Big vote of confidence for Vitamin C as viral fighter. Now being tested

By Jerome Burne

Last weekend a surprising and remarkable document was published on the web about Vitamin C and its possible relevance for treating patients suffering from a dangerous immune condition (sepsis) that many of the severely infected Covid-19 patients in intensive care units (ICU’s) die from.

It announced that a large global trial involving 7,000 patients, known as REMAP-CAP, that had just begun testing the effectiveness of 19 drugs against the virus, will now include vitamin C as a possible treatment. It describes it as an ‘inexpensive, readily available and potentially lifesaving treatment for patients with sepsis (what kills many Covid-19 patients).

‘Intravenous vitamin C may be the first therapy to mitigate the dysregulated cascade of events that leads to sepsis,’ the document reads. ‘If proven effective, it could be used worldwide and improve outcomes in high and low-income settings alike.’

This welcome decision comes against a background of fierce controversy about whether high dose vitamin C is a plausible treatment or whether all claims that it is useful are ‘Fake Information’ and should be ignored or indeed suppressed.

Closing down information about Vitamin C

Social media platforms such as Facebook and YouTube have been blocking posts that claim benefits for it. The CEO of YouTube explained recently in a TV interview on Fox News that telling people to take vitamin C was contrary to the advice given by the WHO and so a violation of company policy and they would remove it. In fact, the WHO recommends it.

Newspaper articles also routinely dismiss high doses of vitamin C on the grounds that we don’t need much, about a single orange, so any excess will either be peed out or just loosen your bowels. Now that also looks very much like fake news. 

Official NHS bodies have not shown any interest in running any trials on Vitamin C, even though it has little else to directly combat the sepsis – what sometimes happens in serious infections when the immune system goes haywire. 

Survival rates from sepsis in the acute and fatal phase of Covid-19 in both UK and New York Intensive Care Units run at about 50:50 or worse. Meanwhile, a soon-to-be-published randomised trial run in China at the main Wuhan hospital found that fewer patients who were in a critical condition and on ventilators, died when they got high dose vitamin C, compared with those on the placebo – 24% vs 35%.

Contrast that with the anecdotal reports of critical care surgeons at leading London hospitals making jokes about oranges if anyone mentions vitamin C benefits. In the UK it’s seen as just not having the punch needed to fight off something as dangerous as this virus. 

Vitamin C. Multi-tasker for the immune system

Such casual and ill-informed dismissals look set to change as a result of the information in the REMAP-CAP document about what vitamin C does in the body and how it plays a crucial role in the immune system. The boot is now firmly on the other foot. Dismissing it as ineffective or claiming it lacks evidence says little about the vitamin but a lot about the medical profession’s understanding of nutrition.

The hall mark of sepsis is the ‘cytokine storm’ a dramatic rise in both damaging inflammation and the destructive oxidants – produced by a type of immune cell -cytokines – as they battle with the virus. Oxidants can damage the lining of the lungs and blood vessel; this is what kills patients with severe pneumonia, a condition that also kills patients infected with Covid 19.

The natural response of the body to this huge challenge is to produce anti-inflammatory cortisol from the adrenal gland along with vitamin C, which reduces inflammation as well as damping down the oxidants. The adrenal glands, according to new research, contain very high levels of vitamin C compared to the rest of the body. Vitamin C’s multi-tasking abilities also involve repairing the lining of blood vessel and reversing a drop in blood pressure. (Read more)

None of the proposed drugs also being trialled by REMAP-CAP are known to come close to having this range of benefits that specifically help to combat the virus and its effects,

The vitamin C cocktail that can cure

So, the idea that it would be of benefit to patients with sepsis or pneumonia certainly makes sense and an improvement in their chances of survival in UK ICUs is desperately needed. The mortality figure for those on ventilators released by he Intensive Care National Audit & Research Centre (ICNARC) this week puts it at 62% 

One of the pioneering researchers in this area is Professor Paul Marik, chief of Eastern Virginia Medical School’s critical care department. He’s been using a treatment cocktail on seriously ill sepsis and pneumonia patients that combines high doses of vitamin C to support the natural production, along with a drug version of cortisol (cortisone or Methylprednisolone) to create a powerful anti-inflammatory response.  

