Vitamin C in high doses in the treatment of the common cold

figh doses Coftrnon cold VTTAMTN CHIGH DOSES IN THE TREAÎMENT OF THE COMMON COLD J. Asfora Faculty of Medicine of the Federal Universily of Pernaabuco, Recife, Pernambuco, Brazj-l Summary: In order to.t,est vitamin C in the treatment of common cold, 45 patients (25 women and 20 men) received 6.0 g of vitamj.n C daily per os, when they showed the first slmptoms of the disease. The treatment lasted five days regardl_ess of the prospective results. The duration of the cold was sj.gnificantly reduced when the treatment began wit,hin 24 hours of the first symptoms and in several pat.ients it. even did not develop fully. Patients felt quite well the day after the beginni.ng of treatment. Results r¡rere not so good when there was a delay and t,he medication start.ed on the second or third day of i11ness. At that. time we observed that the cold often was complicated by secondary bact.erj.alinfections. Finally it seems important to report that after the end of the research we continue to use :he same vi-tamin C dosage obtaining consistently the same resuLts. Introductlon a virus disease, distributed aLl over the The comrnon cold is 2L9 \^rOrld. or age fat,igue, of these studies Fact,ors predisposing to the concentrati.on of the common col_d include chirling of the body by draughts or wearing wet cl.thes, It affect,s al-1 races vrith no distj-nction as regards sex Its average incubati_on period is three days. environmental pollution, etc. However, the importance factors has been diminished by the findings of recent (Andrewes2, I965; Debré and Ce1ers s, l97O) . The virus infection brings about an inflammation of the upper respiratory tract. The symptoms reflect the involvement of the respiratory tract and the whole body. The patient experiences a feelÍng of congestion in the upper airways, with oedema of the nasal and pharyngear mucosa. There is frequent. rhinorrhoea and sneezing, toget,her r,,rith a sensation of roughness in the throat which makes it. difficult for the patient to swallow food. Although very high temperatures are not observed, fever is aìmost always present and is accompanied by J-istlessness and headache of variable severity6. Provi-ded no bacterial complications ensue, the condition runs a course of 3 to 10 days. The change in the normal physioJ.oglr of the mucosa opens the way for pathogenic bacteriar attack. In many patients t.he common cold is almost always accompanì.ed by bacterial complications. Since there are vari-ous types of cold virus, no inununity to the disease is developed, and it may attack the same patient several times in one year. ïn an analysis of the absence from work caused by the conmon co1d, Paulings's (L9jO, 1971) concluded that the disease results in an annual loss of 15 milli_on doll-ars in the Uni_ted States. ))ñ 22r A, variety of drugs are used Ín the treatment. of this infection, and include analgesics, anti-histamines, decongestants' etc. AIl of them, however, treat only the s}¡mptoms and not the disease' It would be of great value if a treatment could be found which hinders the establishment of the cold, or, in cases r^rhere it has afready gained a hold, shortens 'its duration, reduces the severity of the symptoms, and prevents the occurrence of sec-' ondary infections. lrihi-le a number of authors believe that vitamin C possesses these features, others cast doubts on this opinion. Cowan, Dieh] and Bakera (1942), of the University of Minnesota, carried out a study involving roughly 400 students who took 200 mg vj-tamin C per day or a placebo for a period of T months. They observed no statistically significant difference in the frequency, duration or severity of colds between the group that received the vitamin and the placebo g:roup. )r. Frederj-ck J. Stare, Professor at the Department of Nutrition of the School of Publ-ic Health at Harvard University, states that "there is no conclusive evidence that ascorbi.c acid has any preventi.ve effect or any therapeutic effect on the course of the conìmon cold"l2. Dr. Philip L. White, Secretary of the