User:Shbrown

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My name is Stephen Brown. I have a doctorate in chemistry from Yale University and work as a research scientist. I am working on adding information to pages concerning the safety and effectiveness of B-complex vitamins and vitamin C. I also plan to contribute to pages concerning petroleum refining to fuels and petrochemicals.

Without vitamins, humans can not survive. Vitamins participate in essential metabolic reactions in every single organ in the body ^[1]. Vitamins can act both as catalysts and participants in the chemical reaction. The body typically assembles vitamin-dependent catalysts from a variety of Nicotinamide adenine dinucleotide including amino acids, sugars, phosphates, and vitamins. Each vitamin is typically used in multiple different catalysts and therefore has multiple functions^[2]. The role of a catalyst is to participate in a chemical reaction without being altered itself. Catalysts function like knitting needles, which convert yarn to mittens without undergoing any change themselves.

From deep prehistory until the 1900's, vitamins could only be obtained by eating food. Each food source contains different ratios of vitamins. Therefore if the only source of vitamins is food, a change in diet from season to season, year to year, or day to day changes the doses of vitamins. Ordinary people do not sense any change in health as a consequence. This leads to the conclusion that the nervous system maintains a feeling of normalcy across a wide range of vitamin dosages.

Vitamins have only been produced as commodity chemicals and made widely available at nominal costs for a few decades^[3]. For the first time in human history, parents are empowered to independently control the doses of vitamins eaten by themselves and their children. Because the catalytic action of vitamins is ordinarily imperceptible except at the extremes of deficiency and overdose, the vast majority continues to depend upon food as the sole source of vitamins.

Contents 1 Vitamin C Megadosage 2 The Vitamins Controversy 2.1 Colds 3 What Are the RDA's 4 Side Effects 5 Footnotes and Reference links 6 DO11 Chat 7 Prevention 8 anorexia discussion 9 Continued Discussion

[edit] Vitamin C Megadosage

I am distressed by how this page has evolved. Many of the folks editing this page apparently have a narrow definition of science. Even double blind, placebo-controlled trials apparently aren't good enough. Both those for and against the effectiveness of vitamin C for fighting the common cold are referencing the same article. This Wikipedia article, in my opinion, is expressing the POV that vitamin C isn't much good for fighting colds. Here's a link to a well-referenced alternative view [5] Why shouldn't readers be encouraged to take between 2 and 20 g/day of vitamin C when they are fighting a cold and then decide for themselves? My family of four, all four grandparents, my sister-in-law... the list goes on all take between 4 and 20 g/day of vitamin C (low doses when healthy, higher when fighting a cold). Reading this article makes me feel like we're all kidding ourselves.

I am a practicing research scientist and I am blogging about vitamins. For full disclosure, I'm about to point you to my blog. "Megadoses" - whatever that means - of vitamin C have been proven to be an effective treatment to protect skin from the sun, and to treat a variety of other skin conditions. The vitamin C is formulated into skin creams. When applied to the skin, very high levels of vitamin C can be achieved in the skin. It is going to be very difficult to persuade me that elevating vitamin C levels in the skin by taking 2 to 10 g/day of vitamin C in divided doses is not equally effective. Here's my blog item on this subject [6], and here's a list of very recent scientific papers on the subject [7]

"Megadoses" of vitamin C (specifically between 0.5 and 1 g/day) is recommended by this authoritative source as the cure to scurvy [8]. Do the authors of this page seriously recommend that individuals suffering from scurvy should limit their intake to 60 mg/day? Do they doubt that vitamin C cures scurvy? After all, the vitamin C treatment for scurvy has not been confirmed by a modern, randomized, double-blind placebo controlled trial.

[edit] The Vitamins Controversy

Use of vitamin supplements is controversial. Although unproven, it is commonly believed that whole foods (fresh fruits and vegetables, unprocessed meats) raised without synthetic pesticides and fertilizers are healthier than processed foods of equivalent composition (same amounts of proteins, carbohydrates, fats, vitamins, and minerals). Vitamin supplements are available in every pharmacy and grocery store that contain significantly higher doses than can be obtained by eating commonly available, inexpensive foods. There are proven side effects from using vitamin supplements, and the frequency and severity of side effects increases with increasing dose. Many of these side effects cause discomfort that initiates almost immediately after ingesting the offending supplement. Individual vitamin supplements are/have been claimed to be effective treatments for almost every ailment. Most of these claims have proven to be unfounded. On the other hand, vitamins at doses associated with side effects are effective treatments for some specific conditions, and, like drugs, show increasing effectiveness with increasing dose. For example, niacin raises good cholesterol and lowers bad cholesterol. The recommended dose is between 1000 and 2000 mg/day ^[4]. This is far above the UL value for niacin (see side effects section below for the definition of UL). Another example is the use of vitamin C for treating burns. The recommended dose is close to 100 gm/day injected intravenously supplemented by a topical application of a 3 wt% vitamin C solution.^{[5] [6]} This is far above the UL value for vitamin C of 2 gm/day. Unlike many of the side effects, in both these cases the patients are unable to perceive the proven benefits. In light of these facts, it is not surprising that vitamin supplements are controversial. ^[7] The controversy can be viewed as an argument between the large majority of people who believe that optimal amounts of vitamins can be obtained from food, and a minority who believe supplements are often necessary. It can also be viewed as an argument between those who believe they benefit greatly from taking vitamin supplements, and those who have been harmed by vitamin overdose. Resolution of this controversy is particularly important for tomorrow's children. The health of children in the developed world is deteriorating and there is a consensus that diet is an important part of the problem. Seventeen percent of American children are overweight (triple the percentage in 1980), and increasing numbers of children are developing high blood pressure, high cholesterol, and Type 2 diabetes.^[8] Fifteen percent of American children have learning disabilities or more serious neurological disorders,^[9] and these numbers are also trending upward.^[10] It is a reasonable hypothesis that providing vitamin supplements to children can help prevent the rising rates of childhood diseases and disorders.

