Mackay
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I thought the following info would be helpful to those who try to cure their own ailments. I have found through repeated experimentation that taking vitamin c to bowel tolerance will cure a wide variety of diseases, including bacterial infections. This is why I include 1000 tabs of 1000mg
vitamen Cs in my storage plan.
**************************
A Therapeutic Level of Vitamin C Supplementation as Employed by F .R. Klenner, M.D. (from "The Significance of High Daily Intake of Ascorbic Acid in Preventive Medicine," p. 51-59, Physician's Handbook on Orthomolecular Medicine, Third Edition, Roger Williams, PhD, ed.)
A Working Summation of Dr. Klenner's Formula: 350 mg Vitamin C per kg body weight per day (350 mg./kg./day)
mg. of Vitamin "C" Body Weight Number of Doses Amt. per dose
35,000 mg. 220 lbs. 17-18 2,000 mg
18,000 mg 110 lbs. 18 1,000 mg.
9,000 mg. 55 lbs. 18 500 mg.
4,500 mg. 28 lbs. 9 500 mg.
2,300 mg. 14-15 lbs. 9 250 mg.
1,200 mg. 7-8 lbs. 9 130 - 135 mg.
Vitamin C may be given as liquid, powder, tablet or chewable tablet. Infants often prefer finely powdered, naturally sweetened chewable tablets, which may be crushed between two spoons. You may make your own liquid vitamin C by daily dissolving C powder in a small (1 ounce) dropper bottle and adding a sweetener if necessary. Dr. Klenner of course recommended daily preventive doses, which might be about 1/6 of the above therapeutic amount, divided 3 times daily.
www.doctoryourself.com
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:
TABLE I - USUAL BOWEL TOLERANCE DOSES
GRAMS ASCORBIC ACID NUMBER OF DOSES
CONDITION PER 24 HOURS PER 24 HOURS
normal 4 - 15 4 - 6
mild cold 30 - 60 6 - 10
severe cold 60 - 100+ 8 - 15
influenza 100 - 150 8 - 20
ECHO, coxsackievirus 100 - 150 8 - 20
mononucleosis 150 - 200+ 12 - 25
viral pneumonia 100 - 200+ 12 - 25
hay fever, asthma 15 - 50 4 - 8
environmental and
food allergy 0.5 - 50 4 - 8
burn, injury, surgery 25 - 150+ 6 - 20
anxiety, exercise and
other mild stresses 15 - 25 4 - 6
cancer 15 - 100 4 - 15
ankylosing spondylitis 15 - 100 4 - 15
Reiter's syndrome 15 - 60 4 - 10
acute anterior uveitis 30 - 100 4 - 15
rheumatoid arthritis 15 - 100 4 - 15
bacterial infections 30 - 200+ 10 - 25
infectious hepatitis 30 - 100 6 - 15
candidiasis 15 - 200+ 6 - 25
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.
INDIVIDUAL RESPONSES
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.
MONONUCLEOSIS
Acute mononucleosis is a good example because there is such an obvious difference between the course of the disease, with and without ascorbate. Also, it is possible to obtain laboratory diagnosis to verify that it is mononucleosis being treated. Early in this study a 23-year-old, 98-pound librarian with severe mononucleosis claimed to have taken 2 heaping tablespoons every 2 hours, consuming a full pound of ascorbic acid in 2 days. She felt mostly well in 3 to 4 days, although she had to continue about 20 to 30 grams a day for about 2 months.
Many cases do not require maintenance doses for more than 2 to 3 weeks. The duration of need can be sensed by the patient. I had ski patrol patients back skiing on the slopes in a week. They were instructed to carry their boda bags full of ascorbic acid solution as they skied. The ascorbate kept the disease symptoms almost completely suppressed even if the basic infection had not completely resolved. The lymph nodes and spleen returned to normal rapidly and the profound malaise was relieved in a few days. It is emphasized that tolerance doses must be maintained until the patient senses he is completely well, or the symptoms will recur.
HEPATITIS
Acute cases of infectious hepatitis have responded dramatically. Cases included two orthopaedic surgeons who probably acquired the disease pricking their hands at surgery and being inoculated with a patient's blood. With ascorbate treatment laboratory tests including the SGOT, SGPT, and bilirubins indicated rapid reversal of the disease. In one of these cases, with the doctorpatient and his treating physicians having difficulty believing that the ascorbate was responsible for the improvement, the ascorbate was discontinued. The condition of the patient rapidly deteriorated. The patient's wife took charge and doled out the ascorbate; again the disease rapidly subsided with laboratory findings returning to normal.
Usually oral bowel tolerance doses will reverse hepatitis rapidly. Stools regularly return to normal color in 2 days. It generally takes about 6 days for the jaundice to clear, but the patient will feel almost well after 4 to 5 days. Because of the diarrhea caused by the disease, intravenous ascorbate may need to be used in very severe cases. Often large doses of ascorbic acid, taken orally despite diarrhea, will cause a paradoxical cessation of the diarrhea.
Morishige has demonstrated the effectiveness of ascorbate in preventing hepatitis from blood transfusions (24).
UNSICK
The phenomenon of symptoms returning repeatedly if the ascorbate is not continued in high doses is most convincing. It is possible to have symptoms come and go many times. In fact, there is often a feeling when titrating to bowel tolerance that symptoms are beginning to return just before taking the next dose.
