The Vitamin C Controversy

The debate over Vitamin C is worth observing because it is the most vivid representation of the larger debate over nutritional supplementation. On one side was Linus Pauling, the only person ever to receive two unshared Nobel Prizes: for Chemistry in 1954 and Peace in 1962 (and one presidential Medal of Merit in 1947 from Truman). A humanitarian and social activist whose stated goal was to “minimize human suffering” he wrote The Nature of the Chemical Bond in 1939, the most influential book on chemistry since Lavoisier’s Elementary Treatise of Chemistry in 1789. Pauling also wrote Vitamin C and the Common Cold, and How to Live Longer and Feel Better (as an 85-year-old authority on the subject). Pauling was noted for his energy, athleticism, and extraordinary productivity into his 90's.

In 1991, Pauling, the youngest member ever elected to the National Academy of Sciences coauthored (with Mathais Rath, M.D.) an article titled, “Solution to the Puzzle of Human Cardiovascular Disease: Its Primary Cause is Ascorbate Deficiency, Leading to the Deposition of Lipoprotein(a) and Fibrogen/Fibrin in the Vascular Wall.” The technical name for vitamin C is ascorbic acid or ascorbate. Pauling was opposed by the monopolistic trade association known as the American Heart Association, most of whose members probably studied chemistry in college out of Pauling’s textbook General Chemistry (translated into 13 languages and used by generations of undergraduates). The AMA, which receives grants from the pharmaceutical industry, opposed Pauling’s recommendation of multi-gram ascorbate doses and essentially maintains that you can get all you need by eating fruits and vegetables. Who eats as many fresh fruits and vegetables as we should? And why was Pauling, the founder of orthomolecular medicine which focuses on non-toxic healing, ostracized by the medical establishment? And why is cardiovascular disease the leading killer in civilized nations, with the first symptom often being death, when animals rarely get heart disease?

While I acknowledge the merit of his work and the essential validity of his theories, I disagree somewhat with Pauling's dosage recommendations. For the average person, 8-10 grams may not be ideal on a regular basis because it throws off the ratio of vitamin C to other components of the “c complex.” Bioflavonoids that accompany vitamin C in fruits and vegetables, though less important than vitamin C on an individual basis, collectively are an important nutritional component. My view is that while everyone should be taking at least 2 grams per day, higher dosages are more appropriate for people eating a healthy diet than for those eating an unhealthy diet largely devoid of fruits and vegetables. My theory is counterintuitive to the assumption that the unhealthier one’s diet, the more vitamin C one should take. But I believe that at Pauling-level dosages, this reasoning applies. Furthermore, this highlights the point that supplements and healthy diet work synergistically and optimal health cannot be achieved by one without the other.

Let’s consider the intriguing fact that humans possess three of the four enzymes necessary to make ascorbate from glucose. The vast majority of animals, aquatic and terrestrial, reptilian and mammalian, make their own ascorbate in their liver proportional to body mass. How much do they make? On a per bodyweight basis, an amount that approximates the lower-end range of ascorbate intake recommended by Pauling  - 30 times the RDA or 43 oranges.

It is believed the ability to synthesize ascorbate was lost through genetic mutation millions of years ago, though it’s hard to know for sure. Assuming this is true, even before humans lost the capacity to internally manufacture ascorbate, primitive humans generally consumed a much higher quantity of ascorbate-rich plant food than does modern man. Official pronouncements to the effect that adequate ascorbate can be obtained through diet are further flawed by the fact unless you consume raw plants from your own garden or locally grown produce, much vitamin C is lost during shipping, storage, and as a result of heat applied when cooking.

All of the other species that cannot produce vitamin C (including apes, guinea pigs, and the fruit-eating bat) consume a plant-predominant diet of fresh raw vegetation. Man is the only creature on earth that both cannot make ascorbate and has a low intake of ascorbate-rich foods. Interestingly as well, animals with high ascorbate levels rarely experience heart disease. Only man and woman suffer from heart disease. So what happens when you take an animal like a guinea pig (which, like us, does not make its own ascorbate) and feed it an ascorbate-deficient diet? Pauling’s research shows: heart disease results, in weeks rather than years due to their shorter lifespan.

A study published in the British Medical Journal supports Pauling’s theory, finding a 3.5 greater risk of heart attack among ascorbate deficient men compared with those not deficient. There are other contributing factors and HDL/LDL, triglyceride, and lipoprotein(a) are significant predictive cardiovascular risk indicators. But to reject out of hand that ascorbate deficiency plays a role in development of heart disease, without reading Pauling’s and Rath’s research and that of other scientists, is the height of negligence in my opinion.

In a nutshell, Pauling’s ascorbate theory of heart disease centers on collagen, the most abundant protein in the human and animal body. Collagen is the stuff that holds the body together and maintains the strength and structural integrity of connective tissues, skin, and blood vessels. Collagen production is ascorbate dependent; and, Professor Pauling points-out, ascorbate is not merely a catalyst for the manufacture of collagen but is used up in the process. What does collagen have to do with heart disease? The stronger and healthier the vessels through which blood flows, the less likely they are to clog.

Arterial walls are extremely delicate (compared with skin, tendons, and ligaments) and are regularly subjected to microinjury caused by oxidative stress and toxic blood-borne particles like homocysteine. When adequate ascorbate is not present, insufficient collagen is made to repair the damage, and in the absence of sufficient collagen, plaque forms at the site of the lesion. In Pauling’s view, atherosclerosis is a faulty alternative healing process (leading eventually to arterial blockage) necessitated by unnaturally low ascorbate levels. The optimal healing process is regeneration (rather than patching-up) of blood vessels, but this requires in humans and the relatively few other species that can’t make as much collagen precursor (ascorbate) as needed (or any, for that matter) an intake of vitamin C far greater than the recommended daily allowance.

The RDA of 60 mg. for vitamin C takes no account of Pauling’s research nor does it acknowledge any role for ascorbate in helping to prevent long-term cardiovascular pathology by countering oxidation of LDL cholesterol or facilitating breakdown of cholesterol to bile acids. Rather, it is designed to avoid scurvy. Scurvy occurs when ascorbate levels are so severely depressed that blood vessels become so thin and weak that they break, and the person hemorrhages to death. Is there any logical reason to suppose that vascular health benefits from increasing ascorbate intake up to 60 mg., then no further improvement is registered beyond that point? (Especially considering that every other creature inhabiting Earth either makes many times more ascorbate per gram of bodyweight than the RDA or consumes far more.) No, rather the sounder reasoning and the weight of the evidence suggests that an intake level of vitamin C approximating the RDA promotes progressive degeneration of the vascular system and partially accounts for the appalling rate of cardiovascular disease in the United States and other industrialized nations.