by Steve Hickey
But the evidence linking Chlamydia and atherosclerosis is not fully consistent.66 If atherosclerosis is a result of infection caused by chronic shortage of vitamin C, this lack of consistency is expected: the infection involved in a particular case may simply reflect which virus, or bacteria, was available to infect the tissue. Chlamydia DNA is found in a high proportion of cardiac transplant patients, and higher numbers of antibodies in the blood may be linked with the abnormally rapid atherosclerosis and failure of the transplant.67 The accumulation of evidence linking Chlamydia with atherosclerosis is convincing68 but does not necessarily indicate that it is a dominant cause of the disease.69
Chlamydia has been demonstrated to cause atherosclerosis in animal experiments, which can be prevented by antibiotic treatment.70 A preliminary study with antibiotics on atherosclerotic patients with Chlamydia suggested a decrease in acute coronary events in a month.71 Unlike vitamin C, however, antibiotics are not effective against viruses, do not modulate the inflammatory process, and do not directly aid healing. Chlamydia can act as a local oxidant and free radical generator. It can oxidize cholesterol-related molecules, a process considered to be an essential part of plaque development.72 High-dose vitamin C can prevent such oxidation, protecting the arterial wall.
While the association of Chlamydia with atherosclerosis is established, it is not clear whether it is causative or an opportunistic infection. Its involvement may depend on a shortage of vitamin C and pre-existing damage to the artery. Chlamydia may just be the most commonly available infection for invading damaged arteries. An alternative approach to antibiotics would be to boost the immune response with adequate amounts of vitamin C and prevent the infection occurring.
Other Infective Agents
Antibodies to both herpes and Epstein-Barr virus are often increased in patients with atherosclerosis. The viruses are found separately and in combined infection. Epstein-Barr virus was recently shown to be present in atherosclerotic plaques along with Herpes simplex and cytomegalovirus.73 However, some subjects with atherosclerosis show no antibodies to either virus.74
The human immunodeficiency virus (HIV) implicated in AIDS is associated with suppression of the immune response. Patients infected with HIV have an increased rate of development of atherosclerosis.75 The resulting arterial lesions are intermediate in structure between normal plaque and transplant disease. Some findings indicate the possible involvement of Mycobacterium tuberculosis, the organism that causes TB, in atherosclerosis.76 High levels of Mycobacteria-related protein can be found in animal studies and in atherosclerotic patients. Moreover, atherosclerotic changes can be found in the vascular wall of animals vaccinated with Mycobacteria-related protein.
The presence of organisms in plaques that are usually found in gingivitis is informative. Infected gums potentially present a range of microorganisms to the bloodstream and thus to the arteries. Damaged arteries might be easy and inviting targets to such infection. Several bacteria (Bacteroides forsythus, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, and Prevotella intermedia) found in diseased gums have also been found in arterial plaque.77 However, studies on the association between cardiovascular disease and periodontal disease or loss of teeth have produced conflicting results.78 The presence of gingivitis may indicate an increased risk of atherosclerosis, but the effect may be relatively small.79
Vitamin C and the Antioxidant Defense of Heart Disease
Human plaque might contain more vitamins C and E than is found in healthy arteries. In plaques, however, both vitamin E and coenzyme Q10 are oxidized.80 These antioxidants require a constant re-supply of electrons in order to prevent free radical damage.81 As Dr. Robert F. Cathcart III points out, effective antioxidant treatment of disease needs a massive intake of vitamin C to supply antioxidant electrons. Under the inflammatory conditions within a plaque, normal metabolism is insufficient to provide these reducing electrons. Few dietary antioxidants can provide a free supply of antioxidant electrons to such tissue—the exception is vitamin C under conditions of dynamic flow. Plaques that are in an oxidized state could, in principle, be rendered healthy with sufficient vitamin C.82
The Importance of Nitric Oxide
As we have explained, nitric oxide works with vitamin C in maintaining healthy blood vessels. Damage to the synthesis of this small molecule may be one of the first steps leading to atherosclerosis.83 It is formed from the amino acid arginine and the enzyme nitric oxide synthetase catalyzes the reaction. The manufacture of nitric oxide also involves vitamins B2 (riboflavin) and B3 (niacin).84 Once formed, nitric oxide diffuses through the endothelial cell membrane into the smooth muscle of the arterial wall. Inside the artery, it helps control vascular tone.
