LIFE Health & Fitness Club

Vitamin C has been controversial for decades. In our recent book, “Ascorbate: The Science of Vitamin C”, Dr Hilary Roberts and I examined the scientific evidence surrounding the claims for this vitamin(1). In this article, I list ten myths about the use and action of vitamin C. Before the programme was released, I emailed the Horizon team to make sure they were aware of these new findings. While Horizon ignored the new evidence, others did not.

The US Institute of Medicine, The National Institutes of Health, the Codex and even the Linus Pauling Institute have been independently petitioned to raise their recommended levels. On the basis of this new evidence, world leading independent experts, including Patrick Holford, have signed an open letter demanding the RDA be reconsidered immediately.

1. You only need a few milligrams a day
   People claiming that we need only a few milligrams of vitamin C per day in our diet should be more honest about the current level of ignorance. Small amounts of vitamin C will certainly prevent or cure scurvy, a deadly deficiency disease. Beyond this, the picture is less clear. There is little information on the amount of vitamin C that is optimal for health, or on the long-term effects of an inadequate intake. However, some evidence suggests that many diseases, including heart disease, stroke, cataracts and arthritis, could result from a sub-scorbutic, chronic deficiency of vitamin C (2). If this is true, the dose of vitamin C we require could be far higher than that needed to prevent scurvy.
   
   Without vitamin C, our bodies cannot make collagen, the protein that maintains the structure and mechanical strength of the tissues. The result is scurvy, with symptoms that include bleeding gums, loss of teeth, spontaneous bruising and increased susceptibility to disease. Acute scurvy is a terrible disease; fortunately, it is now rare in the industrialised countries. Because a few milligrams of vitamin C per day can prevent or cure acute scurvy, medical practitioners have assumed that humans need only small amounts in the diet.
   
   Compared to most other animals, humans are unusual because they are unable to synthesise vitamin C, and so need to consume it in their food (3). Animals that synthesise their own vitamin C make it in amounts equivalent to a human taking several grams per day, intravenously. As most animals and plants make large amounts, vegetables and uncooked meat may contain sufficient to prevent scurvy.
   
   Vitamin C occurs throughout the plant and animal kingdoms. Living organisms use it as a water-soluble antioxidant, to protect them against oxidation damage and free radicals. Our distant ancestors, small, furry animals, more like tree shrews than apes, lost the ability to synthesise vitamin C, soon after the dinosaurs became extinct. Because of this, humans have a missing enzyme, an inbuilt error of metabolism, which means we need to obtain vitamin C from the diet. Surprisingly, this may be helpful in times of starvation. Animals that synthesise vitamin C make it in large amounts, from glucose. When food is scarce, not making large amounts of vitamin C conserves energy and may provide an advantage. In the short term, scurvy might be more adaptive than starving to death.
   
   In order to accept the idea that we require only low-doses of vitamin C, we would need an explanation of why animals that synthesise it themselves make so much. For a human to achieve comparable levels would require high dose supplementation. Furthermore, ill or stressed animals make much more; for example, sick goats synthesise the equivalent of 100 grams per day. If they did not need these high levels of vitamin C, why do they waste energy making it, when they are most vulnerable? The answer is that they do need it: they make large amounts of vitamin C to act as a disposable antioxidant. Vitamin C provides antioxidant support to prevent infection, disease, toxins and shock (4).
   
   The idea that people need only a small intake of vitamin C is a hypothesis - an idea that needs to be tested scientifically. However, the current establishment position is to regard the idea almost as if it were a scientific law. The myth that it is a known fact that people only need small intakes is incorrect: the low dose hypothesis requires validation.
   
   
2. Recommended Daily Allowance (RDA)
   The RDA idea is a weak hypothesis with little scientific support, but has been promoted as though it were established knowledge. Numerous reports by independent physicians claim remarkable results with massive doses of vitamin C. However, the core medical and scientific literature has ignored these reports for over 50 years. Considering the health implications, it is no wonder that the great Linus Pauling had staked his reputation on the substance.
   
   An alternative hypothesis is the Dynamic Flow Model. The idea behind dynamic flow is to make human physiology resemble that of animals that synthesize their own ascorbate. Animals make large amounts in their bodies and produce more if they are sick; people can approximate to this condition by taking sufficient ascorbate, in frequent divided doses, to keep their blood levels high and allow vitamin C to be excreted in urine. The antioxidant then flows continuously through the body. For example, a young, healthy person might take half a gram approximately every four hours, a total of three grams per day. At this level, not all the vitamin C is absorbed and some is retained in the gut. In times of stress or illness, when the requirement is increased, more is immediately available from the pool of unabsorbed ascorbate in the gut. Older people, people who are ill, smokers, and so on, would need to take substantially more than this to achieve dynamic flow, as their tissue requirements and gut tolerance level may be much higher.



