There is a case for treating virus victims with vitamin C, say UK intensive care experts

By Jerome Burne

Amid the wall-to-wall discussion about ways to cut your risk of becoming infected by the virus by changing your behaviour, there is rarely any mention of improving your immune response with informed use of nutrition and vitamins.

In fact, various experts have been claiming that there is just no way to boost your immune system and suggest instead the familiar, but discredited and simplistic nostrums, of five-a-day and eating a healthy, balanced diet.

One option, which regular readers will know I’m keen on, is generous amounts of vitamin C, both as a plausible way of cutting your risk and of treating badly infected patients in intensive care. It is, after all, a key player, along with other nutrients such as vitamin D, zinc and selenium, in controlling and activating various parts of the immune system.

One reason for the remarkable official silence around this approach could be because I have taken a very wrong turn and it is, actually, useless. Or it could be the result of the ingrained belief of most of the medical profession that vitamins are not really effective for anything except preventing deficiency disorders – scurvy, rickets – and the like. 

This could be a game-changer

Regardless of why it has been pushed to the fringes, several senior clinicians who are treating seriously affected COVID 19 patients in UK adult intensive care units (ICUs) have become increasingly interested in this novel approach that promises to help rebalance their immune response.

I have been talking to them and I believe their involvement could be a game-changer, as drug PRs are fond of describing a new product. It may be possible to dismiss the claims about the vitamin by such medical lowlife as nutritionists and journalists, dismissing front-line experts does require a more convincing rationale for rejecting the idea than we have been offered so far.  

Our bodies respond to any kind of threat or challenge, such as an infection or stress, by triggering inflammation that alerts the immune system. But this defensive response can become damaging.  When a serious viral infection strikes, it can rapidly push inflammation up to dangerous levels – known as sepsis or a cytokine storm. 

This needs to be damped down fast and one of the body’s most effective anti-inflammatories is vitamin C. Some critical care experts have been testing it out as a possible treatment because many Covid 19 die from sepsis.

Vitamin C being used in an ICU in London hospital

Several months ago, it was announced that the vitamin had just been included in a big global project known as REMAP-CAP, that is running controlled trials of possible treatments, nearly all of the drugs. The UK arm of the vitamin C trial is just getting underway at the Royal Surrey County Hospital. 

ICU patients (depending on their weight) will be getting around 3 grams – 3000 milligrams – intravenously four times a day for four days. This is many times more than the RDA (recommended daily amount) of 90mg for men and 70mg for women. 

 One of the champions of giving patients vitamin C, along with higher than usual doses of other minerals and vitamins that the immune system needs, is Dr Marcela P. Vizcaychipi. She manages the ICU at Chelsea and Westminster Hospital in London and added intravenous vitamin C to the standard treatment package as soon as Covid 19 patients started arriving.

‘I learned medicine in a small hospital in North-East Argentina in the late 80’s’ she told me ‘where we didn’t have any of the brilliant hi-tech equipment we use now. Often the only treatment for badly infected patients was good nutrition and mineral and vitamin supplements to stabilise their system. I saw first-hand how effective that could be.’

Give Vitamin C early and keep giving it

The survival rate for patients in Dr Vizcaychipi’s unit at the Chelsea and Westminster is among the best in the country – a death rate of 32.7 percent compared to the official UK average in ICUs of 40.9 percent, according to an initial report of the unit’s work published online in May. As well as standard care, patients got blood-thinning drugs and vitamin C.

‘We started patients on 2 grams of intravenous vitamin C twice daily when they arrived and that continued until they left,’ she says. This is over 20 times the RDA (recommended daily amount). It is not yet possible to calculate how big a difference vitamin C made to her patients, because of the other treatments they were getting. 

The big REMAP-CAP trial comparing vitamin C to a placebo is intended to show that. ‘All we can say for certain now,’ she says, ‘is that it could have contributed to our lower mortality rate.’ 

Professor Iain Whitaker is an intensive care expert who believes there is enough evidence for the benefit of high doses of vitamin C to start taking it seriously.  He is Chair of Plastic and Reconstructive Surgery and Surgical Speciality Lead for Health and Care Research Wales.

Good evidence that vitamin C can help.

