AIDS and Vitamin C

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VITAMIN C IN THE TREATMENT OF ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) Robert F. Cathcart III, MD Medical Hypotheses, 14(4):423-433, Aug 1984. Copyright ©, 1994 and prior years, Dr. Robert F. Cathcart. Permission granted to distribute via the internet as long as material is distributed in its entirity and not modified. ABSTRACT My previous experience with the utilization of ascorbic acid in the treatment of viral diseases led me to hypothesize that ascorbate would be of value in the treatment of AIDS (acquired immune deficiency syndrome). Preliminary clinical evidence is that massive doses of ascorbate (50-200 grams per 24 hours) can suppress the symptoms of the disease and can markedly reduce the tendency for secondary infections. In combination with usual treatments for the secondary infections, large doses of ascorbate will often produce a clinical remission which shows every evidence of being prolonged if treatment is continued. This clinical remission is achieved despite continuing laboratory evidence of helper T-cell suppression. There may be a complete or partial destruction of the helper T-cells during an initial infection that does not necessitate a continuing toxicity from some source to maintain a permanent or prolonged helper T-cell suppression. However, it is possible ascorbate may prevent that destruction if used adequately during that prodrome period. Emphasis is put upon the recognition and treatment of the frequent intestinal parasites. Food and chemical sensitivities occur frequently in the AID syndrome and may aggravate symptoms considered to be part of the AID syndrome. A topical C-paste has been found very effective in the treatment of herpes simplex and, to a lesser extent, in the treatment of some Kaposi's lesions. Increasingly, clinical research on other methods of treating AIDS is being "contaminated" by patients taking ascorbate. INTRODUCTION I had previously described that the amount of ascorbic acid which can be tolerated orally by a patient without producing diarrhea, increases somewhat proportionately to the toxicity of his disease (1,2,3,4). Among the roughly 80% of persons who tolerate ascorbic acid very well, -bowel tolerance- will be reached when in excess of 10 to 15 grams of ascorbic acid dissolved in water is taken in 4 to 6 divided doses per 24 hours. The astonishing finding was that when that same person is acutely ill with a mild cold, that tolerance may increase to approximately 50 grams per 24 hours. A severe cold can increase tolerance to 100 grams; an influenza, even up to 150 grams; and mononucleosis or viral pneumonias, to as much as 200 grams per 24 hours. These higher doses may have to be divided as frequently as hourly. These large amounts of ascorbate are being drawn off the GI tract at a rate sufficient to prevent significant amounts from reaching the rectum and producing diarrhea. Measurements of ascorbate in urine, saliva, or serum indicate that if sufficient doses of ascorbate are not given when a patient is ill, the body level of vitamin C drops rapidly. In such a case, there is not enough vitamin C left in the body, particularly in the cells directly involved by the disease, to guarantee all the known housekeeping functions of the vitamin. Those functions known to be dependent on vitamin C, including several metabolic reactions necessary for proper functioning of the immune system, are put at risk of malfunctioning. I call this condition -acute induced scurvy.- PREMIERE FREE RADICAL SCAVENGER The reason ascorbate ameliorates so many conditions is that it functions as the -premiere free radical scavenger- (5). This function is not because it is the most powerful free radical scavenger, but because it is possible to saturate every cell of the body with more molecules of ascorbate than any other free radical scavenger. The reason that it takes such massive doses for optimal effect is because high concentrations of ascorbate must be driven into the cells directly affected by the disease process sufficient to neutralize all of the free radicals produced by that process, and have some left over for vitamin C housekeeping functions. When a disease process involves free radicals, that disease process is capable of being ameliorated by massive doses of ascorbate. In the case of many infectious diseases, the relief from free radical suppression of the immune system, allows for more effective attack on the pathogen by that immune system. -Note: this premiere free radical scavenger function has little to do with nutrition but is a pharmacologic effect of ascorbate when utilized in unnatural amounts for humans.