Last updated: 25 March 2020 21:00EST by Frank Cusimano
SUMMARY:
Taking supplemental Vitamin C orally does not prevent you from getting coronavirus. If you get it, it is unlikely to help treat you or reduce your symptoms. In the event that you develop severe Sepsis, Septic Shock, ARDS and require ventilation, High Dose IV Vitamin C may be used by some doctors to replenish the bodies Vitamin C’s stores. Sepsis can cause an over production of reactive oxygen species in the body, something Vitamin C, an antioxidant, can help fight. When a patient with sepsis depletes their Vitamin C, it can be replenished. How well this works is still controversial with insufficient clinical data. Taking Vitamin C as a supplement will not help because your body can not absorb enough. Prophylactically getting high dose IV infusions is also unlikely to help because IV Vitamin C would only be beneficial after you develop sepsis and are in the intensive care unit (ICU).
Background:
The logical assumption is that all viruses or respiratory illnesses are the same. Sadly, this is not the case. The pathophysiology of asthma, COPD, pneumonia, or interstitial lung disease are all different .
Because the pathology is different, so too are the symptoms, the disease progression, and the treatments. When thinking about potential therapies, there are countless of experimental drugs that clinicians have considered or tested in treating those infected with SARS-CoV2 . Most successfully, these medications are ones that effect viral replication, viral cell entry, or that inhibit an immune cell-mediated cytokine storm .
The Science:
Vitamin C has long been touted for its controversial usefulness in viral and upper respiratory illnesses. Vitamin C is a potent antioxidant that supports epithelial barrier function. In-vitro it has been shown to enhance B & T-cell differentiation, modulate cytokine production & decrease histamine levels . In-vivo (meaning in human research) meta-analyses consistently show differing results. For every article that says it helps, another says they saw no affect.
Rumors:
I heard rumors that patients in Wuhan were treated with high dose IV VitC, so like any scientist, I looked through the research. To date there are over 900 publications on COVID19: case reports, experimental treatments, mechanism. I found TWO papers that mentioned Vit C . Neither of them discussed patient data. One was an opinion piece. The other, a paper discussing ARDS (acute respiratory distress syndrome) & previous viral clinical trials where Vitamin C DID NOT improve respiratory outcomes .
Ok so maybe I missed the paper.
I went & scoured the 68 page treatment handbook published by a medical school (Zhejiang University School of Medicine) & hospital (First Affiliated Hospital) in Wuhan, no mention of Vit C . Then I looked through pubs on PubMed, the NIH, CDC COVID19 site, Harvard’s Covid clinical guidelines, & a few other sites. STILL NOTHING. Ok, where did those rumors come from? It turns out there is a physician (Dr. Cheng) from china claiming that his colleague (Dr. Mao of Ruijing Hospital) treated 50 patients with 5-20g of IV Vit C reducing their hospital stay by 4-5 days with 0% mortality but with an increase risk of hyper-coagulability. This data is NOT published, but he is claiming its true.
This is where the tough decisions come in. Do you trust unpublished data or not? For some, I understand how you may say, just because it isn’t proven doesn’t mean it doesn’t work. I get that. But for me, I know how many scientists jump at the chance of discovering something or being known for something. An example: in less than 90 days, over 900 papers were published on the coronavirus – why? Because scientists publish things they learn or find to be true. If this data is accurate, why isn’t it published? For this reason, I DO NOT TRUST UNPUBLISHED DATA.
Data like this scares me for a few reasons:
- If it’s accurate we are ignoring data that could help patients and data that could improve the COVID19 death rate.
- If it’s false, it scares me because it blatantly misleads the public, trust between the scientific community and the public is already tenuous.
- Lastly, It confuses physicians & the medical community.
Clinical Trials
In additional digging there is a clinical trial started by a Dr Peng of Zhongnan Hospital in Wuhan for the treatment of patients using IV VitC but no results or preliminary data have been posted; so far the trial is designed around the theory that Vitamin C may help.
