Labeled as “health fanatics” and “vitamin whackos,” the users of mega-dose vitamin C pills are about to be vindicated. No more hiding their vitamin C pills from their doctors. No more condescending glances from their friends when they say they are taking a few grams of vitamin C every day. According to newly revealed science, the belittled mega-dose vitamin C users may be purchasing the cheapest and most effective health insurance one can buy.
The prevalent belief is that vitamin C is an essential nutrient but excessive amounts consumed from mega-dose vitamin pills produce expensive urine since excesses are excreted. This flawed idea emanates from studies conducted by researchers at the National Institutes of Health (NIH) in 1996. [Proceedings Natl Acad Sci 93:14344-8, 1996] Ever since then physicians, pharmacists, dietitians and other health practitioners have echoed the same mistaken chorus --- you’re wasting your money by taking mega-dose vitamin C pills.
Health authorities claim mega-dose vitamin C pills are worthless
The current Recommended Dietary Allowance (RDA) for vitamin C, 75 milligrams for males, 90 milligrams for females, and an additional 35 mg for smokers, is based on the amount of vitamin C needed to prevent a person from getting scurvy and provide body stores for about 30 days, with a margin of safety. [Proceedings Natl Academy Sciences 98: 9842-46, 2001] An NIH press release states “at 200 mg oral intake, blood plasma had more than 80 percent maximal concentration of vitamin C and tissues were completely saturated. Doses of 500 mg and higher are completely excreted in urine.” [National Institute of Diabetes and Digestive and Kidney Diseases, NIH Press release April 15, 1996]
A study conducted by NIH investigators emphatically states that doses of supplemental vitamin C above 200 milligrams daily are “nearly completely excreted in urine.” Furthermore, the concentration of ascorbic acid (the technical name for vitamin C) in blood plasma never exceeds much more than 70-85 micromole per deciliter of blood regardless of the dosage of vitamin C consumed, so said NIH researchers. [Biofactors 15: 71-74, 2001] (Micromole is a measure of concentration of substances in liquids.) So NIH investigators assert 5 servings of fresh fruits and vegetables provide about 200 milligrams of vitamin C and that the diet should be sufficient to reach optimal blood levels. Vitamin C pills are not required, period.
What about the half life?
This is not so, says a new book, Ascorbate: The Science of Vitamin C,* written by Drs. Steve Hickey and Hilary Roberts, University of Manchester graduates in pharmacology in England. The book exposes the many flaws involved in the establishment of the Recommended Daily Allowance for vitamin C, and the revelations are alarming. Millions of people could have delayed or avoided health problems such as cataracts, cancer, blood vessel disease, aneurysms, gall stones and more had NIH researchers properly conducted tests to determine the human need for vitamin C.
Hickey and Roberts note indisputable flaws in the RDA for vitamin C. NIH scientists waited 12 hours before measuring the concentration of ascorbic acid in the blood circulation to develop an RDA for 280 million people. Hickey and Roberts show that NIH investigators failed to calculate for the half life of vitamin C, which is about 30 minutes in humans. (The half life is the time it takes for something to disappear from the human body.) “To be blunt,” says Hickey, “the NIH gave a dose of vitamin C, waited until it had been excreted, and then measured blood levels.” Then, 24 half-lives later, NIH researchers concluded this was the saturation level.
It’s also obvious there weren’t enough subjects tested to develop adequate conclusions. The NIH only studied 7 and 15 subject in the two studies they used to develop the RDA. Also, there was the false assumption that concentrations of vitamin C in blood plasma reflect the need for vitamin C in other tissues throughout the body. The brain has ten times greater vitamin C concentration than the blood plasma. A 1991 study found that 2000 mg of daily vitamin C increased vitamin C levels by 22-32 percent in the human eye over levels achieved by taking 148 milligrams.
