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In this issue:
- How does Vitamin C actually work?
- The Biochemistry of Vitamin C and Immune Cells
- How to Avoid Loose Stools with Oral Dosing of Vitamin C
- IV Vitamin C’s Utility in Infectious Disease
- Is High Dose Intravenous Vitamin C Safe For Use In Conjunction With Chemotherapy?
Key Links:
IV Vitamin C In Infectious Disease
Papers on IV Vitamin C Use in Covid-19 for Improved Outcomes (See References)
Intravenous Vitamin C In-Patient Guide for Hospital, Pharmacy, and Nursing Staff
IV Vitamin C in Cancer Care
Summary of Original NIH Research on IV Vitamin C in Cancer Care
Collated Papers on Safety of IV Vitamin C & Chemotherapy
Improved QOL in Cancer Patients with IV Vitamin C, Research Papers
1. Vollbracht C, et. al. Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo. 2011 Nov-Dec;25(6):983-90.
2. A Yeom CH Jung GC, Song KJ. Changes of terminal cancer patients’ health-related quality of life after high dose vitamin C administration. J Korean Med Sci. 2007 Feb;22(1):7-11.
3. Guidelines for the Utilization of IV Vitamin C in the Supportive Care of Patients with Advanced Malignancies: SIO Poster Presentation, 2012 Authors: Eiko Klimant MD, Heather Wright ND, Hadassah Hilewitz ND
Continuing Education Webinars
IVC Continuing Education Webinar for Healthcare Workers
Video Podcast Versions of This Article
Other Resources
Paper on Vitamin C Content in Foods
Vitamin C Summary – Harvard School of Public Health
Preemptive Lab Work for IV Vitamin C Safety
Laboratory results should be run before administering high doses of vitamin C intravenously. These include:
– CMP or metabolic panel (To assess kidney function and electrolytes)
– CBC or blood count (To assess for signs of hemoglobinopathy, thalassemias etc.), and
– G6PD (Critical to assess the protective antioxidant production in the red blood cells which protects against the peroxide surge that occurs with high dose vitamin C. *Note: This test is often not needed with low-dose intravenous vitamin C.)
Medical disclaimer: This article is meant for informational purposes only and should not be interpreted as medical advice. Always consult a physician before starting a treatment regimen. Only commence IV vitamin C therapy after addressing appropriate precautions.
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Humans cannot create our own Vitamin C.
Such a vital molecule for our immune response, and we must get it from:
– foods we consume
– supplements
– intravenous administration
Not only that, but Vitamin C is a water soluble vitamin and we can’t store much in our cells. This means we’ll either use up or urinate our current stores, and have to restore levels over time.
The body relies on the antioxidant activity of Vitamin C, so levels continue to drop when we are:
– sick
– exposed to infections
– exposed to environmental toxins & chemicals
– flying on planes
– stressed
When Vitamin C levels drop, our immune cells slow down.
How Vitamin C Helps Our Immune System
Vitamin C is like both the gas and the firefighter controlling a brush fire. The controlled fire (infection & inflammation) itself isn’t bad, but if it gets out of control it is.
When you get sick, the immune system triggers a body wide inflammatory response. We actually want that. It’s key to fending off infection. (This is part of the cold & flu symptoms we experience.)
But, we must curb the response so lingering inflammation doesn’t cause damage. (i.e. chronic inflammation and autoimmunity)
This shows the 2 Key Functions of Vitamin C:
– act as “gas” for immune cells to respond rapidly
– act as a “firefighter” to then calm that immune response when the job is complete
You need enough gas to get the brush fire started.
Then you need enough firefighters to control the brush fire.
This is the dynamic balance between disease and our immune system. If the immune cells aren’t as spunky as they ought to be, the disease has a better chance of doing damage.
This is where Vitamin C comes in. It’s a modulator.
It encourages the initial upswing in protective inflammatory activity. It then helps the body bring inflammation levels back down to normal.
You get enough immune response, but not too much.
Biochemistry of Vitamin C and the Immune Response
The Vital Function of Oxidation-Reduction
The baseline strata of redox in your body involves vitamin C, glutathione and Vitamin E.
Vitamin E takes care of your fat soluble areas, like cholesterol and your cell membranes. Glutathione and Vitamin C take care of the water-soluble areas.
Free radicals have extra electrons floating around in our bodies that can do damage.
‘Free radical’ definition: an uncharged molecule (typically highly reactive and short-lived) having an unpaired valence electron.
Free radicals are problematic because they damage cell structures and lead to disease.
That’s where vitamin C comes in, an antioxidant:
If a radical or oxidant bumps into vitamin C, vitamin C takes away the radical (the free electron). You could say vitamin C digests the rogue electron to protect the rest of your body.
