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An American ] in the late 20th century, the evolving megavitamin therapy are integrated with orthomolecular and ]. Although megavitamin therapy still largely remains outside of the structure of ], they are increasingly used by patients, with or without the approval of their treating physicians.<ref name="pmid10893280">{{cite journal |author=Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE |title=Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology |journal=J. Clin. Oncol. |volume=18 |issue=13 |pages=2505–14 |year=2000 |month=July |pmid=10893280 |doi= |url=http://jco.ascopubs.org/cgi/content/full/18/13/2505}}</ref> In the 21st century, proposed megavitamin therapies with vitamin C are being evaluated for their possible use in cancer, but clinical results have shown no effect on treating or reducing the risk of cancer.<ref name="pmid19116389">{{cite journal |author=Lin J, Cook NR, Albert C, ''et al'' |title=Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial |journal=J. Natl. Cancer Inst. |volume=101 |issue=1 |pages=14–23 |year=2009 |month=January |pmid=19116389 |doi=10.1093/jnci/djn438 |url=}}</ref> An American ] in the late 20th century, the evolving megavitamin therapy are integrated with orthomolecular and ]. Although megavitamin therapy still largely remains outside of the structure of ], they are increasingly used by patients, with or without the approval of their treating physicians.<ref name="pmid10893280">{{cite journal |author=Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE |title=Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology |journal=J. Clin. Oncol. |volume=18 |issue=13 |pages=2505–14 |year=2000 |month=July |pmid=10893280 |doi= |url=http://jco.ascopubs.org/cgi/content/full/18/13/2505}}</ref> In the 21st century, proposed megavitamin therapies with vitamin C are being evaluated for their possible use in cancer, but clinical results have shown no effect on treating or reducing the risk of cancer.<ref name="pmid19116389">{{cite journal |author=Lin J, Cook NR, Albert C, ''et al'' |title=Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial |journal=J. Natl. Cancer Inst. |volume=101 |issue=1 |pages=14–23 |year=2009 |month=January |pmid=19116389 |doi=10.1093/jnci/djn438 |url=}}</ref>


==Criticism and side effects == ==Criticism ==
The effectiveness of various megavitamin therapies has been disputed by results of clinical trials, including about safety, definition and validation of efficacy.<ref name="WHI"/><ref name="pmid19116389"/> For example, a thorough review of clinical trials in the treatment of colds with small and large doses of Vitamin C have established that there is no evidence for its efficacy.<ref name="pmid17636648">{{cite journal |author=Douglas RM, Hemilä H, Chalker E, Treacy B |title=Vitamin C for preventing and treating the common cold |journal=Cochrane Database Syst Rev |volume= |issue=3 |pages=CD000980 |year=2007 |pmid=17636648 |doi=10.1002/14651858.CD000980.pub3 |url=}}</ref>
The effectiveness of various megavitamin therapies has been disputed by results of clinical trials, including about safety, definition and validation of efficacy.<ref name="WHI"/><ref name="pmid19116389"/> For example, some critics claim that there is no evidence that ingesting once a day supplements of 1 to 3 grams of Vitamin C is significant in treating the common cold for ordinary people. Reviews and re-examinations by Colchrane Collection author, Harri Hemilä, have meticulously documented that many previous "expert" statements on vitamin C have suffered from serious mathematical errors, selection bias, and misinterpretation,<ref name="Hemilä">Hemilä H. Univ. of Helsinki, Dissertation, Faculty of Medicine, Dept. of Public Health. 2006.</ref> and that even these infrequent, intermediate "megadoses", although much lower than the dosages recommended by vitamin C megavitamin advocates,<ref>, , accessed online 27 Feb 2008.</ref> do show statistically significant benefit. There has been more general agreement that such intermediate dosages may help some stressed or compromised subpopulations.<ref name="Hemilä"/> The orthomolecular advocates publish, and use, much higher, more frequent oral dose recommendations for vitamin C, in the 40 to 100+ grams per day range for treating ] and around 150 grams per day for flu.<ref> Cathcart RF, , ''Medical Hypotheses'', 7:1359-1376, 1981.</ref>


The term "megavitamin therapy" itself was criticized by opponents of ] in the early 1970s as misleading, because they believed the term falsely implied therapeutic benefit, because of still unresolved disputes over scientific rigor and efficacy for the early 1950s treatment of a carefully specified type of acute schizophrenia.<ref></ref><ref>Lipton M and others. Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Washington D.C., 1973, American Psychiatric Association.</ref><ref> In Reply To Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Canadian Schizophrenia Foundation. August 1976</ref> The term "megavitamin therapy" itself was criticized by opponents of ] in the early 1970s as misleading, because they believed the term falsely implied therapeutic benefit, because of still unresolved disputes over scientific rigor and efficacy for the early 1950s treatment of a carefully specified type of acute schizophrenia.<ref></ref><ref>Lipton M and others. Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Washington D.C., 1973, American Psychiatric Association.</ref><ref> In Reply To Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Canadian Schizophrenia Foundation. August 1976</ref>

Revision as of 17:00, 18 February 2009

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Megavitamin therapy is the use of large amounts of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat many types of diseases.

