Thursday, January 17, 2008

Orthomolecular veterinary medicine

…a trip to the twilight zone (ll)

There is no question that nutritional intake is a foundational pillar of any animals’ health and well being. Along with reproduction, adequate food intake is likely key to the supreme goal of survival- at least long enough to “get the job done’’. Animals and humans are living longer healthier lives today in part due to improvements in nutrient intake and significant research is under way to explore any potential advantages different foods and food profiles (i.e.; Mediterranean diet) might have.

Animal Veterinary Nutritionists and Certified Nutritionists among other qualified professionals continue to delve into the intricacies of nutrient actions. With such disciplines as biochemistry, genomics, physiology, and medicine the effort goes on towards expanding this nutritional knowledge.

There are an increasing number of novel avenues of study that are shedding new light on the meaning of “optimum” nutrition and whatever this really means. The evolutionary dietary histories of many species offer insight into how flexible or not their nutrient profiles might be and may add to our understanding of ideal nutritional parameters. For example, in humans, the evolutionary tale seems to suggest that we posses an incredibly wide and flexible nutrient range where nutritional needs can be met in many different ways depending on the conditions- “optimum” nutrition may not even really exist as we might imagine!

Enough is known to realize the importance of maintaining nutrient intake during times of stress and disease. It’s a no brainer that it significantly impacts therapeutic outcomes. That nutritional consideration in medicine has been somewhat under the radar and given less importance than it deserves is a problem that is being remedied with increasing urgency. The coming deluge of retiring baby boomers, for example, demands increasing attention to a host of health and social issues including nutritional considerations.

However, as mentioned in other posts, there is still much to be gleaned, a huge tangle of complex data needs sifting, and in some cases more studies need to be completed before some promising ideas can be implemented.

So, it was with some interest that a glossy promotional mailing caught my eye highlighting an upcoming veterinary nutritional seminar. Unfortunately the title “Nutritional Integrative Therapeutics” immediately sent up red flags as “integrative” and “nutritional therapeutics” are often utilized to dress up alternative or less mainstream practices. A further perusal of this promotion revealed a familiar pattern- learned during a brief naïve experience of my own- of classic descriptors for a pseudo-scientific nutritional supplement support program.

The lecturer states “From cancer, heart disease and allergies, to arthritis, anxiety, and nervous conditions, some level of nutritional deficiencies can be traced to every disease condition in the world today” This is only a slightly more nuanced yet typical non sequitor of fallacious causality that is often prostetlyzed- usually to a ready audience.

The reasoning behind believing, as implied here, that disease is a product of nutritional deficiencies is based on a long history of claims- albeit unsubstantiated- and has allowed some in the supplement industry the opportunity to capitalize on an eager and credulous consumer.

In this particular promotional program, there are two topics of interest worth mentioning. They illustrate some of the dissonant thinking commonly encountered in the world of pseudo-scientific discussion. First, the seminar starts with a lecture titled “Whole food nutritional vitamin complexes…and how they differ from synthetic vitamins”- they really don’t as discussed in a previous post.

Second, a large portion of the seminar is dedicated to something I had not seen before- at least under this title “Orthomolecular Nutritional Medicine” with the following descriptor: “Using nutritional components to augment your current medical protocols and gain greater patient response in disease…improving immune function….”

This particular section, it seems, is especially laden with significant pseudo-science. “Orthomolecular” and “augmentation” seem to be interchangeable terms often used to describe the concept of treating disease with nutrient supplements as therapeutic compounds- as in mega-vitamin therapy- a fairly common and unproven alternative nutritional modality.

A simple data search on “orthomolecular medicine” opened the doors to a strange world of peculiar medical claims and a strange cast of characters including the great novel prize winner Linus Pauling and his infamous and bizarre vitamin C obsession. Though his well known antics deserve consideration, its the other weirdness that is of interest today.

The Orthomolecular Medicine Online site notes that “Orthomolecular medicine describes the practice of preventing and treating disease by providing the body with optimal amounts of substances which are natural to the body...The key idea in orthomolecular medicine is that genetic factors affect not only the physical characteristics of individuals, but also the biochemical milieu. ”

This introduction sounds reasonable at first glance- until you read further. Another page on this site describes the principles that define orthomolecular medicine (OM)1. It is a rambling essay that bounces between holistic and conventional descriptions of OM in an attempt to have your cake and eat it too.

