Why A Sick Body Needs So Much Vitamin C

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Megadoses: Why?

The Third Face of Vitamin C

Robert F. Cathcart, M.D.

Journal of Orthomolecular Medicine, 7:4;197-200, 1993.

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ABSTRACT

Bowel tolerance to orally ingested ascorbic acid increases with the

toxicity of diseases. Bowel tolerance with a disease such as mononucleosis

may reach 200 or more grams per 24 hours without it producing diarrhea. A

marked clinical amelioration or cure is achieved in many disease processes

when threshold doses near bowel tolerance are given. In a sense, it is the

reducing equivalents carried by free radical scavengers that quench free

radicals, not the free radical scavengers themselves. Ascorbic acid can be

dramatically useful in quenching free radicals because it is usually

tolerated in amounts necessary to provide the reducing equivalents

necessary to quench almost all the free radicals generated by severe

disease processes. Vitamin C functions are incidental at these dose levels;

the benefit is from the reducing equivalents carried. To the extent that

free radicals are either essential to the perpetuation of a disease or just

part of the cause of symptoms, the disease will be cured or just

ameliorated. These effects are even more dramatic from intravenous sodium

ascorbate.

Keywords: vitamin C, ascorbate, acute induced scurvy, bowel tolerance,

titrating to bowel tolerance, the ascorbate effect, free radical

scavengers, reducing equivalents.

INTRODUCTION

A clinical experience prescribing doses of ascorbic acid up to 200 or more

grams per 24 hours to over 20,000 patients during the past 23 year period

has revealed its clinical usefulness in all diseases involving free

radicals. The controversy continues over the value of vitamin C mainly

because inadequate doses are used for most free radical scavenging

purposes. Paradoxically, the non controversial use of minute doses of

vitamin C in the prevention and treatment of scurvy has set the minds of

many against more creative uses.

I have found vitamin C exceptionally useful in a very high dose range. Its

usefulness is in three such distinct realms that I will describe them as

the three faces of vitamin C.

1. vitamin C to prevent scurvy

(up to 65 mg/day.)

2. vitamin C to prevent acute induced scurvy

and to augment vitamin C functions

(1 to 20 grams/day.)

3. vitamin C to provide reducing equivalents

(30 to 200 or more grams/day.)

One might criticize the wisdom of my use of these massive doses but Klenner

had successfully utilized them previously. The works of Irwin Stone, Linus

Pauling, and Archie Kalokerinos have supported many of my observations. It

was apparent that in all the studies yielding negative or equivocal

results, inadequate doses were used. In some studies, doses barely

bordering on adequate, tease the investigator with statistically

significant but not very impressive beneficial results.

My early discovery was that the bowel tolerance to ascorbic acid of a

person with a healthy GI tract was somewhat proportional to the toxicity of

their disease. Bowel tolerance doses are the amounts of ascorbic acid

tolerated orally that almost, but not quite, cause diarrhea. A patient who

could tolerate orally 10 to 15 grams of ascorbic acid per 24 hours when

well, might be able to tolerate 30 to 60 grams per 24 hours if he had a

mild cold, 100 grams with a severe cold, 150 grams with influenza, and 200

grams or more per 24 hours with mononucleosis or viral pneumonia (1, 2).

Marked clinical benefits in these conditions occur only at the bowel

tolerance or higher levels. I named the process whereby the patient

determined the proper dose as titrating to bowel tolerance. These increases

in bowel tolerance in the vast majority of patients normally tolerant to

ascorbic acid (perhaps 80% of patients) are invariable. The marked clinical

benefits are noted only when a threshold dose, usually close to the bowel

tolerance dose, is consumed. I call this benefit the ascorbate effect.

Most patients are started at first with hourly doses of ascorbic acid

powder dissolved in small amounts of water. Later, after the patient has

learned to accurately estimate the dose necessary to achieve the ascorbate

effect, comparable doses of tablets or capsules are also used. Where

patients are intolerant to adequate amounts of ascorbic acid orally and the

severity of the disease warrants it, intravenous sodium ascorbate is used.

Failures are related to individual difficulties in taking the proper

adequate doses. I now have had 22 years to gather clinical experience and

to reflect on this phenomenon.

I want to emphasize the importance of this increasing bowel tolerance with

increasing toxicities of diseases. The sensation of detoxification one

experiences at these doses is unmistakable.

The effect is so reliable and dramatic in the tolerant patient as to make

obvious the fact that something very important, that has not been widely

appreciated before, is going on.

THE THREE FACES

Vitamin C probably always functions by being an electron donor. At the

lowest dose level (the first face), it is necessary as a vitamin to prevent

scurvy. It is essential for certain metabolic functions which are well

described and mostly non controversial.

At a second level (the second face) vitamin C is still used as a vitamin

but larger doses are necessary to maintain its basic vitamin C functions

because the vitamin is destroyed rapidly in diseased or injured tissues

where there is an overabundance of free radicals. I described the resulting

state of deficiency, if the vitamin C is not replaced, as acute induced

scurvy (1, 2). There is ample evidence of this depletion of vitamin C by

stress and disease as recently reviewed in the literature.

