Vitamin C and Cancer: Raising the Stakes

1976i2

Ewan Cameron, Ava Helen and Linus Pauling. Glasgow, Scotland, October 1976.

[Part 3 of 4]

By 1970, the year that Linus Pauling published Vitamin C and the Common Cold, the federal government’s “war on cancer” was soon to arrive. The National Cancer Act, passed in 1971, increased federal funding for treatment and prevention research, embracing cytotoxic treatment solutions like chemotherapy. That same year, Pauling began to push for investigations between nutrition and cancer, especially concerning vitamin C. Since the role of vitamin C in immune defense is arguably much less significant than Pauling supposed, the idea that intake of vitamin C should prevent or treat cancer seemed ludicrous to many physicians. Incredibly, evidence is now emerging that the opposite might be true.

In hindsight, there is a tendency for critics to see Pauling simply as a politically liberal proponent of alternative medicine; one who lashed out against a consumerist medical establishment that was firmly supported by conservative citizens, among others. However, proponents of alternative health and holism in the 1960s and 1970s prescribed to a broad range of political ideologies; Pauling was just one among many people who were searching for better preventative and alternative treatments.

In 1980, when Pauling was actively campaigning for a vitamin C treatment for cancer, Americans spent 13.1 billion dollars on cancer diagnosis and treatment. Five years later, a survey of over one-thousand individuals showed that a majority believed clinics using unorthodox cancer therapies should be permitted to operate in the U.S., and just over half said they would seek alternative treatment if seriously ill.

Pauling and his ideological positions are remembered now as having been central to the vitamin C “movement.” Perhaps this is because he was renowned in many arenas and easily attracted a great deal of media attention. Or perhaps, especially knowing his penchant for protesting against nuclear weapons testing and war, this was another issue on which Pauling was the most outspoken opponent of what he saw as a wrong to be made right.


1979p.1_new

Table from “Ascorbic acid and cancer: a review”, co-authored by Pauling and Cameron, 1979.

For Pauling, the continuing suffering of cancer victims was unnecessary, since a useful treatment was already cheap and readily available. He argued that,

The involvement of ascorbic acid (vitamin C) in the natural defense mechanisms is now known to be so great that we hope that a really significant control of cancer might be achieved by the proper use of ascorbic acid.

Of the studies that Pauling found so convincing, none were as crucial as those conducted at the Vale of Leven Hospital, near Glasgow, Scotland. There, Dr. Ewan Cameron found that mega doses of vitamin C (10 grams daily or more) seemed to slow and even reverse cancerous growth in some patients. He wrote to Pauling in 1971, who eagerly responded that this “attack” on cancer was the most promising application of vitamin C that he knew of.  Pauling, who had been studying the role of dietary vitamin C in issues of orthomolecular psychiatry such as schizophrenia, now shifted his focus to cancer.

Far from being the flaky alternative health guru that many came to see him as, Pauling’s work with vitamin C— like all his research on the subject of orthomolecular medicine (a field that he spearheaded)— was consistent with a biomedical model of molecular disease. Since Pauling saw this work as fitting within the framework of molecular biology, it was frequently unclear to him why the medical community resisted what was, to him, a straightforward and significant scientific endeavor.

Further complicating matters was the fact that Stanford University, Pauling’s academic home at the time, rejected his request for additional lab space to pursue cancer research. Now the target of regular media pummelings, Pauling’s ideas were becoming a potential source of bad press for the university. Refusing to take no for an answer, Pauling and his young lab assistant, Arthur Robinson, solicited private funding to continue their work on vitamin C outside of the university setting. Raising $50,000 in donations from wealthy supporters of vitamin therapies, the duo helped to found the Institute for Orthomolecular Medicine in 1973, subsequently renamed the Linus Pauling Institute of Science and Medicine (LPISM) one year later.

From 1973 to 1976, Pauling published co-authored articles with Cameron, who continued to study the effects of vitamin C on cancer from his base in Glasgow. And in 1975, Pauling and Robinson secured additional funds to begin their own animal testing. Two years later, the collaborators began reporting their results in the Institute’s newsletter.  In 1979 Cameron and Pauling likewise published an extensive review article in Cancer Research that cited previous studies corroborating their own conclusions. The duo published their book, Cancer and Vitamin C, that same year.


Sci 11.044, 44.14

A sample of Pauling’s notes compiled in response to the Mayo Clinic trials, 1979.

Cameron and Pauling’s data seemed to show that vitamin C would be especially valuable for cancer patients. Whereas a daily intake of 10 g of vitamin C in a healthy individual would bring the vitamin C level in the blood to a saturation point that could not be exceeded by increasing or prolonging intake, cancer patients showed a different pattern. Known already to have abnormally low blood levels of vitamin C, the patients in fact achieved just over half the same level of vitamin C blood saturation found in healthy individuals subscribing to a daily intake of 10 grams. For those afflicted with cancer, it was seen as necessary to take 10 grams a day just to reach the normal level of vitamin C found in healthy individuals who did not take supplements at all.