When it absorbs an electron, vitamin C changes shape from ascorbic acid to dehydro-ascorbic acid. It is now ‘oxidized’ and the free radical neutralized.
Glutathione can then reduce vitamin C by taking the electron burden. This allows vitamin C to neutralize other radicals. They work together.
What Does Oxidation-reduction have to do with the Immune System?
When we get sick, we have a big upswing of inflammatory cytokines, or immune messengers. This is what we want, it’s our immune system kicking in.
Vitamin C ensures the proper amount of cytokine activity and prevents too much. This keeps the inflammatory effect from spreading to and damaging normal cells.
We don’t want to quell the immune response when possible – that’s immune suppression. We want to support and manage it; that’s what antioxidants like vitamin C, glutathione, and vitamin E do.
We’ll return later to how vitamin C biochemistry aids the immune system.
How to Dose Vitamin C (hint: it changes when we’re sick)
Your diet should always be the baseline for consuming nutrients.
Find a preliminary list of foods high in vitamin C here: https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
At the same time, supplementation is very critical in modern times due to the stressors on our bodies.
Remember vitamin C is water-soluble. That means what goes in, goes out with the water.
This means vitamin C storage is more precarious than glutathione and vitamin E.
Glutathione can be produced in our bodies from amino acids, and Vitamin E gets stored in fat cells for longer.
Only a small amount of vitamin C gets stored in our cells. Hence, we need to maintain regular intake of vitamin C to sustain systemic levels.
How to Avoid Diarrhea or Loose Stools When Dosing Vitamin C
Many people have had the experience where they took vitamin C by mouth and they got diarrhea. That’s because it’s an osmotic agent. It gets into your digestive tract and pulls fluid towards it.
This helps absorption, but causes loose stools or diarrhea.
So, when you’re taking vitamin C by mouth
- It’s best to divide the dose up throughout the day
- Find the dose that your digestive system is comfortable with (aka ‘bowel tolerance’)
But, here’s an interesting caveat.
When you’re going about daily life (moderate stress and minimal illness exposure):
You might handle 1,000 to 2,000 mg (aka 1-2 grams) in divided doses throughout the day.
What you will find, when you get sick, start to get sick, or get exposed to people who are sick:
You may be able to double, triple, or even quadruple the dose of oral vitamin C without any digestive issues.
That’s because the body realizes it’s going to need more vitamin C, and it will take more into the blood.
You should decrease the dose when you’re starting to feel better. Your body won’t need as much and it will absorb less.
Your body will tell you how much you need.
Functions of Vitamin C, Continued
There are various functions of vitamin C that expand beyond immune modulator:
- Local Cell Regulation
- Intracellular Oxidation-Reduction
- Protection of Mitochondria
- Enzyme & Adrenal Pathways
- Peroxide Modulation (See section on cancer treatment below)
One example is its critical role in local cell regulation. In this case, it works with enzymes to trigger oxidation-reduction inside cells. This is imperative to protect internal structures like the mitochondria.
This is important to protect cells from damage when we are sick or exposed to damaging stimuli.
Remember vitamin C is a primary stabilizing antioxidant molecule.
It also functions in some enzymatic pathways and in adrenal chemistry.
IV Vitamin C Primer
Intravenous vitamin C means we’re putting it straight into your vein.
Intravenous vitamin C circumvents the digestive tract so it can go into the body at higher doses without causing bowel issues.
Intravenous vitamin C (aka IV vitamin C) has a low dose and a high dose strategy we’ll get into later. It has a variety of uses, one of its most compelling being cancer treatment.
Primary consideration before engaging with IV vitamin C:
Only receive under the care of a licensed physician and after appropriate precautionary measures. (See lab testing warning at the beginning of the article)
IV Vitamin C Dosing
Dosing with Infectious Disease Process
What we prefer with acute infection is a higher dose on the front end of the infection and then back it down.
We want more oxidant activity when the immune system is working hardest. A dose at this stage might be 50-75 grams or more.
When you’re in the hospital, you’re staying put for a longer period of time. Dosing strategy, therefore, looks different than an out-patient local clinic.
Rather than give you a big bolus of vitamin C via IV, they can spread out the dose. This might be a continuous drip or administration of smaller doses over time. This is great at keeping your systemic vitamin C levels steady for an extended period.
In contrast, when you’re out-patient at a local clinic you can’t do a constant IV drip. Since you can’t stay in your doctor’s office for 2 or 3 days like in the hospital, they might give you a larger dose.
This would look like 25, 50, or 75+ grams. Your body then takes that initial dose and distributes it throughout the body. This elevates systemic vitamin C levels for hours to days.
