Tegan Taylor: Norman, I know that you’re not a supplement guy, but if I could choose one supplement to have, it would definitely be the chewy vitamin C.
Norman Swan: Oh really?
Tegan Taylor: They’re yummy. They taste like a lolly.
Norman Swan: Has it got sugar in it? Is it rotting your teeth too?
Tegan Taylor: No, I think they’re called ‘sugarless C’ or something like that. I think there’s something Pavlovian about it, like as a kid it felt like maybe getting a bit of a treat, and so even as an adult when I see them, I’m like, ‘Ooh, yummy treat.’
Norman Swan: And have you been relieved of a cold as a result?
Tegan Taylor: No, you’ve cured me of wanting any supplements, which I suppose is kind of pre-empting the answer to today’s question here on…
Norman Swan: I might be wrong, I might be wrong, so let’s just not give it away here.
Tegan Taylor: All right, all right, all right. Well, let’s get into it. This is, of course, What’s That Rash?.
Norman Swan: The podcast which answers the health questions that everybody’s asking.
Tegan Taylor: People today, Norman, are asking about vitamin C supplementation. Angeline says, ‘I tend to catch colds and flu pretty easily, so I try to get the flu shot each year and generally keep a healthy lifestyle. In recent years I’ve also started taking vitamin C, a 1,000-milligram daily dose. I’m not sure if it’s actually helped me. Is there any evidence vitamin C supplements work, and, if so, how much should we take daily? My brother-in-law takes 2,000 milligrams every day, and he never seems to get sick. He claims that it’s the vitamin C that does it.’ Claude has also emailed, saying, ‘Although I prefer to get my vitamins from food rather than supplements, I tend to have one or two chewable Cs a day.’
Norman Swan: Oh, he’s onto the same thing as you.
Tegan Taylor: Yeah, they taste good. ‘I remember reading a study that said the more C in your blood, the less cancer cells. Also it’s associated with boosting the immune system. But I’ve heard you say it can be counterproductive, and someone said it’s hard on the kidneys.’
And then Beatrice is blowing everyone else out of the water, asking about mega-doses of vitamin C, like 60,000 milligrams administered via an IV drip. Is it safe? So yeah, we’ve got questions about vitamin C today, Norman.
Norman Swan: We have, and it’s got a rich history.
Tegan Taylor: Oh my gosh…
Norman Swan: We should explain what a vitamin is to start with. You say vitt-amins, I say vite-amins…
Tegan Taylor: All I want to talk about is scurvy, but fine, let’s talk about it. What is the definition of a vitamin?
Norman Swan: So, a vitamin is micronutrient (and we’ll come back to this idea of a micronutrient), a small dose that your body needs to survive, for important metabolic processes, that we can’t make ourselves. The one exception to that is vitamin D which you can make yourself when exposed to sunlight. But most of the vitamins are ones where you actually need to take them via your mouth.
Tegan Taylor: And for an animal, say a human, that needs something but can’t manufacture it in their body, we’re actually pretty well adapted to getting it out of the food that we eat. So for most humans, vitamin C, you get it most notoriously through fruit and vegetables. And I think most people associate vitamin C specifically with citrus fruit, because they are very high in it.
Norman Swan: Indeed. And there are animals that can make their own vitamin C, but not humans.
Tegan Taylor: Most animals can make their own vitamin C. That’s what’s actually really wild to me, that humans and most primates, but not all primates, and bats also, need to supplement vitamin C from their diet, but most other animals can just figure it out by themselves.
Norman Swan: So let’s get to scurvy. How can we stay away from it!
Tegan Taylor: I thought you’d never ask. I think if you are informed enough about health to be listening to What’s That Rash?, you probably know that scurvy is a vitamin C deficiency. Just a little recap on how scurvy presents in the body. It’s hectic. Vitamin C is important in the manufacturing of collagen, which is pretty important for our bodies sticking together.
Norman Swan: It’s part of our connective tissue.
Tegan Taylor: And so then the symptoms of scurvy…well, let me read to you part of the ship’s log from Commander George Anson. This is from a British exhibition in the 1740s, they lost 1,300 of an original 2,000 men to illness, at least some of which to scurvy. And he described almost the whole crew was afflicted by symptoms, including ‘a luxuriancy of funguous flesh, putrid gums and the most dreadful terrors’.
