The
Method of Determining Proper Doses of Vitamin C for the Treatment of Disease by
Titrating to Bowel Tolerance
----------------------------------- --- Dr. Robert F. Cathcart, M.D. --- --- Allergy, Environmental, and --- ----- Orthomolecular Medicine ----- ------- Orthopedic Medicine ------- --- 127 Second Street, Suite 4 --- --- Los Altos, California, USA --- ---- Telephone: 650-949-2822 ---- ---- Fax: 650-949-5083 ---- ----------------------------------- Copyright (C), 1981 and prior years, Dr. Robert F. Cathcart. Permission granted to distribute via the internet as long as material is distributed in its entirity and not modified.
OTHOMOLECULAR PSYCHIATRY,10:2,125‑132,1981
The Method of Determining Proper Doses of Vitamin C for the Treatment of Disease by Titrating to Bowel Tolerance
Robert F. Cathcart III,M.D., 58 N EL Camino Real, No. 119 San Mateo, California 94401
ABSTRACT
My
experience (Cathcart 1975,1976,1978,1979) in utilizing vitamin C in large doses
has extended over a nine-year period and has involved over 9,000 patients. Much
of the original work with large amounts of vitamin C was done by Fred R.
Klenner M.D. (1948, 1949,1971,1974) of Riedsville, North Carolina. Klenner
found that viral diseases could be detoxified and subsequently cured by
intravenous sodium ascorbate in amounts up to 200 grams per 24 hours. Irwin
Stone (1965,1966,1972) 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 (1970, 1976) 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 (1976, 1978) has shown the usefulness of ascorbic acid in the treatment
of cancer.
The
purpose of this paper is to describe a method that maximizes the effectiveness
of ascorbic acid taken orally for various diseases and stress processes. Much
of the controversy about ascorbic acid has been due to studies utilizing
totally inadequate doses of vitamin C. It seems incredible to the growing
number of physicians familiar with the proper doses of ascorbic acid that
recent papers would describe studies utilizing only up to four grams per 24
hours. Also the hypothesis that not only do humans suffer from chronic
hypoascorbemia but that stress and disease can induce localized and systemic
anascorbemia (a type of scurvy) will be presented.
Bowel Tolerance Method
In
1970, I discovered the sicker a patient was, the more ascorbic acid he would
tolerate by mouth before diarrhea was produced. At least 80 percent of adult
patients will tolerate 10 to 15 grams of ascorbic acid fine crystals in one
half-cup water in four divided doses per 24 hours without having diarrhea. The
astonishing finding was that almost all patients would absorb far greater
amounts without having diarrhea when ill. 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.).
Admittedly
increasing the frequency of doses increases tolerance perhaps to half again as
much; but the tolerance exceeding sometimes 200 grams per 24 hours was totally
unexpected. Representative doses taken by patients titrating their ascorbic
acid intake between the relief of most symptoms and the production of diarrhea
were as follows:
TABLE 1
USUAL BOWEL TOLERANCE DOSES
CONDITION Grams per Number
of Doses
24
Hours per 24 Hours
normal. well 4
- 15 4
mild cold 30
- 60 6 - 10
severe cold 60
- 100 8 - 15
influenza
100
- 150 8 - 15
ECHO. coxsackie virus
100
- 150 8 - 15
mononucleosis 150
- 200+ 12 - 18
viral pneumonia 150 -
200+ 12 - 18
hay fever. asthma 15
- 25 4 -
8
burn. injury. surgery
25 - 150 6 - 15
anxiety. exercise and
other mild stresses 15 - 25 4 -
6
cancer 15 - 100
4 - 15
ankylosing
spondylitis 15 - 100
4 - 15
rheumatoid arthritis 15 - 100
4 - 15
bacterial infections 30 - 200+
10 - 18
It was found that maximum relief of
symptoms, the most shortening of the course of the disease, and the greatest
reduction in complications could be obtained by the oral doses just below the
point causing diarrhea. The patient usually easily senses this titration to
bowel tolerance. In many conditions symptoms are markedly suppressed but will
return rapidly if the dose levels are not maintained long enough. In the case
of very toxic diseases, doses may have to be taken every half hour. Even short
delays in taking these doses may prolong the disease. The necessary duration of
treatment is usually also easily sensed by patients.
