At Incline Village, Nev., I have prescribed massive doses of synthetic Vitamin C in water to over 2,000 acutely ill patients over an almost three-year period.
I have been very guarded about prescribing maintenance doses. Primarily Vitamin C has been used in doses of 15 to 30 to 60 grams a day for acute viral diseases. These diseases have included not only the common cold but influenzas, infectious hepatitis, viral pneumonia, mononucleosis, rubella, mumps, chicken pox, herpes zoster, and herpes simplex.
A remarkable increase in the tolerance to Vitamin C in ill patients has been observed. Roughly 80% of well patients will tolerate about 12 to 16 grams a day in divided doses before diarrhea is produced. These same patients will easily tolerate 30 to 60 grams a day divided in 4 to 6 gram and sometimes 8 to 12 gram doses when acutely ill. Only then does the Vitamin C always produce diarrhea. This dramatic difference in the same patient required to produce diarrhea strongly suggests an increased absorption with viral diseases for some reason.
Approximately 20% of patients do not tolerate Vitamin C in these doses well. They may not like the taste, have much flatus, or have diarrhea at low doses. The rare patient having epigastric distress usually has known peptic disease. None of these problems have been serious and cease immediately on lowering or stopping the medication. Even most of these patients become more tolerant when very ill. The diarrhea produces no significant problem and is usually almost painless. Although urine is made acid, dysuria is not produced in these doses. There ha been no case of urinary stone. Occasionally moderated doses will produce constipation. There have been no true allergic reactions to the pure synthetic powder although the natural tablets have been suspected on rare occasions. There has been no "withdrawal scurvy" with these massive doses used for short periods. No complications related to pregnancy have yet been observed.
It is my opinion that there is considerable beneficial effect but final proof of this benefit must await double blind tests. Several points should be made however. Patients regularly report a feeling of improvement just as "bowel tolerance" doses are reached. There seems to be less recurrence of symptoms when these doses are maintained for a day or so. Lesser doses often permit recurrence of symptoms if not maintained for a time approaching the usual uncomplicated course of the disease. As described in other studies, morbidity may be reduced. However, producing the maximum benefits thought to be obtained requires considerable physician management. All of the usually indicated medications are used.
Vitamin C may reduce the incidence of viral diseases but does not absolutely prevent them even in high doses. Responding to early symptoms with massive doses appears possibly most effective. The wisdom of long run high maintenance doses should be decided by long follow-up.
The doses of Vitamin C as described have been ingested for short periods of time by large numbers of patients without any serious difficulties. Problems were minor and rapidly reversed when the medication was decreased of stopped. Almost all problems were related to gastro-intestinal tolerance. On the basis of the clinical experience with large numbers of patients, it is thought that benefits of Vitamin C are maximum only at these high doses. Smaller amounts may prove helpful but are not as suggestive.
Mechanisms of action not ordinarily considered in nutrition should be sought.
Robert F. Cathcart, M.D. Orthopedic Surgeon Incline Village, Nev. June 25, 1972
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