COMBAT SCHIZOPHRENIA WITH THE

MEGAVITAMIN
AND NUTRITIONAL STRATEGIES OF
ORTHOMOLECULAR
PSYCHIATRY

Schizophrenia is a disease and syndrome with biochemical origins that has the hallmarks of
debilitating perceptual disorders and thought disturbances. Orthomolecular psychiatry, a treatment
strategy that uses megadoses of vitamins B-3 and C in conjunction with correct nutrition, yields a
90 percent recovery rate in acute cases and up to 50 percent in chronic patients. This guide by the
cofounder of orthomolecular therapy offers a step-by-step approach so that patients and their
families will get the maximum benefits from treatment.
ABOUT THE AUTHOR

A. Hoffer, M.D., Ph.D., is one of the founders of the field of orthomolecular medicine. His
discovery that niacin lowers cholesterol is credited with the initiation of the paradigm in
nutritional medicine that we now accept as standard, that vitamins are used for treatment and not
just for prevention of deficiency disease. He was also one of the researchers who discovered that
megadoses of vitamin B-3 and ascorbic acid were therapeutic for schizophrenia, the premise that
remains at the heart of orthomolecular psychiatry as it is practiced today. Dr. Hoffer is the editor-
in-chief of the journal of Orthomolecular Medicine. He is the author of several books about
orthomolecular therapy and has over 500 published articles to his credit.
Orthomolecular
Treatment for
Schizophrenia
Megavitamin supplements
and nutritional strategies
for healing and recovery
Contents

Preface ............................................................................................ 7

Terminology: The Evolution of "Orthomolecular" .............. 9

History ofvthe Paradigm Conflict: "Vitamins-asPrevention" versus "Vitamins-as-

Treatment . ................. 10

Vitamins-asPrevention ......................................................... 10

Vitamins-as-Treatment .......................................................... 11

What Is Schizophrenia? ............................................................. 12

The Symptoms ....................................................................... 12

Schizophrenia Defined-A Brief History .......................... 13

How Diagnosis Affects Treatment ..................................... 14

My Approach to Diagnosis and Treatment ......................... 15

Diagnostic Tests to Detect Schizophrenia ........................ 15

Schizophrenia as a Syndrome ............................................. 16

Food Allergies ................................................................... 17

Cerebral Allergies and the Vitamin Dependencies (B-3 and B-6): The Adrenochrome
Hypothesis of Schizophrenia ..................................................................... 17

The Therapeutic Regimen .................................................... 21

How the Physician Makes a Probable Diagnosis ........... 21

The Nutritional History .......................................................... 22

Cerebral Allergies .................................................................. 22

Some Memorable Case Histories Involving Cerebal Allergies

............................................................................... 23

Vitamins ...................................................................................... 25
 Vitamin B-3 ............................................................................. 25

Safety and Side Effects ..................................................... 26

Dosages ................................................................................ 27

Duration of Treatment ...................................................... 28

Vitamin B-6 (Pyridoxine) ..................................................... 28

Vitamin C ................................................................................ 28

Folic Acid and Vitamin B-12 .............................................. 29

Essential Fatty Acids (EFA) ................................................. 29

Minerals .........................................................................................30

Zinc and Copper ................................................................... 30

Selenium ................................................................................. 31

Manganese .............................................................................. 31

Medication ................................................................................... 32

Tranquilizers ........................................................................... 32

Tranquilizers and Recovery: A Catch 22 ...................... 33

The Partnership of Tranquilizer Therapy and Orthomolecular Regimens

............................................... 35

Antidepressants and the Orthomolecular Regimen ....... 35

Other Medication and the Orthomolecular Regimen.... 36

Putting It All Together ............................................................ 37

Patients Already on Medication ......................................... 37

Patients Who Are Not on Medication .............................. 42

Results of Orthomolecular Treatment ................................... 43

Acute Patients ........................................................................ 43

Chronic Schizophrenic Patients .......................................... 44

 The Future for Orthomolecular Treatment ...................... 50

References .................................................................................... 50
PREFACE

On a pleasant mid-June Saturday afternoon in 1996, I attended my patient's graduation party. He

had just received a B.A. in Psychology from the University of Victoria and was planning to do
postgraduate work.'

What is remarkable about this young man's achievement is that four years earlier his family had
been told by his psychiatrist that: (1) he would never get well, (2) he would never complete grade
twelve, and (3) he would never get off tranquilizers. His father had been devastated by such a
dismal prognosis, but his son was schizophrenic and tranquilizers were standard treatment. Had
the boy remained in the care of that psychiatrist, it is likely that the doctor's predictions would
have come true, since such is the fate of 90 percent of the early schizophrenic patients treated by
drugs alone.

Fortunately, this patient was referred to me and started on the orthomolecular regimen. Today he
is well. My definition of "well" is that a patient is free of symptoms, gets along with his family and
community, and works or is preparing for work. Coincidentally, I have saved Canada $2 million,
since this is what it costs the country to support the care of any schizophrenic who becomes ill,
whether the person is treated with drugs or left untreated during the typical forty-year life span
after the disease strikes.

At the party and my patient introduced me to his cousin, an educated woman with an M.A. in
social work, who had been teaching and held responsible jobs, but had become schizophrenic
three years earlier. She had been treated with electroconvulsive therapy (ECT) and was taking
lithium, clozapine, and resperidal. She whispered to me that at least she was free of voices, but
she could not drink her coffee without someone steadying her hand. She had severe tardive
dyskinesia, a debilitating neuromuscular reaction that causes tremors and random movements of
any muscle group. The medication she was taking made her obese, swollen with fluid from her
ankles to her waist. She had so little energy that the exposure of a few hours to the tea party would
force her to go to bed for three days, according to her mother, whose predictions proved accurate.
No wonder the young woman was demoralized.

In December 1996, the young man and his parents came to see me to review his progress. He
was halfway through a postgraduate course, after which he planned further study. He had gained
self-confidence and was getting on well. The family then told me that the young woman I'd met had
become so ill after the party she had to remain in bed for several weeks. However, after several
months she asked her psychiatrist whether she could follow the same program that included
megadoses of vitamin B-3 and vitamin C, as her cousin had. Her psychiatrist, who admitted that he
had been unsuccessful in helping her during the three years they had worked together as patient and
doctor, approved of her new regimen. She was hospitalized briefly but remained on the vitamin
program and began to improve.
 These two cases represent the two different treatment modalities. The standard treatment, drugs
only, left both cousins gravely impaired and heading downhill. In contrast, using orthomolecular
treatment, the male cousin, a patient considered by modern psychiatrists to be terminal in the sense
that he would never recover, did recover. After a few months of treatment, the female cousin was
also on the road to recovery. If they had not been treated by orthomolecular means, these patients
would have never been able to live normal lives. Four years of drug therapy using tranquilizers
did not work for either of them, but a few months of orthomolecular treatment created powerful,
positive changes and set the stage for their return to wellness.
TERMINOLOGY: THE EVOLUTION OF
"ORTHOMOLECULAR"

The term "orthomolecular" was used for the first time in 1968 by Linus Pauling2 in his Science
report called "Orthomolecular Psychiatry." This terminology was an improvement over the earlier
phrase, "molecular" medicine, coined shortly after he had demonstrated that sickle-cell anemia is a
molecular disease.' He showed that a genetic anomaly of the molecular structure of the hemoglobin
was responsible for its tendency to change its shape into a sickled cell which could not traverse
the capillaries, as did normal cells, under certain conditions. The conceptual distance traveled
between "molecular" and "orthomolecular" was immense, according to Pauling, who now
suggested that these molecular diseases could only be treated successfully by using orthomolecular
methods.

"Ortho" means the "right" or the "best." This implies that to treat these molecular diseases
properly, one needs to use molecules normally present in the body. No deficiency of any kind can
be treated by anything other than that which replaces the specific deficiency. An excess of
something can only be dealt with by removing that excess. An enzyme deficiency cannot be
replaced by any drug. Pauling's work suggests that no molecular disease-no disease caused by
some defect in the biochemical reactions in the body-will be cured by the use of xenobiotic
molecules because, whether very valuable or very harmful, they are of limited use. This is why
none of the drugs available today have ever been curative for any of the chronic diseases.
HISTORY OF THE PARADIGM CONFLICT:
"VITAMINS-ASPREVENTION" VERSUS "VITAMINS-
AS-TREATMENT"

Orthomolecular therapy arose out of megavitamin therapy, and that's one of the main reasons it has
been rejected for so long. We are witnessing a major battle of the paradigms, a shift in which the
whole area of nutrition and nutritional medicine is being transformed from the accepted
"vitaminsas-prevention" paradigm to the modem "vitamins-as-treatment" paradigm. As is common
with all paradigm shifts, the defenders of the old do not like the vociferous proponents of the new
and will use every resource at their command to block the new ideas. The new eventually wins
acceptance, but it may take over four decades before a new paradigm is firmly established. The
history of orthomolecular medicine is a history of this paradigm battle.'
VITAMINS-AS-PREVENTION
The vitamins-as-prevention paradigm was very useful in its day. It arose out of the observation that
vitamins were needed in tiny amounts and only for a few classical deficiency diseases. Thus,
vitamin B-1 would prevent beriberi, vitamin C would prevent scurvy, and so on. The isolation of
these factors depended upon creating these deficiency diseases in animals and then restoring their
health by giving them back what had been taken from their food. Initially this paradigm was
resisted vigorously by the medical establishment, but it was finally accepted and in widespread
practice by 1950. The years spanning 1935 to 1950 witnessed an amazing flowering of practice
and theory using this paradigm and led to large-scale public health measures that in cluded adding
a few of these factors to our food: flour, apple juice, milk, and so on.

