|C Titration Paper
|Copyright (C), 1994 and prior years, Robert F. Cathcart,
M.D. Permission granted to distribute via the internet as long as material
is distributed in its entirity and not modified. |
Medical Hypotheses, 7:1359-1376, 1981.
VITAMIN C, TITRATING TO BOWEL TOLERANCE, ANASCORBEMIA,
AND ACUTE INDUCED SCURVY Robert F. Cathcart, III, M.D.
Allergy, Environmental, and Orthomolecular Medicine 127 Second Street,
Los Altos, California 94022, USA
For more papers by Dr. Cathcart: http://www.doctoryourself.com/biblio_cathcart.html
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
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
FIGURE 1. REPRESENTATIVE DOSES TO TREAT ACUTE SYMPTOMS OF
GRAMS ASCORBIC ACID NUMBER OF DOSES
CONDITION PER 24 HOURS PER 24 HOURS
normal 4 - 15 4 - 6
mild cold 30 - 60 6 - 10
severe cold 60 - 100+ 8 - 15
influenza 100 - 150 8 - 20
ECHO, coxsackievirus 100 - 150 8 - 20
mononucleosis 150 - 200+ 12 - 25
viral pneumonia 100 - 200+ 12 - 25
hay fever, asthma 15 - 50 4 - 8
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
DISEASE IN PATIENTS VERY TOLERANT TO ASCORBIC ACID
GRAMS ASCORBIC ACID ORALLY 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
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.
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
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,
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.
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).
The phenomenon of symptoms returning repeatedly if the ascorbate is not
continued in high doses is most convincing. It is possible to have symptoms
come and go many times. In fact, there is often a feeling when titrating
to bowel tolerance that symptoms are beginning to return just before taking
the next dose.
Often a patient will sense that he is probably catching some viral disease
and that he is in need of large doses of ascorbic acid. If he is experienced
in taking ascorbic acid he may be able to suppress more than 90% of the
symptoms. He feels that he should take large amounts of ascorbate, does
not feel quite right, and may have peculiar mild symptoms. I call this
condition UNSICK. Recognition of this state is important because it can
be mistaken for more serious conditions.
INTRAVENOUS AND INTRAMUSCULAR ASCORBATE
Symptoms from acute viral diseases can most frequently be more permanently
eliminated with intravenous sodium ascorbate. While it is true that tolerance
doses of oral ascorbate will usually eliminate complications of acute viral
diseases; at times, such as with certain cases of influenza, the large
amount of oral ascorbate necessary to suppress symptoms over a period of
a week or more, sometimes makes intravenous ascorbate desirable. Clinically
large amounts of ascorbate used intravenously are virucidal (2, 5, 7, 8).
The sodium ascorbate used intravenously and intramuscularly must contain
no preservatives. Usually there is only a small amount of EDTA in the preparation
to chelate trace amounts of copper and iron which might destroy the ascorbate.
Solutions containing sodium ascorbate 250 or 500 mgm per cc can be obtained.
The 250 mgm solutions may be used in young children intramuscularly in
doses usually 350 mgm/kg body weight up to every 2 hours. When the volume
of the material becomes too great for intramuscular injections, then the
intravenous route should be used. Inadequate doses will be ineffective.
Quite frequently a child initially refusing oral ascorbate will cooperate
after injections if given the alternative. While this method of persuasion
seems cruel, it is better than the complications which might otherwise
occur. These intramuscular injections can be used in a crisis situation.
Kalokerinos (22) describes cases where certain death in infants already
in shock has been averted by emergency intramuscular ascorbate.