A large enough number of people believe that supplements are required for optimal health to support a small group of physicians to provide them with guidance. Many of these physicians catagorize themselves as orthomolecular physicians, a term coined by two-time nobel prize winner Linus Pauling. A number of physicians in this group are pediatricians, and have been prescribing vitamin supplements to treat childhood physical and nervous disorders. An account of the experiences of this group is available.^[11] Supplementation during pregnancy is claimed to be the most important preventative measure. Treating childhood obesity, neurological disorders, or any other child health problems with vitamins is outside of mainstream practice despite the positive clinical reports continuously eminating from orthomolecular physicians.^[12]

The credibility of orthomolecular physicians is buttressed by their use of vitamin C supplements to combat colds. At least 21 double-blind, placebo controlled clinical trials involving a total of over 6000 participants have been conducted. These trials were reviewed in the 1990's.^[13][14] Reports from physicians have provided ample clinical confirmation that vitamin C reduces the duration and severity of colds (but not the frequency).^[15] Interviewing 10 Americans with post graduate educations is usually sufficient to find one who takes 5 gm per day or more of vitamin C to ward off an incipient cold.

The credibility of orthomolecular physicians is harmed by their tendency to underplay the side effects of vitamins. Ordinary B-complex tablets contain levels of these vitamins that are difficult to ingest through food. Also unlike food, the contained vitamins release rapidly. Finally, the vitamins contained in the tablets are not always exactly the same as the most common form in food. For these reasons, vitamin levels that are tolerated in food often cause side effects when consumed from supplements. Because the benefits of vitamins are imperceptible, and the side effects feel bad immediately, this understandably leads many people who have trouble with side effects to commit to never taking extra vitamins again and to recommend that others follow their example. Some manufacturers of high potency B-complex vitamins claim that there are no side effects, and few, if any, vitamin manufacturers provide warning labels. In reality, side effects have been reported from supplements containing close to 1 RDA of B-complex vitamins. More troublesome, some of these reports demonstrated that people can take daily supplements for months or even years before the side effects emerge.

Hence the controversy. People who have seen their health improve dramatically after initiating daily supplements, and who do not experience side effects tend to be strong supporters of the view that the RDA's are inadequate. People who did not see dramatic benefits, and who experienced unpleasant side effects tend to be strong supporters of the view that optimal doses of vitamins are best obtained from food. There is a need for better education on both sides, and a more balanced view.

Proof that vitamins far in excess of the R.D.A's are effective treatments for some specific conditions is unsettling because it proves that the full benefits of vitamins can not always be obtained without taking on the risks of side effects. One of the central roles of vitamins is to catalyze the growth and development of children into adults. The R.D.A's were set to ensure that no children were harmed by vitamin side effects. An unspoken assumption is that at the R.D.A values no children are harmed by vitamin deficiency. What if this assumption is not true?

[edit] Colds

At least 29 controlled clinical trials (many double-blind and placebo-controlled) involving a total of over 11,000 participants have been conducted. These trials were reviewed in the 1990's ^[16][17] and again recently.[9] The trials show that vitamin C reduces the duration and severity of colds but not the duration. The data indicate that there is a normal dose-response relationship. Vitamin C is more effective the higher the dose. The vaste majority of the trials were limited to doses below 1 g/day. As doses rise, it becomes increasingly difficult to keep the trials double blind because of the obvious gastro-intestinal side effects. So, the most effective trials at doses between 2 and 10 g/day are met with skepticism. Reports from physicians have provided ample clinical confirmation.[10] Interviewing 10 Americans with post graduate educations is usually sufficient to find one who takes 5 gm per day or more of vitamin C to ward off (reduce the duration of a cold to less than two days)an incipient cold.

The controlled trials and clinical experience prove that vitamin C in doses ranging from 0.1 to 2.0 g/day have a relatively small effect. The duration of colds was reduced by 7% for adults and 15% for children. The studies provide ample justification for businesses to encourage their employees to take 1 to 2 g/day during the cold season to improve workplace productivity and reduce sick days. The clinical reports provide the strongest possible evidence that vitamin C at higher doses is significantly more effective. However, the effectiveness typically comes at the price of gastro-intestinal side effects. It is easy for physicians to minimize these side effects since they cause no lasting harm. Adult patients, however, have proven reluctant to subject themselves to gas and cramping to deliver an unknown benefit (the duration and severity of colds is highly variable so the patient never knows what he/she is warding off). It is well worth the effort of identifying the small subset of individuals who can benefit from high daily doses (>10 g/day) of vitamin C without side effects and training them to regularly take 5 g/day during cold season and to increase the dose at the onset of a cold.