Anascorbemia
The term "anascorbemia" is coined
to mean complete absence of ascorbate from the blood. It accompanies the
"acutely and chronically induced scurvy" discussed.
The object of this titration to bowel
tolerance is to eliminate the "toxicity" of the disease and to
maintain a high level of ascorbate in all tissues of the body especially the
tissues directly involved by the disease process. Bearing in mind that almost
continual sipping of ascorbic acid would be optimum especially with the more
toxic diseases, for practical purposes compromise to the number of doses listed
often suffices. Apparently there is an almost unbelievable and unappreciated
potential draw by diseased tissues on ascorbic acid. Only by fully satisfying
this "need" of stressed tissues can the condition of anascorbemia and
localized scurvy be absolutely prevented. Fully satisfying this need probably
accounts for the striking amelioration of symptoms just before bowel tolerance
is reached. This need for ascorbate is probably the reason many toxic diseases
or stressful situations produce complications or even secondary diseases later
on. The induced anascorbemia may predispose to pneumonia, heart attacks,
phlebitis, Guillian‑Barre syndrome and perhaps rheumatoid arthritis and
cancer.
It is my custom to speak of 20 to 100 gram
colds, etc. A 100-gram cold would mean that the patient is capable of ingesting
100 grams of ascorbic acid per 24 hours at the peak of the disease. In the case
of systemic viral infections, it is often more important to properly estimate
what gram disease it is and persuade the patient to take adequate doses than to
know what virus is being treated. A patient who learns to start titrating at
the earliest symptoms of a disease will have the best results. Nevertheless,
adequate doses will usually reduce symptoms even late in the disease.
By this method large amounts of ascorbate are
spilled in the urine; but this is necessary to push adequate amounts of
ascorbate into the tissues of the very seat of the disease and maintain full
vitamin C functions. One who argues that ascorbate can have no effect above
renal threshold misses the point entirely and would, I suppose, maintain that
one could not become more intoxicated on ethyl alcohol above renal threshold.
Also, large amounts of ascorbate in the urine will prevent many kidney and
bladder infections.
In the case of the more "toxic"
conditions, half‑hourly doses may be necessary. Absorption and presumably
destruction of ascorbate occur so rapidly as to require this frequency of doses
for adequate amounts of ascorbic acid to keep the diseased tissues saturated
without requiring too large doses that produce diarrhea. Even short delays in
taking these doses may prolong the disease and reduce the effectiveness of
ascorbic acid in blocking symptoms.
Infants and children tolerate ascorbic acid
remarkably. I encourage the use of water rather than juice because the
unsweetened taste aids in helping the patient select the proper dose. Juice is
allowed only if the child refuses doses otherwise. Children 10 years old take
adult doses; most teenagers take half again as much as adults. Older adults
often tolerate ascorbic acid less well and more frequently require intravenous
ascorbate. Young children refusing to take oral ascorbic acid often will
subsequently take oral doses after intramuscular injections of ascorbate.
Although this method of persuasion seems cruel it is better than the
complications of serious diseases and probably hurts no more than a
penicillin shot.
IM and IV
Injections
Per gram intravenous and intramuscular
sodium ascorbate is more effective than oral ascorbic acid, (Klenner, 1971;
Kalokerinos, 1974). Solutions of sodium ascorbate 250 mg per cc with no
preservative except for EDTA must be used. The volume of a single IM injection
can be as much as one could give as a saline shot. Usually 2 cc is used;
sometimes a little more, sometimes in two sites. The object of the
intramuscular injection is to avert a crisis, break the fever, etc. Usually
very rapid conversion to oral doses is possible.
In adults, intravenous injections can be
made with the same 250 mg per cc solutions in pushes of 10 cc or very slowly up
to 50 cc. Care is necessary here to make sure that the vein does not hurt as
the injection is made and that the patient does not dehydrate or have tetany.