Under oxidizing conditions, superoxide can be produced instead of nitric oxide.85 Superoxide is also generated during inflammation (white blood cells activated by inflammation release superoxide) and will quench nitric oxide and prevent it from relaxing and dilating the local arterial wall. As inflammation develops, superoxide will directly constrict local blood vessels, further antagonizing the action of NO. Vitamin C at high concentration can prevent such oxidative damage to the arteries and restore the beneficial role of nitric oxide.86
Nitric oxide is a central part of many normal and disease processes, including inflammation, infection, and regulation of blood pressure. The roles of NO, like other redox active species, depend on the local tissue and its environment. Too much nitric oxide can contribute to vascular cell pathology, killing cells and producing free radical damage.87 Exceptionally high levels of NO can damage brain cells when the blood supply is inadequate. Conversely, release of nitric oxide from endothelial cells can reduce injury from lack of blood flow by dilating the blood vessel. Low NO in tissues, or decreased sensitivity to its effects, impairs the ability of arteries to expand when required and increases the ability of atherosclerosis to produce clinical illness.88 In advanced atherosclerosis, arteries may produce less nitric oxide, which may be related to the presence of oxidized cholesterol and other free radicals.89
A high level of antioxidants, and particularly vitamin C, are necessary for nitric oxide to protect the blood vessels, especially in people with conventional risk factors for atherosclerosis. Nitric oxide may inhibit the proliferation of smooth muscle cells in the blood vessel wall, which occurs in atherosclerosis. When tissue levels of oxidants are high, as in an inflamed arterial wall, NO production may be high but ineffective. Shock, generalized inflammation, and bacterial toxins can increase the synthesis of NO and induce hypotension. Clinical reports beginning sixty years ago with Dr. Frederick R. Klenner suggest that sufficiently high levels of vitamin C can prevent this pathology. Several antioxidants appear to be able to quench free radicals and preserve nitric oxide’s function in blood vessels. These antioxidants include vitamins C and E,90 alpha-lipoic acid,91 coenzyme Q10,92 glutathione,93 superoxide dismutase (SOD),94 selenium,95 and quercetin.96 However, the antioxidant function of vitamin C is unique in providing a driving potential promoting the actions of these other antioxidants.97
Antioxidant Network Therapy
The well-known five-a-day portions of fruits and vegetables is aimed at increasing the intake of antioxidants and phytochemicals. This recommendation may have originated as the requirement to achieve conventional, Recommended Dietary Allowance (RDA) levels of vitamin C. However, the recommendation is at best misleading, and at worst it promises more than it can deliver. The biggest problem with “five-a-day” is that this intake is clearly inadequate to provide sufficient antioxidants to compensate for the modern diet of fast food and abnormal fats. There has been a dramatic loss of nutrients in vegetables over the last half century, caused by changes in variety, storage, and preservation. This may also be due to intensive farming and chemical fertilizers (organic foods typically contain more nutrients). The government recommendations do not appear to take full account of the decline in nutrients in our food, reducing the availability of food with high levels of
vitamin C and other nutrients.
High-dose vitamin C and other antioxidants is the only answer. High-dose vitamin C can inhibit atherosclerosis in animals even in the presence of high blood cholesterol. There is supporting evidence on the benefits of antioxidants in humans from epidemiology and clinical trials.98 Low levels of quercetin, for example, may be associated with increased death from heart attack.99 Alpha-lipoic acid has a strong anti-inflammatory action on damaged arterial walls100 and induces production of nitric oxide. However, studies on humans have generally used low doses and inappropriate antioxidant supplements and give conflicting results.101
Vitamin C drives the capability of numerous other antioxidants, such as alpha-lipoic acid, vitamin E, and coenzyme Q10. This simple vitamin is at the core of an antioxidant network that protects the body from damage and ill health. Following from the early work of Linus Pauling and others, orthomolecular nutrition has derived an antioxidant network therapy based on the central role of vitamin C.