The trials proved that vitamin C is more effective for children. Reports from the field confirm the observations in the trials and suggest that children are less prone to vitamin C side effects.[11] Colds and flu are a servious problem for children. Every time a cold infects a child, its growing mind and body must divert energy from its usual business of growth and development. If the cold is followed by an opportunistic infection, such as bronchitis or ear infection, more energy must be diverted. Colds are the number one trigger for asthma.[12] Pre-school children in daycare are nearly constantly fighting infections (5-10 per year).[13] It is unfortunate that pediatricians and parents are reluctant to using several g/day of vitamin C to treat children with colds during these important years of growth and development. There is little hope of this changing until the controversy surrounding vitamins is resolved.

Use of vitamin supplements is controversial. Although unproven, it is commonly believed that whole foods (fresh fruits and vegetables, unprocessed meats) raised without synthetic pesticides and fertilizers are healthier than processed foods of equivalent composition (same amounts of proteins, carbohydrates, fats, vitamins, and minerals). Vitamin supplements are available in every pharmacy and grocery store that contain significantly higher doses than can be obtained by eating commonly available, inexpensive foods. There are proven side effects from using vitamin supplements, and the frequency and severity of side effects increases with increasing dose. Many of these side effects cause discomfort that initiates almost immediately after ingesting the offending supplement. Individual vitamin supplements are/have been claimed to be effective treatments for almost every ailment. Most of these claims have proven to be unfounded. On the other hand, vitamins at doses associated with side effects are effective treatments for some specific conditions, and, like drugs, show increasing effectiveness with increasing dose. For example, niacin raises good cholesterol and lowers bad cholesterol. The recommended dose is between 1000 and 2000 mg/day.[14] This is far above the UL value for niacin (see side effects section below for the definition of UL). Another example is the use of vitamin C for treating burns. The recommended dose is close to 100 gm/day injected intravenously supplemented by a topical application of a 3 wt% vitamin C solution.[15] ^[18] This is far above the UL value for vitamin C of 2 gm/day. Unlike many of the side effects, in both these cases the patients are unable to perceive the proven benefits.

In light of these facts, it is not surprising that vitamin supplements are controversial. Proof that vitamins far in excess of the R.D.A's are effective treatments for some specific conditions is unsettling because it proves that the full benefits of vitamins can not always be obtained without taking on the risks of side effects. One of the central roles of vitamins is to catalyze the growth and development of children into adults. The R.D.A.'s were set to prevent classic vitamin deficiency diseases and to ensure that no children were harmed by vitamin side effects. An unspoken assumption is that the R.D.A.'s enable the optimal growth and development of every child. What if this assumption is not true?

Use of vitamin supplements is controversial. This controversy is evident in the language used by the government in association with the Dietary Supplement Health and Education Act of 1994. According the government, "Scientific evidence supporting the benefits of some dietary supplements (e.g., vitamins and minerals) is well established for certain health conditions." In this sentence the government admits that vitamins can cure diseases. Yet in a subsequent sentence the government says, "Dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure disease."[16]

Individual vitamin supplements and/or supplements containing multiple vitamins are/have been claimed to be effective treatments for almost every ailment. This can be verified by typing in the name of a disease and the word vitamin into an internet search engine. Some preparations are claimed to be a panacea.[17] Most of these claims have proven to be unfounded. For example, 50 mg/day of vitamin B6 does not prevent PMS.[18] However, vitamins are effective treatments for some specific conditions, and, like drugs, show increasing effectiveness with increasing dose. For example, niacin raises good cholesterol and lowers bad cholesterol. The recommended dose is between 1000 and 2000 mg/day.[19] This is far above the UL value for niacin. Another example is the use of vitamin C for treating burns. The recommended dose is close to 100 gm/day injected intravenously supplemented by a topical application of a 3 wt% vitamin C solution.[20] ^[19] This is far above the UL value for vitamin C of 2 gm/day. There are proven side effects from using vitamin supplements, and the frequency and severity of side effects increases with increasing dose. Many of these side effects cause discomfort that initiates almost immediately after ingesting the offending supplement. In light of these facts, it is not surprising that vitamin supplements are controversial. Proof that vitamins far in excess of the R.D.A's are effective treatments for some specific conditions is unsettling because it proves that the full benefits of vitamins can not be obtained without taking on the risks of side effects.

Scientific evidence supporting the benefits of some dietary supplements (e.g., vitamins and minerals) is well established for certain health conditions, but others need further study. Research studies in people to prove that a dietary supplement is safe are not required before the supplement is marketed, unlike for drugs. It is the responsibility of dietary supplement manufacturers/distributors to ensure that their products are safe and that their label claims are accurate and truthful. If the FDA finds a supplement to be unsafe once it is on the market, only then can it take action against the manufacturer and/or distributor, such as by issuing a warning or requiring the product to be removed from the marketplace. The manufacturer does not have to prove that the supplement is effective, unlike for drugs. The manufacturer can say that the product addresses a nutrient deficiency, supports health, or reduces the risk of developing a health problem, if that is true. If the manufacturer does make a claim, it must be followed by the statement "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."

