MD, PhD, FMedSci, FSB, FRCP, FRCPEd

In 1747, James Lind conducted what may well be the first documented controlled clinical trial in the history of medicine. He treated a small group of healthy sailors with a range of different remedies to see whether one of these regimen might be effective in preventing scurvy. The results showed that lemon and lime juice – effectively vitamin C – did the trick. This trial changed the world: it saved tens of thousands of lives, gave Britain the advantage at sea needed to become a dominant empire, and set medicine on the track to eventually become evidence-based.

Of course, Lind did not know that the effective principle in his lemon/lime juice was vitamin C. The Hungarian physiologist Albert Szent-Gyorgyi discovered vitamin C only ~200 years later and received the Nobel Prize for it in 1937. Since then, research has been buoyant, and vitamin C has been advocated for almost every condition one can think of. Looking at some of the claims made for it, I get the impression that more charlatans have jumped on the vitamin C band-waggon than the old vehicle can support. In alternative medicine, high-dose IV vitamin C is a popular variation of Lind’s concept, not least for the treatment of cancer.

Researchers from the NIH in the US surveyed attendees at annual CAM Conferences in 2006 and 2008, and determined sales of intravenous vitamin C by major U.S. manufacturers/distributors. They also queried practitioners for adverse effects, compiled published cases, and analyzed FDA’s Adverse Events Database. Of 199 survey respondents (out of 550), 172 practitioners had administered IV vitamin C to 11,233 patients in 2006 and to 8876 patients in 2008. The average dose was 28 grams every 4 days, with a mean of 22 treatments per patient. Estimated yearly doses used (as 25g/50ml vials) were 318,539 in 2006 and 354,647 in 2008. Manufacturers’ yearly sales were 750,000 and 855,000 vials, respectively. Common reasons for treatment included infection, cancer, and fatigue. Of 9,328 patients for whom data was available, 101 had adverse effects, mostly minor, including lethargy/fatigue in 59 patients, change in mental status in 21 patients and vein irritation/phlebitis in 6 patients. Publications documented serious adverse events, including two deaths. The FDA Adverse Events Database was uninformative.

The authors of this paper conclude that high dose IV vitamin C is in unexpectedly wide use by CAM practitioners. Other than the known complications of IV vitamin C in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency, high dose intravenous vitamin C appears to be remarkably safe. Physicians should inquire about IV vitamin C use in patients with cancer, chronic, untreatable, or intractable conditions and be observant of unexpected harm, drug interactions, or benefit.

I find these results somewhat worrying. Desperate cancer patients are constantly being told that they can fight the disease with high-dose vitamin C, for instance on the >9 million (!) websites on this subject. One site, for instance, leaves little doubt about the efficacy of vitamin C as a treatment for cancer: First shown to be a powerful anti-cancer agent in 1971, it wasn’t until 20 years later that vitamin C started to be accepted by the mainstream medical profession. Eating a vitamin C-rich diet substantially reduces the risk of cancer, and high intakes – above 5000mg a day (the equivalent of 100 oranges) – substantially increases the life expectancy of cancer patients.

Statements like this one give false hope to cancer patients which is unethical and cruel and might hasten the death of many. The reality is quite different and provides little reason for such hope. Here are just a few conclusions from recent scientific analyses on this or closely related topics:

post-diagnosis vitamin C supplementation at the level observed in our population was not associated with survival

Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease

We could not find evidence that antioxidant supplements prevent gastrointestinal cancers. On the contrary, they seem to increase overall mortality. The potential cancer preventive effect of selenium should be studied in adequately conducted randomised trial

The question whether the regular intake of high doses of vitamin C have a preventative effect for certain cancers is currently open. But there is no good reason to suggest that high dose IV vitamin C is an effective treatment for any cancer. To pretend otherwise, as so many alternative practitioners seem to do, is less than responsible – in fact, it is a hallmark for cancer quackery.

