Nutrition Update and Editorial:

Vitamin C, RDAs and Politics

Vitamin C has long been a politically loaded subject in US medical circles, especially after the late Dr. Linus Pauling had the gall to pronounce that it was effective in decreasing the severity and duration of the common cold. Pauling’s 1971 meta-analysis of the then-published studies was published in the Proceedings of the National Academy of Sciences and concluded that vitamin C significantly lessened cold-related illness (P.00003). Although a P value less than 0.05 is considered significant and a P value less than 0.001 is considered outstanding, few physicians accepted Pauling’s analysis.

The medical community’s resistance to Pauling’s conclusion soon found a champion in Robert Chalmers, who, in 1975, published his own meta-analysis of “reasonably well controlled” studies in which he concluded that vitamin C only decreased colds by 0.11 days, a “minor and insignificant” matter.

The fact that Chalmers’ analysis flatly contradicted Pauling’s resulted in it being highly cited in the medical literature — more than twice as often to date. This discrepancy is especially telling because Chalmers’ analysis was more superficial and made numerous errors reporting on the results of studies considered in his analysis. Just how many errors was not clear until recently when Harri Hemilä of the University of Helsinki and Zelek Herman of the Linus Pauling Institute published a retrospective analysis of Chalmers’ review citing an appalling number of mistakes, almost all of which were prejudicial against vitamin C. Replacing Chalmers’ flawed data with correct data resulted in a finding of 0.93 fewer days of illness (P.01), a 21% savings in sick time (P.001) and a combined P value from the six statistically significant studies of less than 0.000004 (2-tailed probability of difference). In other words, Linus Pauling was right. Vitamin C does, in fact, decrease both the duration and severity of colds. And studies conducted after Pauling’s and Chalmers’ meta-analyses have born this out.

Why were so many scientists on the wrong side of this matter? The answer is simple: politics! Medical attitudes against vitamins were strident in the 1970s, despite a considerable volume of evidence indicating their effectiveness. In the 1990s, the anti-vitamin rhetoric is still alive, but it is being toned down to a large degree by the volume of young professionals entering science and medicine who know beyond a shadow of a doubt that their older peers are just plain wrong.

The ostracism of Pauling is a testament to the corrupting influence of politics in medicine and science. This is partly due to the anticompetitive nature of medical regulation in which peer standards of conduct are the primary considerations by which physicians are judged (clinical efficacy is considered optional). Scientists have their peer-review standards for publishing and government grants. But political corruption of science and medicine is also due to the fact that scientists and doctors are people, and people are social and political animals.

Science vs Science

There is an essential difference between science as a methodology (a system of discovery) and science as an institution (a group of like-minded people). As a methodology, science can make claims to impartiality, detachment and lack of bias. But as an institution, it can never be so. Scientists do not abandon their egos, pride, prejudice, curiosity, spirituality or emotion — some of the things that define our essential humanity — when they choose science as an avocation, no matter how some might pretend that they are not influenced by peer pressure, social conformity or whatever. Scientists, and doctors, are people like everybody else. Their claim to know “the truth” is just as tenuous as the claims of religious institutions to know the “the will of God.” And just as religious institutions have been corrupted to the interests of wars and genocide, scientists are corrupted by politics, pride and avarice to suppress good science.

It may seem strange for a scientist to be saying all this “bad stuff” about science. But in my opinion, the search for the truth cannot know such bounds. One must take the search for truth wherever it leads. If I can’t stand the answer, I shouldn’t ask the question in the first place.

Three Nobel Prizes?

Lack of imagination is as much a limiting factor in science and discovery as lack of technology is. In other words, it is easier to discover what is when one can imagine what might be. In this respect, Linus Pauling was one of the best examples of a modern-age scientist. His curiosity and imagination led him to explore many diverse fields of science, many in which he demonstrated excellence. Not only is he the only person to win two unshared Nobel prizes, he might well have won a third for discovering the structure of DNA if the US government had not prevented him from attending a scientific meeting in Europe where key crystallographic data on DNA were presented. Pauling had most of the structure worked out and only needed a few additional pieces of information to put it all together. But the US government decided that Pauling’s political views about nuclear testing were a security risk and withheld his passport. So Watson and Crick attended the meeting, got the key data, put the pieces together, and won a Nobel Prize for their efforts.

In the meanwhile, the bias against vitamin C and nutrition continues. The US RDAs, for example, are designed to prevent overt deficiency disease in most people, not to prevent the most disease in all people. Despite evidence that higher vitamin C intake would enhance public health and decrease disease, political considerations are preventing the RDA for vitamin C from being raised from 60 mg to 75 mg or (gasp!) 100 mg. Some scientists are even proposing that it be lowered to 45 mg. The recommended daily dose of vitamin C for a chimpanzee is 300 mg, and chimps weigh less than humans do.

A Wrench in the Works

In April, a study by Mark Levine and associates at the National Institutes of Health was published which confirmed the inadequacy of the current 60 mg RDA. In the study, seven young, healthy men were hospitalized and fed a vitamin C deficient diet (5 mg/day). After they were depleted, they were given vitamin C at 30 mg, 60 mg, 100 mg and 400 mg. Six of 7 were tested at 1000 mg (see Figure A) and 3 of 7 at 2500 mg.

Vitamin C intake of 30 mg hardly had any effect at all on the depleted vitamin C levels. 60 mg was barely able to double levels from the depleted state. 100 mg was able to double them again, and significantly saturate blood-cell vitamin C levels. And 200 mg was sufficient to raise levels “over the hump” of the sigmoid (S-shaped) dose-response curve, a “standard” for establishing RDA levels. Blood levels of vitamin C continued to increase at 400, 1000 and 2500 mg dosages.

Based on pharmacological considerations considered basic to the establishment of RDAs, Dr. Levine and colleagues suggested that 200 mg would be a better RDA for humans. They found the existing 60 mg RDA to be “on the lower third of the [dose-response] curve.”

Interestingly, one of the seven study participants appeared to have a distinctly greater response to vitamin C than all the others. This “highest responder” (see Figure B) was able to develop higher vitamin C blood levels at the 60 mg dose than the average response at 100 mg. This finding was based on 13 separate blood test results, so it is not likely to be a statistical accident.

Although this study establishes that 200 mg is an adequate RDA for young, normal, healthy men, it does not address the vitamin C requirements of women, children, middle aged and elderly adults, and individuals dealing with special circumstances (special diets, tobacco smoking, sickness, infection, toxemia, trauma, metabolic and genetic disorders, or degenerative diseases).

While we may be able to reset the RDA or change the regulation of medicine from a social-conformity standard to a quality-of-services standard, we cannot legislate human nature. We cannot control other people’s beliefs. But we do have the power to challenge ourselves with divergent opinions to better avoid the traps of orthodoxy and narrow-mindedness within our society and ourselves.

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