Under the Dietary Supplement Health and Education Act of 1994, the dietary supplement manufacturer is responsible for ensuring that a dietary supplement is safe before it is marketed. FDA is responsible for taking action against any unsafe dietary supplement product after it reaches the market. Dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure disease. In some cases, dietary supplements may have unwanted effects, especially if taken before surgery, with other dietary supplements or medicines, or if the person taking them has certain health conditions.

Use of vitamin supplements is controversial. This controversy is evident in the language used by the government in association with the Dietary Supplement Health and Education Act of 1994. According the government, "Scientific evidence supporting the benefits of some dietary supplements (e.g., vitamins and minerals) is well established for certain health conditions." In this sentence the government admits that vitamins can cure diseases. Yet in a subsequent sentence the government says, "Dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure disease."[2]

Individual vitamin supplements and/or supplements containing multiple vitamins are/have been claimed to be effective treatments for almost every ailment. This can be verified by typing in the name of a disease and the word vitamin into an internet search engine. Some preparations are claimed to be a panacea.[3] Most of these claims have proven to be unfounded. For example, 50 mg/day of vitamin B6 is not a generally effective treatment for PMS.[4] In spite of powerful scientific evidence, the claims are not going away. Worse, the individuals and organizations promoting vitamins as cures sometimes claim that vitamins are safe and minimize the seriousness of proven vitamin side effects. Vitamin advocates contest many alleged vitamin side effects. As a result, few people taking vitamins are aware of the long list of ailments that have been associated with vitamins. A comprehensive discussion of vitamin side effects requires a lengthy discussion.[20]

However, vitamins in very high doses are effective treatments for some specific conditions. For example, niacin raises good cholesterol and lowers bad cholesterol. The recommended dose is between 1000 and 2000 mg/day.[5] This is far above the UL value for niacin of 35 mg/day. Another example is the use of vitamin C for treating burns. The recommended dose is close to 100 gm/day injected intravenously supplemented by a topical application of a 3 wt% vitamin C solution.[6] [21] This is far above the UL value for vitamin C of 2 gm/day.

In light of these facts, it is not surprising that vitamin supplements are controversial. Proof that vitamins far in excess of the R.D.A's are effective treatments for some specific conditions is unsettling because it proves that the full benefits of vitamins can not be obtained without taking on the risks of side effects.

Use of vitamin supplements is controversial. Vitamin advocates believe that vitamin supplements are often required to achieve optimum health. They recommend taking doses of vitamins far in excess of the RDA.[21] The RDA committee of the U.S. Food and Nutrition Board recommends that most Americans get optimal doses of vitamins by eating a healthy diet, since the RDA's of vitamins are readily obtained from food. Vitamin advocates believe that taking doses of vitamins far in excess of the RDA can often be helpful treating health problems. Vitamin skeptics believe vitamins in excess of the RDA do more harm than good.[22] Skeptics made efforts to have vitamin supplements regulated. Vitamin advocates resisted. The negotiations about regulation ended with the Dietary Supplement Health and Education Act of 1994. The controversy remains evident in the language of the act. According to the act, "Scientific evidence supporting the benefits of some dietary supplements (e.g., vitamins and minerals) is well established for certain health conditions." In this sentence the government asserts that vitamins cure diseases. Yet in a subsequent sentence the government says, "Dietary supplements are not intended to treat, diagnose, mitigate, prevent, or cure disease."[23]

Individual vitamin supplements and/or supplements containing multiple vitamins are/have been claimed to be effective treatments for almost every ailment. This can be verified by typing in the name of a disease and the word vitamin into an internet search engine. Some preparations are claimed to be a panacea.[24] Most of these claims have proven to be in need of qualification. For example, a review of the scientific literature investigating the effectiveness of vitamin B6 for the treatment of PMS came to the conclusion that the vitamin was not obviously effective.[25] Despite the scientific evidence, the claims are not going away. Individuals and organizations promoting vitamins as cures often claim that vitamins are safe and minimize the seriousness of proven vitamin side effects. Compared to drugs, vitamins are safe, and reports of vitamin side effects are rare. As a result, few people taking vitamins are aware of the long list of ailments that have been associated with vitamins. A comprehensive discussion of possible vitamin side effects requires a lengthy discussion.^[20]

The credibility of vitamin advocates has been enhanced by the proven effectiveness of vitamins in the treatment of some health problems at doses of >100 [26] and even >1000 [27] ^[21] RDA's. Side effects are common at these doses.

[edit] What Are the RDA's

RDA stands for recommended daily allowance. The RDA's for vitamins are based on something called the "body pool" of vitamins and minerals. The amount of each vitamin in the body ranges from a pinch to a teaspoon. Scientists measured the amount of each vitamin in groups of adult males in stable health. The average amount for these men was named the "body pool".

