Nutrition and Pollution are moving to center-stage in medicine today, competing with Infection and Genetics, i.e. germs and genes, which have been the main concepts in our classification of disease for the past 100 years. Germs and genes are 19th century concepts that have matured in the light of 20th century chemistry and molecular biology, culminating in antibiotics and genetic engineering. Food and poisons, are pre-historic concepts, they have been with us forever; but advances in science and technology help us to see them in a new light, beyond the concept of food and into the realm of nutrients, components of food that are essential to health.

Orthomolecular medicine means that we seek to provide optimal doses of nutrients for specific medical purposes: e.g. vitamin A against leukemia and cancer, vitamin C against viruses, iodides against antigens, vitamin E against peroxides and free radicals, magnesium against smooth muscle spasm (as in asthma and angina), lysine-arginine to stimulate growth hormone, manganese and also vitamin E against tardive dyskinesia, etc.

Just as genetics advanced after the discovery of the molecular structure of DNA, we are only now coming to appreciate foods and poisons after we see their vital role in biochemistry. Nature has yielded her secrets about the chemistry of life, one by one in the past 150 years until finally we can see the magnificent overview. With this perspective we are now beginning to recognize nutrients and toxins as the major determinants of our personal health. Germs and genes are important but they can be modified by foods and poisons—at the right doses. Foods used this way are orthomolecular.

We are seeing the birth of nutrition-ecology medicine: health in relation to both the foods that nurture and the poisons that modify body chemistry. Orthomolecules are the first choice, of course, and that is something to consider in every illness and especially in self-care, in pursuit of wellness. Poisons at therapeutic doses are the essence of pharmacology or drug therapy and we all know this can be life-saving. Arsenic, mercury, strychnine and atropine are all good examples. Pollution of the environment is another matter, especially because of the lack of control of doses, and because many chemicals accumulate in the body and thus grow more toxic over the years. But even at low doses we are now exposed to thousands of molecules whose toxic effects are only partly understood. Combinations of poisons are understood even less. We are like guinea pigs in a giant test tube!

It has taken fifty years of progress since World War II for America to wake up to fact that we are paying a high price for food technology and industrial progress, namely sub-clinical malnutrition and a degree of poisoning of every man, woman and child! We have only begun to cope with the epidemic of chronic diseases, which are clearly influenced by our toxic ecosystem and for which no other cause is found. Have we have been looking in the wrong places for answers?

Of course we appreciate that food technology has expanded our food supply and given us cosmetic quality and convenience, but it has not given us the equal of fresh natural foods. Nutrients are lost at each stage of production from soil depletion, food refining, preservation and storage. This would not be a problem if we ate more fresh foods; but few of us are able to get the recommended five servings of fruits and vegetables every day. For one thing, we have been over-sold on the diet of commerce, i.e. packaged, processed and preserved foods. It will take some time before we Americans are ready to fully appreciate the old reliable values: variety, moderation, whole foods, purity and balanced diet. Even now, we seem to be over-sold on the low fat diet. Is a diet really in balance when it excludes whole milk, butter, eggs, meat, nuts and nut butters?

Beyond nutrition, how about the pollution that we do to ourselves? For one thing we Americans drink more soft drinks than we do water; and thus we imbibe an excess of sweeteners, sugars and corn syrup, not to mention phosphates. But even if we drank only water, our public supplies are treated with alum, chlorine and fluoride, all of which are toxic. And our groundwater throughout America is likely to be contaminated with nitrates, solvents and other toxic chemicals. Home water purification systems are truly a necessity in most locations.

Pollution of food and water is only the beginning. The ozone hole represents contamination of the uppermost reaches of the atmosphere; lead has been found in the Greenland ice sheet, deposited there by air currents during this century, since leaded gasoline has been with us; and widespread industrial pollution of the Northern hemisphere by industrial and automotive exhaust has caused acid rain and destruction of forests in the northeastern United States, Canada and Europe, especially Germany.

Closer to home, house-paint is an insidious source of poison. The mercury preservatives in indoor paints have only been identified as a hazard since 1990 when an alert physician put two and two together after a baby died overnight in a just-painted at-home nursery. All those babies with ruddy cheeks (from mercury intoxication) who turn into children with learning disorders have to be reconsidered from the perspective of mercury, a hazard that has gone unrecognized for over a hundred years. Almost every home in America still has mercury vapor coming from wall paints. The danger fades with time but must be considered in poorly ventilated rooms, especially if there is a painted radiator. Of course, the danger is magnified by additional exposure to mercury in dental amalgam, which should be avoided if possible.

Mercury has only been taken out of paint since 1991. Lead on the other hand was forbidden in 1976 but toxic chips of exterior paint are a toxic time bomb for many years to come. The worst of the toxins, dioxin, will also be with us for a long time because, once exposed, it takes about seven years to get half of it out of the body. There is hardly a living creature on earth that does not carry a measurable amount of dioxin in his body fat. You know about dioxin: it is a family of chlorine-containing carbon-hydrogen ring compounds, that are known to cause cancer, nerve damage, endometriosis and thyroid disorders. These effects occur at tissue levels almost below detection, measured in parts per trillion. There is no detectable level at which dioxin toxicity is absent. If it is detected at all, it is poisonous. All we can do is try to maintain the best of health so as to stay a jump ahead of this toxic devil!