Often a patient will sense that he is probably catching some viral disease and that he is in need of large doses of ascorbic acid. If he is experienced in taking ascorbic acid he may be able to suppress more than 90% of the symptoms. He feels that he should take large amounts of ascorbate, does not feel quite right, and may have peculiar mild symptoms. I call this condition UNSICK. Recognition of this state is important because it can be mistaken for more serious conditions.
BACTERIAL INFECTIONS
Ascorbic acid should be used with the appropriate antibiotic. The effect of ascorbic acid is synergistic with antibiotics and would appear to broaden the spectrum of antibiotics considerably. I found that penicillin-K orally or penicillin-G intramuscularly used in conjunction with bowel tolerance doses of ascorbic acid would usually treat infections caused by organisms ordinarily requiring ampicillin or other more modern synthetic penicillins. Cephalosporins were used in conjunction with ascorbic acid for staphylococcus infections. The combination of tetracycline and ascorbate was used for nonspecific urethritis; however, patients who had previously repeated recurrences of nonspecific urethritis found they were free of the disease with maintenance doses of ascorbate. I am not sure that the tetracycline was necessary even in the acute cases, but it was used for legal reasons. Some other cases of unknown etiology such as two cases of Reiter's disease and one case of acute anterior uveitis also responded dramatically to ascorbate.
A most important point is that patients with bacterial infections would usually respond rapidly to ascorbic acid plus a basic antibiotic determined by initial clinical impressions. If cultures subsequently proved the selection of antibiotic incorrect, usually the patient was well by that time.
In the case of a 45-year-old man who had developed osteomyelitis of the 5th metacarpal of the right hand following a cat bite, a partial amputation of the hand had been recommended and surgery scheduled. Consultants agreed. The patient delayed surgery and signed himself out of the hospital. He was given intravenous ascorbate 50 grams a day for 2 weeks. The infection resolved rapidly. While this patient had destruction of the distal end of the metacarpal, there has been no recurrence of the infection (25).
This case illustrates the frequent problem of an indolent infection with an organism non-responsive to the most sophisticated antibiotic treatment which then may respond rapidly to treatment with intravenous ascorbate.
Treating simultaneously with the appropriate antibiotic plus ascorbate has the additional advantage that if, unexpectedly, the infection is actually viral, the infection will be suppressed and the incidence of allergic reaction to the antibiotic reduced.
VITAMIN C AND ALLERGY
Patients seemed not to develop their first allergic reaction to penicillin when they had taken bowel tolerance ascorbate for several doses. Among the several thousand patients given penicillin, two cases of brief rash were seen in patients who had taken their first dose of penicillin along with their first dose of ascorbate. If one understands the reasons for bowel tolerance doses of ascorbate, it is obvious that these patients were not as yet "saturated." I saw three patients who had taken penicillin without ascorbate who had developed an urticarial rash. These cases rapidly responded to oral ascorbic acid. Only a single dose of antihistamine was usually used. I would have anticipated longer reactions in most of these cases. I saw one case of a delayed serum sickness type of penicillin reaction in a ten-year-old girl who had not taken ascorbate previously. The rash in this patient did not immediately respond to ascorbic acid. The rash took about two weeks to completely resolve; however, if the ascorbate was not taken regularly to tolerance, the rash would worsen. It was difficult to maintain high doses in this patient.
Patients who had known-previous-allergic reactions to penicillin were never given the antibiotic anticipating that vitamin C would protect them. I suspect that the deficit of body ascorbate produced by disease may have something to do with malfunction of the immune system and the development of allergies. However, whether ascorbate may give some protection from an antibiotic known previously to cause an allergic reaction in a patient, when subsequent reactions might involve anaphylaxis, is a question which must be approached very carefully. Certainly, inadequate doses of ascorbate could be disastrous.
Patients with mononucleosis, untreated with ascorbate, have a very high incidence of allergic reaction to penicillin. It is interesting that this same disease seems to cause some of the highest bowel tolerances of any disease.
As can be seen from the previous discussion of the increasing bowel tolerance phenomenon, there is undoubtedly increased utilization of ascorbate under stressful conditions. If this increased utilization creates a deficit, there may be malfunctions of various systems of the body such as the immune system which are dependent on ascorbate. Therefore, it should not be surprising that certain malfunctions of the immune system and adrenal glands associated with stress might be ameliorated by ascorbate.
Hay fever is controlled in the majority of patients. Bowel tolerance doses are usually required only at the peak of the season; otherwise, more modest doses suffice. Many patients find the effect of ascorbate more satisfactory than immunizations or antihistamines and decongestants. The dosages required are frequently proportional to exposure to the antigen.
Asthma is most often relieved by bowel tolerance doses of ascorbate. A child regularly having asthmatic attacks following exercise is usually relieved of these attacks by large doses of ascorbate. So far all of my patients having asthmatic attacks associated with the onset of viral diseases have been ameliorated by this treatment.
Large clinical studies will be necessary to prove this point, but for now prudent practice would be to take large doses ofascorbate when stressed or when ill.
This theory begins to make some sense of the observation that many patients will develop allergic disorders or other diseases following combinations of stress, disease, and malnutrition. Immunologists should be particularly interested in the control of these allergic problems and particularly the dramatic responses of cases of ankylosing spondylitis, Reiter's disease, and acute anterior uveitis. All three of these problems have a high association with the HLA-B27 antigen. The possibility that ascorbate might have some value in controlling the immune response at the gene level should be thoroughly investigated because there could be some basic implications in histocompatibility (graft acceptance), cancer control, and destruction of foreign invaders. Ascorbate would appear to help stabilize some homeostatic mechanisms.
