In 1995, it is estimated that our national sickness care system will account for more than 1.3 trillion dollars of our money. That's more than we spend on defense, housing, food, and education combined. The problem is that we are not seeing major breakthroughs, cures, or even successful prevention programs for any of the serious diseases. We hear a great deal about cancer, AIDS, heart disease, and arthritis. But the largest single disorder group in America is mental illness.

It is estimated by the National Institute of Mental Health that more than 40 million Americans are affected by any one of a number of mental and emotional conditions that adversely affect the quality of their lives. These include depression,schizophrenia, bipolar disorder, dementia, and autism, as well as other conditions, which,while they may not fall strictly under the rubric of "mental illness," have a mental component, e.g., fatigue, insomnia, learning disabilities, attention deficit disorder, eating disorders, PMS, alcoholism, and aggressive behavior. When you consider that probably an additional 50 million people suffer from intermittent bouts of any number of these conditions, then you can see that close to one third of the entire American population is personally grappling with mental health concerns.

Yet despite the extent of mental disorders, the American medical establishment has paid little attention to causes, as opposed to symptomatic relief. Take alcoholism, for instance. There are dozens of studies showing that alcoholics are chronically deficient in certain essential nutrients. Other studies show that when these nutrients are given at optimal levels, the chemical imbalances that precipitate the craving for alcohol are diminished or eliminated, thus biochemically breaking the addictive response. One would think that we would pick up on the ramifications of this in terms of treatment. But we're not. Currently, 185 billion dollars are being spent yearly on drug and alcohol treatments, of which only 25 percent have been shown to be successful.We need to look at the fact that when biochemical imbalances are corrected and chemical sensitivities addressed, there is a success rate of nearly 85 percent, with a lack of relapse. This is the kind of cause- and prevention-oriented approach we should be encouraging, for alcoholism and other problems.

It is in an attempt to help encourage such an approach that I put together this book. In it, numerous clinicians explore their experience in dealing with various mental conditions, and patients describe their experience as well. I've interviewed nearly500 individuals in depth--psychiatrists, psychologists, behaviorists,neuropsychoimmunologists, and environmental medicine experts, among others. Some of these people have particular areas of specialization, such as autism, alcoholism, or fatigue. By the way, fatigue, or lack of energy, is a condition that probably affects more people and yet receives less attention than any other. Fatigue--not just chronic fatigue syndrome,but simple fatigue--affects peoples' attitudes and behavior, and is a common factor in depression, bipolar disorder, and insomnia.

After interviewing the experts in a variety of fields, it was remarkable to see how many used similar treatment modalities--treatment with vitamin C or the B Complex vitamins, for example--and to see also that their therapeutic approaches had certain elements in common, such as the cleansing of the body of toxins through diet, and the rebalancing of the body through the use of herbs, botanicals, nutrients, and diet. It should be noted that all of the treatment modalities mentioned in the following material have been proven successful.

In addition to interviewing hundreds of clinicians--and getting input from over 3000 patients--I've reviewed thousands of articles and abstracts in scientific peer-reviewed journals in preparing this material. I've included summaries of some of these articles in an appendix to this book so that interested readers can see that, yes,we do have a scientific basis when we claim that nutritional deficiencies play a role in precipitating the biochemical imbalances that lead to a variety of conditions, and that,yes, nutritional treatment does have scientifically shown value in alleviating these conditions.

Concerning the scientific literature, we have an interesting phenomenon in America today. We have tens of thousands of articles in peer-reviewed journals clearly demonstrating that nutrition will affect either the cause or treatment--or the prevention--of different diseases. It is estimated that up to 90 percent of all diseases could be eliminated if we understood the role that nutrition plays. Now that we have the evidence, the question is, why have the medical community, the educational community, and the media not advocated that we implement it?

