Physicians Anecdotes and the Safety of Large Doses

[Part 2 of 4 in a series on Vitamin C and the Common Cold]

“The medical profession itself took a very narrow and very wrong view.  Lack of ascorbic acid caused scurvy, so if there was no scurvy there was no lack of ascorbic acid.  Nothing could be clearer than this.  The only trouble was that scurvy is not a first symptom of lack but a final collapse, a premortal syndrome and there is a very wide gap between scurvy and full health.”

-Albert Szent-Gyorgyi

In writing his book Vitamin C and the Common Cold, one of Linus Pauling’s primary aims was to convince the general public of the safety and effectiveness of ingesting vitamin C in large doses. Early on in his text, Pauling stated that “an intake of about 10 mg per day is enough to provide protection against scurvy for most people, but to achieve the best health a much larger intake is probably needed.” The exact amount of vitamin C needed for optimum health is not known, since each person has a different requirement, but Pauling proposed that most people need between 250 mg and 10 g daily.

The range that Pauling prescribed was much higher than was the daily allowance recommended, at the time, by the Food and Nutrition Board of the National Research Council. In 1970, at the time that Vitamin C and the Common Cold was published, the Board was advising a healthy daily allowance of vitamin C of 35 mg for infants, 40 mg for children, 55 mg for women and 60 mg for men – amounts which were somewhat higher than the minimum 10 mg necessary to prevent scurvy, as calibrated to allow for individual variability and for potential losses in food. The current Recommended Daily Allowance for vitamin C is similar to that of the 1970s for infants and children, but has increased to 90 mg for men and 75 mg for women.

In his counterargument to the RDA, Pauling stressed that vitamin C is totally harmless, noting that guinea pigs given 0.5% of their body weight of vitamin C every day for a few days showed no adverse symptoms. He also noted that human subjects were known to have consumed as much as 40 g per day for a month without negative side effects. In fact, negative side effects seemed only to occur when a large amount of vitamin C was taken on an empty stomach.  As Pauling put it

A large amount (several grams) of ascorbic acid eaten without other food may cause an upset stomach and diarrhea in some people (hence the recommendation in Chapter 10 that it usually be taken at the end of a meal) but more serious side effects have not been reported.

Indeed, vitamin C is regarded to be as non-toxic as most cooking ingredients – no deaths or serious illnesses, Pauling wrote, have been attributed to it’s ingestion. Vitamin C is present in many fruits and vegetables, such as green peppers, red peppers, parsley, and turnip greens, as well as orange juice, lemon juice, lime juice, grapefruit juice, and tomato juice. Pauling noted, however, that cooked vegetables lose about half of their vitamin content, and as such should be cooked for the minimum amount of time and with a minimum amount of water.

Physicians Anecdote: Irwin Stone

Having made his case that vitamin C is totally harmless even in large amounts, Pauling moved on to include a few anecdotes from physicians who had personally benefited from a specialized ascorbic acid regimen. The influential Dr. Irwin Stone, a biochemist from Staten Island, New York, wrote in 1966 that he had ingested 3 g to 5 g of ascorbic acid per day for ten years. During this time he observed that he had not suffered a single cold. Stone’s recommended procedure for warding off the common cold was to take 1.5 g of vitamin C at the first sign of symptoms, and another 1.5 g again every hour. Stone’s experience suggested that the cold was usually eradicated by the time the third dose had been taken.

Edmé Régnier

Another physician, Edmé Régnier of Salem, Massachusetts, reported in 1968 that he had also found large doses of ascorbic acid to be useful in the prevention of the common cold. Régnier had suffered from chronic bouts of middle ear infection from the age of seven, an affliction for which he was unable to find a remedy and which led to his interest in vitamin C. Finally, after twenty years and several trials involving bioflavonoids and ascorbic acid, he found that “the serious and disagreeable manifestations of the common cold and the accompanying inflammation of the middle ear could be averted by the use of large amounts of ascorbic acid.” Régnier studied 22 subjects, giving them either ascorbic acid alone, ascorbic acid plus bioflavonoids, only bioflavonoids, or a placebo, over the course of five years. The subjects were not told which preparation they were receiving, but eventually one subject realized that he was not receiving the ascorbic acid that could have prevented his developing a cold.

Edmé Régnier

Régnier recommended the administration of 600 mg of ascorbic acid at the first manifestations of a cold, a quantity quite a bit lower than Stone’s recommendation of 1.5 g.  Régnier likewise suggested that the initial dose should be augmented by 600 mg of ascorbic acid every three hours, or 200 mg every hour, ending with a dose of 750 mg just before bedtime. This regimen, Régnier argued, should be continued for three or four days, decreasing to 400 mg every three hours, and then to 200 mg every three hours. According to Régnier’s study, 31 out of 34 colds were averted using ascorbic acid plus bioflavonoids, and 45 out of 50 colds were averted using only ascorbic acid. Neither bioflavonoids alone nor the placebo were effective. He cautioned, however, that if the ingestion of ascorbic acid were to be suddenly discontinued, a cold may resurface again, even if a week or more has passed by.

Douglas Gildersleeve

In the July-August 1967 issue of Fact magazine, Douglas Gildersleeve, M.D., added a somewhat conspiratorial tone to the conversation in his article “Why Organized Medicine Sneezes at the Common Cold.” In it, Gildersleeve stated that ascorbic acid, an “effective treatment” for the common cold, was being ignored because it would adversely affect “pharmaceutical manufacturers, professional journals, and doctors themselves.”

Gildersleeve studied more than 400 colds in 25 subjects, mostly his own patients, giving them about 4 g of ascorbic acid per day. He reported that the ascorbic acid was effective in 95 percent of his patients, eliminating completely the most common symptom – excessive nasal discharge – while drastically reducing other symptoms of a cold. None of his patients suffered negative side effects. Gildersleeve wrote a paper in 1964 detailing his observations, and submitted it to eleven different professional journals. Every single one rejected it. According to Gildersleeve, one editor told him that medical journals depended on the support of advertisements, over twenty-five percent of which were related to drugs for symptoms of the common cold or complications of colds. This same editor allegedly told him that it would be “harmful to the journal to publish a useful treatment for the common cold.”  And so it was that Gildersleeve’s data went unpublished until the Fact article three years later.