Why Does Science Still Ignore Vitamin C? From colds to Covid, ascorbate has long been marginalized | 為什麼科學仍然忽視維生素 C? 從感冒到 Covid,抗壞血酸早已被邊緣化

FOR IMMEDIATE RELEASE
Orthomolecular Medicine News Service, May 18, 2022

by Pim Christiaans

OMNS (May 18, 2022) For more than 20 years, Dr. Harri Hemilä, biochemist, physician and epidemiologist, has been analyzing research conducted with vitamin C. In 2017, ORTHO magazine had an interview with him. [1] At that time, the interest in vitamin C was mainly about the common cold. Now it also concerns another virus infection, Covid-19. Has anything changed since then? The near-total lack of interest within medical science for vitamin C still exists. And apparently, medical professors don’t give a damn about the vitamin, as if it were a career killer.

OMNS(2022 年 5 月 18 日)20 多年來,生物化學家、醫師和流行病學家 Harri Hemilä 博士一直在分析用維生素 C 進行的研究。2017 年,ORTHO 雜誌對他進行了採訪。 [1] 當時對維生素C的興趣主要是關於普通感冒。 現在它還涉及另一種病毒感染,Covid-19。 從那以後有什麼改變嗎? 醫學界對維生素 C 幾乎完全缺乏興趣仍然存在。 顯然,醫學教授們並不在乎維生素,就好像它是職業殺手一樣。

Since 2002, Hemilä has considered it his professional duty to analyze studies conducted on vitamin C and to publish the analyses. What is the common thread after more than a hundred scientific publications, of which twelve were published in the years 2020 and 2021, and three in 2022? Well, one of these three reveals that common thread. In a review article of 27 pages in the open access magazine Life, [2] Hemilä unfolds his experiences and explains them in a long telephone conversation with ORTHO. The title of the article speaks volumes: “Bias against Vitamin C in Mainstream Medicine: Examples from Trials of Vitamin C for Infections.” Remarkable. It turns out that prejudices (“bias”) are a major common thread in the medical scientific world.

自 2002 年以來,Hemilä 將分析有關維生素 C 的研究並發表分析結果視為自己的職業職責。 一百多篇科學出版物(其中十二篇發表於 2020 年和 2021 年,三篇發表於 2022 年)之後的共同點是什麼? 好吧,這三個中的一個揭示了這個共同點。 在開放獲取雜誌 Life 的一篇 27 頁的評論文章中,[2] Hemilä 在與 ORTHO 的長時間電話交談中展示了他的經歷並解釋了這些經歷。 這篇文章的標題說明了很多:“主流醫學中對維生素 C 的偏見:來自維生素 C 感染試驗的例子。” 卓越。 事實證明,偏見(“偏見”)是醫學科學界的一個主要共同點。

Thousand versus half a million

In the article, Hemilä shows, among other things, that the authors of the COVID-A to Z Study wrongly conclude that vitamin C is ineffective against Covid-19, because the data they rely on incorrectly show otherwise. [3] This will be discussed in more detail below.

Hemilä is pleased that Life has published his extensive article on the prejudice against vitamin C for everyone to read. [2] However, he is under no illusions about its impact: “According to the counter on Life’s website, more than a thousand people have read my article. The COVID-A to Z Study on JAMA’s website also has a counter. And it was at half a million the last time I looked.”

一千對一百萬

在文章中,Hemilä 表明,除其他外,COVID-A 到 Z 研究的作者錯誤地得出結論,維生素 C 對 Covid-19 無效,因為他們所依賴的數據錯誤地表明並非如此。 [3] 這將在下面更詳細地討論。

Hemilä 很高興 Life 發表了他關於對維生素 C 的偏見的大量文章供大家閱讀。 [2] 然而,他對它的影響並不抱任何幻想:“根據生活網站上的計數器,有超過一千人閱讀了我的文章。JAMA 網站上的 COVID-A 到 Z 研究也有一個計數器。而且它 我上次看的時候是半百萬。”

In the Life article, Hemilä refers to articles by scientists who note that since the beginning of the last century, doctors and medical scientists have been writing about and discussing nutritional supplements with disdain. According to these researchers, over-the-counter vitamin pills undermined the authority of doctors, because they allowed the patient to self-treat. Moreover, it was not possible to patent nutrients, so there was little to gain for the pharmaceutical industry. And in the second half of the twentieth century, the discovery of patentable antibiotics overshadowed the promising effects of vitamin C against infectious diseases.