Potential?
It is always important to ask: is there a precedent to use Vitamin C for patients with COVID19?
As I mentioned at the beginning, every disease process is different. In this case, many SARS-CoV2 infected patients rapidly decompensate to full ARDS (acute respiratory distress syndrome) often times needing invasive ventilation. In one of the original papers published on COVID19, those that required intubation had a poor prognosis with up to 57% of them not surviving . Patients with COVID19 also develop severe sepsis and septic shock . So I decided to scour the literature to see if there was literature showing Vitamin C being used in the treatment of ARDS, for patients on ventilation, or in the treatment of sepsis or septic shock. First the VITAMINS randomized clinical trial: published 17 January 2020 found that for patients with septic shock, treatment with IV Vitamin C, hydrocortisone and thiamine did not significantly improve their outcome or mortality . For ARDS, the CITRIS-ALI randomized clinical trial: published on 1 October 2019 found that for patients with sepsis and ARDS, infusion of Vitamin C did not significantly improve organ dysfunction or alter markers of inflammation and vascular injury . Lastly, in January of 2020, a meta-analysis was published identifying if vitamin C could reduce the duration of mechanical ventilation. Although they found strong evidence that vitamin C may shorten the duration of mechanical ventilation, they did not look at patients with only severe ARDS and they found that as time spent on a ventilator increased, the correlation disappeared . With the COVID19 disease process being as severe as it is, it is unlikely that Vitamin C would help given the long duration of respiratory distress.
Discussion:
So what do we make of all this? Nothing. I have no opinion. I do not plan on taking a vitamin C supplement nor will I trust claims that it works for patients infected with SARS-CoV2 until I see a peer-reviewed publication on it. High Dose intravenous Vitamin C can have consequences (hypercoagulalation) ; something we should remember when thinking about potential therapies.
For more articles on the coronavirus, check here.
Update: (25 March 2020)
NYC Hospitals Treating Patients with IV Vitamin C
NEWS UPDATE: Above, I discussed Vit C & COVID-19 & the lack of scientific evidence for using it as a treatment. After publishing I learned that a NYC hospital is treating infected patients with High Dose IV Vitamin C. There are a few things to note, High Dose IV VitC is not the same as taking Vitamin C orally. In the Levine et al. paper, it would be impossible to reach the dose used in these treatments by taking oral supplements .
The original concepts for using high dose VitC in the ICU was from the Marik Protocol published in 2017 . They used IV Hydrocortisone, VitC & Thiamine to treat 47 patients at a single hospital. Several similar studies have been done as well. The best two, The CITRIS-ALI & VITAMINS trials both multi-center, randomized, double-blind placebo-controlled trials found no improvement with VitC. Does this mean it doesn’t work, NO, currently the VICTAS trial is going on which includes 40 hospitals & 2000 patients . Many ICUs still use the Marik Protocol in sepsis. So if it does work, why would it & should I be taking IV infusions prophylactically? In theory, getting IV infusions now won’t help. The reason: IV VitC working has nothing to do with the virus. It has to do with the oxidative stress of sepsis where reactive oxygen species cause lipid peroxidation, endothelial disruption, & increased vascular permeability. Critically ill, septic patients routinely have low plasma VitC due to the activation of complement-mediated inflammation leading to inadequate intracellular concentrations. Replenishing the VitC, IV during sepsis, attenuates some of this stress & may improve epithelial barrier function & alveolar fluid clearance.
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Disclaimer: Opinions on this site or on social media do not reflect that of my institutions. I do not provide medical advice. If you have a medical question please see your doctor or if you have a medical emergency, please go to the nearest emergency room.. I have a PhD in Nutrition and Metabolic Biology and three masters degrees including two master’s in nutrition & metabolism. I am a personal trainer & have researched nutrition for 12 years. The info I post is my interpretation of the medical and scientific literature.