More experiments showed that vitamins naturally break down in the body over time. The RDA's are an estimate of how much a person needs to take of each vitamin every day to maintain a steady body pool, plus an ample safety margin to account for individual variability.

If more vitamins break down in a given day than the person eats, the body pool starts to empty. Deficiency symptoms start to occur as chemical reactions in the body's cells can't be completed. when the body pool gets too low, the body excretes almost none of the vitamins it takes in. As the body pool rises above the normal range, more and more of vitamins ingested are excreted (a lower and lower percentage of the vitamins are retained). Although the body does excrete a larger percentage of vitamins taken at high dosages, it doesn't excrete all the extra. Like any drug, the total amount of a vitamin in the body increases with increasing dose. Again, like drugs, the effectiveness of vitamins increase with increasing dose, but so do side effects. The optimal doses strikes a balance between the benefits and the side effects.

[edit] Side Effects

All vitamins have well documented side effects.[28] Common awareness of vitamin side effects is small because side effects are largely confined to the minority of people taking vitamin supplements. Supplement users often associate side effects with the supplements at an early stage and tend to reduce dosages long before the high severity symptoms of serious vitamin overdose emerge.

Vitamin advocates tend to confuse vitamin side effects and vitamin safety. Unlike the side effects from many drugs, vitamin side effects rarely cause any permanent harm. There is no known toxic dose for the B-complex vitamins and vitamin C. When vitamin side effects emerge, full and rapid recovery is accomplished by reducing the supplement dosage.

The mission of the Food and Nutrition Board is to prevent side effects rather than to optimize health. The physicians on the board carefully review all the clinical data on supplement use and have determined the upper dosage threshold for each vitamin that can be tolerated as a daily dose by the entire population without side effects. Harrell, RF et al. Can nutritional supplements help mentally retarded children? An exploratory study. Proc Natl Acad Sci 78 (1):574-578, 1981. Tolerance varies with age and state of health.

[edit] Footnotes and Reference links

[edit] DO11 Chat

Thanks for your note at my page.

Tough conversation you're in at the vitamin D page. Builds character and invaluable skills. Excellent job maintaining an even tone. I need to work on that.

I understood RDA is a redirect. Am I correct that there is no link from the vitamin page to the RDA page? It took me long enough to find megavitamin therapy so I'll believe it if the link is already there.

I support the goal of NPOV. I try to be very generous in this area because when I write I read what I write and ask myself if there might be other POV's which would be better supported if I used different words. Invariably I can think of other POV's and other words.

I have found some references on RDA's to give you a head's up on where I'm going. [29] This is a nice page. Why isn't there a page like this at webMD or the likes? Outstanding pages on the vitamin deficiency diseases did show up at a mainstream site. [30][31][32][33] These articles show that the RDA's are not meant as guidance for individuals concerned that they might be vitamin deficient. Surprisingly, large numbers of Americans have a reason to be concerned that they might be vitamin deficient. My evidence for this is that large numbers of Americans exhibit symptoms of vitamin deficiency. I was surprised to learn that one in five Americans has some kind of mental illness [34]. Malabsorption is a recognized risk for the elderly population. Few in the >60 age category would claim that their health is as good as it was when they were young. Chronic problems with some of the same symptoms as some of the deficiency diseases are common in the elderly. I'm only arguing that some mental illness and some chronic problems of the elderly might be caused by vitamin deficiency. Finally, hosptialization and/or severe illness can lead to the onset of deficiency disease. Deficiency disease itself is a "point of view". When exactly does someone cross the border from healthy to vitamin deficient (0.3 RDA, 0.28, 0.25??) Science says with certainty that steadily lowering the dose of a vitamin over time will cause the deficiency disease.

I've started searching the internet on the subject of anorexia. So far I'm having trouble finding the connection between anorexia and vitamin deficiency. Apparently over a million young women suffer from anorexia. Surely starving people should be expected to be suffering from vitamin deficiency? Wouldn't it be a good idea to recommend that all young women take a multivitamin supplement?

Sigh. My POV has gone overboard again.

Cheers. I will happily edit away when I'm ready and look forward to your continued support.

[edit] Prevention

Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of thiamine (vitamin B1). [35] Supplementation with thiamine prevents beriberi, and therefore anorexia. Dietary thiamine phosphates are hydrolyzed by enzymes in the intestines. The resulting free thiamine requires energy and functional thiamine transport proteins to be absorbed. The transport system is readily saturated, limiting the amount of thiamine that can be absorbed in a single dose to 2.5 mg. Less common fat-soluble forms of thiamine, known as allithiamines, do not require energy and thiamine transport proteins to be absorbed. Both free thiamine and allithiamines are readily available as supplements.

Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of thiamine (vitamin B1). Orthomolecular physicians have recently advanced a new theory that anorexia can be prevented by taking vitamin supplements. They recommend reformulating vitamin supplements to include fat-soluble forms of thiamine. [36]

Are you questioning the assertion that anorexia is an acknowledged clinical marker for anorexia?? Are you questioning Lonsdale's authoritative knowledge of beriberi? Although the Lonsdale review referenced was in an alternative health journal, his previous reviews were published elsewhere. Lonsdale D. Thiamine metabolism in disease Crit Rev Lab Sci 1975; 5: 289–313 And what exactly is your inference here? Articles in alternative medicine journals are not verifiable? Why not let Wikipedia readers decide for themselves.

