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Megavitamin therapy

Megavitamin therapy is the use of large doses of vitamins, often many times greater than the recommended dietary allowance (RDA) in the attempt to prevent or treat diseases. It is typically used in complementary and alternative medicine by practitioners who call their approach "orthomolecular medicine", but also used in mainstream medicine for "exceedingly rare" genetic conditions which respond to megadoses of vitamins.[1] In 2002, a review of these conditions identified about 50 which respond to "high-dose vitamin therapy".[2] Further understanding of these conditions is expected to play a part in the emerging field of nutrigenomics.[3]

Nutrients may be useful in preventing and treating some illnesses,[4] but the conclusions of medical research are that the broad claims of disease treatment by advocates of megavitamin therapy are unsubstantiated by the available evidence.[4][5][6] Critics have described some aspects of orthomolecular medicine as food faddism or even quackery.[7][8][9] Research on nutrient supplementation in general suggests that some nutritional supplements might be beneficial, and that others might be harmful;[10][11][12] several specific nutritional therapies are associated with an increased likelihood of the condition they are meant to prevent.[13]


[edit] Multivitamin vs megavitamin

Megavitamin therapy must be distinguished from the usual 'vitamin supplementation' approach of traditional multivitamin pills. Megavitamin doses are far higher, orders of magnitude higher than the levels of vitamins ordinarily available through western diets. Multivitamin supplementation has been demonstrated to have negligable effect in treating cancer. A study of 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".[14] However, this evidence against use of multivitamin does not appear to have any implication for megavitamin dose therapy.

[edit] History

In the 1930s and 1940s, some scientific and clinical evidence suggested that there might be beneficial uses of vitamins C, E and B3 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".[15] Tentative experiments in the 1930s[16] with larger doses of vitamin C were superseded by Fred R. Klenner's development of megadose intravenous vitamin C treatments in the 1940s.[17] William Kaufman published articles in the 1940s that detailed his treatment of arthritis with frequent, high doses of niacinamide.[18]

In 1954, R. Altschul and Abram Hoffer applied large doses of the immediate release form of niacin (Vitamin B-3) to treat hypercholesterolemia (high cholesterol).[19] The 1956 publication of Roger J. Williams Biochemical Individuality introduced concepts for individualized megavitamins and nutrients.[20] 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.[21]

Several orthomolecular megavitamin protocols have been publicized.[22] 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).[23] 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.[24]

Other treatments include orthomolecular oral dosing schedules for an early treatment of colds,[25] and for bowel tolerance for more established colds.[26]

[edit] 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.[27] In the 21st century, proposed megavitamin therapies with vitamin C are being evaluated for their possible use in cancer. Clinical results from one trial evaluating use of vitamins not in the megavitamin dose range have shown no effect on treating or reducing the risk of cancer.[28] However analysis of historical data has indicated suprisingly promising results when using megavitamin doses, when combining a variety of vitamins, but with improved outcomes frequent even when supplementing only vitamin C. [1]

In 2008 researchers established that higher vitamin C intake reduces serum uric acid levels, and is associated with lower incidence of gout. The effect is more pronounced as intake increases into the megavitamin range [29]

[edit] Criticism

The proposed efficacy of various megavitamin therapies has been contradicted by results of some clinical trials, but since this study was not a megavitamin regime, the relevance seems lacking.[28] For example, a review of clinical trials in the treatment of colds with small and large doses of Vitamin C has established that there is no evidence for its efficacy.[30]

Toxic effects of high doses of vitamin A,[31] and vitamin D[31] are well-established. Some vitamins such as vitamin B12 have no recommended maximum dosage, or tolerable upper intake level. A 1986 article argued that although "it is not known whether maintaining a prolonged high level of vitamin B12 is harmful", megadoses of vitamin B12 should not be used in dialysis patients because there are no "demonstrable benefits" and a possible risk of toxicity based on epidemiological and animal evidence.[32] In 1998 the group which set the U.S. Dietary Reference Intakes stated that "there appear to be no risks associated with intakes of supplemental B12 that are more than two orders of magnitude higher than the ninety-fifth percentile of intake".[33]