To Pauling, this alone justified continued research on the matter. After persistently stating his case to Dr. Vincent De Vita, director of the National Cancer Institute, two rounds of trials were conducted through the Mayo Clinic to solve what the medical community perceived to be problems in Cameron’s studies. When the trials indeed failed to produce anything like Cameron’s results, funding effectively dried up for vitamin C research – a significant blow to LPISM’s functional well-being.

In response, Pauling and his supporters argued that the Mayo Clinic was missing the point. The Mayo trials had attempted to measure the effectiveness of vitamin C in a manner similar to drug treatments, because the advent of chemotherapy and antibiotics, and the biases of the pharmaceutical industry, had placed primary medical emphasis on the disease, and not on the patient. Pauling saw the results of the Mayo studies not as a definitive defeat, but as the triumph of a complex of interdependent federal and private organizations that held a vested interest in supporting the chemotherapy status quo.


Pauling had claimed that, with vitamin C, lifespan could be increased, tumors could regress, and even full recovery was possible. For many in the medical community, these were not only foolish assertions, they were dangerous as well.

Dr. Charles Moertel, chairman of the Department of Oncology at the Mayo Clinic, was particularly vocal in his rebuke, stating that

For such a message to be conveyed to desperate and dying people, with the endorsement of a Nobel laureate, the presumption must be that it is based on impeccable scientific methodology.

Moertel’s implication, of course, was that Pauling’s argument was instead based on unsound science and certainly lacked the scientific basis to challenge the use of chemotherapy.

Yet vitamin C retained a broad appeal because many saw the prevailing treatment, and its manifold side effects, as inhumane. John Cairn, head of the Mill Hill Laboratory of the British Imperial Cancer Research Fund, provided a voice to the other side the coin by calling out the survivorship data. To wit: in 1986, 200,000 patients were receiving chemotherapy and, by 1991, five year survival rates for colon cancer remained at just 53%. Cairn spoke for many in suggesting that, when it came to the prevailing course of treatment, “the benefit for most categories of patients has yet to be established.”


1981i.3

Ava Helen Pauling, June 1981.

For Pauling, the debate turned from the public to the personal when, at the height of his study of vitamin C, his wife Ava Helen was diagnosed with stomach cancer. Following Ewan Cameron’s advice, she took 10 grams of vitamin C daily, and did not receive chemotherapy.  Throughout her treatment, Linus clung to the belief that mega doses of vitamin C would work for Ava Helen, just as it had for Cameron’s success stories in Scotland.

“Daddy was convinced that he was going to save her,” remembered Linus and Ava Helen’s daughter, Linda. “And that was, I think, the only reason he was able to survive… He said to me after she died that until five days before, he thought he was going to be able to save her.”

Ava Helen Pauling passed away in December of 1981. And though he was badly shaken by his wife’s death, belief in the value of vitamin C in the fight against cancer did not fade from Pauling’s mind. Suffice it to say, the medical community remained whole-heartedly unconvinced.

Advertisements

Vitamin C and the Common Cold: Pauling vs. the Physicians

LPSafe_4.053_1980

Diary entry by Linus Pauling, 1980. The text reads: “L[inus] P[auling] / Found enzymes enthralling / He was filled with glee / By Vitamin C”

[Part 2 of 4]

As a double Nobel laureate, Linus Pauling’s recommendation that everyone ingest 1 to 4 grams of vitamin C daily developed into a media frenzy. And with time, the debate took on a distinctly political flavor, with the battle over vitamin C argued on talk shows and in press releases, rather than vindicated in the lab.

Pauling’s accusations that the medical establishment was ignoring the potentially profound benefits of vitamin C in part because of a mutually beneficial relationship with Big Pharma did not, as one might expect, go over well with many medical professionals. Indeed, his work with vitamin C was written off by many as a passing craze, and Pauling was increasingly referred to as a “kook” and a medical “quack.”


Sci 11.022, 22.1

Notes by Linus Pauling regarding vitamin C and the common cold, 1974.

As Pauling and the physicians went back and forth, the two sides sometimes found themselves citing the same data and producing opposite conclusions. Often Pauling argued that the studies under consideration – discarded by dissenting physicians for apparently showing negligible effects – actually suggested a real value to the use of vitamin C that would be amplified if only larger doses were used.

One study in particular, authored in 1942 by A.J. Glazebrook and Scott Thomson, found vitamin C to only slightly decrease the occurrence of colds and their symptoms in a sample of college students. For proponents, the work was heralded nonetheless as significant evidence in vitamin C’s favor. The problem, Pauling believed, was that physicians expected vitamin C to act like a drug, with a concomitant “tendency…to use relatively small amounts and look for big effects.” But vitamin C wasn’t a drug, it was a nutrient, and Pauling thought its effects would not be easily observed in a typical physician’s research paradigm.

