Vitamin C: Supplements 101

Tina 0:00

Hello, and welcome to episode 31 of the cancer pod today, we're talking about vitamin C insufficiency, deficiencies, how it's relevant to cancer care, all this and more on today's episode I'm Dr Tina Kaczor and as Leah likes to say I'm the science-y one

Leah 0:15

and I'm Dr Leah Sherman and on the cancer inside

Tina 0:19

And we're two naturopathic doctors who practice integrative cancer care

Leah 0:23

But we're not your doctors

Tina 0:25

This is for education entertainment and informational purposes only

Leah 0:29

do not apply any of this information without first speaking to your doctor

Tina 0:34

The views and opinions expressed on this podcast by the hosts and their guests are solely their own

Leah 0:40

Welcome to the cancer pod

Tina 0:58

How you doing Tina? I'm doing. That's all that counts. This is now our fourth time. I don't know. I lost track fourth time, fifth time. I'm not sure how many times we've already done half of this podcast.

Leah 1:10

Yeah, we can. We can't seem to get to the other half and we keep losing our recordings.

Intro: Vitamin C

Leah 1:15

So let's just start from the beginning. It's a very good place to start. So Tina higher primates, Guinea pigs, and fruit bets. What do they have in common?

Tina 1:26

Well, trying to make some of the sound free.

Leah 1:28

You've never heard me ask

Tina 1:29

you that question before. I know the answer. None of them can make. Vitamin C

Leah 1:35

exactly, exactly. They all have to get it through their diet. And it's an essential nutrient that is used in so many enzymatic reactions. it's used in pretty much every tissue in our body. So it's really important to make sure that you do get it in your diet. And that's why we are talking about.

Tina 1:56

Vitamin C today. Yeah. Yeah. And it does have quite a bit of research around cancer care too. And so we'll get into

Leah 2:02

that. Yeah. So we will start covering, like, we usually do, the guidelines for taking a supplement. So does it help with an acute deficiency? What does it do if there's a chronic deficiency and then also green pharmacy, which is when it's used at different doses to address a specific purpose. So I'm

Scurvy, Sailors, and tall tales

Leah 2:25

guessing most people have heard of scurvy for one reason or other. if not for the, um, the legend of British sailors, having Lyme to prevent their

Tina 2:37

scurvy. Yeah. I think that some people know that story about how limes were taken on board to prevent scurvy. And that was credited to James Lynn. He

Leah 2:48

was a British Navy surgeon who had noticed that when people had citrus fruits or juice, that the symptoms of scurvy improved.

Tina 2:59

Yes. Now for their reasons he thought he like many physicians of his day thought scurvy was due to. Future vacation of food within the body. And so he set up a little experiment and said, if that's the case, then acidic food should improve things. And he had five different groups. Each group took a different item. Some of them's sulfuric acid, some of them took oranges and lemons. Some of them took seawater.

Leah 3:26

Hmm that's that's a good

Tina 3:27

one. In any case of the five different arms. First of its kind clinical trial at sea, he found that only the group who took oranges and lemons were saved from having scurvy the other group. Went on to have scurvy. And some of them actually died

Leah 3:44

of scurvy because he gave them

Tina 3:46

seawater. Well, that didn't help for sure. Um, but here's, here's the, I thought one interesting little factoid in this whole story of his being credited with this one, he didn't invent it. He just happened to set up an experiment that was rather convincing. Once we knew what was going on in its day. It wasn't convincing despite the fact that he wrote an essay on it in 1753 a treatise of the scurvy. Um, in any case, nobody gave him. love for this whole thing. And so much, much later, he himself never embraced the idea that the citrus contained something that reversed scurvy, because he continued to believe that it was purification of food. He didn't really advocate for citrus as a single solution for scurvy, even though it

Leah 4:29

was. But I wonder if he used the citrus on patients with this alleged putrefaction. That wasn't actually scurvy and if it just didn't work,

Tina 4:38

right. Sure. Yeah. Yeah. That's totally possible. Whatever it is, he couldn't let go of that kind of dominant paradigm in his brain. So for that reason, he never fully appreciated it in his lifetime and it wasn't until we looked back. And found out what was in the citrus that we also appreciate it, but just so we're clear, he didn't come up with the idea of putting citrus on the boats that had been done for hundreds of years prior to him, but he got the credit he wrote, he wrote about it and yes, he went down in history as the person synonymous with this as a remedy, even though I think it was a traditional medicine, but I think. Just as famous for doing what they consider. One, maybe the first trial in humans, you know, the first kind of trial, five different arms taking five different things and proving which one work

Leah 5:24

interesting. So, um, but ultimately, uh, score Vic acid or vitamin C wasn't even discovered until 1932. So it was this idea that citrus fruit could help eliminate the symptoms, but they didn't know what it was particularly in it. That was the

Tina 5:39

cure. Right. They did not know the compound. Which goes along with so many times that this happens, right? I mean, we often find that some food contains an item, essential nutrient, that cures fill in the blank. You know, so B12 deficiencies were cured with foods before we knew what B12 was in this case, it happens to be vitamin C, but that happened over and over again where, you know, they used food to prevent overt deficiencies of a nutrient, but they didn't know the nutrient chemically. They didn't identify it. They just knew that eating the food, prevented it. Another example of. Is adding lime to corn flour. Many traditions. And what that did, was it made the vitamin B3 more available and spared people, vitamin B3 deficiency or

Leah 6:23

pellagra nixtamalization, that's what that's known as

Tina 6:26

nixtamalization is adding the Lyme.