The underlying premises of this paradigm were firmly established in public policy, medical
practice, and popular use. Essentially, they were reduced to the following ideas-as well known to
some of us in the medical profession as the tenets of the Ten Commandments are to the general
public. These are:

1. Thou shalt not use vitamins to treat anything which is not a classical deficiency disease.

2. Thou shalt not use megavitamin therapy.

3. Thou shalt use the holy Recommended Daily Allowances (RDAs).

Even though RDAs had not been extensively field-tested to prove their efficacy, belief in the
utility of RDAs became firmly established in the medical community. Like any church, the
vitamins-as-prevention paradigm severely punished its heretics-doctors who refused to obey its
commandments have lost their licenses to practice medicine.

Even as this paradigm was being established, the seeds of its own destruction began to sprout.
Chronic pellagrins did not recover with FDAs of vitamin B-3. Megavitamin doses of 600 mg daily
were often needed to get relief.

In 1955, we published data to prove that niacin lowered cholesterol levels,5 a finding
confirmed shortly thereafter by the Mayo Clinic. Today, niacin is recognized as one of the most
valuable, effective, and inexpensive substances for lowering cholesterol and elevating high density
lipoprotein cholesterol. Our finding disobeyed both commandments. We used megadoses of a
vitamin to treat a condition that is not a vitamin deficiency disease. The startling result is credited
with being the beginning of the new paradigm-"vitamins- as-treatment." Thus our work actually
instigated the major assault on the RDA paradigm.
VITAMINS-AS-TREATMENT
The modern paradigm, vitamins-as-treatment, acknowledges that many conditions not recognized
as classical vitamin deficiency diseases can be treated by vitamins, and that one should use
optimum doses, not the arbitrarily low doses of the RDAs. Different diseases, as well as different
degrees of stress such as pregnancy and lactation, will have different optimum requirements.
Perhaps we should have ODAs (Optimum Disease Allowances). These would serve as more
useful guidelines but would also require a wider margin of dosages. The treatment of
schizophrenia is a case in pointit represents a disease in which megadoses of vitamin B-3 must be
used. The treatment of heart disease by megadoses of vitamin E represents another such condition.
In fact, there are many nondeficiency diseases that respond to megavitamin therapy and can be
defined as vitamin dependency diseases-those for which patients require much larger dosages of
vitamins if they are to attain optimum health.

Fortunately, modern medicine is rapidly accepting the new paradigm; unfortunately, psychiatry
is not. Modern psychiatry, seduced by the drug companies and their wares, has no use for nutrition
nor for nutrients (these are not being promoted with huge advertising budgets, commercially
motivated conferences, training sessions, etc.). When treatment is determined by a bottom-line
mentality, the only profit that flows from drugs is the long-term, unsuccessful treatment of the
chronically ill, a monetary profit of benefit to the industry, not the patient. We cannot forget that the
business of business is to make money, but the business of medicine is to cure the sick.
WHAT IS SCHIZOPHRENIA?
THE SYMPTOMS
Schizophrenia is a mental disorder that involves two primary categories of symptoms: perceptual
symptoms and thought disorder. Perceptual symptoms affect one or many of the senses (i.e.,
illusions and hallucinations such as voices, visions, and more often, subtle distortions of the visual
world). Thought disorders refer to the inability to correctly judge the real world (i.e., paranoid
thinking, ideas of reference, grandiosity, etc.), so that the person concludes that such perceptual
changes are real and may or may not act upon them accordingly. Thus, if a person hears a voice
telling him to burn down his neighbor's house, and if he does not realize the voice is created by his
own sick brain, he may conclude that the voice must be coming from God. If he is a God-fearing
person, he will obey and burn the house down. The neighbors will be totally amazed because,
although they know what he has done, they do not know why. This leads to a lot of useless
speculation about the "real" motives. Thus a shy, young person commits some heinous act. The
neighbors rally round and say he was so quiet, so nice, polite, but reserved. They wonder why this
could have happened. They do not realize that schizophrenia can so distort the personality of its
victims that no matter how normal they were, they are no longer normal after the illness has struck.
SCHIZOPHRENIA DEFINED-A BRIEF HISTORY
The history of how schizophrenia has been defined is interesting and illustrates why there has been
so much diagnostic confusion and inadequate treatment to date. Schizophrenia was first described
about 200 years ago. By 1900 it was called "dementia praecox," which was later replaced by the
term "schizophrenia," meaning a split: a schism between thinking and feeling. This concept has
been interpreted to mean that there was a split personality. However, the idea of a split was
wrong. The only split was the one that separated the patients from their families and the
communities.

Definitions have changed. In England until 1900, schizophrenia was defined as a disease of
perception combined with an inability to tell whether these perceptual changes were real or not. J.
Conolly's book, Indications of Insanity,6 provides the best and most accurate description of this
disease. After 1900, Dr. E. Bleuler' confused the issue by emphasizing thought disorder and
relegating perceptual changes to a minor status. This has become today's standard definition and is
one reason for the extensive diagnostic confusion-schizophrenia has been confused with manic
depressive disease (bipolar) and, more recently, with borderline personality disorders (BPD). If
such diagnostic confusion could be eliminated, earlier diagnosis would be possible and treatment
results would improve significantly.

In the United States, however, the diagnosis of schizophrenia had been more precise for twenty
to thirty years and has included both sets of symptoms. Eventually, however, English psychiatrists
convinced the Americans that they were too free and easy in their diagnosis and demanded that
American physicians restrict the diagnosis of schizophrenia to deteriorated patients. All the others
previously labeled schizophrenic were now to be classified as manicdepressive or any one of a
number of new diagnoses invented by the creative genius of the APA diagnostic manual, the most
recent version of which is DSM-IV.8
HOW DIAGNOSIS AFFECTS TREATMENT
At one time, the diagnosis determined what the treatment should be. Manic depressives were
treated with lithium, schizophrenics were treated with one or more powerful tranquilizing drugs.
Today, modern medicine tries to eliminate all traces of schizophrenia. The bias is such that if
doctors detect any evidence of mood disorder, the patient is promptly relabeled manic-depressive
and given lithium and if patients have prominent changes in personality, they are promptly declared
untreatable and dismissed. It does not much matter what the diagnosis is because the treatment will
be the same: any one of a number of tranquilizers and/ or antidepressants, psychotherapy, and
perhaps for a lucky few, some support patiently given over many years.
MY APPROACH TO DIAGNOSIS AND TREATMENT

I use the Conolly diagnostic definition.' Conolly defined insanity as a disease of perception
combined with the inability to determine that the perceptual changes were false. Schizophrenia
exists when perceptual symptoms are present, combined with thought disorder as described
earlier. Unless patients tell you what their perceptual disturbances are and talk about how they
react to them, it will be impossible to explain their behavior.

To illustrate, many years ago a clergyman was admitted to the psychiatric ward because he had
been caught in the act of behaving inappropriately, chasing a young girl on the main street of a big
city. He was very puzzled when he was forced to come to hospital. When I examined him and
asked him what he had been doing, he said that while he was walking downtown in the late
afternoon he suddenly saw the heavens open with a vast illumination from which he heard God tell
him, "You have syphilis. You must have intercourse with a young virgin." He interpreted this
command as an order from God and obediently began to chase the young girl. His visual and
auditory experiences were the hallucinations. His determination that the words came from God
was his delusion, and his behavior resulted from the combination of these two sets of symptoms.
He was one of the first patients we treated with niacin. He recovered, remained well, and rose to a
high position in the church.
DIAGNOSTIC TESTS TO DETECT SCHIZOPHRENIA
These symptoms are usually easily elicited by direct questions. There are two especially valuable
and helpful diagnostic tests: the Hoffer Osmon Diagnostic (HOD)9,'o," and the Experiential World
Inventory by El Meligi and Os- mond,12 which is more advanced and precise but takes more time
to administer and to interpret. The Conolly description of schizophrenia is provided in our book,
How to Live with Schizophrenia.

The Hoffer Osmond Diagnostic (HOD) test consists of 145 cards, each containing a statement
on the front and a number on the back. The questions are designed so that the tester gets a view of
the experiential world of the person being tested. The subject is instructed to read each card and to
place the card in a True or False category-a process that takes, on average, between 10 and 20
minutes. The cards are recorded by their numbers on a scoring sheet. The pattern of the scores is
assessed using templates, or more recently, by a computer program. Since the basis for the
questions is the schizophrenic experience, it is not surprising that schizophrenic patients score very
much higher than patients who are not schizophrenic or are normal. I have been using this test for
thirty-five years, as have a few other physicians. Psychiatrists and psychologists prefer to use the
MMPI (Minnesota Multiphasic Inventory), a test that, in my opinion, is useless in the diagnosis of
most cases of schizophrenia. It is interesting that many chiropractors are skillfully using the HOD
test now.
SCHIZOPHRENIA AS A SYNDROME
Having just described schizophrenia as a disease, I hasten to add that it is, in fact, not one disease,
but a group of diseases: a syndrome. Several factors lead to the constellation of perceptual
disturbances and thought disorder. Some of these factors are:

1. allergies known as cerebral allergies

2. vitamin B-3 and vitamin B-6 dependencies

3. vitamin deficiences such as scurvy or pellagra

4. essential fatty acid deficiencies

5. mineral deficiencies, such as zinc deficiency

6. toxic reactions to lead, for example, or to drugs

7. LSD and similar hallucinogens 8. infections such as rheumatic fever, syphilis, and many
others

Let us now consider the first two: food allergic reactions and the vitamin dependencies.
Food Allergies
As obvious as this sounds, it must be stated unequivocally: It is essential to determine what is
the cause of the syndrome. About half of the chronic patient population experience allergies to one
or more foods. If the patient is schizophrenic due to daily milk consumption, giving him
tranquilizers will control some of the symptoms but that person will not respond to vitamin therapy
alone. There will be no cure until the dairy products are removed from the diet.
Cerebral Allergies and the Vitamin Dependencies (B-3 and B-
6):
The Adrenochrome Hypothesis of Schizophrenia 13,14,15,16
The causal factors can lead to schizophrenia, but in each case there must be a final common
pathway that accounts for the perceptual changes and thought disorder. It is my hypothesis that the
adrenochrome reaction is the common end pathway. Thus, a cerebral allergy, or any of the other
causes, will initiate the adrenochrome reaction.