CANDIDA ALBICANS
Yeast infections occur less frequently in patients treated with antibiotics if bowel tolerance doses of ascorbic acid are simul- taneously used. Ascorbic acid seems to reduce the systemic toxicity considerably but does not eliminate the primary infection. It has been helpful to patients with allergic problems secondary to candida.
FUNGUS INFECTIONS
Although ascorbic acid should be given in some form to all sick patients to help meet the stress of disease, it is my experience that ascorbate has little effect on the primary fungal infections. Systemic toxicity and complications can be reduced in incidence. It may be found that appropriate antifungal agents will better penetrate tissues saturated in ascorbate.
TRAUMA, SURGERY, AND BURNS
Swelling and pain from trauma, surgery, and burns are markedly reduced by bowel tolerance doses of ascorbic acid. Doses should be given a minimum of 6 times a day for trauma and surgery. Burns can require hourly doses. Serious burns, major trauma, and surgery should be treated with intravenous ascorbate. The effect of ascorbate on anesthetics should be studied. Barbiturates and many narcotics are blocked, (26) so their use as anesthetic agents will be limited when ascorbate is used during surgery. While practicing orthopaedic surgery, I had some experience with trauma cases in which I used ascorbic acid post-operatively. There was virtual elimination of confusion in elderly patients following major surgeries such as with hip fractures when ascorbate was given. This confusion is commonly ascribed to fat embolization and the subsequent inflammation provoked in the tissues by the emboli. I did several menisectomies where one knee had been done before vitamin C was used, and the other side after vitamin C was used. The pain and post-operative recovery time were lessened considerably. The amount of inflammation and edema following injury and surgery were markedly reduced. The pain medications used were relatively minimal. My limited experience in replacing skin flaps avulsed by trauma indicated a whole degree of lessened difficulties with much greater success.
Anyone who has done animal surgery other than on humans is impressed by the rapid recovery rate. Humans loaded with ascorbate would appear to recover similarly to the animals which make their own ascorbate in response to stress. In the past, vitamin C administered to patients in hospitals post-operatively has been in trivial amounts never exceeding several grams. I predict that reimplantations of major amputations, even transplant surgeries, and especially fine surgeries of the eyes, ears, or fingers will enjoy a phenomenal increase in success rate when ascorbate is utilized in doses of 100 grams or more per 24 hours.
The limited stress-coping mechanisms of humans seems to be the result of rapid ascorbate depletion. With surgery this leads to vascular thrombosis, hemorrhage, infection, edema, drug reactions, shock, adrenal collapse with limited adrenaline and steroid production, etc.
CANCER
I have avoided the treatment of cancer patients for legal reasons; however, I have given nutritional consults to a number of cancer patients and have observed an increased bowel tolerance to ascorbic acid. Were I treating cancer patients, I would not limit their ascorbic acid ingestion to a set amount but would titrate them to bowel tolerance. Ewan Cameron's advice against giving cancer patients with widespread metastasis large amounts of ascorbate too rapidly at first should be heeded. He found that sometimes extensive necrosis or hemorrhage in the cancer could kill a patient with widespread metastasis if the vitamin was started too rapidly (16). Hopefully, in the future ascorbic acid will be among the initial treatments given cancer patients. The additional nutritional needs of cancer patients are not limited to ascorbic acid, but certainly the stress involved with having the disease depletes ascorbate levels in the body. Ascorbate should be used in cancer patients to avert disorders of ascorbate deficiency in various systems of the body including the immune system.
BACK PAIN FROM DISC DISEASE
Greenwood (27) observed that 1 gram a day would reduce the incidence of necessary surgery on discs. At bowel tolerance levels, ascorbic acid reduces pain about 50% and lessens the difficulties with narcotics and muscle relaxants (2). It is not, however, the only nutritional support that patients with back pain should receive.
ARTHRITIS
Bowel tolerance is not increased by degenerative arthritis although occasionally ascorbate has some beneficial effect.
Ankylosing spondylitis and rheumatoid arthritis do increase tolerance. Clinical response varies. Norman Cousins (28) curing his own ankylosing spondylitis with ascorbate is not unexpected. With these and other collagen diseases, food and chemical allergies can sometimes be found. It may be that the blocking of allergic reactions with augmented adrenal function is one of the reasons these patients are sometimes benefitted.
SCARLET FEVER
Three cases with typical sandpaper-like rash, peeling skin, and diagnostic laboratory findings of scarlet fever have responded within an hour or overnight. I think this immediate response is due to the neutralization of the small amount of streptococcus toxin responsible for the disease. Although I have not seen a case of acute rheumatic fever, I would anticipate rapid effects.
HERPES: COLD SORES, GENITAL LESIONS, AND SHINGLES
Acute herpes infections are usually ameliorated with bowel tolerance doses of ascorbic acid. However, recurrences are common especially if the disease has already become chronic. Zinc in combination with ascorbic acid is more effective for herpes; however, caution and regular monitoring of patients on zinc should be done.
For chronic herpes, intravenous ascorbate may also be of benefit.
CRIB DEATHS (SUDDEN INFANT DEATH SYNDROME)
I would agree with Kalokerinos (22) and Klenner (8) that crib deaths are often caused by sudden ascorbate depletions. The induced scurvy in some vital regulatory center kills the child. This induced deficiency is more likely to occur when the diet is poor in vitamin C. All of the epidemiologic factors predisposing to crib deaths are associated with low vitamin C intake or high vitamin C destruction.