His reported, but not yet published, results with Covid patients have been impressive and so have those of his colleague Dr Joseph Varon at the United Memorial Medical Centre in Houston. ‘We have a consortium of five intensive care doctors across the USA,’ says Varon, ‘using the same protocol and getting the same results.’ See here for more details.

The two doctors say they have treated a total of 65 ICU Covid patients with the protocol and had just two deaths. Both were over 85 and had diseases that had reached the end-stage. The obvious question is why haven’t senior NHS officials been holding Zoom conferences with Marik and his collaborators to find out what he is doing that the NHS isn’t?

‘The problem is that no one believes us, says Marik.’ It’s too cheap and too simple. If our patients need ventilation, they don’t become dependent but usually can come off within five or six days. 

Benefits in the fight against Sepsis

‘In the last few years my clinic has treated 1600 sepsis patients without encountering any side-effects’ Marik says. The published account of his treatment, mentioned in the REMAP-CAP document, reported a big drop in deaths among those who got his treatment; just 8.5% compared with 40% of those who didn’t. 

But it is not just his combination treatment that that is responsible for the results. ‘What’s key’, he says,’ is recognising that Covid infection comes in two stages each of which needs a different approach.

First, the virus enters the body via the upper part of the throat (nasopharynx) where it starts multiplying rapidly. This can be slowed with half a gram of vitamin C 4x a day plus zinc which stops cells building more viruses and quercetin, which gets the zinc into cells. This is what Marik gives patients, along with Vitamin D, on arrival in hospital.

When the symptoms – cough, fever, sore muscles – appear that means the virus has moved to the lungs, which are becoming dangerously inflamed. At that point, it is vital to immediately infuse vitamin C – three grams every 6 hours – along with the cortisone. This cuts the risk of irreversible lung damage.

Vitamin C champion under attack

Given the weight of promising evidence, it is hard for anyone outside the medical profession to understand why running trials didn’t start weeks ago and why the reaction to the idea is still met with such hostility. 

Marik, like other champions of vitamin C, has weathered a number of attacks on his work, which he believes are driven by a desire to show it is ineffective. 

For example, a recent RCT trial of 167 patients with serious breathing problems caused by sepsis who got his treatment cocktail had been expected to show benefit. But when it was published, the conclusion read: The ‘96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury.’

But isn’t that what happens in science? You may have to watch your beautiful hypothesis destroyed by the findings. But Marik didn’t believe this was pure unbiased science, instead, it was part of a campaign of disinformation. 

Statistics twisted to hide the truth

So, he hit back with a reply entitled ‘How statistics were used to obfuscate the true findings.’ He writes that the paper deliberately made it look as if vitamin C didn’t help with patients serious breathing difficulties or cut the risk of dying. It also made no mention of the lack of side-effects. Paper here, subscription only

‘It was intended to deceptively minimise the role that this potentially lifesaving, safe and cheap intervention may have in the management of patients with sepsis,’ he wrote. What the negative summary totally ignored, amazingly, was that the paper clearly showed that mortality had been reduced by a third in people on vitamin C, just has it had in the Chinese study. A UK professor of Pharmacology, who has seen the paper, comments: ‘The way they got a negative result was by not including deaths in one analysis and then ignoring a drop in deaths in another.’

The inclusion of vitamin C as part of the Remap-CAP is likely to change mainstream attitudes to this research. Another area that needs changing is the assumption that vitamin C is small and low powered, a nutrient that we need in small amounts to stay healthy, which most people can get from their diet. This makes it impossible to believe it could help with patients in intensive care.  

Exactly how it can do that became dramatically clear to me when I read papers by both Professor Marik and a New Zealand critical care expert Professor Anitra Carr at the University of Otago. They revealed something that almost nobody knows, and which might change their mind about Vitamin C if they did.

Infected patients can develop scurvy. But why?

Both reported that about 40% of seriously-ill sepsis patients, also qualify for a diagnosis of scurvy – the classic deficiency disease suffered by sailors 200 years ago whose diets were fruit and vegetable-free. Marik’s colleagues have tested covid-19 patients and their vitamin C level are virtually undetectable

Now that is a puzzling finding for vitamin C deniers, who believe that the amount of vitamin C we need is a constant 70 to 80 mg a day, which you can get from two oranges. It seems implausible that all these patients and been eating like 18th-century sailors. 