The use of megadoses of vitamin B-3 and vitamin C was not serendipitous. It arose out of the
adrenochrome hypothesis that my two colleagues and I first published in 1954. The hypothesis can
be expressed with the following equations.

(1) noradrenalin + methyl group adrenalin

(2) adrenalin + oxygen r v adrenochrome

Earlier, Osmond and Smythiesl' had suggested that a substance related to adrenalin with the
psychological properties of mescalin, one of the hallucinogenic drugs, might be present in the
schizophrenic's body. This was the first transmethylation hypothesis in psychiatry.
Transmethylation is a reaction that transfers a methyl group from one substance to another.
Equation 1 is an example of a transmethylation reaction.

Later we centered our investigation on adrenochrome. This is the first oxidation derivative of
adrenalin. Equation 2 is an oxidation reaction easily seen when a pure solution of adrenalin is
exposed to air and turns pink, then later becomes more discolored and turns gray or black. The
early research that I directed in Saskatchewan arose out of this very useful observation. We
hypothesized that schizophrenia is one of the oxidation-reduction diseases, that is, it results from
excessive free radical formation (hyperoxidation) and too little antioxidant concentration.
Therefore, treatment should try to decrease the hyperoxidation and increase the concentration of
antioxidants. We have tested ascorbic acid but there have been few tests of the other antioxidants
such as vitamin E, the carotenoids, glutathione, uric acid, and selenium.

With a substantial, six-year Rockefeller Foundation grant to pursue these views and to expand
our research in 1954, we showed that adrenochrome is an hallucinogen that could be made in the
body and proved our hypothesis, although our work was ignored for many years. Now we not only
know that it is present in the body but we have methods by which it can be accurately measured.
The adrenochrome hypothesis has been highlighted in a series of excellent reports by John
Smythies.18,19,20,21,22

Schizophrenia is a very complex biochemical disorder involving tryptophan, vitamin B-3,

vitamin B-6, ascorbic acid, folic acid, vitamin B-12, EFAs, zinc, and chemicals made in the body
such as adrenalin and other catecholamines, serotonin, prostaglandin, and many others. But I think
that adrenochrome and similar substances will play major roles in the end point of the disease, at
the synaptic levels in the brain.

The adrenochrome hypothesis accounts for a large number of the physical and psychological
findings in schizophrenic patients. We described these in our book, The Hallucinogens.23 As an
interesting aside, the fact that schizophrenia still exists in all human populations proves that it is a
genetic -morphism. This means that while there is no advantage in being sick with schizophrenia,
there is some advantage conferred by carrying the genes: having enough of them without becoming
sick. First-order relatives are a case in point: in the Darwinian sense of being biologically
superior, they are reproductively successful. Schizophrenics themselves tend to be physically
superior to nonschizophrenics24 and appear more youthful (even in old age); their hair does not
turn gray as early as the normal population's would; they have higher tolerance to pain; they do not
have as high an incidence of arthritis or cancer; and they are more resistant to bacterial infections.
They also seem to be more creative, a psychological trait due perhaps to their inner experiences
with perceptual changes.

We hoped we could treat schizophrenics successfully by slowing down the transformation

process from adrenalin to adrenochrome. We thought that we could decrease the formation of
adrenalin from noradrenalin, a methyl acceptor, by using large doses of another methyl acceptor,
vitamin B3. By the addition of a methyl group, noradrenalin becomes adrenalin. Decreasing the
amount of adrenalin would therefore decrease the amount of adrenochrome. We therefore decided
to give our patients large doses of this vitamin, hoping it would soak up the methyl groups and thus
stop the excessive formation of adrenalin. We also knew that pellagra was one of the
schizophrenic-like conditions and in its early stages often could not be differentiated from
schizophrenia. Vitamin B-3 was safe, with a huge LD50 in animals, about 4 grams per kilogram
body weight. For a 70-kilogram person this would be over one-half pound of vitamin per day.

This hypothesis also pointed toward ascorbic acid as another very useful substance. Ascorbic
acid is a water-soluble reducing agent, the body's best water-soluble antioxidant. It is more
difficult for the adrenalin to be oxidized into adrenochrome in the presence of ascorbic acid. We
realized that we would need to use very large doses if we were going to use this reaction in the
body. As far as I can tell, this is one of the first uses of the antioxidant series of compounds such as
vitamin E, selenium, coenzyme Q10, and glutathione that are so commonly used today. What we
did not know in 1954 was that the presence of scurvy was used in the differential diagnosis in
psychotic patients around the turn of the twentieth century because it produced a schizophrenic-like
syndrome. In summary, vitamin B-3 could decrease the formation of adrenalin, and vitamin C
would make it more difficult for the body to oxidize the adrenalin to adrenochrome.

The first time I used megadoses of vitamin C in the early 1950s, I saw a remarkable therapeutic
response. A middleaged woman with breast cancer was admitted to our psychiatric ward. The
operative site of her mastectomy had become infected, was suppurating, and would not heal. At the
same time, she became psychotic. Her psychiatric diagnosis was schizophrenia and her
psychiatrist ordered electroconvulsive therapy (ECT) to commence the following week. (This was
before the tranquilizer drugs had been introduced and ECT was the only treatment available.) For
reasons I now do not remember, I decided to give her a megadose of vitamin C, perhaps 3 grams
each day, and asked her psychiatrist whether he would delay the ECT for a few weeks so that I
could try out the vitamin C. He agreed that he would delay giving her ECT for a few days. I
therefore ordered that she be given 1 gram of vitamin C every hour, day and night. If she slept, the
vitamin C was held, and when she awakened, what she had not taken was given to her. From
Saturday morning to the following Monday morning she was given 45 grams. When her psychiatrist
came to give her the ECT, he found her mentally normal and she was discharged to her home one
week later without ECT. To my amazement, the ulcerated mass on her chest had begun to heal with
fresh granulation tissue. Although she died six months later from her cancer, she had remained
mentally normal. I was not a breast cancer researcher and did not follow that observation until
many years later, but I was impressed with the vitamin's effect on her psychosis and after that used
vitamin C on as many patients as possible.

The adrenochrome hypothesis describes the final common pathway for this disease, but
schizophrenia may be triggered by a number of conditions. Probably every factor I have listed
earlier as causing the syndrome will activate the adrenochrome pathway. For this reason, the best
treatment must eliminate the causal factors and at the same time neutralize the adrenochrome
pathways. Our book, The Hallucinogens, 23 provides a complete description of the adrenochrome
hy pothesis and how it accounts for most of the clinical phenomena found in schizophrenia.
THE THERAPEUTIC REGIMEN 25,26,27,28,29
The therapeutic regimen includes several nutrients and drugs that must be added to the basic
nutritional recommendations given to a patient. This regimen is a simple one that any physician can
offer, even a practitioner who does not have access to laboratories for some of the tests that are
now available.

This regimen is not necessarily followed by all orthomolecular physicians; however, every
orthomolecular physician will follow its underlying principles while using different combinations
of nutrients and medications to achieve the desired responses.
HOW THE PHYSICIAN MAKES A PROBABLE
DIAGNOSIS
Because the diagnosis is so important, the first step of the treatment is to determine the most
probable diagnosis. I am interested in the history of the illness so I listen to the patients and to
members of their families, guiding them with the right questions. I do not routinely ask about the
psychodynamic factors usually sought by analysts and psychotherapists. After the history, I spend a
lot of time assessing all the areas of the mental state including perceptual changes, thought
disorder, mood changes, and behavioral changesthis is the most important aspect of the diagnosis
since it determines what the treatment will be. I may use one of the two diagnostic perceptual tests
I listed above. Once I am reasonably certain of the diagnosis, I advise the patient and family of it.
If it is schizophrenia, I will tell them this is not a mental disorder but a biochemical disorder that
expresses itself in mental symptoms. Schizophrenia is not caused by trauma, anxiety, or childhood
factors, even though these may influence the disease. It is caused by unknown genetic factors as
well as the other etiological factors described earlier that influence biochemistry and cause the
body to generate toxins or chemicals which adversely react within and upon the brain. I outline my
recommendations for a therapeutic regimen and estimate how much time it will take long before
they are much improved or fully recovered. I send all results of such a consultation to the referring
physician.
THE NUTRITIONAL HISTORY30,31,32,33
CEREBRAL ALLERGIES
Taking a complete nutritional history is a crucial part of the examination. I ask about food allergies
and how they were expressed early in life, such as colic in infancy, frequent sore throats, frequent
colds, enlarged adenoids and tonsils, rashes, flu, asthma, and so on. If the history suggests a food
allergy is involved, I explore the patient's food preferences. The favorite foods are usually the
ones that the patient is allergic to. If food allergies are suspected, I will suggest regimens such as
elimination diets and rotation diets designed to elicit what these allergies are. An elimination diet
lasts several weeks and omits the food or foods that may be responsible for the allergic reaction. If
there is marked improvement at the end of this period, that food is reintroduced and if it causes a
recurrence of symptoms, we can establish a diagnosis that shows food is a factor. In a rotation diet
the same foods are not repeated each day. There are four-day, five-day, and seven-day diets. With
the seven-day diet the same foods are eaten every seventh day. I find the four-day water fast, a
special category of elimination diet since it eliminates all foods, to be very useful. Over a period
of several years I fasted over 200 of my schizophrenic patients.

