Vitamin C,
Titrating to Tolerance
----------------------------------- ----- Robert
F. Cathcart,M.D. ----- --- Allergy, Environmental, and --- ----- Orthomolecular Medicine
----- ------- Orthopedic Medicine
------- --- 127 Second
Street, Suite 4 --- --- Los Altos, California, USA --- -------- Fax:650-949-5083
---------
-----------------------------------
Copyright (C), 1994 and prior years,
Robert F. Cathcart, M.D. Permission granted to distribute via the internet as
long as material is distributed in its entirity and not modified.
Medical Hypotheses,
7:1359-1376, 1981.
VITAMIN C, TITRATING TO BOWEL TOLERANCE,
ANASCORBEMIA, AND ACUTE INDUCED SCURVY
Robert F. Cathcart, III, M.D.
Allergy, Environmental, and Orthomolecular Medicine 127 Second Street, Los
Altos, California 94022, USA Telephone 650-949-2822
ABSTRACT
A method of utilizing vitamin C in
amounts just short of the doses which produce diarrhea is described (TITRATING
TO BOWEL TOLERANCE). The amount of oral ascorbic acid tolerated by a patient
without producing diarrhea increases somewhat proportionately to the stress or
toxicity of his disease. Bowel tolerance doses of ascorbic acid ameliorate the
acute symptoms of many diseases. Lesser doses often have little effect on acute
symptoms but assist the body in handling the stress of disease and may reduce
the morbidity of the disease. However, if doses of ascorbate are not provided
to satisfy this potential draw on the nutrient, first local tissues involved in
the disease, then the blood, and then the body in general become deplete of
ascorbate (ANASCORBEMIA and ACUTE INDUCED SCURVY). The patient is thereby put
at risk for complications of metabolic processes known to be dependent upon
ascorbate.
INTRODUCTION
Over the past ten-year period I have
treated over 9,000 patients with large doses of vitamin C (Cathcart 1, 2, 3, 4, 5). The effects of this substance when used in adequate amounts markedly
alters the course of many diseases. Stressful conditions of any kind greatly
increase utilization of vitamin C. Ascorbate excreted in the urine drops markedly
with stresses of any magnitude unless vitamin C is provided in large amounts.
However, a more convenient and clinically useful measure of ascorbate need and
presumably utilization is the BOWEL TOLERANCE. The amount of ascorbic acid
which can be taken orally without causing diarrhea when a person is ill
sometimes is over ten times the amount he would tolerate if well. This
increased bowel tolerance phenomenon serves not only to indicate the amount
which should be taken but indicates the unsuspected and astonishing magnitude
of the potential use that the body has for ascorbate under stressful
conditions.
If this massive draw on the small
ascorbate stores of the body is not fully satisfied, the condition of
ANASCORBEMIA results. The deficit of ascorbate probably starts in the tissues
directly involved in the disease and then spreads to other tissues of the body.
A condition of localized and then systemic acute scurvy is produced. This ACUTE
INDUCED SCURVY leads to poor healing and ultimately to complications involving
other systems of the body.
Much of the original work with large
amounts of vitamin C was done by Fred R. Klenner, M.D. (6, 7, 8, 9) of Reidsville, North Carolina. Klenner found that viral diseases could
be cured by intravenous sodium ascorbate in amounts up to 200 grams per 24
hours. Irwin Stone (10, 11, 12) pointed out the potential of vitamin C in the treatment of many
diseases, the inability of humans to synthesize ascorbate, and the resultant
condition hypoascorbemia. Linus Pauling (13, 14) reviewed the literature on vitamin C and has led the crusade to make
known its medical uses to the public and the medical profession. Ewan Cameron
in association with Pauling (15, 16, 17) has shown the usefulness of ascorbate in the treatment of cancer.