One of the problems is that once a physician has been trained in a particular area of specialization in a particular way, for that physician to relinquish his or her mind set and embrace a new paradigm of knowledge is not an easy process. Even with the best of intentions for their patients' well-being, doctors will continue to use modalities that have been outmoded, or that have been shown to be of no benefit, or that are actually harmful. Examples abound: radical mastectomies, hysterectomies, cesarean operations, coronary bypass operations, electroconvulsive therapy, and Thorazine. All have been associated with devastating side effects, high mortality rates, and chronic abuses,and yet there are nontoxic, successful alternatives for all of these that are being ignored, even though the science is there to more than justify the change in treatment modality.

We must also consider the power and influence of the pharmaceutical industry and of the various medical technology industries. These would stand to lose a substantial part of that trillion dollars a year, year in and year out, if the public changed its perspective on the nature of acceptable treatment and began demanding nontoxic therapies.

Despite the forces tending toward the maintenance of the medical status quo, there are changes happening. There are some physicians--albeit a relative handful out of the 600,000 in the U.S.--who are using the therapies referred to in this book. These physicians are in the vanguard of revolutionizing American health care. There is also a growing segment of the public becoming aware of these nontoxic therapies.

This book will, I hope, greatly enlarge that segment. It was written with the idea of helping to ease the enormous mental health costs, both economic and personal, in this country today.

The answers are here. It's a matter of implementation, which requires a diligent media community, a focused legislative process, and a committed medical community, working in unison to see that these are given proper attention.

ORTHOMOLECULAR PSYCHIATRY AND CLINICAL ECOLOGY
IN THE TREATMENT OF MENTAL CONDITIONS:
FOUR DOCTORS' OVERVIEWS

DR. MICHAEL SCHACTER

The major difference between the way I look at patients psychiatrically and the way my colleagues do is that I explore possible imbalances in the body that could be caused by nutritional and other environmental nonpsychosocial factors that can play areole in the development of psychological symptoms. Now I don't entirely disregard the psychosocial aspect, meaning interpersonal relationships and so on. Most psychiatrists will tend to either look at the psychosocial factors or to consider the possibility of an imbalance in the brain. In the latter case, they then immediately resort to using some kind of drug to try to right the balance, without looking into the possibility that there could be nutritional factors contributing to the patient's psychological state. For instance, they don't bother inquiring how much sugar a person is eating, or how much coffee someone is drinking. They do look at alcohol consumption, especially if it's excessive, but most psychiatrists are unaware that sometimes even small amounts can be a problem.

Whenever possible, I tend to use nutritional substances or substances that are natural to the body, either food substances or accessory food factors--such as vitamins or minerals or amino acids--to treat a person's mental disorder. Sometimes the vitamins may be megadoses because a person may be what we call vitamin-dependent on a particular nutrient. For example, some children who are hyperactive or having learning disorders will respond to one vitamin, for instance vitamin B1 (thiamine), and actually might get worse if you give them large doses of vitamin B6. So treatment really has to be individualized. I try to find what seems to be most effective for a particular child's or adult's condition.

I look at the clinical ecological factors: the factors in a person's environment--the foods they eat, the water they drink, the air they breathe, the imbalances in the body, as well as their habits. For example, I check for hormonal imbalances or subtle low-thyroid conditions, which are very common in depression. If these are treated, there will often be marked improvement in depression. Calcium and magnesium deficiencies are very common as precipitators for anxiety in general or even panic attacks.By correcting some of these nutrient imbalances, you can reduce tremendously the chances of a person having panic attacks. Then, if everything else is not sufficient to bring about improvement, I would use psychotropic drugs if I had to, but I would try to keep them at the lowest possible dose and I would use nutrients and other dietary supplements to minimize the side effects.

DR. ABRAM HOFFER

The term "orthomolecular" was developed by Dr. Linus Pauling in his paper in Science in 1968. It was based upon his recognition that certain vitamins are effective when they are used in large quantities.

The problem was that for many years it was considered that the only role vitamins played was to prevent certain things. The old model was that you used vitamins only for prevention. You required tiny amounts and you only needed them for the prevention of deficiency diseases, like scurvy or beriberi. A nutritionist accepted the fact that if you had scurvy you would eat oranges or you would take small quantities of vitamin C. It was unheard of to give someone a thousand mg of vitamin C. If you suggested this they would throw up their hands in horror.

