Vitamin C Dosage to Disease

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Medical Hypotheses, 7:1359-1376, 1981.

VITAMIN C, TITRATING TO BOWEL TOLERANCE, ANASCORBEMIA, AND ACUTE INDUCED

SCURVY

Robert F. Cathcart, III Allergy, Environmental, and Orthomolecular Medicine

127 Second Street, Los Altos, California 94022, USA Telephone 650-949-2822

ABSTRACT

A method of utilizing vitamin C in amounts just short of the doses which

produce diarrhea is described (TITRATING TO BOWEL TOLERANCE). The amount of

oral

ascorbic acid tolerated by a patient without producing diarrhea increases

somewhat proportionately to the stress or toxicity of his disease. Bowel

tolerance doses of ascorbic acid ameliorate the acute symptoms of many

diseases.

Lesser doses often have little effect on acute symptoms but assist the body in

handling the stress of disease and may reduce the morbidity of the disease.

However, if doses of ascorbate are not provided to satisfy this potential draw

on the nutrient, first local tissues involved in the disease, then the

blood, and then the body in general become deplete of ascorbate (ANASCORBEMIA

and

ACUTE INDUCED SCURVY). The patient is thereby put at risk for complications

of metabolic processes known to be dependent upon ascorbate.

INTRODUCTION

Over the past ten-year period I have treated over 9,000 patients with large

doses of vitamin C (Cathcart 1, 2, 3, 4, 5). The effects of this substance

when used in adequate amounts markedly alters the course of many diseases.

Stressful conditions of any kind greatly increase utilization of vitamin C.

Ascorbate excreted in the urine drops markedly with stresses of any magnitude

unless vitamin C is provided in large amounts. However, a more convenient and

clinically useful measure of ascorbate need and presumably utilization is the

BOWEL TOLERANCE. The amount of ascorbic acid which can be taken orally without

causing diarrhea when a person is ill sometimes is over ten times the amount

he would tolerate if well. This increased bowel tolerance phenomenon serves

not only to indicate the amount which should be taken but indicates the

unsuspected and astonishing magnitude of the potential use that the body has

for

ascorbate under stressful conditions.

If this massive draw on the small ascorbate stores of the body is not fully

satisfied, the condition of ANASCORBEMIA results. The deficit of ascorbate

probably starts in the tissues directly involved in the disease and then

spreads to other tissues of the body. A condition of localized and then

systemic

acute scurvy is produced. This ACUTE INDUCED SCURVY leads to poor healing and

ultimately to complications involving other systems of the body.

Much of the original work with large amounts of vitamin C was done by Fred

R. Klenner, M.D. (6, 7, 8, 9) of Reidsville, North Carolina. Klenner found

that viral diseases could be cured by intravenous sodium ascorbate in amounts

up

to 200 grams per 24 hours. Irwin Stone (10, 11, 12) pointed out the

potential of vitamin C in the treatment of many diseases, the inability of

humans to

synthesize ascorbate, and the resultant condition hypoascorbemia. Linus

Pauling (13, 14) reviewed the literature on vitamin C and has led the crusade

to

make known its medical uses to the public and the medical profession. Ewan

Cameron in association with Pauling (15, 16, 17) has shown the usefulness of

ascorbate in the treatment of cancer.

BOWEL TOLERANCE METHOD

In 1970, I discovered that the sicker a patient was, the more ascorbic acid

he would tolerate by mouth before diarrhea was produced. At least 80% of

adult patients will tolerate 10 to 15 grams of ascorbic acid fine crystals in

1/2

cup water divided into 4 doses per 24 hours without having diarrhea. The

astonishing finding was that all patients, tolerant of ascorbic acid, can take

greater amounts of the substance orally without having diarrhea when ill or

under stress. This increased tolerance is somewhat proportional to the toxicity

of the disease being treated. Tolerance is increased some by stress (e.g.,

anxiety, exercise, heat, cold, etc.)(see FIGURE I). Admittedly, increasing the

frequency of doses increases tolerance perhaps to half again as much, but

the tolerances of sometimes over 200 grams per 24 hours were totally

unexpected. Representative doses taken by tolerant patients titrating their

ascorbic

acid intake between the relief of most symptoms and the production of diarrhea

were as follows:

