of treatment from nutrition includ- Medline consistently has refused to ing the role of allergies, the role of cover our journal for the past 33 years toxic foods, the role of diets too rich even though it covers Time magazine. in refined carbohydrates, the role of Until the internet arrived this was a a few key vitamins and minerals most very effective way of censoring infor- often used, and the role of the essen- mation that did not appeal to NIH. tial fatty acids.

4 Light on Schizophrenia Orthomolecular treatment There are many other deficiencies but they are not characterized as readily. Orthomolecular is the term used by These diseases should be and usually to describe treatment are under control. that uses substances and molecules, that are normally present in the body. An extraordinary decision by the These are vitamins, minerals, essential United States government during fatty acids, amino acids, enzymes, and World War II forced the addition other substances normally present of vitamin B1, B2 and B3 to white in food. flour. This logical decision eradi- cated pellagra which was one of Nutrient dependency the major scourges in the southeast United States and in some seasons A dependency is present when the helped fill their mental hospitals with need for any nutrient is so great that psychotic pellagrins whose illness is even what would be considered an identical with schizophrenia. optimum diet cannot provide the right amount. This enrichment of flour saved the United States billions of dollars in This is due to genetic variation, to health costs and saved millions of the vitamin-depleting effect of many people from the terrible ravages of drugs, to chronic mild deficiency, to this difficult but so easily preventable increased need created by certain dis- and treatable disease. eases, and to enzyme defects, so that important reactions in the body have Phases of nutrient discovery to be driven by a greater quantity of that nutrient. The history of the discovery of vita- mins has gone through two phases. The term dependency was first used The first phase started about 1900. It to describe patients who needed led to the discovery of the vitamins, much larger amounts of vitamin B6. which was very important. I have widened the meaning to apply to any condition and to any disease It also led to the RDAs which have where large doses have been shown proven to be very harmful when to be effective. applied to every person. RDAs are recommended daily doses of vita- The first diseases that were recog- mins which have become standard as nized as deficiency diseases were beri if writ in holy stone. beri, due to a deficiency of vitamin B1, scurvy, due to a deficiency of This phase of vitamin theory and vitamin C, pellagra due to a deficiency practice is called the vitamin–as-pre- of vitamin B3, and rickets due to a vention paradigm. It is still with us, deficiency of vitamin D. very powerful and is one of the main reasons why the use of large doses

Introduction 5 has been condemned. Its main prin- Wittenborn who corroborated our ciples are: (1) that vitamins are useful findings working with a National only to prevent classical deficiency Institute of Mental Health grant in diseases; (2) that vitamins must only New Jersey. be used in very small doses. With the help of a small number of The second and currently develop- pioneer physicians, the treatment has ing phase is the vitamin-as-treatment been greatly expanded and we now phase. In this phase we recognize use other nutrients as well, including that there are other diseases that vitamin C, the B-complex prepara- will respond to vitamins if used in tions which provide all the , optimum doses even though these vitamin B6, folic acid, zinc, essential conditions have not been recognized fatty acids and minerals. as vitamin dependencies. What was originally a simple matter Orthomolecular medicine deals pri- of giving our patients 1 g of vitamin marily with optimum doses which B3 three times daily, in addition may be very small as with vitamin to whatever other treatment they B12 or very large as with vitamin B3 were getting, has become much and vitamin C. more sophisticated and much more efficacious. Schizophrenia treatment Causes of schizophrenia The research group, psychologists, psychiatrists, nurses, Schizophrenia is a syndrome not a dis- and social workers, all worked ease. A syndrome is a constellation together under my direction when we of symptoms and signs which may introduced the use of vitamin B3 for be caused by more than one factor. treating the . Dr. Carl Pfeiffer was the first phy- We conducted several prospective, sician to clearly recognize the randomized, double-blind con- importance of the multiple causes trolled therapeutic trials starting of the schizophrenia syndrome. This in 1952 and we showed that adding is still not recognized in psychiatry the right amount of this vitamin to the where psychiatric diagnosis is entirely treatment then available doubled the descriptive and not based upon two-year schizophrenia recovery rate. clearly recognized causal factors. In his 1988 book The Schizophrenias: Since then many American and Ours to Conquer, he showed that Canadian physicians corroborated schizophrenia causal factors can our findings using the usual clinical be divided into: pyroluria 30%; hista- open-ended methods. These meth- delia 20%; histapenia 50%; cerebral ods are today considered merely allergy 10%; gluten allergy 4% anecdotal. Our original double-blind and porphyria 0.1%. studies were, and still are ignored, as is the double-blind study by J. Richard

6 Light on Schizophrenia The Quakers and modern in most psychiatric wards although schizophrenia treatment I suspect some of the very costly About 150 years ago the Quakers private hospitals might be somewhat in England developed the Moral better with this. Treatment of the Insane. The term The natural recovery rate is facili- schizophrenia had not been invented. tated by decreasing the patient’s level The diagnostic term was insanity. of stress. Under stress the secretion They reported a fifty percent recovery of adrenalin in the body is increased. rate. Half of their patients recovered. Adrenalin is the precursor of adre- They were really guests, not patients, nochrome, one of the causes of since doctors and nurses were not psychosis. (Adrenochome will be dis- involved. Dr. J Conolly, one of the cussed further on page 9) foremost psychiatrists in England, Modern psychiatry does not pro- reported the same recovery rate in vide proper shelter and too many his mental hospital. The Dorothea patients subsist in grossly inadequate Dix Hospitals in New England at the places including the streets of North same time also reported similar recov- American cities, under bridges, in ery rate. The recovery rate today, a parks, or in prison. This hardly qual- century and a half later, is ten percent ifies as shelter and does nothing to or less. alleviate stress. Too few patients are fortunate enough to have families Decency and respect that can provide adequate shelter. The Quakers established houses, each housing 12 insane people. They The Quakers of 1850 had no access were provided with shelter, with to modern food. They probably used food, and they were treated with the cheapest foods they could buy respect and decency. These three and that was, of course, advanta- essential elements of any satisfac- geous, as it avoided antinutrients such tory treatment allowed their patients as sugar and white flour. to heal. Modern psychiatry does not show Modern psychiatric hospitals do not any interest in providing nourishing treat their schizophrenic patients with food for patients. Eat a few meals in decency and respect. Almost every any psychiatric ward and you’ll see the one of the patients who are treated in food is too rich in refined carbohy- these hospitals complain of the way drates, too poor in protein, too low in they were treated. essential fatty acids and nearly devoid of essential nutrients. The Quakers, in contrast, treated them as human beings. They would The Quakers had no drugs and they spend Saturday nights having dinner did not use any of the harsh physical with them, and would interact and methods that were torture to the poor even dance with them. This is rare hapless patients in the usual mental hospitals of that day.

Introduction 7 Modern xenobiotic psychiatry in- ness: health, warm personal relations, creases the stress on patients and sufficient means to keep you from obviously this is one explanation of want, and successful work.” their very low recovery rate. Xeno- “Recovery” can mean something biotic compounds are substances more than drugged docility, it can that are not found naturally in mean that patients are free of symp- living tissue. toms, that they are getting on well Drugs do decrease the intensity of with their own family and with the symptoms but do little to offer real community and that they are paying recovery of a patient’s former life. income tax or are otherwise produc- Bertrand Russell wrote “I believe four tive in other activities. ingredients are necessary for happi-

8 Light on Schizophrenia