Some Memorable Case Histories Involving Cerebral Allergies

The first three patients were the most memorable, because the effect of removing the offending
allergen was so striking. Two sisters came to see me in 1970, one a local resident in Saskatoon,
the other from Toronto. The Toronto sister had been ill for three years and had a history of three
psychiatric hospital admissions during that time period. She was very paranoid and suspicious that
her husband was poisoning her and became so fearful she fled to her sister in Saskatoon to get
away from her husband. The woman was clearly schizophrenic but I could not get her admitted to
the local hospital at which I had privileges, so I suggested that she and her sister try a four-day
water fast. I was familiar with the cerebral allergy concept by then but frankly did not know if such
a fast would help the patient. I actually thought it most unlikely that she would respond and hoped I
could buy some time until a hospital bed became available. Her sister promised to help. The
patient was instructed to start the fast the next day by avoiding breakfast. She was to eat nothing for
four days, but had to drink at least 8 glasses of water each day. The two women were given an
outline of how to reintroduce foods one at a time into the patient's diet and they were to test four
different foods each day. Every food item that did not produce any paranoid or other symptoms
was to be added to the diet. She completed the fast and began to test the foods, but not one of them
was an offender. She remained well. She had recovered by the fifth day, called her husband in
Toronto and said something like, "Dear, I am so sorry I was so foolish. May I come home?" As she
continued the process of testing foods she developed pain in one hip and took an aspirin tablet.
Within hours she was very paranoid again. This woman's situation was a clearcut example of an
aspirin allergy causing her schizophrenic syndrome. Then I discovered that she had suffered from
hip pain for over two years and had been using aspirin the entire time, even when she was
admitted to the psychiatric wards. Since I had advised that all medication not be taken during the
fast, she had not taken the aspirin. A few days later, recovered, she flew back to her home in
Toronto.

The second patient was a middle-aged man who had been depressed for at least four years. He
had been treated for schizophrenia in a mental hospital for many months. His wife had left him
because she could not tolerate his abnormal behavior. After discharge, he was being cared for by
an aunt. I tried the four-day water fast with him and instructed him not to smoke or take any
medications. I was actually looking for patients who wouldn't respond to this regimen! But, like the
previous patient, his symptoms cleared up and he found no foods that triggered another depressive
episode. He began to smoke again a week after completing his fast. His depression returned as
soon as he did so. He quit smoking again and remained well. One month after treatment, he was
able to return to work as a high school principal. The insurance company that had been paying him
support sent a representative from Vancouver to Saskatoon to find out what I had done that had
rehabilitated this man so quickly. The irony was that his brother was a tobacco company executive
and had been supplying him with free cartons of cigarettes.

The third case was a catatonic young woman who was so rigid with tension that she could not
walk. I first examined her in her home and promptly ordered an ambulance to take her to the
hospital. However, she did not respond to my nutrient regimen. Since I was familiar by then with
Dr. Allan Cott's visit to Moscow where he had observed the fasting treatment for chronic
schizophrenic patients,' I asked my patient if she would try the Russian protocol. She agreed.
Amazingly, she was normal after the fifth day. But as I was not yet aware of the allergy concept, I
continued the fast to its conclusion and since she was still well at that point, I began to reintroduce
foods. Within a few days she again became sick. I could not fast her again right away because she
had lost so much weight. I kept her in the hospital until she had regained enough weight and then
fasted her, but this time only for five days. She again recovered. I then found out she was allergic
to all meats. When she avoided meat she was normal and stayed normal. Her situation illustrates a
severe allergic reaction to animal protein.

These three examples were so striking that I began to fast those patients who had not recovered
or who responded only partially. Approximately 200 patients were asked to do the fast. Only ten
percent were fasted in the hospital. Out of the total group, about 60 percent were allergic to foods
and when these foods were eliminated, they improved or became normal. As a result, I came to
believe that cerebral allergy plays a major role in the etiology of the schizophrenic syndrome. I
have become more skillful at determining the potential food allergies over the past twenty years,
so I have fasted very few patients during that time period. The elimination diets are just as
effective in discovering the offending substances and are easier for the patients to handle. But even
when there are no allergies I advise the elimination of all junk food, especially those that contain
added sugars. That step will effectively cleanse most modern diets by about 90 percent. Foods
containing added sugars invariably contain other additives.
VITAMINS
VITAMIN B-3
Vitamin B-3 (the term brought back into the literature by Bill W., cofounder of Alcoholics
Anonymous) refers to nicotinic acid and nicotinamide, more often called niacin and niacinamide in
medical literature.35 Both are precursors to nicotinamide adenine dinucleotide (NAD), the active
coenzyme in the body, and share similar properties. However, they also differ. Niacin is a
vasodilator: It lowers triglycerides and total cholesterol, and elevates high density lipoprotein
cholesterol. Niacinamide has no effect on the lipid profile.
Safety and Side Effects
Although both forms are safe," each has side effects. Too high a dose of niacinamide can cause
nausea, often resulting in vomiting. The dose should be decreased whenever there is nausea.
Allergic reactions are possible but unpredictable.

The most common and least dangerous side effect with niacin is the vasodilatation or flushing
accompanied by a sensation of itching and heat because niacin opens the capillaries in the skin and
increases blood flow. The flush may last anywhere from several minutes to several hours; it
usually starts in the forehead and travels down the body. Rarely, it envelops the whole body. The
most intense flush can be expected the first time it is taken; subsequently, it fades until it is barely
noticeable. Vitamin use must be discontinued if the flush remains intolerable.

Flush intensity depends upon the rate of niacin absorption into the blood. If it is injected
intravenously, the flush will be most intense. Most people take it by mouth, however. Dissolving it
in hot tea and drinking the mixture on an empty stomach will also produce an intense flush. You can
reduce the intensity of the flush by having food in your stomach and by drinking a cold drink. Other
flush reduction strategies are to take aspirin a few days before starting niacin therapy or to take an
antihistamine such as Periactin half an hour before ingestion of niacin.

One form of niacin is a slow-releasing formulation; though flush is reduced or nonexistent, very
few serious liver complications have occurred with use of this product, but the source of the side
effect is unknown. The second forminositol niacinate (hexaniacin inositol)-is an ester of inositol
and niacin. It is flush-free, more easily tolerated, and just as effective as the flush-producing
varieties. It has not been reported to cause any liver complications, but is a more expensive
product.

Schizophrenics generally do not flush much, not nearly as much as other patients. Often they do
not flush at all until they have started to recover. This is now the basis for a diagnostic test
developed by Horrobin. ' As with an overdose of niacinamide, nausea leading to vomiting is a side
effect of niacin use if the dose is too high. This reaction may be used as a way of determining the
optimum dose-that is, one increases the dose until there is some nausea and then decreases it to just
below that level to get the maximum effective dosage for that patient.

A more serious and much rarer side effect is an obstructive type of jaundice, which clears when
the niacin is discontinued. The usual liver function tests are misleading because they may read high
when niacin is taken, suggesting there is a liver problem when, in fact, there is none. Therefore
niacin should not be taken for five days before these liver tests are run. They will then be normal.
It is probably an artifact. If tests are normal, liver damage did not exist; if damage is present, the
results would not show normal values so quickly. However, niacin should be discontinued
immediately at the first sign of jaundice. It is possible that someone who had jaundice as a side
effect with one course of niacin therapy can try it again with no recurrence. I have not seen any
cases of jaundice for at least ten years. If a patient has high cholesterol or heart disease, niacin
therapy is indicated and may increase their life span.
Dosages
The usual therapeutic dose for schizophrenics is between 3 and 6 grams daily in three divided
doses, after meals. I usually start with 3 grams and will increase it after several months if the
response is too slow. The dosage range is enormous. I have had patients on 30 grams daily with no
discomfort and one subject, a young girl with schizophrenia, increased the dose on her own until
she was taking 60 grams daily. At that level, the voices she had been constantly hearing vanished.
Later, she was able to maintain herself on 3 grams. Patients should take niacin in these large doses
only under medical supervision. It is not possible to go to such high dosages with niacinamide
because it causes nausea at lower doses than does niacin. The most frequent dose range is 3 to 4.5
grams daily. After patients have become well, the dose may be decreased to a lower maintenance
level. I think that most of my patients do this anyway and will often find out how much they need to
take to stay well.
Duration of Treatment
There is a direct relationship between the duration of the disease and the amount of time needed
to achieve recovery, and therapists must have enough patience to stay with their patients until they
do recover. Treatment with vitamin B-3, and with the other components of the program, continues
until the patient is well, and should then carry on until there is reason to believe that no relapse
will occur if the program is discontinued. Recovery may take many years if the patient has been
sick for many years. Unfortunately, not everyone will get well, but most will.
VITAMIN B-6 (PYRIDOXINE)
When I was Director of Psychiatric Research in Saskatchewan between 1960 and 1967, we found
that when the urine of early schizophrenic patients was tested, up to 75 percent of them had a
mauve staining area on the paper chromatogram containing kryptopyrrole. Dr. C. C. Pfeiffer and
his research group showed that this substance bound both zinc and vitamin B-6, producing a
double deficiency. The treatment for this condition was to supply both of these nutrients. The
detection of this condition has been described by Pfeiffer.37

