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Thursday, July 22, 2010

High Dose Vitamin C Gains Acceptance in Western Medicine

It is 3:00 PM on a typical mid-summer day when the call comes in over the EMS radio. A 9-year old boy suffering thermal burns is in rout to our Emergency Department; ETA 10-minutes. A very characteristic summertime event, as the report continues that the child was dousing a still smoldering pile of burning yard-trash with gasoline. The resultant flash back scorched his face, neck and hands. For the purposes of this article we will call him Jimmy. Jimmy arrives with 1st and 2nd degree burns to over 15% of his body surface area. We rush to stabilize him, administering morphine IV for pain control and boluses of Ringer Lactate IV solution according to the Parkland formula for fluid resuscitation. The burn team members on the other end of the phone at the regional Burn Center in Augusta are accommodating as usual, as we get ready to air transport this little fellow to their center. Jimmy does exceptionally well at the center, a week later he is discharged and I receive a report from the burn surgeons. To my utter amazement it includes details of the use of high dose intravenous Vitamin C infusions the day off and the days that followed his arrival.

High Dose Vitamin C? In my 17 years of practicing traditional Western Medicine, I thought I would never see the day when a “vitamin” was a mainstay of care in a critically injured patient. Research has proven the utility of this vitamin in reducing capillary leakage and reducing fluid loss, enhancing healing and reduction in scar formation. While trained as an allopath my interests have in the past decade and a half been leaned towards the alternative. My approach in my private practice is integrative. By integrative I refer to my allopathic trained as a medical doctor (MD) but subscribing to selected, evidence based alternative or complementary diagnostics and therapeutics. Shying away from the temptations of polypharmacy and pill pushing for a more holistic and natural approach. With the advent in recent years of higher doses of Vitamin D3 replacement being prescribed by American physicians it was only a matter of time before other “nutritional” therapies caught on. I cheer on the embracing of these therapies.

Vitamin C, also known as ascorbic acid or ascorbate, is a carbohydrate compound closely related to and derived from the glucose molecule. Glucose is a simple sugar that is used by most living organisms as a fuel for cellular energy. Vitamin C remains one of the most important nutrients we as humans rely on for good health whether we know it or not.

Vitamin C was first identified by a Hungarian scientist named Albert Szent-Gyorgyi, MD, PhD in 1926, while conducting research on the chemical process that causes fruits and vegetables to turn brown. He succeeded in isolating a white crystalline substance from the adrenal gland of cows, which he referred to as Cx11. He later isolated these same crystals from the juice of potatoes and cabbages renaming it hexuronic acid. Finally, in 1932 after producing the first pure crystals of vitamin C, Dr. Gyorgyi bestowed the name ascorbic acid to the substance in recognition of its role in preventing scurvy. The Latin word, ascorbic means "without scurvy". Scurvy, a rather horrible disease, results in defective collagen synthesis leading to defective dentine formation, hemorrhaging into the gums, and loss of teeth. Hemorrhaging is a hallmark feature of scurvy and can occur in any organ not just the gums. Hair follicles are one of the common sites of cutaneous bleeding. Bony changes are usually observed in the very young. Scurvy was first described by the Egyptians as early as 1500 BC, and struck the crew of Magellan's around-the-world journey in 1519-22. A British report in c.1600 indicated that in the previous 20 years some 10,000 mariners had suffered the disease. Seafarers were often susceptible due to poor dietary intake of Vitamin C on their long voyages. In 1747 as the HMS Salisbury sailed from England to the Plymouth Colony, James Lind the ship's physician performed a simple experiment to determine the cause of this disease, it was one of the first controlled scientific studies using fresh citrus fruit in some sailors and having a control population that ate citrus-free meals. The ingestion of limes and oranges saved those sailors from scurvy. Consequently, British sailors during WWII were often referred to affectionately as “limeys” for their now notably historic consumption of this fruit while at sea.

Unfortunately for humans, we do not possess the ability to manufacture their own Vitamin C. And by definition a vitamin is a substance necessary for survival that must be taken in from the outside (ingested exogenously). Plants and most animals possess an enzyme called gluconolactone oxidase (GLO) that allows them to readily convert glucose into Vitamin C. Humans have somehow lost the ability to do what virtually every other life form on earth can do with ease during our evolutionary development by losing the ability to make GLO and requiring ingestion of Vitamin C containing foods. In actually GLO is the 4th enzyme in the pathway to converting glucose to Vitamin C and the only one we humans are missing. Besides ourselves, three other species of mammals do not make this vitamin and they include the gorillas, guinea pigs and the fruit bats. Why these four mammalian species lost this ability is poorly understood.