BOWEL
TOLERANCE METHOD
In 1970, I discovered that the
sicker a patient was, the more ascorbic acid he would tolerate by mouth before
diarrhea was produced. At least 80% of adult patients will tolerate 10 to 15
grams of ascorbic acid fine crystals in 1/2 cup water divided into 4 doses per
24 hours without having diarrhea. The astonishing finding was that all
patients, tolerant of ascorbic acid, can take greater amounts of the substance
orally without having diarrhea when ill or under stress. This increased
tolerance is somewhat proportional to the toxicity of the disease being
treated. Tolerance is increased some by stress (e.g., anxiety, exercise, heat,
cold, etc.)(see FIGURE I). Admittedly, increasing the frequency of doses increases tolerance
perhaps to half again as much, but the tolerances of sometimes over 200 grams
per 24 hours were totally unexpected. Representative doses taken by tolerant
patients titrating their ascorbic acid intake between the relief of most
symptoms and the production of diarrhea were as follows:
TABLE I - USUAL BOWEL TOLERANCE DOSES GRAMS
ASCORBIC ACID
NUMBER OF DOSES CONDITION
PER 24 HOURS PER 24 HOURS normal
4 - 15
4 - 6 mild cold
30 - 60
6 - 10 severe cold
60 - 100+
8 - 15 influenza
100 - 150
8 - 20 ECHO, coxsackievirus 100 -
150
8 - 20 mononucleosis
150 - 200+
12 - 25 viral
pneumonia
100 - 200+
12 - 25 hay fever,
asthma 15
- 50
4 - 8 environmental and
food
allergy
0.5 - 50
4 - 8 burn, injury, surgery 25 - 150+
6 - 20 anxiety, exercise
and
other mild stresses
15 - 25
4 - 6 cancer
15 - 100
4 - 15 ankylosing
spondylitis
15 - 100
4 - 15 Reiter's syndrome 15
- 60
4 - 10 acute anterior
uveitis 30
- 100
4 - 15 rheumatoid arthritis 15
- 100
4 - 15 bacterial
infections 30 - 200+
10 - 25 infectious
hepatitis 30 - 100
6 - 15 candidiasis
15 - 200+
6 - 25
FIGURE 1. REPRESENTATIVE DOSES TO TREAT ACUTE
SYMPTOMS OF
DISEASE IN PATIENTS VERY TOLERANT TO ASCORBIC ACID
DISEASE IN PATIENTS VERY TOLERANT TO ASCORBIC ACID
GRAMS ASCORBIC ACID ORALLY PER 24 HOURS
1) Note that
disease symptom curves indicate very little effect on acute symptoms until
doses of 80-90% of bowel tolerance are reached. Perhaps it is only near
tolerance doses that the ascorbate is pushed into the primary sites of the
disease. 2) Suppression of symptoms in some instances may not be total; but
usually it is very significant and often the amelioration is complete and
rapid. 3) Hepatitis may require 30 to 100 grams.
TITRATING
TO BOWEL TOLERANCE
The maximum
relief of symptoms which can be expected with oral doses of ascorbic acid is
obtained at a point just short of the amount which produces diarrhea. The
amount and the timing of the doses are usually sensed by the patient. The
physician should not try to regulate exactly the amount and timing of these
doses because the optimally effective dose will often change from dose to dose.
Patients are instructed on the general principles of determining doses and
given estimates of the reasonable starting amounts and timing of these doses. I
have named this process of the patient determining the optimum dose, TITRATING
TO BOWEL TOLERANCE. The patient tries to TITRATE between that amount which begins
to make him feel better and that amount which almost but not quite causes
diarrhea.
I think it is
only that excess amount of ascorbate not absorbed into the body which causes
diarrhea; what does not reach the rectum, does not cause diarrhea.
It is interesting
to know, when one speculates on the exact cause of this diarrhea, that while a
hypertonic solution of sodium ascorbate is being administered intravenously,
the amount of ascorbic acid tolerated orally actually increases.
THE 100 GRAM COLD
When a person is
ill the amount of ascorbic acid he can ingest without diarrhea being produced
increases somewhat proportionally to the severity or the toxicity of the
disease. A cold severe enough to permit a person to take 100 grams of ascorbic
acid per 24 hours during the peak of the disease, I call a 100 GRAM COLD.
Perhaps one of
the most important principles in ORTHOMOLECULAR MEDICINE is BIOCHEMICAL
INDIVIDUALITY (18). Every individual responds to substances differently. Vitamin C is no
exception. However, at least 80% of my patients tolerated ascorbic acid well.
Admittedly, there were relatively few older patients in my practice. Infants,
small children, and teenagers tolerate ascorbic acid well and can take,
proportionate to their body weight, larger amounts than adults. Older adults
tolerate lesser amounts and have a higher percentage of nuisance difficulties.
Patients with multiple food intolerances may have more difficulties but should
attempt taking ascorbate because of benefits often obtained.
For several
years while I was treating only sick people with ascorbic acid, I was unaware
of the number of people who had nuisance problems with maintenance doses. The
tolerance of the sick person to ascorbate is so high as to prevent many of the
complaints one would have if he were well. When ascorbic acid is prescribed to
a sick person, the beneficial effect is obvious enough so that few complain of
the gas and diarrhea. With illness the effects of an overdose do not last long
because of the rapid rate of utilization.
It is important
for the physician to understand the principles of treating this vast majority
of tolerant persons. Patients frequently underdose themselves and need
professional guidance to push the doses to effective levels. The small number
of persons, especially elderly persons, intolerant to oral doses are in my
experience able to take intravenous ascorbate without difficulties. Additionally,
patients with severe problems may need to be treated intravenously if very high
doses will have to be maintained for some time for adequate suppression of
symptoms.