Furthermore, page 151 of Bender's textbook on the biochemistry of vitamins notes that thiamine deficiency in animal models is associated with severe anorexia. And here's another reference.

Prevalence of thiamin deficiency in anorexia nervosa. Author: Winston, A P : Jamieson, C P : Madira, W : Gatward, N M : Palmer, R L Citation: Int-J-Eat-Disord. 2000 Dec; 28(4): 451-4 Abstract: OBJECTIVE: Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. METHOD: Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. RESULTS: Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. DISCUSSION: Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated. Copyright 2000 by John Wiley & Sons, Inc.

I'm sure there are more references. I'm familiar with the guiding philosophy of Wikipedia. If in doubt, content is to be left in. Stop deleting this factual section that contains no original research until you've provided references contradicting the statements and furthermore proven more than that my facts are wrong. You can add your referenced facts to my referenced facts. This will allow readers to visit both sets of references and decide for themselves.

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Thiamine is a clinical marker for beriberi. I searched and found 106 references.

Many of the 106 references are to numerous animal models including monkeys. I already referenced the Benton text book above to that effect and you already dismissed this for reasons I don't understand. So - here's a number of references with direct evidence on human beings.

Clinical studies of experimental human vitamin B complex deficiency. Elsom, K. O'Shea; Lewy, F. H.; Heublein, G. W. American Journal of the Medical Sciences (1940), 200 757-64.

Abstract

cf. C. A. 34, 5120.7. Studies were made on a healthy woman aged 60 who was placed for 4 months on a diet deficient only in vitamin B. Pulse rate increased but blood pressure and electrocardiogram were not altered; cardiovascular abnormalities subsided during thiamine administration. Anorexia was relieved by thiamine, but improvement of other gastrointestinal symptoms required yeast in the diet. The mild neurologic symptoms and physical signs disappeared following thiamine, but the prominent mental symptoms while responding somewhat to thiamine required yeast for complete relief. Mild macrocytic anemia, uninfluenced by thiamine or riboflavin, was relieved by general diet and yeast. There were both edema and loss of body weight, corrected only by yeast.

The determination of vitamin B1 deficiency. Goth, Endre. Orvosi Hetilap (1941), 85 138-9.

Abstract

Clinical experiments show that anorexia is a milder and less important symptom of vitamin B1 deficiency than are the neuritic symptoms. A reliable test for vitamin B1 deficiency is to inject 10 mg. of the vitamin and analyze the urine passed during the following 24 hrs. fluorometrically with K ferricyanide. In normal cases the vitamin content ranges from 20 to 30  %. Values below 18 mg. % indicate deficiency.

Induced thiamine (vitamin B1) deficiency in man. Relation of depletion of thiamine to development of biochemical defect and of polyneuropathy. Williams, Ray D.; Mason, Harold L.; Power, Marschelle H.; Wilder, Russell M. Archives of Internal Medicine (1943), 71 38-53.

Abstract

cf. C. A. 36, 4863.6; 37, 3481.7. Two human volunteers were restricted by diet to a thiamine (I) intake of 0.2 mg./day (2000 cal.) for 120 days. A test dose of 1.0 mg. I-HCl was administered subcutaneously about every 2 weeks; this raises the av. daily intake to 0.35 mg. I (0.175 mg. per 1000 cal.). This "periodic partial cure" was attended by increase in appetite and activity 7-10 days after administration. Symptoms of I deficiency were manifested as early as the 30th day of restriction. The first objective evidence of abnormality in these subjects consisted of a decrease in their ordinary urinary excretion of I. At about the 50th day the urinary excretion after a test dose of 1 mg. I was reduced. After this time whenever dextrose was given, abnormally high values for pyruvic and lactic acids in the blood were observed. Also anorexia and weakness became more severe and paresthesia of the legs was observed. The earliest stages of I deficiency were demonstrated by detn. of excretion after administration of a test dose of I, more advanced stages by data on blood lactic and pyruvic acids, and still more advanced stages by progressively higher blood pyruvate curves after administration of dextrose.

Nutritional standards for men in tropical climates. Johnson, R. E. Gastroenterology (1943), 1 832-40.

Abstract

cf. C.A. 38, 3709.3, 4293.1, 46689, 59083. Dietary requirements are qualitatively similar in hot and in temperate climates. However, they are quantitatively altered in hot climates by increased losses of sweat, anorexia and suggested specific increases in requirements by mere exposure to heat. Water, cals., NaCl and vitamin B complex are considered crit. for emergency rations intended for use over short periods. Water deficiency can be one of the most rapidly induced of all deficiency syndromes and may have deleterious effects in only a few hrs. Deficiency of NaCl does not produce heat cramps in a single day even under severe conditions; replacement day by day (15-20 g. per day for most working men) is desirable. Within very wide limits protein intake appears to have little effect on the well-being or performance of working men. No considerable loss of thiamine or ascorbic acid in the sweat was noted; even under the most severe conditions the loss of vitamins was much greater in the urine than in the sweat. Maintenance of caloric balance, essential in the long run, is not necessary from day to day. Palatability is as important as the quant. compn. of any ration. A table is given showing the rapidity of onset of undesirable effects in deficiency of the various nutrients.