Frequently used in complementary and alternative medicine and orthomolecular medicine, megavitamin therapists also may employ nutrients such as dietary minerals, enzymes, amino acids, essential fatty acids, natural antioxidants, fermentable dietary fiber or short chain fatty acids.

Nutrients may be useful in preventing and treating some illnesses, but the conclusions of medical research are that the broad claims of disease treatment by advocates of orthomolecular medicine or megavitamin therapy are unsubstantiated by the available evidence. The American Medical Association stated in 1997 that "much of the dietary intervention stressed by alternative healers is prudent and reasonable", but described as a "myth" the idea that "most diseases are caused by faulty diets and can be prevented by nutritional interventions". Critics have described some aspects of orthomolecular medicine as food faddism or even quackery. Research on nutrient supplementation in general suggests that some nutritional supplements might be beneficial, and that others might be harmful; several specific nutritional therapies are associated with an increased likelihood of the condition they are meant to prevent. A recent study analyzing over 161,000 individuals (post-menopausal women) provided, in the words of the authors, "convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease, or total mortality in postmenopausal women".

History

In the 1930s and 1940s, some scientific and clinical evidence suggested that there might be beneficial uses of vitamins C, E and B-3 in large doses. Beginning in the 1930s, the Shutes in Canada developed a megadose vitamin E therapy for cardiovascular and circulatory complaints, naming it the "Shute protocol". Tentative experiments in the 1930s with larger doses of vitamin C were superseded by Fred R. Klenner's development of megadose intravenous vitamin C treatments in the 1940s. William Kaufman, MD, PhD, published articles in the 1940s that detailed his treatment of arthritis with frequent, high doses of niacinamide.

In 1954, Professor R. Altschul and Abram Hoffer, MD, PhD, applied large doses of the immediate release form of niacin (Vitamin B-3) to treat hypercholesterolemia (high cholesterol). The 1956 publication of Roger J. Williams Biochemical Individuality introduced concepts for individualized megavitamins and nutrients. In the 1960s, biochemist Irwin Stone, author of The Healing Factor, observed that vitamin C's utility in the megadose treatments of human disease parallels the amounts of vitamin C physiologically produced in most animals and postulated humans' evolutionary loss of this capability. Megavitamin therapies were also publicly advocated by Linus Pauling in the late 1960s.

Several orthomolecular megavitamin protocols have been publicized. While formal medical recognition of niacin therapy for hypercholesterolemia followed confirmation by William Parsons of the Mayo Clinic (1956) and the Canner study (1986), the success of several popular books since the 1980s has made the public more aware of niacin's role, in combination with other medications, for dyslipidemias (abnormal lipid levels in the blood). Pauling's advocacy of megadoses of vitamin C for colds, beginning in the 1960s, and later for cancer, made millions aware of the concept of megavitamin treatment in disease. Pauling's vitamin C recommendations are lower than some modern recommendations.

Other treatments include orthomolecular oral dosing schedules for an early treatment of colds, and for bowel tolerance for more established colds.

Usage of therapy

An American cottage industry in the late 20th century, the evolving megavitamin therapy are integrated with orthomolecular and naturopathic medicine. Although megavitamin therapy still largely remains outside of the structure of evidence-based medicine, they are increasingly used by patients, with or without the approval of their treating physicians. In the 21st century, proposed megavitamin therapies with vitamin C are being evaluated for their possible use in cancer, but clinical results have shown no effect on treating or reducing the risk of cancer.

Criticism

The effectiveness of various megavitamin therapies has been disputed by results of clinical trials, including about safety, definition and validation of efficacy. For example, a thorough review of clinical trials in the treatment of colds with small and large doses of Vitamin C have established that there is no evidence for its efficacy.

The term "megavitamin therapy" itself was criticized by opponents of orthomolecular psychiatry in the early 1970s as misleading, because they believed the term falsely implied therapeutic benefit, because of still unresolved disputes over scientific rigor and efficacy for the early 1950s treatment of a carefully specified type of acute schizophrenia.

Some megadose vitamin uses, often older pharmaceutical ones such as neonatal use of synthetic menadione, "a synthetic lipid soluble product which was once called vitamin K3", can cause toxicity. In the specific case of synthetic K3, large doses may cause hemolytic anemia, which occurs when the red blood cells die more quickly than the body can reproduce. In addition, K3 speeds liver damage, producing jaundice, deafness, and severe neurological problems, including retardation in infants. There is no record that the other two, natural series of Vitamin K, have produced toxic levels. The pharmaceutical synthetic, K3, is now banned in most countries for neonatal or general human use. These were previously conventional medical therapeutics, not orthomolecular type megavitamin treatments.

