Vitamin C in COVID-19 Prevention
This is not medical advice. This is a petition to federal and state governments to urgently publish recommendations for vitamin C intake as a prevention measure against COVID-19.
Introduction
Can vitamin C prevent or alleviate symptoms of acute respiratory tract infections, including COVID-19? (Gorton & Jarvis, 1999) reported 85% decrease of cold and flu symptoms in the test group taking vitamin C, compared with the control group, not taking vitamin C. The test group took vitamin C prophylactically and over the course of disease at 3,000 mg per day (1,000 mg x 3), and an increased dose of 6,000 mg (1,000 mg x 6, hourly) on the first day of symptoms onset. This specific regimen is important: taking a moderate amount of vitamin C prophylactically and during illness, and a larger dose on the first day of symptoms onset.
There is a caveat. The dosage in this study is 1.5-2 times higher than what doctors feel comfortable recommending to the public, as far as I see. Nevertheless, the research reviewed below supports the conclusion that 1.5-2 times lower doses help against broad class of ARTI, including colds and flu, although expectably less. COVID-19 is an acute respiratory tract infection (ARTI). The reasonable assumption is that what helps against multiple prior viral ARTI would help against COVID-19.
Vitamin C Role in the Immune System
Vitamin C does not prevent infection, but it helps the immune system combat it. It has been shown to alleviate symptoms, sometimes to the point where symptoms are not detectable. Thus, a person can feel as if s/he never got sick, since no symptoms ever presented, and may count this as having prevented the illness.
Vitamin C, at its normal level 70 μmol/L, is a necessary part of the immune system. Excess vitamin C intake (over 200 mg/day) is normally excreted in urine. But when a body experiences physiological stress, it consumes the vitamin C present in the blood and thus, needs an increased intake (Hemilä, Vitamin C and Infections, 2017). All existing studies agree on this point. Observations have shown that in such conditions even many grams of vitamin C per day are neither excreted nor accumulate in blood.
(Hemilä & Chalker, 2019) listed several studies, showing that vitamin C levels drop in patients hospitalized with acute respiratory infections to less than 10-35% of the normal level. (Carr, 2017) found that all ICU patients in one hospital had less than on third of the normal vitamin C level.
The rationale behind discovered Vitamin C supplementation
When a person gets a viral respiratory infection, the body starts fighting it using the vitamin C present in the blood. That decreases vitamin C levels in the blood, impairing the immune system, even before the symptoms appear. But if it regularly receives extra vitamin C, it stops excreting it, but consumes in fighting the infection. In the most successful regimens (Ran, 2018), symptoms are used as a signal that the body requires even more vitamin C in order to maintain normal vitamin C blood levels while consuming more of it in fighting the infection. That justifies increased intake of it on the first symptomatic day and until the body overcomes the virus. This time might be shorter than the period for which symptoms exist. The first symptomatic day might have a special significance, possibly because it is when the body have not produced enough antibodies specific to the virus.
Safety
The human body has natural safety valves for vitamin C. First, excess of it is removed in urine. Second, it typically causes diarrhea before getting close to potentially dangerous levels.
(National Institute of Health, 2020) confirms safety of vitamin C:
Vitamin C has low toxicity and is not believed to cause serious adverse effects at high intakes. The most common complaints are diarrhea, nausea, abdominal cramps, and other gastrointestinal disturbances due to the osmotic effect of unabsorbed vitamin C in the gastrointestinal tract.
Possible Vitamin C Regimen
This is a possible Vitamin C regimen against COVID-19, for adults.
- 500 mg 2-3x per day, prophylactically
- 1,000 mg 3-4x on first day of symptoms onset and until some symptom relief is observed
- 500 mg 2-3x per day until full recovery
Some doctors recommend taking the higher dose only on the first day of symptoms onset. The dose is for an average 70 kg person. Those weighing much more or less should adjust proportionately. Older and non-healthy persons (i.e., the most at-risk group) should consult their physicians
Possible contra-indications: some kidney diseases, chemotherapy and radiation treatments, cholesterol lowering drugs, diabetes in postmenopausal women (National Institute of Health, 2020). For other people, diarrhea is a sign to decrease or stop taking vitamin C.