So, what is going on? ‘Although the general public isn’t aware of it, critical care physicians have known for over two decades that acute illness results in an acute deficiency of vitamin C, in both the blood and in cells,’ says Marik. ‘If the amount of vitamin C in your blood is really low you are likely to have more severe organ failure and increased risk of mortality.’ 

But why? The crucial fact, that even dietitians and nutritionists, let alone doctors or the general public, are unaware of is that while 80 milligrams is adequate when you are well,  you need 30 to 40 times that when you fall sick. 

Massive doses needed when the cytokine storm hits

During the ‘healthy balanced diet’ phase vitamin C behaves like the staff in a Caribbean holiday resort – in the background, unobtrusively making everything run smoothly.

When a hurricane hits, however, they are the guys you rely on to know what to do and maybe save your life. The same thing happens when you come down with a virus or suffer major stress. It’s known as a ‘cytokine storm’ or sepsis – the troops of the immune system, the leucocytes and neutrophils, become dysregulated and start attacking rather than defending the body. 

Then vitamin C has a quite different and far more demanding job. It is part of the system for taking back control; dealing with inflammation and oxidants and repairing damaged cells. To do that you need large amounts of extra vitamin C, fast. If you don’t get it your natural supplies are used up and you have the equivalent of scurvy.  

Virus lays bare NHS’ flaws

The misunderstandings and bias against vitamin C, highlighted by the virus, has revealed just how dangerously ignorant the NHS is about prevention and nutrition. Nowhere in the pandemic preparations was there any thought that a healthy immune system might be vital for fighting off a virus.

Instead, the response was to outlaw one of its most powerful players. All we could do was wait for the experts to order social changes, deliver – or not – PPEs and tests and come up with drugs and vaccines. The PPEs might help protect on the outside, but you also need something that works inside.

And that’s just a single vitamin. Imagine if a proper knowledge of all the rest involved in the immune system had been deployed to keep front line staff and the elderly well. It is something that would be useful for all of us when lockdown ends.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “The Hybrid Diet” was written with nutritionist Patrick Holford, published 2018. Award: 2015: Finalist for 'Blogger of the Year' Medical Journalists' Association.


  • I’ll be very interested to see what Big Hospital / Big Pharma / Big Egos have to say when the trial is published.

    Another therapy for later stage SARS-CoV2 (a.k.a. covid-19) – just before ventilation becomes indicated, is Hyperbaric Oxygen Therapy, HBOT.
    One wonders why Racing Teams and vacuum cleaner companies etc did’nt look at the easier “invention” of a cheaper single-patient pressure chamber, instead of the more complex invasive ‘Ventilator’ machines.

  • Many thanks Jerome. It’s a really pathetic situation with many NHS doctors and other health practitioners… appalling situation with well regarded nutritional practitioners and doctors hounded and pursued by GMC often for stating the obvious about vitamins …or for suggesting adrenal or thyroid extracts as a therapy.

    B12 or not B12 That is the Question!

    On another controversial matter- a friend who needs B12 injections has been told they are potentially dangerous if he were to catch Covid. ( Blood thickening properties).
    Others have been told that it is risks from visiting surgeries to have them (for staff as well as patients) …… ….
    What is the truth please?
    The NHS treates B12 therapy badly and with distain anyway and the various statements being issued are shedding more shade than light to vulnerable patients as their levels drop and they are refused from having them.
    Thabks in anticipation

  • There is a crowdfunder to deliver Vitamin C, Vitamin D and Zinc to NHS healthworkers

    They have received many messages of wonderful “thank you” from nurses and doctors who now feel more confident to go to work with an enhanced immune system

    Please inform everyone that you can – and give generously !

  • Another great article on Vitamin C. Thank you. Everyone should take a minimum of one gram of vitamin C a day to provide support to their immune and cardiovascular system. At the first sign of any infection/inflammation then 5 grams should be taken and then 1 to 2 grams per hour until symptoms disappear. In Australia there are a number of GPs who will administer vitamin C intravenously but for some reason this is not a treatment allowed in the Uk.
    I have no doubt that if the Vitamin C protocols practised in China and parts of the US were followed then there would be far fewer deaths from Covid 19 in UK.
    I remember in the 1990s, as a CEO of an NHS Ambulance Service in Staffordshire, being taken to task by Hospital Consultants for bringing too many resuscitated elderly patients to the A&E Department. I was reminded that, although the NHS has many targets, it had none for saving life nor for making any patient healthy again.