RDA itself is misleading
Furthermore, the RDA itself is misleading because it is intended to set a level of nutrient consumption that would prevent disease (scurvy) among the vast majority (95%+) of the population. The RDA for vitamin C is established for healthy people. Yet smokers (50 million), estrogen or birth control pill users (13 million and 18 million), diabetics (16 million), pregnant females (4 million) and people taking aspirin (inestimable millions) or other drugs, have increased need for vitamin C and comprise more than 35 percent of the population. The current RDA wouldn’t meet the needs of these large subpopulations. Every time the RDA is printed on dietary supplements and food labels it should be accompanied by an asterisk that *This RDA intake level was established for healthy people only and it is likely more vitamin C may be needed by smokers, diabetics, senior adults, pregnant females, and individuals taking certain medications (steroids, estrogen, birth control pills, aspirin).
How did NIH researchers box themselves into a corner?
How did the NIH researchers so emphatically claim that mega-dose vitamin C was worthless and then later box themselves into a corner with their own data? What NIH researchers set out to do was further investigate the difference between oral and intravenous absorption of vitamin C. Their report, which was published in the March 2004 issue of the Annals of Internal Medicine, contradicted their earlier published studies.
Dr. Linus Pauling vindicated
First, the study revealed that concentrations of vitamin C in blood plasma are six times greater when given intravenously over oral doses (885 vs 134 micromolar concentration). This caused the investigators to suggest intravenous vitamin C may achieve concentrations that “might have antitumor activity” and that the “role of vitamin C in cancer treatment should be evaluated.” [Annals Internal Medicine, April 6, Volume 140: pages 533-37, 2004] Heavens to Betsy! This revelation validated the work of Dr. Linus Pauling who used intravenous vitamin C to more than double the survival rates among terminal cancer patients in 1976. [Proc Natl Acad Sci 73:3685-9, 1976] Later Dr. Pauling’s published studies using intravenous vitamin C were discredited by Mayo Clinic researchers. The news media missed this important story. It should have made worldwide headlines, particularly because oncologists have not been able to significantly improve survival times for cancer for the past few decades.
The second half of the study
Second, the comparative oral-dosing data in the Annals of Internal Medicine study revealed a more important shocker. When 3000 milligrams was given orally every 4 hours, concentrations were nearly three times greater (220 micromole) than what was believed to be the maximum that could be achieved through oral consumption (70-85 micromole). What happened to the claim that that body tightly controls blood plasma vitamin C concentrations with excesses dumped into urine? In the researchers own words, “single one gram supplement doses can produce transient plasma concentrations that are 2 to 3-fold higher than those from vitamin C-rich foods (200-300 milligrams daily)!” Hold your horses. The NIH researchers should have retracted previously published papers, asking medical journal editors to publish erratum, and they should have called for a re-evaluation of the RDA for vitamin C. This didn’t happen, says Hickey.
In March of 2004 another scientific paper was being published, again co-authored by NIH researchers, which remarkably showed that 2000 milligrams of oral vitamin C produced 143 micromole concentrations in blood plasma. The researchers remarked that numbers rose even among subjects with already had relatively high blood concentrations (87 micromole). Plasma concentrations rose progressively with increasing vitamin C doses up to 1000 milligrams per day! [Archives of Biochemistry and Biophysics, 423, 109-115, 2004] The researchers concluded that “optimizing vitamin C intake appears warranted” given the relationship of low vitamin C status with stroke, coronary heart disease, cancer and brain disease.
NIH researchers said blood plasma concentrations cannot reach beyond 70-85 micromole from oral vitamin C because amounts over 200 milligrams per day are excreted in the urine. But the above chart, reproduced from an NIH study reveals that oral vitamin C attained 220 micromole concentrations in blood plasma, three times greater than what the National Institutes of Health said could not be achieved.
The impact of a bogus RDA
These revelations are likely to have a far-reaching impact beyond the RDA. The U.S. is deliberating approval of a worldwide trade agreement known as CODEX which would restrict essential nutrients in dietary supplements to certain minimums and maximums (the so-called safe upper limit), which are based upon an obviously flawed RDA. The CODEX vote must now be halted until this matter over the validity of the RDA for vitamin C is clarified.