It is not expected to completely protect against the Wuhan coronavirus or to approach the effectiveness of HCQ + Zn prophylaxis.
I remind that this is not medical advice, but a starting point for CDC/NIH/FDA and state governments to develop the medical advice. Follow your doctor’s recommendations.
Vitamin C Controversies and Misconceptions
Some confusion surrounds the use of vitamin C because different amounts are used for different purposes and produce different results. The officially recommended minimum intake of vitamin C 75-90 mg per day is just that – the minimum, established long ago to prevent scurvy. Many people exceed this amount simply by eating ordinary food; a medium orange contains 70 mg of vitamin C.
Studies with vitamin C supplementation of less than 1 g/day have shown little or no effect on respiratory infections. This was a cause of the confusion among medical professions. At such amounts, “control” group’s vitamin C intake was not controlled and might have exceeded the amounts taken by the intervention group. Also, low level vitamin C supplementation might provide benefits too low to detect. That might have caused confusion among medical professionals. Further, most studies gave vitamin C either prophylactically or during illness, but not both (Hemilä, Vitamin C and Infections, 2017).
On the high end, mega-doses of vitamin C (like tens of grams per day), delivered intravenously in hospital settings, is successfully used in treatment of many serious diseases and conditions, including late stages of severe cases of COVID-19. They are used for patients with sepsis (Kashiouris, 2020) and acute respiratory distress syndrome. Such doses and associated treatments are beyond the scope of this article.
Thus, this review is only concerned with vitamin C doses of 1 – 3 g/day prophylactically, and 3 – 6 g/day during ARTI. Such doses have been shown helpful in easing ARTI, and safe for almost all people.
Studies Review
Peer Reviewed Papers
(Hemilä, 2017) is a meta-analysis of multiple studies. It concludes that vitamin C is helpful against many infections, especially the common cold. The study suggests a linear dose – effect function up to 6-8 g/day.
(Hemilä & Chalker, 2019) is another meta-analysis. In 12 trials, totaling 1766 patients , vitamin C, given during the time of treatment, reduced ICU stays by an average of 7.8%. The vitamin C doses were relatively small, 1-3 g/day. (In four studies, higher doses were used, but those studies were either excluded from the meta-analysis (Dingchao 1994) or given very low weight in the calculations (Tanako 2000, Fowler 2014, Zabet 2016)). In this studies vitamin C was given too little too late.
(Marik & Hooper, 2017) explains that vitamin C acts like a “stress hormone”. Most vertebrates synthesize their vitamin C and increase its production during physiological stress. Humans, as well as primates and guinea pigs, are exceptions to this rule. Therefore, we need to obtain vitamin C from food or supplements, and we may need to increase our intake in times of physiological stress.
(Colunga Biancatelli, Berill, & Marik, 2019) explains concepts behind vitamin C antiviral benefits. Unfortunately, they cite a 2013 review by Hemilä et al., which did not find benefits of vitamin C supplementation, as explained above. The more recent meta-analysis (Hemilä, Vitamin C and Infections, 2017) has firmly established evidence of such benefits.
(Ran, 2018) is a review, showing benefits of taking daily vitamin C supplements before and increasing the dosage when common cold occurs. It proposes a regimen of taking 1 g/day prophylactically while healthy and 3-4 g/day while having a cold.
Non peer reviewed sources
Beneficial effects of vitamin C supplementation have been reported for
Elderly people with acute respiratory infections
Recurrent acute respiratory distress syndrome
Reducing the severity and duration of the common cold
Reducing the length of hospital stay and symptoms in elderly patients with pneumonia
Reducing the duration of mechanical ventilation in people in ICU
Preventing the common cold in people who are vitamin C deficient
Preventing the incidence of pneumonia in people who are vitamin C deficient.
Studies have shown that excretion of vitamin C is decreased during infections, such as the common cold, suggesting that more is utilized during times of need.