The idea that you could use large quantities of vitamins to treat conditions, not just to prevent them, was a major step forward. In fact, it is considered a major paradigm change.

In 1955, my colleagues and I published a paper in which we showed that nicotinic acid lowered cholesterol levels but that you had to give 3000 mg per day. This was a major step forward because it proved that you sometimes needed large amounts of a vitamin for a condition not known to be a vitamin deficiency disease. High blood cholesterol was not known to be a vitamin deficiency disease.

This was the beginning of the modern paradigm, which is that in certain cases you need large quantities of vitamins to treat conditions that are not assumed to be vitamin deficiencies. For example, in a recent Harvard study, over 100,000 subjects were given vitamin E. The study found a 40-percent reduction in their coronary rate. No one looks upon coronary disease as a vitamin deficiency and yet substantial quantities of vitamin E--they used 100 I.U. a day--are very effective. So we are now in a paradigm in which we use vitamins as treatment, not just as prevention.

Orthomolecular psychiatry and medicine was the first major movement to adopt this treatment paradigm. What it means is that when we have a sick patient, we correct their diet. This is vital. I don't talk to any patient until we have spent sometime on their diet. We also use any drugs that have to be used. If I have a schizophrenic patient I will use tranquilizers; if I have a depressed patient I will use antidepressants; if they're epileptic I'll use anticonvulsants; if they're suffering an din a lot of pain, I'll use analgesics.

But that's not all. In addition to that we use the appropriate nutrients. It can be any one of the 20 or 30 nutrients currently in use. We combine the mall. When the patient begins to respond, we gradually withdraw the drugs until we are able to maintain them on the nutrients alone or on such a tiny amount that it doesn't interfere with their ability to function.

Orthomolecular medicine is the appropriate use of molecules, nutrients,which are native to the body in the appropriate concentration at the appropriate time.

I don't like the term "alternative." I think, rather, that we are going back to our historical roots. If you go back 100 years we had no treatment except nutritional treatment. For 2000 years the best doctors in the world always emphasized good nutrition, but over the past hundred years nutrition suddenly disappeared from medicine. We're just bringing it back again.

Not just us. I'm delighted to say that the whole field of medicine is moving very, very quickly in this direction. If you've seen The Wellness Letter from Berkeley lately there is a tremendous change in their attitude from a couple of years ago when they were totally against vitamins. Now they're extolling them to the skies. This is a fantastic change. I consider that we are the mainstream of medicine, even though most doctors don't yet recognize it.

I must admit that my colleagues in psychiatry are still ten years out of date. I think it's the natural conservatism of the profession combined with the fact that they have had the least training in biochemistry and physiology of all physicians and that they are the least likely to look upon the body as a physiological organism. They look upon psychosocial problems as primary when, in fact, in many cases they are secondary.

I think also that the American psychiatric establishment-- including the Canadian, and including the National Institutes of Mental Health--has taken a very strong position against the use of vitamins in psychiatry and they still haven't been able to change their view, again, I think, because they're slow learners.

DR. GARY VICKER

A Look at Psychiatric Disorders

Schizophrenia

Schizophrenia is a group of illnesses of unknown cause that have as their common features disorders of perception and emotion. Schizophrenic illnesses are classified, according to common terminology, as paranoid or nonparanoid, and they are termed either chronic or acute.

The new research that's being done suggests that there are, in fact,differences in prognosis, in part related to the shape of the brain itself, the age at onset, and complicating factors relating to co-existing drug abuse and other conditions. Clearly, schizophrenic illnesses are a group of the most serious biochemical disorders there are; it can be said that schizophrenia is to psychiatry what cancers are to general medicine. The bulk of the lost revenue to society, the bulk of psychiatric expenses, and the sheer horror to the families are unfortunately all consequences associated with the diagnosis of schizophrenia.