TABLE I - USUAL BOWEL TOLERANCE DOSES

 

GRAMS PER NUMBER OF DOSES

CONDITION 24 HOURS PER 24 HOURS

normal 4 - 15 4 - 6

mild cold 30 - 60 6 - 10

severe cold 60 - 100+ 8 - 15

influenza 100 - 150 8 - 20

ECHO, coxsackievirus 100 - 150 8 - 20

mononucleosis 150 - 200+ 12 - 25

viral pneumonia 100 - 200+ 12 - 25

hay fever, asthma 15 - 50 4 - 8

environmental and

food allergy 0.5 - 50 4 - 8

burn, injury, surgery 25 - 150+ 6 - 20

anxiety, exercise and

other mild stresses 15 - 25 4 - 6

cancer 15 - 100 4 - 15

ankylosing spondylitis 15 - 100 4 - 15

Reiter's syndrome 15 - 60 4 - 10

acute anterior uveitis 30 - 100 4 - 15

rheumatoid arthritis 15 - 100 4 - 15

bacterial infections 30 - 200+ 10 - 25

infectious hepatitis 30 - 100 6 - 15

candidiasis 15 - 200+ 6 - 25

 

FIGURE 1. REPRESENTATIVE DOSES TO TREAT ACUTE SYMPTOMS OF DISEASE IN

PATIENTS VERY TOLERANT TO ASCORBIC ACID

 

[graph not available] GRAMS ASCORBATE PER 24 HOURS

1) Note that disease symptom curves indicate very little effect on acute

symptoms until doses of 80-90% of bowel tolerance are reached. Perhaps it is

only near tolerance doses that the ascorbate is pushed into the primary sites

of

the disease.

2) Suppression of symptoms in some instances may not be total; but usually

it is very significant and often the amelioration is complete and rapid.

3) Hepatitis may require 30 to 100 grams.

TITRATING TO BOWEL TOLERANCE

The maximum relief of symptoms which can be expected with oral doses of

ascorbic acid is obtained at a point just short of the amount which produces

diarrhea. The amount and the timing of the doses are usually sensed by the

patient. The physician should not try to regulate exactly the amount and timing

of

these doses because the optimally effective dose will often change from dose

to dose. Patients are instructed on the general principles of determining

doses and given estimates of the reasonable starting amounts and timing of

these

doses. I have named this process of the patient determining the optimum

dose, TITRATING TO BOWEL TOLERANCE. The patient tries to TITRATE between that

amount which begins to make him feel better and that amount which almost but

not

quite causes diarrhea.

I think it is only that excess amount of ascorbate not absorbed into the

body which causes diarrhea; what does not reach the rectum, does not cause

diarrhea.

It is interesting to know, when one speculates on the exact cause of this

diarrhea, that while a hypertonic solution of sodium ascorbate is being

administered intravenously, the amount of ascorbic acid tolerated orally

actually

increases.

THE 100 GRAM COLD

When a person is ill the amount of ascorbic acid he can ingest without

diarrhea being produced increases somewhat proportionally to the severity or

the

toxicity of the disease. A cold severe enough to permit a person to take 100

grams of ascorbic acid per 24 hours during the peak of the disease, I call a

100 GRAM COLD.

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. R

ate 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 of ascorbate 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 gout

y 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

 

__

_Dr. Cathcart Bibliography_ (http://www.orthomed.com/)

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

 

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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

 

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14. Pauling, L. Vitamin C, the Common Cold, and the Flu. W.H.

 

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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.

 

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29. Williams, R.J. The Prevention of Alcoholism Through Nutrition.

 

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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,

 

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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

 

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