Additionally, the recent extensive research on vitamin C has concerned

itself with certain functions that may be augmented by higher than minimal

doses of vitamin C (20). Strangely, any usefulness of these larger than

minimal doses of vitamin C remain mostly neglected by clinicians. This

level is from about 1 to 20 grams a day. Benefits vary from person to

person.

At this second level, as in studies reviewed by Pauling (11) and more

recently by Hemil„ (20), there may be expected a slight decrease in the

incidence of colds but a more significant reduction in the complications

and the duration of colds. Personally, I am impressed by the number of

patients (but certainly not all) who tell me that they have not had a cold

for years since reading Pauling's book and taking vitamin C. Patients with

chronic infections frequently have those infections cured for the first

time. Antibiotics work synergistically with these doses. A surprising

number of elderly persons benefit from doses of this magnitude and may

indeed have what Irwin Stone described as chronic subclinical scurvy (10).

The third level of doses (the third face) is virtually undiscussed in the

literature but is the most interesting. These doses range usually from 30

to 200 grams or more per 24 hours. The most important concept to understand

is that while incidentally at these dose levels the vitamin C performs all

the functions of levels one and two, it is mostly thrown away for the

reducing equivalents it carries (3). With these doses it is possible to

saturate the body with reducing equivalents, neutralize the excessive free

radicals, and drive a reducing redox potential into involved tissues.

Inflammations mediated by free radicals can be eliminated or markedly

reduced. In many instances patients with allergies or autoimmune disease

have their humeral immunity controlled while their cellular immunity is

augmented (19). To the extent that free radicals are either essential to

the perpetuation of a disease or just part of the cause of symptoms, the

disease will be cured or just ameliorated.

The list of diseases involving free radicals continue to grow. Infections,

cardiovascular diseases, cancer, trauma, burns both thermal and radiation,

surgeries, allergies, autoimmune diseases and aging are now included. It is

more difficult to think of a disease that does not involve free radicals.

Progressive nutritionists routinely give vitamin C, vitamin E, beta

carotene, selenium, NAC, etc. to counter free radicals. I certainly agree

with this practice. However, there is one important concept neglected.

In the spirit that if you throw a bucket of water on a fire, it is the

water that puts the fire out, not the bucket; it is the reducing

equivalents carried by the free radical scavengers that quench the free

radicals, not the free radical scavenger itself.

Most of the reducing equivalents utilized by non enzymatic free radical

scavengers do not come from the ingested free radical scavengers but come

through glycolysis, the citric acid cycle, NADPH, FADH2, glutathione, etc.

Dietary free radical scavengers carry in on ingestion only a small

percentage of the total reducing equivalents carried by those scavengers

during their lifetime in the body. After their first pass neutralizing free

radicals, the free radical scavenger must be recharged with reducing

equivalents made available in the mitochondria.

Consider the following: 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 without it producing diarrhea. 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.

Subsequently, all my young mononucleosis patients with excellent GI tracts

have responded similarly and have had equivalent increases in bowel

tolerance during the acute stage of the disease.

I believe that the loose stools caused by excessive doses of ascorbic acid

orally ingested is due to a resulting hypertonicity of ascorbate in the

rectum. Water is attracted into the rectum by the increased osmotic

pressure and results in a benign diarrhea. With toxic illnesses, the

ascorbate is destroyed rapidly in the involved tissues resulting in a rapid

absorption from the gut. Of the ascorbate, what does not reach the rectum,

does not cause diarrhea. Intravenous sodium ascorbate does not cause

diarrhea and, in fact, increases bowel tolerance to orally ingested

ascorbic acid while the IV is running. With hypertonicity of the ascorbate

both in the blood and in the rectum, the osmotic pressure of the ascorbate

is more equal on both sides of the bowel wall so no diarrhea results. If

the diarrhea was cause by other metabolic processes, diarrhea would be

caused by intravenous ascorbate.

It should be noted that in some cases of pathological diarrhea, ascorbic

acid stops the diarrhea. Presumably in these cases some of the increased

destruction of ascorbate is from free radicals in the bowel. However, in

most toxic systemic diseases there is no reason to believe that the

destruction of the additional ascorbate occurs directly in the bowel, so it

is a safe hypothesize that this increased destruction occurs in the

interior of the body.

The increased tolerance to ascorbic acid orally provides an interesting and

somewhat useful measure of the toxicity of a disease. Probably it is

somewhat a measure of the free radicals involved in a disease. I describe a

cold that at its maximum makes it possible for a patient to just tolerate

100 grams of ascorbic acid orally without diarrhea, a "100 gram cold."

Patients, appearing to be well, who have a tolerance over 20 to 25 grams

per 24 hours probably have some subclinical condition which is being hidden

by their own free radical scavenging system.

Patients with chronic infections (and a normally strong stomach) can ingest

enormous amounts of ascorbic acid. One of my chronic fatigue patients is

functional only because of his ingestion of 65 pounds of ascorbic acid in

the past 12 months. In 22 years, I, personally, have ingested approximately

361 kilos ( 797 lbs ) ( 4.3 times my body weight ) of ascorbic acid because

of chronic allergies and perhaps chronic EBV.