Happily, it is now practical to diagnose nutrient deficiency, pesticide levels, toxic metals and chemical exposures. This provides a basis by which to understand health factors beyond germs and genes; and to prescribe food choices, nutrient supplements and specific detoxification treatments rationally. Orthodox medicine does not routinely use these tools or consider information about nutrient levels and toxic substances. In fact our present disease concepts do not generally include nutrition, except in cases of gross deficiency, such as malnutrition, malabsorption and alcoholism! Nutrition problems cannot be diagnosed and corrected unless they are investigated in specific detail; and so far this is not the case in orthodox medical practice. In fact, I know of many cases where orthomolecular physicians have been slandered by colleagues and delicensed by state medical boards because of testing and treating with nutrients. To the orthodox medical mind, nutrition still smacks of quackery.

One would think that doctors would be more unanimous about pollution and toxins; but such is not the case. We all know that environmental pollutants are a serious hazard to health; but orthodox physicians do not routinely search for lead, mercury, pesticides nor PCBs. In fact, our authorities do not usually acknowledge the harm caused by low concentrations of metals and pesticides. Though detoxification of pollutants is most likely to be effective in just these low-level cases, it is hazardous to the doctor to treat them because he may be labeled a quack, even if the patient gets well!

I have diagnosed over fifty patients with borderline or low cholinesterase enzyme levels. Though the laboratory data were only marginally abnormal, these patients described symptoms of tremor, tension, handwriting change, insomnia and emotional instability, especially after casual exposure to household and commercial carbamate and organophosphate insecticides—the kind that are advertised in the media for public use. Were it not for the cholinesterase test I would have mis-diagnosed most every one!

I have recognized thousands of patients with mineral deficiency by testing hair, blood and urine levels. In addition, toxic metals, such as lead, mercury, arsenic, cadmium and aluminum are dangerous even when none is by itself at a toxic level. When multiple metals are increased at low level, their toxic effects add up. This is seldom mentioned in the textbooks. You never know which of us has been poisoned. My own infant son seemed perfectly normal when I took a lock of his hair for mineral testing when he was but a year old. I was just curious about the adequacy of his nutrition and so I was checking his mineral levels in general. To my complete surprise the lead level was 80 mg per gram of hair, i.e. 80 parts per million. Normally there should have been none. Without the hair test for minerals my son would have been mentally retarded by lead poisoning; we would never have discovered the lead in the painted toy that he was chewing. How many babies are tested? None! How many should be? All! How often? At least yearly. What does it cost? Thirty to fifty dollars per test. Why isn’t it done?

Orthomolecular and Toximolecular are the buzzwords that best define medical practice as a matter of nutrition and pollution. It is so obvious: diagnosis and treatment should begin with a practical strategy: put in the good molecules (nutrients); and take out the bad ones (poisons). Unfortunately, orthodox authorities resist this view. Let me give you a case in point and you can draw your own conclusions.

I enjoy reading the New England Journal of Medicine and have read every issue for over 25 years. From time to time I write letters to the editor, usually to tweak their nose about the omission of nutrition in some article. In a recent issue, the weekly case report made my blood boil.[i] A 26-year-old woman was eventually diagnosed with a rare disease, giant cell arteritis, an inflammation of the coronary arteries. This young woman was troubled by angina pain, tightness in her chest after exercise, but her symptoms were relieved by rest and she had not had a heart attack. The electrocardiogram showed signs of ischemia, poor circulation, but no infarct. However an angiogram showed severe narrowing of the main coronary artery and she therefore underwent a triple coronary-artery bypass.

The operation failed to relieve her chest pain and therefore a second by-pass operation was done after only a couple of months. This time the surgeon observed inflammation and edema of the previous grafts. He took biopsies of the aorta and the microscopic exam showed inflammatory cells, fibrous changes and damage to the elastic fibers. Only a few giant cells were found. After surgery she was treated for eight months with high doses of cortisone; but again her chest pain relapsed. Luckily, she did then improve after treatment with cyclosporine, an immune-suppressant, which presumably reduced the inflammatory reaction in her arteries; however the case report concludes that her future prospects call for cardiac transplantation!

My point is that this case report is one-sided and incomplete. It is as if nutrition doesn’t exist or is irrelevant. I am dismayed to find no mention of diet, no reference to the measurement of a single vitamin or mineral level, and no search for a toxic or chemical exposure. Other than inflammation, no actual cause of illness was identified. The report told of other symptoms, such as recurrent hives and joint pains. How about food and bacterial sensitivity? A complete allergy test panel and survey of fungal, viral and bacterial sensitivities, including Klebsiella (a specific bacteria that often causes joint pains and chest problems), might offer a clue. In addition there was no mention of her serum ferritin (iron) level. There is no mention if she had been taking iron supplements; but women often do and in this case it could aggravate all her symptoms.