MAINTENANCE DOSES
Maintenance doses are established by the patient taking bowel tolerance doses 6 times a day for at least a week. He observes if there is any unexpected benefit such as clearing of sinuses, decrease in allergies, increase in energy, etc. Should any chronic problem be benefitted, then the dose is decreased to the minimum amount producing the effect. Otherwise a dose such as 4 to 10 grams a day divided in 3 to 4 doses is recommended.
In addition, the patient is told to increase the dose on stressful days. If a patient well tolerates ascorbic acid dissolved in water, then after a short period of time his taste will begin to regulate the dosages. Most patients can easily sense their ascorbate needs.
Patients who take ascorbate in large amounts over a long period of time should probably suppliment with vitamin A and a multiple mineral preparation. The "Fortified Formulation for Nutritional Insurance" of Roger Williams (29) is recommended as a base.
COMPLICATIONS
It is my experience that ascorbic acid probably prevents most kidney stones. I have had a few patients who had had kidney stones before starting bowel tolerance doses who have subsequently had no more difficulty with them. Acute and chronic urinary tract infections are often eliminated; this fact may remove one of the causes of kidney stones. Six patients have had mild pain on urination; five of these patients were over fifty and none had stones.
Three out of thousands had a light rash which cleared with subsequent doses. It was difficult to evaluate the cause of this because of concomitant infections. Several patients had discoloration of the skin under jewelry of certain metals. A few patients complaining of small sores in the mouth with the taking of small doses of ascorbate had them clear with bowel tolerance doses.
Patients with hidden peptic ulcers may have pain, but some are benefitted. Mineral ascorbates can be used for maintenance doses in these cases. Two patients who had mild epigastric discomfort with maintenance doses of ascorbic acid who after being given ascorbate by vein for several days were then able to tolerate the acid orally.
It is my experience that high maintenance doses reduce the incidence of gouty arthritis. I have not seen difficulties with giving large amounts of ascorbic acid to patients with gout. Almost all my patients have been Caucasian, so I have no comment on the report that ascorbate can cause certain blood problems in certain non-white groups (30).
There has been no clinical evidence as Herbert and Jacob (31) suspected that ascorbic acid destroys vitamin B12.
If maintenance doses of ascorbic acid in solution are used over very long periods of time I would rinse the teeth after each dose. I would not brush my teeth with calcium ascorbate.
There is a certain dependency on ascorbic acid that a patient acquires over a long period of time when he takes large maintenance doses. Apparently, certain metabolic reactions are facilitated by large amounts of ascorbate and if the substance is suddenly withdrawn, certain problems result such as a cold, return of allergy, fatigue, etc. Mostly, these problems are a return of problems the patient had before taking the ascorbic acid. Patients have by this time become so adjusted to feeling better that they refuse to go without ascorbic acid. Patients do not seem to acquire this dependency in the short time they take doses to bowel tolerance to treat an acute disease. Maintenance doses of 4 grams per day do not seem to create a noticeable dependency. The majority of patients who take over 10-15 grams of ascorbic acid per day probably have certain metabolic needs for ascorbate which exceed the universal human species need. Patients with chronic allergies often take large maintenance doses.
The major problem feared by patients benefiting from these large maintenance doses of ascorbic acid is that they may be forced into a position where their body is deprived of ascorbate during a period of great stress such as emergency hospitalization. Physicians should recognize the consequences of suddenly withdrawing ascorbate under these circumstances and be prepared to meet these increased metabolic needs for ascorbate in even an unconscious patient. These consequences of ascorbate depletion which may include shock, heart attack, phlebitis, pneumonia, allergic reactions, increased susceptibility to infection, etc., may be averted only by ascorbate. Patients unable to take large oral doses should be given intravenous ascorbate. All hospitals should have supplies of large amounts of ascorbate for intravenous use to meet this need. The millions of people taking ascorbic acid makes this an urgent priority. Patients should carry warnings of these needs in a card prominently displayed in their wallets or have a Medic Alert type bracelet engraved with this warning.
CONCLUSION
The method of titrating a patient's dosage of ascorbic acid between the relief of most symptoms and bowel tolerance has been described. Either this titration method or large intravenous doses are absolutely necessary to obtain excellent results. Studies of lesser amounts are almost useless. The oral method cannot by its very nature be investigated by double blind studies because no placebo will mimic this bowel tolerance phenomenon. The method produces such spectacular effects in all patients capable of tolerating these doses, especially in the cases of acute self-limiting viral diseases, as to be undeniable. A placebo could not possibly work so reliably, even in infants and children, and have such a profound effect on critically ill patients. Belfield (32) has had similar results in veterinary medicine curing distemper and kennel fever in dogs with intravenous ascorbate. Although dogs produce their own ascorbate, they do not produce enough to neutralize the toxicity of these diseases. This effect in animals could hardly be a placebo.
It would be possible to conduct a double blind study on intravenous ascorbate; however, doses would have to be determined by someone experienced with this method.
Part of the difficulty many have with understanding ascorbate is that claims for its benefits seem too many. Most of these clinical results merely indicate that large doses of ascorbate augment the healing abilities of the body already known to be dependent upon minimal doses of ascorbate.