Considering the reducing equivalents carried by such amounts of ascorbic

acid, one can only guess at the turnover rate of the non enzymatic free

radical scavengers in a patient acutely ill with a 200 gram mononucleosis.

However, one gains the impression that all the non enzymatic free radical

scavengers would have to be rereduced many times a day.

AN ANALOGY

Suppose you owned a farm and on one end of the property there was a barn

and on the other end of the property there was a water well. One day the

barn catches fire and neighbors come with buckets to set up a bucket

brigade between the water well and the barn and are putting out the fire

when the well goes dry.

My use of ascorbate is like thousands of neighbors coming from miles

around, each with a bucketful of their own water, throwing their own water

on your fire once, and then leaving.

CONCLUSION

Because of the invariable (in patients tolerant to ascorbic acid)

increasing bowel tolerance to ascorbic acid in patients roughly in

proportion to the toxicity of their disease, there has to be something

happening to ascorbate in the sick patient other than its being used as

vitamin C in the classic sense. The amelioration or sometimes cure of

different diseases appears related to the importance of free radicals in

the perpetuation of the paticular disease.

The sudden marked benefit in many disease processes which is achieved at

doses near to the bowel tolerance level suggests that a reducing redox

potential is forced into the affected tissues only at those dose levels.

This ascorbate effect only at the high dose levels is also suggestive that

something other than classic functions of vitamin C is involved. This

ascorbate effect is more compatible with principles of redox chemistry.

Only a small percentage of the total reducing equivalents donated by non

enzymatic free radical scavengers to neutralize free radicals, come in on

the ingested nutritional free radical scavengers. Ascorbate is unique in

that the body can tolerate doses adequate to supply the necessary reducing

equivalents to quench the free radicals generated by severely toxic disease

processes. The vitamin C is thrown away for the reducing equivalents it

carries. Only in this way can the large amounts of free radicals generated

by the most toxic disease processes be rapidly quenched.

REFERENCES

1. Cathcart RF. The method of determining proper doses of

vitaminC for the treatment of disease by titrating to bowel

tolerance. J Orthomolecular Psychiatry 1981; 10: 125-32.

2. Cathcart RF. Vitamin C: titrating to bowel tolerance,

anascorbemia, and acute induced scurvy.

Medical Hypotheses 1981; 7:1359-76.

3. Cathcart RF. A unique function for ascorbate.

Medical Hypotheses 1991; 35: 32-7.

4. Klenner FR. Virus pneumonia and its treatment with vitamin C.

J. South. Med. and Surg. 1948; 110: 60-3.

5. Klenner FR. The treatment of poliomyelitis and other virus

diseases with vitamin C.

J. South. Med. and Surg. 1949; 111:210-4.

6. Klenner FR. Observations on the dose and administration of

ascorbic acid when employed beyond the range of a vitamin in

human pathology. J. App. Nutr. 1971; 23: 61-88.

7. Klenner FR. Significance of high daily intake of ascorbic

acid in preventive medicine.

J. Int. Acad. Prev. Med. 1974; 1:45-9.

8. Stone I. Studies of a mammalian enzyme system for producing

evolutionary evidence on man.

Am. J. Phys. Anthro. 1965; 23:83-6.

9. Stone I. Hypoascorbemia: The genetic disease causing the human

requirement for exogenous ascorbic acid.

Perspectives in Biology and Medicine 1966; 10: 133-4.

10. Stone I. The Healing Factor: Vitamin C Against Disease.

Grosset and Dunlapp, New York, 1972.

11. Pauling L. Vitamin C and the Common Cold.

W.H. Freeman and Company, San Francisco, 1970.

12. Pauling L. Vitamin C, the Common Cold, and the Flu.

W.H.Freeman and Company, San Francisco, 1976.

13. Pauling L. How to Live Longer and Feel Better.

W.H. Freeman and Company, New York, 1986.

14. Kalokerinos A. Every Second Child.

Keats Publishing, Inc., New Canaan, 1981.

15. Cathcart RF. Clinical trial of vitamin C. Letter to the

Editor, Medical Tribune, June 25, 1975.

16. Cathcart RF. Vitamin C in the treatment of acquired

immunedeficiency syndrome (AIDS).

Medical Hypotheses 1984; 14(4): 423-33.

17. Cathcart RF. Vitamin C: the nontoxic, nonrate-limited,

antioxidant free radical scavenger.

Medical Hypotheses 1985; 18:61-77.

18. Cathcart RF. HIV infection and glutathione (Letter to editor

concerning Vitamin C tolerance in AIDS).

Lancet 1990; 335(8683);235.

19. Cathcart RF. The vitamin C treatment of allergy and the

normally unprimed state of antibodies.

Medical Hypotheses 1986;21(3): 307-21.

20. Hemil H. Vitamin C and the common cold.

Br J Nutr 1992; 67:3-16.

__________________________________________________

Robert F. Cathcart, M.D.

Allergy, Environmental, and Orthomolecular Medicine

Orthopedic Medicine

127 Second Street, Suite 4, Los Altos, California, USA

Telephone: 650-949-2822

Fax: 650-949-5083