Norman Swan: And sudden death.
Tegan Taylor: Why do you die from it?
Norman Swan: Well, your body essentially falls apart and you bleed and you get internal haemorrhage and external haemorrhage. Basically, body failure.
Tegan Taylor: The thing with scurvy that’s interesting to me is that the cure for it is really simple, vitamin C almost straight away starts to reverse the effects of scurvy. And it’s something that humans have kind of known about and then forgotten and rediscovered and forgotten and rediscovered over a few thousand years. There’s even, in ancient Egyptian texts, this idea that eating vegetables can help prevent it, but…
Norman Swan: We’ve made a false hero here though, out of scurvy, haven’t we, in the British navy?
Tegan Taylor: There are a few heroes. Are you talking about Lind?
Norman Swan: James Lind, who found that lemon juice improved scurvy, but he actually never really tied that down.
Tegan Taylor: He also blamed a lot of things on damp air, which, I mean, people loved to blame things on air back in those days. And to be fair, I can only imagine…
Norman Swan: Well, you and I did for Covid a lot.
Tegan Taylor: Well, that’s true.
Norman Swan: Maybe we should have been taking vitamin C…no, no, I’m not going to go down that track again.
Tegan Taylor: No, let’s not go there, please. No, I mean, obviously some diseases are aerosol and airborne diseases, but vitamin deficiency is not one of them. But I can only imagine what the inside of a ship’s hull smelled like after 10 or 12 weeks at sea, so maybe it’s a defensible thing. Also, on ships’ hulls, sailors who ate the ship’s rats were inadvertently protecting themselves against scurvy, because rats are one of the creatures that can synthesise their own vitamin C. And if you were a hungry enough sailor to eat a rat, you probably were getting vitamin C from that rat.
Norman Swan: And Lind never smelled a rat in terms of his research.
Tegan Taylor: Exactly. So Lind is the person that we often associate with vitamin C and scurvy prevention, but there was a couple of generations of scientists that built on that research to take us to knowing about vitamin C specifically and also synthesising it. A couple of really important people in this journey, Albert Szent-Györgyi, who was awarded the 1937 Nobel Prize in Physiology or Medicine, he was one of the people that got the chemical structure nailed down. He didn’t want to call it vitamin C at first. Do you know what he wanted to call it?
Norman Swan: I think he called it hexuronic acid or something, didn’t he?
Tegan Taylor: Before he called it that. So you know how if something’s a sugar it’s sometimes got the suffix -ose? He wanted to call it ‘godnose’ because he didn’t really know what it was for, but he knew it was a sugar of some sort.
Norman Swan: Hilarious.
Tegan Taylor: Anyway, basically they figured it out. It was the same thing as ascorbic acid. Do you know why it’s called ascorbic acid?
Norman Swan: No, I don’t.
Tegan Taylor: ‘A’ as in preventing or against, ‘scorbi’, scurvy. It’s anti-scurvy-acid, that’s really where the name comes from.
Norman Swan: But then we have another Nobel laureate who gets involved in the vitamin C story.
Tegan Taylor: Are you talking about Linus Pauling?
Norman Swan: I am.
Tegan Taylor: This is a really weird sidebar…
Norman Swan: Well, it’s more than a sidebar, he was front and centre.
Tegan Taylor: Anyway, so I suppose the thing to say about Linus Pauling is he’s a Nobel Laureate. So his field of science was chemistry…
Norman Swan: And structural chemistry, so really very, very basic chemistry, on which modern chemistry is built. So it was a brilliant Nobel Prize. But like a few Nobel laureates, he expanded beyond his area of expertise, but pretty much like a medical journalist.
Tegan Taylor: I’ll let you say it, not me. He actually won two Nobel prizes. So he won one for chemistry (good for him), and then he also won a second Nobel in 1963, the Peace Prize for his work towards nuclear disarmament. So he was a politically charged figure, he was sort of tarred with the communist brush. But in addition to that, he suffered from some health issues, and in his quest to keep himself healthy, he sort of fell down a bit of a vitamin C rabbit hole that we’re kind of really only just climbing out of today.
Norman Swan: He became a major promoter of vitamin C for extended life span, extended healthy life span, and, indeed, to prevent the common cold. He just thought vitamin C was an amazing compound that had huge health benefits, not just in preventing infection, but also preventing cancer.