I anticipate that other essential nutrients will be found being utilized at unsuspectedly rapid rates in disease states. Compli- cations caused by failures in systems dependent upon those nutrients will be found. The magnitude of supplimentations necessary to avert those complications will seem extraordinary by standards accepted today.
http://www.vitamincfoundation.org/www.orthomed.com/titrate.htm
vitamen Cs in my storage plan.
**************************
A Therapeutic Level of Vitamin C Supplementation as Employed by F .R. Klenner, M.D. (from "The Significance of High Daily Intake of Ascorbic Acid in Preventive Medicine," p. 51-59, Physician's Handbook on Orthomolecular Medicine, Third Edition, Roger Williams, PhD, ed.)
A Working Summation of Dr. Klenner's Formula: 350 mg Vitamin C per kg body weight per day (350 mg./kg./day)
mg. of Vitamin "C" Body Weight Number of Doses Amt. per dose
35,000 mg. 220 lbs. 17-18 2,000 mg
18,000 mg 110 lbs. 18 1,000 mg.
9,000 mg. 55 lbs. 18 500 mg.
4,500 mg. 28 lbs. 9 500 mg.
2,300 mg. 14-15 lbs. 9 250 mg.
1,200 mg. 7-8 lbs. 9 130 - 135 mg.
Vitamin C may be given as liquid, powder, tablet or chewable tablet. Infants often prefer finely powdered, naturally sweetened chewable tablets, which may be crushed between two spoons. You may make your own liquid vitamin C by daily dissolving C powder in a small (1 ounce) dropper bottle and adding a sweetener if necessary. Dr. Klenner of course recommended daily preventive doses, which might be about 1/6 of the above therapeutic amount, divided 3 times daily.
www.doctoryourself.com
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:
TABLE I - USUAL BOWEL TOLERANCE DOSES
GRAMS ASCORBIC ACID NUMBER OF DOSES
CONDITION PER 24 HOURS PER 24 HOURS
normal 4 - 15 4 - 6
mild cold 30 - 60 6 - 10
severe cold 60 - 100+ 8 - 15
influenza 100 - 150 8 - 20
ECHO, coxsackievirus 100 - 150 8 - 20
mononucleosis 150 - 200+ 12 - 25
viral pneumonia 100 - 200+ 12 - 25
hay fever, asthma 15 - 50 4 - 8
environmental and
food allergy 0.5 - 50 4 - 8
burn, injury, surgery 25 - 150+ 6 - 20
anxiety, exercise and
other mild stresses 15 - 25 4 - 6
cancer 15 - 100 4 - 15
ankylosing spondylitis 15 - 100 4 - 15
Reiter's syndrome 15 - 60 4 - 10
acute anterior uveitis 30 - 100 4 - 15
rheumatoid arthritis 15 - 100 4 - 15
bacterial infections 30 - 200+ 10 - 25
infectious hepatitis 30 - 100 6 - 15
candidiasis 15 - 200+ 6 - 25
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.
INDIVIDUAL RESPONSES
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.
MONONUCLEOSIS
Acute mononucleosis is a good example because there is such an obvious difference between the course of the disease, with and without ascorbate. Also, it is possible to obtain laboratory diagnosis to verify that it is mononucleosis being treated. Early in this study a 23-year-old, 98-pound librarian with severe mononucleosis claimed to have taken 2 heaping tablespoons every 2 hours, consuming a full pound of ascorbic acid in 2 days. She felt mostly well in 3 to 4 days, although she had to continue about 20 to 30 grams a day for about 2 months.
Many cases do not require maintenance doses for more than 2 to 3 weeks. The duration of need can be sensed by the patient. I had ski patrol patients back skiing on the slopes in a week. They were instructed to carry their boda bags full of ascorbic acid solution as they skied. The ascorbate kept the disease symptoms almost completely suppressed even if the basic infection had not completely resolved. The lymph nodes and spleen returned to normal rapidly and the profound malaise was relieved in a few days. It is emphasized that tolerance doses must be maintained until the patient senses he is completely well, or the symptoms will recur.
HEPATITIS
Acute cases of infectious hepatitis have responded dramatically. Cases included two orthopaedic surgeons who probably acquired the disease pricking their hands at surgery and being inoculated with a patient's blood. With ascorbate treatment laboratory tests including the SGOT, SGPT, and bilirubins indicated rapid reversal of the disease. In one of these cases, with the doctorpatient and his treating physicians having difficulty believing that the ascorbate was responsible for the improvement, the ascorbate was discontinued. The condition of the patient rapidly deteriorated. The patient's wife took charge and doled out the ascorbate; again the disease rapidly subsided with laboratory findings returning to normal.
Usually oral bowel tolerance doses will reverse hepatitis rapidly. Stools regularly return to normal color in 2 days. It generally takes about 6 days for the jaundice to clear, but the patient will feel almost well after 4 to 5 days. Because of the diarrhea caused by the disease, intravenous ascorbate may need to be used in very severe cases. Often large doses of ascorbic acid, taken orally despite diarrhea, will cause a paradoxical cessation of the diarrhea.
Morishige has demonstrated the effectiveness of ascorbate in preventing hepatitis from blood transfusions (24).
UNSICK
The phenomenon of symptoms returning repeatedly if the ascorbate is not continued in high doses is most convincing. It is possible to have symptoms come and go many times. In fact, there is often a feeling when titrating to bowel tolerance that symptoms are beginning to return just before taking the next dose.