11 Responses to Intravenous vitamin C as a treatment for cancer, a hallmark for cancer quackery?

  • You have just given conclusive proof that telepathy exists [giggle]. I am currently looking on pubmed for exactly the same thing after I was told that the sinister Paul Jaconello (http://www.jaconello.com/fees) in Toronto is using this to treat cancer. I have limited myself to 2013, which gives me 94 results, many of which are pre-2013, casting doubt on pubmed’s accuracy. Furthermore, most studies are not accessible to me, since I am not a member of an academic institution, but the evidence for any efficacy (when not administering a lethal dose) seems to be non-existent.

    On the other hand, the evidence that these quacks may not be as selfless and money-averse as they suggest seems to be a lot more solid.

    A doctor providing critical care to a patient in a life-or-death situation makes $238.45 CAD for the first hour and $145.4 CAD per hour after that. Ontario quacks routinely ask $250.00 CAD per hour, even for simply talking on the phone. In order to volunteer as a new victim of Paul Jaconello’s (who is a medical doctor who has turned to the dark side), one has to cough up CAD $1,225.75 + tax.

    You said that homoeoquacks tend to be somewhat economical with the truth. It seems that they have a lot of company.

    • There is no known “lethal dose” of vitamin C that I can find anywhere. Water seems to be more lethal.

      • Vitamin C is an organic acid naturally occurring in our body and important for many physiological processes. As it is abundant in virtually all plant based food, meat and liver, Vitamin C deficit is only seen in extreme circumstances, e.g. prolonged starvation or severely unbalanced diets.
        The toxicity of Vitamin C is remarkably low. LD50 (the dose that kills half of the test subjects) of Vitamin C is very large, in rats it has been found to be about 12 grams per kg. That would mean, if extrapolated, which is usually neither realistic nor a good idea, that if 100 people were given 840 grams each, it would kill about fifty of them.
        No reported cases of accidental or intentional death by vitamin C ingestion exist to suggest how much a human could tolerate. I doubt that anyone is willing to do a human experiment 😉
        A lethal dose would probably kill by “mechanical” action i.e. mucosal injury before a toxic effect.
        Indigestion, nausea, vomiting and diarrhea are common side effects with large doses and would set in long before an overdose could reach a toxic effect. High doses of Vitamin C have been at one time or another touted as a cure-all for almost any human ailment but there is nothing that substantiates such claims. On the contrary, high doses of Vitamin C may suppress progesterone production in pregnant rodents and mediate cancerogenic effects of hexavalent chromium, to name a couple of items that suggest that overdosing on Vitamin C might not be a good idea after all.

        • Untrue. Actually, amounts we’ll over 200g are frequently administered via IV, without harmful effects. Personally, I take 25-30 g per day and my side effects include more energy, no longer get sick numerous times per year, and overall better health.

          The “side effects” you speak of are a simple laxative effect caused by too much oral C being taken at a given time and is not dangerous outside of really overdoing it orally to the point of dehydration. Are you aware that the amount that would cause diahrrea in a healthy individual can rise to upwards of 10x that amount when they are ill?

          Are you aware that most animals synthesize it internally to equivalent human bodyweight amounts of anywhere from 2-12 grams when in a healthy state and their bodies crank this up to upwards of 100g/day equivalent when I’ll or injured?

          Are you saying that scurvy doesn’t happen at a local level when specific tissue levels of vitamin C are depleted in specific areas, like the coronary artery or eyes or gums? This is a real issue Björn. Time after time, diseases and breakdown occurs in areas of the body where levels of vitC have been at zero, or nearly gone.

          I understand you haven’t seen the evidence, but this doesn’t mean it isn’t out there. As for possible cancerous effects, there is little reliable evidence for this.

          • Untrue. Actually, amounts we’ll over 200g are frequently administered via IV, without harmful effects. Personally, I take 25-30 g per day and my side effects include more energy, no longer get sick numerous times per year, and overall better health.

            What do you mean “untrue”? I did not write anything about parenteral doses. Please provide evidence for your claim that large parenteral doses do any good and never have harmful effects.
            Your personal anecdotes are useless as evidence. The effects you describe may as well be figments of your own wishful thinking. No such effects have been confirmed in proper studies. Please provide real evidence for your claims that Vitamin C has beneficial effects consistently on anyone taking them, except of course people with real deficiency.

