关于高摄入维生素C的持久争论 Ever-Lasting Debate over High Intake of Vitamin C

In the U.S., there has been a large debate over the medical benefits of vitamin C for more than 20 years. The debate was triggered by Dr. Linus Paling, winner of two Nobel Prizes. Although he was highly respected for his achievement in science, Pauling was unmercifully ridiculed by many in the arena of medicine for his unique insight into the health benefits of large doses of vitamin C.

The Person Who Triggered the Debate

Dr. Linus Pauling died at age 93 on August 19, 1994 at his home in California. Voice of America reported news of his death saying that Mr. Pauling was the only scientist who had solely won the Nobel Prize twice. Pauling was regarded by New Scientist (a British journal) as one of top 20 outstanding scientists in human history. He was ranked together with Newton, Einstein, and Madame Curie. Einstein praised Pauling saying that he was a real genius. However, when Reuters reported Pauling’s death, the news agency said that Pauling was a 20th century scientist that was both respected and ridiculed.

The reason for such a respected scientist to receive vehement ridicule was because of his insight into the health effects of vitamin C, particularly for his advocacy for use of large doses of vitamin C.

Pauling was a chemist, physicist, molecular biologist, and medical researcher. Yet he was not a licensed physician. Still, he unintentionally triggered a huge ever-lasting debate in the medical arena.

New Idea Rejected by Medical Researchers and Practitioners

Based on his own research of many years, Dr. Pauling published in 1970 a book titled Vitamin C and Common Colds. In the book, he believed that the daily intake of 1,000 mg or more of vitamin C can prevent colds. Additionally, he believed that vitamin C can protect against viral infection. The book was appreciated by many readers, and it became one of the best publications in popular science.

However, the medical experts vehemently opposed Pauling’s opinions. Some said, “no evidence supports the claim that vitamin C can prevent colds.” Others said that, “vitamin C is no use in preventing or relieving colds.” Authority departments also echoed the opposition. For instance, an American health foundation warned readers that, “there is no sufficient evidence to support the claim that daily intake of 1000 mg of vitamin C can prevent colds.” The American Medical Association also declared that, “vitamin C can’t prevent nor cure colds!” Only a few medical experts and hundreds of patients who experienced the benefit of vitamin C supported Pauling.

Dr. Pauling was under besiegement. His attackers said he was not a trained medical doctor, and he did not qualify to talk about the effects of vitamin C on colds. Some even called him a quack or said his advocacy for use of vitamin C was media propaganda. Respectful individuals, however, regretted that he did not constrain himself. They said he could otherwise have peacefully enjoyed the honor he earned; he intruded the medical arena, which was no way close to his chemistry arena.

Pauling ignored the opposition. In 1979, he co-authored with Dr. Cameron a book titled Cancer and Vitamin C. He suggested that every cancer patient should take ten grams or more of vitamin C daily. He also suggested that the vitamin C regimen should get started as early as possible as a supplementary treatment for the conventional cancer treatment. In the book, they said “we believe this is simple, yet effective way to drastically improve the outcome of cancer treatment.”

The authorities were more doubtful about his opinion this time. Pauling had applied eight times to the National Cancer Institute for grants to further his study in animal models. However, all applications of this world-famous scientist were rejected. Dr. Pauling’s work was mainly supported by individuals. Even so, the authority organizations and individuals still declared that vitamin C had no effect on cancer. Only the patients who experienced the benefit of vitamin C supported Pauling’s opinion.

In 1985, Pauling also authored a book on health and longevity. He mentioned a way to maintain health including 12 detailed steps. The first step was a “daily intake of six to 18 grams of vitamin C or more without any cessation.” In his opinion, “the way to maintain good health was characterized by using an increased amount of vitamins.” He also used vitamins himself. He said,”In 1985, when I write the book, I take four pills of nutrient supplements plus 18 grams of vitamin C.” Pauling believed that no matter how old you were, it was beneficial to take an optimal amount of vitamin C and the dose should be gradually increased. He said, “from a young or middle age, moderate intake of vitamins and other nutrients coupled with some exercise can elongate one’s lifespan by 25 to 35 years.” He added, “If you are entering an old age, moderate intake of vitamins along with some exercise can retard the aging process and increase your lifespan by 15 to 20 years.” His view on the effect of vitamin C was naturally rejected again by the medical practitioners.

Debate over the Dosage

The largest issue for the debate was the dosage of vitamin C. Pauling believed, “to most adults, the optimal intake of vitamin C is between 2.3 and ten grams.” If necessary, the dosage could be increased to 20, 30 or even more grams a day. Pauling believed the dosage of vitamin C should be larger than the recommended amount when it was used to deal with viruses, cancer or aging. Strictly speaking, the debate was about the dosage.

Before Pauling’s death, a U.S. agency – Food and Nutrition Commission – recommended a daily intake of 60 mg of vitamin C while some nutritionists believed that 30 or 40 mg should be sufficient. Pauling’s advocacy for a dosage that was a few dozens or even hundreds times higher than the recommended was surely destined to receive a firm opposition from the medical workers. The president of an American health foundation alerted people that, “so-called large-dose vitamin therapy should be avoided.” The only reason the medical force opposed high intake of vitamin C was that such a regimen could cause kidney stones. However, Pauling rebutted: although such an outcome was theoretically possible, there never was any case reported in the medical literature, which was attributed to the high intake of vitamin C.

The debate continued until Pauling’s death.

Who can Judge?

