VIEWPOINT Vitamin C And

VIEWPOINT claims and promotions are unwar- Vitamin C and the ranted. The book itself is written with the common cold fervour of a missionary, and in this cause Linus Pauling appears to take G. H. Beaton, ph.d. and S. Whalen, b.sc, Toronto that stance. The introduction de¬ scribes his earlier acceptance and per¬ Success in the search for an effective body and are required for health". sonal trial of the high-level ascorbic cure or preventive for the common This approach has great popular and, acid regimen of Dr. Irwin Stone, an cold has eluded the health profession to a degree, scientific appeal. Howev¬ industrial biochemist. His conviction in spite of extensive research and er, it cannot be assumed to be either and mission are clearly stated in the numerous trials. Today our pharma¬ effective or without potential harm; conclusion to this section: "It will cies are stocked with thousands of adequate clinical testing is still re¬ take decades to eradicate the com¬ patent medicines intended for this quired. mon cold completely, but it can, I purpose (the annual bill in the United Is Pauling's proposed regimen of believe, be controlled almost entirely States is estimated to be more than any greater value than the many nos- in the United States and some other $500 million). To the best of the trums now in use? Pauling is con- countries within a few years through writers' knowledge there is no evi¬ vinced that it is, and concludes his improvement of nutrition of the peo¬ dence that any of these preparations book with the statement "I am con- ple by an adequate intake of ascorbic will either prevent or ameliorate the vinced that the value of ascorbic acid acid. I look forward to witnessing this basic disease process. Undoubtedly should now be recognized." On the step toward a better world." some of them offer at least partial whole, his reviewers seem less con- In his book Pauling presents the relief of symptoms and are judged to vinced and have expressed or implied theoretical basis of his personal con¬ be beneficial by the consumer. How¬ opinions that Pauling's views range viction along with a discussion of ever, it is also probable that some are from near quackery to a brilliant but concepts which relate to his basic actually harmful, particularly if tak¬ speculative venture of an outstanding arguments in only a minor way but en in excess. scientist who applies the approach of which, to the casual reader, may give To this armamentarium Linus a theoretician to practical medical added credibility. In essence, Paul¬ Pauling1 urges that we add vitamin C, problems. ing's argument rests on the beliefthat to be taken in large doses as a preven¬ It is of interest that both the author some 25 million years ago man's pre- tive measure and in still larger doses and his critics seem to agree on one historic ancestors lost the enzymatic as a treatment for the cold. In support central point.at the moment there is ability to synthesize ascorbic acid at a of this he points to the benefits of no scientifically valid evidence that time when the intake of this vitamin "Orthomolecular Medicine", as de¬ Pauling's proposed prophylaxis will was close to the optimum so that its fined by him, "the preservation of work, at least to the degree that he synthesis was no longer an advantage. good health and the treatment of claims, nor is there proof that it will Since man is one of the few species disease by varying the concentrations not work. The major controversy that does lack the necessary enzyme in the human body of substances hinges on a subtle but important for synthesis, this concept has credi¬ which are normally present in the point.upon whom does the onus of bility. Assuming that man was then a proof lie, upon him who proposes a complete vegetarian, Pauling calcu- From the Department of Nutrition, School of new approach or upon the one who lates his probable vitamin C intake on Hygiene, University ofToronto, Toronto, criticizes a new theory? The bias of the basis of the composition of mod¬ Ontario. the and of many ern foods and concludes that this, the Reprint requests to: Dr. George H. Beaton, writers, perhaps Professor and Head, Department ofNutrition, medical scientists, leads them to feel optimum intake by his theory, was School of Hygiene, University ofToronto, that until the evidence is much more within the range of 2.3 to 9 g. per day Toronto 5, Ontario. substantive than at present, major (in contrast to the usually recom- C.M.A. JOURNAL/AUGUST 21, 1971/VOL. 105 355 Hasselblad. mended intake of 20 to 60 mg. per day). This would be a major overesti- mate if our ancestors at that time Some people never settle for second best. consumed