ACAM  Research
High-Dose Vitamin C for People with Cancer: A Promising Adjunct to Mainstream Cancer Treatment
by John C. Pittman, MD, and Mark N. Mead, MSc

A great many cancer sufferers die from chronic inflammatory problems that are associated with the disease, such as cancer cachexia.  A recent report published in the March 2011 Journal of Translational Medicine presents a powerful argument for using intravenous (IV) vitamin C in the context of life-threatening infections and cancer.  The authors report that IV vitamin C has been effective in directly treating cancer as well as in helping to reverse chronic inflammation and stave off life-threatening infections in these patients.

Vitamin C is the most widely used single-nutrient supplement in the United States, and has long been lauded by the general public for its supposed powers to treat many ills, from colds to cancer, from herpes to heart disease.  Back in the 1970s, two-time Nobel Prize winner Linus Pauling did much to bolster the vitamin’s profile by touting it as an immune-enhancing and tumor-killing therapy.  Pauling asserted that the anti-cancer potential of vitamin C depended on getting the proper dosage, and toward the end of his life, he further emphasized that vitamin C was best combined with various other anti-cancer agents that worked synergistically with vitamin C.

Dr. Pauling was among the first scientists to recognize that it’s impossible to attain the therapeutically optimal level of vitamin C by taking the vitamin orally—that is, in the form of the standard vitamin C pills or tablets.  On one hand, it's virtually impossible for people to overdose on oral vitamin C, since the body only assimilates a certain quantity through the mouth and then stops allowing it to build up.  On the other hand, this prevents health care professionals from being able to achieve the blood levels that have been linked with killing tumors.  One solution, of course, is to use intravenous (IV) vitamin C.  
With IV vitamin C, you can bypass the digestive system and thus circumvent the body’s normally tight regulation of vitamin C levels.  As researchers recently reported in a recent issue of the Proceedings of the National Academy of Sciences, IV vitamin C generates hydrogen peroxide which will destroy primitive cells like bacteria, viruses and cancer cell, and this in turn leads to the shrinkage of aggressive tumors—including ovarian, pancreatic and brain tumors—in laboratory animals.   Despite the very high levels of vitamin C used in these studies normal cells appear to be completely unharmed by the therapy.  The researchers stated that it’s feasible to intravenously boost levels of vitamin C in humans to the same levels used in the mice. 

Indeed, numerous studies have suggested that high-dose IV vitamin C may help eliminate cancer, even when combined with conventional treatments.  For example, in a report for the August 8th2010 issue of Cancer Chemotherapy and Pharmacology, Dr. Mark Levine, chief of the U.S. National Institutes of Health's Molecular and Clinical Nutrition Section, concluded that exposing tumors to vitamin C made them more vulnerable to the killing effects of at least four widely used chemotherapy drugs.  Previously, Dr. Levine had published research with mice suggesting that IV doses of vitamin C could one day reduce the size of malignant tumors in people.

Dr. Levine’s findings confirm what we have been seeing for the past 15 years at the Carolina Center for Integrative Medicine.  On numerous occasions, we have observed that IV vitamin C enabled patients with advanced cancers to respond to chemotherapy drugs to which they had previously failed to respond.  We therefore believe that it can enhance the effectiveness of cancer chemotherapy and pave the way for therapeutic success.  In a recent issue of PloS One, Dr. Levine concluded that high-dose IV vitamin C is in wide use by integrative practitioners and that “high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer [and] chronic, untreatable, or intractable conditions…”
Clinical studies of the potential therapeutic value of high-dose vitamin C began in Scotland in 1971.  The findings from these early investigations were dramatic indeed.  In addition to the aforementioned three studies showing a four-fold increase in survival, one other study of 100 “terminal” cancer patients showed a nearly six-fold increase in survival for patients with advanced cancer.  To date, six out of a total of seven clinical studies have concluded that high-dose vitamin C did increase survival in patients with advanced cancers. Many of these patients also noted significant improvements in their energy levels, pain reduction, appetite, and other measures of quality of life.

Understandably, these findings attracted much media attention and ignited an explosion of public interest in using vitamin C for cancer therapy.  Many thousands of cancer patients began self-prescribing the vitamin.  At the same time, however, some scientists sharply criticized Pauling’s research on the grounds that his early studies were not randomized controlled clinical trials, the “gold standard” of medical research.  For this reason, the studies’ findings were deemed unreliable or preliminary at best.
Controlled clinical trials are indeed the best way to assess the true value of any proposed treatment strategy.  In the case of vitamin C, the ideal study would randomly assign cancer patients to receive either vitamin C or a placebo (a substance having no biological or therapeutic activity), and to do so without the patients knowing which one they were receiving. 
The jury is still out on vitamin C as a potential cure for cancer, and no one has adequately tested Pauling’s hypothesis with the appropriate controlled clinical trial design.