He’s been researching its role in the immune system.. ‘It started as an academic exercise,’ Whitaker says. ‘When the epidemic began, we surgeons became less busy because resources switched to dealing with those who were badly infected. So, my team started trawling the literature to find reports of additional treatments that might help them.

‘We discovered good evidence from trials showing that vitamins C, D and B 1 (thiamine) can treat other infections that cause breathing difficulties, such as sepsis or pneumonia, which many Covid 19 patients develop.’

Whitaker’s says his systematic review of the evidence, due to soon be published in the journal ‘Nutrients’, shows there is enough to justify intensive care units at least considering adding it to standard treatment with ventilation, drugs to raise blood pressure and antibiotics.

The big hope is that the global REMAP-CAP vitamin C trial, just one of nearly 20 trials of other treatments, all drugs, will prove it works. The head of the UK end of this massive project is Professor Tony Gordon, a consultant in Intensive Care Medicine at St Mary’s Hospital in London. 

Vitamin C’s major role in the immune system

‘A growing body of evidence suggests that vitamin C is an inexpensive and readily available treatment that is potentially lifesaving in sepsis,’ he explained. ‘But it is not conclusive, and we need clarity.’ Those in the trial will just get vitamin C or a placebo added to regular treatment.

The idea is that treatments which calm down the sepsis caused by other infections should help against the virus. However, there are concerns that the length of time the patients will be getting the vitamin – just four days – may not be nearly long enough to demonstrate benefit. Units that have used it successfully have given it for much longer.

When you get infected your body becomes a battleground between the rapidly multiplying virus and the defence mounted by the white cells of the immune system. 

Vitamin C plays a major part in keeping the immune response strong but without tipping over into sepsis. According to research collected by REMAP-CAP, it stimulates the production of white blood cells (leucocytes), such as T-cells and NK killer cells, and can also damp down excessive inflammation. 

Men might benefit more from vitamin C than women. The current issue of Nature suggests that the reason women are more resistant to the virus is because women’s T cells mount a more ‘robust and sustained response’ than men’s do. Vitamin C could compensate for this.

Interestingly, it is also involved in the production of the natural anti-viral compound interferon. Recently, preliminary results from a trial giving a synthetic version of inhaled interferon beta to patients reported very promising results against the virus. 

Unlike most animals, humans can’t make vitamin C

Unfortunately, Public Health England (PHE) doesn’t seem aware of any of this evidence,which strongly suggests that, since the vitamin is very cheap, very safe and there is nothing else, it could well be worth running some trials. 

The organisation responded to a parliamentary question in June with this statement: ‘Public Health England is not aware of any robust evidence that vitamin C can ‘boost’ immunity or prevent or treat infection.’ The famous Mayo Clinic in America is equally uninterested, saying that high doses have the potential to cause nausea, diarrhoea and abdominal pain.

PHE’s dismissal is based on a review of the evidence for benefit by SACN (Scientific Advisory Committee on Nutrition) which relied on just three papers – the only ones, the committee reported, it could find. 

Experienced nutritionist Patrick Holford, who is one of the authors on Professor Whitaker’s review, has seen SACN’s report and describes it as ‘very poor’. He goes on to say that: ‘The claim that its members could only find three relevant studies doesn’t inspire confidence. It took a quick PubMed search to  find over 40. What’s more, SACN misrepresented the studies it did find. Rather than containing no evidence, they showed its effects were worth investigating further.’ 

One search result, for instance, said that being deficient meant you were more likely to develop ‘severe respiratory infections’. A second that deficiency would result in a poorer immune response and increase the risk of infection.  

The committee also ignored studies of intravenous vitamin C given to seriously infected ICU patients. One meta-analysis, for instance, has found it significantly reduced time on a ventilator. 

Professor Whitaker believes PHE’s response is based on a misunderstanding. ‘It ignores the fact that when you are sick you need much more vitamin C than when you are healthy,’ he says. 

Demand for Vitamin C goes up as an infection gets worse

Increasing vitamin C production is something nearly all animals can do but humans and other primates have lost this ability. This is a point made in the introduction to REMAP-CAP which says that: ‘Vitamin C is a key circulating antioxidant, but it cannot be made by humans.’ 