在 Life 文章中,Hemilä 提到了科學家的文章,他們指出,自上個世紀初以來,醫生和醫學科學家一直在輕蔑地撰寫和討論營養補充劑。 根據這些研究人員的說法,非處方維生素藥片破壞了醫生的權威,因為它們允許患者自我治療。 此外,不可能為營養素申請專利,因此製藥行業幾乎沒有收益。 而在 20 世紀下半葉,可申請專利的抗生素的發現掩蓋了維生素 C 對傳染病的有希望的影響。

It was not until the end of the 1960s that there was renewed interest in the vitamin when Linus Pauling got involved. This led to a series of relatively large studies that, according to Hemilä, supported the effectiveness of vitamin C. Nevertheless, scientific interest in the vitamin fell again in the late 1970s. Hemilä points to the so-called “Karlowski Study” as the main cause, along with two other articles from 1975.

直到 1960 年代末,當 Linus Pauling 參與其中時,人們才重新對維生素產生了興趣。 這導致了一系列相對較大的研究,據 Hemilä 稱,這些研究支持維生素 C 的有效性。然而,科學界對維生素 C 的興趣在 1970 年代後期再次下降。 Hemilä 指出所謂的“Karlowski 研究”是主要原因,以及 1975 年的另外兩篇文章。

Start of the problem

In 1975, five years after the publication of Linus Pauling’s book Vitamin C and the Common Cold, the scientific journal JAMA published the results of the Karlowski Study, a double-blind randomized placebo-controlled trial of vitamin C. [4] Although colds in the group of subjects who took 6 grams of vitamin C were 17% shorter, the authors attribute this outcome entirely to a placebo effect. Hemilä did not agree with this, and in 1996 subjected the data to a thorough re-analysis. [5] Astonished, he concluded that the data in fact do show a real, physiological effect of vitamin C and that the placebo explanation is incorrect. He caught the authors making all kinds of mistakes. For example, 42% of the recorded colds were apparently omitted from the subgroup analysis without further explanation – an unforgiveable sin within the statistics. The data indicate a dose-response effect: the tested dose of 6 grams per day is twice as effective as the tested dose of 3 grams per day. Hemilä calculates that if you draw the line, a study with 12 grams of vitamin C would have been the obvious choice. Such a study, however, never materialized, partly due to the discouraging placebo explanation of the Karlowski Study.

問題的開始

1975 年,也就是 Linus Pauling 的著作《維生素 C 與普通感冒》出版五年後,科學期刊 JAMA 發表了 Karlowski 研究的結果,這是一項維生素 C 的雙盲隨機安慰劑對照試驗。 [4] 雖然感冒在服用 6 克維生素 C 的受試者組縮短了 17%,作者將這一結果完全歸因於安慰劑效應。 Hemilä 不同意這一點,並在 1996 年對數據進行了徹底的重新分析。 [5] 驚訝的是,他得出的結論是,事實上數據確實顯示了維生素 C 的真實生理效應,而安慰劑的解釋是不正確的。他發現作者犯了各種各樣的錯誤。例如,42% 的感冒記錄在亞組分析中顯然被忽略了,沒有進一步解釋——這是統計數據中不可原諒的罪過。數據表明劑量反應效應:每天 6 克的測試劑量是每天 3 克測試劑量的兩倍有效。 Hemilä 計算出,如果你劃清界限,一項含有 12 克維生素 C 的研究將是顯而易見的選擇。然而,這樣的研究從未實現,部分原因是卡洛夫斯基研究中令人沮喪的安慰劑解釋。

He compares the Karlowski-Study to a zombie: “Although liquidated long ago, it refuses to disappear into the grave and continues to leave a trail of destruction through scientific literature.” Hemilä’s skilful disassembly of the Karlowski Study has never been disproved, but nevertheless has had little impact. According to him, this study has remained by far the most influential study on vitamin C and the common cold. The vitamin C skeptics couldn’t have it any better. There is a good chance that if a skeptical scientist mentions evidence on vitamin C, he will refer to this study.