Leah 6:29

Yeah. You'll notice that if you buy like corn tortillas and stuff, that's the kind

Tina 6:33

you want. It's not just to make them.

Leah 6:36

No, it does soften the corn and

Tina 6:38

it makes the corn's vitamin B3 available too. That's awesome. Yeah. So anyways, a lot of these things that we do with traditional foods and in cultures around the world was done to prevent disease states or prevent deficiencies of nutrients. Unwittingly had no idea. That's why we were doing it at least.

Leah 6:58

Okay. So from

Symptoms of Vit C defiency

Leah 7:00

looking at the side effects of scurvy, you can kind of see all of the effects that vitamin C has on the body. fatigue is a big one and that may have to do with the role of carnitine, which helps with heart function. And so carnitine is vitamin C dependent, um, inflamed gums, joint pain, poor wound healing, thicken skin, corkscrew hairs, iron deficiency, anemia, bruising, like these little tiny bruises known as Um, And then eventually there was impaired collagen synthesis and weak connective tissues. So it just shows you how, how prevalent, the need for vitamin C is

Tina 7:44

in our bodies. Yeah, and I, I think that it's essential for college and to be produced in our bodies. And for those who didn't hear this in our last episode, which focused on college and college and makes up 30% of the protein in the human body. It's the major structural protein. It creates almost like a scaffolding. It helps the structure of all of our tissue. Most people think of audit for skin, but it's everywhere and there's 28 different colleges. And we talked about that in detail, but vitamin C is needed for making collagen throughout the body. So you could see. Has global effects. If you don't have enough vitamin C, if you can't make college in a lot of things will break

Leah 8:21

down. Yeah. And scurvy can be fatal. So severe vitamin C deficiency is fatal. Um, we don't really see that so much, at least in the U S it can happen in certain areas where there might be, lack of access to foods, fresh foods, because vitamin C is volatile. So if you're buying. Canned fruits. They may not have the vitamin C content through their PR depending on what their processing

Who is vulnerable?

Leah 8:50

is. Um, the elderly people with restrictive diets, malabsorption people with kidney

Tina 8:56

disease. Yeah. The irony of that one is that you did a lot of trials on those with kidney disease, severe kidney disease. They gave them vitamin C and. Definitely helps improve function. So there might be a little bit more requisite and a little bit higher requisite for those who have severe kidney diseases. And by that, I mean like, you know, kidney failure stages two, three, and beyond, right.

Leah 9:18

Um, another group of, people who might need. Higher doses would be smokers and passive smokers as well as women who are pregnant or breastfeeding. And then another group that would be potentially deficient in vitamin C would be infants who are fed, boiled or evaporated milk. Interesting. Which I I've never heard. I will, I guess, you know, if you're you heat breast milk, but you don't bring it to a boil. So I don't know much about. What infants eat.

Tina 9:54

Yeah. And well, that whole heat heat will break down vitamin C pretty quickly. So vitamin C you often hear about in fruits or in berries or things that we eat raw, you know, pepper. that's where you hear about getting vitamin C, because once you cook it down, like you're eating a soup where there was a bunch of vegetables that had it when they were up, it's going to be broken down because of the heat because of the heat. Yeah. It's pretty, it's pretty fragile in the grand scheme of molecules.

Recommended minimum doses

Leah 10:19

So the doses, the recommended dose for vitamin C, it is pretty low who recommends about 45 milligrams, which is. Like maybe like a really small, like one of those cutie oranges or something it's like a half an orange. Um, the FDA says about 60 milligrams and then Linus Pauling Institute, which is where I got a lot of my notes from, um, they recommend about 75 milligrams for non breastfeeding non-pregnant women and 90 milligrams for men. And then smokers would be. About 30 milligrams higher for each. So that really comes to like, uh, you know, at the very most, a hundred to 125 milligrams of vitamin C, which is easily obtained through the diet.

Tina 11:02

Yeah. And because the requisite amount of vitamin C can be. Easily acquired from the diet. That means we don't see it where people are well fed as much as we will see it, where people have no access to fresh fruit and vegetables or no access to, you know, good food in general. Right? So this becomes a bigger problem around the world than we have in our kind of well fed societies in the way.

