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Orthomolecular Medicine News Service, January 17, 2017

To Give Credit Where Credit is Due

Commentary by Allan N. Spreen, MD

(OMNS, Jan 17, 2017) It caused me a degree of chagrin to read the interview published by Medscape on Nov. 8, 2016, concerning the possibility of a nutritional supplement preventing mental illness.[1]

The interview is with a Dr. Robert Freedman, the psychiatrist who treated James Holmes, the man involved in the shooting of twelve movie-goers in a theater in 2012. Since clearly the current treatment of such individuals appears to leave something to be desired, the article discusses the possibility of a lack of a properly functioning nicotinic acetylcholine receptor being involved in mental disorders.[2] This receptor type is widely distributed in the brain. Dr. Freedman realized that, because a nicotinic acetylcholine receptor binds nicotine from tobacco smoke, it might explain the "very heavy rates of smoking in patients with schizophrenia; they might be self-medicating to increase activity of the faulty receptor."

The detailed interview latches onto the possibility that some pregnant women may have a deficiency of choline (which I don't doubt for a moment, along with many other deficiencies), due to its apparent ability to affect acetylcholine receptors in the brain.

The discussion quickly segues into the world of genetics, as he mentions the discovery that "There are also genetically (sic) abnormalities in the regulation of choline, some of which are also associated with schizophrenia." Other genes associated with schizophrenia are touched upon, putting the discussion into the realm of today's technically hot (and scientifically acceptable) topic of gene research. There is no mention of epigenetics, which alters all sorts of genetic factors.

When asked, "What other preventive measures for mental illness have been studied?" Dr. Freedman asserts, "There's not much out there." (emphasis added) He also laments the fact that "(t)he National Institutes of Health are not currently funding any trials of interventions in humans during pregnancy to prevent mental health problems." I certainly have to agree with him there, though one always must look carefully at some of the past results obtained.

A Patient's Letter to Abram Hoffer:

"I "lost" my mind after my third child was born. I was finally diagnosed with bipolar disorder and was put on lithium and Paxil. For the next two years I lived life from the couch with not enough energy to cook meals or respond to the children's needs. I cycled every three days and dealt with almost constant horrible suicidal thoughts. My weight grew from 123 to 200lbs until I discovered nutritional therapy."

"My mental symptoms disappeared within just a few weeks of supplementing with niacin and other vitamins. I was then able to get off the medications that were making me so lethargic."

"Now I have my life back, and my children have their mother back. I feel very fortunate to have your research and that of others in your field to back up the "miraculous" healing that I experienced. It gives me much comfort and assurance that I am not the only one being helped so tremendously by megavitamin therapy."

"Sincerely, Nicole and children:" (Letter to Abram Hoffer, originally published in the Doctor Yourself Newsletter, Vol 2, No 25, Nov 5, 2002.)

Now, to prevent any confusion in the reader's mind, the type of acetylcholine receptor mentioned in the article by Dr. Freeman, a "nicotinic acetylcholine receptor", is one of two classes of acetylcholine receptor (the other being muscarinic) in the brain. A nicotinic receptor opens a membrane ion channel to activate a neuron when it senses the presence of nicotine. The reader should not make the mistake that a "nicotinic receptor" could be functionally related to "nicotinic acid," another name for niacin. Although niacin was originally derived from nicotine, they are different molecules and have different biochemical functions in the body.[3] Niacin does not bind to the nicotinic acetylcholine receptor mentioned by Dr. Freeman. However, niacin has a long history of correcting mental illness problems including schizophrenia.[4,5]

Not to rain too hard on anyone's parade, but in a topic as serious as schizophrenia (and its effects on anyone near the disorder), it is somewhat mind-blowing that, when specifically studying the effect of nutrition on the brain, the pioneering work of Dr. Abram Hoffer, MD, PhD, is totally ignored. Well over half a century ago, and without the advent of advanced genetics, Dr. Hoffer (and others) found an important link between niacin and schizophrenia.[4-7] The identification of a specific gene was less important, clinically, than the finding that there was a biochemical problem with the body's ability to either absorb, or assimilate niacin, otherwise known as vitamin B-3. Using niacin in (sometimes very) high doses (dare I say 'megadoses'?), he found that the delusions of schizophrenia could be successfully controlled!

"Like the author, it blows me away the way Dr. Hoffer's explanation of the relationship of niacin to schizophrenia is dismissed. Finding a solid biochemical basis for disease surely beats what is revealed from being on the couch." - Ralph Campbell, MD

On the more personal side, this niacin treatment certainly was a major factor in the recovery of my sister, who was institutionalized, our parents told that she would never be a useful, productive member of society; "It's permanent," they said. "Drug her up and get over it." Eighteen months after Dr. Hoffer's intervention with niacin, she was accepted to law school, graduating, on time, as an attorney. (Whether that qualifies as a useful, productive member of society is a separate issue.)

It saddens me that such powerful and insightful work, available for over half a century, can be totally overlooked, particularly when the topic is the treatment of schizophrenia using dietary nutrients.[8] My personal opinion is that, once the moniker of "orthomolecular" or "megavitamin" is applied, useful and effective therapies can end up being ignored. In this case, an old "wheel" of preventing illness with diet was reinvented, and perhaps the new one isn't even totally round: I'm for choline, too, but I'm also for inositol along with the entire membership of the B-complex, in amounts that get the job done on an individual basis.[8,9]

If one cares to look, there's a lot out there. Grateful thanks to Dr. Abram Hoffer for starting us on this productive pathway so many years ago.

To learn more:

Interview with Dr. Hoffer: , from Journal of Orthomolecular Medicine Vol. 24, No. 3, 2009.

Niacin Therapy as Used by Dr. Hoffer:

Dr. Hoffer's Detailed Reply to Critics of Niacin Therapy

A Short Autobiography:

Schizophrenia: , from Journal of Orthomolecular Medicine Vol. 10, No. 2, 1995.

Vitamin C Therapy for Cancer Patients:

Niacin, Coronary Disease and Longevity:


1. Stetka B, Freedman R "Can a Prenatal Supplement Prevent Mental Illness?", Medscape Family Medicine - Medscape Psychiatry, Nov 8, 2016.

2. Freedman R. Alpha7-nicotinic acetylcholine receptor agonists for cognitive enhancement in schizophrenia. Annu Rev Med. 65:245-261, 2014.

3. Laurence Brunton L, Chabner B, Knollman B. Chapters 11, 31 in: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th Edition, McGraw-Hill Education / Medical; 12 edition, 2011, ISBN-13: 978-0071624428.

4. Hoffer AF, Osmond H, Smythies, Schizophrenia: a New Approach. II. Results of a Year's Research. J. Mental Sci. 100: 29-45, 1954.

5. Hoffer A, Osmond H, Callbeck MJ & Kahan I: Treatment of schizophrenia with nicotinic acid and nicotinamide. J. Clin. Exper. Psychopathol. 18:131-158, 1957.

6. Hoffer A, "Niacin Therapy in Psychiatry," CC Thomas, Springfield Ill, 1962.

7. Hoffer A, Saul AW. Niacin: The Real Story: Learn about the Wonderful Healing Properties of Niacin. Basic Health Publications. (2015) ISBN-13: 978-1591202752.

8. Ames BN, Elson-Schwab I, Silver EA. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms. Am J. Clin. Nutr. 57:616-658, 2002.

9. Hoffer A, Saul AW, Orthomolecular Medicine for Everyone: Megavitamin Therapeutics for Families and Physicians. Basic Health Publications, 2008. ISBN-13: 978-1591202264.

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