他將 Karlowski-Study 比作殭屍:“儘管早已被清算,但它拒絕消失在墳墓中,並繼續在科學文獻中留下毀滅的痕跡。” Hemilä 對 Karlowski 研究的巧妙拆解從未被推翻,但影響甚微。 據他介紹,這項研究仍然是迄今為止關於維生素 C 和普通感冒的最有影響力的研究。 對維生素 C 持懷疑態度的人再好不過了。 如果一位持懷疑態度的科學家提到維生素 C 的證據,他很有可能會參考這項研究。

Recent studies ignore evidence

Even now, according to Hemilä, studies are published with negative conclusions in their summaries, while the data on which they are based imply a very different conclusion. A good example of this is the ‘CITRIS-ALI study’ that was published in JAMA in 2019. [6]

最近的研究忽略了證據

根據 Hemilä 的說法,即使是現在,發表的研究的摘要中也有負面結論,而它們所依據的數據卻暗示了一個非常不同的結論。 2019 年發表在 JAMA 上的“CITRIS-ALI 研究”就是一個很好的例子。 [6]

In that study, participants were 167 patients in the ICU with sepsis and acute respiratory distress syndrome (ARDS). They received intravenous vitamin C (50 mg/kg body weight every 6 hours) or a placebo for four days. The researchers conclude: “A 96-hour infusion of vitamin C showed no significant improvement in organ dysfunction scores, nor did it alter markers of inflammation and vascular damage, compared to placebo.” but did not mention a major result: a strong decrease in mortality. Hemilä checked this and explained that during the first four days (when the vitamin C was administered) the mortality in the vitamin C group decreased by 81%. “The main clinically relevant result of the CITRIS-ALI trial was mortality and the measurement of a dozen biomarkers should not distract from that,” said Hemilä.

在該研究中,參與者是 ICU 中的 167 名膿毒症和急性呼吸窘迫綜合徵 (ARDS) 患者。 他們接受靜脈注射維生素 C(每 6 小時 50 毫克/千克體重)或安慰劑四天。 研究人員得出結論:“與安慰劑相比,96 小時的維生素 C 輸注顯示器官功能障礙評分沒有顯著改善,也沒有改變炎症和血管損傷的標誌物。” 但沒有提到一個主要結果:死亡率大幅下降。 Hemilä 對此進行了檢查並解釋說,在前四天(服用維生素 C 時),維生素 C 組的死亡率降低了 81%。 “CITRIS-ALI 試驗的主要臨床相關結果是死亡率,十幾個生物標誌物的測量不應分散這一點,”Hemilä 說。

A second study

As a second example, Hemilä provided the previously mentioned COVID-A to Z-Study, which was published in JAMA Network Open in 2021. [3] The aim of that study was to evaluate the effect of 8 grams per day of vitamin C in 520 ambulatory Covid-19 patients. However, the study was terminated prematurely due to the slow influx of patients. This slowness led, as the researchers had mentioned, to a state of “futility.” [3] Therefore, in this aborted study, the number of patients remained at 214.

第二項研究

作為第二個例子,Hemilä 向 Z-Study 提供了前面提到的 COVID-A,該研究於 2021 年在 JAMA Network Open 上發表。[3] 該研究的目的是評估每天 8 克維生素 C 在 520 名門診 Covid-19 患者。 然而,由於患者湧入緩慢,該研究提前終止。 正如研究人員所說,這種緩慢導致了一種“徒勞”的狀態。 [3] 因此,在這項中止的研究中,患者人數保持在 214 人。

But Hemilä explained that this premature stopping was unjustified, because the effects of vitamin C were actually greater than the researchers had anticipated. [2] The researchers had expected a 1.0 day reduction in the duration of Covid-19, but they found a reduction of 1.2 days. Hemilä calculated that the recovery percentage in the vitamin C group was 70% greater than in the control group. None of this was reflected in the abstract of the article. The researchers, in turn, concluded that vitamin C did not significantly reduce the duration of symptoms.

但 Hemilä 解釋說,這種過早停止的做法是不合理的,因為維生素 C 的效果實際上比研究人員預期的要大。 [2] 研究人員原本預計 Covid-19 的持續時間會減少 1.0 天,但他們發現減少了 1.2 天。 Hemilä 計算得出,維生素 C 組的恢復百分比比對照組高 70%。 這些都沒有反映在文章的摘要中。 反過來,研究人員得出結論,維生素 C 並沒有顯著減少症狀的持續時間。

How can this difference between the facts found and the conclusions of the research be explained? Hemilä does not need to look far: one of the authors of the COVID-A to Z-Study declared in the “Conflict of Interest” statement that she has carried out paid consultancy work for Gilead Sciences.” [3] This pharmaceutical company is the producer of Remdesivir, the first virus-inhibiting drug that was approved by the FDA for the treatment of Covid-19. Hemilä writes in his Life article: “What motivation does such a researcher have to find out whether a very cheap nutrient is actually effective against Covid-19 when an expensive drug available is available from a company for which she is a consultant?”