Deficiency vs. Insufficiency

Tina 11:27

So we don't see scurvy per se in the United States very often, but we probably see more of the effects of when people don't eat fresh fruit and vegetables, when they don't get enough vitamin C to maintain adequacy over a long period of time. So that shows up as cardiovascular disease. That means specifically endothelial dysfunction, which means the vasculature itself suffers, um, gums and teeth. So there'll be. Affects on the enamel and the gums, the mouth will show some inflammation sometimes. So maybe some Gingervitis there can be effects on neurotransmitters over time. the effects are more

Leah 12:05

subtle. It's more like insufficiency, right? It's more like chronic insufficiency. Cause they're getting enough to not have overt deficiency like scurvy, but they're just not getting enough to reduce their risk of other things. We see that with poor wound healing a lot too. because as we discussed in our last episode, you need that vitamin C for collagen. it's what helps with that structure. Um, it can affect the eyes there's some information showing that cataracts or macular degeneration may be reduced. The risk of that may be reduced with vitamin C foods. Um, maybe diabetes. Alzheimer's, it's really hard because a lot of these studies will show benefit and then there'll be studies that don't show benefit. So,

Tina 12:52

you know, and that goes back to how the study was designed, whether these people have. Had an actual need for that nutrient or not. So that's often the case in those studies that are conflicting is the designs are different. so on that note, I don't think we mentioned the one thing

Vit C as antioxidant

Tina 13:07

that most people associate vitamin C with, and that is it's an antioxidant as well.

Leah 13:11

Nope. No, we, I don't even think we mentioned that the first four times we recorded it. Think we

Tina 13:18

got well in it's role to protect the eyes or protect the vasculature or cells throughout the body, or even in those smokers. the reason there's a higher need of vitamin C is vitamin C is an antioxidant in. Plays a role in antioxidant enzyme systems within the cells. So it helps alongside things like vitamin E to perpetuate kind of an antioxidant effect within cell. So it prevents damage, long story, short damage due to pollution damage due to high sugar diets damaged due to aging itself. I mean, there's just damage that happens to cells as just a matter of course of living. Right? So vitamin C has global effects in so many ways. It's the

Leah 13:59

anti-aging.

Tina 14:01

Oh, did you just make that up or did you make that up?

Leah 14:04

Yeah, I'm going to hashtag market copyright. so that kind

Green pharmacy uses

Leah 14:08

of leads us to the green pharmacy use of vitamin C, which as I mentioned, you know, it's something that I do recommend for my patients. A couple of weeks leading up to surgeries, as well as continuing it after surgeries during the healing period, because it does support with scar formation and healing and all of that. I think people mostly know it for cold prevention, right? I mean, the products like. Airborne or emergency, you always hear someone saying like, oh, I'm getting a little tickle in my throat. I'm going to take some airborne or I'm going on. A plane is that's the whole reason airborne came about. And again, the information it's that's out there, does it really show benefit? I don't know.

Tina 14:50

Yeah. It does seem to increase some of the white blood cells that we need to fight off infections. And, and, you know, it's like so many of these nutrients we can say for sure that a deficiency or insufficient. Does you no. Good. So I think, I think that's like making sure that you have enough for proper function is good. When a green pharmacy or what we call green pharmacy with a mega dose, a specific dose, a larger dose than you would get from food when that's indicated is always up for debate and may vary by doctor's opinions. The other thing I use it in larger amounts for is to goad people's bowels to go, go to the hall and use it to taunt their bowels go them along. No for constipation. Yeah. So, um, the classic term is taking vitamin C to bowel tolerance and bowel tolerance is literal it's as much as your bowels can tolerate. So in other words, once you hit bowel tolerance, your stools get loose and loosening. The stool. So if you're constipated that can be useful in bell tolerance is the maximum amount you can absorb. Um, so some people can absorb two or four grams and other people can absorb eight or 12 grams in a day. And so finding that and using it to loosen the stool can be helpful for some people.

Leah 16:06

And I guess that kind of brings us to like the doses that you can get in supplements. You know, it's typically a 500 or a thousand milligram capsule or tablet for wound healing. I usually have patients take between 1,002 thousand a day and I try to make sure they're including all the foods as well. But knowing that, you know, like 125 milligrams is really like, what is recommended as the RDA, the recommended daily allowance, like even 500 is a really high dose. And so it's interesting because your body can only utilize so much. Right. And so taking a thousand milligrams at once may not even be. Beneficial.

Tina 16:45

Yeah. The question, I think that we don't know the answer to that. I've I have never seen an adequate answer to is what the rest of that vitamin C does. So let's just say you take a thousand milligrams and you absorb half of that into your bloodstream and the other 500 milligrams, you know, winds its way through your small intestine and into your colon, how that affects the gut bacteria, But I don't know what it does down the line. I think when we use something traditionally and we notice an effect, sometimes we don't know why it's happening. In other words, like vitamin C up to bowel tolerance, maybe the leftover vitamin C that's floating down. The colon actually has a physiological. As well as the sea, that's making it into your bloodstream.