ANASCORBEMIA -- ACUTE
INDUCED SCURVY
It is well
established that certain symptoms are associated with an almost total lack of
vitamin C within the body. Symptoms of scurvy include lassitude, malaise,
bleeding gums, loss of teeth, nosebleeds, bruising, hemorrhages in any part of
the body, easy infections, poor healing of wounds, deterioration of joints,
brittle and painful bones, and death, etc. It is thought that this disease only
occurs with dietary deprivation of vitamin C. However, an analogous condition
is produced as follows:
Well-nourished
humans usually contain not much more than 5 grams of vitamin C in their bodies.
Unfortunately, the majority of people have far less ascorbate than this amount
in their bodies and are at risk for many problems related to failure of
metabolic processes dependent upon ascorbate. This condition is called CHRONIC
SUBCLINICAL SCURVY (12).
If a disease is
toxic enough to allow for the person's potential consumption of 100 grams of
vitamin C, imagine what that disease must be doing to that possible 5 grams of
ascorbate stored in the body. A condition of ACUTE INDUCED SCURVY is rapidly
induced. Some of this increased metabolic need for ascorbate undoubtedly occurs
in areas of the body not primarily involved in the disease and can be accounted
for by such functions as the adrenals producing more adrenaline and corticoids;
the immune system producing more antibodies, interferon (19, 20), and other substances to fight the infection; the macrophages
utilizing more ascorbate with their increased activity; and the production and
protection of c-AMP and c-GMP with the subsequent increased activity of other
endocrine glands (21), etc. Also, there must be a tremendous draw on ascorbate locally by
increased metabolic rates in the primarily infected tissues. The infecting
organisms themselves liberate toxins which are neutralized by ascorbate, but in
the process destroy ascorbate. The levels of ascorbate in the nose, throat,
eustachian tubes, and bronchial tubes locally infected by a 100 gram cold must
be very low indeed. With this acute induced scurvy localized in these areas, it
is small wonder that healing can be delayed and complications such as chronic
sinusitis, otitis media, and bronchitis, etc. develop.
I had assumed
that much of this ascorbate was used for functions somehow directly related to
neutralizing the toxicity of viral and bacterial diseases. When ill, one has
the internal sense that something of this nature is happening when bowel
tolerance is approached. Recently, however, I had the personal experience of
ingesting 48 grams in an hour and a half when I had a sudden hay fever reaction
to roses. Upon withdrawal from the roses tolerance dropped rapidly to normal.
This experience plus my experiences with many patients under emotional stress,
would indicate that the adrenals are capable of utilizing large amounts of
ascorbate with benefit if it is made available.
This draw on
ascorbate, from whatever source, lowers the blood level of ascorbate to a
negligible level. I have coined the term ANASCORBEMIA for this condition. If
this anascorbemia is not rapidly rectified by the oral administration of bowel
tolerance doses of ascorbic acid or by intravenous administration of ascorbate,
the remainder of the body is rapidly depleted of ascorbate and put at risk for
disorders of the metabolic processes dependent upon vitamin C.
The following
problems should be expected with increased incidence with severe depletion of
ascorbate: disorders of the immune system such as secondary infections, rheumatoid
arthritis and other collagen diseases, allergic reactions to drugs, foods and
other substances, chronic infections such as herpes, or sequelae of acute
infections such as Guillain-Barre' and Reye's syndromes, rheumatic fever, or
scarlet fever; disorders of the blood coagulation mechanisms such as
hemorrhage, heart attacks, strokes, hemorrhoids, and other vascular thrombosis;
failure to cope properly with stresses due to suppression of the adrenal
functions such as phlebitis, other inflammatory disorders, asthma and other
allergies; problems of disordered collagen formation such as impaired ability
to heal, excessive scarring, bed sores, varicose veins, hernias, stretch marks,
wrinkles, perhaps even wear of cartilage or degeneration of spinal discs; impaired
function of the nervous system such as malaise, decreased pain tolerance,
tendency to muscle spasms, even psychiatric disorders and senility; and cancer
from the suppressed immune system and carcinogens not detoxified; etc. Note
that I am not saying that ascorbate depletion is the only cause of these
disorders, but I am pointing out that disorders of these systems would
certainly predispose to these diseases and that these systems are known to be
dependent upon ascorbate for their proper function.
Not only is
there the theoretical probability that these types of complications associated
with infections or stresses could result from ascorbate depletion, but there
was a conspicuous decrease in the expected occurrence of complications in the
thousands of patients treated with oral tolerance doses or intravenous doses of
ascorbate. This impression of marked decrease in these problems is shared by
physicians experienced with the use of ascorbate such as Klenner (8, 9) and Kalokerinos (22).