如何解釋發現的事實與研究結論之間的差異? Hemilä 不需要看得太遠:COVID-A 到 Z-Study 的作者之一在“利益衝突”聲明中宣稱,她已為 Gilead Sciences 開展了有償諮詢工作。” [3] 這家製藥公司是 Remdesivir 的生產商,這是 FDA 批准用於治療 Covid-19 的第一種病毒抑製藥物。Hemilä 在他的 Life 文章中寫道:“這樣的研究人員有什麼動機要找出一種非常便宜的營養素是否真的是 當她擔任顧問的公司提供昂貴的藥物時,對 Covid-19 有效嗎?”

Timing purely coincidental

In February 2020, a team led by Harri Hemilä published a meta-analysis in the Journal of Intensive Care on the effect of vitamin C on the duration of artificial respiration given to ICU patients. [7] The timing was purely coincidental, but could not be better: the SARS-CoV-2 virus had only just started to spread from Wuhan and would cause death and destruction in the rest of the world in the months that followed. Hospitals’ intensive care units everywhere were overloaded by Covid-19 victims, some of whom had to be on artificial ventilation for an unusually long time. The article’s analysis seemed to imply a benefit from treatment with vitamin C. Hemilä and colleagues had collected data from eight studies involving a total of 685 patients who had ended up in ICU for a variety of reasons. Their calculations indicated that vitamin C had shortened the duration of artificial respiration by an average of 14%. In the most critically ill patients who had been on the ventilator the longest, vitamin C had actually reduced the duration by 25%.

時間純屬巧合

2020 年 2 月,由 Harri Hemilä 領導的團隊在《重症監護雜誌》上發表了一項關於維生素 C 對 ICU 患者人工呼吸持續時間影響的薈萃分析。 [7] 時機純屬巧合,但再好不過了:SARS-CoV-2 病毒剛剛從武漢開始傳播,並在隨後的幾個月裡在世界其他地區造成死亡和破壞。各地醫院的重症監護病房都擠滿了 Covid-19 受害者,其中一些人不得不長時間進行人工通氣。這篇文章的分析似乎暗示了維生素 C 治療的益處。Hemilä 及其同事從 8 項研究中收集了數據,這些研究涉及總共 685 名因各種原因最終進入 ICU 的患者。他們的計算表明,維生素 C 將人工呼吸的持續時間平均縮短了 14%。在使用呼吸機時間最長的最危重患者中,維生素 C 實際上將持續時間縮短了 25%。

More about vitamin C and Covid-19

The big question now is whether lives would have been saved if the vitamin had been given as standard to all Covid-19 patients in the ICU from the start of the pandemic as a precaution? Very likely, but we’ll never know. In any case, Hemilä’s hopeful article received little attention. The field has not rushed to start the bigger and better research studies called for in the last paragraphs.

有關維生素 C 和 Covid-19 的更多信息

現在最大的問題是,如果從大流行開始就將維生素作為標准給予 ICU 中的所有 Covid-19 患者作為預防措施,是否會挽救生命? 很有可能,但我們永遠不會知道。 無論如何,Hemilä 充滿希望的文章很少受到關注。 該領域並沒有急於開始最後幾段所要求的更大更好的研究。

In a telephone interview, Hemilä reacted resignedly to this finding: “It is a very big step to add vitamin C to the treatment protocol for Covid patients in ICUs. Based on our publication, it is too early for that. The studies we had to rely on were small and therefore of poor quality. However, there is very strong evidence for a biological effect of vitamin C, which justifies better and larger studies. In the meantime, you could assuredly give it to patients — because vitamin C is cheap, and safe even in doses of tens of grams administered orally or intravenously. This is again confirmed by a 2010 review of vitamin C researchers, including the first and last authors of researchers from the most respected institute in the US, the National Institutes of Health (NIH). [8]

在電話採訪中,Hemilä 無奈地回應了這一發現:“將維生素 C 添加到 ICU 中 Covid 患者的治療方案中是非常重要的一步。根據我們的出版物,現在這樣做還為時過早。我們不得不進行的研究 依賴很小,因此質量很差。但是,有非常有力的證據表明維生素 C 具有生物學效應,這證明了更好和更大的研究是合理的。與此同時,您可以放心地將其提供給患者——因為維生素 C 很便宜 , 並且即使在口服或靜脈注射數十克的劑量下也是安全的。2010 年對維生素 C 研究人員的審查再次證實了這一點,其中包括來自美國最受尊敬的研究所美國國立衛生研究院的研究人員的第一和最後一位作者 (美國國立衛生研究院). [8]

