##Dr Robert F. Cathcart: Vitamin C, Titrating to Tolerance http://www.orthomed.com/titrate.htm
Allergy, Environmental, and Orthomolecular Medicine, Orthopedic Medicine
127 Second Street,Suite 4, Los Altos,California, USA,Fax:650-949-5083 –
TITRATING TO BOWEL TOLERANCE
The maximum relief of symptoms which can be expected with oral doses of ascorbic acid is obtained at a point just short of the amount which produces diarrhea. The amount and the timing of the doses are usually sensed by the patient.
The physician should not try to regulate exactly the amount and timing of these doses because the optimally effective dose will often change from dose to dose. Patients are instructed on the general principles of determining doses and given estimates of the reasonable starting amounts and timing of these doses. I have named this process of the patient determining the optimum dose, TITRATING TO BOWEL TOLERANCE.
The patient tries to TITRATE between that amount which begins to make him feel better and that amount which almost but not quite causes diarrhea.
I think it is only that excess amount of ascorbate not absorbed into the body which causes diarrhea; what does not reach the rectum, does not cause diarrhea.
It is interesting to know, when one speculates on the exact cause of this diarrhea, that while a hypertonic solution of sodium ascorbate is being administered intravenously, the amount of ascorbic acid tolerated orally actually increases.
THE 100 GRAM COLD
When a person is ill the amount of ascorbic acid he can ingest without diarrhea being produced increases somewhat proportionally to the severity or the toxicity of the disease. A cold severe enough to permit a person to take 100 grams of ascorbic acid per 24 hours during the peak of the disease, I call a 100 GRAM COLD.
Perhaps one of the most important principles in ORTHOMOLECULAR MEDICINE is BIOCHEMICAL INDIVIDUALITY (18). Every individual responds to substances differently. Vitamin C is no exception. However, at least 80% of my patients tolerated ascorbic acid well. Admittedly, there were relatively few older patients in my practice. Infants, small children, and teenagers tolerate ascorbic acid well and can take, proportionate to their body weight, larger amounts than adults.
Older adults tolerate lesser amounts and have a higher percentage of nuisance difficulties. Patients with multiple food intolerances may have more difficulties but should attempt taking ascorbate because of benefits often obtained.
For several years while I was treating only sick people with ascorbic acid, I was unaware of the number of people who had nuisance problems with maintenance doses. The tolerance of the sick person to ascorbate is so high as to prevent many of the complaints one would have if he were well. When ascorbic acid is prescribed to a sick person, the beneficial effect is obvious enough so that few complain of the gas and diarrhea.
With illness the effects of an overdose do not last long because of the rapid rate of utilization.
It is important for the physician to understand the principles of treating this vast majority of tolerant persons. Patients frequently underdose themselves and need professional guidance to push the doses to effective levels. The small number of persons, especially elderly persons, intolerant to oral doses are in my experience able to take intravenous ascorbate without difficulties. Additionally, patients with severe problems may need to be treated intravenously if very high doses will have to be maintained for some time for adequate suppression of symptoms.
The following problems should be expected with increased incidence with severe depletion of ascorbate: disorders of the immune system such as secondary infections, rheumatoid arthritis and other collagen diseases, allergic reactions to drugs, foods and other substances, chronic infections such as herpes, or sequelae of acute infections such as Guillain-Barre’ and Reye’s syndromes, rheumatic fever, or scarlet fever; disorders of the blood coagulation mechanisms such as hemorrhage, heart attacks, strokes, hemorrhoids, and other vascular thrombosis; failure to cope properly with stresses due to suppression of the adrenal functions such as phlebitis, other inflammatory disorders, asthma and other allergies;
problems of disordered collagen formation such as impaired ability to heal, excessive scarring, bed sores, varicose veins, hernias, stretch marks, wrinkles, perhaps even wear of cartilage or degeneration of spinal discs; impaired function of the nervous system such as malaise, decreased pain tolerance, tendency to muscle spasms, even psychiatric disorders and senility; and cancer from the suppressed immune system and carcinogens not detoxified; etc. Note that I am not saying that ascorbate depletion is the only cause of these disorders, but I am pointing out that disorders of these systems would certainly predispose to these diseases and that these systems are known to be dependent upon ascorbate for their proper function.
I have avoided the treatment of cancer patients for legal reasons; however, I have given nutritional consults to a number of cancer patients and have observed an increased bowel tolerance to ascorbic acid.
Were I treating cancer patients, I would not limit their ascorbic acid ingestion to a set amount but would titrate them to bowel tolerance. Ewan Cameron’s advice against giving cancer patients with widespread metastasis large amounts of ascorbate too rapidly at first should be heeded.
He found that sometimes extensive necrosis or hemorrhage in the cancer could kill a patient with widespread metastasis if the vitamin was started too rapidly (16). Hopefully, in the future ascorbic acid will be among the initial treatments given cancer patients. The additional nutritional needs of cancer patients are not limited to ascorbic acid, but certainly the stress involved with having the disease depletes ascorbate levels in the body.
Ascorbate should be used in cancer patients to avert disorders of ascorbate deficiency in various systems of the body including the immune system.
– Cameron, E. and Pauling, L. Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer. Proc. Natl. Acad. Sci. USA, 73:3685-3689, 1976.
– Cameron, E. and Pauling, L. The orthomolecular treatment of cancer: Reevaluation of prolongation of survival times in terminal human cancer. Proc. Natl. Acad. Sci. USA, 75:4538-4542, 1978.
– Cameron, E. and Pauling, L. Cancer and Vitamin C. The Linus Pauling Institute for Science and Medicine, Menlo Park, 1979.