In an effort to put the issue to rest, a University of Maryland study in which eleven prisoners were given 3 grams of vitamin C a day for two weeks found that, when inoculated with cold viruses, each subject became ill. While many considered this proof that Pauling was wrong, he dismissed this study as well. For one, it lacked a placebo control group and did not take the severity of symptoms into account. Pauling likewise suspected that the prisoners were infected with a cold virus potent enough to have overwhelmed any protective effect from vitamin C.

On and on the debate raged and, by the time of Pauling’s death in 1994, little consensus had been reached: Pauling stood firm in his beliefs and the physicians hadn’t from their position.


dr_harri_hemila

Harri Hemilä

Today, while Pauling’s faith in and advocacy of vitamin C has endured in the public consciousness, it has not translated into concrete medical practice. Presently, the United States Food and Nutrition Board has set the Recommended Daily Allowance for Vitamin C at 120 mg at the highest (for pregnant women), nearly three times greater than the RDA in the 1970s, but still about 100 times lower than the levels that Pauling believed to be optimal.

So what does the research really show? Is there, in fact, zero evidence that Vitamin C prevents or cures colds, as the Food and Drug Administration once claimed?

Perhaps the best summation of the current state of affairs has been compiled by Dr. Harri Hemilä, a researcher in public health at the University of Helsinki. Hemilä, whose 2005 comprehensive study on the subject is cited by the National Institutes of Health, makes a number of intriguing points.

For one, Hemilä points out that, while the broad body of research seems to indicate that vitamin C supplementation does not decrease cold incidence in most individuals, it does significantly decrease incidence in marathon runners, skiers, and soldiers – all groups subject to consistent exposure to cold weather or physical stress – by as much as 50%. Daily supplements also appear to decrease the symptoms and duration of colds by a modest degree – observations of 14% in children and 8% in adults.

It is important to note that studies of this sort have used what Pauling would have considered to be minimum dosages for optimal health – 1 to 2 grams daily. To date, few investigations have looked into doses higher than 2 grams, presumably because it is known that, for oral doses of more than 1 gram, absorption rates fall below fifty percent. The operating idea then, is that for supplementation above 2 grams, most of the extra vitamin C is unused and excreted in one’s urine.

Yet there does exist some evidence of a more significant impact at higher dosage levels. Hemilä’s survey of the research concludes that, in some studies, doses larger than 2 grams do appear to provide some measure of therapy, if taken at the onset of cold symptoms.

Digging more deeply into the data, however, one finds conflicting results. In one study, taking 8 grams once at the onset of symptoms appeared to decrease symptoms and duration of colds. In another, 10 gram doses were given for three days during a cold, without impact.

Obviously, when trying to measure the impact of any therapy on the progression of an illness – particularly one as protean as the common cold – numerous co-factors can enter the equation. It would seem then that a thoughtful modern study of vitamin C – one that carefully considers the methodology of those conducted in the past – is still needed before we can be certain of its potential impact on the common cold.


pauling-pill

Had Pauling invested in proving his point in the lab after the publication of Vitamin C and Common Cold, perhaps we would have a better understanding of the immune function of this nutrient today. But Pauling felt vitamin C’s protective effects against the cold were not seriously debatable and that, for him, it was time to move on. The physicians, he believed, were set in their ways – a description he often used during the long argument over vitamin C – and it was pointless for him to spend too much of his time and energy trying to disprove them.

Indeed, in Pauling’s mind, there were more important issues to take into the lab than the common cold. Because Pauling wasn’t just busy arguing that vitamin C could cure the common cold. He believed that it might cure cancer, too.

 

Vitamin C and the Common Cold: The Roots of Controversy

Detail from "The Perils of Pauling", National Observer, November 27, 1971.

Detail from “The Perils of Pauling”, National Observer, November 27, 1971.

[Part 1 of 4]

Growing up in the United States, many children today are told to drink plenty of orange juice to get their vitamin C, in part to avoid getting a cold. And indeed, vitamin C is now widely accepted as an important nutrient. Its antioxidant properties are valuable to cellular health and can protect against heart disease as well as the genetic damage that can lead to cancer and other dysfunctions. It aids the body’s production of collagen and other connective tissues, and is important for optimal healing from injury. It is also implicated in optimal neurotransmission (brain function), and stimulates the production of white blood cells important for immune health. This basic component of healthy living has been repeated so many times on television shows like “Sesame Street,” or in the classroom, or at home around the dinner table, that American children grow up recognizing vitamin C’s  importance as an obvious fact of life.