The implication is we need extra from outside. ‘When you are in the grip of serious infection,’ says Whitaker, ‘your body needs a constant supply of vitamin C to help bring down dangerously high inflammation that could trigger sepsis.’ 

Evidence for the benefit of vitamin C in treating sepsis comes from research published two years ago in Critical Care journal by American critical care expert Professor Paul Marik, chief of Eastern Virginia Medical School’s critical care department. 

He found that nearly half of the sepsis patients in his ICU had a vitamin C level so low that they would normally qualify for a diagnosis of scurvy. They needed 12 grams twice a day to correct the deficiency.

A drug and nutrient cocktail that gets results

Marik uses a cocktail of drugs and supplements on seriously ill sepsis and pneumonia patients. They contain high doses of vitamin C to reduce inflammation and damaging oxidants along with a steroid (Methylprednisolone) to boost the anti-inflammatory effect, His unit, and another using the same protocol, have reported just eight deaths in over 121 Covid 19 patients; all were aged 80 and over with serious chronic diseases. His published 6.6% mortality rate is the lowest recorded in ICUs in the state of Virginia. 

Both Marik and Vizcaychipi take vitamin C daily for prevention – a gram or two – and recommend increasing the dose two to three times at the first sign of infection. You’d have to eat hundreds of oranges to get that much.

Dr Vizcaychipi is part of a network sharing information between 30 or more clinical care groups. Her reports of Vitamin C use have sparked considerable interest, a few have said they are putting their Covid 19 patients on three grams a day. 

A cheap and safe way for the government to show it was ‘following the science’ would be to pick up on this research and ask the experts to test it out in a series of trials.

For more information, see Holford’s book at www.flufighters.net which is due to be published in China.

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.

3 Comments

  • The “experts” may well, eventually, after having been dragged kicking and screaming, do a trial. However, the trial will be designed to fail. That’s my prediction. Just ask professor Marik.

    • Editorial

      Absolutely. The REMAP-CAP trial of Vit C is giving it for only 4 days. Why would that be? Especially if the patients were improving or stabilised? Critical care physicians who do used it give it for much longer.
      Dr Malcolm Kendrick and Professor John Ioannidis among others have detailed how how trials can be fixed and how widespread it is.
      But then what is the alternative?
      Assumptions about best diet for diabetes has changed as a result of non-institutional trials. And dogma about benefit of of low fat has been succesfully challenged independent researchers and clincians. Long shot would be to give trials of treatments an infusion of democracy – patient participation.

  • Note that they’re only giving Vit C to patients AFTER they’ve become so ill they’ve been admitted to the ICU. Maybe if they put the patients on IV C when first admitted to hospital they wouldn’t need to be in ICU at all. I too question whether 4 days treatment is sufficient, but equally concerning is the implication that they’re going to stop the high-dose IV C abruptly, ignoring Linus Pauling’s warnings about rebound scurvy and the need to wean the patients off the high doses. In the flawed Mayo Clinic trial that claimed to disprove Cameron & Pauling’s findings on C and cancer, Mayo’s patients started dying only after their C was stopped abruptly.

    If you want to see a doctor denying the evidence check out the video on YouTube about the NZ farmer suffering from swine flu who was brought back from death’s door by IV C. The doctors wanted to turn off his life support but his family insisted they give him IV C. He started to improve, then another doctor took over and stopped the IV and he began to deteriorate. It took the threat of legal action to get it restarted and he once again began to recover. Then he was transferred to another hospital and yet another doctor stopped the IV. Interestingly when he recovered from the swine flu his cancer had also miraculously disappeared. You’d have thought this would have been greeted with excitement – a cure not only for swine flu but also cancer. But no, it was a case of “Move along please, nothing to see here”. (The cancer may have been eradicated by the infection-primed immune system rather than the C, see Coley’s Toxins)

    When NZ’s 60 minutes program interviews one of the “experts” he denies the patient’s recovery has anything to do with the IV, it’s just coincidence – it “might as well be caused by a bus passing the hospital”. Honestly, it’s so absurd you couldn’t make this stuff up. These doctors are so wrapped up in their egos they’d rather see the patients die than be proved wrong.

    What’s the difference between a doctor and God? God doesn’t think he’s a doctor.

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