COVID-19: Prevention and Treatment, Vitamin C (cihs.edu, Michelle Fauver, Ph.D.):
If you choose to supplement with vitamin C as a preventive, you might want to start with 2 grams a day administered orally
To use vitamin C supplementation as a treatment for colds or flus (remember we still have the flu going around), the best results have been obtained by administering 6-8 g (6,000-8,000 mg) immediately upon appearance of the first symptoms, then continuing that dose daily until the symptoms subside.
8 g/day is likely to cause diarrhea.
Remarks
- The effect of prophylactic doses of vitamin C in COVID-19 infection have not been quantified. But even if the effect were small (and there is no reason to think that it is small), when the infection spreads exponentially, it decreases the exponential coefficient. It is a possibly large impact, at a miniscule cost, with almost no risk. Further, vitamin C seems to help the immune system to decrease the viral load even if it does not alleviate the symptoms.
- Taking vitamin C is not the only helpful prophylactic measure receiving less attention than it deserves. Another research piece shows similar benefits of cod liver oil, used in this country for hundreds of years, or its equivalent – a diet rich in wild caught salmon or mackerel.
- Physiological stress is not the same as psychological stress. I do not know whether lockdowns and forced social isolation cause physiological stress.
- While it is not the role of the federal government to recommend diets and vitamin supplements, Google and Facebook delete and hide information about potentially effective COVID-19 prophylactics and treatment, if it does not come from WHO or a government. Thus, to allow such information to reach the public, the federal government should either rein in Google and Facebook, or itself make the recommendations.
- I prefer the name Wuhan coronavirus the COVID-19 pathogen. This is where the virus was detected first. The name SARS-CoV-2 is associated with SARS of 2003, which had a much higher mortality ratio. This association is misleading and causes unnecessary panic.
- To avoid the appearance of bias, I excluded from this review most known enthusiasts of the vitamin C. I also did not rely upon the peer-reviewed Journal of Orthomolecular Medicine, although it is a recognized medical journal, and included in multiple indexes.
- It is impossible not to mention Linus Pauling in this article. I do not know whether he was right or wrong about vitamin C. It might be that some of his ideas were correct, but explanation and/or clinical recommendations were not.
- A medical group of Eastern Virginia Medical School, headed by Dr. Paul Marik, has developed and published its own COVID-19 prophylactic regimen, including vitamin C, Zinc, and Quercetin. It is occasionally mentioned in comments on this site.
References
Carr, A. (2017). Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes. Critical Care. Retrieved from https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1891-y
Colunga Biancatelli, R. M., Berill, M., & Marik, E. P. (2019). The antiviral properties of vitamin C. Expert Review of Anti-infective Therapy. Retrieved from https://www.tandfonline.com/doi/full/10.1080/14787210.2020.1706483
Gorton, H., & Jarvis, K. (1999). The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. Journal of Manipulative and Physiological Therapeutics. Retrieved from https://doi.org/10.1016/S0161-4754(99)70005-9
Hemilä, H. (2017). Vitamin C and Infections. Nutrients. Retrieved from https://doi.org/10.3390/nu9040339
Hemilä, H., & Chalker, E. (2019). Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients. Retrieved from https://www.mdpi.com/2072-6643/11/4/708
Kashiouris, M. (2020, January 22). The Emerging Role of Vitamin C as a Treatment for Sepsis. Nutrients. Retrieved from https://www.mdpi.com/2072-6643/12/2/292/htm
Marik, P. E., & Hooper, M. H. (2017). Vitamin C and Sepsis, Response. The Chest Journal. Retrieved from https://journal.chestnet.org/article/S0012-3692(17)31252-7/fulltext
National Institute of Health. (2020, February 27). Vitamin C. Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
Ran, L. (2018). Extra Dose of Vitamin C Based on a Daily Supplementation Shortens the Common Cold: A Meta-Analysis of 9 Randomized Controlled Trials. BioMed Research International. Retrieved from https://doi.org/10.1155/2018/1837634
Discover more from Watts Up With That?