Leah 17:23

Yeah. I mean, and thinking back to the people who are at risk of low vitamin C, I mentioned malabsorption. I think, I think I mentioned malabsorption, but you know, I think about people who have had surgeries, where they've had parts of. The upper small intestine removed, and that's where you absorb your vitamins. And so those people might be at a higher need and their bowel tolerance may be lower. And bowel tolerance is it's something that I learned in school, but it's not really something that I use it's was kind of, I want to say it was a trend for a while. Maybe it still is in some circles, but I don't really see it used that much. Yeah. I

Tina 17:58

think that it was definitely more popular, you know, 15 years ago than it is now.

Liposomal Vit C

Tina 18:03

Now people turn to liposomal, vitamin C. Yeah. Yeah. So lyposomal vitamin C is specially packaged so that you can absorb more of it in your small intestine. Yeah. I've

Leah 18:14

never recommended it for patients. I know that it is easier for patients to tolerate, um, as well as buffered. sometimes it can be both. With minerals it can be upsetting to the digestive system. So, um, but I do have patients that I have seen come in and they're like, oh, I'm taking this lyposomal vitamin C. And I'm always like, okay. Like, I mean, vitamin C itself is really cheap. And so when you get into something like lyposomal, it is more

Tina 18:40

expensive. Yeah. Yeah. And I feel like it is. Pretty well, and those liposomes are being used for other molecules out there too. You know, quercetin, resveratrol, curcumin, you can find the lyposomal fill in the blank. Um, it does appear that lyposomal vitamin C leads to higher blood circulating levels of ascorbic acid, right? So there is higher levels of vitamin C in circulation than there is when you take. Vitamin C as whatever magnesium ascorbate potassium, ascorbate calcium, ascorbate whatever orally. So it's a little bit more than you can get from any old, good old vitamin C over the counter. it's very different than if someone is doing intravenous vitamin C. At higher doses. And so we're going to talk about that. I know in a little bit, but I just want to put that out there now because we're mentioning lyposomal and I have had people come to me and say, well, I heard lyposomal can also give me these large doses of vitamin C and it's higher than oral. It's nowhere near as high as what people can do if they get. I V vitamin

Leah 19:41

C and Ivy vitamin C, as we will discuss as a completely different mechanism from the antioxidant action of oral vitamin C, we can even

Tina 19:49

say it's the opposite.

Leah 19:52

We don't want to give away too much. All right. Um, I do

Neurotransmitters

Leah 19:55

want to mention, because I think this is really cool is that vitamin C is important to make neuro-transmitters. So at times when you're really stressed, I know when I get really stressed out, I reach for like either some sweet foods, like. Bittersweet, dark chocolate. That's the sweetest I

Tina 20:11

get, or I

Leah 20:13

reach for crunchy salty foods. But, you know, knowing that vitamin C is important, perhaps I need to reach for strawberries or blueberries and, and the like,

Tina 20:24

yeah, that's a good point. Yeah.

Leah 20:25

Because as we say with pretty much all of these. Supplements 1 0 1 episodes is it's food first.

Tina 20:32

Yeah. Yeah. And generally vitamin C is not something you have to take a supplement up to get adequate amounts. You can totally get adequate amounts from food and find foods that you enjoy and favor those foods. It's in so many different fruits and vegetables. So

Leah 20:45

let's take a break and then we'll come back. We will address the oral versus IV vitamin C and just talk about a few more uses.

Tina 20:56

Okay.

20:59

Citrus fruits have the reputation of being high in vitamin C, but other fruits and vegetables contain as much, if not more of this essential vitamin guavas, kiwifruit, red bell peppers, strawberries, papaya, broccoli, and other brassicas are all rich in vitamin C

Topical application?

Leah 21:17

So we're back. And what I was thinking with other uses of vitamin C is you see a lot of beauty products where there's this topical application with serums and whatnot. And I wonder with the volatility of vitamin C in general, how beneficial are those products?

Tina 21:34

Yeah, that's a good question. Yeah. I don't know. I mean, I always wonder how vitamin C makes it know, not get how it doesn't get degraded oxidized in the bottle itself. There was.

