The study of micronutrients and mental health is known as orthomolecular psychiatry, a term coined by two-time Nobel laureate Linus Pauling in a controversial 1968 essay. Pauling wrote that nutritional supplements, unlike psychotherapy or drugs, represent a way to provide “the optimum molecular environment for the mind.” Varying the concentrations of substances normally present in the human body, he wrote, may control mental disease even better than conventional treatments.
Today the Society for Orthomolecular Health Medicine counts about 200 American members. One of the foremost practitioners, the Canadian psychiatrist Abram Hoffer, claims to have successfully treated thousands of schizophrenics with massive doses of vitamin C and niacin. He contends the vitamins neutralize an oxidized compound that causes hallucinations when it accumulates in the brains of patients. Until recently, such treatments thrived on the power of patient lore, not scientific certainty. Nutritional therapists were generally unwilling to test their claims in well-designed controlled studies. “Even when studies were done, they just didn’t meet the standards of rigor that would make them be taken seriously,” says Charles Popper, a Harvard University psychopharmacologist who studies bipolar disorder.
In 1973 a task force of the American Psychiatric Association issued a withering indictment of orthomolecular psychiatry, concluding that “the credibility of the megavitamin proponents is low.” For the next two decades, funding for orthomolecular research was rare. Academia turned its back on the field, and industry saw no profit in it—vitamins and minerals can’t be patented like other medicines. In recent years, however, grants from the National Center for Complementary and Alternative Medicine, founded in 1998, and new discoveries in brain biochemistry have prompted researchers to take a second look at nutritional therapies. The strongest evidence to date involves omega-3 fatty acids, a group of compounds abundant in fish oil of the kind Gesch gave to prisoners, as well as in the membranes of and synapses between brain cells. In a landmark 1999 study, Harvard psychiatrist Andrew Stoll found that bipolar patients who were given large doses of omega-3s did significantly better and resisted relapse longer than a matched group of patients who were given placebos.
Stoll’s findings have yet to be replicated, but other researchers have since studied omega-3s as a treatment for depression, schizophrenia, borderline personality disorder, and attention deficit hyperactivity disorder, or ADHD. (See “Fish Therapy,” opposite page.) “In every case, the data has been overwhelmingly positive,” Stoll says. Other research has shown correlations between low levels of various nutrients—zinc, calcium, magnesium, and B vitamins—and depression. Researchers have found that anywhere from 15 percent to 38 percent of psychiatric patients have reduced levels of folate. A 2000 study of older women found that 17 percent of those who were mildly depressed and 27 percent of those suffering severe depression were short on vitamin B12.
In an effort to winnow out confounding variables, nutritional research has long focused on single nutrients. Yet some researchers, like Stoll, have suggested that the effects of nutrients are additive—that their real strength becomes apparent only in a multinutrient formula. A formula much like the one that Tony Stephan and David Hardy first stumbled upon in a hog barn.
After Stephan and Hardy’s success, they spread word of the treatment among fellow Mormons in southern Alberta. They began by whipping up batches of the formula for church members suffering all sorts of disorders, from mild depression to ADHD to schizophrenia. Then, in early 1997, they quit their jobs and began selling the formula, which they eventually named EMPowerplus (the EM stands for “essential mineral”). Their company, Truehope Nutritional Support, employs 35 people in a squat building on the edge of Hardy’s hometown, the tiny farm community of Raymond.
Stephan, 52, is stocky and energetic, with blondish-gray hair, earnest blue eyes, and a nose that skews slightly to the right as if it had been broken. Hardy, 55, is tall and lean, with square wire-rimmed glasses. It’s not hard to see him as the high school science teacher he once was. The two relate the story of their supplement with a practiced air. Both are devout Mormons who seem to believe they’ve been given a mission to alleviate mental illness. Although the supplement is not inexpensive—a month’s supply costs $69.98—Stephan and Hardy say it is expensive to manufacture, and the business barely turns a profit.