Prevention of heart disease appears to require a minimum of about 3 grams of vitamin C, in doses spread throughout the day. In general, this should be taken along with a high-quality orthomolecular multivitamin. A broad range of additional dietary antioxidants, such as vitamin E and selenium, would also be beneficial. People at higher risk can increase their intake of vitamin C and add specific antioxidants. The most useful additional antioxidants appear to be vitamin E (mixed natural tocotrienols combined with extra tocopherols) and alpha-lipoic acid. All these antioxidants are widely available from health food stores. Dr. Pauling and others have also proposed the addition of amino acids, such as lysine, proline, arginine, and citrulline. These substances have low toxicity, may be beneficial, and help vitamin C prevent arterial inflammation.
Antioxidant network therapy to prevent heart disease might include the following supplements daily:
• Vitamin C, at or near bowel tolerance (6+ grams)
• Lysine, 3–6 grams
• Proline, 0.5–2.0 grams
• Arginine, 3.5 grams
• Citrulline, 1.5 grams
• Mixed tocotrienols (vitamin E), 300+ mg
• Mixed tocopherols (vitamin E), 800+ IU
• R-alpha-lipoic acid, 300–600 mg
To remove existing atherosclerotic plaques and return a person with pre-existing heart disease to good health is more difficult than preventing the illness. These suggested doses of vitamin C are probably too small for clinical benefit in that case—the bowel tolerance method of dosing, proposed by Dr. Cathcart, is more appropriate (see Chapter 3). The resulting vitamin C dose will vary with the individual, between, say, 10 and 30 grams per day. In cases of existing disease, a minimum of six months of treatment with antioxidant network therapy is needed before any reduction in plaque size would be expected. A maximal effect might take two to three years. However, even subjects with advanced atherosclerosis can stabilize and reduce plaques, preventing heart attack and stroke.
Vitamin C is the key factor, whether heart disease is caused by inflammation, infection, oxidation, fats, or poor lifestyle. This single vitamin protects against the core aspects of the pathology. There are many factors that can initiate minor local damage in the arterial wall, such as poor nutrition and high blood pressure. Chronic infection appears to promote the development of atherosclerosis: while it might not produce the initial lesion, infection can accelerate the development of plaque by promoting local inflammation. Any area of damage in the body and the resulting inflammation is an opportunity for colonization by a microorganism. The role of the microorganism may be to infect, grow, and rupture plaques more quickly than would otherwise be the case.
People with well-functioning immune systems based on an optimal intake of vitamin C may have a distinct advantage and avoid the ravages of heart disease. Heart disease may eventually be shown to be an infectious disease, where the infection takes hold when there is insufficient vitamin C to repair arterial damage. Vitamin C supplementation may be the simplest way of boosting the immune system to prevent atherosclerosis and stroke. High levels of vitamin C are needed to prevent vascular damage and facilitate repair of the tissues. Dynamic flow levels of vitamin C are claimed to prevent infection taking hold. As evidence accumulates, it is clear that shortage of vitamin C appears increasingly likely to be the ultimate cause of heart disease.
The good news is that abundant ascorbate may also provide a cure.
Conclusion
“Actually, we can make more ascorbate than a dog, cat, or rat, but in our chemical plants; we just have to have the brains to know how to take the massive doses necessary in acute situations.”
—ROBERT F. CATHCART III, M.D.
The vitamin C story stretches back to the early evolution of our human ancestors. Because of a prehistoric genetic error, scurvy has plagued humans throughout history, whenever dietary vitamin C was in short supply. It is only in the last hundred years that scientists have isolated vitamin C and identified it as ascorbic acid, a simple organic molecule. A few milligrams of this inexpensive white powder will prevent or cure acute scurvy. Scurvy still occurs, though doctors sometimes misdiagnose it as a severe infection, because the acute disease has become rare and unusual.