IV bottles can be prepared by using
lactated Ringers', one half normal saline, or normal saline and diluting
solutions to 60 grams sodium ascorbate per liter. At this concentration sterile
water can be used but care must be taken to make absolutely sure straight
sterile water is never given. These solutions can be run in two to eight hours
for a liter. It is my experience that sodium ascorbate intravenously in an
edematous patient will usually act as a diuretic. However, one should think
about the sodium and examine the patient frequently. The most frequent difficulty
is dehydration or tetany from running solutions too rapidly. Oral water will
prevent dehydration. A 10 cc vial of calcium gluconate one gram should be added
to one bottle per day if solutions are run more than one day. Remember that
most patients will convert to oral doses of ascorbic acid rapidly. In some
cases such as severe viral or bacterial pneumonias, one may want to give IV
solutions of ascorbate at the same time that oral doses are being given.
Mononucleosis
Mononucleosis responds dramatically to
ascorbic acid although the doses required can be very high. Early in this study
a 23 year old, 98 pound female librarian with severe mononucleosis claimed to
have taken two heaping tablespoons every two hours consuming a full pound of
ascorbic acid in two days. She felt mostly well in three to four days although
she had to continue about 20 to 30 grams a day for about two months. Most cases
do not require maintenance doses for more than two to three weeks. The patient
can sense the duration of need. Professional ski patrol patients can be back on
the slopes in a week. I care mostly that they carry their boda bags full of
ascorbic acid in solution on the hills with them so as to keep the disease
detoxified almost completely while the infection persists. Lymph nodes and the
spleen return to normal rapidly.
Viral Hepatitis
Viral hepatitis of all types, in my
experience, is one of the easiest diseases for ascorbic acid to cure. A
difficulty is that hepatitis often causes diarrhea; so titrating to bowel
tolerance is more difficult. However, with experience one judges what gram
disease it is and gives this amount regardless of diarrhea. This amount could
be from 40 to 100 grams. It becomes obvious whether it is the disease or the
ascorbic acid causing the diarrhea very soon. There is usually a paradoxical
stopping of the diarrhea within a day or two. If too much difficulty is
experienced in judging the dosages, intravenous ascorbate is extremely
effective. Stools and urine return to normal color within two to three days in
acute cases. Chronic cases take longer but in my experience respond rapidly. In
acute cases the patient will usually feel fairly well in two to four days but
it usually takes the jaundice about six days to clear. There would appear to be
a staining of the skin that persists even though physical findings and
laboratory results return rapidly to normal. SGOT and SGPT values so high as
not to be measurable rapidly fall and reflect objectively the subjective
feelings of the patient.
Gastroenteritis
Gastroenteritis of viral origin responds
very rapidly but one must titrate boldly and anticipate paradoxical stopping of
the diarrhea. If titration starts in the first hour of the disease, experienced
ascorbic acid takers may never develop the diarrhea and only suspect what they
have avoided because of the disease being epidemic. These diseases may require
60 to 150 grams of ascorbic
acid to almost
totally block symptoms. If a patient over‑titrates and develops diarrhea
from the ascorbic acid, the change in character of the diarrhea to a relatively
painless, less foul, more like a watery enema diarrhea, and generalized relief
of malaise signals that the doses should be lowered.
Other acute self-limiting viral diseases
respond similarly when the patient titrates properly. Antihistamines and
decongestants should be used when appropriate.
Belfield and Stone (1975) have observed
similar results in veterinary medicine with usually fatal viral diseases when
intravenous ascorbate is utilized.
Bacterial
Infections
Ascorbic acid should be used in conjunction
with the appropriate antibiotic. The effect of ascorbic acid is synergistic
with antibiotics and would appear to broaden the spectrum of antibiotics
considerably. The incidence of allergic reaction to penicillin in patients
"saturated" with ascorbate is almost zero. One must understand that
ascorbate does not always effectively protect against allergic reactions until
the patient has titrated up to bowel tolerance. If a patient has an allergic
reaction to penicillin before bowel tolerance is reached subsequent
"saturation" with ascorbate in conjunction with usual medications
will more rapidly than expected resolve the reaction. It is especially
interesting that mononucleosis would appear to cause more rapid destruction of
ascorbate than other commonly encountered viral diseases. The high incidence of
allergic reaction to penicillin in patients mistakenly given penicillin when
they have mononucleosis is usually prevented by saturation with ascorbic acid.