Subscribe to get the latest posts sent to your email.
People claim that now all the time but haven’t not looked at the detailed function. The role of vitamin D in the immune system is to repress the immune response and it is therefore very important in the context of autoimmune diseases.
Fighting viruses… not that much.
Vitamin C does a lot of good things but the jury is out on any extra benefit for viral disease other than it is good to have a healthy body. We get more than enough with a healthy diet and anything extra is wasted hope against the past trials which showed no extra benefits.
Zinc and Chloroquine at least have a postulated mechanism and some more than anecdotal results.
–
When people use excuses like
“This may mean that more studies with negative results have been systematically included for
analysis, thereby contributing to the lack of significant positive effect for all but one primary outcome”
in a review of a Cochrane study essentially showing no real benefit.
Translation “if you exclude the negative studies you may have a positive effect” it leaves
a slightly unsatisfactory scientific feeling.
–
Look if you like vitamins, take vitamins, but trying to attach benefits without either proof
or a mechanism is medically not on.
The idea is well presented, the arguments have a circular consistency but the fact is that this
article really needed the caveats of alternative medicine and opinion only that were
attached by the author.
For 2020 the USA has an “excess death” rate about 5.5% (50,331) higher than the previous 4 year average for weeks 1 to 16. As a comparison I checked the first 16 weeks of 2018 compared to the previous 4 year average and it was 7.2% (63,260). I’ll update as more data becomes available on the CDC web site.
The script and all related files are here if you want to kick the tires:
https://www.dropbox.com/sh/fh9x5fngmfbeiiu/AAAH-OtOMqiY_R9qqG6YccCRa?dl=0
Recently Yoram Lass (formerly director-general of Israel’s Ministry of Health) gave an interview and said “total deaths” was the only way to look at it.
https://www.spiked-online.com/2020/05/22/nothing-can-justify-this-destruction-of-peoples-lives/
“Mortality due to coronavirus is a fake number. Most people are not dying from coronavirus. Those recording deaths simply change the label.”
“The only real number is the total number of deaths – all causes of death, not just coronavirus.”
TRM-
I agree with you that total deaths is probably a better way to determine the effect of COVID-19. However I don’t understand what you are trying to say in the first paragraph of your comment. I tried to go to the CDC website to look at the data myself, but like all government websites I’ve looked at, it was maddingly hard to find the data you seemed to be using.
Would it be possible for you to provide a link to the CDC data you are using, so that data junkies like myself could have a look at it. It might get some discussion going.
Thank you Leo Goldstein and Anthony for this article. Excellent review and excellent reminder that all things government, Facebook, Google, etc., try to prevent us from thinking for ourselves given the evidence – collected according to the scientific method.
You had a critic above about the topic. I like: About Watts Up With That? News and commentary on puzzling things in life, nature, science, weather, climate change, technology, and recent news by Anthony Watts
My dr refused a prescription for HCQ; “not tested” “no scientific evidence.” So I am doing my best in preparation for a trip. I like the EVMS recommendations. Thanks for adding to my knowledge on Vit C with all the research articles.
erapy-for-covid-19/
Excellent review of Hydroxychloroquine see “Yale Epidemiology Professor Urges Hydroxychloroquine & Azithromycin Early Therapy for COVID-19”
http://covexit.com/yale-epidemiology-professor-urges-hydroxychloroquine-azithromycin-early-th
Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa093/5847586
Where is the Zn?? The article sounds promising to some extent but is not well written. No numbers results etc.
This is criminal misinformation.
Zinc, Vitamin D, K and Folic Acid are what alleviate a large proportion of the symptoms.
Taking C just puts stress on your kidneys.
I agree
If what you write is criminal disinformation then why write it /sark.
A goat of 80 kg produces ca. 15g of vitmin C from sugar per day. What is the exact reason why a goat needs large amounts of vitamin C while the same amount taken by a human is dangerous.