Two quotes from Harri Hemilä:

Hemilä is not an uncritical apologist for Linus Pauling’s views:

“Pauling had a point, but he was too optimistic about vitamin C,” he says. “Unlike Pauling, I don’t think that an ordinary, healthy person would benefit from taking more than 500 mg of vitamin C per day. For the elderly, he recommended something like 10 grams of vitamin C per day, and I see no justification for that. But if people are sick, the dose can be increased considerably. That should be better investigated.”

Harri Hemilä 的兩句名言:

Hemilä 不是不加批判地為 Linus Pauling 的觀點辯護:

“鮑林說得有道理,但他對維生素 C 過於樂觀了,”他說。 “與鮑林不同,我認為普通健康人每天服用超過 500 毫克的維生素 C 不會受益。對於老年人,他建議每天服用 10 克維生素 C,我認為沒有任何理由 。” “但如果人們生病了,劑量可以大大增加。這應該更好地調查。”

(Editor’s note:  Vitamin C is good for even healthy young people.  When they say it does not help you because there is no clinical outcome to improve in healthy young people.  That does not mean vitamin C does not protect against cellular injury which would otherwise lead to premature aging.  Vitamin C is good for everyone.  The question that remains is, how much vitamin C does a person need?)

(編者註:維生素 C 甚至對健康的年輕人也有好處。當他們說它對您沒有幫助時,因為健康的年輕人沒有臨床結果可以改善。這並不意味著維生素 C 不能防止細胞損傷,否則 導致過早衰老。維生素 C 對每個人都有好處。剩下的問題是,一個人需要多少維生素 C?)

About twenty years ago, he considered setting up a clinical trial with vitamin C himself, but he quickly abandoned that plan:

“You need a lot of doctors for such a project and the doctors I approached were not interested. People who matter in science just don’t care. I then decided that it makes more sense to continue to focus on analyzing existing data”

大約 20 年前,他曾考慮過自己開展維生素 C 的臨床試驗,但他很快放棄了這個計劃:

“這樣一個項目需要很多醫生,而我接觸的醫生並不感興趣。在科學界重要的人根本不在乎。然後我決定繼續專注於分析現有數據更有意義”

Reviews and meta-analysis

In his most recent meta-analysis, Hemilä showed that vitamin C increases left ventricular ejection fraction in cardiac patients. [9] He is also the lead author of a number of authoritative meta-analyses on vitamin C for the Cochrane Database of Systematic Reviews: within the medical science field the conclusions of ‘Cochrane reviews’ are often taken as the most reliable evidence.

評論和薈萃分析

在他最近的薈萃分析中,Hemilä 表明維生素 C 可增加心髒病患者的左心室射血分數。 [9] 他還是 Cochrane 系統評價數據庫中有關維生素 C 的多項權威薈萃分析的主要作者:在醫學科學領域,“Cochrane 評價”的結論通常被視為最可靠的證據。

He became best known for his Cochrane review on vitamin C and the common cold. [10] The conclusion is that vitamin C can reduce the severity and duration of a cold, albeit to a modest degree: with a daily intake of at least 1 gram of vitamin C per day an infection with a respiratory virus lasts on average 8% shorter in adults and 18% shorter in children. In 2017 he told ORTHO that you can see these results as a “proof of concept” of the effectiveness of vitamin C against respiratory infections. [1] The small but significant effect proves that vitamin C has an influence on viral infections, and there are indications that the effect is greater at higher doses. Hemilä also published meta-analyses on the effects of vitamin C on pneumonia (“therapeutic supplementation with vitamin C is reasonable”) [11] and vitamin C on the length of stay in IC patients: [12] this appears to be on average 8% shorter under the influence of moderate doses of vitamin C.

