Since this study is 31 years old (!!) I was wondering why it's not more widely referenced. Then, I came upon this excellent article by Andrew W. Saul at doctoryourself.com:
The
Pioneering Work of Ruth Flinn Harrell: Champion of
Children
by Andrew W. Saul
(from
the Journal of Orthomolecular Medicine, 2004. Vol
19, No 1, p. 21-26.)
The person who says it
cannot be done should not interrupt the person doing it. (Chinese proverb.)
Early in 1981, the
medical and educational establishments were shaken to their socks. Ruth F. Harrell and colleagues,
in Proceedings of the National Academy of Sciences (1), showed that high
doses of vitamins improved intelligence and educational performance in
learning disabled children, including those with Down syndrome. Though to
many observers this seemingly came straight out of left field, Dr. Harrell,
who had been investigating vitamin effects on learning for forty years, was
not inventing the idea of megavitamin therapy in one paper. But she had at
last succeeded in focusing much-needed public attention on the role of
nutrition in learning disabilities, a problem that ink-well-era US RDA's and
pharmaceuticals by the lunchbox-full have failed to solve.
The start of the second
World War was breaking news when Ruth
Flinn Harrell
conducted her first investigations into what she called "
superfeeding." Her 1942 Columbia University PhD
thesis, "Effect of Added Thiamine on Learning" (2), was published
by the university in 1943 and would be followed by "Further Effects of
Added Thiamine on Learning and Other Processes" in 1947 (3). Her
research was not about enriched or fortified foods; "added" meant
"provided by supplement tablets." World War II had just ended when
Dr. Harrell stated in a 1946 Journal of Nutrition article (4) that "a
liberal thiamine intake improved a number of mental and physical skills of
orphanage children." By 1956, Dr. Harrell had investigated "The
Effect of Mothers' Diets on the Intelligence of Offspring" (5), finding
that "supplementation of the pregnant and lactating mothers' diet by
vitamins increased the intelligence quotients of their offspring at three and
four years of age."
THIAMINE (Vitamin B-1)
Most everyone has heard
of
beri-beri, and few are all that passionate about
it anymore. But
beri-beri, which literally means
"I can't, I can't," may all too well describe the learning disabled
child. Such children, recognized as truly disabled by the Americans with
Disabilities Act, are not unwilling but rather unable to perform well in
school. To see the physical incapacitation thiamine deficiency causes in impoverished
countries is all too easy. To see the mental incapacitation in American
classrooms is not difficult, either. Yet both may be caused by thiamine
deficiency, and both helped by thiamine supplementation. Harrell zeroed in on
this topic sixty years ago, demonstrating that supplemental thiamine improves
learning. One reporter wrote, "An experiment was conducted by Dr. Ruth
Flinn Harrell which involved 104 children from nine to
nineteen years of age. Half of the children were given a vitamin B1 (thiamine)
pill each day, and the other half received a placebo. The test lasted 6
weeks. It was found by a series of tests that the group that was given the
vitamin gained one-fourth more in learning ability than did the other
group." (6)
Carbohydrates, including
sugar, increase the body's need for thiamine. Children eat a lot of sugar. An
unmet increase is effectively the same as a deficiency. This may be part of
the mechanism of ADHD and other children's learning and behavior disorders,
as many so-called "food faddists" or "health nuts" have
proclaimed for decades. Vitamin deficiency can become vitamin dependency.
Chronic subclinical
beri-beri may result in
thiamine dependency in the same way that chronic subclinical
pellegra results in niacin dependency.
B-COMPLEX
The B-vitamins as a group
are absolutely vital to nerve function, and it would be difficult to imagine
the juvenile owner of malnourished nerves performing well in school.
Specifically, it is well established that thiamine deficiency causes not only
loss of nerve function and ultimately paralysis, but also according to The
Nutrition Desk Reference (7), "memory loss, reduced attention span,
irritability, confusion and depression." (p 43) Riboflavin (B-2)
deficiency causes "nerve tissue damage that may manifest itself as
depression and hysteria." (p 45) Niacin (B-3) deficiency causes
"loss of memory and emotional instability." (p 46) Pyridoxine (B-6)
deficiency results in "impaired production of neurotransmitters (and)
mental confusion." (p 48) Folic acid deficiency causes irritability,
apathy, forgetfulness and hostility. (p 49).