Often a patient will sense that he is probably catching some viral disease and that he is in need of large doses of ascorbic acid. If he is experienced in taking ascorbic acid he may be able to suppress more than 90% of the symptoms. He feels that he should take large amounts of ascorbate, does not feel quite right, and may have peculiar mild symptoms. I call this condition UNSICK. Recognition of this state is important because it can be mistaken for more serious conditions.
BACTERIAL INFECTIONS
Ascorbic acid should be used with the appropriate antibiotic. The effect of ascorbic acid is synergistic with antibiotics and would appear to broaden the spectrum of antibiotics considerably. I found that penicillin-K orally or penicillin-G intramuscularly used in conjunction with bowel tolerance doses of ascorbic acid would usually treat infections caused by organisms ordinarily requiring ampicillin or other more modern synthetic penicillins. Cephalosporins were used in conjunction with ascorbic acid for staphylococcus infections. The combination of tetracycline and ascorbate was used for nonspecific urethritis; however, patients who had previously repeated recurrences of nonspecific urethritis found they were free of the disease with maintenance doses of ascorbate. I am not sure that the tetracycline was necessary even in the acute cases, but it was used for legal reasons. Some other cases of unknown etiology such as two cases of Reiter's disease and one case of acute anterior uveitis also responded dramatically to ascorbate.
A most important point is that patients with bacterial infections would usually respond rapidly to ascorbic acid plus a basic antibiotic determined by initial clinical impressions. If cultures subsequently proved the selection of antibiotic incorrect, usually the patient was well by that time.
In the case of a 45-year-old man who had developed osteomyelitis of the 5th metacarpal of the right hand following a cat bite, a partial amputation of the hand had been recommended and surgery scheduled. Consultants agreed. The patient delayed surgery and signed himself out of the hospital. He was given intravenous ascorbate 50 grams a day for 2 weeks. The infection resolved rapidly. While this patient had destruction of the distal end of the metacarpal, there has been no recurrence of the infection (25).
This case illustrates the frequent problem of an indolent infection with an organism non-responsive to the most sophisticated antibiotic treatment which then may respond rapidly to treatment with intravenous ascorbate.
Treating simultaneously with the appropriate antibiotic plus ascorbate has the additional advantage that if, unexpectedly, the infection is actually viral, the infection will be suppressed and the incidence of allergic reaction to the antibiotic reduced.
VITAMIN C AND ALLERGY
Patients seemed not to develop their first allergic reaction to penicillin when they had taken bowel tolerance ascorbate for several doses. Among the several thousand patients given penicillin, two cases of brief rash were seen in patients who had taken their first dose of penicillin along with their first dose of ascorbate. If one understands the reasons for bowel tolerance doses of ascorbate, it is obvious that these patients were not as yet "saturated." I saw three patients who had taken penicillin without ascorbate who had developed an urticarial rash. These cases rapidly responded to oral ascorbic acid. Only a single dose of antihistamine was usually used. I would have anticipated longer reactions in most of these cases. I saw one case of a delayed serum sickness type of penicillin reaction in a ten-year-old girl who had not taken ascorbate previously. The rash in this patient did not immediately respond to ascorbic acid. The rash took about two weeks to completely resolve; however, if the ascorbate was not taken regularly to tolerance, the rash would worsen. It was difficult to maintain high doses in this patient.
Patients who had known-previous-allergic reactions to penicillin were never given the antibiotic anticipating that vitamin C would protect them. I suspect that the deficit of body ascorbate produced by disease may have something to do with malfunction of the immune system and the development of allergies. However, whether ascorbate may give some protection from an antibiotic known previously to cause an allergic reaction in a patient, when subsequent reactions might involve anaphylaxis, is a question which must be approached very carefully. Certainly, inadequate doses of ascorbate could be disastrous.
Patients with mononucleosis, untreated with ascorbate, have a very high incidence of allergic reaction to penicillin. It is interesting that this same disease seems to cause some of the highest bowel tolerances of any disease.
As can be seen from the previous discussion of the increasing bowel tolerance phenomenon, there is undoubtedly increased utilization of ascorbate under stressful conditions. If this increased utilization creates a deficit, there may be malfunctions of various systems of the body such as the immune system which are dependent on ascorbate. Therefore, it should not be surprising that certain malfunctions of the immune system and adrenal glands associated with stress might be ameliorated by ascorbate.
Hay fever is controlled in the majority of patients. Bowel tolerance doses are usually required only at the peak of the season; otherwise, more modest doses suffice. Many patients find the effect of ascorbate more satisfactory than immunizations or antihistamines and decongestants. The dosages required are frequently proportional to exposure to the antigen.
Asthma is most often relieved by bowel tolerance doses of ascorbate. A child regularly having asthmatic attacks following exercise is usually relieved of these attacks by large doses of ascorbate. So far all of my patients having asthmatic attacks associated with the onset of viral diseases have been ameliorated by this treatment.
Large clinical studies will be necessary to prove this point, but for now prudent practice would be to take large doses ofascorbate when stressed or when ill.
This theory begins to make some sense of the observation that many patients will develop allergic disorders or other diseases following combinations of stress, disease, and malnutrition. Immunologists should be particularly interested in the control of these allergic problems and particularly the dramatic responses of cases of ankylosing spondylitis, Reiter's disease, and acute anterior uveitis. All three of these problems have a high association with the HLA-B27 antigen. The possibility that ascorbate might have some value in controlling the immune response at the gene level should be thoroughly investigated because there could be some basic implications in histocompatibility (graft acceptance), cancer control, and destruction of foreign invaders. Ascorbate would appear to help stabilize some homeostatic mechanisms.