他最出名的是他對維生素 C 和普通感冒的 Cochrane 評論。 [10] 結論是維生素 C 可以降低感冒的嚴重程度和持續時間,儘管程度適中:每天攝入至少 1 克維生素 C,呼吸道病毒感染平均持續 8% 成人短,兒童短 18%。 2017 年,他告訴 ORTHO,您可以將這些結果視為維生素 C 對抗呼吸道感染有效性的“概念證明”。 [1] 小而顯著的效果證明維生素 C 對病毒感染有影響,並且有跡象表明,在較高劑量下效果更大。 Hemilä 還發表了關於維生素 C 對肺炎影響的薈萃分析(“補充維生素 C 是合理的”)[11] 和維生素 C 對 IC 患者住院時間的影響:[12] 這似乎是平均 8 在中等劑量維生素 C 的影響下縮短 %。

Against viral and bacterial infections

Hemilä has gradually become very well established in reference to his knowledge about vitamin C, especially with regard to infectious diseases. We should take the opinion of such a person seriously during a disruptive pandemic caused by a virus. For example, the article “Vitamin C and COVID-19,” published in the journal Frontiers in Medicine in early 2021. [13] In that article, he reviewed the evidence from about a hundred animal studies that have shown that vitamin C can alleviate a wide range of viral and bacterial infections. In mice with sepsis and acute respiratory distress syndrome (ARDS), high-dose vitamin C administration decreased pro-inflammatory genes, improved epithelial barrier function and improved alveolar fluid clearance. According to Hemilä, vitamin C has a number of biological properties that are important in light of Covid-19 and a weakened immune system: the vitamin stimulates the proliferation and function of T lymphocytes and Natural Killer lymphocytes and increases the production of interferon, which are important functions of the immune system.

對抗病毒和細菌感染

Hemilä 在維生素 C 方面的知識,尤其是在傳染病方面的知識方面,逐漸變得非常成熟。在病毒引起的破壞性大流行期間,我們應該認真對待這種人的意見。例如,2021 年初發表在《醫學前沿》雜誌上的文章“維生素 C 和 COVID-19”。 [13] 在那篇文章中,他回顧了來自大約一百個動物研究的證據,這些研究表明維生素 C 可以緩解廣泛的病毒和細菌感染。在患有敗血症和急性呼吸窘迫綜合徵 (ARDS) 的小鼠中,給予高劑量維生素 C 可減少促炎基因,改善上皮屏障功能並改善肺泡液清除率。根據 Hemilä 的說法,鑑於 Covid-19 和削弱的免疫系統,維生素 C 具有許多重要的生物學特性:維生素刺激 T 淋巴細胞和自然殺傷淋巴細胞的增殖和功能,並增加干擾素的產生,干擾素是免疫系統的重要功能。

Low blood levels

An important indication of the usefulness of vitamin C in the treatment of Covid-19 is the fact that patients in critical condition who end up in intensive care often have greatly reduced blood levels of vitamin C. [13] And a vitamin C deficiency is often associated with pneumonia: “While 0.1 grams of vitamin C per day can maintain a normal plasma level in a healthy person, much higher doses (1-4 grams per day) are needed for critically ill patients to raise plasma vitamin C levels to the normal range. Therefore, high vitamin C doses may be needed to compensate for the increased metabolism to reach normal plasma levels.”

低血濃度

維生素 C 在治療 Covid-19 中的作用的一個重要跡像是,最終接受重症監護的危重患者的血液維生素 C 水平通常大大降低。 [13] 維生素 C 缺乏症通常是 與肺炎有關:“雖然每天 0.1 克維生素 C 可以維持健康人的正常血漿水平,但危重患者需要更高的劑量(每天 1-4 克)才能將血漿維生素 C 水平提高到正常水平 範圍。因此,可能需要高劑量的維生素 C 來補償增加的新陳代謝,以達到正常的血漿水平。”

Sepsis and ARDS patients

Hemilä acknowledges in the article that there are currently no large double-blind random-controlled trials that provide direct evidence for an effect of vitamin C against Covid-19. [13] Weighing his words on a gold platter, however, he states that pending more and larger studies, high-dose vitamin C administration is already known to be helpful for Covid patients. After all, the vitamin is cheap and safe. He makes a suggestion based on his own review from 2017: “In patients suffering from a viral respiratory infection, 6 to 8 grams of oral vitamin C was significantly more effective than 3 to 4 grams per day. In recent studies of sepsis and ARDS patients, the dose of intravenous vitamin C was 7 to 14 grams over 3 to 4 days.” [14]