For intravenous solutions concentrations of 60 grams per liter are made
with the 250 or 500 mgm/cc sodium ascorbate diluted with Ringer's lactate,
1/2N saline, 1N saline, D5W, or distilled water for injection. I prefer
the latter, but one has to be absolutely sure that an error is not made
and pure water given. Ascorbate is more efficient intravenously than orally
probably because chemical processes in the gut destroy a percentage of
that orally administered. Doses of 400 to 700 mgm/kg of body weight per
24 hours usually suffice. Rate of infusion and the total amount administered
can be determined by making sure that symptoms are suppressed and that
the patient not become dehydrated or receive sodium too rapidly. Local
soreness in the vein caused by too rapid infusion is relieved by slowing
the intravenous infusion. One gram of calcium gluconate should be added
to the bottles each day to prevent tetany.
I have not yet seen a case of phlebitis develop as a result of ascorbate
administration. This rarity of phlebitis possibly suggests that this condition
sometimes has something to do with ascorbate depletion.
Frequently I have the patient take oral doses of ascorbic acid at the
same time he is taking intravenous sodium ascorbate. Bowel tolerance is
actually increased by concomitant use of intravenous ascorbate. Care and
experience is necessary with concomitant use because tolerance drops precipitously
when the intravenous infusion is discontinued.
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
As can be seen from the previous discussion of the increasing bowel
tolerance phenomenon, there is undoubtedly increased utilization of ascorbate
under stressful conditions. If this increased utilization creates a deficit,
there may be malfunctions of various systems of the body such as the immune
system which are dependent on ascorbate. Therefore, it should not be surprising
that certain malfunctions of the immune system and adrenal glands associated
with stress might be ameliorated by ascorbate.
Hay fever is controlled in the majority of patients. Bowel tolerance
doses are usually required only at the peak of the season; otherwise, more
modest doses suffice. Many patients find the effect of ascorbate more satisfactory
than immunizations or antihistamines and decongestants. The dosages required
are frequently proportional to exposure to the antigen.
Asthma is most often relieved by bowel tolerance doses of ascorbate.
A child regularly having asthmatic attacks following exercise is usually
relieved of these attacks by large doses of ascorbate. So far all of my
patients having asthmatic attacks associated with the onset of viral diseases
have been ameliorated by this treatment.
Large clinical studies will be necessary to prove this point, but for
now prudent practice would be to take large doses ofascorbate when stressed
or when ill.
This theory begins to make some sense of the observation that many patients
will develop allergic disorders or other diseases following combinations
of stress, disease, and malnutrition. Immunologists should be particularly
interested in the control of these allergic problems and particularly the
dramatic responses of cases of ankylosing spondylitis, Reiter's disease,
and acute anterior uveitis. All three of these problems have a high association
with the HLA-B27 antigen. The possibility that ascorbate might have some
value in controlling the immune response at the gene level should be thoroughly
investigated because there could be some basic implications in histocompatibility
(graft acceptance), cancer control, and destruction of foreign invaders.
Ascorbate would appear to help stabilize some homeostatic mechanisms.
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.
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.
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.
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.
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 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.
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
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
Patients with hidden peptic ulcers may have pain, but some are benefitted.
Mineral ascorbates can be used for maintenance doses in these cases. Two
patients who had mild epigastric discomfort with maintenance doses of ascorbic
acid who after being given ascorbate by vein for several days were then
able to tolerate the acid orally.
It is my experience that high maintenance doses reduce the incidence
of gouty arthritis. I have not seen difficulties with giving large amounts
of ascorbic acid to patients with gout. Almost all my patients have been
Caucasian, so I have no comment on the report that ascorbate can cause
certain blood problems in certain non-white groups (30).
There has been no clinical evidence as Herbert and Jacob (31) suspected
that ascorbic acid destroys vitamin B12.
If maintenance doses of ascorbic acid in solution are used over very
long periods of time I would rinse the teeth after each dose. I would not
brush my teeth with calcium ascorbate.