THE
MISSING STRESS HORMONE
Stone (11) has described the genetic defect whereby the higher primates lost the
ability to synthesize ascorbate. This defect is caused by a mutated defective
gene for the liver enzyme, L-gulonolactone oxidase. The higher mammals (except
for the higher primates) developed a feedback mechanism which increases
ascorbate synthesis under the influence of external and internal stresses (23).
There are many
well-established functions of vitamin C that help in the handling of stress.
When stressed, the higher mammals can augment these functions by this feedback
mechanism. For the higher primates, including humans, ascorbate can amount to
the MISSING STRESS HORMONE (4).
I have seen
strong clinical evidence that not only does the bowel tolerance to ascorbate
increase under stress but that fully satisfying that potential use for
ascorbate markedly reduces secondary diseases and complications following
stress or primary disease. Since 1970, with teaching the bowel tolerance method
of determining proper ascorbic acid doses to patients, I have not had to
hospitalize a single patient for an acute viral disease or a complication from
such a disease if the patient utilized the method. In some cases, such as with
three cases of viral pneumonia, it was necessary to utilize intravenous
ascorbate. Admittedly, I have been lucky because no patient has arrived with
such severe symptoms as to necessitate immediate hospitalization. There have
been many patients where there was no question that they would have required
hospitalization in a very short period of time had not ascorbate been
administered. Some patients not quite taking bowel tolerance doses, but taking
significantly large doses of ascorbate, would not have as dramatic suppression
of acute symptoms but would, nevertheless, avert complications.
Acute
mononucleosis is a good example because there is such an obvious difference
between the course of the disease, with and without ascorbate. Also, it is
possible to obtain laboratory diagnosis to verify that it is mononucleosis
being treated. Early in this study a 23-year-old, 98-pound librarian with
severe mononucleosis claimed to have taken 2 heaping tablespoons every 2 hours,
consuming a full pound of ascorbic acid in 2 days. She felt mostly well in 3 to
4 days, although she had to continue about 20 to 30 grams a day for about 2
months.
Many cases do
not require maintenance doses for more than 2 to 3 weeks. The duration of need
can be sensed by the patient. I had ski patrol patients back skiing on the
slopes in a week. They were instructed to carry their boda bags full of
ascorbic acid solution as they skied. The ascorbate kept the disease symptoms
almost completely suppressed even if the basic infection had not completely
resolved. The lymph nodes and spleen returned to normal rapidly and the
profound malaise was relieved in a few days. It is emphasized that tolerance
doses must be maintained until the patient senses he is completely well, or the
symptoms will recur.
Acute cases of
infectious hepatitis have responded dramatically. Cases included two
orthopaedic surgeons who probably acquired the disease pricking their hands at
surgery and being inoculated with a patient's blood. With ascorbate treatment
laboratory tests including the SGOT, SGPT, and bilirubins indicated rapid
reversal of the disease. In one of these cases, with the doctorpatient and his
treating physicians having difficulty believing that the ascorbate was
responsible for the improvement, the ascorbate was discontinued. The condition
of the patient rapidly deteriorated. The patient's wife took charge and doled
out the ascorbate; again the disease rapidly subsided with laboratory findings
returning to normal.
Usually oral
bowel tolerance doses will reverse hepatitis rapidly. Stools regularly return
to normal color in 2 days. It generally takes about 6 days for the jaundice to
clear, but the patient will feel almost well after 4 to 5 days. Because of the
diarrhea caused by the disease, intravenous ascorbate may need to be used in
very severe cases. Often large doses of ascorbic acid, taken orally despite
diarrhea, will cause a paradoxical cessation of the diarrhea.
Morishige has
demonstrated the effectiveness of ascorbate in preventing hepatitis from blood
transfusions (24).
The phenomenon
of symptoms returning repeatedly if the ascorbate is not continued in high
doses is most convincing. It is possible to have symptoms come and go many
times. In fact, there is often a feeling when titrating to bowel tolerance that
symptoms are beginning to return just before taking the next dose.
Often a patient
will sense that he is probably catching some viral disease and that he is in
need of large doses of ascorbic acid. If he is experienced in taking ascorbic
acid he may be able to suppress more than 90% of the symptoms. He feels that he
should take large amounts of ascorbate, does not feel quite right, and may have
peculiar mild symptoms. I call this condition UNSICK. Recognition of this state
is important because it can be mistaken for more serious conditions.
INTRAVENOUS AND
INTRAMUSCULAR ASCORBATE
Symptoms from
acute viral diseases can most frequently be more permanently eliminated with
intravenous sodium ascorbate. While it is true that tolerance doses of oral
ascorbate will usually eliminate complications of acute viral diseases; at
times, such as with certain cases of influenza, the large amount of oral
ascorbate necessary to suppress symptoms over a period of a week or more,
sometimes makes intravenous ascorbate desirable. Clinically large amounts of
ascorbate used intravenously are virucidal (2, 5, 7, 8).
