Wednesday, Ap il 7, 1976 MEDICAL TRIBUNE
DAHLBERG, ENGEL, AND RYDIN
Dykes and Meie men ion he dou-
ble-blind s udy by Dahlbe g, Engel,
and Rydin16 o 2,525 Swedish soldie s
in a camp in no he n Sweden du ing
90 days in 1941, and say ha no di -
e ences we e ound in ei he he inci-
dence o he du a ion o colds. The as-
co bic-acid subjec s (1266) ecei ed
an a e age o 90 mg pe day, and he
con ol subjec s (1259) ecei ed a
placebo. Examina ion o he ables
shows ha he incidence o colds in he
asco bic-acid subjec s was 7.4% less
han in he con ol subjec s, and he
incidence o diseases o all so s was
10.0% less. The diseases we e 5% less
se e e in he asco bic-acid g oup han
in he placebo g oup. The di e ences
a e no s a is ically signi ican , and he
in es iga o s hemsel es concluded ha
he asco bic acid had shown no p o-
ec i e e ec . Thei ables show, how-
e e , ha he small added in ake o
asco bic acid (a e age 90 mg pe day)
is associa ed wi h an appa en dec ease
in in eg a ed mo bidi y o abou 12%,
and hei wo k should no be quo ed as
ha ing shown no e ec .
CHARLESTON AND CLEGG
Fou ecen s udies we e no men-
ioned by Dykes and Meie . One is he
15-week s udy ca ied ou wi h 90 sub-
jec s in Glasgow.17 The 47 asco bic-
acid subjec s (1 g pe day) had an
a e age o 0.94 colds, wi h a e age
du a ion 3.5 days, in eg a ed mo bidi y
3.29 days o illness pe pe son, and he
43 placebo subjec s had an a e age o
1.86 colds, wi h a e age du a ion 4.2
days, in eg a ed mo bidi y 7.81 days
o illness pe pe son. The obse ed de-
c ease in in eg a ed mo bidi y is ac-
co dingly 58%. The s udy was no
double-blind, in ha one in es iga o
knew he iden i y o he subjec s in he
wo g oups. The obse ed di e ence in
amoun o illness is s a is ically signi i-
can a he le el P (one- ailed) <0.002.
ELLIOTT
A 10-week double-blind s udy o 70
c ew membe s on a Pola is subma ine
was ca ied ou by Ellio .18 The 37 sub-
jec s in he asco bic-acid g oup e-
cei ed 2 g o asco bic acid pe day and
he 33 con ol subjec s ecei ed a pla-
cebo. The e was no consis en di e -
ence be ween he wo g oups in he in-
cidence o unny nose and sneezing.
The a e age numbe o days o mo -
bidi y o hoa seness, so e h oa s, non-
p oduc i e coughs, and p oduc i e
coughs was 63%, 72%, 60%, and
69%, espec i ely, less o he asco -
bic-acid subjec s han o he placebo
subjec s, s a is ically signi ican by he
Wilcoxon sequence one- ailed es o
hoa seness (P = 0.0155) and p oduc-
i e coughs (P = 0.0327) bu no o
he o he s. I ake he a e age (wi h 0%
o unny nose and sneezing), 44%, as
he dec ease in in eg a ed mo bidi y in
asco bic-acid subjec s in his s udy.
SABISTON AND RADOMSKI
Sabis on and Radomski o he De-
pa men o Na ional De ense, Canada,
ha e epo ed he esul s o a 4-weeks
s udy o 112 soldie s unde going ope a-
ional aining in no he n Canada.19
Asco bic acid, 1 g pe day, was gi en
o 56 subjec s and a placebo o he
o he 56. Alloca ion o he 8 men in
each en o one o he o he o g oups
o 4 ecei ing he wo kinds o able s
was made a andom. The asco bic-acid
subjec s had 6 colds, mean du a ion 4.3
days, a e age days o illness pe man
0.46, and he placebo subjec s had 14
colds, mean du a ion 5.8 days, a e age
days o illness pe man 1.45. The de-
c ease in in eg a ed mo bidi y is ac-
co dingly 68%, s a is ically signi ican
a he le el P (one- ailed) < 0.05.