There is a certain dependency on ascorbic acid that a patient acquires
over a long period of time when he takes large maintenance doses. Apparently,
certain metabolic reactions are facilitated by large amounts of ascorbate
and if the substance is suddenly withdrawn, certain problems result such
as a cold, return of allergy, fatigue, etc. Mostly, these problems are
a return of problems the patient had before taking the ascorbic acid. Patients
have by this time become so adjusted to feeling better that they refuse
to go without ascorbic acid. Patients do not seem to acquire this dependency
in the short time they take doses to bowel tolerance to treat an acute
disease. Maintenance doses of 4 grams per day do not seem to create a noticeable
dependency. The majority of patients who take over 10-15 grams of ascorbic
acid per day probably have certain metabolic needs for ascorbate which
exceed the universal human species need. Patients with chronic allergies
often take large maintenance doses.
The major problem feared by patients benefiting from these large maintenance
doses of ascorbic acid is that they may be forced into a position where
their body is deprived of ascorbate during a period of great stress such
as emergency hospitalization. Physicians should recognize the consequences
of suddenly withdrawing ascorbate under these circumstances and be prepared
to meet these increased metabolic needs for ascorbate in even an unconscious
patient. These consequences of ascorbate depletion which may include shock,
heart attack, phlebitis, pneumonia, allergic reactions, increased susceptibility
to infection, etc., may be averted only by ascorbate. Patients unable to
take large oral doses should be given intravenous ascorbate. All hospitals
should have supplies of large amounts of ascorbate for intravenous use
to meet this need. The millions of people taking ascorbic acid makes this
an urgent priority. Patients should carry warnings of these needs in a
card prominently displayed in their wallets or have a Medic Alert type
bracelet engraved with this warning.
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.
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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
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.
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acid when employed beyond the range of a vitamin in human pathology. J.
App. Nutr., 23:61-88, 1971.
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in preventive medicine. J. Int. Acad. Prev. Med., 1:45-49, 1974.
10. Stone, I. Studies of a mammalian enzyme system for producing evolutionary
evidence on man. Am. J. Phys. Anthro., 23:83-86, 1965.
11. Stone, I. Hypoascorbemia: The genetic disease causing the human
requirement for exogenous ascorbic acid. Perspectives in Biology and Medicine,
12. Stone, I. The Healing Factor: Vitamin C Against Disease. Grosset
and Dunlap, New York, 1972.
13. Pauling, L. Vitamin C and the Common Cold. W.H. Freeman and Company,
San Francisco, 1970.
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and Company, San Francisco, 1976.
15. Cameron, E. and Pauling, L. Supplemental ascorbate in the supportive
treatment of cancer: Prolongation of survival times in terminal human cancer.
Proc. Natl. Acad. Sci. USA, 73:3685-3689, 1976.
16. Cameron, E. and Pauling, L. The orthomolecular treatment of cancer:
Reevaluation of prolongation of survival times in terminal human cancer.
Proc. Natl. Acad. Sci. USA, 75:4538-4542, 1978.
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Institute for Science and Medicine, Menlo Park, 1979.
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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
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,
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,
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of disc integrity. Medical Annals of the District of Columbia, 33:274-276,
28. Cousins, N. Anatomy of an Illness as Perceived by the Patient. W.W.
Norton & Company, New York, 1979.
29. Williams, R.J. The Prevention of Alcoholism Through Nutrition. Bantam
Books, New York, 1981.
30. Campbell, G.D. Jr., Steinberg, M.H. and Bower, J.D. Ascorbic acid
induced hemolysis in G-6-PD deficiency. Ann. Int. Med. 82:810, 1975.
31. Herbert, V. and Jacob, E. Destruction of vitamin B12 by ascorbic
acid. JAMA, 230:241-242, 1974.
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therapy: A new orthomolecular modality in veterinary medicine. Journal
of the International Academy of Preventive Medicine, 2:10-26, 1975.
----- Robert F. Cathcart,M.D.
--- Allergy, Environmental, and ---
----- Orthomolecular Medicine -----
------- Orthopedic Medicine -------
--- 127 Second Street, Suite 4 ---
--- Los Altos, California, USA ---
---- Fax: 650-949-5083