Angst in the twenty-first century.

Anxiety: Orthomolecular Diagnosis and Treatment

by Jonathan Prousky, ND, BPHE, BSc, FRSH

Introduction by Abram Hoffer, MD, PhD, FRCP (C)

Softcover; c. 2006; $17.95 US; $24.95 CAN; 127 pp.

My old College Edition Webster's defined anxiety as "a state of being uneasy, apprehensive, or worried about what may happen; misgiving." This seems like a common enough human condition--isn't everyone anxious about something, sometimes? Of course, it's a matter of degree. When it's a constant condition and debilitating, anxiety is considered a mental disorder. The current psychiatric diagnostics classifies anxiety disorders into various categories, such as generalized anxiety (GAD), obsessive-compulsive disorder (OCD), panic disorder (PD), post-traumatic stress disorder (PTSD), and social phobia/social anxiety disorder (SAD).

There is even more fine-tuning, as "most patients do not meet the criteria necessary for a diagnosis of a primary anxiety disorder; rather, patients usually have a diagnosis pertaining to one of the following four categories:

1. Adjustment disorder with anxious mood

2. Anxiety due to a general medical condition

3. Substance-induced anxiety disorder

4. Anxiety associated with another psychiatric condition."

This certainly outshines "apprehensive" and "misgiving," and undoubtedly keeps the psychiatrist busy; just reading the categories elicited some slight anxiety in this reviewer!

On a more serious note, this criteria is tricky: "The medical diagnosis of an anxiety disorder can be arbitrary," and "Despite different diagnoses, treatments for the nine descriptive DSM classifications are relatively the same." Why bother with all the little nuances, then? Abram Hoffer summed up the problem with the current system of psychiatric diagnosis:

  In psychiatry, we are still in the pre-rational stage of diagnosis.
  All psychiatric diagnosis is descriptive and has almost nothing to do
  with cause, nor does it have much to do with treatment. Thus, of the
  approximately 50 different diagnostic terms (with code numbers) for
  disturbed and sick children, no matter what the final code or word is,
  the modern treatment is the same--Ritalin--and lip service to
  psychotherapy.

Orthomolecular medicine considers anxiety a functional problem as well, but goes one step further by elucidating plausible causes. From the orthomolecular perspective, "anxiety results from the perturbation of brain function due to nutrient deficiencies, nutrient dependencies, cerebral allergies, and/or hypoglycemia." The author describes nutrient deficiencies and dependencies and associated cerebral allergies, viewing cerebral allergies as "an ecologically induced mental illness." Thus, the human brain is vulnerable to insults from the environment, whether from inhaled or ingested sources. Mainstream psychiatrists do not, of course, acknowledge environmental causes as yet (maybe they'll come around as President Bush did on global warming).

Low blood sugar (hypoglycemia) can also cause anxiety: "Refined foods and sweets tend to be the cornerstones of the anxiety patient's diet. This leads to a chronic state of inadequate nutrition, overwhelmed blood glucose regulatory systems, and an inability to cope." Hypoglycemia should always be considered when diagnosing anxiety disorders.

The star of orthomolecular treatment for anxiety is niacinamide (vitamin B3). Dr. Prousky illustrates the protocol and outcomes with four cases of anxiety from his practice. It's believed that the mechanism of action of micotinamide treatment could include several factors: correction of subclinical pellagra; correction of an underlying vitamin B3 dependency disorder; Benzodiazepine-like effects; ability to increase the production of serotonin; ability to modify the metabolism of blood lactate (lactic acid). Dr. Prousky believes that most often niacinamide corrects a vitamin B3 dependency. Most patients require a minimum of 2000 to 4500 mg per day to achieve therapeutic results.

Another useful B vitamin in the orthomolecular treatment of anxiety is vitamin B12 (cobalamin). Patients most likely to develop vitamin B12 deficiency have clinical conditions, such as atrophic gastritis, bacterial overgrowth of the small intestine, or pernicious anemia. However, many anxiety patients seem to benefit psychologically from regular injections of vitamin B12, despite the absence of disease. Other B vitamins with anxiolytic effects include thiamine (B1) and pyridoxine (B6), which are discussed along with inositol and essential fatty acids. Evidence-based studies have shown these orthomolecular treatments to be very effective for the management of anxiety. Side effects are rare, making it a first-line treatment.

An important chapter on hypoglycemia-related anxiety points out the difficulties in diagnosing among the many symptoms such as cerebral allergies, and the importance of administering functional laboratory tests of glucose tolerance. This slender volume can guide patients (and practitioners) through and around the land mines of mainstream psychiatry and their pharmaceutical treatments, which are sometimes effective, but always harmful, as well.

"The most important aspect of evaluation involves ruling out organic
cause(s) and making certain that alcohol abuse/dependence is not a
factor in the patient's complaint of anxiety."

review by Irene Alleger