Cobalamin
(B-12) deficiency causes "degeneration of the spinal cord, fatigue,
disorientation, ataxia, moodiness, and confusion." (p 51)
Though these symptoms
generally appear after prolonged deficiency, they are very serious and, if
untreated, the ultimate result in each case would be death. Practically
speaking, a shortage of any one of the B-vitamins can be seen to lead to
neurological damage sufficient to contribute to learning and behavioral
troubles.
Harrell recognized that
thiamine and the rest of the vitamins work better as a team. She used two
clinically effective but oft-criticized therapeutic nutrition techniques:
simultaneous supplementation with many nutrients (the "shotgun"
approach), and megadoses. Working on the reasonable assumption that learning
disabled children, because of functional deficiencies, might need higher than
normal levels of nutrients, she progressed from her initial emphasis on
thiamine to later providing a wide variety of supplemental nutrients.
DEFICIENCY DEBATE
The only escape from the
inevitability of concluding that vitamin deficiency is a serious factor in
learning is the political one: declare a victory. Dodging the issue is as
easy as proclaiming that, thanks to food fortification (coupled with a
generous portion of wishful thinking), no child has such deficiencies. Though
the processed food industry and its apologists continue to assert exactly
this, statistics fail to bear this out.
An analysis of National
Health and Nutrition Examination Survey (NHANES III) data from 1988 to 1994
by Gladys Block, PhD, indicates that over 85 percent of American elementary
school-age children fail to eat the recommended five or more daily servings
of fruits and vegetables. "NHANES III, a federally sponsored survey
shows that on any given day, 45 percent of children eat no fruit, and 20
percent eat less than one serving of vegetables. The average 6 to 11 year-old
eats only 3.5 servings of fruits and vegetables each day, achieving only half
the recommended 7 servings per day for this age group." (8)
Additionally, Dr. Block reports, 20% of children's caloric intake comes from
junk snacks, such as soda pop, cookies, and candy.
Though it is a stretch to
say that all learning and behavioral disabilities are due to inadequate
vitamin intake, it is certain that some are. Behavioral deficiency tends to
show up before nutritional deficiency is recognized. Arthur Winter, MD,
writes that "In thiamine (vitamin B1) deficiency, symptoms such as lack
of well being, anxiety, hysteria, depression, and loss of appetite preceded
any clinical evidence of beriberi. Other studies using the Minnesota
Multiphasic Personal Index (MMPI) have also demonstrated that adverse
behavioral changes precede physical findings in thiamine deficiency."
(9)
DOSAGE DEBATE
Dr. Harrell anticipated
that her use of megadoses would result in "controversy and
brickbats." (10) She was right. A number of well-publicized studies
(11-15) conducted to "replicate" Dr. Harrell's work seemingly could
not do so. Would-be "replications" fail the moment they start when
they refuse to use adequate dosages. Surely it is the most basic condition
for any replication that one must exactly copy the original experiment, or it
is not a replication at all. When DNA replicates, it forms an exact and
indistinguishable copy of the original. Even the smallest of changes can
result in dysfunction, mutation, and death. Yet Harrell's "
replicators" failed to adhere to her protocol, and
consequently but not surprisingly, failed to get her results. (16)
Probably one of the
closer replications was done by Smith et al (17) and even that study totally
omitted
dessicated thyroid, a component of the
Harrell protocol that her coauthor Donald R. Davis, PhD, says was
"emphasized to Smith (as) Harrell's subjects received thyroid
continuously." (18)
F.
Jack Warner, MD,
a supporter the Harrell approach (19) writes: "Even today many medical
professionals scoff at the validity of Dr. Ruth Harrell's study with
nutritional supplements and the important addition of thyroid medication. Dr.
Harrell pleaded with her
replicators to use exactly
the same chemical values of supplements and medications. To date, this still
has not been accomplished." (20) In spite of obvious bias, negative
"replication" studies using incomplete or low doses are the ones
that have been accepted, and Harrell's work shelved. This is saying that the
results of inaccurate replication are more valuable than the original
successful research. Imagine cloning a sheep, getting a hedgehog, and then
claiming that it was the sheep's fault. Incredible. But that is what
politicized medical apologetics are capable of.