Pyridoxine is safe when used in the usual dose ranges. At doses greater than 2,000 milligrams
daily, and in the absence of other vitamins, it can cause a peripheral neuropathy which clears when
the vitamin is discontinued. I have seen no side effects for daily doses under 1,000 milligrams. If
given to children B-6 should be combined with magnesium, since it tends to increase their activity
levels when used alone. I usually use it in combination with vitamin B-3.
VITAMIN C
I use 3 grams of vitamin C daily but may go higher if there is a special need to do so, though
schizophrenic patients don't usually require such high doses. The optimum levels are those just
below the laxative level. This effect has been called a toxic reaction, but technically it is not,
because it simply arises from the inability of the patient to absorb it all and it therefore draws fluid
into the bowel. Vitamin C is extraordinarily safe. Contrary to the fiction propagated by some
physicians, it does not cause kidney stones, pernicious anemia, or sterility, nor does it destroy the
blood. Furthermore, it has great value in alleviating the symptoms of the common cold.38
FOLIC ACID AND VITAMIN B-12
More research should be done about the roles of folic acid and vitamin B-12 in the treatment of
schizophrenics. DeLiz39 used it in combination with niacin. Dr. L. Kotkas treats many
schizophrenic patients with large doses of folic acid and B-12. These vitamins and vitamin B-3
are involved in transmethylation reactions, which are probably very important in schizophrenia,
but B-12 also improves the flow of red blood cells through the capillaries (Simpson",41) Blood
flow through the frontal lobes of the brains of schizophrenic patients tends to be low. Any
therapeutic measure which will improve this blood flow ought to be helpful. Large-scale trials are
warranted.
ESSENTIAL FATTY ACIDS (EFA)
Both classes of EFAs are important. In modern diets there is more apt to be a deficiency of omega-
3 EFA compared to omega-6 EFAs. Linoleic acid is the precursor to the omega6 series. However,
many patients experienced a partial block in its conversion to the next members of the chain.
Evening primrose oil and other oils contain gamma linolenic acid, which is converted into
dihomogammalinolenic acid, which, in turn, is the precursor to Prostaglandins, series 1 and 2.
Horrobin42,43,44,45 suggests that the EFAs and the Prostaglandins are involved in the
biochemical pathology of schizophrenia. Rudin46 found flaxseed oil therapeutic for schizophrenic
patients. He describes two types of pellagra (one of the schizophrenic syndromes). The best known
is caused by the deficiency of vitamin B-3. This is needed in the conversion of EFAs to
Prostaglandins. But if there is a deficiency of EFAs-even with adequate amounts of vitamin B-3-
there will still be a deficiency of Prostaglandins. He calls the first the "vitamin deficiency" type
and the second the "EFA deficiency" type. 47,41 Thus, in treating schizophrenia, one must take into
account the provision of all of the essential nutrients, including the EFAs.
MINERALS
ZINC AND COPPER
Kryptopyrrole was found in the majority of schizophrenic patients in Saskatchewan .49-'o After it
was identified, Carl Pfeiffer-formerly Director of Research at the Brain Bio Center near Princeton,
New Jersey, a facility that no longer exists-studied it intensively, named it pyroluria, discovered
that it bound both pyridoxine and zinc, thus causing a double deficiency, and described it
clinically. He considered that pyroluria characterized one of the three main variants of
schizophrenia, the other two being the high histamine and the low histamine groups. This work
drew attention to the role of zinc and copper since these minerals have an inverse relationship in
the body. To lower copper one can increase zinc levels. The book, Mental and Elemental
Nutrients, contains the first detailed description of the role played by zinc and copper in
schizophrenia.

Pfeiffer51,52 emphasized the copper as a negative factor and zinc as a positive factor. In the
large series of patients tested in his laboratory, very few patients had too little coppermost had too
much. He prepared a liquid solution containing 10 percent zinc sulfate and 0.5 percent manganese
chloride and gave patients up to ten or more drops per day of this preparation. I have found this to
be very helpful in treating patients with tardive dyskinesia, and I usually use one per day of the
common zinc tablets containing 50 milligrams of zinc.
SELENIUM
Selenium is a good antioxidant with antidepressant properties, so it should be a valuable adjunct
for treating schizo- phrenia.53 Foster54 conducted a massive survey of the relationship of various
diseases to the composition of the soils for minerals. He found that the prevalence of schizophrenia
is increased where fodder crops are selenium deficient. The correlation coefficient was 0.58, a
very high association for natural phenomena. The hypothesis that there is a relation between low
selenium levels and increased incidence of schizophrenia is further supported by more recent
data.55 He also found a negative correlation between mercury levels and schizophrenia. Selenium
is an antidote to mercury. Dietary deficiency of selenium increases the difficulty in making
prostaglandins in the body. The antioxidant glutathione peroxidase (selenoenzyme) contains
selenium. These findings suggest that selenium ought to be used in the treatment of schizophrenia. I
use 200 to 600 micrograms daily.
MANGANESE
Tardive dyskinesia is a neuromuscular reaction similar to Parkinson's disease. It causes various
tremors and random movements and can affect any group of muscles. It may be irreversible and
can be very debilitating. The most serious side effect of the tranquilizers was tardive dyskinesia
until clozapine came along with an even more serious side effect: death. Thus, if clozapine is used,
extraordinary precautions, including blood counts every two weeks, must be taken to safeguard the
patient's life. As new drugs were developed, this neuromuscular toxic side effect just described
was minimized to some degree. However, the drug companies have ignored the best solution of
all-to provide manganese. If each tablet of tranquilizer were to contain microgram amounts of
manganese it is likely this condition would not develop. Kunin56 showed that giving manganese
would remove tardive dyskinesia in most patients, and that using manganese in combination with
niacin worked even better. I have confirmed his observation and routinely add manganese to the
regimen when I see a patient upon intake who is already suffering from tardive dyskinesia. I have
rarely seen this condition in patients I have treated from the onset of their disease, but if and when
such symptoms appeared, manganese therapy promptly removed them. I use 30 milligrams of the
chelated manganese or Carl Pfeiffer's preparation-that is, 5 to 10 drops daily of a solution
containing 10 percent zinc sulfate and 0.5 percent manganese chloride. Patients treated by
orthomolecular methods do not get tardive dyskinesia.
MEDICATION
TRANQUILIZERS
The most commonly used drugs are the tranquilizers, first discovered around 1950 and introduced
to North America in 1955, and the antidepressants, an offshoot of the tranquilizers discovered
about 1956 and rapidly introduced to North America. We began our vitamin B-3 and vitamin C
studies before these drugs had been discovered. Chlorpromazine (thorazine in the U.S.) came from
France, where it was first used. It was rejected by most academics and especially by the National
Institute of Mental Health (NIMH), which at that time was under the thumb of psychoanalysts. The
drug was more readily accepted by psychiatrists working in mental hospitals after they saw how
quickly and effectively it controlled a patient's psychotic behavior.

It took a combination of immense and intense pressure from a large number of senators and
congressmen led by Mary Lasker before NIMH shifted its position about the tranquilizers. Mrs.
Lasker was influential in Washington, and the Lasker award was sought by many prominent
scientists. It took her determination and the help of many others to achieve a change in NIMH. The
drug companies saw the huge potential in these drugs and soon had persuaded almost all
psychiatrists that tranquilizers were the answer to the treatment of schizophrenia. It is true that
these drugs are very effective, and newer ones have been developed over the years. The problem
with the all the drugs used was that they were only partially effective and had many undesirable
side effects, such as dry mouth and tardive dyskinesia.

The Holy Grail is a tranquilizer which will cure the patients and have no side effects. In fact
we already have it: the orthomolecular regimen. Unfortunately, it has not been recognized and does
not have multi-billion-dollar drug companies to promote it. Though the newer drugs have fewer
troublesome side effects than their predecessors, none are more effective than orthomolecular
regimens in restoring the patients to health.
Tranquilizers and Recovery: A Catch-22
Reliance on tranquilizers alone creates a major dilemma for both the patients and the psychiatrists.
The problem becomes obvious as soon as one recognizes three facts.

1. Tranquilizers are helpful in reducing the intensity of the psychotic symptomatology (obvious
to anyone who has ever used these compounds), but they do not remove them.

2. Tranquilizers make normal people sick (obvious to anyone who has taken them in error, or to
the Russians who, committed to hospitals as dissidents, were placed on tranquilizers such
as thorazine, and were made psychotic this way). These drugs produced catatonic reactions
in animals, one of the early tests of drug efficacy.

3. Schizophrenia is a chronic disease. Once established it has a momentum of its own and runs
on and on until it is interrupted by some therapeutic measure.

Spontaneous recovery from schizophrenia is rare. Partial recovery is more typical-many of

these patients no longer complain of visual or auditory hallucinations but will suffer from chronic
depression or anxiety. In many cases, the thought disorder becomes manifest only under severe
stress, and for many only under the influence of alcohol. I have seen many alcoholic patients who
are very paranoid when drunk but do not display these symptoms when sober. Estimates of
recovery don't include the group of partially improved patients; instead, they are included in the
"recovered" group for statistical analysis so it looks as if the rate of recovery is 33 percent. My
opinion is that the true figure is probably closer to 10 percent and is based on the large number of
patients I have seen who have never had to go back to mental hospitals but who remained ill.

