by John C. Pittman, MD, and Mark N. Mead, MSc
It may come as a surprise to learn that most people with cancer do not die from the disease itself, but from life-threatening infections such as sepsis. A great many cancer sufferers also die from chronic inflammatory problems that are associated with the disease, such as cancer cachexia. A recent report published in the March 2011 Journal of Translational Medicine presents a powerful argument for using intravenous (IV) vitamin C in the context of life-threatening infections and cancer. The authors report that IV vitamin C has been effective in directly treating cancer as well as in helping to reverse chronic inflammation and stave off life-threatening infections in these patients.
Vitamin C is the most widely used single-nutrient supplement in the United States, and has long been lauded by the general public for its supposed powers to treat many ills, from colds to cancer, from herpes to heart disease. Back in the 1970s, two-time Nobel Prize winner Linus Pauling did much to bolster the vitamin’s profile by touting it as an immune-enhancing and tumor-killing therapy. Pauling asserted that the anti-cancer potential of vitamin C depended on getting the proper dosage, and toward the end of his life, he further emphasized that vitamin C was best combined with various other anti-cancer agents that worked synergistically with vitamin C.
Dr. Pauling was among the first scientists to recognize that it’s impossible to attain the therapeutically optimal level of vitamin C by taking the vitamin orally—that is, in the form of the standard vitamin C pills or tablets. On one hand, it's virtually impossible for people to overdose on oral vitamin C, since the body only assimilates a certain quantity through the mouth and then stops allowing it to build up. On the other hand, this prevents health care professionals from being able to achieve the blood levels that have been linked with killing tumors. One solution, of course, is to use intravenous (IV) vitamin C.
With IV vitamin C, you can bypass the digestive system and thus circumvent the body’s normally tight regulation of vitamin C levels. As researchers recently reported in a recent issue of the Proceedings of the National Academy of Sciences, IV vitamin C generates hydrogen peroxide which will destroy primitive cells like bacteria, viruses and cancer cell, and this in turn leads to the shrinkage of aggressive tumors—including ovarian, pancreatic and brain tumors—in laboratory animals. Despite the very high levels of vitamin C used in these studies normal cells appear to be completely unharmed by the therapy. The researchers stated that it’s feasible to intravenously boost levels of vitamin C in humans to the same levels used in the mice.
Indeed, numerous studies have suggested that high-dose IV vitamin C may help eliminate cancer, even when combined with conventional treatments. For example, in a report for the August 8th 2010 issue of Cancer Chemotherapy and Pharmacology, Dr. Mark Levine, chief of the U.S. National Institutes of Health's Molecular and Clinical Nutrition Section, concluded that exposing tumors to vitamin C made them more vulnerable to the killing effects of at least four widely used chemotherapy drugs. Previously, Dr. Levine had published research with mice suggesting that IV doses of vitamin C could one day reduce the size of malignant tumors in people.
Dr. Levine’s findings confirm what we have been seeing for the past 15 years at the Carolina Center for Integrative Medicine. On numerous occasions, we have observed that IV vitamin C enabled patients with advanced cancers to respond to chemotherapy drugs to which they had previously failed to respond. We therefore believe that it can enhance the effectiveness of cancer chemotherapy and pave the way for therapeutic success. In a recent issue of PloS One, Dr. Levine concluded that high-dose IV vitamin C is in wide use by integrative practitioners and that “high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer [and] chronic, untreatable, or intractable conditions…”
A Short History of Vitamin C Therapy
Vitamin C has long been the most widely used dietary supplement, and much of the initial excitement surrounding this vitamin can be traced back to studies conducted in the 1970s by two-time Nobel Prize winner Linus Pauling. Dr. Pauling and his Scottish colleague Ewan Cameron, MD, published two studies that demonstrated an approximate quadrupling in survival in “terminal” cancer patients who received vitamin C by a combination of IV and oral routes. These findings were subsequently replicated by a clinical trial in Japan. In addition, the Scottish and Japanese clinical studies found significant improvements in the quality of life for cancer patients receiving high-dose vitamin C.
A chemist by training, Dr. Pauling had publicly questioned the adequacy of the Recommended Daily Allowance (RDA) for vitamin C, and he suggested that taking gram doses of vitamin C—that is, 1000 milligrams (mg) or more—could be effective in the prevention and treatment of colds. At the time, the RDA was a mere 45 mg per day, an amount considered sufficient to prevent scurvy, the classic disease of vitamin C deficiency. (Today, the RDA is 90 mg per day for men, and 75 mg per day for women.)
Pauling took the controversy up another notch when he proposed daily doses of 5 to 30 grams—5000 to 30,000 mg—for the treatment of advanced cancers. To this day, the very mention of Pauling’s vitamin C research still sparks heated arguments among medical professionals, oncologists in particular.
Clinical studies of the potential therapeutic value of high-dose vitamin C began in Scotland in 1971. The findings from these early investigations were dramatic indeed. In addition to the aforementioned three studies showing a four-fold increase in survival, one other study of 100 “terminal” cancer patients showed a nearly six-fold increase in survival for patients with advanced cancer. To date, six out of a total of seven clinical studies have concluded that high-dose vitamin C did increase survival in patients with advanced cancers. Many of these patients also noted significant improvements in their energy levels, pain reduction, appetite, and other measures of quality of life.