The Harrell study was
successful because her team gave learning-disabled kids much larger doses of
vitamins than other researchers are inclined to use: over 100 times the adult
(not child's) RDA for riboflavin; 37 times the RDA for niacin (given as
niacinamide); 40 times the RDA for vitamin E; and 150 times the RDA for
thiamine. Supplemental minerals were also given, as was natural
dessicated thyroid. Harrell's team achieved results that
were statistically significant, some with confidence levels so high that
there was less than on chance in a thousand that the results were due to
chance (P < 0.001) Simply stated, Ruth Harrell found IQ to be proportional
to nutrient dosage. This may simultaneously be the most elementary and also
the most controversial mathematical equation in medicine.
There is a tone to the
controversy that does more than merely suggest that Harrell's research was
careless or incompetent. This is unlikely in the extreme; Dr. Harrell,
formerly the chairman of the psychology department at
Old Dominion
University, had been
studying children before many of her critics were even born. What is more
likely is that Harrell's critics embrace the assumption that medicine must
ultimately prove to be the better approach, and if there are any megadoses to
be given, they shall be megadoses of pharmaceutical products. Vitamin therapy
is unattractive to pharmaceutical companies. There is no money in products
that cannot be patented. Children learn at an early age that mud pies don't
sell. No investment is
made, no research is done
where no money is to be recovered. Drug companies do not expect to find, nor
do they want to find, a cure that does not involve a drug. A tragic example
is modern medicine's approach to Down syndrome.
DOWN SYNDROME
If there is orthodox
resistance to using vitamins to enhance student learning, there is positively
a fortified roadblock to the suggestion that vitamins can help children with
Down syndrome. Nutrition, critics say, can not undo
trisomy
21. But nutritional therapy is not a science-fiction attempt to rearrange
chromosomes. Nutritional intervention may help the body to biochemically
compensate for a genetic handicap. Roger Williams, discoverer of the vitamin
pantothenic acid, termed this the "genetotrophic concept."
Genetotrophic diseases are "diseases in which the genetic pattern of the
afflicted individual requires an augmented supply of one or more nutrients
such that when these nutrients are adequately supplied the disease is
ameliorated." (1) Ruth Harrell's decades of research showed that it is
plausible. Conventional Down syndrome educational material holds that it is
hogwash.
As of August 2003, the
National Down Syndrome Society's "Position Statement on Vitamin Related
Therapies" states that "Despite the large sums of money which
concerned parents have spent for such treatments in the hope that the
conditions of their child with Down syndrome would be bettered, there is no
evidence that any such benefit has been produced." (21)
At the heart of the issue
are the usual, and largely philosophical, front-line disagreements of
definition and interpretation. First, what precisely constitutes a
"deficiency" in a society that, as nutritional legend would have
it, has eliminated vitamin deficiency? Adherents of
conventional dietetics presuppose that anyone who claims that there are
widespread vitamin deficiencies among children must proceed from a false
assumption. Those who advocate vitamin therapy would answer that Down's
creates a "functional deficiency" which must be met with
appropriate supplementation. The very idea that doses sufficiently high to
effectively do so should be 100 times the RDA is positively repellent to most
investigators. When asked about whether she had received National Institutes
of Health funding for her study, Dr. Harrell replied, "Heavens, no!
Nobody knows anything about the area of dietary supplementation, but the
National Institutes of Health knows for sure it's impossible." (10)
Some reviews of Down
nutrition studies actually state that doses as low as 500 mg of vitamin C are
unsafe, and
that other Harrell-sized dosages are
harmful as well. In one such article posted at the Down Syndrome Information
Network, the authors conclude that "If it is necessary for additional
vitamins to be given to someone with Down syndrome, all that is usually
needed is a multivitamin tablet, not more than once a day, at a cost of about
one penny per tablet. Meanwhile, the best nutritional advice anyone can
honestly offer is to consume a varied and balanced diet - whether you have
Down syndrome or not." (22)
Another popular argument
is that, even allowing that children eat poorly, there is insufficient
evidence that
Downs is aggravated by poor
nutrition, or helped by good nutrition. After all,
Downs
is a genetically-determined disease. But surely the genes do not operate in a
nutrient vacuum. For example, vitamin E has recently been demonstrated to
preferentially protect genetic material in Down patients' cells.