Council on Foods and Iutrition of the American Medical Association, doubts that viramin C is capable of preventing the common cold or has any influence on its course. Dr. Charles C. Edwards is equally sceptical, and considers it absurd that vitamin C should be used in the prevention or treatment of the common co1d. C. Andrewes2 (1965) , Honorary Consultant to the Cold Research Unit at Sa.l-isbury, Eng:J_and, does not make a single mention of vitamin c in his paper "The common cold: prospects for its control " . Referring to the relevant literat.ure, lj-nus pauling, a strong advocate of using vitamin C, explains these unfavourable results as the outcome of using small doses of ascorbic acid. According to Pauling, there are differences between the vitamin and placebo groups even in the study by Cowanq (1942), and ì_n his opinion these could be significantly j_ncreased by using Iarger doses of the vitamin. Studies involving the use of larger doses, such as t.hat of Sheila Charlest.on and Mary Clegg3 (I9j2), that of Anderson, Reid and Beatonl Q972), and the trial conducted by Ritzelrr (196I), showed significant diffêrences in the incidence and duration of the co1d, which were considerabl_y lower in t.he group that received vitamin C than in the placebo group. fn a comparison between man and various species of animals, the biochemist rrwin stoner' (Lglz), of staten rsrand, states that for man a suitable dose of vitamin c would be between r_ and 4 grams per day, In order to abort the cold, this author recommends taking 1.5 g of ascorbic acid on the onset of the fi_rst symptoms, and further doses at hourly intervals. rf the medication is taken at a sufficiently early st,age, by the third dose the cold has generally been aborted. Dr. Edme Régnierro (t9e8) recommends treating the cold with 600 mg of vitamin C on Lhe appearance of the first symptoms, followed by doses of 600 mg every 3 hours (or 200 m9 every 222 223 hour) , the dose being increased to 750 mg on retiring to bed' in the authorl,s personal experience, the sneezing which marked ne onset of a new cold would appear two or three times Per :,ear, and was followed, on the 2nd or 3rd day' bY the unpleasant and apparently inevitable signs and symptoms of secondary bacterialinfection. The author's activities would be restricted for tvto or even as much as four weeks by the clinical symptoms of the bacterial complications. As an experiment' on the appearance of the first :old symptoms he then decided to take 6 g vitamin C divided into 3 doses, and in 24 hours the cold had cleared up' Since that exPerinent, ll years ago, whenever he has felt tbe slmptomsofacoldhehassucceededinabortingtheconditlonin one day. Since vitamin C in large doses is completely harmless and the substance has no sj-de-effects, there are no contraindicatj'ons :o its use7. The purpose of thi-s clinical study j-s to obtain data on the effect of large doses of vitamin c in the treatment of the cornmon cold b/ith regard to its duration, the severity of ies symptoms and the occurrence of secondary infections' observations and method The total patlent material comPrised 136 persons of both sexes and various ages. Two were excluded because they were found to be suffering from ínfectious mononucleosis, and one because of infectionwithtoxoplasmosis.Thel33patientsincludedinthe analysis comprised 7g 89. females and 55 nales aged between 14 and The group inc'uded students of medicine at the Federar, university of Pernambuco¡ physj_cians, the investigators, patj-ents of privat,e clinics and Social Security (ïpNS) members (Gouveia de Barros Clinic) , so that the trial was conducted on persons from the most varied economi.c, social and cultural groups. The fo1l0wing s1¡mptoms r^rere most frequently comprai-ned of : sore painful throat, hoarseness, sneezing, nasal obstruction, lacrimatj-on, headache, muscular and bone pain, weakness, chiJ_ls, sweat.ing and general malalse. A d.ouble_blind trialr,/as conducted in which the preparations, numbered 1 and g, h¡ere given to al_ ternate patient.s as they presented themselves. The preparations,. in