The problem with tranquilizer use is this. The drugs start the process of recovery by reducing
the intensity and frequency of symptoms and signs. But it becomes a Catch-22: As the patient
becomes more clinically and biochemically "normal," that person begins to react more and more
as if she or he were normal, which means they become psychotic from the drug. We are
considering two different psychoses-the initial schizophrenic psychosis described earlier, and the
tranquilizer-induced or iatrogenic psychosis characterized by both physical and psychological
symptoms. Physical side effects range from mild to severe, with the shaking and tremors and
grotesque involuntary muscular movements of tardive dyskinesia being the most severe. Interest in
sex may wane; males may also become impotent and refuse to remain on the drugs.

Psychologically, side effects may include perceptual changes, but they tend to be less intense
than if the patient were not medicated at all. The same is true of thought disorder-although it is not
as troublesome, there is increased difficulty in concentration, memory problems occur, and the
patients become increasingly preoccupied with themselves. Inertia, flat affect, and an inability to
feel sorrow or happiness are all side effects of tranquilizer use. Many of these tranquilized
patients lose the qualities that make men and women spontaneous, responsive, interested, and
interesting. In most cases, they cannot work in any responsible positions. I personally would not
allow a surgeon on 6 milligrams of resperidal to operate on me, nor would I want my bus driver to
be on 50 milligrams of Haldol.

So, this is the dilemma. How can we transform the original psychosis back into the normal state
without inducing the tranquilizer psychosis? Psychiatrists attempt to deal with this problem by
decreasing the doses and eventually taking their patients off the offending drug or by placing them
on a new drug. But since the disease process is still active, when the drug dose is reduced too far,
the original schizophreniainduced psychosis returns. Patients deal with this problem by refusing to
take the medication, preferring to be ill with their original psychosis rather than having to suffer
the ravages of the iatrogenic psychosis. Thus, patients tend to flip back and forth between these
two psychoses. Orthomolecular psychiatry gives them a third and appropriate choiceto become
well.
The Partnership of Tranquilizer Therapy
and Orthomolecular Regimens
Tranquilizers work very quickly. This makes them valuable to psychiatrists who want to see
rapid control of a disease state. But tranquilizers do not allow the patient to recover. On the other
hand, nutrients work very slowly. They often need many months to become optimally effective.
However, they never make anyone psychotic. By combining the two types of regimens using drugs
and nutrients, it is possible to take advantage of the rapid effect of the drugs. When the nutrients
have become effective, the amount of drugs needed to manage the psychoses can be gradually
reduced. The healthier the person is, the less the drug will be needed. In most cases, patients will
no longer need any drugs and will remain well on the nutrients alone. This resolves the dilemma of
side effects and compliance with therapy. Some patients need very low doses of drugs, so low that
there are no side effects. Many patients learn how to use the tranquilizers as needed, much as one
would take an aspirin for headaches.
ANTIDEPRESSANTS AND THE ORTHOMOLECULAR
REGIMEN
Antidepressants should be used when depression is a major component of the schizophrenia. I
started using clomipramine many years ago for my paranoid patients who were not deeply
depressed. It occurred to me that I had never seen a cheerful paranoid person. There seems to be a
very strong correlation between being paranoid and being depressed. This suggested that if I could
lift the mood of these paranoid patients, it would become easier to dispel their paranoid ideas.
Furthermore, clomipramine was also still the best antidepressant for the obsessive compulsive
conditions. Paranoid ideas often have this same type of obsessive characteristics. To test my
theory, I added clomipramine to the treatment regimen of a chronic schizophrenic who had been ill
since he was thirteen and who had remained paranoid throughout his therapy. For example, he was
afraid to leave the house because he "knew" that the children half a block away were talking about
him. After three months on clomipramine, his paranoid ideas had receded and, after several years
on that antidepressant, were almost gone. Eventually, I was able to take him off the clomipramine
and he remained much improved. I have used this approach many times over the years, and in most
cases it works well.
OTHER MEDICATION AND THE ORTHOMOLECULAR
REGIMEN
Drugs such as lithium, the benzodiazepines, anticonvulsants and so on, are used for the same
conditions in the same ways as they would be by any traditional psychiatrist. The orthomolecular
program is compatible with all medications. Over the course of treatment, the amount of drug
needed in combination with the orthomolecular program is very much lower than it is when drugs
alone are used. This is one of the reasons why tardive dyskinesia is not seen as a side effect when
orthomolecular treatment is used in conjunction with other medications.

I have treated several patients with tardive dyskinesia (TD). I start them on the regimen and add
manganese. Kunin showed that the combination of manganese and vitamin B-3 was very effective
in preventing and treating TD.

A survey by Dr. David Hawkins,57 one of the pioneers in this field, showed that in over 58,000
patients treated by orthomolecular doctors there were no cases of TD. This in itself is an adequate
reason for the nutrients to be used.
PUTTING IT ALL TOGETHER
PATIENTS ALREADY ON MEDICATION
The following case history illustrates my treatment program. Every patient is, of course, unique,
and will need an approach that is best suited to that person. But this patient's treatment history is a
model on which the orthomolecular treatment can be based. (I assume that most readers of this
discussion will not have access to the more sophisticated modern tests for allergies, for blood
levels of amino acids and vitamins, etc. A survey of these tests is available from Kunin,58 whose
book describes, references, and codes over fifty procedures.)

Michael, born in 1927, was brought to my office by his wifeA and brother in June 1993. He
was obese (250 pounds at 5 foot 11 inches), confused, and appeared retarded. He showed no
emotional reaction and answered questions briefly. I had to depend on his relatives to give me his
history. He had not worked for ten years.

He married at age twenty-seven and shortly after that was treated in a psychiatric ward for his
first mental breakdown. At age forty-six he suffered another breakdown, and he was admitted
again at age fifty-nine and improved after three weeks on medication. However, he had been
deteriorating steadily during the year before I saw him and had become so confused he could not
drive. During the course of his illness he had about five series of electroconvulsive therapy during
at least five hospitalizations.

He displayed perceptual and thought disorder characteristic of the schizophrenic syndrome. He

heard voices, believed that people were staring at him, was very paranoid, and believed people
were plotting against him. He had often complained to his wife about the telephone being bugged.
His memory and concentration were very poor, and he was confused. At times he was agitated and
excited, but he never had manic-depressive mood swings. He was medicated daily with 800
milligrams of chlorpromazine, 900 milligrams of lithium, and 32 milligrams of perphenazine. He
needed to take a drug to protect him against the side effects of these drugs. These are very high
doses, so high I have seldom had to use these levels in forty-five years of psychiatry.

He met my diagnostic criteria for schizophrenia. I discussed this with him and his family, and
told him that schizophreniaB was a biochemical disorder and that it was best treated by the use of
the right nutrients in combination with the drugs he was then taking.c Then I advised him to change
to a sugar-free diet, adding 1 gram each of niacin and ascorbic acid' after each meal. The vitamin
C was added to reduce the bodily stress of the enormous drug doses. I told him I wanted him to
avoid sweets, except for fruit, in order to remove most of the additives from his diet and to help
him lose weight. There was no evidence he suffered from food allergies.

One month' later, he was a little better. His family had decreased his chlorpromazine (CPZ)
("thorazine" in the U.S.) to 700 milligrams daily. By the end of that year he had lost thirteen
pounds, was on 300 milligrams of CPZ, and 16 milligrams of perphenazine. His family members
were pleased with his progress as they saw his pre-illness personality reemerging.

One month later, he developed severe chills, fever, confusion, and a bladder infection, and was
nearly comatose. He was admitted to hospital where the doctor in charge would not permit him to
take vitamins. Each day in the hospital, off his vitamins, he deteriorated more and more, and was
started on resperidal.F After discharge, his family stopped the new drug and restarted my
regimen.G He was now on 600 milligrams lithium, 16 milligrams perphenazine, 200 milligrams
CPZ. On March 22, 1994, 1 increased his niacin to 2 grams after each meal.H His mood was good.
By the end of April, he weighed 223 pounds and was walking a lot more. The voices were
receding and he was much less paranoid. I decreased his CPZ to 150 milligrams. On June 9, I
added 1,200 milligrams (international units) of vitamin E and decreased the CPZ to 100
milligrams.' But a month later I had to increase it to 125 as he developed nausea.] He had now
gone for entire days without hearing any voices. I added 5 milligrams of folic acid three times each
day.'

By October 1994, he was normal. By December 1994 his CPZ dose was decreased to 50
milligrams; his weight had dropped to 217 pounds. He continued to improve and by June 1995, the
voices were gone, his memory was much better, and he was off all medication. When he had
difficulty sleeping in September 1995, I added 2 grams of tryptophan to be taken on an empty
stomach before bed. Early in 1996, he would take 50 milligrams of CPZ occasionally. In July 1997
he was still normal. The last time I saw him he was alert, relaxed, at ease, spoke easily, and joked
with his wife. We discussed his painting when I discovered he was an artist. I thought he was
normal as did his wife; he had no complaints and felt well.

He fulfilled my criteria for recovery: he was symptom free and got on well with his family and
with the community. I expected he would be back at his artist profession. He had reached my
therapeutic objective: to get him off drugs, cured of his tranquilizer psychosis, and cured of his
schizophrenia. The odds are very good that he will not relapse as long as he remains on his
orthomolecular program. If relapse does occur, he might need some revision of his treatment. He
will do well unless he falls into the hands of a psychiatrist who does not believe the nutrient
program helped him, and insists he again be put on the tranquilizers from which he had suffered so
much for so many years.