CANDIDA ALBICANS
Yeast infections occur less frequently in patients treated with antibiotics if bowel tolerance doses of ascorbic acid are simul- taneously used. Ascorbic acid seems to reduce the systemic toxicity considerably but does not eliminate the primary infection. It has been helpful to patients with allergic problems secondary to candida.
FUNGUS INFECTIONS
Although ascorbic acid should be given in some form to all sick patients to help meet the stress of disease, it is my experience that ascorbate has little effect on the primary fungal infections. Systemic toxicity and complications can be reduced in incidence. It may be found that appropriate antifungal agents will better penetrate tissues saturated in ascorbate.
TRAUMA, SURGERY, AND BURNS
Swelling and pain from trauma, surgery, and burns are markedly reduced by bowel tolerance doses of ascorbic acid. Doses should be given a minimum of 6 times a day for trauma and surgery. Burns can require hourly doses. Serious burns, major trauma, and surgery should be treated with intravenous ascorbate. The effect of ascorbate on anesthetics should be studied. Barbiturates and many narcotics are blocked, (26) so their use as anesthetic agents will be limited when ascorbate is used during surgery. While practicing orthopaedic surgery, I had some experience with trauma cases in which I used ascorbic acid post-operatively. There was virtual elimination of confusion in elderly patients following major surgeries such as with hip fractures when ascorbate was given. This confusion is commonly ascribed to fat embolization and the subsequent inflammation provoked in the tissues by the emboli. I did several menisectomies where one knee had been done before vitamin C was used, and the other side after vitamin C was used. The pain and post-operative recovery time were lessened considerably. The amount of inflammation and edema following injury and surgery were markedly reduced. The pain medications used were relatively minimal. My limited experience in replacing skin flaps avulsed by trauma indicated a whole degree of lessened difficulties with much greater success.
Anyone who has done animal surgery other than on humans is impressed by the rapid recovery rate. Humans loaded with ascorbate would appear to recover similarly to the animals which make their own ascorbate in response to stress. In the past, vitamin C administered to patients in hospitals post-operatively has been in trivial amounts never exceeding several grams. I predict that reimplantations of major amputations, even transplant surgeries, and especially fine surgeries of the eyes, ears, or fingers will enjoy a phenomenal increase in success rate when ascorbate is utilized in doses of 100 grams or more per 24 hours.
The limited stress-coping mechanisms of humans seems to be the result of rapid ascorbate depletion. With surgery this leads to vascular thrombosis, hemorrhage, infection, edema, drug reactions, shock, adrenal collapse with limited adrenaline and steroid production, etc.
CANCER
I have avoided the treatment of cancer patients for legal reasons; however, I have given nutritional consults to a number of cancer patients and have observed an increased bowel tolerance to ascorbic acid. Were I treating cancer patients, I would not limit their ascorbic acid ingestion to a set amount but would titrate them to bowel tolerance. Ewan Cameron's advice against giving cancer patients with widespread metastasis large amounts of ascorbate too rapidly at first should be heeded. He found that sometimes extensive necrosis or hemorrhage in the cancer could kill a patient with widespread metastasis if the vitamin was started too rapidly (16). Hopefully, in the future ascorbic acid will be among the initial treatments given cancer patients. The additional nutritional needs of cancer patients are not limited to ascorbic acid, but certainly the stress involved with having the disease depletes ascorbate levels in the body. Ascorbate should be used in cancer patients to avert disorders of ascorbate deficiency in various systems of the body including the immune system.
BACK PAIN FROM DISC DISEASE
Greenwood (27) observed that 1 gram a day would reduce the incidence of necessary surgery on discs. At bowel tolerance levels, ascorbic acid reduces pain about 50% and lessens the difficulties with narcotics and muscle relaxants (2). It is not, however, the only nutritional support that patients with back pain should receive.
ARTHRITIS
Bowel tolerance is not increased by degenerative arthritis although occasionally ascorbate has some beneficial effect.
Ankylosing spondylitis and rheumatoid arthritis do increase tolerance. Clinical response varies. Norman Cousins (28) curing his own ankylosing spondylitis with ascorbate is not unexpected. With these and other collagen diseases, food and chemical allergies can sometimes be found. It may be that the blocking of allergic reactions with augmented adrenal function is one of the reasons these patients are sometimes benefitted.
SCARLET FEVER
Three cases with typical sandpaper-like rash, peeling skin, and diagnostic laboratory findings of scarlet fever have responded within an hour or overnight. I think this immediate response is due to the neutralization of the small amount of streptococcus toxin responsible for the disease. Although I have not seen a case of acute rheumatic fever, I would anticipate rapid effects.
HERPES: COLD SORES, GENITAL LESIONS, AND SHINGLES
Acute herpes infections are usually ameliorated with bowel tolerance doses of ascorbic acid. However, recurrences are common especially if the disease has already become chronic. Zinc in combination with ascorbic acid is more effective for herpes; however, caution and regular monitoring of patients on zinc should be done.
For chronic herpes, intravenous ascorbate may also be of benefit.
CRIB DEATHS (SUDDEN INFANT DEATH SYNDROME)
I would agree with Kalokerinos (22) and Klenner (8) that crib deaths are often caused by sudden ascorbate depletions. The induced scurvy in some vital regulatory center kills the child. This induced deficiency is more likely to occur when the diet is poor in vitamin C. All of the epidemiologic factors predisposing to crib deaths are associated with low vitamin C intake or high vitamin C destruction.