Common Question: Can high-dose Vitamin C be an oxidant and cause damage?
Vitamin C is antioxidant, but can’t it also be prooxidant?
This is a common question with infections and during cancer treatment.
Vitamin C can be a prooxidant and trigger ‘peroxide surges’ in abnormal tissues. These tissues include virally infected cells, some bacteria, and other infections.
However, normal cells are generally protected from the peroxide surge due to the catalase enzyme. See full details in the cancer section below.
Vitamin C’s Utility in Respiratory Infections
Is vitamin C useful in infections? It has application against abnormal cells and with our immune system – so what’s the research? We’ll dive into that here.
There are a few research papers looking into vitamin C use with the most top of mind infection – Covid19.
Papers on IV Vitamin C used in Covid-19 for Improved Outcomes (See References)
The bottom line is, the RCTs point to:
– shorter hospital time
– higher survivability, and
– decreased severity of Interleukin-6 cytokine storms
There are currently more RCTs underway, but what I can say beyond the research findings above:
In my anecdotal experience administration of IV vitamin C early on improved outcomes. This has been corroborated by other colleagues in the hospital systems.
Positive outcomes include decreased symptom severity, ventilator use, and reduced hospital stay
This isn’t a magic cure. It is a good tool to consider for infectious diseases. In my experience, if you’re doing it correctly (early enough in the disease process), it can help. That also correlates with what I’ve heard from other hospital based staff.
Remember, in the hospital they can dose vitamin C in a continuous IV drip vs bolus out-patient dosing. This is great because it provides a steady systemic level of vitamin C.
Furthermore, one can receive it right alongside the other standard of care medications.
Keep in mind there is an FDA approved IV vitamin C drug for use in hospitals called Ascor. We just don’t use IV vitamin C in hospitals that often in the United States.
When dosing vitamin C with severe cases, earlier is better, generally speaking. That looks like a high dose of vitamin C administered early in the disease process, i.e. during the first few days when patients are febrile before they need to go to the hospital.
Once in the hospital, IV vitamin C can be difficult to arrange, because you need someone in the hospital system motivated to facilitate the non standard of care therapy.
We ran into this often at the beginning of the pandemic where hospital staff were skeptical, or willing but didn’t know the pharmacy or dosing, etc.
So, I worked with hospital staff and a medical editor to write a very short publication:
In-Patient IV Vitamin C Guide for Use in Hospitals
Which has instructions for IV vitamin C use in hospitals for things like Covid-19. It has instructions not only for medical staff, but the nursing and pharmacy staff as well. It includes what to do and how to do it.
You can find that here:
Will Vitamin C make it so I don’t get an infection?
It’s hard to prove prevention – you need a lot of people, money and a long research trial. What I tell people is this, it’s not a guarantee that something like vitamin C will keep you from getting sick.
If you had a low-level attack of something and your immune system was right there, it would fend it off. Our immune systems do this every day. So no it’s not a guaranteed preventive, but vitamin C would likely be helpful in this respect.
IV Vitamin C in Cancer Care
Another topic fraught with controversy is vitamin C in cancer care. This can be a real hot-button issue.
My history and background in vitamin C therapy and research stretches back for three decades. I’ve facilitated care and researched use in patients with cancer and chronic illness.
National Institute of Health’s Integrative Oncology Research on IV Vitamin C
Starting about a decade ago, I got involved in an NIH trial investigating IV therapies in integrative oncology treatment.
The research compared standard of care treatments to outcomes when patients included integrative oncology therapies, including IV therapies. Vitamin C was the primary IV utilized (although many agents were investigated). I contributed to the interventional arm of the study, managing IV therapies.
You can find that research summarized here: https://www.medscape.com/viewarticle/813217
Current trials currently underway are building on the findings of this early work.
A common first question is: can vitamin C be beneficial to me and how much do I need to support my body with cancer care?
This is different for everybody. Again, there is no guarantee any therapy, and that includes vitamin C, will provide positive clinical outcomes.
Let’s look at the research to get a grounded perspective.
There seems to be different levels of vitamin C that are helpful.
Intravenous low doses of vitamin C appear to be helpful with quality of life. There are at least 3 published papers looking into this.
Vollbracht C, et. al. Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo. 2011 Nov-Dec;25(6):983-90.
A Yeom CH Jung GC, Song KJ. Changes of terminal cancer patients’ health-related quality of life after high dose vitamin C administration. J Korean Med Sci. 2007 Feb;22(1):7-11.
Guidelines for the Utilization of IV Vitamin C in the Supportive Care of Patients with Advanced Malignancies: SIO Poster Presentation, 2012 Authors: Eiko Klimant MD, Heather Wright ND, Hadassah Hilewitz ND
Then there is the potential for oral supplementation (as a ‘low-dose’ strategy) to be supportive. It appears oral consumption can help with certain immune cell activation, i.e. help your natural killer cells to stay active and engaged in the fight with cancer.