A reversal the vitamin supplement nay-sayers may never live down
Such a reversal of events is likely to awaken the polarized camps that advocate or oppose high-dose vitamin C supplementation. For example, Quackwatch advises consumers that among things to watch for in detecting health quackery are claims that the RDAs are too low. Up till now, every health practitioner who espoused mega-dose vitamin C therapy has been labeled as a quack. Now the vitamin C advocates are likely to go on the offensive. [Twenty-Five Ways to Spot Quacks and Vitamin Pushers, Stephen Barrett, M.D., Victor Herbert, M.D., J.D.]
Here is a quotation from a university-based website which describes a prevalent attitude by scientists about vitamin supplements:
“Vitamin hucksters spend millions promoting fear that you are not getting enough vitamins and minerals. They recommend vitamin, mineral and nutritional supplements as ‘vitamin insurance.’ The American Dietetic Association, the National Academy of Sciences, the National Research Council and other major medical societies all agree that you should get the vitamins and minerals you need through a well-balanced diet.”
There is going be an adjustment period required for sure. How will the vitamin C nay sayers live this down?
The greater tragedy
In retrospect, now that it is apparent the RDA for vitamin C is flawed, the greater tragedy lies in the effect vitamin C supplementation could have upon mortality rates. An epidemiological study published by the NIH in the year 2000 showed that adults whose blood plasma concentrations exceeded the 73.8 micromole level experienced a 57 percent reduced risk of dying from any cause and a 62 percent reduced relative risk of dying of cancer when compared to adults who consumed low amounts of vitamin C (28 micromole). [Am J Clinical Nutrition 72: 139-45, 2000]
Another study found that for every 500 microgram increase in blood serum concentration of vitamin C an 11 percent reduction in coronary heart disease and stroke prevalence could be anticipated. [Epideminology 9: 316-21, 1998] Now that we know that much higher blood concentrations of ascorbic acid can be achieved through oral consumption than previously recognized, Dr. Hickey estimates 500 milligrams of vitamin C taken orally in 5 divided doses every three waking hours daily (2500 mg total per day) could reduce the cardiovascular mortality risk by 55 percent compared to people consuming low doses of vitamin C!
Millions of Americans have been misled by health authorities and have received errant advice in the development of their personal health regimens. Consumers read labels on vitamin bottles which said it supplied “100 percent of the RDA” and believe that is all they needed to stay healthy. This no longer holds for vitamin C. Consumers are likely to be angry once these revelations are aired in public.
Calculating the aftermath of the error
Aside from the decreased risk for cardiovascular disease and cancer, what else would have happened had the RDA for vitamin C be set much higher, an RDA for optimal health, like the 2500 mg per day in divided doses as suggested by Drs. Hickey and Roberts?
Had the public responded to this knowledge in a widespread manner and begun to consume vitamin C pill en masse, one could expect all manner of human disease to decline. For example, the incidence of cataracts would likely drop significantly, or at least they would be delayed by quite a few years. [J Clinical Epidemiology 52: 1207-11, 1999; Am J Clin Nutrition 66: 911-16, 1997] Arthritic symptoms would diminish in the population at large due to the maintenance of collagen. [Arthritis Rheumatism 39: 648-56, 1996] Rates of skin cancer might drop. The number of days in a year that people would be hampered with cold symptoms might be reduced, which would likely improve productivity in society overall. [Advances Therapy 19: 151-59, 2002] Viral eruptions such as herpes and SARS would be better controlled or even averted. [J Antimicrobial Chemotherapy 52: 1049-50, 2003] Smokers might live longer and not exhibit much of the pathology they develop. [J Am College Nutrition 22: 372-78, 2003] Rates of gall bladder disease would drop by about 25 percent. [J Clinical Epidemiology 51: 257-65, 1998] The incidence of aortic aneurysms (bulging and possible rupture) would be virtually eliminated. [Med Sci Monitor 10: 1-4, 2004]
A study published in the March 2004 issue of the American Journal of Epidemiology indicates males taking high-dose vitamin C exhibit 2.68 times less calcification in their arteries compared to males who consume low doses of vitamin C. The risk for angina among adults who consume significant amounts of alcohol would be cut in half. [Ann Epidemiology. 9: 358-65, 1999] One study concluded that 3000 mg of oral vitamin C daily even increases the frequency of sexual intercourse. [Biological Psychiatry. 2002 52:371-4, 2002]
All of these potential health benefits can only be achieved with consumption of vitamin C at levels exceeding what the best diet provides. For taking just ¼ teaspoon of vitamin C five times a day, at an estimated cost of 25 cents per day, Americans can achieve a level of health never achieved by large populations groups.