the form of 1 g effervescent tablets, v/ere prescribed in accordance v¡ith the following plan for aJ.l patients: 2 tablets dissolved in water (2 g) three times per day for five consecu_ tj-ve days, or j.n other words 6 g per day or a total of 30 g. When 42 patients had received substance No. 1 and 4l had received No. g, Èhere was no 1onger any point in continuing the double-blind trial, since in vlew of the clinical progress of the patients there v/as not the slightest doubt that substance No. I was the vitamin C and lto. g was the placebo. From then until the end of the trj.al our 133 patlents therefore took l only preparation No. l-. We divided our patients into four groups, nameì_y: Group f: 45 patients (25 females and 20 males) mean agre 33 _ treatment begun early, in the first 24 hours after the onset of coj_d sl¡mptoms. Group II: 30 pati_ents (17 femal-es and .l-3 males) mean ag.e 33 _ treatment begun between 24 and 4g hours after the onset of col,d symptoms. Group IIf: 17 patients (Ì1 females and 6 males) mean age 37 - treatment begun late , 48, j2 or more houxs after thq onset of sympioms. p rcebo qrqup: 41 patients (25 females and L6 males) mean age 36. Results The results obtained in the various groups are summarj-zed in Tables L, 2,3 and 4, thus allowing the course of col-ds treat.ed w.th vitamin C to be compared with that of colds treated with o:her drugs. Statistical anal is of the resul-ts îhe first remark on this study concerns the crlterion used to establish the duration of the cold. This is too subjectlve and ,,-rdoubtedly subject to large variations, particul_arty slnce tiìere is no exact definitj-on of what exactly marks the beginning or end of the "cold". However, with the acceptance of the adopted criterion it is possible to test vitamin c with regard to a possible superiority over other drugs commonly used in the treatment of co1ds. '-he statisticalmethod employed is Student's "t" test, which anaiyses the difference beti¡/een the two means. The results obtained !,rere as follows: I. For Table I - treatment with 6 g per day of vitamin C for five (5) consecutive days; treatment begun early, ì_n the first 24 hours after the onset of s).mptoms. )1À ))Ê, Tab. l. Patlents treat.ed v¡i-th 6 g vitamin c pex day for 5 consecutive days. Treatment begun early, in the first 24 hours after the onset of s)mpnoms. comparison of the duration of cord.s created. with vitamin c and Èhose treated with other drugs (aspirin, phenacetin, antihistanines, etc.) No. of cases: 45. Vitamin COther drugs Nane Sex DuraÈi-on of cold in days after initiation of treatment Durat.ion of previous colds in days afÈer initiâtion of treaÈment I 20; developed bacterial conplications 2 2 l5; developed bacteri-al complications 2 I 8; developed bacterialcompl-icaÈions 2 I 2 I 2 3 2 I I 4 2 3 I 30; developed bacterialcomplj-cations 2 5 15 co 20; frequent bacterial complications 5 6 to l0t frequent. bacterial complicat.ions I5; frequent baccerialcompl j-catj-ons 2 l0 to 15; freguent bacterlaI complicat'ions 8 to I0; frequent bacterial complications 5to6 4to5 5 3to4 4 3 8 to 15; frequent bacterial compl.icèÈions 5 5 4 5 6 4to5 20 to 30; frequent. bacterj-al conplications 8 to 15; frequent bacterial complicaÈions aÞ M.S.C.L 38 35 37 2B M F M F M M ,.F c. L. ¡.u 22'- r.c.r. 15 yrs J.C.l L4 25 63* M. L.P.A M.J, D. S A.G. S. M.L.P.S. t9 51 ao M2 I 8; developed bacterial complj-cations I 2 I ) I 1 I 10; developed bacterial complicat.ions I I 2 I 2 4to5 5 l0; frequent bacterlat complications 4 8; frequent bacterial complications I0; frequent bacterial complications 5to6 l0 to 12; frequent bacteri-al complications 4Lo5 I to l0; frequent bac¿erial complications 5 4 5ro6 4 4to5 I0 to 12; frequent bacterial compJ-icat.ions 3 4 4 6 7 to l0; frequent bacterial compl-ications ÁÔ 46 F t 2 F F F ¡' M M F Ão I5 89 F M M F M M F F F F M M F 2 S. R. M. G. S. J. C. V. N.Q. L8 )A 29 22 44 43 39 51 47 43 46 57 24 IB J.A.A. H. H.A. M. C. L. s. H. A. <¡M A. J.M. L J.A.A. vl.L.t-A J.S.A.M L. G. J. P. À. S. !. A. F. G.F.S I5 L4 L4 23 18 1A 20* 40* 34 52 27 L7 I5 4 F I F M M M F F M F M F M M -Àr .t.L. c. R. F. D. F. H.H.