significant amounts of ei¬ ther cereals or meats; it might be seriously in error ifthe foods then had a different composition from modern foods. Pauling enlists support for his theory by citing the amounts of ascor¬ bic acid synthesized by the rat. Since the rat does not require a dietary source of the vitamin, Pauling sug¬ gests that it synthesizes an optimal amount. If this amount is translated to the human on a simple weight basis, the estimate obtained is in rough accord with Pauling's predict¬ ed optimal requirement for man. On the other hand, if one attempts to translate the rat synthesis rate on the basis of "metabolic size", W°75, a relationship which seems more ap¬ propriate than simple weight for a number of other biological phenome¬ na, the derived estimate of human requirements is much lower than Pauling's postulated figure, albeit still higher than the usual recom¬ mended intake. Pauling infers further support for his theory from the well- accepted concept of individual varia¬ bility in biological phenomena. He suggests that in the case of ascorbic acid, man's optimal requirement may vary from 250 mg. or less to as much as 10 g. or more. Thus, the response of an individual to a given level of ascor¬ bic acid intake might vary depending upon where his own optimal require¬ ment lay. These are the arguments of a theoretician and can only be chal- lenged on a theoretical basis; it seems improbable that they will ever be proved or disproved by experimental test. It is in the area of the claimed specific effect of vitamin C on the They're aware. Involved. On the move. They From the Carl Zeiss lens through to the common cold that the controversy like to get the most out of everything they interchangeable magazines. You'll see all the this book is most heated. do. own a Hasselblad camera. want reasons for and surrounding They They performance dependability Such claims are not new. There have the superb picture quality the Hasselblad that have made Hasselblad the choice of been claims for almost all of system gives. And they don't mind paying for it. U.S. astronauts on every NASA space flight parallel If settling for second best isn't quite since 1962. For information, write to: Braun the vitamins dating from the period of your way, check in at a franchised Hasselblad Electric Canada Ltd., 3269 American Drive, their discovery and the realization by dealer and check out the Hasselblad system. Mississauga, Ontario. the medical scientist that the lack ofa necessary factor, as well as the pre¬ sence ofa noxious factor, could be the HASS£LBLAD cause ofclinical disease. In the case of ascorbic acid, the literature does con¬ tain many trials. Unfortunately many ofthe studies are poorly controlled or uncontrolled and must be discredited. A few are well controlled. But even the system here, Pauling and his critics differ on the interpretation of the data and more particularly on how it relates to his basic premise that large doses 356 C.M.A. JOURNAL/AUGUST 21, 1971/VOL. 105 (much larger than those used in the 0.58 for the experimental group-a while." From the quotation cited ear- reported trials) will eradicate or at 20% reduction. He suggests that this lier, it is apparent that Pauling thinks least greatly reduce the incidence and is a measure of severity and concludes that the success rate will be almost severity of the common cold. To ex- that ascorbic acid reduces the severity 100%. Many of his critics are a good emplify the difficulty, one study of colds. The number of complica- deal less optimistic. which has been cited and countercited tions might also be considered a In conclusion, how do we assess Dr. by Pauling and his critics2-7 is de- measure of severity, and this was Pauling's claim for the use of vitamin scribed below. reported in the original paper to be C in the prevention of colds? Unsub- In 1942 Cowan, Diehl and Baker8 somewhat higher in the experimental stantiated. Do we think that practi- reported the results of a study carried group than in the control group. tioners should advise their patients to out with students at the University of Again one might ask what the correct take the amounts of vitamin C pro- Minnesota. Over a 28-week period interpretation in the present context posed by Pauling? No. Do we think the students took either a placebo or should be. that controlled clinical trials should approximately 200 mg. of ascorbic Pauling cites from the literature a be undertaken to test his proposal? acid on a daily basis and a record was number of studies which suggest at On the basis of the arguments pre- kept of the symptoms which might be least small effects of vitamin C.

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