The most disturbing part of schizophrenia is the disturbance of thought. These are patients who may have vague symptoms, who go through periods in the old classical style of stage fright, and then something happens and they start to believe that their disordered perceptions represent them. The disordered perceptions are called delusions; they are simply fixed, false beliefs. Patients will start to believe their delusions and then start to believe their misinterpretation of a perceptual nature. They may hear a voice and believe that the voice is real and represents some real event or real person. They'll act on that. An example would be, if I hear somebody calling my name, if I don't think it's my thought anymore but that there really is somebody calling my name, I will act accordingly. If I think that people are looking at me and making faces, I might think there is something very wrong about me and feel bad or upset about it. If I'm eating my meal and there's a piece of moldy cheese, I might think I've been poisoned and that someone did it to me. The process starts to escalate and snowball.

The most diabolical part of the illness is the loss of insight, the ability to test. For instance, if you're driving down the street at night and it's dark and hard to see, and you see something at the side of the road, you might slow down to be cautious, thinking that somebody is going to cross the street. Then you get close enough and see that it's really just shrubs or a mailbox or just part of the normal landscape,and you say, I'm glad I was cautious. If, however, you start to distort that and really believe that there's someone who might jump out on the road or that somebody is trying to hurt you and can get in the way of your vehicle, you might take evasive action. In the process, you can have an accident or cause somebody else to have one. You start to distort things without realizing that you are distorting them. That's the really disastrous part of the illness.

When you become paranoid and don't know why, you begin to wonder, what is it about you that's so bad? Why are people saying bad things about you? It can become very serious. I had a patient who believed that then President Reagan was making comments about him--about this individual--and he felt compelled to call the White House and protest to the FBI that he was being hounded by President Reagan. He firmly believed that.When he got better he didn't believe that but when he got delusional be believed that President Reagan was, in fact, interfering with his life. It can become all-consuming and unfortunately very painful.

Bipolar Disorders

Bipolar disorders are the illnesses that are commonly known as mood disorders, or affective disorders. Bipolar disease is a term that refers to an illness that has a manic component and a depressed component. If we want to look at mood disorders as a group, which I think is a better way to do it, we're again talking about diseases of unknown etiology characterized by recurrences of disturbed mood.

If the mood is one of agitation or elevation of mood, one calls that hypomanic or, at the most extreme, manic. Manic individuals are those whose moods are elevated, with, typically, accompanying disorders of energy and enthusiasm.

The opposite pull, which is where this term of polarity comes in, is that of the depressed mood. Here, there's slowness of thinking, a lowness of mood, a slowness of motor activity. Of course, there are people whose mood disorders consist of simply one pull, that is, they have recurrent depressive disorders.

The primary problem associated with the mood disorder is exactly what it says: There is a problem with mood. Along with that come other features: e.g., people who have depressed moods will also very often end up having slowdowns in body functions, such as disturbances in sleep and appetite for food, sex, and pleasurable pursuits. Depressed people often find that food doesn't taste as good as it did. They lose their ability to enjoy pleasurable activities, whether these are sports, hobbies, or sexual activity.

With depression there's an overwhelmingly painful, heavy, loss of sense of the ability to function in the world, a sense of uselessness about oneself. The danger,of course, is that people may become so overwhelmed that they think their lives are not worth living or that others think that their lives are not worth living. In the worst case, someone will lose perspective and think that the world is so terrible that their loved ones shouldn't live. Then you have the specter of the potential homicidal/suicidal activities.

There are illnesses that fall under the rubric of mood disorders that don't have a manic component. These are recurrent depressions. There are more incidences of mood disorders, especially depressive disorders, than schizophrenic disorders. Recurrent depressions certainly occur frequently. Depression is a very serious illness and a very insidious one in which people lose their perspective on themselves and their views of where they fit into the world.

At the opposite end of depression is what I consider a hypomanic state. Nowadays you don't get people so sick that they become truly manic. But they can become excessively elevated in their moods. They become more expansive. They might go on spending sprees and spend money they don't have or get involved in activities that they truly are not qualified for. They may run up charge cards, or get involved in gambling, financial affairs, extramarital affairs, alcohol, or possibly drug abuse that they would not otherwise be doing. It becomes almost the opposite end of the depression spectrum--they need less sleep, they need less food, and everything is very intense. It can become rather horrific because people can become exhausted. They're sleeping two or three hours a day,if that. They may be getting by on a cup of coffee and a soda and cigarettes. At the same time they have this overwhelming sense of omnipotence about themselves and their abilities. So it can be a very, very dangerous period of time.