MAINTENANCE DOSES
Maintenance doses are established by the patient taking bowel tolerance doses 6 times a day for at least a week. He observes if there is any unexpected benefit such as clearing of sinuses, decrease in allergies, increase in energy, etc. Should any chronic problem be benefitted, then the dose is decreased to the minimum amount producing the effect. Otherwise a dose such as 4 to 10 grams a day divided in 3 to 4 doses is recommended.
In addition, the patient is told to increase the dose on stressful days. If a patient well tolerates ascorbic acid dissolved in water, then after a short period of time his taste will begin to regulate the dosages. Most patients can easily sense their ascorbate needs.
Patients who take ascorbate in large amounts over a long period of time should probably suppliment with vitamin A and a multiple mineral preparation. The "Fortified Formulation for Nutritional Insurance" of Roger Williams (29) is recommended as a base.
COMPLICATIONS
It is my experience that ascorbic acid probably prevents most kidney stones. I have had a few patients who had had kidney stones before starting bowel tolerance doses who have subsequently had no more difficulty with them. Acute and chronic urinary tract infections are often eliminated; this fact may remove one of the causes of kidney stones. Six patients have had mild pain on urination; five of these patients were over fifty and none had stones.
Three out of thousands had a light rash which cleared with subsequent doses. It was difficult to evaluate the cause of this because of concomitant infections. Several patients had discoloration of the skin under jewelry of certain metals. A few patients complaining of small sores in the mouth with the taking of small doses of ascorbate had them clear with bowel tolerance doses.
Patients with hidden peptic ulcers may have pain, but some are benefitted. Mineral ascorbates can be used for maintenance doses in these cases. Two patients who had mild epigastric discomfort with maintenance doses of ascorbic acid who after being given ascorbate by vein for several days were then able to tolerate the acid orally.
It is my experience that high maintenance doses reduce the incidence of gouty arthritis. I have not seen difficulties with giving large amounts of ascorbic acid to patients with gout. Almost all my patients have been Caucasian, so I have no comment on the report that ascorbate can cause certain blood problems in certain non-white groups (30).
There has been no clinical evidence as Herbert and Jacob (31) suspected that ascorbic acid destroys vitamin B12.
If maintenance doses of ascorbic acid in solution are used over very long periods of time I would rinse the teeth after each dose. I would not brush my teeth with calcium ascorbate.
There is a certain dependency on ascorbic acid that a patient acquires over a long period of time when he takes large maintenance doses. Apparently, certain metabolic reactions are facilitated by large amounts of ascorbate and if the substance is suddenly withdrawn, certain problems result such as a cold, return of allergy, fatigue, etc. Mostly, these problems are a return of problems the patient had before taking the ascorbic acid. Patients have by this time become so adjusted to feeling better that they refuse to go without ascorbic acid. Patients do not seem to acquire this dependency in the short time they take doses to bowel tolerance to treat an acute disease. Maintenance doses of 4 grams per day do not seem to create a noticeable dependency. The majority of patients who take over 10-15 grams of ascorbic acid per day probably have certain metabolic needs for ascorbate which exceed the universal human species need. Patients with chronic allergies often take large maintenance doses.
The major problem feared by patients benefiting from these large maintenance doses of ascorbic acid is that they may be forced into a position where their body is deprived of ascorbate during a period of great stress such as emergency hospitalization. Physicians should recognize the consequences of suddenly withdrawing ascorbate under these circumstances and be prepared to meet these increased metabolic needs for ascorbate in even an unconscious patient. These consequences of ascorbate depletion which may include shock, heart attack, phlebitis, pneumonia, allergic reactions, increased susceptibility to infection, etc., may be averted only by ascorbate. Patients unable to take large oral doses should be given intravenous ascorbate. All hospitals should have supplies of large amounts of ascorbate for intravenous use to meet this need. The millions of people taking ascorbic acid makes this an urgent priority. Patients should carry warnings of these needs in a card prominently displayed in their wallets or have a Medic Alert type bracelet engraved with this warning.
CONCLUSION
The method of titrating a patient's dosage of ascorbic acid between the relief of most symptoms and bowel tolerance has been described. Either this titration method or large intravenous doses are absolutely necessary to obtain excellent results. Studies of lesser amounts are almost useless. The oral method cannot by its very nature be investigated by double blind studies because no placebo will mimic this bowel tolerance phenomenon. The method produces such spectacular effects in all patients capable of tolerating these doses, especially in the cases of acute self-limiting viral diseases, as to be undeniable. A placebo could not possibly work so reliably, even in infants and children, and have such a profound effect on critically ill patients. Belfield (32) has had similar results in veterinary medicine curing distemper and kennel fever in dogs with intravenous ascorbate. Although dogs produce their own ascorbate, they do not produce enough to neutralize the toxicity of these diseases. This effect in animals could hardly be a placebo.
It would be possible to conduct a double blind study on intravenous ascorbate; however, doses would have to be determined by someone experienced with this method.
Part of the difficulty many have with understanding ascorbate is that claims for its benefits seem too many. Most of these clinical results merely indicate that large doses of ascorbate augment the healing abilities of the body already known to be dependent upon minimal doses of ascorbate.
I anticipate that other essential nutrients will be found being utilized at unsuspectedly rapid rates in disease states. Compli- cations caused by failures in systems dependent upon those nutrients will be found. The magnitude of supplimentations necessary to avert those complications will seem extraordinary by standards accepted today.
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