"Vitamin E treatment decreased the basal and G2 chromosomal aberrations
both in control and Down Syndrome (DS) lymphocytes. In DS cells, this protective
effect, expressed as a decrease in the chromosomal damage, was greater (50%)
than in controls (30%). These results suggest that the increment in basal and
G2 aberrations yield in DS lymphocytes may be related to the increase in
oxidative damage reported in these patients." The results would also
suggest that antioxidant vitamin supplements would be an especially good idea
for Down's individuals. (23)
Although the greater
question may be, can optimum nutrition help compensate for a genetic defect,
the essential question must be this: can nutrition help a given
Downs child? Dianne Craft, a special education teacher,
comments on Harrell's 1981 research:
"Dr. Harrell noted that one of the observations that
they made during this study was that when there was a ten point rise in IQ,
the family noticed it. When there was a fifteen point rise in IQ, the
teachers noticed it. When there was a twenty point rise in IQ, the
neighborhood noticed it.
"The story of one child is particularly poignant.
This seven year old child was still wearing diapers, didn't recognize his
parents, and had no speech. His motor skills were relatively unimpaired and
he could walk and run fairly well. In forty days, after some of the
supplements were increased, his mother telephoned. .
. saying, "He's turned on, just like an electric light. He's asking the
name of everything. He points and says, 'What zis?'
Finally he pointed to his father and said, 'zis?' I
said, 'That's your father and you call him daddy, and he looked at him and
said 'daddy.' I'm your mother; can you call me mommy?" She went on to
say, "I think he saw us for the first time." This little boy went
on to do very well in his learning, and eventually tested with an IQ of
ninety, which an average IQ." (24) I have seen a beautiful photo in Medical Tribune (9)
of Dr. Harrell being hugged by one of the study group children. The kids
noticed their own improvement.
Perhaps Harrell's
dramatic IQ gains were merely due to the placebo effect. If so, I want every
school district on earth to lay in a stock of sugar pills, for gains like
this, in only eight months, are astounding. Perhaps success was due to Dr.
Harrell's group's expectations or to her bedside manner. But, as Abram Hoffer
has said, "I am nice to all my patients. Only the ones on vitamins
improve." Harrell colleague Donald Davis writes, "No amount of
matching or variable control with Harrell's subjects could change their large
IQ gains which are the crucial and so far unexplained difference between the
Harrell group and others." (25)
When Dr. Harrell died in
1991, she was far from being alone in reporting success with high-dose
nutrition therapy. Dianne Craft writes, "For over forty years, Dr. Henry
Turkel (26, 27) treated Down's children successfully using orthomolecular
methods. He used a combination of vitamins, minerals, and thyroid hormone
replacement. His patients improved mentally and they lost the typical Down's
syndrome facial appearance. With over 600 children treated, he found an
eighty to ninety percent improvement rate." (24)
To date, the orthodox
Down authorities' position may be summed up as, there is no evidence that it
helps, so do not try it. Dr. Harrell's view would be
,
there is reason to believe that nutrition might help, so let's see if it
does. The first view prevents physician reports. The second generates them.
Theorization can only go
so far. The proof is in the pudding, and Ruth
Flinn
Harrell's approach yielded smarter, happier children. Her results are
sufficiently compelling justification for a therapeutic trial of
orthomolecular supplementation for every learning-impaired child.
References:
1. Harrell RF,
Capp RH,
Davis
DR, Peerless J, and
Ravitz
LR. Can nutritional supplements help mentally retarded children? An
exploratory study. Proc
Natl Acad
Sci USA,
1981. 78: 574–8.
2. Harrell RF. Effect of
added thiamine on learning. NY: Bureau of Publications, Teachers College,
Columbia University, 1943. Issued in the
series: Contributions to education, no. 877. Reprinted:
New York, AMS Press, 1972. ISBN:
0404558771.
3. Harrell RF. Further
effects of added thiamine on learning and other processes. NY: Bureau of
Publications, Teachers College,
Columbia
University, 1947.
Issued in the series: Contributions to education, no. 928. Reprinted:
New York, AMS Press,
1972. ISBN: 040455928X.
4. Harrell RF. Mental
response to added thiamine. J Nutrition, 1946. 31:283.
5. Harrell RF,
Woodyard E and Gates AI. The effect of mothers' diets on
the intelligence of offspring. Also known as: Relation of maternal prenatal
diet to intelligence of the offspring. NY: Bureau of Publications, Teachers
College,
Columbia
University, 1956.
6. Dr. Ruth
Flinn Harrell: Effect of added thiamine on
learning." The Health Seeker, p 18-19.
http://www.geocities.com/HotSprings/2194/vitamin.html
7. Garrison RH and
Somer E. The Nutrition Desk Reference.