It can also be a period when, instead of being overly expansive, people become overly suspicious. They become paranoid. The opposite side of paranoia is not just the persecutory but the grandiose. If the grandiose fails, they become persecutory. They become irritable, angry, and upset at other people who are getting in the way of the wonderful achievements they have to offer the world.

Schizo-affective Disorders

Somewhere in between schizophrenia and mood disorders--and I don't think the research scientists have really come to a conclusion on this yet--are those illnesses that are known as schizo-affective disorders. They seem to have an equal part of a schizophrenic component and a mood component. You start to make fine-line distinctions when you take family histories to learn about what other family members have.

Tardive Dyskinesia

Tardive dyskinesia is a neurological condition which, as its name implies, if one of late onset, that is, tardive. Dyskinesia refers to abnormal movement. Tardive dyskinesia refers to the abnormal neurological movements that occur after a patient has spent a period of time on certain kinds of medicines. When the medicine is reduced or eliminated, the patient starts to demonstrate these abnormal movements. The movements typically involve disturbances around the mouth, the face--involuntary blinking,smacking of lips, twitching around the face. They can occur at varying levels.

It used to be said tardive dyskinesia was untreatable, but that certainly is not true now.

If you want more of a precise overview of psychiatric classifications you can refer to the American Psychiatric Association publication called DSM4,Diagnostic Criteria , which gives a breakdown of all the psychiatric disorders.

The Name of the Game is Getting Better: A Combination of Approaches

If you do nothing at all to the individuals who have these illnesses they will clearly get worse, except for those with depressive disorders, although we don't know when they will remit. It may take years. Depressed people can suffer for years and then the illness will spontaneously go away. Well, you don't do that to people. It's inhumane and I think wrong. Clearly you have to do something.

Doctors have a tendency to close their minds to anything other than what they read in their literature. So I think if you have some material referring to the diagnostic qualifications and some of the terminology that most physicians are familiar with and will accept, then that gives them a framework within which to look at the problem. I think that if we're trying to educate the public, we want to educate them not only about where to get the health care, but also about how to go about it in such a way that they don't alienate the people that they really want to help them. Why not say, "This is our understanding of what the illness is. This is what the APA says. This is what the traditionalists say. Is there something we can do in addition to treat this illness that would not be so out of your realm of expertise that you would oppose it? We want your help. We want to deal with it."

The name of the game is getting better. You can't make people want to treat you if you come at them and say, "You guys are all wrong. You don't know what you're doing." Doctors want to be helpful, but how you approach them is important.

Medicines have not been perfect. But without medicines, things are often worse. So let's assume we have to look at the role of medications up to a point. I think you have to have a framework. I think it's important not to become so radical that you say that medicines are no good; they're dangerous all the time and inherently bad. That's not true. Medicines are not always bad any more than nutritional supplements are always good,because people can be harmed from inappropriately using nutritional supplements,especially herbs that have pharmacological effects in certain doses.

I don't oppose the use of medications, but I do think there is a time when you have to look at reducing medication when you start to see some benefit and perhaps enhancing the benefit of the medicine by the addition of vitamin and other supplements.

Test and Treatment Protocols

My evaluations include making sure that the patients have thorough physical examinations. There are standard blood tests that are done by every doctor. They involve tests of the ability to produce blood cells, and screens for liver function,kidney function, and so on. I test rather routinely for thyroid functioning because it's not at all uncommon to pick up a low thyroid as a cause of depression.

I don't do a lot of the fancy allergic testing. I do try to get six-hour glucose tolerance on my patients if they'll cooperate. If they won't cooperate or if it's an issue where they simply refuse to consider that, I do instruct them on proper diet--eliminating sugar, caffeine, and a lot of the empty-calorie foods. And of course I discourage smoking and alcohol, but those are pretty fundamental things that every doctor should be doing.