3. Body saturation occurs with low doses
   Saturation : the point at which a solution of a substance can dissolve no more of that substance. (Standard chemical definition)
   
   This myth stems from the National Institutes of Health’s (NIH) claim that plasma saturation occurs at doses of 400 mg per day (5) . There was a tremendous amount of confusion in the field following Pauling’s death in 1994. The NIH were publishing ideas on blood and tissue “saturation” that seemed to show the megadose claims of Linus Pauling and others were wrong. However, when we looked at the NIH research we found they had interpreted their results incorrectly. Reinterpreting the data, the results are consistent with a high requirement for vitamin C: several grams. The NIH research actually supports Pauling’s case.
   
   The NIH’s first mistake includes their use of the term “saturated” to describe background levels of vitamin C. The half-life of high dose vitamin C is about half an hour. The blood level rises to a peak 2-3 hours after taking an oral dose. It then falls back to background levels, over a similar period. In their research, the NIH gave subjects a dose of vitamin C and waited 12 hours before measuring blood levels. These measured values did not increase with the dose because, after 12 hours, the subjects had excreted most of the vitamin. Incorrectly, the NIH described these minimum, background levels as maximum or "saturated" values. In one paper, they report that “saturated” blood plasma contains about 70 microM, yet in a later paper they describe levels of 220 microM, or three times as much(6). They seemed to be blind to the peaks in their own published graphs of the concentration of ascorbate in plasma. The NIH’s cavalier redefinition of the term saturation has caused widespread confusion.
   
   Secondly, the NIH papers refer to “bioavailability”, a misleading term that suggests a measure of the biological availability or usefulness to cells. However, bioavailability simply reflects the proportion of the oral dose absorbed from the gut. With higher doses, a smaller proportion, but a larger absolute amount, is absorbed. Although they claimed that bioavailability was complete at 200mg and incomplete above this level, this does not mean that less is available to the tissues with higher doses. Their own data suggest that the reverse is true: higher absolute amounts were absorbed following higher doses, up to the maximum tested (2.5 grams). In the NIH studies, increasing the dose increased the amount available to the tissues.
   
   Finally, the NIH used white blood cells to estimate body “saturation”. White blood cells are specialized in relation to the absorption and use of vitamin C. The NIH used these cells because they were easy to sample, and then made up reasons to explain their choice. White blood cells have pumps that allow them to accumulate vitamin C within the cell, even when surrounding blood plasma levels are low. The NIH researchers did not understand that the number of ascorbate pumps on the outside of cells determines the internal concentration. The number of pumps varies between cell types and, in times of need, cells can increase the number by redeploying pumps from inside the cell.
   
   If white blood cells really were typical of body cells, we would normally have about 40 grams of vitamin C in our bodies, which is about 20 times more than we do have. If this body load were correct, people with scurvy taking the recommended daily allowance would take 2-3 years to replenish their body stores. In reality, victims recover in days when given low doses of vitamin C. The NIH did not consider these immediate and rather obvious implications of their assumption that white blood cells are a suitable model for the rest of the body.



4. High dose vitamin C is dangerous
   The media carry substantial responsibility for this myth. Vitamin C is classified as a GRAS (Generally Regarded As Safe) substance. Water is more dangerous: it is easier to kill yourself by overdosing on water than vitamin C. There is no reliable evidence for any problems with high dose supplements of vitamin C.
   
   There has been a concerted effort over several decades to find such problems but none has been established. However, every few months the media release a vitamin C scare story, suggesting that it causes a health problem. These stories have never been confirmed. A longstanding suggestion is that vitamin C can cause kidney stones. However, such stones are not found in supplement users. For example, a 14 year study of 85,557 women found no evidence that vitamin C caused kidney stones (7). Evidence for the formation of kidney stones is theoretical and is unsupported by the scientific data. Recent media reports have suggested that vitamin C causes cancer, atherosclerosis, arthritis and genetic damage, without providing sensible evidence. It is notable that the media promote these silly ideas, but have not reported the claims that vitamin C can cure heart disease, cancer and severe infections.
   
   Even Dr Mark Levine and the NIH group agree with us on this point. They state that vitamin C is remarkably safe, with few concerns for toxicity. They point out that although toxicities have been suggested, the evidence does not substantiate the claims. Therefore, they add that vitamin C does not have a narrow window from therapeutic safety to toxicity as is true for many drugs and for the fat-soluble vitamins A and D.
   
   The only reliable side effect of taking too much vitamin C is loose stools. When the dose is increased, a person will eventually get diarrhoea. Instead of viewing this as a healthy alternative to laxatives, the medical establishment have chosen to classify it as a side effect. Perhaps prunes should carry a health warning!