Understandably, these findings attracted much media attention and ignited an explosion of public interest in using vitamin C for cancer therapy. Many thousands of cancer patients began self-prescribing the vitamin. At the same time, however, some scientists sharply criticized Pauling’s research on the grounds that his early studies were not randomized controlled clinical trials, the “gold standard” of medical research. For this reason, the studies’ findings were deemed unreliable or preliminary at best.
Controlled clinical trials are indeed the best way to assess the true value of any proposed treatment strategy. In the case of vitamin C, the ideal study would randomly assign cancer patients to receive either vitamin C or a placebo (a substance having no biological or therapeutic activity), and to do so without the patients knowing which one they were receiving.
In the late 1970s, researchers from the Mayo Clinic did conduct two randomized clinical trials, but alas, these studies only focused on oral, not intravenous, vitamin C. In the first study, the cancers were too far advanced to reasonably expect any intervention to affect the outcome. (the average survival for all patients was only 51 days). In the second trial, there was no difference in survival for colorectal cancer patients who received the high-dose oral vitamin C. Strangely, neither study adhered to Dr. Pauling’s recommended protocol for achieving “bowel tolerance”—that is, in order to prevent diarrhea, the oral dose was supposed to have been increased gradually over time.
Because neither of the Mayo Clinic studies provided vitamin C in oral form, they have no bearing on the issue of whether high-dose IV vitamin C can be an effective treatment for advanced cancers. Thus the jury is still out on vitamin C as a potential cure for cancer, and no one has adequately tested Pauling’s hypothesis with the appropriate controlled clinical trial design.
Intravenous Vitamin C May Be Essential
In order to achieve the doses that have a therapeutic impact, as noted earlier, it seems necessary to use intravenous (IV) vitamin C. The original protocol recommended by Drs Pauling and Cameron involved a 10-day course of IV vitamin C in which the vitamin was given as a slow-drip infusion of 10 grams sodium ascorbate. After this, vitamin C was given orally in the form of a syrup, at a dose of 2.5 grams every 6 hours for a total dose of 10 grams per day. This strategy enables patients to avoid the diarrhea that otherwise accompanies vitamin C doses in excess of 6 to 7 grams per day. Subsequent studies used oral and intravenous doses ranging from10 to 30 grams per day.
The recommended dose for IV vitamin C has steadily increased over the past two decades, and physicians continue to report striking benefits. In the March 2008 issue of Puerto Rico Health Sciences Journal, researchers reported that, “only by intravenous administration, the necessary [vitamin C] levels to kill cancer cells are reached in both plasma and urine.” By giving the vitamin intravenously, one can readily achieve the blood levels (at least 20 mM) that have been reported to selectively kill tumor cells. In at least two clinical trials now in progress, scientists are trying to determine the safety, tolerability, best therapeutic dose, and other key aspects of using IV vitamin C.
The power of this approach has been well documented in mainstream medical journals. In March 2006, the Canadian journal CMAJ (Canadian Medical Association Journal) told the story of three patients with advanced cancer who had received IV vitamin C. One was a 49-year-old man with “terminal” bladder cancer who had declined chemotherapy. Nine years after receiving the deadly prognosis, he was still alive and apparently free of cancer.
Another patient, a 66-year-old woman, had an aggressive lymphoma with an extremely poor prognosis. After IV vitamin C, her disease went into remission and she was alive and well 10 years later. In a third case, IV vitamin C was given to a 51-year-old woman with kidney cancer that spread to her lungs. Two years later, she had a normal chest X-ray, and a pathologist confirmed the findings.
Why did these patients succeed where others have not? It could be that the secret is in the dosage. Only two controlled clinical trials of vitamin C have been done, and both used oral vitamin C rather than the IV route. But oral doses can never achieve the high blood levels provided by IV methods, the levels necessary for killing cancer.
Dr. Levine recently demonstrated that, indeed, only IV vitamin C can achieve the desired blood levels. The reason for this is that your kidneys will get rid of vitamin C as fast as your gut can absorb it. With the IV approach, the blood levels are immediately elevated, and it takes much more time for the kidneys to eliminate the excess. Thus, for an extended period, you’re able to expose cancer cells in your body to the levels that can make a difference.
Dr. Levine also confirmed that vitamin C is metabolized to hydrogen peroxide. Unlike normal cells, cancer cells lack the internal defenses to protect themselves from this highly unstable and reactive ( compound. As a result, they die. (Many chemotherapy agents operate, in part, through a similar mechanism. Green tea, resveratrol, and artemisinin may have similar effects; taken in combination, these natural agents may reach levels of peroxide lethal to malignant tumors.)
These days, IV vitamin C doses may range from 10 grams to as high as 300 grams per day (300,000 mg!), though most doses are in the range of 30 to 80 grams per day. The optimal strategy, as designed by Dr. Hugh Riordan, includes certain other nutrients, such as alpha lipoic acid. The good news is that, in contrast with conventional chemotherapy, IV vitamin C is not a particularly expensive therapy.
If you have cancer, talk to your Integrative Medicine physician about IV vitamin C. Preliminary reports from a clinical trial in Kansas City indicate that giving IV vitamin C prior to chemotherapy can dramatically reduce the toxicity of those treatments while bolstering the tumor-killing impact of the chemo.
John C. Pittman, MD, is the Medical Director of the Carolina Center for Integrative Medicine in Raleigh, NC, and is certified by the American Board of Clinical Metal Toxicology. Mark N. Mead, MSc, serves as the Center’s Integrative Medicine Research Consultant.
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