People who are mentally ill don't usually eat well. I think it's very difficult to bring anyone into any level of appropriate well-being when they're not healthy. If they're low in folic acid and B12 then they're not able to produce blood cells that are necessary to carry the nutrients to the different parts of the body.

I have a lot of patients who are hospitalized and very sick. I have to work from the standpoint of what is going to work the fastest. And the fastest approach is going to be the use of antipsychotics at first. Once they start to stabilize and get better I might want to encourage them to go for additional treatment elsewhere if they have food-related problems or allergies or other things because I don't personally treat that.

Schizophrenia

I think in any chronic illness, such as schizophrenia, you have to maximize the person's whole functioning. You want to make them as healthy as possible. You don't want to have an imbalance where your left arm is really maximally in shape because you're a pitcher but the rest of you is flab. You have to have the whole organism as healthy as possible.

If, in fact, people have abnormal thinking because of deficiencies ofB12, maybe they have a lack of an enzyme in their stomach that doesn't carry out the necessary conversion of B12 into what the body needs. These people have a disease called pernicious anemia that can result in their becoming paranoid. Once in awhile you'll find a person who lacks this thing called intrinsic factor. You have to give B12 supplements to prevent them from becoming paranoid and from developing nervous system signs and symptoms and gait disturbances. With B12 they get better. So there are simple things that can be done that we lose track of in this modern age.

I do B12 and folic acid evaluations increasingly. In fact, nowadays,there's more evidence that these should be looked at, particularly in the potential HIV population. Those patients at risk for HIV and those people who end up with HIV infections may be low on B12.

I check for magnesium levels in all my patients, especially adolescents who drink a lot of soda pop. I also do zinc, copper, and manganese levels because there is some evidence that low manganese is implicated in tardive Dyskinesia. A low magnesium level is implicated in irritability, nervousness, even nerve conduction problems and seizures. The worse-case scenario is a premenopausal woman who just had a baby on birth control pills and then gets prenatal vitamins and goes back on the pill after the baby is born. She'll have sky-high copper levels, almost toxic relative to zinc.

With the schizophrenic patient I use niacinamide or niacin (more frequently niacinamide because most patients won't tolerate niacin). I tend to use much of what Abram Hoffer has come up with. I look for a minimum of 3000 mg of niacinamide a day with an equal amount of C. I recommend a B complex with 50 to 150 mg of the entire B Complex, mineral balance, depending upon zinc and copper levels. We try to titrate a dose until we reach a level of improvement with the least amount of medicine and the amount of vitamin and mineral supplements that the patient can tolerate.

Bipolar Disorders

It's much the same idea with mood disorders except that we have certain advantages there if you accept that the mood disorders are related to possibly disturbed serotonin metabolism. In Canada they have tryptophane; we used to have it here.

I don't use other amino acids but I certainly use lithium. Now we're discovering that some of the other anti-seizure medications may work in patients with lithium intolerance. Lithium is a naturally occurring substance so I prefer it over the other anti-seizure medications which are, of course, man-made. In fact, this is a perfect example of a naturally occurring substance being used by traditional psychiatrists to treat biochemical diseases. Sometimes you use lithium in schizophrenic patients who also have secondary depressions of their moods. You want to be cautious, however.

If a patient is manic and having psychotic symptoms, I tend to use a formulation similar to that given to psychotic patients. Lithium is certainly added in large part. If their mood is down and they're depressed, lithium is sometimes of value,but not always. In addition to traditional antidepressants, I make sure they have enough B Complex.

Before tryptophane was taken off the market, I used a fair amount of it. There are some people who use phenylalanine or tyrosine, and they can be purchased, but it is often difficult for patients to access those. Not every hospital will stock them for you either. Also, sometimes the quality of the product is hard to verify.

Tardive Dyskinesia

The patients I've seen with tardive dyskinesia often come to me from some other sources. These are patients who have been on antipsychotic medications. If they're on an antipsychotic drug and they don't in fact have a psychotic or a schizophrenic illness, they're at higher risk. For example, somebody with a mood disorder given an antipsychotic drug is at higher risk for developing tardive dyskinesia.

