Mega-Dose vitamin C, a Magic Bullet?

Dr Damien Downing shares his research and findings into the use of  Vitamin C for people with cancer

Yes to Life is "the UK's integrative cancer care charity” – integrative not alternative. Integrative medicine means using the best of every approach, because particularly with cancer there are very few “Magic Bullets”. But when your back is against the prognostic wall it is so easy to search for and grasp at treatments that might be “Magic”. I guess the favourite is currently mega-dose intravenous vitamin C. We need to curb our enthusiasm a bit here, for two reasons.

The first is that it just doesn’t make sense to be non-integrative and to put all your eggs in one basket. This is certainly true of vitamin C and it’s true generally. If a treatment is only considered to improve your prospects by 20 percent, or 30 or even 60, why would you bet on that alone? It’s not like horse-racing, there isn’t a prize for first-past-the-post. What does make sense is to stack the percentages up; 30 percent benefit from treatment A, 30 from B, 20 from a third, and so on. Vitamin C, and antioxidant therapy in general, can be a useful component of this approach. But you need to know about the pitfalls too.

The second reason is that there are difficulties – practical, financial and logistical – with mega-dose IVC. The financial problem is this; at over £250 a treatment, how often and for how long can you afford them? The logistical one depends on where you live; if it’s a 100-mile trip each way to get an IV, how often can you afford the time and energy? The top practical one is probably this; if you’ve had chemotherapy your veins are a mess, and IVC won’t help that. How many treatments will your veins tolerate?

So let’s reframe this.

The use of vitamin C (ascorbic acid) in cancer is the legacy of Linus Pauling, twice Nobel Prize winner, who with Abram Hoffer invented the term “orthomolecular” for therapies using  molecules that are familiar to the body. In the 1970’s Pauling published, with Scottish surgeon Ewan Cameron, two studies reporting that cancer patients, who had been told that there was no further orthodox treatment for them, given 10 grams (2 teaspoons) of vitamin C per day, lived longer and had better quality of life [1,2]. It is important to note that in these studies the vitamin C (intravenous at first, then oral) was used alongside surgery, radiotherapy and chemotherapy. Of the two studies at the Mayo Clinic which have been claimed to refute the Pauling/Cameron hypothesis [3,4], one used vitamin C alone as the treatment, and the other gave it after chemotherapy had finished.

Most importantly though, both Mayo studies only gave vitamin C until there were signs of disease progression – which was an average of only 10 weeks. The principal author, Prof. Moertel, remarked; The claim that a life-extending treatment for a disease must be given until the day the patient dies is a bit unusual. This shows a profound misunderstanding of what they were dealing with – it’s not a drug, it’s food.

You can see why it mattered from the survival chart here, which I had to cobble up myself from the original Cameron & Pauling data, so apologies if it looks a bit wobbly. If you follow the 50% line across the middle you can see that in the control group the average survival of these “terminal” patients was about 40 days, or 6 weeks, and in the ascorbate group it was over 100 days, by which time the Mayo studies had stopped the ascorbate in most cases. One patient in 6 was still going at the end of the study just over a year later.

Now that’s not very long, but look at the second graph, which comes from the first analysis that Abram Hoffer made [5], of patients treated from 1976 to 1988. He tweaked the protocol by adding smallish doses of zinc and B vitamins to the vitamin C – and again it was integrative therapy; the patients also received chemo-, radio-therapy and/or surgery, in fact all of them did except one patient. And what a difference that simple and sensible tweak made; 1 in 3 still alive 9 years down the line, and the standard 5-year survival end-point increased by 800 percent.




The below image is how Pauling and Cameron summed up in 1979 [6];

Briefly, it is our view that supplemental ascorbate is of some value to all cancer patients, and can be of very great value, inducing tumor regression, in a fortunate few.

This, then is where I advise anybody with cancer to start – to be exact, this plus reforming the diet (see other blogs). At the 10 gram/day oral dose level the vitamin C can only be supporting the white blood cells of the immune system in doing their job – it can’t be killing cancer cells directly. But that’s OK; the treatment is scientifically plausible, it has been shown to be clinically effective (once you cut through the Mayo-derived confusion), and it’s cheap and easy to do.

And it’s safe, and doesn’t clash with other treatments. Despite frequent hyped-up claims to the contrary, my reading of the research is that it doesn’t interfere with chemotherapy at all. The conclusion of two systematic reviews on this in 2007 [7,8] was;

None of the trials reported evidence of significant decreases in efficacy from antioxidant supplementation during chemotherapy. Many of the studies indicated that antioxidant supplementation resulted in either increased survival times, increased tumor responses, or both, as well as fewer toxicities than controls.

There are two compounds that appear to work synergistically with vitamin C against cancer [9]. Because you/we probably don’t know how responsive your tumour is to vitamin C, it is sensible to take both. If you do have some data about tumour response, this might change.

Lipoic acid; a new, demonstrably more potent form of this, known as R-lipoic acid, is now available. In vitro (in the laboratory) this reduced the level of vitamin C needed to achieve an anti-cancer effect by about a factor of five [9]. Daily dose should be at least 400mg.

Vitamin K; has the same in vitro impact, and may also work on cancer in other ways. We therefore now recommend taking this as well. Daily dose over 300 mcg (micrograms).

References

1. Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A. 1976;73(10):3685-89.

2. Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: re-evaluation of prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A. 1978; 75 (9): 4538-42.

3. Creagan ET, Moertel CG et al., Failure of High-dose Vitamin C (Ascorbic Acid) Therapy to Benefit Patients with Advanced Cancer, N Engl J Med. 1979; 301: 687-90

4. Moertel CG, Fleming TR, Creagan ET, Rubin J, O'Connell MJ, Ames MM. High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomized double-blind comparison. N Engl J Med. 1985; 312(3): 137-141

5. Hoffer A. Antioxidant Nutrients and Cancer. J Orthomol Med 2000; 15 (4): 193-200

6. Cameron E, Pauling L, Ascorbate and Cancer, Proceedings of the American Philosophical Society 1979; 123: 117-23.

7. Block KI, Koch AC, Mead MN, Tothy PK, Newman RA, Gyllenhaal C. Impact of antioxidant supplementation on chemotherapeutic efficacy: A systematic review of the evidence from randomized controlled trials. Cancer Treat Rev. 2007; 33(5): 407-18

8. Block KI, Koch AC, Mead MN, Tothy PK, Newman RA, Gyllenhaal C. Impact of antioxidant supplementation on chemotherapeutic toxicity: A systematic review of the evidence from randomized controlled trials. Int J Cancer 2008; 123(6):1227-39

9. Casciari JJ, Riordan NH, Schmidt TL, Meng XL, Jackson JA, Riordan HD. Cytotoxicity of ascorbate, lipoic acid, and other antioxidants in hollow fibre in vitro tumours. Br J Cancer 2001;84(11):1544–50. 5

I am not an oncologist and have no expertise in the treatment of cancers. I do not and cannot claim to treat cancer. I see patients, some of whom have cancers, and to those I offer adjunctive nutritional therapy, in which I do have expertise. I will not advise you on the use of chemotherapy, surgery etc. At all times my recommendation is for an integrative approach.