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How to
Determine a Therapeutic Dose of Vitamin C, by Robert F. Cathcart, MD |
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C Titration Paper
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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 http://www.orthomed.com 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
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. INDIVIDUAL RESPONSES
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. MONONUCLEOSIS
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. HEPATITIS
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). UNSICK
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. BACTERIAL INFECTIONS
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. CANDIDA ALBICANS
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. FUNGUS INFECTIONS
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. CANCER
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. ARTHRITIS
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. SCARLET FEVER
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
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. COMPLICATIONS
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. REFERENCES
1. Cathcart, R.F. Clinical trial of vitamin C. Medical
Tribune, June 25, 1975. 2. Cathcart, R.F. Clinical use of large doses of ascorbic acid. Presented
at the annual meeting of the California Orthomolecular Medical Society, San
Francisco, February 19, 1976. 3. Cathcart, R.F. Vitamin C as a detoxifying agent. Presented at the
annual meeting of the Orthomolecular Medical Society, San Francisco, January
21, 1978. 4. Cathcart, R.F. Vitamin C - The missing stress hormone. Presented at the
annual meeting of the Orthomolecular Medical Society, San Francisco, March 3,
1979. 5. Cathcart, R.F. The method of determining proper doses of vitamin C for
the treatment of disease by titrating to bowel tolerance. J. Orthomolecular
Psychiatry, 10:125-132, 1981. 6. Klenner, F.R. Virus pneumonia and its treatment with vitamin C. J.
South. Med. and Surg., 110:60-63, 1948. 7. Klenner, F.R. The treatment of poliomyelitis and other viral diseases
with vitamin C. J. South. Med. and Surg., 111:210-214, 1949. 8. Klenner, F.R. Observations on the dose and administration of ascorbic
acid when employed beyond the range of a vitamin in human pathology. J. App.
Nutr., 23:61-88, 1971. 9. Klenner, F.R. Significance of high daily intake of ascorbic acid in
preventive medicine. J. Int. Acad. Prev. Med., 1:45-49, 1974. 10. Stone, I. Studies of a mammalian enzyme system for producing
evolutionary evidence on man. Am. J. Phys. Anthro., 23:83-86, 1965. 11. Stone, I. Hypoascorbemia: The genetic disease causing the human
requirement for exogenous ascorbic acid. Perspectives in Biology and
Medicine, 10:133-134, 1966. 12. Stone, I. The Healing Factor: Vitamin C Against Disease. Grosset and
Dunlap, New York, 1972. 13. Pauling, L. Vitamin C and the Common Cold. W.H. Freeman and Company,
San Francisco, 1970. 14. Pauling, L. Vitamin C, the Common Cold, and the Flu. W.H. Freeman and
Company, San Francisco, 1976. 15. Cameron, E. and Pauling, L. Supplemental ascorbate in the supportive
treatment of cancer: Prolongation of survival times in terminal human cancer.
Proc. Natl. Acad. Sci. USA, 73:3685-3689, 1976. 16. Cameron, E. and Pauling, L. The orthomolecular treatment of cancer:
Reevaluation of prolongation of survival times in terminal human cancer.
Proc. Natl. Acad. Sci. USA, 75:4538-4542, 1978. 17. Cameron, E. and Pauling, L. Cancer and Vitamin C. The Linus Pauling
Institute for Science and Medicine, Menlo Park, 1979. 18. Williams, R.J. Biochemical Individuality. John Wiley, New York, 1956.
University of Texas Press, Austin, Texas, 1973. 19. Siegel, B.V. Enhancement of Interferon Response by poly(rI).- poly(rC)
in Mouse Cultures by Ascorbic Acid. Nature 254:531-532, 1975. 20. Siegel, B.V., Morton, J.I. Vitamin C and the Immune Response.
Experientia 33:393-395, 1977. 21. Lewin, S. Vitamin C: Its Molecular Biology and Medical Potential.
Academic Press, London, 1976. 22. Kalokerinos, A. Every Second Child, Thomas Nelson, Australia,
1974. 23. Subramanian, N. et al. Detoxification of histamine with ascorbic acid.
Biochemical Pharmacology. 27:1671-1673, 1973. 24. Murata, A. Virucidal activity of vitamin C: Vitamin C for the
prevention and treatment of viral diseases. Proceedings of the First
Intersectional Congress of Microbiological Societies, Science Council of
Japan, 3:432-442, 1975. 25. Salaman, M. Fighting infection-the cat and the "C". Let's
Live, 128-130, April 1980. 26. Libby, A.F. and Stone, I. The hypoascorbemia-kwashiorkor approach to
drug addiction therapy: A pilot study. J. Orthomolecular Psychiatry,
6:300-308, 1977. 27. Greenwood, J. Optimum vitamin C intake as a factor in the preservation
of disc integrity. Medical Annals of the District of Columbia, 33:274-276,
1964. 28. Cousins, N. Anatomy of an Illness as Perceived by the Patient. W.W.
Norton & Company, New York, 1979. 29. Williams, R.J. The Prevention of Alcoholism Through Nutrition. Bantam
Books, New York, 1981. 30. Campbell, G.D. Jr., Steinberg, M.H. and Bower, J.D. Ascorbic acid
induced hemolysis in G-6-PD deficiency. Ann. Int. Med. 82:810, 1975. 31. Herbert, V. and Jacob, E. Destruction of vitamin B12 by ascorbic acid.
JAMA, 230:241-242, 1974. 32. Belfield, W.O. and Stone, I. Megascorbic prophylaxis and megascorbic
therapy: A new orthomolecular modality in veterinary medicine. Journal of the
International Academy of Preventive Medicine, 2:10-26, 1975. -----------------------------------
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