Typically those with tardive dyskinesia are patients who have be entreated for schizophrenia over the course of many years. The ravages of the illness become combined with the effects of the medicine. The older antipsychotic drugs--Thorazine,chlorpromazine, Stelazine, Prolixin, Haldol--work in a certain part of the brain where the neurotransmitter function is tied in with movements. The implication is that they can lead to movement disorders.

Attempts to remedy this have resulted in the creation of newer antipsychotic medications such as Clozaril and Risperdal. These are allegedly less likely to cause tardive dyskinesia because they work on different centers of the brain. They relieve some of the schizophrenic symptoms without the potential for tardive dyskinesia. These drugs haven't been out long enough to know if they will cause side effects, whereas the antipsychotics have been out for 30 or 40 years in some instances. Clearly we haven't had enough time to know if they ultimately will or will not cause similar problems.

To treat tardive dyskinesia you have to walk a fine line. You have to help patients reinstitute the very medicine that is implicated in causing it to relieve the dyskinesia. Sometimes I call neurologists in. They may have to use, in very interesting combinations, some of the antiseizure medicines that have antispasmodic effects.

We used to think, many years ago, that the crucial missing ingredient inpatients with tardive dyskinesia was vitamin B6. It turns out that it is probably vitamin E that is the protective element necessary with regard to TD.

I treat TD patients with choline and lecithin and large doses of vitamins. The choline and lecithin are tied in with the presumptive mechanism of action of this abnormal movement. If there's an imbalance in the different neurochemical pathways,then it is thought that the choline and lecithin will help along what is called the phosphytotyl choline pathway. You add the lecithin so you don't have to give as much choline, because choline tends to lead to a very fishy smell in the body. It is presumed that this brings a balance back, or re-establishes the proper chemical balance in the brain to relieve the abnormal movements.

If the chemical pathways in the brain were altered by the use of Haldol and other drugs, there may have been a disturbance of the intricate balance of neurochemicals necessary to coordinate smooth movements. The presumption is that choline and lecithin will help correct the imbalance that was created by the traditional antipsychotic drugs.

In sum, I use a balance of B vitamins, lots of choline and lecithin,manganese where appropriate, and sometimes I have to call in a neurologist to see what treatments they might want to give, depending on the level of severity.

Schizo-affective Disorders

Even traditional psychiatrists will tell you that if you give an antidepressant to a schizophrenic it can make them worse. And it can make them worse, I think, because of what it does biologically. That tends to feed into the whole idea that these are biological illnesses, which I think most psychiatrists are now willing to accept. Ten years ago they didn't accept that idea at all. That being the case, you have to modify. You may have to give a combination of an appropriate antipsychotic and antidepressant, and use vitamin supplements.

Limiting Factors of Orthomolecular Treatment

The information is there if people want to access it. Health care,however, has become a political and economic issue. If you are bound by the restrictions of the standard insurance, you're going to have one devil of a time finding places to get this treatment covered. If you want to get into any kind of alternative health care program, you have to go outside of your regular health care. Unless you have a budget that allows you to do that, you can't.

If you've got lots of money and you can afford to buy supplements,that's fine. Nobody is going to tell you not to spend your money. But for the average individual--which includes most of us who have to buy health insurance--most insurance will barely cover psychiatric treatment to begin with, and most insurance certainly won't routinely cover the use of vitamins and mineral supplements, which can become quite expensive. It's not a matter of going out from time to time to buy a One-a-Day pill. You have to be using a large enough amount of vitamins to have a pharmacologic effect. You're talking about unreimbursible expenses for many people, so it becomes very expensive.

There are areas in the country where people will be given greater access to complementary medicine. Perhaps California has that kind of mind set where people think nothing of it. Complementary medicine is more limited in other parts of the country.

We also have the problem that some products are no longer available, for instance tryptophane, which was, and still is, I believe, a marvelous substance for people with mood disorders, alcoholism, and histories of drug abuse. It's off the market in the United States. The FDA has forbidden its use, even though the tainted substance was isolated to a specific lab in Japan.