5. Five helpings of fruit and vegetables provide all you need
   This idea is false. Because of individual variability, a few people will get adequate vitamin C from fruit and vegetables, but most will not. Even vegetarians may be deficient. The claim that fruits and vegetables provide enough vitamin C is surprisingly “new-age” for the medical establishment. It is also difficult to test scientifically.
   
   Vitamin C is a single molecule, its structure and chemical properties are well known. Samples of pure vitamin C can be used to determine its biological activity. By contrast, there are millions of chemicals in fruit and vegetables. When fruit and vegetables are shown to have health benefits, the useful substance(s) could be vitamin C or one (or more) of many others. Trials in which a health benefit is linked to vitamin C in fruit and vegetables can easily be discounted by the establishment, as the benefit could have come from the other components.
   
   The establishment’s fruit and vegetables recommendations are excellent in that these foods provide many antioxidants, minerals and other nutrients. However, as far as optimal vitamin C intake is concerned, they are irrelevant. In my opinion, the amount of vitamin C available in fruit and vegetables may be described simply – not enough!



6. Vitamin C does not help colds
   Surprisingly, the scientific evidence on the use of vitamin C in the treatment and prevention of the common cold is deficient. Linus Pauling’s book “Vitamin C and the Common Cold” sparked the vitamin C controversy. Experiments on the common cold have been a central feature of the evaluation of vitamin C by the establishment. So why is the evidence inadequate?
   
   Before we wrote the Ascorbate book, high dose studies on vitamin C supplements appeared to indicate that it would reduce the severity and duration of a cold, but not prevent the condition. However, on investigation, we found that the prevention studies generally gave a single dose, or occasionally two doses, of vitamin C a day. Since the half-life of high-dose vitamin C is about half an hour, the ascorbate in the blood falls back to background levels within a few hours. If we assume the protective effect of vitamin C is a result of its blood levels, the supplement takers in these experiments were unprotected for the majority of the day. We cannot conclude that vitamin C does not prevent colds from this kind of study. Taking supplements more frequently, according to the dynamic flow model, may be much more effective, but this procedure has not been tested. After so many years, the question of whether or not vitamin C will prevent colds remains open.
   
   As for treatment of colds with vitamin C, the experiments have been a sham. The researchers have ignored the difference between nutrition and pharmacology. A nutritional dose is the amount we need in the diet to keep us healthy and free of disease. Such doses are in the range 200mg to 20 grams per day. Pharmacology is about the effects of drugs. In using vitamin C as a treatment for disease, we are considering its use as a drug. In this case, the minimum dose is more like 10 grams and physicians have sometimes used more than 200 grams per day. Certain members of the medical profession have been less than honest: they have tested nutritional doses of vitamin C as a treatment for the common cold and other diseases, and then extrapolated the unpromising results to vitamin C in general.
   
   Dr Robert Cathcart, a most experienced physician in the use of ascorbate as a treatment for disease, recommends doses of up to 100 grams for the common cold. So, for example, a person might take 4 grams per hour. He classifies colds in terms of the amount of ascorbate necessary to produce loose stools – the bowel tolerance. He might say Sam has a 40 gram cold, but Susan has a 60 gram cold. These are the doses that have been claimed to provide relief: the establishment has not tested anything close to these levels.
   
   Clinical trials on the common cold have used, say, 200mg of vitamin C per day, in a single dose. When they obtain a negative result, the researchers claim that vitamin C is ineffective. This is not supported by their results: they should say that single, daily, low-dose supplementation does not work, but other doses may be effective. Instead, they make grand, unscientific claims. How can a single daily dose of 200 mg show that a treatment using 4 grams per hour is ineffective? It is a sad day when medical misinformation is the norm.



7. Vitamin C does not prevent heart disease
   Linus Pauling and other scientists have proposed that the fundamental cause of heart disease is long-term, low-level scurvy. In other words, people have heart attacks and strokes because, over a period of years, they do not take adequate amounts of vitamin C. Atherosclerosis is generally a disease of humans and is rare in animals that manufacture ascorbate. Few vets will express concern about the amount of cholesterol and fat you are feeding to your cat, at least with respect to atherosclerosis.
   
   Pauling and others have suggested that prevention of heart disease requires daily doses in the 3-10 gram range. People who are prone to heart disease require more vitamin C to maintain their cardiovascular health than others. The medical establishment, drug companies and the food industry have spent billions of dollars over decades, studying multiple “risk-factors” such as cholesterol and saturated fat. For over half a century, the hypothesis that heart disease results from low-level scurvy has never been properly tested. This idea is much stronger than the idea of a risk factor: it is that shortage of vitamin C is the cause of heart disease. It states that people with adequate vitamin C will not suffer atherosclerosis, coronary thrombosis or stroke. In addition, it claims that the fundamental treatment for these conditions should be based on vitamin C and other antioxidants. Such fundamental and important claims deserve to be tested.