Perhaps surprisingly then, there is still little consensus in the medical community as to the ability of Vitamin C to significantly reduce the incidence, duration, or severity of the common cold. For Linus Pauling in 1971, it seemed so clear that Vitamin C was critical to human health that he felt compelled to publish his best-selling book, Vitamin C and the Common Cold, feeling that to withhold such simple and valuable information for the public’s general well-being would be negligent. His work sparked a vitamin C craze in America: after the book’s publication, consumption of vitamin C increased so much that bulk prices nearly tripled. The public certainly believed Pauling. Professional physicians, on the other hand, were highly critical.


While the full benefits of vitamin C are better known now than was the case in Pauling’s day, even in the 1970s no one argued against the vitamin’s fundamental importance. The real argument that emerged was about how much Vitamin C was enough, and why.

Oranges and other fruits and vegetables were known to prevent scurvy from at least 1753, when British naval physician James Lind reported on its effectiveness in treating this disease of nutritional deficiency. Vitamin C was first isolated in the early 1930s by Albert Szent-Györgyi, William Waugh, and Charles Glen King, and produced in the lab shortly after by Norman Haworth and Edmund Hirst. Unlike most mammals, human beings do not naturally synthesize vitamin C within our own bodies. Along with Guinea pigs, other primates, and fruit bats, we need to acquire the entirety of our vitamin C through our diet. The Federal Recommended Daily Allowance (RDA) was duly set at 60 mg each day – enough to keep one from falling prey to scurvy – by the time that Pauling arrived on the scene.


Irwin Stone. (Image by Oscar Falconi)

Irwin Stone. (Image by Oscar Falconi)

To Irwin Stone, “giving someone enough vitamin C to prevent scurvy was like feeding them just enough to keep them from starving.” Stone, a biochemist, published on Vitamin C as a food preservative beginning in 1935. In the course of this research, he discerned that a 150 lb human would need to ingest 4 to 10 grams of Vitamin C a day in order to match what a healthy rat produces on its own.

Stone met Pauling in 1966, not long after Pauling had delivered an acceptance speech for the Carl Neuberg Medal, awarded for Pauling’s assessment of sickle cell anemia as a molecular disease. In the speech, Pauling expressed his hope that he might live to see the medical advances that the next 15 years might bring. Afterward, Stone recommended that with vitamin C, Pauling (who was sixty-five years old at the time) might see the advances of the next fifty.  His interest piqued, Pauling began taking 1 gram of Vitamin C per day, and by the late 1970s, this increased to 10 or more grams daily. Around the same time, the RDA was lowered to only 45 mg. In other words, Pauling was now taking over one hundred and sixty times the daily dose of Vitamin C recommended by the government.


The concern in the medical community was, and continues to be, the potential for “overnutrition”; i.e., negative physical effects associated with consuming too much of a particular vitamin or mineral. As Pauling’s ideas gained increasing cultural currency, physicians began to warn that vitamin C consumed in such large doses might cause the development of kidney stones. Pauling countered that this was only likely in a small segment of the population – those with pre-existing hyperoxaluria – and that it could be entirely avoided by ingesting sodium ascorbate pills rather than ascorbic acid or natural sources. Pauling pointed out that, in fact, there were no health problems associated with high dose vitamin C intake other than potential stomach irritation and loose bowels – symptoms now known to occur with a daily intake of approximately two grams. For Pauling, the decision to take large doses in spite of these drawbacks seemed obvious.

But for many clinicians it was not. Leading nutritionist Dr. Victor Herbert attacked Pauling’s claims as unsupported, as did FDA head Charles Edwards, who denounced Pauling as spurring a national frenzy over vitamin C with no scientific basis. This backlash begged the question, if the benefits of Vitamin C were really medically obvious, then why would physicians mislead the public?

Medical Tribune, June 6, 1973.

Medical Tribune, June 6, 1973.

Pauling’s answer, as delivered through the media, provoked even greater controversy. Physicians were misleading the public, he said, because the reality of a cheap, safe alternative to expensive pharmaceuticals would prove economically disastrous for the medical industry. In other words, the physicians, in partnership with drug companies, had an economic interest against vitamin C. “Every day,” Pauling explained, “even every hour, radio and television commercials extol various cold remedies… I am convinced by the evidence now available that ascorbic acid is to be preferred to the analgesics, antihistamines, and other dangerous drugs that are recommended for the treatment of the common cold by purveyors of cold medicines.”

Pauling’s assertion was based in part on the opinion of Albert Szent-Györgyi, who had first isolated Vitamin C, and who told Pauling in a personal letter that,

…right from the beginning I felt that the medical profession misled the public. If you don’t take ascorbic acid with your food you get scurvy, so the medical profession said that if you don’t get scurvy you are all right. I think this is a very grave error. Scurvy is not the first sign of the deficiency, but a premortal syndrome, and for full health you need much more, very much more. I am taking, myself, about 1 gram a day.