For years, they say, they tinkered with the formula, using Autumn as their guinea pig. “A lot of it was trial and error,” Stephan says. “There’s nothing out there saying that if you’re bipolar you need 50 milligrams of zinc.” The latest incarnation of the supplement contains 36 vitamins, minerals, amino acids, and antioxidants. Most are the same ingredients found in a typical multivitamin but at much higher doses. For example, a daily dose of the supplement contains a whopping 120 milligrams of vitamin E, six times the recommended daily allowance. So far, the only side effects appear to be nausea and diarrhea, but no one really knows the long-term dangers of taking high vitamin and mineral doses.
News of the supplement has spread quickly through the Internet and patient support groups. Hardy says at least 6,000 people have used the supplement for psychiatric problems, and a few thousand more have tried it for other central nervous system disorders such as multiple sclerosis, Parkinson’s disease, cerebral palsy, and stress. Like many alternative therapies, the supplement has generated tales of dramatic results, but Stephan and Hardy know that they need solid research to prove its effects.
Several years ago, they began contacting scientists, including Bonnie Kaplan, a research psychologist at the University of Calgary, and Harvard’s Charles Popper, inviting them to study their mixture. The scientists had essentially the same response. “I told them to take their snake oils somewhere else,” as Kaplan later recalled to a reporter. Popper was so leery of the pair after his first meeting that he hid the bottle of the supplement they gave him under his coat as he walked back to his office: “I was afraid someone was going to see me with the stuff.”
Kaplan finally agreed to meet with Hardy and Stephan in 1996. Impressed by their sincerity, she decided to offer the formula to a handful of patients who had not responded to conventional treatments. Kaplan first tried the supplement on two boys with wildly shifting moods and explosive tempers. One was so obsessed with violent fantasies that he could not go more than 20 seconds without thinking about guns. After he started taking the supplement, Kaplan later wrote in a case study, his obsessions and his explosive rage diminished. When he quit the supplements, the obsessions and anger returned. Back on the supplements again, the symptoms retreated.
Those results were encouraging enough that within a few months Kaplan started a small clinical study of 11 bipolar patients who had not been able to control their illness with conventional medications. After six months of treatment, each of the 11 showed improvement in both their depression and mania. Most were able to cut down on their medications, and some quit using them altogether.
In 2000 Kaplan accompanied Hardy and Stephan to Harvard’s McLean Hospital to talk with other scientists. Popper was skeptical, despite Kaplan’s credentials. That night, however, he got a call from a colleague whose son had suddenly developed bipolar disorder and was throwing violent tantrums daily. Popper reluctantly offered him the sample bottle of the supplement that Hardy and Stephan had given him, figuring it couldn’t hurt. He did not believe it would help. Four days later, the father called to tell him the tantrums were gone. “The kid wasn’t even irritable,” Popper recalls. “We don’t have anything in psychiatry that can do that.”
Omega-3s are a family of fatty acids found in seafood and certain plants such as flax. Researchers are interested in their therapeutic potential for several reasons: Large population studies have shown a correlation between rates of seafood consumption and depression. Small studies have found patients with depression have reduced levels of these fatty acids in their blood. A variety of small clinical trials have also suggested that omega-3s (at doses ranging from one to four grams) may alleviate the symptoms of depression, schizophrenia, and bipolar disorder, as well as improve patients’ response to conventional medicines.
Some researchers speculate that fatty acids help maintain fluidity in the cellular membranes, allowing neural receptors to better detect incoming signals. Others, like Harvard psychiatrist Andrew Stoll, believe that omega-3s affect the brain in ways similar to mood-stabilizing drugs like lithium and Depakote: They tamp down excessive signaling between cells. Stoll says the compounds also reduce cellular inflammation—common in people with mental disorders—stirred up by omega-6s, another family of fatty acids. In centuries past, humans ate a great deal of wild game, greens, and other foods rich in omega-3s. Today we eat fewer omega-3s, while filling up on foods heavy with processed vegetable oils, which are high in omega-6s. The change may help account for the increased incidence of depression in the past 100 years, Stoll says.
Stoll’s colleagues say that the compounds show promise but require further research. “The problem is there’s not a lot of published evidence yet,” says Harvard psychiatrist David Mischoulon. “So it’s hard to compare this modest body of evidence against evidence for a medication like Prozac or Zoloft that has numerous studies to back it up.” —S.F.