The United States Department of Agriculture establishes a maximum intake level for most vitamins, at which no adverse effects should occur including many infrequent or minor effects. These are part of the Tolerable upper intake level (UL) recommendations. Extremely high dose vitamin A for previous conventional pediatrics and dermatology practices, beyond orthomolecular therapy ranges, have been deprecated by some medical organizations of minor political units as ineffective and potentially toxic. Administration of very large doses of vitamin A, vitamin C, vitamin D, and pyridoxine (Vitamin B6) may have adverse side effects .

See also

Footnotes

  1. ^ "ACS : Orthomolecular Medicine". American Cancer Society. 2007-06-19. Retrieved 2008-04-04.
  2. Lakhan SE, Vieira KF (2008) Nutritional therapies for mental disorders. Nutr J 7: 2. doi:10.1186/1475-2891-7-2 PMID 18208598
  3. Stuart Aaronson et al. "Cancer Medicine", 2003, BC Decker Inc ISBN 1–55009–213–8, Section 20, p76
  4. Nutrition Committee, Canadian Paediatric Society (1990). "Megavitamin and megamineral therapy in childhood". CMAJ. 143 (10): 1009–1013. PMID 1699646. Retrieved 2008-04-04.
  5. Report 12 of the Council on Scientific Affairs: Alternative medicine American Medical Association June 1997, Accessed 21 March 2008
  6. Jarvis WT (1983). "Food faddism, cultism, and quackery". Annu. Rev. Nutr. 3: 35–52. doi:10.1146/annurev.nu.03.070183.000343. PMID 6315036.
  7. Jukes, T.H. (1990). "Nutrition Science from Vitamins to Molecular Biology". Annual Review of Nutrition. 10 (1): 1–20. doi:10.1146/annurev.nu.10.070190.000245. A short summary is in the journal's preface.
  8. Braganza, S.F. (2005). "Fad Therapies". Pediatrics in Review. 26 (10): 371–376. doi:10.1542/pir.26-10-371. PMID 16199591. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. "NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention". NIH Consens State Sci Statements. 23 (2): 1–30. 2006. PMID 17332802.
  10. Huang HY, Caballero B, Chang S; et al. (2006). "The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference". Ann. Intern. Med. 145 (5): 372–85. doi:10.1001/archinte.145.2.372. PMID 16880453. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C (2008). "Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases". Cochrane Database of Systematic Reviews (2): CD007176. doi:10.1002/14651858.CD007176.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. "Long-term Use of {beta}-Carotene, Retinol, Lycopene, and Lutein Supplements and Lung Cancer Risk: Results From the VITamins And Lifestyle (VITAL) Study". American Journal of Epidemiology. 2009. doi:10.1093/aje/kwn409. {{cite journal}}: Unknown parameter |authors= ignored (help)
  13. ^ Neuhouser ML, Wassertheil-Smoller S, Thomson C; et al. (2009). "Multivitamin use and risk of cancer and cardiovascular disease in the Women's Health Initiative cohorts". Arch. Intern. Med. 169 (3): 294–304. doi:10.1001/archinternmed.2008.540. PMID 19204221. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. VOGELSANG A, SHUTE E, SHUTE W (1948). "Some medical uses of vitamin E". Med World (New York). 161 (2): 83–9. PMID 18911314. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  15. Jungeblut, CW (1937). "VITAMIN C THERAPY AND PROPHYLAXIS IN EXPERIMENTAL POLIOMYELITIS". The Journal of Experimental Medicine. 65: 127–146.
  16. KLENNER FR (1949). "The treatment of poliomyelitis and other virus diseases with vitamin C". South Med Surg. 111 (7): 209–14. PMID 18147027. {{cite journal}}: Unknown parameter |month= ignored (help)
  17. KAUFMAN W (1953). "Niacinamide therapy for joint mobility; therapeutic reversal of a common clinical manifestation of the normal aging process". Conn State Med J. 17 (7): 584–9. PMID 13060032. {{cite journal}}: Unknown parameter |month= ignored (help)
  18. ALTSCHUL R, HOFFER A (1960). "The effect of nicotinic acid on hypercholesterolaemia". Can Med Assoc J. 82: 783–5. PMC 1938010. PMID 13792994. {{cite journal}}: Unknown parameter |month= ignored (help)
  19. Williams, Roger Lawrence (1998). Biochemical Individuality. New York: McGraw-Hill. ISBN 0-87983-893-0.
  20. Stone, Irwin (1982). The healing factor: "vitamin C" against disease. New York: Perigee Books. ISBN 0-399-50764-7.
  21. "Cancer Survival - Cancer Help". Retrieved 2009-02-18.
  22. Sanford M, Curran MP (2008). "Niacin extended-release/simvastatin". Drugs. 68 (16): 2373–86. PMID 18973399.
  23. "The Vitamin C Foundation - Cold Cure". Retrieved 2009-02-18.
  24. Cathcart RF (1981). "Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy". Med. Hypotheses. 7 (11): 1359–76. PMID 7321921. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE (2000). "Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology". J. Clin. Oncol. 18 (13): 2505–14. PMID 10893280. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  26. ^ Lin J, Cook NR, Albert C; et al. (2009). "Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial". J. Natl. Cancer Inst. 101 (1): 14–23. doi:10.1093/jnci/djn438. PMID 19116389. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  27. Douglas RM, Hemilä H, Chalker E, Treacy B (2007). "Vitamin C for preventing and treating the common cold". Cochrane Database Syst Rev (3): CD000980. doi:10.1002/14651858.CD000980.pub3. PMID 17636648.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  28. Orthomolecular Therapy
  29. Lipton M and others. Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Washington D.C., 1973, American Psychiatric Association.
  30. Megavitamin Therapy In Reply To Task Force Report on Megavitamin and Orthomolecular Therapy in Psychiatry. Canadian Schizophrenia Foundation. August 1976
  31. FDA, Environmental Assessment: Vitamin K Active Substances, Section 2.4.3.2. Animal Toxicity, "Phylloquinone and menaquinone are nontoxic to animals even when given in large doses. For example, mice receiving a single oral dose of 15-25 g phylloquinone/kg BW showed no adverse effects (Molitor and Robinson, 1940).
  32. DrugBank, Vitamin K3, University of Alberta
  33. Vitamin K, Innvista
  34. FDA, Environmental Assessment: Vitamin K Active Substances
  35. CA Burtis, ER Ashwood, DE Bruns (2005) Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, p. 1089, Elsevier-Saunders; 4th ed. ISBN 0721601898 "The use of high doses of naturally occurring vitamin K (K1 and K2) appears to have no untoward effect; however, menadione (K3) treatment can lead to the formation of erythrocyte cytoplasmic inclusions known as Heinz bodies and hemolytic anemia....As no adverse effects associated with vitamin K consumption from food or supplements have been reported in humans or animals, the U.S. Institute of Medicine has reported that a quantitative risk assessment cannot be performed, and thus a UL cannot be derived for vitamin K"
  36. Goodman & Gilman's The Pharmacological Basis of Therapeutics, 9th ed, Ch 63.
  37. "Vitamin Therapy, Megadose / Orthomolecular Therapy" British Columbia Provincial Health Services Authority 2000
  38. Penniston KL, Tanumihardjo SA (2006) The acute and chronic toxic effects of vitamin A. Am J Clin Nutr. 83:191-201. PMID: 16469975

