Over the past ten-year period I have treated over 9,000 patients with large doses of vitamin C (Cathcart 1, 2, 3, 4, 5). The effects of this substance when used in adequate amounts markedly alters the course of many diseases. Stressful conditions of any kind greatly increase utilization of vitamin C. Ascorbate excreted in the urine drops markedly with stresses of any magnitude unless vitamin C is provided in large amounts. However, a more convenient and clinically useful measure of ascorbate need and presumably utilization is the BOWEL TOLERANCE. The amount of ascorbic acid which can be taken orally without causing diarrhea when a person is ill sometimes is over ten times the amount he would tolerate if well. This increased bowel tolerance phenomenon serves not only to indicate the amount which should be taken but indicates the unsuspected and astonishing magnitude of the potential use that the body has for ascorbate under stressful conditions.
If this massive draw on the small ascorbate stores of the body is not fully satisfied, the condition of ANASCORBEMIA results. The deficit of ascorbate probably starts in the tissues directly involved in the disease and then spreads to other tissues of the body. A condition of localized and then systemic acute scurvy is produced. This ACUTE INDUCED SCURVY leads to poor healing and ultimately to complications involving other systems of the body.
Much of the original work with large amounts of vitamin C was done by Fred R. Klenner, M.D. (6, 7, 8, 9) of Reidsville, North Carolina. Klenner found that viral diseases could be cured by intravenous sodium ascorbate in amounts up to 200 grams per 24 hours. Irwin Stone (10, 11, 12) pointed out the potential of vitamin C in the treatment of many diseases, the inability of humans to synthesize ascorbate, and the resultant condition hypoascorbemia. Linus Pauling (13, 14) reviewed the literature on vitamin C and has led the crusade to make known its medical uses to the public and the medical profession. Ewan Cameron in association with Pauling (15, 16, 17) has shown the usefulness of ascorbate in the treatment of cancer.
BOWEL TOLERANCE METHOD
In 1970, I discovered that the sicker a patient was, the more ascorbic acid he would tolerate by mouth before diarrhea was produced. At least 80% of adult patients will tolerate 10 to 15 grams of ascorbic acid fine crystals in 1/2 cup water divided into 4 doses per 24 hours without having diarrhea. The astonishing finding was that all patients, tolerant of ascorbic acid, can take greater amounts of the substance orally without having diarrhea when ill or under stress. This increased tolerance is somewhat proportional to the toxicity of the disease being treated. Tolerance is increased some by stress (e.g., anxiety, exercise, heat, cold, etc.)(see FIGURE I). Admittedly, increasing the frequency of doses increases tolerance perhaps to half again as much, but the tolerances of sometimes over 200 grams per 24 hours were totally unexpected. Representative doses taken by tolerant patients titrating their ascorbic acid intake between the relief of most symptoms and the production of diarrhea were as follows: GRAMS ASCORBATE PER 24 HOURS
1) Note that disease symptom curves indicate very little effect on acute symptoms until doses of 80-90% of bowel tolerance are reached. Perhaps it is only near tolerance doses that the ascorbate is pushed into the primary sites of the disease.
2) Suppression of symptoms in some instances may not be total; but usually it is very significant and often the amelioration is complete and rapid.
3) Hepatitis may require 30 to 100 grams.
TITRATING TO BOWEL TOLERANCE
The maximum relief of symptoms which can be expected with oral doses of ascorbic acid is obtained at a point just short of the amount which produces diarrhea. The amount and the timing of the doses are usually sensed by the patient. The physician should not try to regulate exactly the amount and timing of these doses because the optimally effective dose will often change from dose to dose. Patients are instructed on the general principles of determining doses and given estimates of the reasonable starting amounts and timing of these doses. I have named this process of the patient determining the optimum dose, TITRATING TO BOWEL TOLERANCE. The patient tries to TITRATE between that amount which begins to make him feel better and that amount which almost but not quite causes diarrhea.
I think it is only that excess amount of ascorbate not absorbed into the body which causes diarrhea; what does not reach the rectum, does not cause diarrhea.
It is interesting to know, when one speculates on the exact cause of this diarrhea, that while a hypertonic solution of sodium ascorbate is being administered intravenously, the amount of ascorbic acid tolerated orally actually increases.
THE 100 GRAM COLD
When a person is ill the amount of ascorbic acid he can ingest without diarrhea being produced increases somewhat proportionally to the severity or the toxicity of the disease. A cold severe enough to permit a person to take 100 grams of ascorbic acid per 24 hours during the peak of the disease, I call a 100 GRAM COLD.
Perhaps one of the most important principles in ORTHOMOLECULAR MEDICINE is BIOCHEMICAL INDIVIDUALITY (18). Every individual responds to substances differently. Vitamin C is no exception. However, at least 80% of my patients tolerated ascorbic acid well. Admittedly, there were relatively few older patients in my practice. Infants, small children, and teenagers tolerate ascorbic acid well and can take, proportionate to their body weight, larger amounts than adults. Older adults tolerate lesser amounts and have a higher percentage of nuisance difficulties. Patients with multiple food intolerances may have more difficulties but should attempt taking ascorbate because of benefits often obtained.
For several years while I was treating only sick people with ascorbic acid, I was unaware of the number of people who had nuisance problems with maintenance doses. The tolerance of the sick person to ascorbate is so high as to prevent many of the complaints one would have if he were well. When ascorbic acid is prescribed to a sick person, the beneficial effect is obvious enough so that few complain of the gas and diarrhea. With illness the effects of an overdose do not last long because of the rapid rate of utilization.
It is important for the physician to understand the principles of treating this vast majority of tolerant persons. Patients frequently underdose themselves and need professional guidance to push the doses to effective levels. The small number of persons, especially elderly persons, intolerant to oral doses are in my experience able to take intravenous ascorbate without difficulties. Additionally, patients with severe problems may need to be treated intravenously if very high doses will have to be maintained for some time for adequate suppression of symptoms.