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Vitamin C has a long history of use in the treatment of various viral diseases. There has been much confusion about vitamin C recently that has come about mainly due to negative articles reported in the media. Some of this has been around the use of vitamin C for the common cold, some around the cardiovascular effects of vitamin C and some around the role of vitamin C in cancer. In particular, there have been statements made that vitamin C contributes to arterial thickening and thus atherosclerosis, and that vitamin C causes cancer. Certainly the impression that is received by the general public at large is one of alarm, but in short time the general public tends to forget these concerns and will be swayed by whatever the latest finding is, or return to their previous use of vitamin C.

Without fail, the research that has painted vitamin C in a bad light has been in vitro, and further to this the experimental designs have been highly isolated biochemical environments that have placed abnormal presentations of vitamin C in contact with cells etc. These conditions do not occur at all in vivo, and in fact the in vivo evidence on all of these issues overwhelmingly supports the clinical improvements gained from the use of vitamin C. Further to this, on reading the actual articles cited in the negative media reports, the authors of the articles make no mention of vitamin C causing atherosclerosis or cancer, these claims have been extrapolated by the media. Vitamin C as ascorbic acid, if placed in high enough concentrations with DNA or exposed lipids, probably will have deleterious effects on these substances, but really the same can be said for any substance, even water. What we need to focus on, to be of any clinical value, is appropriate in vivo research, especially clinical research, and most importantly the experience of thousands of clinicians, past and present, who have used and continue to use vitamin C appropriately because it gets them results.

There is a long history of the clinical use of vitamin C, going all the way back to the 1930s and 40s. Some of the earliest attempts at using vitamin C as a therapeutic agent were with polio victims, and as the doctors administering the vitamin C tried larger and larger doses, their results improved significantly. One of the earlier doctors to use higher doses of vitamin C was Dr. Frederick Klenner, following on the heels of positive research by Jungeblut in 1939 in which he showed that the administration of ascorbic acid to monkeys infected with poliomyelitis produced a distinct reduction in the severity of the disease and enhanced their resistance to it. Sabin attempted to reproduce these findings, but although he found a major lethal effect of vitamin C to polio virus in the test tube he was unable to achieve these results in vivo. In retrospect it is apparent that in the early days not a lot of attention was paid to the size and frequency of the dose given, accordingly results were variable.

In 1949, the first of a remarkable series of papers appeared. Klenner described his successful treatment of poliomyelitis, as well as a variety of many other viral infections, using ascorbic acid. He gave the rationale for his treatment, his technique in detail, and his dramatic case histories. Klenner realized that the secret was in the massive doses he employed, and he tried to impart this knowledge to an unbelieving profession. In his 1952 paper, Klenner further discussed his ascorbic acid treatment of polio and comments on Jungeblut's earlier work, stating:

"His results were indecisive because the amount of vitamin C given was inadequate to cope with the degree of infection. Sabin's results were not as suggestive as Jungeblut's because he, Sabin, used a greater dose of virus and less Vitamin C.'

Klenner's suggested optimal dosage rate for virus infections, calculated on the basis of a 70-kilogram (154-pound) adult, was 4.5 to 17.5 grams of ascorbic acid given every two to four hours around the clock (27 - 210 grams per day). This amount goes far beyond anything that had been previously tried. He records one successful case history after another in these papers, as well as in his 1953 report.

With the success of Klenner, and in the absence of any clear explanation as to why these high dose vitamin C therapies were getting results, various other doctors and scientists got involved with administration of vitamin C in various doses. Linus Pauling conducted some of the better technical research into vitamin C, and in the meantime there were many doctors (mainly in the united States) who were finding success against a whole range of viruses and infectious diseases in general, as long as they maintained high doses of vitamin C. If the dose is right, vitamin C has been found clinically to be effective against a range of viruses, including herpes, human papilloma virus, hepatitis viruses and more recently HIV/AIDS. What is important here is that we have now covered a period in excess of fifty years where medical practitioners have consistently and repeatedly administered vitamin C in high doses, and have continued to do so because they have achieved excellent clinical results. Doctors who start using vitamin C appropriately invariably do not stop using it, rather they tend to expand the use of vitamin C over its appropriate indications. Furthermore, after fifty years of administration by thousands of doctors the negative effects of vitamin C reported in the media have simply not occurred clinically. Doctors who have used vitamin C successfully do not stop considering it when confronted by negative research, however patients may not ask for vitamin C therapy as often when there is a media headline.

There is an enormous amount of published research, past and present, covering the use of vitamin C in viral disorders. While much of this is in vitro research, there still exists an enormous amount of clinical research, which is unfailingly positive, and supportive of the position that vitamin C is a desirable and effective therapeutic agent. It is clearly impossible to exhaustively examine this research here (there are roughly 25,000 such articles on PubMed), but some of the more recent research covers the use of vitamin C in the treatment of herpes virus, hepatitis A, HIV/AIDS and HPV in cervical dysplasia and cervical cancer.

The AIDS community uses Vitamin C heavily and in high doses. The balance of evidence in research suggests that vitamin C interferes with reverse transcriptase activity, increasing the delay to sero-conversion and decreasing the spread of virus from infected cells. Harakeh et al (1) state “In chronically infected cells expressing HIV at peak levels, ascorbate reduced the levels of extracellular reverse transcriptase (RT) activity (by greater than 99%) and of p24 antigen (by 90%) in the culture...” and “These results indicate that ascorbate mediates an anti-HIV effect by diminishing viral protein production in infected cells and RT stability in extracellular virions.” Rivas et al have found “Exposure to high concentrations of vitamin C preferentially decreased the proliferation and survival of the HIV-infected cells and caused decreased viral production.” (2). Tang et al state “The highest levels of total intake (from food and supplements) of vitamins C and B1 and niacin were associated with a significantly decreased progression rate to AIDS” (3) and another article by Harakeh et al has found “Long-term experiments showed that continuous presence of ascorbate was necessary for HIV suppression” (4).