Beriberi in Japanese prison camp. Hibbs, Ralph E. Cleveland Clinic, O. Annals of Internal Medicine (1946), 25 270-82.

Abstract

Thiamine chloride alone corrected the anorexia, nervous manifestations, tachycardia, and arrhythmia, and improved exercise tolerance of the heart in patients with beriberi. Peripheral neuritis responded sooner to the entire B complex. Intrathecal was no more efficient than subcutaneous administration. Complete satn. was not attained by a short course of large doses. There may be a nutritional cause of polyneuritis in beriberi other than lack of thiamine. Posterior column degeneration of the spinal cord may result from lack of vitamin B1. An irreversible optic atrophy may be caused by beriberi.

The Lonsdale article you are rejecting on this page is an allowed reference on Wikipedia's thiamine page. Lonsdale reviewed thiamine deficiency symptoms in 1973. I also can't understand why you rejected that reference. I found 13 publications from Lonsdale who has been publishing on thiamine deficiency for 30 years.

Regarding web pages as references. Your assertion that references to web pages aren't allowed is obviously incorrect. They are all over the place in Wikipedia, and will and should become more and more common. I'm sure you are aware that there are several others in this article.

However, I agree that web pages deserve scrutiny. I did not refer readers to just any web page. The web page links to the Orthomolecular News Service, which is provided by the editors of the Journal of Orthomolecular Medicine. The press releases are peer reviewed and heavily referenced. There was no doubt in my mind that I would find anorexia as a clinical marker of beriberi. The JOM editors are the most authoritative voice that I know of when it comes to facts about vitamins. They are physicians and scientists in good standing. What group of individuals do you know of that is more qualified to speak about vitamins?

[edit] anorexia discussion

Here's from the verifiability page you sent me to. I followed the link on reliable sources.

This page in a nutshell: Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy.

As I mentioned above, the webpage I linked to that is published by the JOM editors meet this criterion. Their press releases are peer reviewed and well-referenced. I don't see a problem and, as I also mentioned above, I don't think that's the issue here. Almost every Wikipedia page references web pages that don't meet this criteria. The issue my edit raises is this one from the "red flags section". My edit raises:

          > surprising or apparently important claims not covered by mainstream sources

My edit claims that anorexia is a recognized clinical marker for beriberi and most main stream sources do not. Nonetheless, my claim is supported by multiple sources that meet Wikipedia's verifiability criteria and is therefore eligible for inclusion.

Here are your own words:

"So I've moved the text below. It's quite a simple process to include it in the article, you just to find and provide provide references that meet WP:Verifiability criteria for all claims in the paragraph. I've looked and have found none although I would be pleased to hear of some I have missed."

I provided the references you requested and you again deleted my edit. I'm asking you to restore what you have deleted.

With that said, let's move to your final objection - that my edit is off-topic because it deals with the symptom of loss of appetite and not the mental disease associated with loss of appetite. Again, I'll start with what I see as the real issue. I am editing this page and not the "anorexia" page, because this is the page that people read. When parents and friends become concerned about the behavior and weight-loss of a loved one, they will often type "anorexia" into a search engine. The #1 hit is Wikipedia's "anorexia nervosa" page. I believe these readers would like to know that anorexia is a clinical marker for thiamine deficiency, that anorexia caused by thiamine is easily prevented with supplements, and that there are different kinds of thiamine supplements (supplements that require transport proteins to be distributed throughout the body and supplements that don't). According to the prevalence statistics on this Wikipedia page, in the next 20 years another 500,000 women will develop anorexia in their teenage years. Are you really that sure supplements won't help even a small fraction of these women?

Now let's get directly to your objection. The references I provided do not distinguish between anorexia and anorexia nervosa. I wouldn't be surprised to learn that the distinction didn't exist when some of them were written in the 1940's. As you pointed out, there is no blood test, tissue test, or any other type of biochemical marker test to distinguish between anorexia (the symptom of loss of appetite) and anorexia nervosa (the mental disease). If I sent a psychiatrist the anorexic group of Japanese prisoners discussed in the one article, how do can you say none would be diagnosed with anorexia nervosa? I imagine you would respond that the article said the anorexia was cured by thiamine alone and therefore was obviously not a mental disease. In reply, I would note that the article did not say that all the anorexics were cured, only that most of the anorexics were cured. If you read much about thiamine deficiency, you'll find it frightening. It is important to diagnose thiamine deficiency early and supplement with thiamine immediately. Prolonged thiamine deficiency causes irreversible damage.

Next, I would like to point out that thiamine deficiency, in addition to causing a loss of appetite, causes mental disease. Just read the Wikipedia article on Wernicke-Korsakoff syndrome. Thiamine deficiency causes widespread damage to the central nervous system and specifically causes damage to the brain.