Leah 21:45

A doctor that I worked with whose wife was an aesthetician and he would buy bottles of vitamin C capsules and she would use them. Mix it with some sort of gentle face cream, open each capsule, put some in and then apply that. And apparently that's not a bad way of doing it because there's no time for it to break down whether it actually has the same effect as these highly processed vitamin C serums, who knows. If anyone wants to send us some highly processed, very expensive vitamin C CRMs, we could try them out and see,

Tina 22:20

I'll go so far. It's just put on half of my face and let you see what. Yeah, no,

Leah 22:24

I'm going to put it on my whole face, but maybe I'll try the capsules. I, you know, I, I bought some capsules with that intent and I think I ended up taking them so

Tina 22:33

orally. Well, you got to only put on half your face. How would you know if it's, if it's working or not? Oh, I'll know. Oh, you think so? Huh? Oh, well, no, I got very good. I was going to say you have very close friends. That'll tell you the truth. Maybe I have

Leah 22:48

my own eyes anyways. Okay. So I'm just trying to think of there's any other use with vitamin C and I, at this point, my brain is shutting down. So,

Vit C and cancer(s)

Leah 22:56

um, let's talk about the role of vitamin C, the role it plays in various cancers. Yeah.

Tina 23:01

Yeah. I think the two areas that are of most concern at least in the Western world, cardiovascular disease, and cancer. And I think vitamin C is prominent in each of them. So we mentioned cardiovascular disease and that's everything from stroke and hypertension to atherosclerosis. I mean, vitamin C is preventative across the board for cardiovascular diseases in cancer. We have a lot of observational studies. We don't have. Interventional studies. So the problem with this is vitamin C has gotten from food and those foods are complex, right? So you're eating fruits and vegetables. Well, higher fruit, vegetable intake is already associated with lowering the risk of various cancers. So they did look at studies and it, from what it looks like higher levels are better. And by higher levels, you're talking about a couple hundred milligrams a day. 30 milligrams a day. and this is from food again. So there's a lot more going in these, in anyone's mouth. When they eat the fruit, they're getting all these good phytochemicals are getting polyphenols and bioflavonoids and all this good stuff going in that we know has, you know, benefits. Can lower the risk of various cancers that said the research. At least if we're going to just be research intensive about this is strongest, or we have the most data on breast stomach, colorectal cancer and non-Hodgkin's lymphoma. And each of those, they're all found on the Linus Pauling website. They did a nice job of summarizing the data on each of those to date in humans. And like I said, most of this is. Observational. Right. You're watching a population of people over time and you're making determinations about trends in the data, you know, so adequate and higher intake of vitamins. Through food was associated with lowering the risk of various cancers. once I heard this years ago that wasn't just a population study. They actually looked at the tissue. They had removed from people who had their colon resected. So they had colon cancer. They had surgery to remove, remove the tumor. They looked at the amount of vitamin C in the tissue itself in this study. And then they watched people over time. And those who had the highest vitamin C. in the tissue at the time of surgery had much lower rates of recurrence over the next five years. Interesting. Yeah. Yeah. I mean, that was the most profound study for me to kind of think about in my practice because I'm usually seeing people once they have cancer. So as much as I'm, you know, an advocate for reducing risk in every way, shape and form, by the time I'm seeing people, they already have a cancer diagnosis. The question is, how does. Make it, so we reduce your risk of recurrence and, you know, making sure your vitamin C intake is adequate seems kind of an easy inexpensive, why not kind of thing to put on a list of, to do's. And I don't want to

Leah 25:45

discourage people from eating cooked vegetables there actually.

Bell peppers at the science fair

Leah 25:49

Um, I found this really interesting article about a young girl who was a freshman in high school. And for her science fair, she looked at. How much vitamin C is in cooked versus raw green bell peppers. I guess she liked cooked bell peppers, but didn't like raw. And the article mentions that about one cup of green bell peppers have 129 milligrams. Of vitamin C. And so she prepared the green peppers and she weighed them and some were fresh. And then she put some in boiling water for 10 minutes. Another was for 20 minutes. And then the last one was for 30 minutes and she kind of separated the solid bits out. And then she tested the liquid using. Uh, vitamin C test kit that she purchased and she used the pepper juice in the testing kit to see how much concentration of vitamin C was in each pepper. And the raw peppers did have the most vitamin C as to be expected. And the 10 minutes of boiling showed the peppers had about 25% less vitamin C, but when the peppers were boiled for 20 or 30 minutes, The vitamin C level came up again. And the thought was, it was because of. As the peppers lose water, the vitamin C starts to be concentrated more in the

Tina 27:10

pepper. Ah, I see what you're saying. So the concentration goes up of the fluid yeah. From the juice,

Leah 27:15

from the juice of the pepper. Yeah. So, I mean, you're still getting vitamin C if you're cooking your peppers, if you don't like raw peppers and you want cooked peppers, there still is vitamin C in there. You just have to eat

Tina 27:26

more of it. Okay, sure. Yeah. Yeah.

Leah 27:29

And digest raw vegetables. Well, so I do want people to know that you can, and there are other nutrients cooking, um, you know, dark leafy greens is how you get certain nutrients from them that you might not get from raw. So eating a mix of raw and cooked vegetables, I think is important for people to realize it's not one or the other, if you don't like raw bell peppers, you can have them cook. Right.