Ã. pq *Passed a number of d.iarrhoeic stools during treatmênt with vitamj-n C Mean durati-on of the col-d after start of treatment days in the group treated t^/ith vitamin C. It was 6. in the group treated with other drugs. v/as 3.6 9 days 226 227 From thls comparison h¡e obtain: t = 3.54, D,F. = 88 and P <0.01-. Takj-ng P <0.05 as the level of sj-gnificance, v/e find that the shortening of the durat,i-on of the cold vrith vitamin C in relatíon to other drugs is statistically significant. II. For Table 2 - treatment vrith 6 g per day of vitamin C for 3 consecutÍve days; treatment. initiated bet\^reen 24 and 48 hours after the onset, of s)¡mptoms. In t,he group treat.ed with vitamin C the mean durat.ion of cold after start of treatment v/as 5.3 days. It was 7.5 days in the group treated with other drugs. Îab. 2. PaÈients treated with 6 9 per day of vitamin C for 5 consecutive days. Treatment initiated between 24 and 48 hours after the onset Õf sl¡mptoms. Comparison of the durat.ion of colds treated wiÈh vitamin C and col-ds treated with other drugs (aspirin. phenacetin. antihistami-ne, etc.) No. of cases: 30. Vitamin COther drugs Name v.G.M.** c. s. L.A. J. A. M. D. P. S. J.N.S. o . G.L. I. J.G. L. J.M.A. J. C. L.t. A.P. S. c. s. M.J. E.M.L. À Þa L.A.A. M. Þ. D. M. C. L. r.c.L. N.G. F. 39M2 4 3 15; devel"oped bacteria]- complications I0 Èo l5; frequênt bacterlal complications 3to4 3 l0 to 15; frequent bacterialcomplications 20; frequent bacterial compl j-cat.ions 2to3 J 5to6 6to / 8 to l0; grequent bacterial cornplicatj-ons 7 8; frequent bacÈerÍal complications I to 12; frequent bacterial complications 4 10; frequent bacterial complicatiôns 4to5 4to5 15 to 20i frequent bacterial complications 3to4 3to4 I Èo I0; frequent bacterial complications 5to6 4Eo5 20 to 30; frequent bacterial complicat.ions 5l AO L6 F F 40F3 5 3 2 2 M F M M M M M F F F 4L 50 2L l_6 38 15 50 5I 28 4L F F F M F M F F F I 4 8; developed bacterial complicaÈions 4 Age yrs Sex Du.ration of coLd in days aft.er start of treatment Duratj-on of previous colds in days after start of treatment )^ 48 32 27 33 I 2 20; developed bacterial complications 3 4 15; developed bacterial compLications I 2 30; developed bacteria.lcomplications A.L.J. J.A. S. o. s.G. R 51 M3 L8F4 L7M 8; developed complicat.ions I 2 5 5 I to l0; frequent bactêrial complicatj-ons 4to5 8 Eo I2t frequent. bacterial complications l0 to 15; frequent bact.erial conplications 24 L7 29 N.E.S. l8 27 27 M f F3**EpigasÈric pain during treatment with vitamin C. *Passed a number of diarrhoeic stools during creatment wi¿h vitamin c 228 229 From t.his comparison we obtain: t = I.45, D.F. = 58 and P >0.1. The difference is not statj-stically significant. IlI. For Table 3 - treatment with 6 g per day of vitami_n C fc|¡ 5 consecutive days; treatment cornmenced later than 48 hours after onset of s]¡mptoms. Mean duration of the cold after start of treatment r¡ras 9.0 days in the group treated with vitamin C. It was 7.8 days j-n the group treated vrith other drugs. From this comparison we obtain: t = 0.62, D.E. = 32 and P >0.5. The difference j-s not statistically siginificant. Îab. 3. Patients treated with 6 g per day of viÈamin C for 5 consecutive days. Treatment begun late. i.e. 48, 72 or more hours after the onset of sl'mptoms. Comparison of the duration of the cold t.reated with vitamj-n C and colds treated with other drugs (aspirin, phenacetin, antihistamj-nes, etc.) No. of cases: L7. Vitamin COther drugs Name **Epigastric pain during treatment with vj-tamin c. *Passed a nrunber of diarrhoeic stools during treatnent wj-th vitanin c 'lâb. 4. croup which received placebo. Comparison with the use of oÈher .rugs in previous colds. No. of cases: 41. Placebo other drugs c50M l2; developed bacterial complications 7 i0; developed bacterial complicãtions 15; developed bacterial complications 6 30; developed bacÈerial complicaÈions 5 3 3 I0; developed bacterial complications l0 to 15; freqrent bacrerial compl-j-cations 4to5 5to6 15; frequent bacterial complicat. ions 6 15 to 20; frequent bacterial complicaÈions 4to6 3co5 3tÕ4 L0; frequenc bacterial complicaÈions i.s. 38 M /t M F F M I6 33 F M F F P.L s.c. 0. âÀ 39 .