References

  • Abram Hoffer (1998) Putting It All Together: The New Orthomolecular Nutrition, McGraw-Hill, ISBN 0-87983-633-4
  • Pauling, Linus (1986) How to Live Longer and Feel Better, W. H. Freeman and Company, ISBN 0-380-70289-4
  • Roger J. Williams, Dwight K. Kalita (1979) Physician's Handbook on Orthomolecular Medicine, Keats Publishing, ISBN 0-87983-199-5
  • Roger J Williams (1998) Biochemical Individuality: The Basis for the Genetotrophic Concept. 2nd ed. Keats Publishing. ISBN 0-87983-893-0
  • Canner, P.L., Berge, K.G., Wenger, N.K., et al. Fifteen year mortality in Coronary Drug Project patients: long-term benefit with niacin. J Am Coll Cardiol, 1986, 8: 1245-1255.
  • Meyers, et al, Varying Cost and Free Nicotinic Acid Content in Over-the-Counter Niacin Preparations for Dyslipidemia, Annals of Internal Med. 2003 Dec 16;139(12):996-1002
  • Guyton, J. R., Blazing, M.A., Hagar, J., et al. Extended-release niacin vs Gemfibrozil for the treatment of low levels of high density lipoprotein cholesterol. Arch Intern Med, 2000, 160: 1177-1184.
  • Kamanna, V.S., Kashyap, M.L., Mechanism of Action of Niacin on Lipoprotein Metabolism, Current Atherosclerosis Reports 2000, 2:36-46
  • Heady JA, Morris JN, Oliver MF. WHO clofibrate/cholesterol trial: clarifications. Lancet 1992; 340: 1405-1406.
  • Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med 1987; 317: 1237-1245.
  • Irwin Stone (1972) The Healing Factor: Vitamin C Against Disease, GD/Perigee Books (Putnam Pub) ISBN 0-399-50764-7

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