Tina 27:52

Right. Sure. Yeah.

Leah 27:54

And I don't know if I would cook bell peppers necessarily for, for 30 minutes. I think they would get really gross by then. And I think she even commented in the article that, yeah, it smelled bad, but you know, it is like we mentioned in previous episodes, you know, cooking those green vegetables until they turn bright and not until they turn gray.

Tina 28:11

Totally agree. Yes. A mixture of raw and cooked vegetables is your

Leah 28:15

best bet.

Intravenous Vit C (IVC)

Leah 28:16

Okay. So this is a really big one. People want to know about IV vitamin C. We're not going to delve into it. We're just going to kind of touch on it. But that's a big question. And we do have patients taking high doses of lyposomal or other types of vitamin C thinking they can achieve the same effect as Ivy.

Tina 28:36

Yes. And so there is more and more information on the use of higher doses of intravenous vitamin C by high doses. We're talking. 10 grams intravenously. So directly into the vein is still not considered a high dose in the world of people who do Ivy vitamin

Leah 28:52

C. And that's what Linus Pauling had studied. He had studied 10 grams a day. I V N he did it for 10 days, followed by at least 10 grams a day of oral vitamin C. And that was to be repeated forever.

Tina 29:07

Yeah. And those were fairly advanced patients and he showed. People fared better. And they felt better was a big part of that too.

Leah 29:14

As we mentioned, the, the action, the mechanism of action of Ivy, vitamin C is not the same as oral vitamin C.

Tina 29:22

you're right. The intravenous vitamin C, once you give it over 10 grams certainly is no longer in antioxidant. It's not an anti. In any way, shape or form. It is a pro-oxidant it's actually causing more oxidation within the tissue itself. So there's an enzyme called that's found throughout the body and catalyst breaks down hydrogen peroxide. And normally there's that if your body has hydrogen peroxide around the cells, catalyst comes along, breaks it down, basically into water and a little oxygen, no big deal. Tumors have a hard time with that. This is, one of the reasons that people give high dose vitamin C intravenously, hydrogen peroxide in and around the tumor bed builds up and causes more oxidative pressure kind of stresses the cells out, because those tissues do not break down. Hydrogen peroxide as readily as normal tissue does. Now, the other thing that happens with IV vitamin C has to do with hypoxia inducible factor, H I F, and this is a whole nother pathway that I'm not going to get into. Cause it's a little too much for our podcast, but maybe we'll do a larger lesson on IV vitamin C at some point that's more of a visual, cause I think we need visuals for this discussion. Um, but suffice to say the idea here is that IV vitamin C lower. The stimulation of new blood vessel growth in and around a tumor. So those other reasons. The other is that hydrogen. Has some anti-microbial effects. So, maybe if there's a tendency towards infections or there's some low counts or there's a high risk of infection, someone, you know, the high dose vitamin C could be used for that as well. But when we have studies using high dose IV, vitamin C, it's generally done alongside and another oxidative therapy. So like right alongside radiation at the same time, but it's again, it's I V vitamin C. About the polar opposite of taking oral vitamin C, because now we're giving in a large dose it's causing oxidation in the tissue. It is no longer acting as an antioxidant. It does it for a very short amount of time to Ivy, vitamin C doesn't have a lasting effect. You hit these giant amounts of vitamin C in the tissue for a couple hours after you receive it. And then it comes back down because your body gets rid of the. So that's the short story.

Leah 31:42

Yeah. And I remember when I was down in Arizona, there was a multicenter trial going on, looking at patients with pancreatic cancer. And I think they were receiving the chemotherapy regimen. Fulfirinox and maybe something else, maybe it was gemcitabine. I don't remember. Concurrent IV vitamin C. And so that was really interesting that this was happening at, I believe it was like university of Arizona, maybe Mayo. I can't remember all of the centers that were, that were conducting this trial. So like you said, it was concurrent with other treatments. But, yeah, we don't want to go too much into IV vitamin C because we're just talking more about vitamin C as a supplement, not as a treatment or concurrent treatment. Right. So, okay. Let's take another break and then we'll come back and we'll talk about, potential interactions, contraindications and, oral vitamin C. Can you do it with your cancer treatment? All right, let's do that next.

Tina 32:41

According to some animal studies, vitamin C should not be taken alongside proteasome inhibitors. That's drugs like bortezomib, better known as Velcade often used in multiple myeloma and some lymphomas.

Safety concerns/ Interactions

Leah 32:56

okay. So safety concerns and interactions. Um, we have talked about what happens if. Don't get enough. Vitamin C, we briefly touched on what if you get too much, which would be diarrhea, but you know, what else can happen if somebody gets too much vitamin C and the concern that besides diarrhea that I have seen and heard is kidney stones.