For example the author notes “On the one hand we are confused with Holistic Medicine; on the other we are seen only as the avant garde of orthodox medicine. In hopes of defining our true identity let me update the concept of OM as a new medical specialty.” Later he continues “First of all, the orthomolecular data base rests strongly on the following areas of scientific knowledge: 1.nutrition 2. biochemistry 3.cell biology…10. toxicology…12. parasitology…19. climatology 20. medical politics.” He then goes on to say “The following therapeutic modalities fit the definition of orthomolecular: 1. vitamins 2. minerals…6.enzymes… 9. cell therapy, 10. chelation therapy…17air ion therapy…20. acupuncture…23. biofeedback. 24. hypnotherapy…” This seems to be an attempt to cover all the bases, make everyone happy, and essentially not say a thing!

Essentially it seems that with OM you can treat disease with nutrients, enzymes, hormones, among other things. Finding the right amount to give of these substances for “optimal” dosage is difficult because laboratory tests don’t really reflect the patients’ nutrient status and you really can not rely on statistical models because of “biochemical individuality”; therefore “therapeutic trial and dose titration is often the most practical test.” Folded within these claims is an outright rejection of evidence based medicine and research. Another page attempts to minimize scientific methodology and the lack of evidence for OM stating that “Although double-blind studies are an important part of the scientific endeavor to find the truth, so to, are observations...Then, too, in a broad sense science incorporates philosophy. Some point out that science, too, must recognize that experiments once observed by a observer, become changed by the act of observation. The character of scientific procedures places restriction on the relevance of results.” This is classic complementary and alternative medicine (CAM) cognitive dissonance at its best.

This is also evident in some of the interesting discussions of other diagnostic tools such as chromatography, electrophoresis, and mass spectrometry where the science of “metabolomics” might produce an effective means of obtaining a rich and unique “cellular metabolic fingerprint.”

This forms part of the nascent science of nutrigenomics where “New types of functional foods with proven health claims could be developed, and perhaps personalized diets created…” So far, this is conjecture and may or may not provide some helpful information in the future. The problem is that OM and OVM seem to have created a world of clinical maladies and treatments with minimal solid and durable evidence.

The story of nutritional supplement companies making assumptions and hijacking ideas (some of which may prove to be sound at some level) has a long and convoluted history and parallels, to a degree the “snake oil” trade of other centuries.

Refocusing on the veterinary side, a search for veterinary related sites or information regarding OVM presented several complementary and alternative veterinary medicine (CAVM) sites that mention OVM in conjunction with a variety of other modalities (i.e.; acupuncture, homeopathy, herbal therapy) and mirror the above discussion on OM.

According to one web site, the advent of orthomolecular veterinary medicine was initiated by a Dr Belfield in the 1960s’ via the administration of injectable sodium ascorbate (vitamin C) to a dog infected with Canine Distemper. His bio page “There is a tendency by many, in and out of the healing sciences, to trivialize vitamins and minerals beyond the treatment and prevention of deficiency diseases. Dr. Belfield has made a giant step beyond this archaic perception by administering nutrients in gram amounts that will treat, prevent, and control conditions other than deficiency diseases.” The page goes on to critique “conventional” nutritional concepts and prop up OVM. This is basically the same old OM discussion regarding nutritional therapeutics. That is, basing theory and treatment more on the promise of an idea rather than -to name a few- reliable amassed data, controlled studies, and a well honed scientific consensus.

The Veterinary Institute of Integrative Medicine and the American Holistic veterinary Medical Association both have similar descriptions of OVM on their sites. The VIIM site mentions environmental and individual deficiencies adding “Orthomolecular medicine becomes necessary because of variability in food quality due to soil depletion or contamination and because individual patients have unique nutritional needs depending on heredity, health status, and lifestyle.”

Additionally, this site promulgates a publication titled “Veterinarians Desk Reference of Natural Medicines” that combines different conditions and diseases with recommended nutrient products. Similar booklets and publications exist for a variety of supplement companies and their specific products creating an impossible quagmire of different treatments and protocols and “a fast and loose with the facts” approach- partly due to lax regulations and intense industry competition.

Coming back to the little veterinary seminar that started this whole adventure, it seems one successful method for making CAVM modalities more mainstream is to provide educational seminars analogous to regular continuing education courses given throughout the country and layer them with a veneer of legitimacy. This particular seminar for example, allows for certain credit hours that may count towards veterinary practitioners’ continuing education hours per year- an obligation in the states.

With very little probing, the wording and make up of this veterinary informational seminar- while superficially innocuous- quickly takes on familiar CAVM overtones and directly associates it with some very serious pseudo- science. Whatever sound information this seminar may have is drowned and diluted by the insidious nature of integrating incompatible non-science with science. You inevitbly end up with a pile of garbage.


1) Among the mentioned areas of established sciences that OM claims to depend on, in part for its “data base” are the veterinary sciences- so we can probably safely describe this area as orthomolecular veterinary medicine or OVM

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