Human evolution has been marked by periods of environmental crises, in which the population appears to have crashed. At times, only a few thousand early humans may have remained. These people were probably under dietary stress, through food shortage and starvation. Surprisingly, people and animals that do not manufacture ascorbate within their systems might have a survival advantage when food is short. Since they did not use essential glucose and energy to synthesize vitamin C, these people may have saved the energy equivalent of a small cup of milk each day. Thus, if we had not lost the gene for vitamin C, our species may not have survived.
In recent times, with the gradual extension of life expectancy, people have experienced an increased incidence of chronic disease. However, thousands of years ago, as our ancestors struggled to survive and reproduce, such diseases were irrelevant compared to finding food and not being eaten by predators. Few prehistoric people lived long enough to suffer the chronic diseases of old age.
For decades, nutritionally aware doctors have suggested that chronic diseases, such as heart disease, arthritis, and cancer, are now common because we have too low an intake of vitamin C. These physicians have made astounding claims for the effectiveness of vitamin C against these diseases. However, conventional medicine has ignored such clinical reports, or explained them away as wishful thinking or the placebo effect. Despite this, reports continue, though they are not followed up with the clinical trials we might expect. A cynical view is that there are scant profits to be made from nutrition compared with those from drugs and related treatments.
Conventional and Orthomolecular Nutrition
The science of nutrition falls into two categories, conventional and orthomolecular. Conventional nutritionists (also known as dieticians, particularly in health settings) consider that vitamins are micronutrients, required in small quantities. Orthomolecular practitioners suggest that higher doses are needed for optimal health. According to the conventional view, supplemental vitamins or nutrients offer few health benefits and may, supposedly, even cause harm. The general message seems to be that, provided we consume a balanced diet, cut down on fats, and eat fruits and vegetables, we will all enjoy optimal health.
Orthomolecular nutritionists consider that nutrition is the primary factor in good health rather than being merely peripheral to drug-based or surgical interventions. They realize that the available information on vitamin C and other nutrients is incomplete. Nevertheless, using vitamin C in high doses, they report that it has a powerful antiviral action, prevents heart disease, and, in large enough doses, is selectively toxic to cancer cells. Orthomolecular medicine is full of promise and excitement and provides a way to break through the major problems facing conventional medicine, and each of us.
Not the End but the Fu
ture
We have followed the story of vitamin C from its evolutionary beginnings to its identification as ascorbic acid in the early years of the twentieth century. Its classification as a vitamin confused conventional medicine into a rigid paradigm, in which only milligram amounts were deemed “necessary.” However, since its isolation, some doctors and scientists have been arguing that people need larger amounts. These doctors were ignored and censored, despite reporting effects for very large doses of vitamin C that are unparalleled in medicine.
The great chemist Linus Pauling put his massive scientific reputation behind the vitamin, after claiming that it might help prevent or treat the common cold. Dr. Pauling’s cold-cure claim caused him to be branded a quack and charlatan. Since then, the public has been made aware of the strange claims and story behind vitamin C, even though the media and medical establishment have done virtually nothing to tell the real story of ascorbate. One way they have deceived the public is by telling them that a gram (1,000 mg) of vitamin C each day is a “high dose” and then reporting that such a “high” dose has no effect on colds or other illnesses. We agree that a gram of vitamin C each day will have little beneficial effect on a cold, but would add that it would be supportive of good health. However, the idea that a gram is a high dose is simply absurd.
Indeed, vitamin C studies have usually involved doses 50–100 times too small, taken at intervals perhaps ten times too long. We have been told that the effects of vitamin C are small and thus only studies that include a placebo control can be considered valid. This is wrong. The claims for high-dose vitamin C are among the strongest scientific hypotheses possible in clinical medicine. The humble placebo could not cause such large effects.
In recounting the story of vitamin C, we have taken a meandering route, including accounts of several physicians and scientists whose work is central to the plot. We have also covered the way science has evolved from an experimental and clinical discipline to what today is almost a branch of sociology dominated by statistical analysis. Without an appreciation of how modern medicine has generated the myth that the placebo has superpowers, it would be difficult to see how this has been used to suppress the direct clinical reports of the effects of vitamin C.