[edit] See also

[edit] References

  1. ^ Menolascino FJ, Donaldson JY, Gallagher TF, Golden CJ, Wilson JE (1988). "Orthomolecular therapy: its history and applicability to psychiatric disorders". Child Psychiatry Hum Dev 18 (3): 133'50. doi:10.1007/BF00709727. PMID 2898324. 
  2. ^ Ames BN, Elson-Schwab I, Silver EA (April 2002). "High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms". Am. J. Clin. Nutr. 75 (4): 616'58. PMID 11916749. http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=11916749. 
  3. ^ Kaput J, Rodriguez RL (January 2004). "Nutritional genomics: the next frontier in the postgenomic era". Physiol. Genomics 16 (2): 166'77. doi:10.1152/physiolgenomics.00107.2003. PMID 14726599. 
  4. ^ a b "ACS : Orthomolecular Medicine". American Cancer Society. 2007-06-19. http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Orthomolecular_Medicine.asp?sitearea=ETO. Retrieved 2008-04-04. 
  5. ^ Aaronson S et al. (2003). "Cancer medicine". Cancer medicine 6 (Frei, Emil; Kufe, Donald W.; Holland, James F., eds). Hamilton, Ont: BC Decker. pp. 76. ISBN 1-55009-213-8. 
  6. ^ Nutrition Committee, Canadian Paediatric Society (1 January 1990). "Megavitamin and megamineral therapy in childhood". CMAJ 143 (10): 1009'1013. PMID 1699646. PMC 1452516. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1452516. Retrieved 2008-04-04. 
  7. ^ Jarvis WT (1983). "Food faddism, cultism, and quackery". Annu. Rev. Nutr. 3: 35'52. doi:10.1146/annurev.nu.03.070183.000343. PMID 6315036. 
  8. ^ 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. PMID 2200458.  A short summary is in the journal's preface.
  9. ^ Braganza, S.F.; Ozuah, P.O. (2005). "Fad Therapies". Pediatrics in Review 26 (10): 371'376. doi:10.1542/pir.26-10-371. PMID 16199591. 
  10. ^ "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. http://consensus.nih.gov/2006/2006MultivitaminMineralSOS028main.htm. 
  11. ^ Huang HY, Caballero B, Chang S, et al. (September 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. http://www.annals.org/cgi/pmidlookup?view=reprint&pmid=16880453. 
  12. ^ 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. PMID 18425980. 
  13. ^ Satia JA, Littman A, Slatore CG, Galanko JA, White E (2009). "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. doi:10.1093/aje/kwn409. 
  14. ^ Neuhouser ML, Wassertheil-Smoller S, Thomson C, et al. (February 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. 
  15. ^ VOGELSANG A, SHUTE E, SHUTE W (February 1948). "Some medical uses of vitamin E". Med World (New York) 161 (2): 83'9. PMID 18911314. 
  16. ^ Jungeblut, CW (1937). "VITAMIN C THERAPY AND PROPHYLAXIS IN EXPERIMENTAL POLIOMYELITIS". The Journal of Experimental Medicine 65 (1): 127'146. doi:10.1084/jem.65.1.127. PMID 19870585. PMC 2133474. http://jem.rupress.org/cgi/content/abstract/65/1/127. 
  17. ^ KLENNER FR (July 1949). "The treatment of poliomyelitis and other virus diseases with vitamin C". South Med Surg 111 (7): 209'14. PMID 18147027. 
  18. ^ KAUFMAN W (July 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. 
  19. ^ ALTSCHUL R, HOFFER A (April 1960). "The effect of nicotinic acid on hypercholesterolaemia". Can Med Assoc J 82: 783'5. PMID 13792994. 
  20. ^ Williams, Roger Lawrence (1998). Biochemical Individuality. New York: McGraw-Hill. ISBN 0-87983-893-0. 
  21. ^ Stone, Irwin (1982). The healing factor: "vitamin C" against disease. New York: Perigee Books. ISBN 0-399-50764-7. 
  22. ^ "Cancer Survival - Cancer Help". http://www.cancersurvival.com/help_pauling.html. Retrieved 2009-02-18. 
  23. ^ Sanford M, Curran MP (2008). "Niacin extended-release/simvastatin". Drugs 68 (16): 2373'86. doi:10.2165/0003495-200868160-00008. PMID 18973399. 
  24. ^ Pauling L (April 1971). "Vitamin C and common cold". JAMA 216 (2): 332. doi:10.1001/jama.216.2.332b. PMID 5107925. 
  25. ^ "The Vitamin C Foundation - Cold Cure". http://www.vitamincfoundation.org/surefire.htm. Retrieved 2009-02-18. 
  26. ^ Cathcart RF (November 1981). "Vitamin C, titrating to bowel tolerance, anascorbemia, and acute induced scurvy" ([dead link]). Med. Hypotheses 7 (11): 1359'76. doi:10.1016/0306-9877(81)90126-2. PMID 7321921. http://linkinghub.elsevier.com/retrieve/pii/0306-9877(81)90126-2. 
  27. ^ Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE (July 2000). "Complementary/alternative medicine use in a comprehensive cancer center and the implications for oncology". J. Clin. Oncol. 18 (13): 2505'14. PMID 10893280. http://jco.ascopubs.org/cgi/content/full/18/13/2505. 
  28. ^ a b Lin J, Cook NR, Albert C, et al. (January 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. 
  29. ^ Choi, MD, DrPH, Hyon K.; Xiang Gao, MD, PhD; Gary Curhan, MD, ScD (March 9, 2009). "Vitamin C Intake and the Risk of Gout in Men". Archives of Internal Medicine. 169 (5): 502'507. doi:10.1001/archinternmed.2008.606. PMID 19273781. PMC 2767211. http://archinte.ama-assn.org/cgi/content/abstract/169/5/502. 
  30. ^ 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. 
  31. ^ a b Snodgrass SR (1992). "Vitamin neurotoxicity". Mol. Neurobiol. 6 (1): 41'73. doi:10.1007/BF02935566. PMID 1463588. 
  32. ^ Mangiarotti G, Canavese C, Salomone M, et al. (November 1986). "Hypervitaminosis B12 in maintenance hemodialysis patients receiving massive supplementation of vitamin B12". Int J Artif Organs 9 (6): 417'20. PMID 3818116. 
  33. ^ Food and Nutrition Board, Institute of Medicine. (1998). Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline, p. 347. National Academies Press.

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