It is probable that this high incidence of allergic reaction to penicillin in
mononucleosis patients is due to the tremendous draw on ascorbate by the
disease.
It has been my experience the indications
for ampicillin are markedly reduced by ascorbic acid because of the synergism
with Penicillin K and
vitamin C.
Candida Albicans
Candida infections occur less frequently in
patients being treated with antibiotics if bowel tolerance doses of ascorbic
acid are simultaneously used. Ascorbic acid seems to have little effect on
established candida infections. It should be used, nevertheless, to help the
patient with the stress of the disease.
Fungal Infections
Although ascorbic acid should be given in
some form in some way to all sick patients to help them meet the stress of the
disease, it is my experience that ascorbate has little effect on the primary
fungal infection. It will probably be found certain complications can be
reduced in incidence. It may be found that appropriate ant fungal agents will
penetrate tissues saturated in ascorbate better.
Trauma, Surgery
Swelling and pain from trauma and surgery
is markedly reduced by bowel tolerance doses of ascorbic acid. Doses should be
given a minimum of six times a day. More major surgeries should require
intravenous sodium ascorbate postoperatively. The effect of ascorbate on
anesthetics should be studied. Barbiturates and many narcotics are blocked.
Refer to the work of Libby and Stone (1977). The need for these substances
postoperatively is greatly reduced.
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 of the cancer could kill
the patient if the vitamin was started too rapidly in patients with widespread
metastasis. Hopefully, ascorbic acid will become the first treatment given cancer
patients and not the last. The nutritional treatment of cancer should not be
limited to ascorbic acid.
Stress and Disease
in General
After considerable experience with patients
in stressful situations, (Cathcart, 1979) and with diseases producing stress,
it
is my opinion that
saturation with ascorbate continuously has markedly reduced the incidence of
secondary complications. It is difficult to prove, but it is my definite
impression the incidence of disease months following stress is reduced.
Allergies
Hay fever and asthma are most frequently
benefited. Sometimes, pantothenic acid and/or vitamin B6 is helpful in acting
synergistically with ascorbic acid. Frequently, hay fever and asthma are
benefited at dose levels lower and more comfortable than bowel tolerance doses.
However, treatment should be begun with bowel tolerance doses at least six
times a day so that the response of some more. difficult cases will not be
missed.
Back Pain from
Disc Disease
Greenwood (1964) observed that one gram a
day would reduce the incidence of necessary surgery on discs. At bowel
tolerance levels, ascorbic acid more markedly reduces pain about 50 percent and
lessens the difficulties with narcotics and muscle relaxants. It is not the
total answer for back pain patients however.
Ankylosing
Spondylitis and Rheumatoid Arthritis
Ankylosing spondylitis and rheumatoid
arthritis increases bowel tolerance. Clinical response varies. Sometimes, these
diseases are put into remission; sometimes not. I would advise the patient's
increased needs for ascorbate be met regardless.
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. It is thought this immediate response is
due to the neutralization of the small amount of residual streptococcus toxin
causing the disease.
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 infections.
Crib Deaths
(Sudden Infant Death Syndrome)
I would agree with Kalokerinos (1974) and
Klenner (1971) that crib deaths are caused by sudden ascorbate depletions. The
induced anascorbemia 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 epidemiological factors predisposing to crib deaths are associated
with low vitamin C intake or high vitamin C destruction. I have
never heard of a crib death in an infant saturated with ascorbate.
Maintenance Doses
I advise patients to take bowel tolerance
doses of ascorbic acid for about a week and observe if anything beneficial
happens. Some patients clear sinuses, or get a lift from it, etc. In these
cases, doses are reduced to a comfortable effective level. If a patient feels
nothing then the amount is lowered to about four grams a day divided in about
three to four doses for a good day. During a stressful day, doses are raised to
a total of perhaps 10 grams or more. When ascorbic acid crystals are used
dissolved in a small amount of plain water, the patient usually develops a
taste for the substance that tells him how much to take. At the slightest hint
of a threatening viral disease, doses are increased in frequency and to bowel
tolerance.