The sodium
ascorbate used intravenously and intramuscularly must contain no preservatives.
Usually there is only a small amount of EDTA in the preparation to chelate
trace amounts of copper and iron which might destroy the ascorbate. Solutions
containing sodium ascorbate 250 or 500 mgm per cc can be obtained. The 250 mgm
solutions may be used in young children intramuscularly in doses usually 350
mgm/kg body weight up to every 2 hours. When the volume of the material becomes
too great for intramuscular injections, then the intravenous route should be
used. Inadequate doses will be ineffective. Quite frequently a child initially
refusing oral ascorbate will cooperate after injections if given the
alternative. While this method of persuasion seems cruel, it is better than the
complications which might otherwise occur. These intramuscular injections can
be used in a crisis situation. Kalokerinos (22) describes cases where certain death in infants already in shock has
been averted by emergency intramuscular ascorbate.
For intravenous
solutions concentrations of 60 grams per liter are made with the 250 or 500
mgm/cc sodium ascorbate diluted with Ringer's lactate, 1/2N saline, 1N saline,
D5W, or distilled water for injection. I prefer the latter, but one has to be
absolutely sure that an error is not made and pure water given. Ascorbate is
more efficient intravenously than orally probably because chemical processes in
the gut destroy a percentage of that orally administered. Doses of 400 to 700
mgm/kg of body weight per 24 hours usually suffice. Rate of infusion and the
total amount administered can be determined by making sure that symptoms are
suppressed and that the patient not become dehydrated or receive sodium too
rapidly. Local soreness in the vein caused by too rapid infusion is relieved by
slowing the intravenous infusion. One gram of calcium gluconate should be added
to the bottles each day to prevent tetany.
I have not yet
seen a case of phlebitis develop as a result of ascorbate administration. This
rarity of phlebitis possibly suggests that this condition sometimes has
something to do with ascorbate depletion.
Frequently I
have the patient take oral doses of ascorbic acid at the same time he is taking
intravenous sodium ascorbate. Bowel tolerance is actually increased by
concomitant use of intravenous ascorbate. Care and experience is necessary with
concomitant use because tolerance drops precipitously when the intravenous
infusion is discontinued.
Ascorbic acid
should be used with the appropriate antibiotic. The effect of ascorbic acid is
synergistic with antibiotics and would appear to broaden the spectrum of
antibiotics considerably. I found that penicillin-K orally or penicillin-G
intramuscularly used in conjunction with bowel tolerance doses of ascorbic acid
would usually treat infections caused by organisms ordinarily requiring
ampicillin or other more modern synthetic penicillins. Cephalosporins were used
in conjunction with ascorbic acid for staphylococcus infections. The
combination of tetracycline and ascorbate was used for nonspecific urethritis;
however, patients who had previously repeated recurrences of nonspecific
urethritis found they were free of the disease with maintenance doses of
ascorbate. I am not sure that the tetracycline was necessary even in the acute
cases, but it was used for legal reasons. Some other cases of unknown etiology
such as two cases of Reiter's disease and one case of acute anterior uveitis
also responded dramatically to ascorbate.
A most important
point is that patients with bacterial infections would usually respond rapidly
to ascorbic acid plus a basic antibiotic determined by initial clinical
impressions. If cultures subsequently proved the selection of antibiotic
incorrect, usually the patient was well by that time.
In the case of a
45-year-old man who had developed osteomyelitis of the 5th metacarpal of the
right hand following a cat bite, a partial amputation of the hand had been recommended
and surgery scheduled. Consultants agreed. The patient delayed surgery and
signed himself out of the hospital. He was given intravenous ascorbate 50 grams
a day for 2 weeks. The infection resolved rapidly. While this patient had
destruction of the distal end of the metacarpal, there has been no recurrence
of the infection (25).
This case
illustrates the frequent problem of an indolent infection with an organism non-responsive
to the most sophisticated antibiotic treatment which then may respond rapidly
to treatment with intravenous ascorbate.
Treating
simultaneously with the appropriate antibiotic plus ascorbate has the
additional advantage that if, unexpectedly, the infection is actually viral,
the infection will be suppressed and the incidence of allergic reaction to the
antibiotic reduced.