What we showed overtime was that treatment with a collaborative integrative approach:
– traditional oncology care, paired with
– integrative treatment care
Showed increased length of life in a number of very difficult to treat cancers.
That has led to follow-up research that is currently ongoing.
The Imperative Roll of Peroxide in Immune Intolerance to Cancer Cells
With high levels of vitamin C, the most astonishing finding is it affects cancer cells and abnormal cells differently than normal cells.
The vitamin C permeates the extracellular fluid throughout your body compartments, surrounding both normal and abnormal cells.
When the vitamin C molecule encounters an abnormal cell, it will engage with a metal or mineral molecule on the outside of the cell, usually iron or copper. This flips electrons and the state of the vitamin C molecule, creating a peroxide molecule.
The peroxide will then settle outside (and to some degree inside) of the abnormal cell and cause it damage. This triggers local immune cells to flag the cell for investigation and apoptosis, or destruction.
But how does vitamin C induced peroxide not damage normal cells?
Normal cells have a sufficient amount of protective molecule called catalase enzyme. Most cancer cells do not.
When a peroxide molecule encounters a normal cell, the peroxide will be broken down by catalase into benign components, mostly water.
Not only that, the normal cells can then take up the vitamin C for positive redox use internally.
As you can see, we have two parallel benefits going on:
– Abnormal cells are getting damaged and flagged for immune cleanup
– Normal cells are spared and supported with vitamin C, including immune cell activity
This is a great benefit. Here we see how high doses of vitamin C guide the immune system to attack abnormal cells proactively and support normal cells.
This is in contrast to cytotoxic chemotherapies because they often damage abnormal and normal cells alike. These drugs are important in cancer care and can be beneficial, but they can have significant side-effects from this undifferentiated cellular damage.
Can patients get high doses of vitamin C while undergoing chemotherapy?
Many colleagues during the NIH research study at cancer care and integrative care centers had heard that vitamin C is not beneficial while giving chemo. One concern being that the vitamin C would decrease the efficacy of the chemotherapy.
Since we dealt with these questions daily, I started to collect and collate research on the topic.
It turns out, when you look into the research on vitamin C and chemotherapy used in conjunction, there is actually a positive effect.
Collated Papers on Safety of IV Vitamin C & Chemotherapy
Vitamin C turns out to be very supportive and synergistic with chemotherapy. Although this was often surprising to oncology teams we worked with, we often had no major problem coordinating with them after sharing the research.
What are the cautions and contraindications to be aware of when administering IV vitamin C?
There are a handful of cautions that must be managed before commencing treatment.
Laboratory results should be run before administering high doses of vitamin C intravenously. These include:
– CMP or metabolic panel (To assess kidney function and electrolytes)
– CBC or blood count (To assess for signs of hemoglobinopathy, thalassemias etc.), and
– G6PD (Critical to assess a key antioxidant system in the red blood cells that protects against the peroxide surge that occurs with high dose vitamin C.)
Another caution concerns kidney function. Vitamin C, particularly high doses, must be processed and excreted through the kidneys. Remember it is water-soluble.
So, if kidney function is impaired, and particularly when people are actively in chemo, you must be cautious with high dose vitamin C dosing and timing.
Overload of the kidney excretory mechanisms can be avoided with a protocol as simple as not administering both chemo and IV vitamin C on the same day. When I consult on this matter we generally have 12-24 hours between chemotherapy and a moderate dose of IV vitamin C administration. This gives the kidneys time to process both therapies individually.
Can IV Vitamin C stall or reverse tumor progression? And how many sessions will it take to see if my cancer is responding to IV vitamin C?
Beyond quality of life, whether someone’s cancer process will respond to vitamin C treatment is very individualized and never certain.
Our data show that we would have to do 15-20 high dose IV vitamin C treatments before we could retest and track positive development. Tests might include imaging or whatever diagnostic marker that measures tumor burden and progression for that cancer type.
If you’re going to do a trial for supportive cancer care, make sure to budget time and expectation for 15-20 treatments before definitively measuring benefit.
Then, if it isn’t helpful, we would recommend stopping the IV vitamin C, reducing its frequency, and trying something else.
Or if it is helpful, we would keep going forward. You can adjust the dose or schedule, but generally continue as long as it stays helpful.
There you have it. That is the vitamin C blueprint for physicians and patients. Please reference the articles at the beginning of the page for further information.
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Original content by Dr. Paul Anderson
Edited for current format by Dr. Charles Thorpe