            The “side effects” you speak of are a simple laxative effect caused by too much oral C being taken at a given time and is not dangerous outside of really overdoing it orally to the point of dehydration. Are you aware that the amount that would cause diahrrea in a healthy individual can rise to upwards of 10x that amount when they are ill?

            Did you read my comment? Of course diarrhea is because of a laxative effect. No need to put quotes around the words. Diarrhea from large oral doses of ascorbic acid is an avoidable side effect because it is not necessary to take such high doses, if anything. If you have evidence to the contrary it is your job to refer to it.

            Are you aware that most animals synthesize it internally to equivalent human bodyweight amounts of anywhere from 2-12 grams when in a healthy state and their bodies crank this up to upwards of 100g/day equivalent when I’ll or injured?

            And your point is…? Humans and other primates lack an enzyme to produce ascorbic acid, that’s why it’s a vitamin.

            Are you saying that scurvy doesn’t happen at a local level when specific tissue levels of vitamin C are depleted in specific areas, like the coronary artery or eyes or gums? This is a real issue Björn. Time after time, diseases and breakdown occurs in areas of the body where levels of vitC have been at zero, or nearly gone.

            And the source of these ideas is…? Please provide proper references for this.

            I understand you haven’t seen the evidence, but this doesn’t mean it isn’t out there. As for possible cancerous effects, there is little reliable evidence for this.

            It is up to you to provide evidence for your claims.
            I gave a reference for a possible connection of high doses of Vitamin C to a mechanism of cancerogenicity. If you wish to contest this, please do but it would help if you used verifiable arguments, not unsupported statements.

        • Björn, would you please do me the professional favor of showing me where Dr. Thomas E. Levy has gone wrong with the evidence he provides in this presentation?
          https://www.bing.com/videos/search?q=vitamin+c+levy+silicon&view=detail&mid=4472D31658C8A51A85B44472D31658C8A51A85B4&FORM=VIRE

          I promise to give any counter evidence you may provide the same professional consideration.

          Thanks in advance,

          Antony Reed

          • The scientific consensus based on massive research is that overdosing Vitamin C does not confer any health benefits in the absence of manifest Vitamin C deficit. The sad story of how this fallacy started in Linus Pauling’s aging head and has been disproven in several clinical studies, even before his death, can be readily found in several places. For example here and here. Both examples contain links to verifying material.

            If you have information that says otherwise, please summarize and refer to verifiable scientific evidence, not anecdotes and your own ideas or some bloke who got through medical school but apparently suffers from several “idée fixe”-delusions such as the purported perils of root-canal dentistry.
            I have better things to do than listen to disturbed people elaborate their dimwitted delusions on Youtube videos.

            And BTW, your link doesn’t work.

  • I’m not a Professional in the topic, but I do know many person that improved they health with combinations of alternative IV therapies, with Vitamin C as one of the components. Many of this patients were suffering the secondary effects of conventional anti-cancer treatments.

    My questions is: Do you really believe that IV Vitamin C business is more lethal or contraindicated than most of the anti-cancer treatments offered actually? But I’m agree that any health care professional should never offer false hope or lie to a cancer patient.

    I also think, that if we analyze the situation, many more patients had lost all their savings and houses to pay for a conventional cancer treatment and the final result is horrible secondary effects and death. If we compare, I don’t think that it is the case for the patients that use the IV vitamin C therapy.

    • My questions is: Do you really believe that IV Vitamin C business is more lethal or contraindicated than most of the anti-cancer treatments offered actually?
      My answer is: No, but the relevant question is not about absolute risks, it is about the balance between risk and benefit.

    • How do you know they improved their health instead of harmed it by interfering with the anti-cancer treatments?
      And, yes, there are expensive cancer medicines, very likely overpriced, but there are cancers that cannot be treated otherwise. And, by the way, the most expensive cancer medicines have moderate or little side effects and rarely end in death (usually anaphylaxis).

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