膿毒症和 ARDS 患者

Hemilä 在文章中承認,目前沒有大型的雙盲隨機對照試驗為維生素 C 對 Covid-19 的作用提供直接證據。 [13] 然而,他在金盤上權衡他的話,指出在等待更多和更大的研究之前,已知高劑量維生素 C 給藥對 Covid 患者有幫助。 畢竟,維生素既便宜又安全。 他根據自己 2017 年的評論提出了一個建議:“對於患有病毒性呼吸道感染的患者,每天口服 6 至 8 克維生素 C 明顯比每天 3 至 4 克更有效。在最近對敗血症和 ARDS 患者的研究中 ,靜脈注射維生素 C 的劑量為 7 至 14 克,持續 3 至 4 天。” [14]

Currently, Hemilä finds that his call to utilize vitamin C has been little heeded. The fact that doctors have not started to give vitamin C to Covid-19 victims en masse can be explained by the appalling lack of good and large-scale studies. But why have they not been implemented? When asked about the state of affairs regarding the science of vitamin C and Covid-19 during the interview, he answered: “I can’t say exactly because there is so much published that I can’t keep up with it. Most of it is of low quality.”

目前,Hemilä 發現他對利用維生素 C 的呼籲很少受到重視。 醫生尚未開始向 Covid-19 受害者大規模提供維生素 C 的事實可以用令人震驚的缺乏良好的大規模研究來解釋。 但為什麼他們沒有實施呢? 在採訪中被問及維生素 C 和 Covid-19 的科學狀況時,他回答說:“我不能確切地說,因為發表的文章太多了,我跟不上。大部分都是 是低質量的。”

The Chinese Vitamin C Trial (2020)

As early as mid-2020, Hemilä was asked as a reviewer to comment on the protocol of a Chinese double-blind randomized placebo-controlled study. [15] The intention of the study was that 308 Covid-19 patients in the ICU would receive 24 grams daily of vitamin C or a placebo by infusion for a week. However, the execution of the experiment largely failed because of the draconian lockdown measures of the Chinese government, and too few patients ended up in the ICU. It eventually became a ‘pilot study’ with 56 patients: the duration of artificial respiration did not decrease in the vitamin C group. [16] According to Hemilä, however, the number of test subjects was too low to draw clear conclusions. After the interview, he sent in an e-mail: “You asked about the state of affairs about vitamin C and Covid. See what you find when you type [vitamin C] and [Covid-19] on pubmed.” The scientific search engine turns out to cough up sixteen reviews and four clinical studies. Hemilä, disappointed wrote: “That says enough. And most of it is junk.”

中國維生素 C 試驗 (2020)

早在 2020 年年中,Hemilä 就被要求對一項中國雙盲隨機安慰劑對照研究的方案進行評論。 [15] 該研究的目的是讓 ICU 中的 308 名 Covid-19 患者每天接受 24 克維生素 C 或通過輸註一週的安慰劑。然而,由於中國政府的嚴厲封鎖措施,該實驗的執行在很大程度上失敗了,最終進入ICU的患者太少。它最終成為一項包含 56 名患者的“試點研究”:維生素 C 組的人工呼吸持續時間沒有減少。 [16] 然而,根據 Hemilä 的說法,測試對象的數量太少,無法得出明確的結論。採訪結束後,他發了一封電子郵件:“您詢問了有關維生素 C 和 Covid 的情況。看看您在 pubmed 上鍵入 [vitamin C] 和 [Covid-19] 時會發現什麼。”科學搜索引擎結果顯示出 16 條評論和 4 項臨床研究。 Hemilä 失望地寫道:“這就夠了。而且大部分都是垃圾。”

How it started

How can the half-baked treatment of vitamin C be explained? Harri Hemilä explains it based on his own experiences over the years. His fascination for the vitamin started in the 1970s when he saw Linus Pauling on television. The two-time Nobel laureate has just published his book Vitamin C and the Common cold. In it, he argued, based on the studies available at the time, that the common cold can be treated with high doses of C. A few weeks later, a Swedish professor appeared on Finnish television. “A very arrogant man,” Hemilä recalls. “He had a bottle of vitamin C tablets with him and said, “This is junk without any effect.” But he had no factual arguments or study results to support his negative statements.”

