Diets & Nutrition

Introduction

Status of Diet and Nutrition Research in the United States

Diet and nutrition research goes on in almost every medical school, university, and pharmaceutical laboratory throughout the world. Thus, the knowledge of how to prevent illness and maintain health through nutrition grows every year. However, for such areas as reversing the effects of chronic disease through dietary or nutritional intervention or determining levels of nutrients required to achieve optimal metabolic or immune system functioning, there often is no critical mass of researchers or funds to follow up promising initial experimental results.

In fact, the history of nutrition research is marked by examples where, for one reason or another, preliminary reports of a positive therapeutic effect of a certain vitamin, mineral, or nutritional manipulation appear but are often not followed up by the overwhelming majority of the medical community. In cases where such therapies eventually are proven to be safe ~and effective, it is sometimes not until years or even decades after the initial reports. The result is that many individuals may die or suffer needlessly, while effective interventions are available but not yet validated.

For example, in the 1930s, Australian psychiatrist John Cade began a series of crude experiments on guinea pigs in which he injected them with the urine of psychiatric patients to test his hypothesis that mania--a mood disorder characterized by, among other things, periods of euphoria--might represent a state of intoxication resulting from an excess of some commonly occurring metabolite. Depression, on the other hand, might represent the effects of abnormally low levels of the same metabolite (Johnson, 1984). Although all the urine samples proved toxic to the guinea pigs--Cade traced the toxicity to the urea component of the urine--the urine from the manic patients was far more toxic than urine from the schizophrenic or depressive patients.

In his attempts to find out what was increasing the toxicity of the urea in the manic patients' urine, Cade happened upon the compound lithium citrate, which he eventually began ~injecting by itself into the guinea pigs to judge its effect. To his amazement, the guinea pigs became lethargic and unresponsive for several hours after receiving lithium, before fully recovering. In 1949, Cade published the results of a crude clinical trial, stating that lithium salts given to 10 manic patients resulted in a dramatic improvement in each one's condition (Cade, 1949). Unfortunately for Cade, just as his results were reaching the United States, a number of table salt substitutes containing lithium chloride had just been recalled by the Food and Drug Administration (FDA) due to toxic side effects and, in some cases, death with heavy use. So much publicity was given to the toxicity associated with these salt substitutes--which were marketed for use by people on salt-restricted diets--that for 5 years after Cade's original report, relatively little work with lithium was undertaken (Georgotas and Gershon, 1981).

According to medical historian Frederick Johnson (1984), "Cade's report of lithium treatment of mania might well have succumbed to the same fate as that suffered by many proposed therapeutic techniques before and after that time ... had lithium salts been at all expensive or hard to come by...." Instead, because canisters of lithium salts were to be ~found in most hospitals and pharmacies at the time, many psychiatrists in the mid-1950s, for lack of adequate treatments for manic disorders, simply started experimenting with lithium on their own. By the mid-1960s, a spate of reports appeared in the medical literature reporting on the effectiveness of lithium in the treatment of manic and other psychiatric disorders (Gershon and Yuwiler, 1960; Schlagenhauf et al., 1966). Today lithium, in some patients with bipolar disorders (i.e., mood swings), is the most successful therapeutic drug of the five major types of drugs currently used in psychiatry (Horrobin, 1990), often producing normalization in acute mania patients in 1 to 3 weeks.