To emphasize his points, Pauling cited in his 1985 book Nobel laureate Dr. Albert von Szent-Gyorgyi as saying: “that as far as ascorbic acid is concerned, from the very beginning, I have a feeling that people are misled by the medical education. They believe if you don’t eat vitamin C rich foods, you will suffer from scurvy. If you don’t get scurvy, it means you are normal. I believe that is a huge mistake. To have a completely healthy body, you are in desperate needs of vitamin C. I myself take one gram a day. This dose does not mean to be really optimal, but what I can tell you is this, people can take any dose of ascorbic acid without any risk.”

However, Albert von Szent-Gyorgyi’s opinion was not accepted by the U.S. medical force.

It was unknown whether it was intentional or not, but after Pauling’s death, the world learned that the view on the use, dosage and effect of vitamin C has changed a bit.

In February, 1995, American Cardiology Society and some nutritionists suggested to the Food and Drug Administration that the recommended daily intake of vitamin C should be raised from 60 mg to 250 mg to 1000 mg.

In April, 1996, Scientists at the National Health Institutes claimed the optimal daily intake of vitamin C was 200 mg, not 60 mg.

In 1996, the New York Times reported an investigation saying that 30 to 40 percent of Americans took vitamin C and one fifth of them took more than one gram daily.

On October 7, 1997, Xinhua News Agency cited the Journal of American Clinical Nutrition as saying that researchers found after a survey of 247 women aged 56 to 71, that 11 percent of the surveyed who took vitamin C daily for more than ten years did not suffer from cataract. Researchers believed a long-term supplementation of vitamin C can reduce the cataract risk by more than 77 percent. These statements are what Pauling stated as early as 1985 and the medical circle did not believe it.

In 2000, the Food and Nutrition Committee at National Health Institutes believed for adults, daily intake of no more than 2000 mg vitamin C was safe.

Some reports claimed that 14 clinical trials showed that with a daily intake of ten grams of vitamin C for three years, no case of cataract was found. For now, the majority of the medical force believes that vitamin C indeed has some preventive effect on colds. Researchers found that with a daily intake of 300 to 400 mg of vitamin C, males live six years longer than those who took only 60 mg or less.

Now, many specialists admitted that vitamin C could protect against cancer and many other diseases including Alzheimer’s. Some reports said that among 18 cases of cancer, patients in their late stage who received IV administration of ten to 20 grams of vitamin C, seven out of 14 who suffered from whole body joint pain experienced a pain relief after just one week of treatment.

Professor Ge Keyou, President of Chinese Nutrition Association, said in 2003 that he took 400 mg vitamin C every day for more than ten years. He believed vitamin C prevents against arteriosclerosis and cancer. Professor Liu Qipei, President of Shanghai Nutrition Association, said in 1999 that daily intake of 1000 mg or more of vitamin C imposed no side effects. He believed that the toxicity report on the over-burden of oxalic acid and iron was baseless.

The debate over the dosage and effect of vitamin C spread across borders to other countries due to the overwhelming influence of the American medicine and famous scientists. Initially, the medical researchers and practitioners in all countries stood behind their U.S. medical counterparts. Pauling alone was fighting with a whole army of medical experts and authority organizations. He suffered from long-term ridicules that ordinary people would not stand. Pauling defended his opinions for more than 20 years. His brevity and exploration spirit alone had gained him respect from many.

Today, many experts in the U.S. and other countries have admitted or almost accepted Pauling’s opinion although the debate is far away from over. For instance, some believe vitamin C can protect against cancer while others believe vitamin C can cause cancer. In a word, the research on the dosage and effect of vitamin C continues. Accordingly, Pauling has been regarded differently. In China, some publications accused Pauling’s opinion on vitamin C as being a lie or fraud. In 2003, some people called Pauling a quack saying he was a great chemist, but infamous in medicine. Until September, 2004, some had insisted in their publications that the daily intake of vitamin C should be 50 mg. For this, readers can’t help but suspect that these people either had had some bias against Pauling or they did not know anything about vitamin C.

In any case, Pauling himself took a few grams of vitamin C a day and lived to the age of 93. A noted professor named Zhen Jie at Nanjiang University has taken 600 mg of vitamin C daily for more than a dozen years. Now, he is over 100 years old and still working. In a study, Finnish researchers gave one to three grams of vitamin C to 60 elderly people and found no case of myocardial infarction or stroke. Although we can not say anything for sure on whether vitamin C can promote health and longevity, it at least indicates that large doses of vitamin C cause no harm. The so-called daily intake of 50 mg or 60 mg recommendation makes no sense. It’s Pauling’s opinion that makes sense. “Authority’s opinion may not be necessarily correct or right. It is highly unfair that after so many years, some people and organizations have been still accusing that Pauling’s opinion was a fraud or he was a quack.”

Of course, some of Pauling’s opinions may not be correct and remain to be tested. Even if one of these days, his opinion proves to be wrong, his spirit of exploration influences many people. Exploration and science are endless and we do not have reasons to dwell in the past. The debate over vitamin C, particularly the research and practice after Pauling has made us ponder. Dr. Pauling’s other viewpoints alert us that, “doctors should need to be cautious, but if you want to advance medicine, medical practitioners need also to accept new thoughts.”

“Don’t let medical authorities or politicians mislead you.”

“Doctor’s opinions are not always correct. Although they are not evil-minded, the patients should make their own decisions.”

Article was originally authored in Chinese by Shi Chenke and published in “Nature and Man”. Translated by David Liu without any substantiation.