它是如何開始的

如何解釋維生素 C 的半生不熟的處理方式? Harri Hemilä 根據自己多年來的經驗對此進行了解釋。 他對維生素的迷戀始於 1970 年代,當時他在電視上看到了 Linus Pauling。 這位兩屆諾貝爾獎獲得者剛剛出版了他的著作《維生素 C 和普通感冒》。 在其中,他認為,根據當時可用的研究,普通感冒可以用高劑量的 C 治療。幾週後,一位瑞典教授出現在芬蘭電視上。 “一個非常傲慢的人,”Hemilä 回憶道。 “他隨身帶著一瓶維生素 C 片,並說,‘這是沒有任何作用的垃圾。’但他沒有事實論據或研究結果來支持他的負面陳述。”

Hemilä was studying biochemistry at the time and he asked himself who is right: Pauling or the skeptical professor? “I started collecting all the articles about vitamin C and infections. I didn’t understand how it was possible that the important reviews judged the vitamin so negatively, while you could conclude from the results of studies that C is actually effective.”

Hemilä 當時正在學習生物化學,他問自己誰是對的:鮑林還是持懷疑態度的教授? “我開始收集所有關於維生素 C 和感染的文章。我不明白重要的評論怎麼可能對維生素做出如此負面的評價,而你可以從研究結果中得出結論,維生素 C 實際上是有效的。”

(Pim Christiaans is a journalist, magazine maker and author of health books in the Dutch language. He writes about scientific developments in the field of healthy aging at his website www.lifeunlimited.nl . Christiaans has no financial ties with or interests in companies that manufacture or sell nutritional supplements.)

Translated from Dutch and reprinted in English with permission of the author and Orthomoleculair Magazine, April 2022. Those seeking permission to reprint or translate may contact the magazine’s publisher Gert Schuitemaker ([email protected])

 

References

1. Christiaans P (2017) Vitamine C tegen verkoudheid. Orthomoleculair Magazine. 5:184-189. https://docplayer.nl/154405845-Vitamine-c-tegen-verkoudheid-opnieuw-op-een-rij-gezet-door-finse-wetenschapper.html

2. Hemilä H, Chalker E (2022) Bias against Vitamin C in Mainstream Medicine: Examples from Trials of Vitamin C for Infections. Life 12:62. https://pubmed.ncbi.nlm.nih.gov/35054455.

3. Thomas S, Patel D, Bittel B, et al. (2021) Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection: The COVID A to Z randomized clinical trial. JAMA Netw Open. 4:e210369. https://pubmed.ncbi.nlm.nih.gov/33576820

4. Karlowski TR, Chalmers TC, Frenkel LD, et al. (1975) Ascorbic acid for the common cold: A prophylactic and therapeutic trial. JAMA 231:1038-1042. https://pubmed.ncbi.nlm.nih.gov/163386

5. Hemilä H (1996) Vitamin C, the placebo effect, and the common cold: A case study of how preconceptions influence the analysis of results. J Clin Epidemiol. 49:1079-1084. https://pubmed.ncbi.nlm.nih.gov/8826986

6. Fowler AA, Truwit JD, Hite RD et al. (2019) Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA 322:1261-1270. https://pubmed.ncbi.nlm.nih.gov/31573637

7. Hemilä H, Chalker E (2020) Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis. J Intensive Care 8:15. https://pubmed.ncbi.nlm.nih.gov/32047636

8. Padayatty SJ, Sun AY, Chen Q, et al. (2010) Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects. PLoS ONE 5(7):e11414. https://pubmed.ncbi.nlm.nih.gov/20628650

9. Hemilä H, Chalker E, de Man AME (2022) Vitamin C May Improve Left Ventricular Ejection Fraction: A Meta-Analysis. Front Cardiovasc Med. 9:789729. https://pubmed.ncbi.nlm.nih.gov/35282368

10. Hemilä H, Chalker E (2013) Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013(1):CD000980. https://pubmed.ncbi.nlm.nih.gov/23440782

11. Hemilä H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev 2013; 8:CD005532. https://pubmed.ncbi.nlm.nih.gov/23925826

12. Hemilä H, Chalker E (2019) Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients 2019; 11:708. https://pubmed.ncbi.nlm.nih.gov/30934660

13. Hemilä H, de Man AME (2021) Vitamin C and COVID-19. Front Med. 7:559811. https://pubmed.ncbi.nlm.nih.gov/33537320

14. Hemilä H (2017) Vitamin C and infections. Nutrients 9:339. https://pubmed.ncbi.nlm.nih.gov/28353648

15. Liu F, Zhu Y, Zhang J, et al. (2020) Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial. BMJ Open 10:e039519. https://pubmed.ncbi.nlm.nih.gov/32641343

16. Zhang J, Rao X, Li Y, et al. (2021) Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Ann. Intensive Care 11:5. https://pubmed.ncbi.nlm.nih.gov/33420963

 

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