- Actually, the complete neutralization of free radicals requires several steps involving other substances, e.g. glutathione. However clinically, the most frequent limiting factor in the reduction of free radicals is ascorbate. In certain conditions such as chemical allergies, certain other limiting factors may become critically important, e.g. selenium and glutathione. Some have worried that a buildup of dehydroascorbate would be toxic in certain of these conditions. Clinically, this consideration has not created a problem when very large doses of ascorbate are used. Perhaps it is the high ratio of ascorbate to dehydroascorbate, I am careful to maintain in these patients, that protects against any temporarily accumulating dehydroascorbate. Further, I should like to point out that the dehydroascorbate formed should not be as toxic as that free radical the ascorbate reduces as it itself is oxidized into dehydroascorbate. In a way, it is unfortunate that this free radical scavenger and vitamin C are the same substance. When ascorbate is destroyed in the process of destroying free radicals, the vitamin C stores, particularly in the cells directly involved in the disease process, are so depleted as to cause disorders of known housekeeping functions of vitamin C. It is certain that AIDS causes this depletion. The sicker the patient is, the more ascorbate will be destroyed by the disease process. This depletion certainly contributes to the terminal events and probably plays a key role in the increased susceptibility of AIDS patients to various pathogens. ASCORBATE VS. AN AIDS SUPPRESSOR FACTOR A recent article describes the discovery of a -suppressor factor- in AIDS patients. This suppressor factor was found to be neutralized in the test tube by concentrations of ascorbate equivalent to that which would be achieved in a man who ingested 10 to 20 grams of ascorbate a day. It was thought that this amount was -"far too toxic"- to use in humans and that a less toxic antioxidant should be found (6). -Actually, 10 to 20 grams/24 hours of ascorbate is easily tolerated and is not toxic- (1,2,3,4,7,8,9,10,11,12,13,14). Unfortunately, clinically I have shown that the AIDS disease process destroys even larger amounts of ascorbate than the 10 to 20 grams because bowel tolerance is regularly increased to the range of from 40 to 185 grams of C per 24 hours in the patient who has moderate Kaposi's lesions and/or moderate lymphadenopathy. -Therefore, the 10 to 20 gram equivalent of ascorbate in the test tube will not be adequate in vivo-. PRELIMINARY STUDY Because of the hypothesis that AIDS patients would benefit from large doses of ascorbate, I began the actual treatment of AIDS patients and have found that ascorbate is indeed very valuable when used in conjunction with certain conventional treatments. The following preliminary recommendations are based partly upon an anecdotal group of approximately 90 AIDS patients who sought medical care from physicians but who also took high doses of ascorbate on their own. Additionally, it is based upon 12 of my AIDS patients, 6 of whom were given intravenous ascorbate for a short period of time. Most of these patients have had considerable improvement in their condition. This improvement seems somewhat proportional to the amount of ascorbate taken by the patient relative to the severity of his disease. If the patient tolerates enough ascorbate to "neutralize the toxicity" of his disease and if the secondary infections are treated; his condition will go into remission. Subjectively, symptoms decrease and increase inversely with how closely the patient titrates to bowel tolerance. The only death has been in a patient who had previously chemotherapy, interferon, and total body Xray therapy. Additionally, his veins were so destroyed by previous treatments that intravenous vitamin C therapy could not be continued under the existing circumstances. Such a preliminary report of recommendations is justified only because of the urgency of the problem addressed and because in San Francisco and now New York, news of the ascorbate treatment is spreading rapidly. Ascorbate is being used by an increasing percentage of the AIDS patient population but without much guidance. There have been many requests by physicians for the treatment protocol. ASCORBATE TREATMENT PROTOCOL FOR AIDS PATIENTS The following protocol is recommended for AIDS and AIDS related conditions including lymphadenopathy, idiopathic