After the patients recover, I advise them to stay on the orthomolecular program for at least five
years, or better still, for the rest of their lives. It leads to a dramatic improvement in the quality of
life and probably an increase in life span as well.59 Notes on this patient's treatment:

A. I find it very helpful to have the family in my office during the interview, with the patient's
permission. A lot of time is saved in gathering the information needed to make the diagnosis. It
also helps when the family hears the discussion and knows what the treatment will be. Although
most psychiatrists no longer blame the family for the illness of a relative, it can still occur. It is
important to remove any guilt the family may have derived from previous outmoded, harmful
explanations.

B. Although my patient was clearly schizophrenic, he also showed all the features of the
tranquilizer psychosis I discussed earlier. The problem was how to get him off the medication that
was destroying him without causing a relapse into his schizophrenic state. I did not have to talk to
his family about the tranquilizer psychosis. They had been aware of this for a long time. Patience is
a very important factor in achieving a positive treatment outcome. If the drugs are withdrawn too
rapidly, there is bound to be a marked reaction and a precipitous return to the original
schizophrenic state, as the disease is still burning brightly in the body and the vitamin program has
not had enough time to become fully operative. If a therapist does not have the patience to work for
years with such a patient, it is a disservice to the patient to undertake the treatment.

C. The patient's obesity was caused by the excessively high intake of drugs and his resultant
inactivity. It is important that a therapist do everything possible to restore the patient's self-
confidence; helping them regain their earlier physical state is a good place to begin, so if they are
too fat or too thin, this must be dealt with.

D. I prefer niacin for middle-aged men and women who may also have blood circulation
problems in addition to their schizophrenia. Usually they can tolerate the initial flush without much
discomfort.60 Schizophrenic patients generally do not flush as much as nonschizophrenic patients.
Dr. D. Horrobin61,6z,6a has developed a diagnostic test based upon this finding. He applies an
adhesive strip containing four different concentrations of niacin. After five minutes, the strip is
removed. He found that most patients with schizophrenia do not have any erythema, the areas under
the strip do not turn red, whereas most other people do show the reddening reaction. There is very
little overlap. This test will soon be available commercially. If the vasodilatation could cause
embarrassment to the patients, or if they are younger, they may prefer to take niacinamide. Both are
probably equally effective, but the advantage with niacin is that one can prescribe much higher
dosage without getting the patient into the upper dosage limit marked by nausea. Often,
schizophrenic patients do not flush at all at the beginning. Some have started flushing only after
months or years of treatment and this physical reaction is accompanied by a sudden major clinical
improvement.

E. If the patient is very psychotic or the family very disturbed I will agree to see them again in a
week or two. However, in most cases patients already controlled by drugs do not have to be seen
more frequently than every month. As they get better, the interval between visits is increased.
When they are well, they no longer need to see me, but they know they can call me at any time to
renew the therapeutic relationship.

F. Being denied access to their vitamins is a common problem for my patients who have to be
admitted to a hospital. Doctors are so ignorant of the value of vitamins that they either fear using
them or think them valueless. This attitude is declining as families and patients are become more
forceful in demanding to be allowed to continue the vitamin program. A few of my patients have
been so demanding that the hospital relented and allowed them to remain on the regimen. One of
my patients, a young male, took vitamins the whole time he was in the hospital. The staff did not
know this. He walked about in big boots with the tops unlaced; all his vitamins were hidden in his
boots and he told me about this after discharge. He recovered. When patients are taken off the
program they tend to deteriorate, and often after discharge I will have to start the orthomolecular
program all over again. This is a pity; one day I hope that it will be considered unethical or even
malpractice to force a patient to discontinue a vitamin regimen while an inpatient.

G. It is obvious that the patient and his family had no trust nor respect for the doctors who were
treating him in the hospital. They liked and trusted me and resented the attempts of the hospital
doctors to interfere with my treatment. Having seen the effect of using drugs alone, they wanted no
more of them.

H. I often double the dose of niacin if I want to accelerate the recovery. The increased niacin
would make it easier to get off the drugs.

I. I have regretted not having run a therapeutic trial with vitamin C alone, one of the body's
more effective water soluble antioxidants. Since schizophrenia is one of the free radical diseases,
it makes sense to also treat schizophrenics with vitamin E. which of course has many other
beneficial properties.

J. One way of determining the optimum dose of any drug is to either increase or decrease it.
Symptoms will reappear if the dose is decreased too quickly and then the dose must be adjusted
upward.

K. Folic acid participates in transmethylation reactions as does nicotinic acid. I find that adding
folic acid improves its efficacy, at least in the treatment of atrial fibrillation, and I assume it will
be equally helpful for schizophrenia. It has no side effects. It is available with prescription as 5-
milligram tablets.
PATIENTS WHO ARE NOT ON MEDICATION
Most of the patients I see have already been diagnosed and started on treatment by other
psychiatrists. They are referred to me only because they have not responded to the program they
were advised to follow. But I do see a few who are becoming ill and who have not been treated. In
those cases, I follow the same principles using the same nutritional and nutrient approach, but I
may not use any medication. If they are very depressed I will use the antidepressants. If they are
too anxious and restless, I will use the other drugs in combination. But almost every patient needs
only small doses of the tranquilizers and the antidepressants until recovery, when they no longer
need them.
RESULTS OF ORTHOMOLECULAR TREATMENT
ACUTE PATIENTS
"Acute" refers to the class of patients who are sick for the first time or who have recovered from
an episode and have relapsed. We used this class of people in our six doubleblind. controlled
experiments started in Saskatchewan in 1953 to 1960.

For our first double-blind experiment we randomized thirty patients into three groups: one was
the placebo group, a second was given niacin (niacin cannot be blinded because of the flush), and
the third took niacinamide, which does not cause any flush-this was our hidden control group. The
clinical staff knew only that there would be two groups: placebo and niacin. They would therefore
assume that all nonflushing patients were getting placebo, but in fact half of them were on
niacinamide. We found out later that the vitamin groups yielded the same results. We found the
usual 35 percent response over two years from the placebo group, and a 75 percent response from
the vitamin groups.

The rest of the controlled experiments gave identical results.

Based on this early experience and upon my personal experience in treating over 4,000 patients
since 1952, I can report with confidence that with this acute class of schizophrenics one should
expect a 90 percent recovery rate if the therapeutic regimen is followed for at least two years
under the supervision of a patient physician who is dedicated to getting the patient well.

Many years ago, a report appeared in the psychiatric press describing the outcome of treatment
of about forty-two physicians who had become schizophrenic and were treated with drugs. The
outcome was dismal. Only twelve were able to resume their practices, and of these, six were able
to do so because their wives were nurses who ran their practices, with the schizophrenic doctors
assuming responsibility for the patients' prescriptions. In sharp contrast, I know of seventeen
teenage schizophrenic males who recovered on orthomolecular therapy. They went to college,
became doctors, and today are practicing medicine and psychiatry. One of them, my patient,
became the president of a major psychiatric organization in North America. Ironically, this very
association attacked the work I was doing with vitamin therapy. They did not know that their
president had failed to get well on placebo but did recover when given niacin. Of this small group,
one is chairman of a large department in a medical school, one is a research psychiatrist, one
heads a large clinic that he founded, and so on. Among the schizophrenic doctors I have treated, all
recovered and became active in the orthomolecular field.

Every physician who has treated this class of patient with the regimen I have described has
obtained identical therapeutic results. The specifics of these therapeutic results are described in
many reports, most of which have been published in the Journal of Orthomolecular Medicine.M,6 ,
, 67,68,69,70,71,72,73,74.
CHRONIC SCHIZOPHRENIC PATIENTS
There are two classes of chronic patients: those permanently institutionalized and those who have
managed to be cared for by resources other than institutions. Let us look at each category.

Those who have been permanently incarcerated in institutions. With the remarkable success of
the deinstitutionalizing program in emptying the mental hospitals in North America, the majority of
the patients have been dumped into nursing homes, run-down hotels, and, of course, the streets.
About 35 to 50 percent of the homeless street people in the major cities are such chronic patients.
Dr. T. P. Millar,75 a Vancouver psychiatrist, concluded, "Maybe the back wards of our mental
hospitals were bad but surely they were more hu mane than what is happening now. I suppose
blaming hospital physicians for sending such sick persons out into the community dispose of the
problem for the ignorant, both lay and professional. It sure doesn't do a thing for those demented
souls freezing to death on our mean and uncaring streets."

I have had no experience in treating them. It would be impossible to do so unless they were in a
hospital setting, since they need shelter and care, as well as good nutrition and ,support.

Chronic patients who have been sick continually or have had fluctuation in their illness, but
have been cared for in their homes or have been able to find shelter somewhat better than one finds
on the streets. With this latter group, the treating doctor must have a great deal of patience. I have
often wondered why the first orthomolecular pioneers like Allan Cott, Harvey Ross,. Moke
Williams, Jack Ward, and many others, who were psychoanalysts by training and experience, were
such good orthomolecular physicians. The reason became obvious later on. They were physicians
who had been trained to be patient and caring. They were not accustomed to the in-andout
emergency-room mentality, in which hospitals are first aid stations designed to rapidly tranquilize
patients and discharge them as soon as possible. Modern psychiatrists are accustomed to seeing
very rapid responses to drugs; they do not have the patience to work gradually with their patients
over the course of many years. Modern psychiatric wards are tranquilizer filling stations similar in
function to gasoline filling stations. Patients are admitted for a refill and rapidly discharged,
irrespective of their real mental conditions.