Pauling was also drawing on the opinion of others in the medical field, such as Dr. Douglas Gildersleeve, who stated in a 1967 Fact magazine article that,

having worked as a researcher in the field, it is my contention that an effective treatment for the common cold, a cure, is available, that is being ignored because of the monetary losses that would be inflicted on pharmaceutical manufacturers, professional journals, and doctors themselves.

Pauling, in other words, wasn’t alone in staking out this controversial ground.

Continuing Work on Vitamin C and Cancer: An Interview with Matthew Kaiser

Matthew Kaiser.

Matthew Kaiser.

The blog recently had the opportunity to sit down with Matthew Kaiser, an Oregon State University undergraduate senior in microbiology from Salem, Oregon.  Kaiser, who hopes to pursue a career as an MD/Ph.D., has led an exciting research project on the potential treatment of cancer using intravenous vitamin C.  He also recently delivered a talk titled “Is Humanity Ready for an Upgrade?” at a recent TEDx symposium hosted by OSU.

What follows below is an edited excerpt of our interview with Kaiser in which he discusses the roots of his project, its potential application, and his experience of conducting and presenting high level research at a very young age.

The Roots of the Research Project 

The beginnings of this research project were more or less like most undergraduate project tend to start. Not all, but some tend to be these big black box projects, we call them, in that there are a lot of unknowns. It’s almost like, “we really don’t know a lot about this but hey, we’ll give it to an undergraduate to take a stab at it. Because even that way if it doesn’t work out, if we find out that there really is no story here, they get the research experience and then we don’t necessarily waste a graduate student’s time or post-doc’s time on a project that didn’t end up being published.”

But where this project started was, of course, back in the days of Linus Pauling who was among the first to suggest that high doses of Vitamin C could have an anti-cancer effect. But following his initial studies with Vitamin C, or ascorbate, there were studies that came out by the Mayo Clinic and other labs that showed that Vitamin C did not have a protective or anticancer effect. And so it was largely abandoned by the medical community for several years but it continued to be researched in kind of an alternative medicine environment. Through that, as our understanding of how Vitamin C is metabolized by the body developed, we were able to understand that if Vitamin C was delivered orally, it was completely different than how Vitamin C could be regulated if it was administered through an IV, because if you administer it through an IV you’re able to bypass all the digestive control and renal reabsorption in your small intestine. That normally would limit the amount of Vitamin C that gets into your bloodstream and then becomes vitally available.

So this project started kind of on the cusp of these exciting studies looking at the pharmacokinetics and, again, looking at the bioavailability of Vitamin C. And just to put it in perspective: so if you go home and eat fifty oranges, like all my friends like to try and do because they know I work on Vitamin C, they’re like “oh, Vitamin C and cancer, I can eat fifty oranges, right? And I can prevent cancer or cure myself or colon cancer?” And what we’re looking at in this project are doses that can only be achieved by IV because if you eat these fifty oranges, the maximum you can saturate your blood plasma level is about 220 micromolar. To put it in perspective, so if you can saturate your blood to a level of about 200 micromolar following oral ascorbate, if you go home and had an IV or you went to a clinic and you had an infusion of IV ascorbate, you can saturate blood plasma up to 30 millimolar. And there’s a thousand micromolars in one millimolar. So, extremely different doses can be achieved by these two different routes.

Continue reading

An Interview with Balz Frei, Director of the Linus Pauling Institute

Balz Frei

Balz Frei

Oregon State University is turning 150 years old in 2018, and already several projects are being developed to mark the occasion.  One of them is a major oral history initiative that is capturing the stories of a wide array of alumni, faculty, staff, administrators and friends of OSU.

Several months ago, the project conducted an interview with Dr. Balz Frei, who has led OSU’s Linus Pauling Institute since 1997.  A Swiss native, Frei worked under Bruce Ames at UC-Berkeley before moving on to Harvard, the Boston University School of Medicine and, ultimately, Oregon State.

Frei’s research has always focused on the processes fundamental to human health. During his time in Berkeley, Frei became interested in vitamin C and met Linus Pauling. His later work has focused on oxidative stress and the role that it plays in atherosclerosis. He has also investigated arterial function and potential dietary compounds – including vitamin C – that might help prevent oxidation of LDL cholesterol.

Under Frei’s leadership, the Linus Pauling Institute has stabilized its funding base, hired several principal investigators and made substantial contributions to the published literature on subjects relating to nutrition and optimal human health.

In 2011 the Institute celebrated a major milestone with the completion of the Linus Pauling Science Center. This 105,000 square foot facility, built for $62.5 million, is the largest academic facility project in OSU history. Now housed in this new space, LPI continues to conduct research on cardiovascular and metabolic diseases, healthy aging, and cancer chemoprotection, and engages in public outreach through its Micronutrient Information Center and Healthy Youth Program.