In many patients viral infections still
occur despite high ascorbic acid intake, although the symptoms of the disease
will be mostly ameliorated. Vitamin A 25,000 iu to 50,000 iu per day should be
taken if high doses of ascorbic acid are maintained for more than several
months. Supplements of all essential minerals should also be taken along with
long‑run maintenance doses of ascorbate. Avoidance of sugar and processed
foods will prove valuable if a patient's goal is almost complete prevention of
viral diseases.
Complications
It is my experience that ascorbic acid
never causes kidney stones, but in fact, probably prevents them. Acute and
chronic urinary tract infections are usually eliminated. One patient in a
thousand will experience some dysuria. A small number will have a light rash
usually clearing with subsequent doses. Patients with hidden peptic ulcers may
have pain but some are benefited. The few patients complaining of canker sores
with small doses of vitamin C do not usually have problems with large bowel
tolerance doses. Patients with canker sores should be given large doses of
vitamin E.
Some patients complaining of acid
conditions do not tolerate ascorbic acid. These cases are very few. Older
patients will have more nuisance
problems with ascorbic acid and have more difficulty reaching bowel tolerance.
Patients started on maintenance doses of
ascorbic acid when well will have a moderately high incidence of nuisance
complaints. Patients treated with bowel tolerance doses for acute diseases have
very few complaints because of the increased tolerance and the marked relief of
symptoms. It is my experience that high maintenance doses of ascorbic acid
reduce the incidence of gouty arthritis. I have not had difficulties giving
large amounts of ascorbic acid to patients with gout.
Almost all of my patients have been
Caucasian, so I have no comment on the recent report that ascorbic acid causes
certain blood problems in certain non‑white groups (Campbell, Steinberg,
Bower, 1975).
There has been no evidence as Herbert and
Jacob (1974) suspected that ascorbic acid destroys vitamin B12.
The major problem, if one wishes, to call
it a problem, 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 encouraged 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 four grams per day do not seem to create a noticeable dependency. The
majority of patients who take 10 to 15 grams of ascorbic acid per day probably
have a certain metabolic need for ascorbate that exceeds the universal human
species need.
The major problem feared by patients
benefiting from these large maintenance doses of ascorbic acid is that they may
be forced into a position when 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
that may include shock, heart attack, phlebitis, pneumonia, allergic reactions,
etc., can be averted only by 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 warning of these needs in a card prominently displayed in
their wallets or should have a Medic Alert type bracelet engraved with this
warning. Physicians should, in addition, carefully ask patients' families about
the patients' ascorbic acid maintenance doses. Regardless of a physician's
philosophical feelings about the usefulness of vitamin C, the physician should
not withhold this essential nutrient from patients who have previously adjusted
their body's metabolism to their increased needs. It would be like withholding
vitamin 812 from a patient with pernicious anemia just because he was
hospitalized. In the case of ascorbic acid, the effect would be much more rapid
however.
Conclusion
The method of titrating a patient's dosage
of ascorbic acid between the relief of most symptoms and bowel tolerance has
been described. This titration method is absolutely necessary to obtain
excellent results. Studies of lesser amounts are almost useless. This method
cannot by its nature be studied by double blind methods 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, work in infants and children, and
have such a profound effect on critically ill patients. More stable patients
will tolerate bowel tolerance doses of ascorbic acid and almost "uniformly
have excellent results. The more suggestible unstable patient is more likely to
have difficulty with the taste.
References
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STONE, I.: Megascorbic Prophylaxis and Megascorbic Therapy: A New
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CAMERON, E. and
PAULING, L.: Supplemental Ascorbate in the Supportive Treatment of Cancer:
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CAMERON, E. and
PAULING, L.: The Orthomolecular Treatment of Cancer: Reevaluation of
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KLENNER, F.R.:
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LIBBY, A.F. and
STONE, I.: The Hypoascorbemia Kwashiorkor Approach to Drug Addiction Therapy A
Pilot Study. J. Ortho. Psychiat. 6:300- 308, 1977.
PAULING, L.: Vitamin
C and the Common Cold. W.H. Freeman and Company, San FrancIsco. 1970.
PAULING, L.: Vitamin
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STONE, I.: Studies of
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STONE, I.:
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Content (C) 2006 and prior years, Dr. Robert F. Cathcart.
Dr. Cathcart
650-949-2822
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