I think removing tryptophane from the marketplace has been disastrous for many, many patients because it removed a valuable, safe treatment. It certainly affected the mood disorder patients, many of whom were sleeping fine with the addition of tryptophane.

There is another barrier to the use of orthomolecular medicine. It's very difficult to double-blind diets, and some of the vitamin studies. Abram Hoffer did the very first double-blind study in psychiatry and then they criticized him for not doing double-blind. You can't double-blind a niacin group of patients because if you're on niacin your going to flush.

Then you get into the ethics of withholding a valued treatment. Even traditional medicine doesn't withhold certain cancer treatments or blood pressure treatments when they see the results. Codes are broken and studies are stopped when you see that the benefits far outweigh the disadvantages.

DR. RICHARD KUNIN

Most experts in orthomolecular psychiatry focus on major psychiatric disorders, such as schizophrenia, or the mood disorders like manic depression, or psychotic depression and disorders. While these disorders, along with panic attacks or severe anxiety problems, can have a major impact on one's life, I want to focus on the vast majority of people whose complaints are less dramatic. They are the ones who just don't feel well, who don't enjoy life fully, because they haven't learned how to live with themselves or reached orthomolecular balance.

Now before Linus Pauling and the word "orthomolecular," most people thought they were in the avant garde if they took a multivitamin. These days most people are still proud of themselves if they cut down on their fat consumption and increase their complex carbohydrates and their intake of high-fiber foods. That seems to be the nutritional prescription that is our current consensus. But the orthomolecular approach that, as a doctor, I have learned to respect, goes beyond a "one-size-fits-all" prescription and looks instead for a person's individual needs as the basis for treatment.

I have adapted a strategy that allows people a chance to test themselves where diet is concerned in order to identify their needs. I call that test the "Listen To Your Body Diet," which I wrote about in my book Meganutrition years ago. The bottom line is that people find their own particular food favorites and their own particular dietary balance, especially relative to carbohydrates. Usually,however, it's a blanket thing, like avoid sugars or increase complex carbohydrates. It leaves a lot unanswered until people go for some specific tests.

Whenever we test vitamin levels, we go a step further and also test the enzymes that the vitamins couple with to ultimately make the body chemistry work. In particular, we see deficiencies stand out in large numbers of the people who come to see us; remember, they are coming to the doctor because they feel something is wrong. The odds of something being wrong, therefore, are 100 percent. But we catch only about 70 to 80percent.

Regarding toxicology and allergy or immunology, there have been great advances. On the toxicology side, since about 1968 or 1970 I have done a screening test for toxics that we call the hair test. It was possible to screen every patient for mercury, lead, arsenic, aluminum, cadmium, nickel, and get a picture of what the environmental input had to say. The test was, unfortunately, unfairly criticized by the AMA and it is not used nearly as much as it should be. Those who are nickel-afflicted are going to be more allergenic. Nickel is a free-radical generator and a sensitizer of the first rank. People with nickel-tainted hair have nickel in their dental alloys or fillings. Nickel is even more sinister than the more well-publicized mercury, which is also a sensitizer. There is nickel in the braces that kids wear, and they can pick up nickel in their systems that way.

How do we test today if a person is, for example, sensitive to apples or to the sprays that are used on them, that is, to pesticides or chemicals? Some immunology labs are now offering remarkably helpful testing for chemical sensitivities for a relatively low cost. For about $200 you can get tested for seven or eight of the major solvents and chemicals, such as benzene and others that people haven't heard too much about. There are also plans to include the dioxins in this screening. These tests are avery helpful marker for environmental exposure. In addition, the IGG4 and the IGE testing can be done in tandem, in which a person is tested for a sample of food, chemical, and inhalant allergies by identifying antibody responses in the blood tests on an automated basis, thus bringing the price way down. These tests make it possible to get a powerful overview of toxicities and allergic responses inside a particular patient.

Doctors who don't test their patients for toxicities and allergens are getting a limited view of their patients, which can lead them to rely on treating symptoms with major tranquilizers, antihistamines, or other nonspecific therapies, rather than treating the source of an individual patient's problems.