Tegan Taylor: So Pauling’s thing was what he would eventually call orthomolecular medicine. It’s a Greek prefix ‘ortho’, meaning sort of straight or correct or right, and his idea was that if you had the right molecules in your body, you could cure a whole suite of health problems. And I suppose it’s fitting that vitamin C is in this debate because you have a deficiency disease, which is scurvy, and you have a vitamin which cures it. And he wanted to kind of extend that to be, like, what if you had even more and you could cure other things as well? And his devotion to the idea that it could be something of a cure-all has had some real long-term ripples in terms of our understanding of what this vitamin can do.
Norman Swan: And it spawned a lot of research. So he was criticised for his views on vitamin C by the mainstream medical community. Now, the mainstream medical community has been wrong about a lot of things, but there was really very little or no research to back this up. He became an author on a few papers which were poorly conducted, and he really was unable to prove scientifically his assertions about vitamin C. And subsequently people have done randomised trials of vitamin C supplementation in the prevention of the common cold, and found that at best it might shorten the duration of symptoms, but that’s about it.
Tegan Taylor: So I think some of the big claims around vitamin C are common cold, like you said, immune system broadly, maybe it’s protecting you against colds, maybe it’s protecting you against other things as well, and then cancer prevention, especially that third question that we got, which was about big IV doses. Let’s talk through what we actually know about these three things.
Norman Swan: Let’s go back to that comment I made right at the beginning, that vitamins are really micronutrients. They work in the body in relatively small doses, associated with other compounds in food that almost certainly help those vitamins and other micronutrients to work. So, vitamin C in doses that you would get in foods is actually an antioxidant. So the oxidative process is part of that ageing process, it’s the toxicity of oxygen essentially rusting your tissues from the inside out. So the idea here is that you have these antioxidants, one of which is vitamin C, which help mop up this process, but not by themselves, in association with other bioactive compounds.
So here’s the weird thing, which Pauling never actually knew about and it has only been known about recently. For reasons which are not fully understood, in high doses, particularly when it’s given intravenously, it turns into a pro-oxidant. In other words, it speeds up the damage to tissues and the ageing process. So when you take very high doses intravenously, you’re taking vitamin C as a drug, which actually can damage cells. So there is in fact, it turns out, almost certainly an anti-cancer effect of high-dose intravenous vitamin C, which by itself does not seem to have any significant effect on cancer, but when given with other chemotherapeutic agents seems to enhance their effects. Now, the evidence is not brilliant on that. There are clinical trials still going on. A little bit of evidence of prolonged survival in pancreatic cancer when high-dose vitamin C is used in association with chemotherapy. So it’s not yet ready for showtime, but there is an anti-cancer effect. But it’s not because it’s good for your body, it’s because it’s bad for your body.
Tegan Taylor: If it’s killing cancer cells, it can kill your healthy cells as well, by the sounds of it.
Norman Swan: That’s the theory, yep.
Tegan Taylor: Because I was going to say, why on earth do we even have these high-dose vitamin C supplements being offered? But it turns out there could be an application for them, but it’s a pretty narrow part of the population.
Norman Swan: Yeah, and it doesn’t look as though it works when you take it orally.
Tegan Taylor: I think the thing with the end of Pauling’s story is that it ended up being this big beef where he was very pro-high-dose vitamin C infusions, because it was controversial, because he was a controversial guy. The Mayo Clinic did some trials basically showing that his theory didn’t work, but they used a different method of delivery, they used an oral delivery instead of an intravenous delivery. Anyway, without getting too much into the weeds, people who have commented on this have kind of observed that this whole back and forth with Pauling put the research into vitamin C back decades, because it was kind of tainted by this episode.
Norman Swan: Yeah. But those orthomolecular physicians who are still around actually give high-dose intravenous vitamin C, and from the evidence that we’ve got, it’s not something you particularly want to have. Interestingly, the Australian Institute of Sport uses vitamin C after intense exercise to help repair muscles.
Tegan Taylor: This is what I wanted to ask about; what’s it doing in muscles? And has this got anything to do with this idea that overall it might be good for your immune system?
Norman Swan: Well, what they’re doing is trying to…the theory is, after intense exercise you get increased oxidation, what’s called reactive oxygen species, and you give the vitamin C to reduce these reactive oxygen species, which you’d have to say that if it was really high-dose, you’d have to question whether or not they’re achieving their end there, but they do seem to have some evidence to back them up.
