An orthomolecular approach to the prevention and treatment of psychiatric disorders.

Orthomolecular medicine is based on the use of endogenous and naturally occurring substances to supplement deficiencies in vitamins, minerals, and other essential substances in the human body. Although the medical community has long regarded it as a nonscientific approach to healing, scientific and clinical evidence is emerging for the supplemental use of orthomolecular medicine in the treatment of schizophrenia, depression, bipolar disorder, generalized anxiety disorder, and attention deficit hyperactivity disorder. Psychiatrists currently treat these common psychiatric disorders using a wide range of pharmacological approaches that often have significant side effects, resulting in patients' noncompliance. With newly gained knowledge about the neurophysiology and neuropathophysiology of psychiatric disorders, researchers now can link potential mechanisms for both pharmacological and orthomolecular treatments to physiological processes. In many cases, the use of orthomolecular supplements may provide a feasible addition to conventional drug therapy.

Orthomolecular medicine: the therapeutic use of dietary supplements for anti-aging.

Dietary supplements at high doses as part of medical therapy have been controversial, but the evidence suggests that they play a significant role in prevention and treatment of diseases as well as protection from accelerated aging that results from oxygen free-radical damage, inflammation, and glycation. This literature review examines several supplements that have documented roles in medical therapy, including vitamins C and E, coenzyme Q10, alpha-lipoic acid, chromium, L-carnitine, and quercetin. The evidence shows benefits in diabetes, cardiovascular disease, hypertension, congestive heart failure, age-related deterioration of brain function and vision, and immune function, as well as other age-related health problems.

Megavitamin and dietary treatment in schizophrenia: a randomised, controlled trial.

OBJECTIVE: The aim of this study was to assess the efficacy of adjunctive megavitamin and dietary treatment in schizophrenia. METHOD: A random allocation double-blind, controlled comparison of dietary supplement and megavitamin treatment, and an alternative procedure was given for 5 months to 19 outpatients with a diagnosis of schizophrenia. In addition to usual follow-up, the experimental group received amounts of megavitamins based on their individual serum vitamin levels plus dietary restriction based on Radioallergosorbent (RAST) tests. The control group received 25 mg vitamin C and were prescribed substances considered allergenic from the RAST test. RESULTS: Five months of treatment showed marked differences in serum levels of vitamins but no consistent self-reported symptomatic or behavioural differences between groups. CONCLUSIONS: This study does not provide evidence supporting a positive relationship between regulation of levels of serum vitamins and clinical outcome in schizophrenia over 5 months.

Impact of nutrition education and mega-dose vitamin A supplementation on the health of children in Nepal.

The impact on vitamin A deficiency (VAD), wasting malnutrition, and excessive childhood mortality of two alternative approaches-nutrition education and mega-dose capsule distribution (6-12-month-olds: 100,000 IU; 1-5-year-olds: 200,000 IU)-in communities in Nepal are compared. Approximately 40,000 children from 75 locations in seven districts in two ecological settings (lowland and hills) took part in the study and were randomly allocated to intervention cohorts or a control group. At 24 months after the implementation of the project the reduction of risk for xerophthalmia was greater among children whose mothers were able to identify vitamin-A-rich foods (relative risk (RR) = 0.25; 95% confidence interval (CI) = 0.10-0.62) than among the children who received mega-dose capsules (RR = 0.59; 95% CI = 0.41-0.84). The risk of mortality at 2 years was reduced for both the nutrition education (RR = 0.64; 95% Cl = 0.48-0.86) and capsule distribution (RR = 0.57; 95% CI = 0.42-0.77) cohorts. The nutrition education programme was, however, more expensive to deliver than the capsule distribution programme. High rates of participation for children in the supplementation programme were achieved quickly. The nutrition education messages also spread rapidly throughout the study population (regardless of intervention cohort assignment). Practices, however, were slower to change. In communities where maternal literacy was low and channels of communication were limited the capsule distribution programme appeared to be more economical. However, there are economies of scale for nationwide education programmes that do not exist for capsule distribution programmes. Although nutrition education provides economies of scale and the promise of long-term sustainability, a comprehensive national programme requires both dietary supplementation and nutrition education components.

PIP: The effectiveness of two approaches to vitamin A deficiency prevention--nutrition education and mega-dose capsule distribution--was compared in a 3-year study involving almost 40,000 children 6 months to 10 years of age from seven ecologically diverse districts in Nepal. The nutrition education program promoted increased intake of vitamin A-rich foods during the dry season, serving wild greens, and primary health care service utilization. At baseline, 44.9% of the study villages did not have any cases of Bitot's spots; by the third year, 65.5% were free of this sign of vitamin A deficiency. 85% of community risk variation was explained by agricultural patterns, market food availability, household income, maternal literacy, sanitation, and the village's average nutritional status. At 12 months, capsule distribution had reduced the risk of new Bitot's spots by 55% (relative risk (RR), 0.45; 95% confidence interval (CI), 0.33-0.60); however, its impact had declined by 24 months and was non-significant at 36 months. At 24 months, the reduction of risk for xerophthalmia was greatest among children whose mothers were able to identify vitamin A-rich foods (RR, 0.25; 95% CI, 0.10-0.62) and were literate (RR, 0.06; 95% CI, 0.01-0.42). By 24 months, child mortality risk had declined in both the nutrition education (RR, 0.64; 95% CI, 0.48-0.86) and capsule distribution (RR, 0.57; 95% CI, 0.42-0.77) groups. Although the effects of both programs were similar, the capsule program achieved higher coverage rates at a lower cost while the educational intervention provided economies of scale and potential for long-term sustainability. Most feasible would be a comprehensive national program that included both these components as well as maternal literacy training.

Effects of megavitamin therapy on children with attention deficit disorders.

The effectiveness of a megavitamin regimen utilizing a two-stage trial in 41 subjects with attention deficit disorders was studied. Stage 1 was a 3-month clinical trial of vitamins (daily maximum: 3 g of niacinamide and ascorbic acid, 1.2 g of calcium pantothenate, and 0.6 g of pyridoxine). State 2 consisted of four, 6-week, double-blind repeated crossover periods. Twenty-nine per cent of the subjects showed significant behavior improvement during stage 1, and these subjects were used in the double-blind crossover phase of the study to evaluate megavitamin therapy. Using analysis of variance methods for crossover studies, there was no significant difference (P greater than .05) in most behavior scores between children receiving vitamin and those receiving placebo during stage 2. Children exhibited 25% more disruptive classroom behavior when treated with vitamins v placebo (P less than .01). There was no significant difference in serum pyridoxine and ascorbic acid levels between subjects and control subjects. Forty-two per cent of subjects exceeded the upper limits of serum transaminase levels while receiving vitamins. It is concluded that megavitamins are ineffective in the management of attention deficit disorders and should not be utilized because of their potential hepatotoxicity.

Megavitamins for minimal brain dysfunction. A placebo-controlled study.

Preliminary to a stimulant comparison study, 31 children with minimal brain dysfunction randomly received either placebo or a megavitamin combination. During a two-week trial, only two children responded so well that stiumlants were not considered necessary; both were in the placebo group. Change scores from pretest to posttest on four blind ratings by teachers and parents did not show a significant difference between the placebo and vitamin groups.