  • When you say “One of the pioneering researchers in this area is Professor Paul Marik, chief of Eastern Virginia Medical School’s critical care department.” you are not being very precise. Dr. Marik copied vitamin C bit from Dr. Fowler but with a lower dose as I have pointed out elsewhere. So when you say “For example, a recent RCT trial of 167 patients with serious breathing problems caused by sepsis who got his treatment cocktail had been expected to show benefit. But when it was published, the conclusion read: The ‘96-hour infusion of vitamin C compared with placebo did not significantly improve organ dysfunction scores or alter markers of inflammation and vascular injury.’” you must realize that this paper is about Dr. Fowler’s work, the pioneer one. And they have corrected their primary measure although post hoc as I have commented elsewhere too. And if you just avoid methodolatry and take a look at THE most objective mortality measure its results are impressive.

    • Editorial

      Don’t feel i can comment on who did what first but Professor Marik seemed to me to qualify as a pioneer in his readiness to run with using Vitamin C as a treatment for sepsis in the face of considerable professonal hostility. A decision which has proved resoundingly correct. Did you see the presentation by Peter Kory at the US Senate yesterday?

      I understand that there was originally a decision not to make a reduction in mortality the primary endpoint, which would seem to have been a mistake, since that meant that the reduction couldn’t be mentioned in the abstract, making it misleading. Professor Marik had to write a response to point that out.

      I’m pleased (if i understand correctly) that the primary endpoint has now been changed, albeit ‘post hoc’.

      Appreciate primacy is important in most fields but surely what is important about both Fowler’s and Marik’s work is that it is saving lives.

      • Certainly saving lives should be the goal always.

        I suppose you are referring to this (first ascorbic acid mention at 12:45) Dr. Kory’s intervention. It looks like Dr. Kory is the one pointing out the timing issue in Critical Care 2020. Nevertheless his focus in all those videos is in early intervention with corticosteroids and how too late intervention is ineffective. By contrast we have quite delayed interventions like CITRIS-ALI one (and non randomized other ones) where vitamin C by itself in a high enough dose seems to be quite effective. I side with late Dr. Klenner conclusion that “Vitamin C should be given to the patient while the doctors ponder the diagnosis.” Actually I side with the doctor yourself approach of not awaiting for any physician intervention and applying Dr. Cathcart’s approach on first symptoms.

        I must confess too that my bias against corticosteroids are related to too long treatments (certainly longer than 4 days) being responsible of subsequent infections in my father case due to his COPD.

        • Editorial

          I’m not a clinician, obviously, but my understanding of Marik’s protocol, which is what Dr Kory follows, is that it involve giving patients a fairly high orral dose of Vit C on arrival to tackle the infection in the throat as it was starting, but certainly not to give steroids. Then when symptoms started and the infection had moved to the lungs, to increase the vitamin C dose plus the steroids to boost that which the body would be making; the combination would then bring down the inflammation and damp down the oxidants. That sounds like the appraoch you are advocating.

          • Let’s hope Dr. Marik’s protocol is adopted widely but there are lots of physicians who won’t use it until there is clear evidence from RCTs. With respect to that, do you know if there is any RCT around there? It looked like one could have been in the making hearing Patrick Holford (1:13:30) a month ago.

          • Editorial

            There is certainly no research equality when it comes to drugs and vitamins. The cheap vitamins always at the back of the queue. At the moment there at dozens of drugs which have absolutly no evidence that they do anything for patients with covid, although it is vaguely possibly they might. All come with a range of side effects, often severe.

            For vitamin C there is the China RCT which hasn’t yet been reported on, there is an RCT on its benefits for patients with sepsis – something ICU patients often die of by Professor Marik at E virginia Uiversity, a meta-analysis showing a reduction of 25% in time spent on ventilation and and the recent clinical experience involveing several of the USA physicians who are using it – 100 intensive care patients; 2 deaths.

            If you were in ICU, badly affected by the virus and you were offered vitamin C or an antibiotic with serious side effects and no research data at all for covid, Would you say “Guess I’ll wait for the RCT on the vitamim C even though use of the other one is a wild hunch?”

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