I have taken ca. 10 g per day for several years without any side effects. The criminal offence of doctors is to tell the public that the minimum amount required to avoid scurvy is what we need. We need much more than the 70 mg of the RDA. How much 5g, 10g or 18g ( Linus Pauling) is an open question but probably we need at least ca. 50 times the RDA every day.
The comment else where that all surplus vitamin C is pissed out is roughly as intelligent as telling a patient that he/she drinks too much water because urine is produced.
Vitamin C is extremely inexpensive so who cares?
An interesting post about Vitamin C turned up at comp.risks. V31no91
https://catless.ncl.ac.uk/Risks/31/91
It is far too long to post here. It is a paper on the use of Vitamin C published in August 1949. It discusses dosage and the differences in deliverable types of C. Note that the doses are HIGH for curative use. Starting dose is 1000mg multiple times per day. 1000 mg *of C* is 20,000 IU of C. (An IU of D is much smaller: look it up.)
Dr. Klenner used C against a range of viral diseases and it worked!
It appears that high blood levels of D are prophylactic. (Search ‘Indonesia Vitamin D at ssrn.com for a recent and scary paper). C is apparently both prophylactic and curative.
I am not a doctor, not even on TV, and did not stay in a hotel last night so this advice is worth what you have paid fot it
Back in 1985 I was training at HMS Vernon to be a RN Clearance Diver, during the winter (84/85) there was a high prevelence of a nasty cold/flu bug going round. As most of the other non-diver ratings on the base succumbed to the virus, and the sickbay filled up, questiones started to be asked why non of the Diver ratings were infected.
Any respiratory virus has serious implications for Divers who mite lose their Special Service Pay if they couldn’t dive due to ‘ears’ (Blocked eustation tube due to excess.mucus) so the task had been put to a group of Diving Dr’s to find the best preventative they could from the literature.
The recomended solution was to take a high dose of Vit C (8-10g) along with the regular daily recomended dose of Zinc. Enterprizing chaps within the branch requisitioned as much ‘harry limers’ (Powdered lime juice) as possible, we had urns of the stuff all over the diving section, and more at Horsea Island (a satelite base where opperational training took place). Nobody within the beanch lost any Special Service Pay.
To this day I have a stock of Vit C and Zinc in my medicine cabinet, if I come into contact with anyone with cold/flu symptoms I start chucking down the Vit C and regular dose of Zinc. I’ve only had a cold once since 1985, I was on holliday with no supply of vitamins!
your Aye, Lurker AB (D) V.D. Scar & Bar
Eustachian tube.
As an undergrad, I participated in Pauling’s attempt at controlled experiments with different dosages. Students make good lab rats. My dose was five grams per day. I caught a cold but got over it quickly.
5gms of what?
Assume vit C. Make sure to be up on your vit D.
We’ve learned SO MUCH since the WuFlu that will save lives.
Taking EGCG green tea, quercetin, small amounts of Zn (10 to 15mg) will make it very hard for any RNA viruses to take hold.
Vit D is essential esp in winter. I recommend at least 4000 IU. I take 6000IU plus.
Direct sunlight reduces skin cancer
Indirect sunlight is not healthy, since the UVB (smaller wavelength) is filtered out, which lets UVA pre-dominate and UVA goes deep, does not tan, and disrupts the DNA. UVA goes through glass and so if you do not get UVB which creates Vit D and brings out melanin which is protective, the UVA is more damaging!!
Sunscreen is a false safety mechanism. It stops burns, stops UVB (the good stuff) and allows UVA to do its damage deep down.
Good informative post. Vitamin C is very important, as is everything else. I try and eat a couple of oranges a day, just for the fibre, and to try and get a natural input of Vitamin C.
My Dr. and nutritionist says it is best to obtain all vitamins and nutrients through a good well balanced diet if possible, so should be priority #1, although when known you are or will be in deficit, then supplemental concentrated dosing is the next preferred method.