- 29 44 2L I9 Age yrs Sex Duration of cold in days after start of treatment Duration of previous colds in days after start of treatment sex Duration of cold in days from start of using placebo Duration of previous colds in days from start of treatment Name Age yrs l0; developed bacterj-alcompl-ications 15; developed bacterial complicaÈions 7 5 5to6 7 to l0; frequent bacterj-al complj-cations l0 to 20; frequent bacterial complications 5to7 5tob 3t.o4 More than 5. Bacterial complications More than 5 Cleared up on 3rd day More than 5. Bacterial conplicaÈ j-ons More than 5. Bacteria-lcomplicaÈions cleared up on 2nd day Cleareci up on 5th day 5to8 3to4 10; frequent bacterial complicat. j-ons 2to3 4to5 c Þ À )c, M5 À A.P.r* M. V. SG.M L7 27 51 3 6 6 F M F F F F F' 5l. A.o D.O.S D.s.s to 35 29 23 65 F F M F il F 68 J.R.F. 77 o. 36 48 53 M,C.A.J 230 23r L.M.C 2LF !4.c.L. E.H.s.M 5] L7 39 36f ò.r.J. )/ f More t.han 5. Bacterial complications More than 5. Bact.er j,äI compl icatlons More than 5. Bacterial complications More than 5. Bacterial complications Cleared up on 3rd day More than 5. Bacterial compl j"cations More than 5. Bacterial complications More than 5 More than 5. Bacterialcomp.Licat.ions C.Leared up on 5Èh day Mo¡e than 5 More than 5 8; frequent bacterial complications 4to5 l0 to l-2; frequent bacterialcompÌications 3to4 4to5 l0 to 15; frêquent bacÈerialcornplications 5 8 to 12; frequent bacterial complicat.ions 4to5 -7 8 to l0; frequent bact.erial complications 4to5 4 5 5 4 l0 to 12; frequent bacterial cornplications I Lo l0; freguent bacterial compl.ications 4to5 15 to 20; frequent bacterial conplications 3 Cleared up on 4th day More than 5 More than 5 Cleared up on 3rd day More t'han 5 More than 5 More than 5. 3to4 5 l0 to 15; frequent bacterial cornplications 3to4 4to5 5 20; frequent bact.erial conplications M F F "l M r M M 3 M.J.S.W. 22 M c.c.s. 42 M M. M. G.M J.A..A M. F. B. v. G. c. S. B. s. L'7 40 34 22 6L F F M.L.B. 23 F Bacterial compl j-cations It. is difficult to specify Èhe duration of the col"d in this plâcebo group, since roughly 503 of the patienÈs changed over to other drugs from the 5th day onwards; Conclusions the basic conclusion to be drawn is that. if the cold is to be of shorter durat.ion than when other drugs are used, vitamin C must be administered in the first 24 hours aft.er the onset of s 'mPt.oms. I. G. F. M.C. L. 49 45 s. J. F. A. S. M"L.A.S 19 24 L7 F F M M F' s.M.s. 26 F F More than 5 F Cleared up on 3rd day F Cl-eared up on 5th day M More thãn 5 M Cleared up on 5th day F More than 5, Bacter j-al complications More than 5. Bact.erial complications More than 5. Bacterial complications More than 5. Bacterj-al complications More than 5 C.Lea¡ed up on 5th day More than 5. Bacterial compl ications More than 5 56 50 2I 58 60 50 J. R.W. 55 N. E. c.M. ÞÀ\r 42 18 t9 7 M F I F J.R.B. 16 F 232 233 Literature l. Anderson, T.W.r Rèid. D.D.ll., Beaton, G.H.: Canad.med.Ass.J. I07, so3 (1972) 2. Andrewes, C.: The Comnon CoId: prospects for its Controlr W.W. Norton & Company, Ne!'r York (1965). 3. Charl-eston, S., Clegg, K.M.: The I,ancet L,7765 (1972). 4. Cowan, D.W., Diehl, H,S., Baker. A.B.: J.Amer.Med.Ass. LzO, L268 (L942\ 5. Debré, R., Celers, J.: Clinical Virology, W.B. Saund.ers Companyf PhiJ.adelphia (1970). 6. HaÌrison, T.R.: In Principles of Internal Mêdicine, Blakistone Company, Nee, York (1950). 7. Hornig, D., f{eiser, H., fÀfeber, F., Wiss, O.: Int.J.Vit.Nutr.Res.43, 28 (L9731 8. Pauling, L.: VitaIoin C and the Comnon Col-d, Freeman and Company, San Francisco (1970), 9. Pauling, L.: Amer.J.clin.Nutr. LI, L294 (f97f). 10. Régnier, E.: Rev.Allergy 22, 835 (1968). 11. Ritzel, G.: Iïelv.med.Acta 28, 63 (196I). 12. St.are, J.F.: Eating for cood EeaLth, Cornerstone Library, New york (1969) . 13. SConer I.3 The Healing Factor. Vitamj-n C against Disease, Grosset & Dunlap, New York (L972',). Prof.J.Asfora, FaculÈy of Medicine of the Federal University of pernaÍlbuco, Recife, Pernambuco, Brazil- . -1-! 234