ANDERSON, BEATON, COREY,
AND SPERO
One o he bes o he con olled
s udies is he hi d To on o s udy, e-
po ed in Ap il 1975.20 O he 448
subjec s who comple ed he 15-week
es 150 ecei ed a weekly 500-mg
i amin C able ( wo- hi ds sodium
asco ba e and one- hi d calcium asco -
ba e), 152 ecei ed a weekly 500-mg
ime- elease capsule o asco bic acid,
and 145 ecei ed a placebo able wi h
he same appea ance and as e as he
asco ba e able . In addi ion he sub-
jec s we e ins uc ed o ake an ex a
able o capsule a he onse o any
symp om o illness and, i symp oms
pe sis ed, o epea he dose wice a 4-
hou in e als on he i s day and once
e e y 12 hou s o up o 4 mo e days.
The in es iga o s epo o each o
he h ee g oups he mean numbe o
days o mo bidi y pe subjec wi h nine
signs o symp oms—con ined indoo s,
o wo k, nose unning o plugged,
h oa so eness, ches so eness o igh -
ness, el e e ish, cold and shi e y,
limbs aching and hea y, and men ally
dep essed, no ambi ion. This mean was
less o each o he wo i amin g oups
han o he placebo g oup o e e y
one o he nine signs o symp oms, wi h
a ios anging om 62 o 98%. The
a e ages o he nine alues o he wo
i amin g oups, 75 and 78%, espec-
i ely, a e nea ly he same, and he in-
es iga o s made o he compa isons be-
ween he combined i amin g oup
(302 subjec s) and he placebo g oup.
The subjec s in each o hese wo
g oups we e di ided in o a high and a
low subg oup in nine ways, acco ding
o age, sex, usual days indoo s, con-
ac wi h young child en, equency in
Doc o s Need To Know Abou
Asco bic Acid and Common Cold
Pa II
By LINUS PAULING, NOBELIST
D . Pauling is P esiden o he Linus Pauling Ins i u e o Science and Medicine, 2700
Sand Hill Road, Menlo Pa k, Cali . 94025, and P o esso Eme i us o Chemis y a
S an o d Uni e si y and he Cali o nia Ins i u e o Technology.
This concludes he examina ion o published s udies o i amin C and he com-
mon cold by Linus Pauling, Ph.D., which MEDICAL TRIBUNE is publishing be-
cause he in o ma ion is impo an o physicians, and he pape was ejec ed by
he Jou nal o Ame ican Medical Associa ion e en a e D . Pauling wice made
e isions o mee he sugges ions o i s e e ees.
c owds, daily juice, i amin supple-
men , smoking, and episodes in ol -
ing nasal symp oms. The mean num-
be o days indoo s pe subjec o each
o he eigh een i amin subg oups was
less han ha o he co esponding
placebo subg oup, wi h he a io ang-
ing om 48% ( o episodes no in ol -
ing nasal symp oms) o 87%.
The mean numbe o days indoo s
pe subjec was 1.202 o he whole
i amin g oup and 1.610 o he pla-
cebo g oup, wi h a io 75%, co es-
ponding o 25% less illness o he
i amin g oup han o he placebo
g oup. The in es iga o s s a e ha
"subjec s in bo h i amin g oups expe-
ienced less se e e illness han subjec s
in he placebo g oup, wi h app oxi-
ma ely 25% ewe days spen indoo s
because o illness (P < 0.05)." They
poin ou ha he esul s a e simila o
hose ob ained in hei i s s udy, in
which hey ound 30% ewe days con-
ined o home (P < 0.001), wi h a
la ge in ake o i amin C. They also
men ion ha in each s udy as much
p o ec ion agains non- espi a o y ill-
ness as agains espi a o y illness was
obse ed, and sugges again ha la ge
doses o asco bic acid p oduce "a gen-
e alized nonspeci ic imp o emen in he
hos 's abili y o cope wi h in ec ion (o
possibly any ype o s ess?)." They ex-
p ess he opinion ha "Taken in con-
junc ion wi h he posi i e esul s e-
po ed by o he in es iga o s, he e is
now li le doub ha he in ake o ad-
di ional i amin C can lead o a e-
duced bu den o 'win e illness'."
DISCUSSION OF THE STUDIES
The amoun s o obse ed dec ease
in illness pe pe son (in eg a ed mo -
bidi y) in asco bic-acid subjec s ela-
i e o placebo subjec s as epo ed in
12 con olled ials a e gi en in Table
2. (In he o he one o he 13 s udies
discussed abo e, ha o Wilson e al.,
he in es iga o s epo ed a s a is i-
cally signi ican dec ease in illness o
gi ls and no dec ease o boys. Thei
epo does no include in o ma ion
ha would pe mi calcula ing he al-
ues o he in eg a ed mo bidi y, so ha
his s udy is no included in Table 2.)