VITAMIN C AND ALLERGY
Patients seemed
not to develop their first allergic reaction to penicillin when they had taken
bowel tolerance ascorbate for several doses. Among the several thousand
patients given penicillin, two cases of brief rash were seen in patients who
had taken their first dose of penicillin along with their first dose of
ascorbate. If one understands the reasons for bowel tolerance doses of
ascorbate, it is obvious that these patients were not as yet
"saturated." I saw three patients who had taken penicillin without
ascorbate who had developed an urticarial rash. These cases rapidly responded
to oral ascorbic acid. Only a single dose of antihistamine was usually used. I
would have anticipated longer reactions in most of these cases. I saw one case
of a delayed serum sickness type of penicillin reaction in a ten-year-old girl
who had not taken ascorbate previously. The rash in this patient did not
immediately respond to ascorbic acid. The rash took about two weeks to
completely resolve; however, if the ascorbate was not taken regularly to
tolerance, the rash would worsen. It was difficult to maintain high doses in this
patient.
Patients who had
known-previous-allergic reactions to penicillin were never given the antibiotic
anticipating that vitamin C would protect them. I suspect that the deficit of
body ascorbate produced by disease may have something to do with malfunction of
the immune system and the development of allergies. However, whether ascorbate
may give some protection from an antibiotic known previously to cause an
allergic reaction in a patient, when subsequent reactions might involve
anaphylaxis, is a question which must be approached very carefully. Certainly,
inadequate doses of ascorbate could be disastrous.
Patients with
mononucleosis, untreated with ascorbate, have a very high incidence of allergic
reaction to penicillin. It is interesting that this same disease seems to cause
some of the highest bowel tolerances of any disease.
As can be seen
from the previous discussion of the increasing bowel tolerance phenomenon,
there is undoubtedly increased utilization of ascorbate under stressful
conditions. If this increased utilization creates a deficit, there may be
malfunctions of various systems of the body such as the immune system which are
dependent on ascorbate. Therefore, it should not be surprising that certain
malfunctions of the immune system and adrenal glands associated with stress
might be ameliorated by ascorbate.
Hay fever is
controlled in the majority of patients. Bowel tolerance doses are usually
required only at the peak of the season; otherwise, more modest doses suffice.
Many patients find the effect of ascorbate more satisfactory than immunizations
or antihistamines and decongestants. The dosages required are frequently
proportional to exposure to the antigen.
Asthma is most often relieved by bowel tolerance doses of ascorbate. A child
regularly having asthmatic attacks following exercise is usually relieved of
these attacks by large doses of ascorbate. So far all of my patients having
asthmatic attacks associated with the onset of viral diseases have been
ameliorated by this treatment.
Large clinical
studies will be necessary to prove this point, but for now prudent practice
would be to take large doses ofascorbate when stressed or when ill.
This theory
begins to make some sense of the observation that many patients will develop
allergic disorders or other diseases following combinations of stress, disease,
and malnutrition. Immunologists should be particularly interested in the
control of these allergic problems and particularly the dramatic responses of
cases of ankylosing spondylitis, Reiter's disease, and acute anterior uveitis.
All three of these problems have a high association with the HLA-B27 antigen.
The possibility that ascorbate might have some value in controlling the immune
response at the gene level should be thoroughly investigated because there
could be some basic implications in histocompatibility (graft acceptance),
cancer control, and destruction of foreign invaders. Ascorbate would appear to
help stabilize some homeostatic mechanisms.
Yeast infections
occur less frequently in patients treated with antibiotics if bowel tolerance
doses of ascorbic acid are simul- taneously used. Ascorbic acid seems to reduce
the systemic toxicity considerably but does not eliminate the primary
infection. It has been helpful to patients with allergic problems secondary to
candida.
Although
ascorbic acid should be given in some form to all sick patients to help meet
the stress of disease, it is my experience that ascorbate has little effect on
the primary fungal infections. Systemic toxicity and complications can be
reduced in incidence. It may be found that appropriate antifungal agents will
better penetrate tissues saturated in ascorbate.
TRAUMA, SURGERY, AND BURNS
Swelling and
pain from trauma, surgery, and burns are markedly reduced by bowel tolerance
doses of ascorbic acid. Doses should be given a minimum of 6 times a day for
trauma and surgery. Burns can require hourly doses. Serious burns, major
trauma, and surgery should be treated with intravenous ascorbate. The effect of
ascorbate on anesthetics should be studied. Barbiturates
and many narcotics are blocked, (26) so their use as anesthetic agents will be limited when ascorbate is
used during surgery. While practicing orthopaedic surgery, I had some
experience with trauma cases in which I used ascorbic acid post-operatively.
There was virtual elimination of confusion in elderly patients following major
surgeries such as with hip fractures when ascorbate was given. This confusion
is commonly ascribed to fat embolization and the subsequent inflammation
provoked in the tissues by the emboli. I did several menisectomies where one
knee had been done before vitamin C was used, and the other side after vitamin
C was used. The pain and post-operative recovery time were lessened
considerably. The amount of inflammation and edema following injury and surgery
were markedly reduced. The pain medications used were relatively minimal. My
limited experience in replacing skin flaps avulsed by trauma indicated a whole
degree of lessened difficulties with much greater success.