There are other nutrient-related diseases to consider. Both of her parents had coronary artery disease at a young age, before age 50, a fact suggestive of homocystinemia, a condition that can be cured by vitamins B6, B12, folic acid and betaine. Immune system disorders are known to contribute to infection and inflammation and we now know that anti-inflammatory activity can be induced by supplemental vitamin E, carotene, bioflavonoids, pantothenic acid, pyridoxine, ascorbic acid, zinc, selenium, molybdenum, omega-3 EPA and omega-6 GLA and retinol. There are hundreds of research and case reports in the medical journals. It just seems to me that the New England Journal sets a bad example for hundreds of thousands of health professionals and hundreds of medical boards world-wide, all of whom are taken in by medical sophistry devoid of orthomolecular substance.

If you are not yet convinced, let’s review another teaching case from the New England Journal.[ii] A 66 year old, male executive was hospitalized three times, for a total of over two and a half months in hospital, because of recurrent fever and diarrhea, until he finally showed dramatic improvement after treatment with vitamins folic acid and B12. There was no mention of diet and no measurement of vitamins until his third hospitalization. Another case of putting nutrition last! He also had been treated for psoriasis over the preceding 15 years. Treatment was with methotrexate, an anti-vitamin that prevents folic acid from being fully active. One should at least be curious about folic acid from the start in such a case, wouldn’t you think?

His case history was further complicated by lymphoma, cancer of the lymph glands, which was discovered and treated by during his first hospitalization. Wouldn’t you like to know about your nutrients, your arsenal of raw materials, if you had a potentially fatal diagnosis and were about to take four cycles of cyclophosphamide, vincristine, doxorubicin and prednisone? Nutrient deficiencies are common amongst sick people, especially in cases of long-term treatment, weight loss, and worse yet, multiple drug therapy for cancer.

In the wake of chemotherapy this patient became severely anemic: his hemoglobin was only 50 percent of normal. In other words he was faced with having to regenerate half his blood. The report said that he was “near death, but he rallied.” The blood picture was not typical of B12 or folic acid deficiency however, because the average red cell volume (MCV) was only 97 micra, whereas B12 and folic acid anemia usually runs 106 and higher Furthermore there were hardly any hypersegmented neutrophils of the type seen in folic acid deficiency. And finally, the blood levels of folic acid and B12 were only moderately deficient. Nevertheless, the consultants diagnosed a B12-folate deficiency anemia and, indeed, after two weeks of treatment with these vitamins his fever disappeared, diarrhea stopped, he regained weight and his blood picture became normal!

That is persuasive testimony to the power of B12 and folic acid; and there is no doubt that that the B12 and folic acid were depleted by multiple medical stresses and blood loss. In addition the ferritin iron level was five times normal (over 1000 mcg) and it was not clear whether this was due to destruction of blood cells by chemotherapy, irritation of liver for the same reason or aftermath of an earlier transfusion. By injecting folic acid and B12, however, the formation of new blood cells was accelerated, thus using up the otherwise toxic load of iron by binding it up in hemoglobin and thus preventing damage caused by iron dependent bacterial growth and also preventing bowel irritation from the bacterial overgrowth and from oxidation by-products produced by reactions with free iron. In fact, this is why treatment with vitamins B12 and folic acid can be effective against infection and inflammation even when they are not deficient at all.

There was no mention of this man’s vitamin A status despite the history of severe infection and psoriasis, both of which are often vitamin A-related. Physicians need to be reminded that vitamin A deficiency is found in about 20 percent of the population at large and at least twice that number of those afflicted with chronic illness, even more after cancer chemotherapy. If vitamin A were depleted, it is possible that this would aggravate anemia due to impaired cell growth. It is very possible that the sudden anemia was due to a bleeding stomach ulcer following chemotherapy, which included prednisone (a known cause of ulcer) and other chemicals known to deplete vitamin A. However I don’t think this is the whole story or he would have lost blood cells and iron at the same time. The high ferritin goes against that scenario.

It is also important to know that the patient gave a history of arteriosclerosis requiring an aortic-femoral graft a decade earlier. This points to homocystinemia, a condition that is aggravated by low folate and B12, and almost certainly aggravated by the methotrexate therapy for psoriasis. Unfortunately the benefits of vitamin D against psoriasis were not known at that time or he might have been spared all the rest of this complicated medical history. Wouldn’t you rather be treated with vitamin D, which works against psoriasis, rather than methotrexate, a toxic anti-vitamin? Nutrients should come first.

All these possibilities were omitted in this case history. That strikes me as egregious because, if a nutrient deficiency is found, it can be easily corrected. In fact that is the real message of this case report. That is why nutrient testing, i.e. vitamin and mineral levels, should be included routinely in every medical work-up. Reading the New England Journal is pretty good evidence that it pays to “put nutrition first in medicine.” The only ones who seem resistant are—the editors of medical journals. In this case I received a letter: “. We can publish only a fraction of the letters we receive.”


[i] Scully RE, Mark EJ, McNeely WF, McNeely BU: Case 4-1995. NEJM, 1995, 332:380-386.
[ii] ibid: Case 51-1991. NEJM, 1991, 325: 1791-1799.

©2007 Richard A. Kunin, M.D.

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