Nine o he hi een s udies ha e been
discussed also by Dykes and Meie ,
who seem no o ha e known abou he
las h ee in Table 2.
These hi een s udies comp ise all
o he con olled ials made o asco -
bic acid in ela ion o he common cold
wi h he asco bic acid o placebo gi en
o subjec s o e a pe iod o ime and
wi h he subjec s in good heal h a he
beginning o he ial and exposed o
cold i uses in he o dina y way, by
casual con ac wi h o he people. In
e e y one o he hi een ials a posi-
i e esul was ob ained; ha is, he
asco bic-acid subjec s had less epo ed
illness han he placebo subjec s.
The a e age amoun o dec ease in
illness pe pe son is 36% (Table 2).
The h ee la ges alues a e 58%,
63%, and 68%. I is my opinion ha
an e ec o his magni ude is clinically
signi ican .
These hi een ials do no suppo
he s a emen made in he AMA p ess
elease o 10 Ma ch 1975 ha "Vi a-
min C will no p e en o cu e he com-
mon cold." The e is no e idence o
his s a emen . Ins ead, all o he e i-
dence, as summa ized abo e, suppo s
he conclusion ha i amin C has some
alue in con olling he common cold.
The AMA p ess elease also s a es
ha "e en i i amin C did p e en o
educe he discom o o colds, i would
be necessa y o ake wo capsules o
able s h ee imes a day o he es
o one's li e o make i wo k." This
s a emen is an exagge a ion. The a -
e age amoun o he i amin used in
he s udies shown in Table 2 is 1 g pe
day. One could p esumably ob ain
36% p o ec ion by aking one 1-g ab-
le each day. Mo eo e , in a numbe
o hese s udies and in wo k epo ed
elsewhe e21 i has been poin ed ou ha
he cou se o a cold can be modi ied by
he inges ion o se e al g ams o as-
co bic acid, beginning as soon as pos-
sible a e he cold has s a ed. Reg-
nie 22 epo ed ha in a single-blind
con olled ial he was able o a e
90% o he colds in his pa ien s by use
o a la ge in ake o asco bic acid. The
ecommended in ake o his pu pose
is abou 1 g pe hou o se e al hou s.22
ADVERSE REACTIONS
Se e al in es iga o s2,9,11 ha e e-
po ed ha no ad e se eac ions we e
obse ed in hei subjec s who ecei ed
1 g pe day o mo e o asco bic acid.
Asco bic acid is a na u al subs ance,
p esen in all li ing o ganisms. I is
manu ac u ed by almos all animals a
a a e co esponding o an in ake o
man o be ween 2 g and 20 g pe day,
and i is acco dingly unlikely ha such
an in ake would be ha m ul o man.
I ha e gi en a gumen s o suppo he
hesis ha his in ake is in ac he
op imum in ake, which leads o he
bes o heal h.23
Dykes and Meie ha e discussed he
ques ion o ad e se eac ions. Thei
conclusion is ha " he e is cu en ly
li le adequa e e idence on ei he he
p esence o he absence o se ious ad-
e se eac ions o such doses o asco -
bic acid, al hough many such eac ions
ha e been hypo hesized." They sugges
ha addi ional s udies in his ield a e
needed. I ag ee ha addi ional s udies
a e needed, bu I do no hink ha i is
Table 2
Summa y o Resul s o S udies o Dec ease in In eg a ed Mo bidi y in
Asco bic-acid Subjec s Rela i e o Placebo Subjec s
jus i ied o e ain om using his al-
uable subs ance un il he s udies ha e
been ca ied ou .
Re e ences
16. Dahlbe g G, Engel A, Rydin H: Ac a Med
Scand 119:540-561,1944.
17. Cha les on SS, Clegg KM: Lance 1:1401,
1972.
18. Ellio B: In e na l Res Comm Sys (73-5)
12-3-1, Dec. 1973.
19. Sabis on BH, Radomski MW: DCIEM Re-
po No. 74-R-1012. De ense Resea ch Boa d,
Dep o Na ional De ense, Canada, 1974.
20. Ande son TW, Bea on GH, Co ey PN, Spe o
L: Can Med Assoc J 112:823-326, 1975.
21. Pauling L: Vi amin C and he Common cold.
WH F eeman and Co., San F ancisco, 1970.
22. Regnie E: Re Alle gy 22:948-956,1968.
23. Pauling L: P oc Na l Acad Sci USA 71:4442-
4446, 1974.
