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Orthomolecular Medicine

By Steven Novella, MD, Assistant Professor of Neurology, Yale University School of Medicine

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Patient Education

Orthomolecular medicine, also called nutritional medicine, is a biologically based practice. It aims to provide the body with optimal amounts of substances that naturally occur in the body (eg, hormones, vitamins) as a way to treat disease and promote wellness. Nutrition is the focus in diagnosis and treatment.

This therapy differs from diet therapy because it uses supradietary doses of individual micronutrients. High doses of vitamins, minerals, enzymes, hormones (eg, melatonin), amino acids, or various combinations may be used. Practitioners believe that people’s nutritional needs far exceed the recommended daily allowances and that nutritional therapy must be individualized based on each patient’s medical profile. High doses of micronutrients are also used as biologic response modifiers in an attempt to modulate inflammation and other disease processes. Doses may be administered orally or, far less often, intravenously.

Evidence and Uses

Treatment claims include benefit for a wide range of disorders (eg, cancer, cardiovascular disease, chronic fatigue, chronic pain, autism, psychiatric disorders). These treatments are widely used, and many patients report clinical improvement. However, no clinical study data support the usefulness of most of these practices. Exceptions include use of high-dose fish oil to treat hypertriglyceridemia (and possibly inflammatory and mood disorders); however, high doses of fish oil have been linked to increased risk of prostate cancer.

Preliminary evidence supported use of high-dose antioxidants to prevent macular degeneration, but later studies found no benefit. In addition, high doses of antioxidants may increase cardiovascular risk.

Preliminary studies of high-dose melatonin for the prevention or treatment cancer have had mixed results; further study is necessary.

If sufficient evidence of usefulness is shown, treatments (eg, high-dose fish oils to treat hypertriglyceridemia) become part of conventional medicine.

Possible Adverse Effects

Clinicians should be aware that high-dose micronutrients may cause harm; eg, some micronutrients may increase the risk of developing prostate cancer or blunt the effects of certain cancer treatments.