Excerpts from Frei’s oral history interview, including his memories of meeting Pauling, his sense of Pauling’s vitamin C work, and his vision for the future of LPI, are included below the cut.

Continue reading

Pauling and Pritikin Duke It Out Over Vitamin C

Interview Letter

Letter to Pauling from Steve Hewitt, August 1979.

Dear Dr. Pauling. Several weeks ago, the Oregonian published an interview with Nathan Pritikin. In it, Mr. Pritikin referred to two studies purporting to show adverse effects from taking vitamin C…. 

In this letter from August 1979, a concerned follower of the nutrition advice given in Linus Pauling’s then recently published book, Vitamin C, the Common Cold, and the Flu­­, confesses that, while he is following the book’s advice and is megadosing on more than a gram of vitamin C supplements every day, he is concerned about adverse effects that might arise from the practice. What, he asks, does Dr. Pauling know of a collection of studies referenced by a Dr. Pritikin and reported on in the Oregonian? Has Dr. Pauling changed his mind about vitamin C?

Pauling replies to the man with his usual clarity:

…You ask about several statements made by Mr. Pritikin. I may say that these statements are just wrong. The reason probably is that Mr. Pritikin is ignorant about vitamins.


Nathan Pritikin

Nathan Pritikin

Nathan Pritikin was a dietician who, in the 1970s, found himself in competition with Linus Pauling for the health of America.  An inventor involved in various scientific fields including chemistry, Pritikin was 40 years old when, in 1955, he was diagnosed with cardiac disease. Though a slender and fit-looking man, Pritikin’s cholesterol and blood pressure were through the roof. His doctors prescribed a series of medications and told him to rest up so as not to strain his heart.

Rather than following this advice, Pritikin began to read. Studying cultures both past and present from around the world, he concluded that heart disease (along with a variety of other degenerative diseases prevalent in the U.S.) could be fought, so long as one was armed with a proper diet and exercise program. Pritikin’s concept of a proper diet was one still followed by many today: low fat, low cholesterol, low sugar, plenty of complex carbohydrates and all the leafy greens and fresh fruit you could eat. The exercise regimen is also familiar: a moderate plan of preferably at least 30 minutes of aerobic activity per day.

For Pritikin, the diet and exercise worked. Within months his cholesterol was lower and he felt better; within a few years, his cardiac disease was a thing of the past. Equipped with the drive and instincts of a veteran inventor, Pritikin next did what came naturally – he invented a new diet and exercise plan for America and he took it to market. Starting with his “Pritikin Longevity Centers,” meant for those who suffered from degenerative diseases, and later moving to the written word, Pritikin became one of the health gurus of the 1970s and 80s, establishing himself alongside such names as Robert Atkins and Herman Tarnower, creators of the Atkins Diet and the Scarsdale Diet, respectively.

This was a space also occupied, of course, by Dr. Linus Pauling.


Pauling note to self, June 22, 1978.

Pauling note to self, June 22, 1978.

Pauling had noticed Pritikin well before he received the letter detailing the Oregonian interview. In a letter from 1977 to Dr. Miles Robinson, a mutual friend of both Pauling and Pritikin, Pauling noted his awareness of Pritikin, his only criticism of the man and his health advice being that Pritikin “neglects his vitamins.” This is about as kind as Pauling would ever treat Pritikin in his correspondence.

The following year, it became apparent to Pauling that Pritikin was not only neglecting supplemental vitamins, but had begun to speak out against them, in particular vitamin C. During a lecture given in early 1978, Pritikin implied that high doses of vitamin C could inhibit certain actions of the body’s immune system, potentially making a person more ill. After composing a memo to himself on the subject, Pauling wrote to Pritikin, telling him that several people had been made upset by his attack on supplementary vitamin C and had written to Pauling about the lecture. Pauling had just completed a paper claiming the exact opposite, complete with 386 references, and he pointed out in no uncertain terms that Pritikin was obviously incorrect in his statements.

In his reply to Pauling’s letter, Pritikin did not bow to the pressure. Rather, he went on the offensive, accusing Pauling of promoting a diet high in fat and cholesterol, ignoring any connections that these habits might have to the development of atherosclerosis. “The public,” he said in his letter, “is led to believe that this type of diet is perfectly acceptable as long as high doses of vitamin C are ingested.”

In the letter, Pritikin also included a statement and a quote that he would repeat over and over in his books, interviews, lectures and letters.  First, that humans had no need of supplements so long as they ate a diet that included vegetables and fruit. And second, according to D.L. Cooper, a doctor cited as serving on the 1972 Olympics medical board, “Americans excrete the most expensive urine in the world because it is loaded with so many vitamins,” a result of all the supplements that they ingest. Pauling answered the attack, naturally, writing that Pritikin’s referenced studies were wrong, and that the quote about excreted vitamins, specifically vitamin C, was also fictitious.