The reasons why Vitamin C is important are many. It offers Antioxidant protection. Vitamin C protects us from the ravages of free radical damage that can destroy cell membranes, damage DNA and lead to the development of degenerative diseases, cancer and pre- mature aging. In addition to helping the body utilize folic acid, Vitamin C helps in the recycling process of other anti-oxidants such as Vitamin E, Coenzyme Q10, alpha Lipoic Acid and Glutathione. Antioxidants are the key to maintaining health and longevity. They are at the root of all degenerative diseases. Did you know that some animals utilize Vitamin C as a “stress hormone”? In goats for example their serum levels of Vitamin C jump exponentially when under physical stress. A goat will on an average day will produce between 5 and 15 grams of ascorbate. Interestingly, that same goat, if under stressed, will produce 5 - 10 times its baseline levels of ascorbic acid. Evolution has conditioned this animal to increase production in times of need. Some have referred to this vitamin in these animals as “the other stress hormone” after cortisol.

Vitamin C is crucial in collagen production. Vitamin C helps in the manufacture of collagen, the basic cellular "cement" that keeps muscles, tendons, bones, teeth, skin and arteries healthy and strong and aids in the repair of blood vessels and broken bones. The amino acids Lysine, Glycine, Proline when combined with Vitamin C make collagen. Zinc is an important mineral in this pathway as well. So without adequate dietary intake of Vitamin C and Zinc skin and tissue repair is hindered. Vitamin C and the mineral Zinc are the two co-factors crucial in the enzymatic production of collagen and hence the particular importance in the use of Vitamin C in full thickness burn victims of late.

News reports tout the importance of Vitamin C in cardiovascular health. Vitamin C benefits heart conditions of all kinds. It has been found to normalize blood pressure, reducing cholesterol and repairing arterial walls. In fact, there are researchers that believe cardiovascular disease is in reality the early stages of scurvy and can be prevented with a vitamin protocol centering on high doses of Vitamin C. This was the belief of two-time Nobel Prize laureate Linus Pauling. Dr. Pauling dedicated much of his life’s work to research on Vitamin C. His own personal daily intake was huge, and who am I to disagree with such a great mind. His theories continue today by other luminaries in medicine and science. Vitamin C does not allow Low Density Lipoprotein (the “bad” cholesterol) to oxidize. It is the oxidation of this "bad" cholesterol that produces plaques on our artery walls and results in coronary artery disease. Vitamin C's effects on the cardiovascular health may soon be revealed in ongoing studies to play a bigger role than some very powerful drugs the medical establishment is currently using as first line medication.

The immune system is not to be overlooked, for ascorbic acid plays a major role. Vitamin C aids white blood cells that attack and destroy everything from cancer cells, viruses, bacteria, to parasites of all kinds. It also controls the release of histamine, a sometimes undesirable side effect of our immune system at work. There are cancer treatment protocols using very high doses of IV Vitamin C. My experience has been with its use in the Myers’ Cocktail infusions.

Since we all lack the GLO enzyme we cannot provide ourselves with the antioxidant protection and other benefits that Vitamin C was designed to provide. We have no way of self-regulation. Antioxidant experts from researcher Linus Pauling to Cellular Health author Dr. Matthias Rath (who discovered the Lp(a) risk factor for heart disease) recommend a rather high oral dosage each day to fully support and aid the immune system and optimize health. Such high doses should first be discussed with a knowledgeable nutritionally minded physician. Doses that exceed oral intake tolerability can be administered intravenously on a set schedule depending on the body’s needs.

By using the bowel tolerance test (or Ascorbic Acid Flush test) everyone can determine his or her own necessary level of Vitamin C and tolerability. This amount is different for each individual and may change depending on the health and stress of that person. If you are stressed by some sort of acute illness such as a cold, conducting the same test rapidly can be achieved by increasing the dose of Vitamin C. Under stress the bowels will tolerate greater doses of the vitamin. I routinely order and advise patients on optimal doses using the Ascorbic Acid flush test. Those patient with Iron metabolism problems such as Hemochromatosis or a blood disorder called Thalassemia need to exert caution for Vitamin C greatly increases iron absorption and this can be harmful in these individuals.

Conversely high doses of Vitamin C can hinder the absorption of Ginseng if taken together. High dose Vitamin C increases serum levels in the concomitant use of the drug Acetaminophen (Tylenol). High levels of Tylenol especially in an individual with liver disease can be harmful. There are reports that high dose Vitamin C inhibits effect of statin (HMG-CoA reductase) drugs such as Zocor, Mevacor and Lipitor. These lipid lowering drugs are used quite commonly in our society. High dose Vitamin C may also reduce the blood thinning effects of warfarin (Coumadin) and that is important for those people taking that medication to be aware.

Before embarking on high dose Vitamin C usage, it is important to determine your personal needs and the correct preparations, dosing schedule and adjunct supplements that need to be taken. Therefore consultation with a nutritionally minded physician is recommended and imperative. Oh, and in closing, Jimmy is doing just fine these days with the most minimal of scars following his accident.

-JP Saleeby, MD is an Emergency Room physician and Integrative Practitioner; he is a medical writer and blogger. Dr. Saleeby has recently relocated to the Myrtle Beach area to open a dedicated Natural Medical practice with other complementary medicine healers.

**To be published in an upcoming edition of Myrtle Beach Quarterly

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Charleston; Myrtle Beach, SC; Raleigh-Durham, NC; Orlando, FL, GA, NC, SC, VA, FL, United States