Tegan Taylor: Okay, so to kind of bring this home, Angeline and Claude were both asking about moderate-level vitamin C supplementation. Beatrice is asking about this really high-level vitamin C supplementation. What do we say?
Norman Swan: You would avoid high-dose supplementation. You would avoid supplementation altogether, to be honest, and really just take it in the diet, because it’s meant to be taken in relatively small doses with other bioactive compounds, bioactive compounds that have yet to be identified, some of which have but some of which haven’t. So you really stick with what we know, that food works.
Tegan Taylor: Food works. And I think just for some clarity, if you don’t want to get scurvy, you only need about eight milligrams a day of vitamin C. You can get this from 100 grams of onion…one orange…one potato has 27 milligrams of vitamin C in it.
Norman Swan: Speaking of potatoes, scurvy broke out in Ireland with the potato blight in the 19th century.
Tegan Taylor: Exactly. And we think of citrus fruits as being very, very high in vitamin C, and they are, but you actually don’t need to eat very much fruit and vegetables to get what you need in terms of vitamin C. you should be eating five and two every day anyway, for all sorts of different reasons. I guess what I’m trying to say here is don’t stress too much about it.
Norman Swan: And the sad story with Pauling…I mean, he lived a long time, I think well into his 90s, but he was extolling the virtues of vitamin C for cancer and unfortunately died the following year of cancer. But, you know, that’s not schadenfreude, just unfortunate.
Tegan Taylor: Exactly. And I guess the fact that we’re all human, even if we’re really, really smart.
Norman Swan: And there was a question about the damage to kidneys, and in fact too much vitamin C can produce kidney stones. So there is a burden on the kidneys from too much vitamin C potentially producing kidney stones. You don’t want to get a kidney stone, very painful.
Tegan Taylor: So those yummy little chews that I was saying before, probably not worth it?
Norman Swan: Probably not worth it. You might get a pain in the side.
Tegan Taylor: Angeline, Claude, Beatrice, thank you all so much for asking us your questions. You can ask us your question by emailing thatrash@abc.net.au.
Norman Swan: What’s in the mailbag?
Tegan Taylor: Megan says, ‘I recently listened to your podcast on peptides.’ And she says, ‘Before a recent hike, one of our group got injured and to aid a speedy recovery did ‘everything they could’ (in inverted commas), including injecting peptides. There were two occasions peptides were injected and they suffered a reaction that increased their heart rate. So the group member went on the hike, no problem, but then returned. They got suspicious about the bacteriostatic water that was used to inject the peptide. So they got this bacteriostatic water, they sniffed it, they got their hands on it and sort of rubbed it on their hands. Again, a couple of minutes, a severe rise in their heart rate and blood pressure, some skin tingling, some dizziness, tremors lasting 30 minutes with zero localised reactions such as redness, itching or swelling. And then two days later had a similar episode at work.’ What on earth could be going on here? And I can’t remember if we went into bacteriostatic water, what it even is, Norman.
Norman Swan: Look, like anything that you buy online, you’ve no idea what was in it. So there could have been an adrenaline-like substance in the water. There could be another chemical that affects the cardiovascular system. You just don’t know all sorts of things because you’ve just got no idea what you’re injecting.
Tegan Taylor: So just massive ‘proceed with caution’, ‘sign here’.
Norman Swan: You don’t know what you’re buying.
Tegan Taylor: Well, Megan, thank you for so much for the question. Also, Norman, I’m smarting because two different people have emailed us to correct my pronunciation of the word ‘asterisk’, which I do know how to pronounce. Sometimes my brain just works faster than my mouth does.
Norman Swan: Apparently you said ‘Asterix’.
Tegan Taylor: I did, and I actually really enjoyed the Asterix and Obelix comics when I was a kid, so thank you for the trip down memory lane.
Norman Swan: Yeah, just an asterisk in history.
Tegan Taylor: If you want to correct Norman’s pronunciation on anything, the email address is thatrash@abc.net.au.
Norman Swan: You say tomay-toe, I say tomah-toe. You say potay-toe, I say potah-toe, lah lah lah, let’s call the whole thing off. But we’re not calling the whole thing off, we’ll see you next week.
Tegan Taylor: See you then.