Letter from Pauling to Pritikin, August 1, 1978.

Letter from Pauling to Pritikin, August 1, 1978.


From his correspondence, we can ascertain that Pauling’s next interaction with Pritikin concerned the interview mentioned above in Northwest magazine, a Sunday insert in Portland’s Oregonian newspaper. In the interview, Pritikin was extremely derisive in his comments on vitamin C, even more so than at the lecture from the year prior. A few highlights:

Well, it’s completely wrong to take [vitamins]…For example, the most vitamin C you can hold in your body is about 20 or 25 milligrams a day. Anything over that just goes out through your urine….

If a woman is pregnant and is ready to deliver a child and she is on high vitamin C, both the mother and the child are set up to destroy vitamin C because the body can’t stand it. Now the child is born, but is not taking any new vitamin C, but the mechanism for destroying it continues for probably 10 to 15 days after you stop taking it, so on the fourth day the child goes into scurvy because its body is destroying vitamin C, but no new vitamins are coming in. Many cases are reported like that.

And, the most inflammatory, at least in the eyes of Pauling:

The bacteria count rises 100 times higher when you are on high vitamin C doses.

Thus, the more vitamin C you take, “the longer you’re going to be sick.” Reminded by the interviewer that this view was in direct opposition to Pauling’s stance, Pritikin retorted, “Well, he can make a statement, but this is what the study shows.”

Excerpt from Pritikin's interview in Northwest magazine.

Excerpt from Pritikin’s interview in Northwest magazine, 1979.

Though Pritikin called Pauling out by name in the interview, Pauling didn’t reply to the salvo, at least not directly. In addition to calling Pritikin ignorant of vitamins in his reply to his follower, he ended his letter with, “I think it is quite wrong for Mr. Pritikin to talk about vitamins when he knows so little about the matter.” He also sent a copy of his response to Nathan Pritikin.

More exchanges occurred from there, including an one in which Pritikin, as reported to Pauling by a correspondent, quoted Art Robinson – who was suing the Linus Pauling Institute of Science and Medicine at the time – in saying that Pauling was sitting on evidence that vitamin C had the potential to cause and aggravate cancer. To that concerned reader, Pauling sent a copy of a letter that he had written to the editor of The Stanford Daily that listed all his reasons why Art Robinson was wrong.

Pritikin’s final attack on Pauling’s position came during a radio interview conducted on KGO-San Francisco’s Owen Spann talk show in October 1983. Pritikin appeared on the show to promote his newest book, The Pritikin Promise: 28 Days to a Longer, Healthier Life, and to clarify some of the diet advice presented within.

After asking his guest a few questions about the recent history of American heart disease, Spann launched into a discussion on vitamin C. And Pritikin, once again, turned to a study, saying “[Stanford University] got so sick of hearing Dr. Pauling say that vitamin C cleans out your arteries that they decided to see if it even does.” From there he described the study, stating that Stanford found that vitamin C raised LDL (bad cholesterol), while lowering HDL (good cholesterol). He finished with this bold statement: “If you want heart disease, take vitamin C.”

Upon hearing a recording of the interview, Pauling went in search of the Stanford study. Pauling’s notes documenting his search suggest that Pritikin was lying.

I telephoned Dr. Donald C. Harrison, professor of medicine and head of the cardiology department at Stanford. He says that he knows nothing about the study Mr. Pritiken [sic] said was made at Stanford, and so far as he knows Stanford has made no study of vitamin C in relation to heart disease.

Pauling note to self, October 31, 1983.

Pauling note to self, October 31, 1983.

The disagreement between Pauling and Pritikin ended with the Spann interview. Though no longer suffering from cardiac disease, Nathan Pritkin had battled leukemia for most of the 1980s. In February 1985, he took his own life. He was 70 years old.

Some Personal Thoughts on Vitamin C in the 1980s and Now

[Guest post written by John Leavitt, Ph.D., Nerac, Inc., Tolland, CT.]

The author in his laboratory at the Linus Pauling Institute of Science and Medicine. Originally published in Science Digest, June 1986.

The author in his laboratory at the Linus Pauling Institute of Science and Medicine. Originally published in Science Digest, June 1986.

During my daily work for pharmaceutical and biotech clients, I am continuously learning about developments resulting from my research at the Linus Pauling Institute of Science and Medicine in Palo Alto, CA in the 1980s. Likewise, I am regularly coming into contact with new medically related developments focusing on vitamin C, an interest of Linus Pauling in those years.