Anyone who has
done animal surgery other than on humans is impressed by the rapid recovery
rate. Humans loaded with ascorbate would appear to recover similarly to the
animals which make their own ascorbate in response to stress. In the past,
vitamin C administered to patients in hospitals post-operatively has been in
trivial amounts never exceeding several grams. I predict that reimplantations
of major amputations, even transplant surgeries, and especially fine surgeries
of the eyes, ears, or fingers will enjoy a phenomenal increase in success rate
when ascorbate is utilized in doses of 100 grams or more per 24 hours.
The limited
stress-coping mechanisms of humans seems to be the result of rapid ascorbate
depletion. With surgery this leads to vascular thrombosis, hemorrhage,
infection, edema, drug reactions, shock, adrenal collapse with limited
adrenaline and steroid production, etc.
I have avoided
the treatment of cancer patients for legal reasons; however, I have given
nutritional consults to a number of cancer patients and have observed an
increased bowel tolerance to ascorbic acid. Were I treating cancer patients, I
would not limit their ascorbic acid ingestion to a set amount but would titrate
them to bowel tolerance. Ewan Cameron's advice against giving cancer patients
with widespread metastasis large amounts of ascorbate too rapidly at first
should be heeded. He found that sometimes extensive necrosis or hemorrhage in
the cancer could kill a patient with widespread metastasis if the vitamin was
started too rapidly (16). Hopefully, in the future ascorbic acid will be among the initial
treatments given cancer patients. The additional nutritional needs of cancer
patients are not limited to ascorbic acid, but certainly the stress involved
with having the disease depletes ascorbate levels in the body. Ascorbate should
be used in cancer patients to avert disorders of ascorbate deficiency in
various systems of the body including the immune system.
BACK PAIN FROM DISC
DISEASE
Greenwood (27) observed that 1 gram a day would reduce the incidence of necessary
surgery on discs. At bowel tolerance levels, ascorbic acid reduces pain about
50% and lessens the difficulties with narcotics and muscle relaxants (2). It is not, however, the only nutritional support that patients with
back pain should receive.
Bowel tolerance
is not increased by degenerative arthritis although occasionally ascorbate has
some beneficial effect.
Ankylosing
spondylitis and rheumatoid arthritis do increase tolerance. Clinical response
varies. Norman Cousins (28) curing his own ankylosing spondylitis with ascorbate is not
unexpected. With these and other collagen diseases, food and chemical allergies
can sometimes be found. It may be that the blocking of allergic reactions with
augmented adrenal function is one of the reasons these patients are sometimes
benefitted.
Three cases with
typical sandpaper-like rash, peeling skin, and diagnostic laboratory findings
of scarlet fever have responded within an hour or overnight. I think this
immediate response is due to the neutralization of the small amount of
streptococcus toxin responsible for the disease. Although I have not seen a
case of acute rheumatic fever, I would anticipate rapid effects.
HERPES: COLD SORES, GENITAL
LESIONS, AND SHINGLES
Acute herpes
infections are usually ameliorated with bowel tolerance doses of ascorbic acid.
However, recurrences are common especially if the disease has already become
chronic. Zinc in combination with ascorbic acid is more effective for herpes;
however, caution and regular monitoring of patients on zinc should be done.
For chronic
herpes, intravenous ascorbate may also be of benefit.
CRIB
DEATHS (SUDDEN INFANT DEATH SYNDROME)
I would agree
with Kalokerinos (22) and Klenner (8) that crib deaths are often caused by sudden ascorbate depletions. The
induced scurvy in some vital regulatory center kills the child. This induced
deficiency is more likely to occur when the diet is poor in vitamin C. All of
the epidemiologic factors predisposing to crib deaths are associated with low
vitamin C intake or high vitamin C destruction.
Maintenance
doses are established by the patient taking bowel tolerance doses 6 times a day
for at least a week. He observes if there is any unexpected benefit such as
clearing of sinuses, decrease in allergies, increase in energy, etc. Should any
chronic problem be benefitted, then the dose is decreased to the minimum amount
producing the effect. Otherwise a dose such as 4 to 10 grams a day divided in 3
to 4 doses is recommended.
In addition, the
patient is told to increase the dose on stressful days. If a patient well
tolerates ascorbic acid dissolved in water, then after a short period of time
his taste will begin to regulate the dosages. Most patients can easily sense
their ascorbate needs.
Patients who
take ascorbate in large amounts over a long period of time should probably
suppliment with vitamin A and a multiple mineral preparation. The
"Fortified Formulation for Nutritional Insurance" of Roger Williams (29) is recommended as a base.