In March 2006, the Canadian journal CMAJ (Canadian Medical Association Journal) told the story of three patients with advanced cancer who had received IV vitamin C.  One was a 49-year-old man with “terminal” bladder cancer who had declined chemotherapy. Nine years after receiving the deadly prognosis, he was still alive and apparently free of cancer.
Another patient, a 66-year-old woman, had an aggressive lymphoma with an extremely poor prognosis. After IV vitamin C, her disease went into remission and she was alive and well 10 years later.  In a third case, IV vitamin C was given to a 51-year-old woman with kidney cancer that spread to her lungs.  Two years later, she had a normal chest X-ray, and a pathologist confirmed the findings.

Why did these patients succeed where others have not?  It could be that the secret is in the dosage.  Only two controlled clinical trials of vitamin C have been done, and both used oral vitamin C rather than the IV route.  But oral doses can never achieve the high blood levels provided by IV methods, the levels necessary for killing cancer. 

Dr. Levine recently demonstrated that, indeed, only IV vitamin C can achieve the desired blood levels.  The reason for this is that your kidneys will get rid of vitamin C as fast as your gut can absorb it.  With the IV approach, the blood levels are immediately elevated, and it takes much more time for the kidneys to eliminate the excess. Thus, for an extended period, you’re able to expose cancer cells in your body to the levels that can make a difference.
Dr. Levine also confirmed that vitamin C is metabolized to hydrogen peroxide.  Unlike normal cells, cancer cells lack the internal defenses to protect themselves from this highly unstable and reactive compound.  As a result, they die.  (Many chemotherapy agents operate, in part, through a similar mechanism.  Green tea, resveratrol, and artemisinin may have similar effects; taken in combination, these natural agents may reach levels of peroxide lethal to malignant tumors.)
These days, IV vitamin C doses may range from 10 grams to as high as 300 grams per day (300,000 mg!), though most doses are in the range of 30 to 80 grams per day.  The optimal strategy, as designed by Dr. Hugh Riordan, includes certain other nutrients, such as alpha lipoic acid.  The good news is that, in contrast with conventional chemotherapy, IV vitamin C is not a particularly expensive therapy.

Preliminary reports from a clinical trial in Kansas City indicate that giving IV vitamin C prior to chemotherapy can dramatically reduce the toxicity of those treatments while bolstering the tumor-killing impact of the chemo.  
John C. Pittman, MD, is the Medical Director of the Carolina Center for Integrative Medicine in Raleigh, NC, and is certified by the American Board of Clinical Metal Toxicology.  Mark N. Mead, MSc, serves as the Center’s Integrative Medicine Research Consultant.

RESEARCH of the RIORDAN INSTITUTE
According to the Riordan Institute, there are several potential benefits to Giving intravenous vitamin C therapy to cancer patients that make it an ideal adjunctive care choice:

• Cancer patients are often depleted of vitamin C, and intravenous vitamin C therapy provides an efficient means of restoring tissue stores.
• Intravenous vitamin C therapy has been shown to improve quality of life in cancer patients by a variety of metrics.
• IVC reduces inflammation (as measured by c-reactive protein levels) and reduces the production of pro-inflammatory cytokines.
• At high concentrations, ascorbate is preferentially toxic to tumor cells 
• Vitamin C is an antioxidant that is important for proper immune cell functioning.
• Since cancer patients are often depleted of vitamin C, replenishment may improve immune system function and enhance patient health.

In 1976 Cameron and Pauling observed a fourfold survival time in terminal cancer patients treated with intravenous ascorbate infusions followed by oral supplementation .

The rationales for using intravenous vitamin C as adjunctive therapy in patients with breast cancer, include:
Published case studies report anti-cancer efficacy, improved patient well-being, and decreases in markers of inflammation and tumor growth.

Phase I clinical studies indicate that intravenous vitamin C can be administered safely with relatively few adverse effects.

A variety of laboratory studies suggest that, at high concentrations, ascorbate does not interfere with chemotherapy or irradiation and may enhance efficacy in some situations (Fujita, et al., 1982; Okunieff& Suit, 1987; Kurbacher, et al., 1996; Taper, et al., 1996; Fromberg, et al., 2011; Shinozaki, et al., 2011; Espey, et al., 2011).

This is supported by meta-analyses of clinical studies involving cancer and vitamins; these studies conclude that antioxidant supplementation does not interfere with the toxicity of chemotherapeutic regiments (Simone, et al., 2007; Block, et al., 2008).
Several other clinical studies have looked into the effect of vitamin C on quality of life in cancer patients.

In a Korean study by Yeom, et al., 2007 intravenous vitamin C therapy significantly improved global quality of life scores, with benefits including less fatigue, reduction in nausea and vomiting, and improved appetite.

In a German study by Vollbracht, et al., 2011 , breast cancer patients receiving intravenous vitamin C therapy along with standard therapy were compared to subjects receiving standard therapy.

Patients given intravenous vitamin C therapy benefited from less fatigue, reduction in nausea, improved appetite, reductions in depression and fewer sleep disorders. Overall intensity scores of symptoms during therapy and aftercare was twice as high in the control group as the intravenous vitamin C therapy group. No side effects due to intravenous vitamin C therapy were observed, nor were changes in tumor status compared to controls reported.