thrombo- cytopenia purpura, and Pneumocystis carinii pneumonia. As predicted, AIDS patients are usually capable of ingesting large doses of ascorbate. It is desirable that the amount of ascorbate taken orally be maximized. Patients are -titrated to bowel tolerance- (the amount that almost, but not quite, causes diarrhea). A -balanced ascorbate- mixture is utilized which is made up of a mixture of approximately 25% buffered ascorbate salts (calcium, magnesium, and potassium ascorbate) and 75% ascorbic acid. This mixture is dissolved in a small amount of water and taken at least every hour. The purpose of the frequent doses and this balanced mixture is to maximize the amount of ascorbate tolerated without producing diarrhea. Patients are permitted to vary the percentage of ascorbate salts to straight ascorbic acid according to taste. The usual amount tolerated initially is between 40 and 100 grams per 24 hours. -Doses in excess of 100 grams per 24 hours may be necessary with secondary bacterial and viral infections-. As the patient's condition improves, bowel tolerance will decrease. When intravenous ascorbate is found necessary because the toxicity of the condition exceeds the ability of the patient to take adequate amounts of ascorbate to scavenge all of the free radicals created by the primary AIDS infection and the various secondary infections, the following intravenous solutions should be utilized. Sodium ascorbate buffered to a pH 7.4 and without preservatives is added to sterile water in a concentration of 60 grams per 500 cc. This concentration is twice the concentration I have recommended before because it is well tolerated in young males with large veins. Patients with small veins may be best treated with solutions of 60 grams per liter. The time of the infusions should be over at least a 3 hour period, preferably longer. As much as daily administration of 3 bottles, 180 grams per 24 hours, may be necessary in acutely ill patients, e.g. Pneumocystis carinii pneumonia, disseminated herpes, disseminated cytomegalovirus, and atypical pneumonia. Enough ascorbate should be administered to detoxify the patient regardless of the amount needed. Additionally, oral doses of ascorbate should be taken simultaneously with the intravenous ascorbate. -Do not let the patients become lazy and discontinue bowel tolerance doses of ascorbate while the intravenous ascorbate is being administered-. INTESTINAL PARASITES If the AIDS patient has intestinal parasites, he must be treated for them. There is a very high percentage of male homo- sexuals infected with intestinal parasites. These intestinal parasites are themselves very immunosuppressive. The prognosis for an AIDS patient is greatly enhanced by proper treatment of these parasites. -Entamoeba histolytica-, especially, and -Giardia lamblia- must be treated. Intestinal parasites, ordinarily considered -non-pathogens-, should be treated. If negative, repeated stool examinations for ova and parasites should be taken if there is the slightest clinical sign of intestinal parasite infection. Samples should be fresh, not over 2 hours old. Laxatives may increase chances of discovering the parasites. Additional samples may have to be taken through a sigmoidoscope if other specimens are negative for ova and parasites. With treatment, Herxheimer's reactions should be expected frequently. Symptoms, including Kaposi's lesions, may be exacerbated, despite the ascorbate, during treatment for intestinal parasites. CANDIDA ALBICANS Candida should be sought and treated. It should be emphasized to patients that they owe it to themselves and society to treat the Candida consistently because of the possibility of breeding resistant strains. The possibility of candida in the gut, esophagus, mouth, sinuses, skin, etc. should be considered. In patients who clinically appear to have Candida but in whom Candida cannot be cultured, sensitivities to Candida should be suspected and treatment of especially the bowel should be considered. Herxheimer's reactions, when antibiotics against Candida are employed, should be considered one indication that Candida is a problem. In these sensitive patients, foods and vitamins containing yeasts should be avoided. Lactobacillus in large amounts should be fed to these patients in an attempt to normalize bowel flora. Sugar and refined carbohydrates should be avoided because Candida thrives on them. There is a high incidence of food and chemical sensitivities associated with Candida sensitivities (15,16,17) and Candida must be suspected whenever such sensitivities are discovered.