Tina 33:22

Yeah. I think most of that has been seen in people with kidney disease. First of all. So they have. With the filtration of the kidneys already. So they have a pre-existing condition. and I believe it was mostly intravenously done, it was mostly intravenously given when the, when they did have incidences.

Leah 33:39

Another thing that I looked up, what I thought was interesting, um, rebound,

Tina 33:44

scurvy, I've never even heard of it. Rebound.

Leah 33:48

Which is when you get the symptoms of scurvy after you stopped taking high dose of oral vitamin C. Oh, okay. I've never, this was just something that was in my resource that I looked up. Um, as possible to get a B12 deficiency. And then there's also, um, high doses of vitamin C can erode your dental enamel. And I'm guessing maybe that's. If you're like sucking on a tablet or having it soaking, in your mouth, I don't know if you would get that from a capsule. I think it would have to be contact directly with the enamel, I think you're right. yeah. And then the upper intake, like the, limit that you will read mostly is about 2000. Milligrams.

Tina 34:31

Yeah. I don't understand the upper limit in that. It's not harmful after that. Most likely. It's just a matter of, you're not going to get much more into your bloodstream after that. Yeah.

Leah 34:41

and the, the things that I think our patients and maybe our listeners need to, be familiar with is that taking vitamin C around certain labs can affect the labs themselves. So looking at Billy Rubin and creatinine and the serum, um, can be affected, and those are labs that are common with, with cancer patients. And then also. The guaiac test looking for blood in the stool that can also be affected by taking vitamin

Tina 35:10

C. Yep. It can give a false positive if you took vitamin C and then you get and

Leah 35:16

then there are, drug interactions. And, you know, I think we've mentioned this before. Sometimes drug interactions are because the drug can deplete a nutrient and then other times it's. The supplement or nutrient can affect how the drug works. So things like aspirin and, non-steroidal anti-inflammatory drugs, you know, inside. Those can lower vitamin C levels and also high doses of taking vitamin C. And again, if 2000 is considered like a high dose, this may be the level that can affect drugs. I don't know. I think it's pretty individual, but, high doses of vitamin C can also cause aspirin ensades to hang out longer, raising that effect. You know, the pain relieving effect in your blood, whether or not that's a good or bad thing, you know, check with your doctor. Um, and then there's something about how vitamin C may actually help protect against the stomach upset from taking those drugs. Cause. Really be irritating on the gut. And so vitamin C may help with that again, I don't know the doses. That's not why we're here. We're just giving you information. All right. Um, also there are drugs like phenobarbital, different barbiturates that can also detect. The effects of, vitamin C and then there are the concerns where vitamin C itself may, increase certain drugs. So there are like antacids, like Maalox or Gaviscon, which are aluminum containing acids. Vitamin C can increase the amount that your body absorbs of the aluminum itself. there is a potential for interaction with things like nitroglycerine. The protease inhibitors, the drugs that are used. There's one drug in particular that's used for HIV in denim, vere, vitamin C may. I think it was about one gram, a thousand milligrams, may potentially lower levels of that drug. There are some antibiotics. There are blood thinners. Coumadin warfarin. Um, you could pretty much put Coumadin on every list, interactions that an aspirin, you know, those two are like, those will interact with everything. and then there's the kind of like the conflicting information where oral contraception and hormone replacement can not only decrease the effects of vitamin C, but then also vitamin C may interact with those medications as

Cancer Treatments & Vit C

Leah 37:43

well. Right. So that's the pharmacology part other than, the cancer treatments, right? Yeah. So as it does have this antioxidant action, there is potential for vitamin C to interact with chemotherapies or, you know, radiation where you want that pro-oxidant action.

Tina 38:03

Right. I think of vitamin C as a fairly. Compound, when it comes to its antioxidant action and that sense of radiation or chemotherapy compared to, for example, resveratrol or quercitin, or, you know, these, polyphenols that actually go into cells, cause the cell to actually produce more glutathione. And that is a powerful molecule throughout the. That is an antioxidant. Like I think of those kind of as heavy hitters and vitamin C as kind of a minor, minor

Leah 38:36

player. And then you're also saying it's not going to achieve this, this high, high state in your blood. I mean, it just kind of reaches a certain level and then it's a steady state.

Tina 38:45

Oral vitamin C is never going to get very high.

Leah 38:48

Right. So I know some people are told not to do certain antioxidant foods during treatment. you know, I don't know if they're told not to divide them in seafoods. I have had patients told not to do blueberries during radiation. Oh, wow.

Tina 39:03

Yeah. Well, that's, that's, that's out of an abundance of concern, right? Because that's not evidence-based necessarily,

Leah 39:09

and it's been, it's been more than one patient in more than one. City or location. it's such an interesting thing. so yeah, I don't know if. A 500 milligram tablet of vitamin C daily is something that I would discourage someone for taking. I think it really is dependent on in my situation, you know, working in hospitals, just making sure that oncologists are comfortable with that.