Inexplicably, Linus Pauling scientists agree with current RDA
Surprisingly, researchers at the Linus Pauling Institute haven’t fully bought into the idea yet that high-dose vitamin C may produce exceptional health benefits. Instead, they followed along with the errant NIH recommendations. Anita Carr, a research associate with the Linus Pauling Institute, says this about the current RDA for vitamin C: "Based upon a preliminary review of many studies done over the past 15 years, a number that seems to stand out right now is about 100 milligrams per day." [Linus Pauling Institute, Oregon State University, June 2, 1998] Dr. Linus Pauling supplemented his diet with about 6000 milligrams of vitamin C daily.
Safety not an issue
Safety is not an issue when it comes to mega-dose vitamin C supplements. Eight placebo-controlled, double-blind studies and six non-placebo controlled clinical trials in whih up to 10,000 milligrams of vitamin C was consumed daily for up to three years, confirm the safety of vitamin C pills in excess of the RDA. [J Am College Nutrition 14: 124-36, 1995] Frequent allegations are made that vitamin C supplements may increase the risk of kidney stones, but are poorly founded. Additionally, the false notion that withdrawal from high-dose vitamin C may cause “rebound scurvy” has also been dispelled. While vitamin C increases the absorption of iron, it has not been shown to induce iron overload in humans. [Nutrition Reviews 57: 71-77, 1999]
Vitamin C supplement users
The question is, do Americans consume enough vitamin C for optimal health? Vitamin C is the most common dietary supplement consumed by American consumers. About 45 percent of dietary supplements used by consumers contain vitamin C. [Archives Family Medicine 9: 258-62, 2000] A 1990 report indicates the average intake of vitamin C from supplements is about 60 milligrams, however, about 5 to 10 percent of supplement users (about 2 percent of the US population) consume more than 1000 mg from pills. [Am J Epidemiology 132: 1091-101, 1990]
The blood plasma vitamin C concentration among vitamin C supplement users is about 60 to 70 percent higher than adults who do not take supplements (75-80 vs. 45-50 micromole). [J Am College Nutrition 13: 22-32, 1994] A daily intake of 1000 mg is needed to maintain plasma vitamin C concentration in the range of 75-80 micromole. Only 4.2 percent of the US population 3 to 74 years of age is likely to have plasma vitamin C levels above the 80 micromole point. [National Health Survey, Series 11, No. 232, DHHS Publication No 83-1682, 1982]
One widely acclaimed study published in 1992 indicated that vitamin C, in oral doses exceeding 750 milligrams per day, increased the lifespan of males by about 6 years. [Epidemiology 3: 194-202, 1992]
For optimal health, what is overlooked is the half life of vitamin C and the importance of divided doses that Drs. Hickey and Roberts now emphasize in order to achieve steady blood levels. Health minded consumers owe a debt of gratitude to Dr. Hickey and Roberts for breaking ranks among scientists who appear to be frozen in their tracks. Despite recently published data that stands in stark contrast to the RDA and the claim that mega-dose vitamin C supplementation is of no benefit, public health authorities are not forthcoming about their past mistakes. The RDA for vitamin C must be re-evaluated. Mega-dose vitamin C supplementation should no longer be demeaned. Hickey and Roberts have confronted the National Institutes of Health and the Food and Nutrition Board of the Institutes of Medicine directly, with little success. Now they are taking the issue to the public in their newly released book. Only the public’s demand for reform is likely to overcome inaction by health authorities. Everyone needs to read Hickey and Roberts’ book. ####
By Bill Sardi
Copyright 2004 Bill Sardi, Knowledge of Health, Inc.
*Ascorbate: The Science of Vitamin C, Steve Hickey, Hilary Roberts, e-book and softcover, 264 pages, referenced, 2004, available at www.lulu.com/ascorbate