Vitamin C is recommended by researchers (and clinicians) for herpes treatment. Terekhina et al have concluded “Impaired inhibition of hydroxy radical and a drop of antioxidant enzymes activities and of the level of ascorbic acid in herpes-infected cornea and tears are factors in the pathogenesis of ophthalmic herpes.” (5) Hovi et al carried out a randomized double-bind, placebo-controlled clinical trial on the topical treatment of recurrent mucocutaneous herpes with a strong water solution of Ascoxal, an ascorbic acid-containing pharmaceutical formulation with mucolytic and non-specific antimicrobial activities. They found “…a brief treatment with this ascorbic acid-containing preparation resulted in statistically significant clinical and antiviral effects, which calls for further and more extensive studies with a more intensive treatment schedule.” (6) Terezhalmy et al used ascorbate in the treatment of fifty episodes of recurrent herpes labialis. Their conclusion was that “Optimum remission of symptoms was observed in 4.2 +/- 1.7 days with the 600 mg. dosage of the water-soluble bioflavonoid-ascorbic acid complex. No adverse reactions were reported by any of the patients who participated in this investigation.” (7)

Vitamin C (and other antioxidants) is receiving favourable research findings in the prevention of cervical cell changes and cancer. Goodman et al conducted a case-control study to examine the association of plasma micronutrient concentrations with the risk of cervical dysplasia after careful adjustment for HPV infection. Tier findings state “…results support existing evidence that high plasma levels of antioxidants may reduce the risk of cervical squamous intraepithelial lesions independent of HPV infection” (8). A study by Herrero et al of 748 cases and 1,411 hospital and community controls in four Latin American countries evaluated the association between certain elements of diet and invasive cervical cancer. Their research finds that “The results are consistent with those of other investigations and provide support for a protective effect of vitamin C, carotenoids, and other substances found in the same fruits and vegetables against the development of invasive cervical cancer” (9).

Many of the older papers, dating back through the 1950s, 60s and 70s give even more exciting indications of the use of vitamin C in therapy against viruses. Research tends to get bogged down in particulars, and in attempts to find the “mechanism” of action of vitamin C (the major assumption being that vitamin C works in isolation). This research necessitates a very reduced approach to analysis; designs incorporate the main known chemistry involved and are almost inevitably in vitro studies. In living systems the interactions are enormously more complex, and in all but extremely well designed experiments bear little resemblance to the results derived from a lot of the in vitro research. This doesn’t mean that the in vitro research is all bad science, rather that in balance we should look hard at our mass of clinical experience to make fundamental decisions about the use of vitamin C in therapy.

Sincerely,

Dr Ian Dettman Ph.D. (Biochemistry), B.Sc. Hons (Biochem),
F.R.M.I.T. (Biochem, Microbiology), N.D.
F.A.C.B.S., F.A.N.T.A., R.A.C.I., M.A.S.M.
ACNEM, A.I.M.S., A.P.S., N.H.A.A., A.T.M.S

Research references:

1. Suppression of human immunodeficiency virus replication by ascorbate in chronically and acutely infected cells.
Harakeh S Jariwalla RJ Pauling L
Proc Natl Acad Sci U S A 1990 Sep;87(18):7245-9.
2. Increased uptake and accumulation of vitamin C in human immunodeficiency virus 1-infected hematopoietic cell lines. Rivas CI Vera JC Guaiquil VH Velasquez FV Borquez-Ojeda OA Carcamo JG Concha II Golde DW
J Biol Chem 1997 Feb 28;272(9):5814-20
3. Dietary micronutrient intake and risk of progression to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus type 1 (HIV-1)-infected homosexual men.
Tang AM Graham NM Kirby AJ McCall LD Willett WC Saah AJ
Am J Epidemiol 1993 Dec 1;138(11):937-51.
4. Comparative study of the anti-HIV activities of ascorbate and thiol-containing reducing agents in chronically HIV-infected cells.
Harakeh S Jariwalla RJ
Am J Clin Nutr 1991 Dec;54(6 Suppl):1231S-1235S.
5. Lacrimal and salivary antioxidants in viral infection
Terekhina NA Petrovich IA Batueva RA Sosnin DI Vesna VA
Klin Lab Diagn 1998 Jan;(1):13-5.
6. Topical treatment of recurrent mucocutaneous herpes with ascorbic acid-containing solution.
Hovi T Hirvimies A Stenvik M Vuola E Pippuri R
Antiviral Res 1995 Jun;27(3):263-70.
7. The use of water-soluble bioflavonoid-ascorbic acid complex in the treatment of recurrent herpes labialis.
Terezhalmy GT Bottomley WK Pelleu GB
Oral Surg Oral Med Oral Pathol 1978 Jan;45(1):56-62.
8. The association of plasma micronutrients with the risk of cervical dysplasia in Hawaii.
Goodman MT Kiviat N McDuffie K Hankin JH Hernandez B Wilkens LR Franke A Kuypers J Kolonel LN Nakamura J Ing G Branch B Bertram CC Kamemoto L Sharma S Killeen J
Cancer Epidemiol Biomarkers Prev 1998 Jun;7(6):537-44.
9. A case-control study of nutrient status and invasive cervical cancer. I. Dietary indicators.
Herrero R Potischman N Brinton LA Reeves WC Brenes MM Tenorio F de Britton RC Gaitan E
Am J Epidemiol 1991 Dec 1;134(11):1335-46.