Tina 39:35

Yeah. I th I think we're talking about, you know, a garden hose and a forest fire and some of these cases, right? Like, I don't think vitamin C is going to undo radiate. For example or some of the more oxidative chemotherapies, it's really just not, it doesn't have it behind it. It's not that one little tiny molecule is not going to do all that. I'm just judging by what it can do, you know, independent of chemo and radiation. So my. It's the least of your worries in the grand scheme.

Leah 40:02

And I do, I do stop it for certain reasons. If, you know, if somebody is taking a high dose, if there is potential for things like diarrhea, just anything where someone can point to it and be like, well, they're taking this. Right.

Tina 40:15

Right. Well, yeah. I mean, sometimes you remove. Because it gives everyone peace of mind, not because there's a really any kind of risk, but just because it's easier to take it out, then keep it in for peace of mind for everybody. and if, if the patient needs that in particular, you know, I would say we just remove it most of the times. That's what I do for peace of mind, if their medical oncologist, radiation oncologist, or whomever's, doesn't like the idea of vitamin C going in, then I'm like, okay, fine. Just give it the vitamin C. And I don't think it's a big enough player either way it's not doing anything that I would defend in that sense.

Leah 40:49

At the same time, I wouldn't have somebody do some really high dose. Lyposomal like, oh, I'm good with someone doing just low doses, but I'd rather them actually just eat the food because again, Going through treatment, you have far more nutritional needs than just one specific vitamin. And so get it from your food. It's got, it's got your fiber. It's got your, all your other nutrients that you need your bioflavonoids blah, blah, blah. Yep, totally. Okay. So the last thing would be like, are there people who should have. High doses of vitamin C. And for sure, I mean, we talked, we touched on people with kidney disease. There are some conditions that are genetic, like hemochromatosis, which is a buildup of iron, like throughout your body. And we briefly touched on vitamin C being helpful for, uh, to be, even touch on it. I can't remember if we talked about at this time, vitamin C can be helpful for the absorption. Iron, especially non-heme non-animal sources of iron. And so if you have this genetic tendency to store iron high doses of vitamin C and vitamin C foods, Can increase

Tina 41:58

that. Exactly. Yeah. So if you want to absorb iron and you're taking an iron supplement, um, vitamin C can be useful for that. But if you're someone who has too much iron, then yeah, you don't want to be doing vitamin C alongside foods that are high in iron.

Leah 42:11

And then the last thing is the glucose six phosphate dehydrogenase deficiency, the G six PD deficiency, which is when people get. Ivy vitamin C, there are checked for that beforehand. Yes. Don't know if taking oral vitamin C as affected by that. I only know it as, for people getting

Tina 42:34

IV. I've only tested it for people getting Ivy. I think that's that overwhelms it. And that can lead to a hemolytic anemia if they don't have a proper enzyme function, but orally, I don't think it's either here nor there. I don't think that you need to know.

Leah 42:49

So, um,

Tina 42:50

anything else? No, I think that, I think we actually covered it. I mean, this was take five, take six. I don't know. We've been here for hours. It's been like five hours. I mean, I remember like the last time I like called it, I was like, it's 1 25 and we're starting

Leah 43:07

it again. Yeah, no, this has been, um, this has been quite the day, but yeah, so this has been our presentation on vitamin

Tina 43:14

C. We did it. We did it. We did it. Where's that cheering. It's not really done until we hear the recording, you know, safely tucked away in our vault of audio. Really? I think I need to hear the applause. Oh wait, let me find the applause button one moment. Please

Leah 43:34

All right. So let's wrap things up.

Wrap up

Leah 43:36

Because I think we're both done. remember to subscribe to the podcast and to share with your friends, we are on Instagram, Facebook, or on the social media. We have a newsletter, please go to our website and sign up and you too can receive the newsletter whenever it comes out again. And, consider buying us a coffee support, the show, the link is in the show notes, and it can help us hire someone to deal with all of this technology stuff that is really, really beyond it's beyond what, but we want to be doing. We just really want to be focusing on content to give to you.

Tina 44:18

Yeah. So if you can. Drop a review, especially, especially if you're on some, you know, apple podcasts or Spotify or wherever that you can put a little note, let other people know and get them to click the button like us. And that way, uh, we'll get the word out. We really want to just help more people as time goes on and we're looking for a little snowball effect. So those of you who are subscribed. Thanks. That's much appreciated because I can see the numbers growing in the background. And I do appreciate it. And I know where you are at, I don't know who you are, but I know where you are. Are there. And maybe next

Leah 44:52

time we will read, some of our, our feedback that we've gotten. We'll we'll read something from, from all of you. I think that's a great idea. Okay. So on that note, I'm Dr. Leah Sherman

Tina 45:01

and I'm Dr. Tina Kaeser, and this is the cancer pod until next time, hate Leah. shut this fucker down. Well, let's do this.