Eating a healthy diet is much more than just getting the correct dosage, since it is all about being able to absorb and retain these vitamins and nutrients with the right concentrations of everything else, i.e. fibre, protein, carbs etc since the liver and digestive tract control how such is integrated into proper bodily retention and function. My GP says it is everything else going on at once correctly that assists in having a healthy immune system, such as healthy diet, exercise/sunlight, personal, family and social life, stress and financial factors, just to name some of the more important ones. Mental health also being a top contender to keeping ones body functioning properly, which also requires a healthy balance of all of the above.
While taking quality supplements may certainly assist assuming they are properly manufactured to begin with, (some vitamin/nutrient manufacturers have been found to be deficient-Made in China crap) this should be a back up plan, and on occasion when getting sick, the time to take supplements to fill in temporally after having tried firstly to having a proper balanced diet and life so that one is already healthy and ones immune system is in tip top shape from the get go. I suppose this is a wholistic point of view, but one that is hard to argue with. But life is hardly or rarely perfect, especially in the depths of winter, or on a lock down pandemic with everything going wrong at once and everyone depressed with the global state of affairs. When all this is very hard to achieve, then is a time to supplement additional vitamins and nutrients to hopefully keep the tank full since staying in perfect shape with everything always firing on all cylinders seems to be a near impossibility for most of us.
Your point is well taken, I think. Something I started doing a couple of years ago is consuming 2 to 3 different juiced veggy and fruit powders, with about 50 plus different foods.
The paragraph “Vitamin C Role in the Immune System” unmistakbly implies that Vit C will create more asymptomatic carriers. I’m not sure this is a desirable message.
“It is not expected . . . to approach the effectiveness of HCQ + Zn prophylaxis.” So HCQ skeptics should expect nothing from Vit C either? This seems like an unnecessary remark.
Thanks for bringing attention to this. I suggest that people who are serious about optimizing their resistance to infections also (in addition to nutrients like C, Zinc etc.) also study the immune-function aspects of hormones (e.g. estrogen melatonin), thymus gland products, heat-shock proteins, digestive health, and activity, at a minimum. Severely at-risk people may also want to investigate Ozone-therapy. There also many compounds that are likely to be beneficial such as quercetin and lithium.
Just tried to share this story on Facebook and they pulled it and banned me from posting for 24 hours. They later pulled back on their “banning” threat in case my posting was a “mistake”
This is a definitely not fake news or some crank e-mail.
It is a report from a highly qualified doctor Dr Jackie Stone MBChB (cum laude) (UCT), BSc (Med) Hons, (Medical Biochemistry) (UCT)MRCP (UK), D Av Med (UK), FRACGP (Aus), FACAsM (Aus)31st March 2020
She has had great success with over 50 patients who were suffering from the Corona Virus.
She is in Zimbabwe where there is little in the way of drugs etc..
Regards,
Dennis Hoines
Attached, fifty recent Covid-19 patients nebulising with silver (Ag+) particles; ALL responded exceptionally well with Ionic Colloidal Silver.
Dr Jackie Stone, nebulising Covid-19 patients: you can watch her recent 70-min talk on https://www.youtube.com/watch?v=byxluN5uplc
Sadly, the history of Vit C and the medical profession is full of examples of solid scientific research being ignored, misrepresented, or simply misapplied. One poster above referenced goats and their internal C production. Adult gorillas which, like Homo sapiens don’t synthesize C, consume enough dark green leaves to cover their required 12 to 15 gm of C per day. Much research on the vitamin requirements of primates was done during the 50s and 60s at University of Texas. The head of the Chemistry dept Dr Roger Williams did incredible work with his team. Read the document written by colleagues of the ACS for an eye opening history of his research.
Among other things, research on guinea pig twins showed that identical twins can vary 100:1 in the amount of C needed for the same blood level. Guinea pig twins are or were produced through mechanically stimulating a fertilized egg causing it to bifurcate.
The vitamin C genes of tarsiers, monkeys and apes are broken. Lemurs and lorises retain intact genes.
Guinea pig and capybara (South American rodents) genes are broken in a different way, and those of some bats in yet another.
Tarsiers eat insects. They’re the only strictly “carnivorous” primate.