I have approximately 500 chronic patients under my care. They are seen from once per month to
once every few years, depending on their need for program adjustment. I recently pulled out
twenty-seven charts from my files and found that seventeen of them have reached a well status.76
They had been sick, on average, for seven years before I saw them. They had failed to respond to
any prior treatment including drugs or ECT, and they had remained on my program for ten years. In
most, the major surge to recovery occurred at about seven years. Therefore, if treatment is
discontinued too soon, the optimum therapeutic effect will not occur. One of my complaints about
psychiatric hospitals is that on the rare occasion when my patients are admitted, the hospital
promptly stops my whole program, places them on other medication, and takes away their
vitamins. When they are discharged and return to me, I have to start them all over again.

The following history illustrates the slow pace of recovery in one patient and the happy final
outcome. Lena came to see me in October 1988, with her father. When they walked into my office,
my first impression was that she was either severely retarded or a chronic deteriorated
schizophrenic. She was unable to tell me anything and sat looking to one side the whole time,
afraid to look squarely at me. I obtained the first history from her father. During her sixth grade
year in school, her parents were told that she was unable to learn. From then on, she went to
special classes. About one month before she came to see me, she had fallen asleep in her chair and
had spent the night there. Her parents awakened her. She accused them of trying to drown her and
ran away. The police picked her up later on, called her parents, and took her home. Her father
complained that she suffered from unusual blotchy skin and that her hands became very sweaty
when she became excited.

The mental state examination revealed only that she was paranoid, believing people were
saying nasty things about her. I concluded that she was a learning disordered adult, a condition
present from childhood. I started her on 1 gram niacinamide after each meal, the same amount of
vitamin C, 250 milligrams pyridoxine, and 50 milligrams zinc gluconate each day. Six months
later, her skin was normal, she was less depressed, had more self-confidence, and found it easier
to communicate. She was no longer paranoid.

During July 1988, she had to be admitted to the hospital. This time, she complained about
hearing her parents' voices when they were not present. I rediagnosed her chronic schizophrenia.
She was started on small doses of thioridazine and was discharged a few days later. She was
admitted again in March 1990, after her mother had advised her to stop the tranquilizer. She was
admitted for the last time in March 1990, for 7 days. She was discharged on the same vitamin
program with 300 milligrams daily of thioridazine, the average dose for this tranquilizer. She no
longer hallucinated her parents' voices.

By the end of 1990, I was able to reduce the drug to 100 milligrams daily. By the end of 1991,
she was getting along well and working part-time. She had been free of the voices. The drug was
decreased to 75 milligrams in April 1992. She was cheerful, working at the same job, getting
along well with her fellow workers. She was on 25 milligrams of the drug plus the same vitamins
in January 1993. She was less sleepy, more cheerful and communicative. I kept on reducing the
drug, but at the end of 1994 had to increase it back to 50 milligrams. Early in 1996, the drug dose
was down to 25 milligrams.

She came to see me in July 1996, very excited. She was free of all symptoms. She brought
along her math test results and had scored 100 percent. She proudly showed me the certificate she
had received for her scholastic performance. She was a better reader than the other patients in her
class and was not afraid to read in front of them. She told me that she was very happy because her
parents, who had not been getting along, had reconciled and were enjoying each other's company
again for the first time in many years.

The woman I had seen eight years earlier no longer existed. She had been transformed from a
sick-looking woman who had the appearance of a retarded person (as used to be portrayed in old
textbooks of psychiatry) and who would answer my questions but would look off to the side, to a
young woman who dressed well and spoke freely to me. She now enjoyed coming to the office and
especially enjoyed saying hello to my secretary and getting a hug from her. She interacted more
appropriately, spoke more spontaneously,, and engaged me in conversation while looking at me. I
wrote to the referring physician, "It is always a delight to see how much improvement Lena is
showing as I continue to see her. Today she was feeling really good, was very cheerful, and was
especially delighted because her parents, who apparently had not been talking to each other for
years,

are getting along very much better. I think she is doing great." Lena has met all four criteria for
recovery, but does not earn enough to pay income tax. She has been sick so long that the handicap
of those lost years has not yet been resolved. But she is learning more skills in a fine rehabilitative
program. Without the vitamins, she would have remained the same dowdy, retarded-looking
woman with no hope of ever getting any better. She remains well.

Another example is a paranoid schizophrenic man from Toronto who had been treated several
times in different hospitals. His wife divorced him and his family disowned him. He drifted to
Victoria and lived on our street for about three months. He was referred to me, and to my surprise,
remained on the vitamin program. After his second visit, I advised him to remain in the care of his
general practitioner who had referred him.

About eight years later, I met the patient in a supermarket when he came up and introduced
himself to me. I found out he was looking for work. He had just graduated with a B.A. from the
local university. He had reunited with his family, was well, and though unemployed, was taking
part in community activities.

A third case was the woman who burned her house down in response to voices. She is now
well and the proud owner of a company that employs about thirty people.

My experience with chronic patients has convinced me of the following things:

1. Chronic patients must be treated patiently and continuously, with adequate support.

2. A combination of medication and nutrient therapy offers the advantages of the rapid effect of
the drugs and the slow curative effect of the nutrients. This permits a gradual reduction of
medication until the dose is so low the drug no longer creates the tranquilizer psychosis.

3. Schizophrenia in children may take the form of a learning disorder so that normally
intelligent persons appear to be retarded. Lifting the psychosis by means of orthomolecular
therapy will remove the apparent learning difficulty.

About ten years ago in New Orleans we put on a oneand-a-half-day training session for
physicians at a meeting of the Huxley Institute of Biosocial Research. During a break, I remarked
to a psychiatrist taking the course that if he used the orthomolecular regimen for one year he would
never give it up. I received a long letter about six months later. He started out by saying, "Dr.
Hoffer: You told me that if I used the program for one year I would not give it up. You were wrong.
I have used it only six months and I will never give it up." Then he told me he was working in a
state clinic responsible for the care of 1,200 schizophrenic patients, and his job description meant
supervising their injections of drugs. His work had become so frustrating and boring, because he
had not seen any recoveries, that he was thinking of leaving his practice. But his world changed
after he started the orthomolecular program. He became very interested and was eager to arrive at
the office each morning to see which patients were showing considerable improvement and getting
well. Eventually, he left his clinic position and opened a private practice. He also became one of
the instructors in orthomolecular therapy.

I have no doubt that if the few mental hospitals still in existence (some of which are being run
by prisons) placed their patients on this orthomolecular program, they would find a major
improvement in their patients over the years and a significant decrease in violent episodes.

I examined twelve of the most violent prisoners in the Prince Albert Penitentiary in northeast
Saskatchewan many years ago. I found nine of them were chronic paranoid schizophrenics who
were violent because, in most cases, they believed they had to defend themselves against their real
or fancied enemies. One patient from this prison escaped and took two Royal Canadian Mounted
Police officers as captives. He was eventually recaptured, and I saw him preparatory to his
defense. He told me that he had to escape because the prison guard had decided to kill him. He
"knew" this was true because he could smell the gas coming from the air vents. He tried repeatedly
to plug the vent with clothes, to the annoyance of the staff. He "knew" they were also poisoning
him because he could taste the bitter poison in his food, and he knew there was a plot because they
were always talking about him. He was clearly schizophrenic. These schizophrenic prisoners need
a treatment trial with the orthomolecular approach, but it is highly unlikely they will ever be
treated adequately without it.
THE FUTURE FOR ORTHOMOLECULAR
TREATMENT
When the first prominent institutions-medical colleges or research bodies-become interested and
venturesome enough to test these claims and publish their results (assuming that they follow these
protocols), there will a rush from all other curious centers to start using the orthomolecular
approach. If and when orthomolecular therapy is widely accepted, the whole field of the
biochemistry of schizophrenia and its treatment will flourish.

It would be very exciting to come back in the year 2020 to see what has happened to this field.
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67. Hoffer, A. and Osmond, H. How to Live with Schizophrenia. New York, NY: University
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68. Osmond, H., and Hoffer, A., "Schizophrenia and Suicide," Journal of Schizophrenia 1: 54-64,
1967.

69. Hoffer, A. "Five California Schizophrenics." Journal of Schizophrenia 1: 209-220, 1967.

70. Hoffer, A. "Treatment of Schizophrenia with a Therapeutic Program Based upon Nicotinic
Acid as the Main Variable," Molecular Basis of Some Aspects of Mental Activity, vol II., ed.
0. Walaas, New York: Academic Press, 1967.

71. Hoffer, A. "Mechanism of Action of Nicotinic Acid and Nicotinamide in the Treatment of
Schizophrenia." In Orthomolecular Psychiatry, ed. D. R. Hawkins and Linus Pauling. San
Francisco: W. H. Freeman and Co., 1973.

72. Hoffer, A. "Natural History and Treatment of Thirteen Pairs of Identical Twins, Schizophrenic
and Schizophrenic-spectrum conditions." Journal of Orthomolecular Psychiatry 5: 101-122,
1976.

73. Hoffer, A. and Osmond H., "Schizophrenia: Another LongTerm Follow-up in Canada." Journal
of Orthomolecular Psychiatry 9: 107-113, 1980.

74. Hoffer, A. "Orthomolecular Medicine." In Molecules In Natural Science and Medicine, An

Encomium for Linus Pauling. Ed. Z. B. Maksic and M. Eckert-Maksic, Chichester, England:
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75. Millar, T. P. "The Revolving Door Is Stuck on Out." The Medical Post, May 20, 1997.

76. Hoffer, A., "Chronic Schizophrenic Patients Treated Ten Years or More." Journal of
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