With regard to our research on human plastins, a gene family of proteins that we discovered, cloned, and characterized at the Pauling Institute, it has recently been reported that plastin (PLS3) is a marker of carcinoma cells circulating in the blood (for example Yokobori, et al.). Our hypothesis was that when this protein was inappropriately expressed in cells from solid tissues, as it is in many tumor types, (e.g. carcinomas, fibrosarcomas, etc.) these potential tumor cells become more like blood cells in that they are able to live and replicate in an anchorage-independent state, an essential property of metastatic tumor cells. It is metastasis that kills us when we get cancer. Thus plastins, discovered and characterized at the Pauling Institute, may turn out to be the “holy grail” of cancer research.

I often run across new information on the medical importance of vitamin C without looking for it. Back in the 1980s, we would receive an annual shipment of loose vitamin C from Hoffmann-La Roche, Inc. as a way of saying thank you to Dr. Pauling for his advocacy of the merits of vitamin C. We received no funding from Hoffmann-La Roche though. One year I recall that two dignitaries from the company visited us. Dr. Pauling, with me and several others, walked our visitors to lunch a few blocks down El Camino Real in Palo Alto to my favorite restaurant, the Captain’s Cabin.

Afterward, while walking back to the Institute, one of the guests asked Dr. Pauling if he thought the perceived benefits of vitamin C were due to the placebo effect. I was amused because I too had said something ill-advised like that to Dr. Pauling in my first few months at the Institute. I mentioned to him that I had a vitamin C-resistant cold to which he replied, “You’re not taking enough!” and told me that he takes 18 grams a day. No doubt he had calculated this number based on the amount of vitamin C that animals produce within themselves every day. He would stir 18 grams into a large glass of water and imbibe the glass with no great rush.


A few months ago I heard a physician state in the national media that taking supplemental vitamins is a waste of money. This bold assertion reminded me of the announcement of the discovery of cold fusion and another premature announcement of the discovery of a cure for AIDS. The progress of science is slow but relentless, like the new developments with plastins fifteen years after I left LPISM’s labs.

On October 31, 2013, Kim, et al. at Seoul National University in South Korea published their findings on a new strain of experimental mice. The researchers knocked out the mouse gene encoding the enzyme L-gulono-γ-lactone oxidase, known as gulo for short. This is the gene that is missing in humans and that keeps us from synthesizing our own vitamin C, unlike nearly all other animals. An extreme lack of vitamin C in our diet can lead to scurvy, caused by aberrant expression of collagen in our connective tissues because of starvation of vitamin C in our diet. In these mice the lack of this gene caused “vitamin C insufficiency” in an animal model – a model that can now be used to learn more about the importance of vitamin C.

As these mice matured they expressed known blood markers of liver damage. This damage, called fibrosis, is basically the scarring of the liver, sort of like the scarring of the skin that is caused by certain types of skin damage. Concomitantly, as the mice aged, reactive oxygen species (ROS) and lipid peroxides increased in the liver, as did activated hepatic stellate cells, which deposited abnormal collagen fibriles on the basement membrane of functional liver cells. There is a wealth of evidence that elevated ROS in the lungs, liver, and kidneys is associated with pulmonary, hepatic, and renal fibrosis. Elevated vitamin C in these tissues will quench ROS.

Currently in the United States, there are no drugs approved to treat any of these forms of fibrosis. Fortunately, Intermune’s drug, pirfenidone, is close to approval for treatment of pulmonary fibrosis and has already been approved in Canada, Europe, and Japan. This drug reduces ROS and inhibits other key targets that are suspected of playing a role in the development of fibrosis. So who is to say that supplementing your diet with vitamin C is of no consequence? It is certainly not toxic in any way. Oh, by the way, pulmonary fibrosis is worse than cancer – it kills you in three to five years once diagnosed. You basically die of asphyxiation.


In the last week I stumbled upon another interesting paper on the effects of vitamin C on humans. A 2011 paper by Juraschek, et al. at Johns Hopkins University Medical School reported the results of a significant meta-analysis (a systematic review of multiple clinical trials) of 13 randomized clinical trials involving 556 patients who took a median dose of 500 mg of vitamin C per day. (I take a full gram)

The purpose of the study was to examine the effects of vitamin C supplementation on uric acid levels in the blood. Elevated uric acid levels in the blood causes gout, because saturation of blood with uric acid causes urate crystals to form in the synovial fluids of joints (e.g. crystal arthritis). Drugs that lower uric acid in the blood are used to treat gout because lowering uric acid causes the urate crystals to dissolve to ameliorate the arthritic pain.

Admittedly gout is not as bad as cancer. But another systematic clinical review of multiple trials on humans published in 2012 by Lottmann, et al. at the IGES Institut GmBH in Germany has shown clearly that having gout is associated with both all-cause mortality and, in particular, cardiovascular mortality. So what could be worse than death by gout?

I think I will keep taking vitamin C.