New Canaan, CT:
Keats, 1990.
8.
http://www.eurekalert.org/pub_releases/2002-05/pn-akp051602.php 16 May, 2002. Accessed August,
2003.
9. Winter A. Differential
diagnosis of memory dysfunction: Finding the cause when your patient can't
remember.
http://www.afpafitness.com/articles/Memory.htm Accessed August, 2003.
10.
Horwitz
N. Vitamins, minerals boost IQ in retarded. Medical Tribune.
Vol 22, No 3. Wednesday, 21 January, 1981. Pages 1 and
19.
11. Bennett FC,
McClelland S,
Kriegsmann EA, Andrus LB, Sells CJ. Vitamin
and mineral supplementation in Down's syndrome. Pediatrics. 1983 Nov;
72(5):707-13.)
12. Bidder RT, Gray P,
Newcombe RG, Evans BK, Hughes M. The effects of
multivitamins and minerals on children with Down syndrome. Dev Med Child
Neurol. 1989 Aug
;31(4):532-7.)
13.
Menolascino
FJ, Donaldson JY, Gallagher TF, Golden CJ, Wilson JE,
Huth
JA,
Ludvigsen CW, Gillette DW.) Vitamin supplements
and purported learning enhancement in mentally retarded children. J
Nutr Sci Vitaminol
(
Tokyo). 1989
Jun
;35(3):181-92.
14. Smith GF,
Spiker D, Peterson CP,
Cicchetti
D, Justine P. Failure of vitamin/mineral supplementation in Down syndrome.
Lancet, 1983. 2:41.
15. Weathers C. Effects
of nutritional supplementation on IQ and certain other variables associated
with Down syndrome. Am J
Ment Defic.
1983 Sep
;88(2):214-7.
16.
Pruess
JB,
Fewell RR, Bennett FC. Vitamin therapy and
children with Down syndrome: a review of research. Except Child. 1989 Jan
;55(4):336-41.
17. Smith GF,
Spiker D, Peterson CP,
Cicchetti
D, Justine P. Use of megadoses of vitamins with minerals in Down syndrome. J
Pediatr. 1984 Aug
;105(2):228-34.
18. Davis DR and
Capp
RH. Vitamins and minerals in Down Syndrome. J
Pediatr.
1985 March
;106(3):531.
19.
Thiel
R.J. Facial effects of the Warner protocol for children with Down syndrome.
Journal of Orthomolecular Medicine, 2002;17(2):111-116
20. Warner FJ. Metabolic
supplement for correction of raging free radicals in
Trisomy
21: A
noncomparative open case study.
http://www.warnerhouse.com/radicals.htm . Accessed August, 2003.
21.
http://www.ndss.org/content.cfm?fuseaction=SearchLink&article=45 . Accessed August, 2003.
22. Sacks B and Buckley
F. Multi-nutrient formulas and other substances as therapies for Down
syndrome: An overview. Down Syndrome News and Update, 1998. 1(2), 70-83.
http://www.down-syndrome.info/library/periodicals/dsnu/01/2/070/DSNU-01-2-070-EN-GB.htm
23. Pincheira J, Navarrete MH, de la Torre C,
Tapia G, Santos MJ. Effect of vitamin E on chromosomal aberrations in
lymphocytes from patients with Down syndrome. Clin
Genet. 1999 Mar;55(3):192-7.
24. Craft
D. Can nutritional supplements help mentally retarded children? 1998.
25. Davis DR. The Harrell study and seven
follow-up studies: A brief review. J Orthomolecular Medicine, 1987. 2:2,
111-115.
26. Turkel H. Medical
amelioration of Down's syndrome incorporating the orthomolecular approach.
Journal of Orthomolecular Psychiatry, 1975. 4:102-115.
27. Turkel H. The medical
treatment for Down's syndrome.
Southfield,
MI:
Ubiotica.
1985.
More on Dr
Turkel’s treatment:
http://www.doctoryourself.com/turkel.html
Copyright 2004 and previous
years Andrew W. Saul.
Andrew Saul is the author of the books FIRE
YOUR DOCTOR! How to be Independently Healthy (reader reviews at
http://www.doctoryourself.com/review.html
) and DOCTOR YOURSELF: Natural Healing that Works. (reviewed at http://www.doctoryourself.com/saulbooks.html
)
For ordering information, Click Here .
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