It is my
experience that ascorbic acid probably prevents most kidney stones. I have had
a few patients who had had kidney stones before starting bowel tolerance doses
who have subsequently had no more difficulty with them. Acute and chronic
urinary tract infections are often eliminated; this fact may remove one of the
causes of kidney stones. Six patients have had mild pain on urination; five of
these patients were over fifty and none had stones.
Three out of
thousands had a light rash which cleared with subsequent doses. It was
difficult to evaluate the cause of this because of concomitant infections.
Several patients had discoloration of the skin under jewelry of certain metals.
A few patients complaining of small sores in the mouth with the taking of small
doses of ascorbate had them clear with bowel tolerance doses.
Patients with
hidden peptic ulcers may have pain, but some are benefitted. Mineral ascorbates
can be used for maintenance doses in these cases. Two patients who had mild
epigastric discomfort with maintenance doses of ascorbic acid who after being
given ascorbate by vein for several days were then able to tolerate the acid
orally.
It is my
experience that high maintenance doses reduce the incidence of gouty arthritis.
I have not seen difficulties with giving large amounts of ascorbic acid to
patients with gout. Almost all my patients have been Caucasian, so I have no
comment on the report that ascorbate can cause certain blood problems in
certain non-white groups (30).
There has been
no clinical evidence as Herbert and Jacob (31) suspected that ascorbic acid destroys vitamin B12.
If maintenance
doses of ascorbic acid in solution are used over very long periods of time I
would rinse the teeth after each dose. I would not brush my teeth with calcium
ascorbate.
There is a
certain dependency on ascorbic acid that a patient acquires over a long period
of time when he takes large maintenance doses. Apparently, certain metabolic
reactions are facilitated by large amounts of ascorbate and if the substance is
suddenly withdrawn, certain problems result such as a cold, return of allergy,
fatigue, etc. Mostly, these problems are a return of problems the patient had
before taking the ascorbic acid. Patients have by this time become so adjusted
to feeling better that they refuse to go without ascorbic acid. Patients do not
seem to acquire this dependency in the short time they take doses to bowel
tolerance to treat an acute disease. Maintenance doses of 4 grams per day do
not seem to create a noticeable dependency. The majority of patients who take
over 10-15 grams of ascorbic acid per day probably have certain metabolic needs
for ascorbate which exceed the universal human species need. Patients with
chronic allergies often take large maintenance doses.
The major
problem feared by patients benefiting from these large maintenance doses of
ascorbic acid is that they may be forced into a position where their body is
deprived of ascorbate during a period of great stress such as emergency
hospitalization. Physicians should recognize the consequences of suddenly
withdrawing ascorbate under these circumstances and be prepared to meet these
increased metabolic needs for ascorbate in even an unconscious patient. These
consequences of ascorbate depletion which may include shock, heart attack,
phlebitis, pneumonia, allergic reactions, increased susceptibility to
infection, etc., may be averted only by ascorbate. Patients unable to take
large oral doses should be given intravenous ascorbate. All hospitals should
have supplies of large amounts of ascorbate for intravenous use to meet this
need. The millions of people taking ascorbic acid makes this an urgent
priority. Patients should carry warnings of these needs in a card prominently
displayed in their wallets or have a Medic Alert type bracelet engraved with
this warning.
CONCLUSION
The method of
titrating a patient's dosage of ascorbic acid between the relief of most
symptoms and bowel tolerance has been described. Either this titration method
or large intravenous doses are absolutely necessary to obtain excellent
results. Studies of lesser amounts are almost useless. The oral method cannot
by its very nature be investigated by double blind studies because no placebo
will mimic this bowel tolerance phenomenon. The method produces such
spectacular effects in all patients capable of tolerating these doses,
especially in the cases of acute self-limiting viral diseases, as to be
undeniable. A placebo could not possibly work so reliably, even in infants and
children, and have such a profound effect on critically ill patients. Belfield
(32) has had similar results in veterinary medicine curing distemper and
kennel fever in dogs with intravenous ascorbate. Although dogs produce their
own ascorbate, they do not produce enough to neutralize the toxicity of these
diseases. This effect in animals could hardly be a placebo.
It would be
possible to conduct a double blind study on intravenous ascorbate; however,
doses would have to be determined by someone experienced with this method.
Part of the
difficulty many have with understanding ascorbate is that claims for its
benefits seem too many. Most of these clinical results merely indicate that
large doses of ascorbate augment the healing abilities of the body already
known to be dependent upon minimal doses of ascorbate.
I anticipate
that other essential nutrients will be found being utilized at unsuspectedly
rapid rates in disease states. Compli- cations caused by failures in systems
dependent upon those nutrients will be found. The magnitude of supplimentations
necessary to avert those complications will seem extraordinary by standards
accepted today.
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