8. Taking high doses just produces expensive urine
   It is true that a proportion of a single, large dose of vitamin C is excreted in urine. It is also the case that much of the remainder will not even be absorbed from the digestive tract. However, according to the dynamic flow model, these are important features of the way vitamin C works.
   
   Antioxidants provide free, high-energy electrons to the body. During illness, oxidation increases and more antioxidants are required. Vitamin C is unique, because since it is a safe, water-soluble antioxidant, huge amounts can be supplied continuously. When the vitamin C has donated its electrons to the sick tissue, it is excreted as the oxidised, dehydroascorbate form.
   
   Notably, when sick animals synthesise additional vitamin C, more is excreted in urine. Is this just an expensive waste of resources? It seems more likely that millions of years of evolution have developed this unique property of the vitamin as a vital mechanism for fighting disease.



9. Vitamin C does not help infections
   Vitamin C was first isolated in 1928. Shortly afterwards, researchers began to report its benefits in infectious disease. Over the following decades, clinical and experimental reports have continued. Dr Tom Levy, in his recent book “Vitamin C: Infectious Diseases and Toxins”, described over a thousand clinical reports(8). The reports are from many independent physicians and are consistent in indicating that high doses can treat or cure severe disease.
   
   The list of diseases is huge. More interesting, perhaps, is the size of the response. Children at the point of death from septic shock, and unresponsive to other treatments, have been described as sitting up and recovering minutes after an injection of sodium ascorbate. Around 1950, a series of 60 people were reportedly cured of acute polio, with no lasting paralysis or other consequences. The placebo effect and experimenter bias are not enough to explain away such unlikely findings.
   
   As with all the claims for high-dose supplementation, these findings have not been followed up by controlled clinical trials. Despite the lack of effective antiviral drugs, the potential role of high-dose ascorbate has been ignored. The use of high-dose sodium ascorbate in severe viral infections, such as SARS and Ebola, should be considered. If there is no other treatment for an otherwise fatal disease, intravenous ascorbate should certainly be tried. Who could think of a more demanding test?



10. Vitamin C doesn’t prevent cancer
    The Mayo Clinic is the main perpetrator of this myth (9). When Linus Pauling and Ewan Cameron published their initial papers on vitamin C and cancer, the medical establishment were forced to respond. However, the Mayo Clinic research team changed the protocol with their pseudo-replication and, instead of intravenous ascorbate, used oral doses. These were known to be far less effective. The alterations biased the experiments and produced a negative result. Despite this, over the following years a steady stream of clinical reports have described the effectiveness of vitamin C in cancer. More recently, several different research groups have independently confirmed the cytotoxic findings. Even the NIH seem to be coming round to the idea of ascorbate as a treatment for cancer, although they were cheeky enough to suggest that Pauling and Cameron’s use of the intravenous route for administering the vitamin was “serendipitous”(10). There is every reason to suspect that vitamin C is indeed an effective cancer treatment.
    
    In the Ascorbate book, we state the current position clearly:
    
    "We have described evidence that vitamin C can kill cancer. Indeed, the properties of ascorbate reflect, perfectly, the requirements for a chemotherapeutic agent. The effects of vitamin C on cancer can be explained theoretically. Cell culture studies clearly demonstrate the killing of cancer cells. Animal studies show anticancer activity. In humans, measurements show that blood levels that would be expected to kill cancer cells can be reached, with intravenous injection. The blood plasma of people injected with vitamin C can kill cancer cells. There are a large number of clinical reports that ascorbate is an effective treatment. Case studies report people with metastatic cancer have been cured. The only item missing from this description is a randomised, double-blind, clinical trial showing intravenous ascorbate is an effective treatment or cure. The double-blind clinical trials by the medical establishment were performed by people who did not understand the difference between injected doses and tablets.
    
    Of course, these studies do not prove that vitamin C is a cure for cancer, or even that it would provide a suitable treatment. However, such criticism is more than unscientific. The thoughtful reader will no doubt recognise a simple cost-benefit analysis. With powerful evidence of efficacy and a large degree of safety, there is little to lose and, potentially, a life to gain."

Summary
The medical establishment is not testing these powerful claims. A single claim might be ignored, but we have reviewed multiple, independent reports of rather astounding properties. One is driven to ask why, if the establishment is so sure that high dose vitamin C is ineffective, they have they been so afraid to test it?