Have I identified the right issues? Is there any way for us to reach a compromise position, or are we at an impasse?

[edit] Continued Discussion

Let's go through the proposed edit:

Anorexia is an acknowledged clinical marker of beriberi, the disease specifically caused by a deficiency of thiamine (vitamin B1). [37] Supplementation with thiamine prevents beriberi, and therefore anorexia. Dietary thiamine phosphates are hydrolyzed by enzymes in the intestines. The resulting free thiamine requires energy and functional thiamine transport proteins to be absorbed. The transport system is readily saturated, limiting the amount of thiamine that can be absorbed in a single dose to 2.5 mg. Less common fat-soluble forms of thiamine, known as allithiamines, do not require energy and thiamine transport proteins to be absorbed. Both free thiamine and allithiamines are readily available as supplements.

I've provided verifiable references for each statement, including multiple references backing the claim that anorexia is an acknowledged clinical marker of beriberi. After the first sentence, all the statements are drawn from Benton's authoritative textbook on the biochemistry of vitamins. Now you have asked me to clear a higher hurdle and get into the distinctions between anorexia (the symptom) and anorexia (the mental disorder). Even on this subject, I have one reference. Here it is again:

Prevalence of thiamin deficiency in anorexia nervosa. Author: Winston, A P : Jamieson, C P : Madira, W : Gatward, N M : Palmer, R L Citation: Int-J-Eat-Disord. 2000 Dec; 28(4): 451-4 Abstract: OBJECTIVE: Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN) but the prevalence of thiamin deficiency in AN has not been reliably established. This study was designed to investigate the prevalence of thiamin deficiency in AN. METHOD: Thirty-seven patients attending a specialist eating disorders unit and meeting all or some of the DSM-IV criteria for AN were compared with 50 blood donor controls. All subjects underwent measurement of erythrocyte transketolase activation following the addition of thiamin pyrophosphate, the standard biochemical test for thiamin deficiency. Deficiency was defined as a result more than 2 SD above the mean of the control population. RESULTS: Fourteen patients (38%) had results in the deficient range; 7 (19%) met the most stringent published criterion for deficiency. Deficiency was not related to duration of eating restraint, frequency of vomiting, or alcohol consumption. DISCUSSION: Thiamin deficiency may account for some of the neuropsychiatric symptoms of AN and routine screening or supplementation may be indicated. Copyright 2000 by John Wiley & Sons, Inc.

You say, "Yes, thiamine deficiency does cause cognitive problems, no this has nothing to do with anorexia nervosa." The authors of the abstract above disagree. They say, "Deficiency of thiamin (vitamin B1) causes a range of neuropsychiatric symptoms that resemble those reported in patients with anorexia nervosa (AN)". Even without this reference I would not agree. Unlike the results of autopsies of patients dying from/with thiamine deficiencies (e.g. ,Wernicke-Korsakoff syndrome) the diagnosis of cognitive problems is subjective. I provided many references showing the scientific consensus that thiamine deficiency both causes anorexia (the symptom) and damage to the nervous system. I believe these references are sufficient to establish a connection between thiamine deficiency and anorexia nervosa (the "mental" disorder).

I'd like to add to my above comments about the "webpage" I referenced and Wikipedia verifiability. The Wikipedia rules again:

"Articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy."

You commented above that alternative health publications generally do not meet this standard. Wikipedia encourages balanced articulation of alternative views. Here's the text from the verifiability page:

"All articles must adhere to Wikipedia's neutrality policy, fairly representing all majority and significant-minority viewpoints that have been published by reliable sources, in rough proportion to the prominence of each view."

The field of alternative health has grown in America into a major industry. The views of this industry must qualify as a "significant-minority viewpoint". The webpage I referenced is published by the editors of the Journal of Orthomolecular Medicine, arguably the highest quality scientific publication in the world of alternative medicine. Each of the editors is highly accomplished and a distinguished member of the communities they serve. Here are their names: Carolyn Dean, M.D., Damien Downing, M.D., Harold Foster, Ph.D., Steve Hickey, Ph.D., Abram Hoffer, M.D., Bo H. Jonsson, MD, PhD., Thomas Levy M.D. J.D., Erik Paterson, M.D. Andrew W. Saul Ph.D. Abram Hoffer, although controversial, is sufficiently distinguished to merit a page in Wikipedia. He is a degreed psychiatrist and the pioneer of orthomolecular psychiatry. Andrew Saul is also the publisher of the well-trafficked doctoryourself.com website. This distinguished group has spoken. They clearly believe that thiamine deficiency causes cognitive problems, and that these cognitive problems have something to do with anorexia nervosa." I ask you again to put the proposed edit back into the article.

Dear Shbrown,

I asked if Saul was touting machine made vitimins and you replied: "Andrew Saul does not sell supplements and does not receive finanacial support from supplement advertisers. According to his website, his sole source of income from Orthomolecular activities is royalties from book sales. I believe that most of the JOM editorial board are in the same position. I don't believe any of them sell or advertise."

Possibly if big-pharma were pushing Saul some editors wouldn't feel drawn to veil him. Good luck.Johnshoemaker (talk) 12:12, 19 March 2008 (UTC)