I love Vitamin C

[BLADEMDA]

I thought this was very interesting data and my Mother always said to take Vitamin C whenever I got a cold.

The ingredients cost about as much as a single dose of antibiotics.

"I obviously have no vested interest," he says. "Nobody's going to make money from this — so this is a very anti-capitalistic thing!

---

Members don't see this ad.

 

[BLADEMDA]

Doctor Turns Up Possible Treatment For Deadly Sepsis

Doctor Turns Up Possible Treatment For Deadly Sepsis

 

[BLADEMDA]

Conclusion
Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine may prove to be effective in preventing progressive organ dysfunction including acute kidney injury and reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

 

[Consigliere]

I thought this was very interesting data and my Mother always said to take Vitamin C whenever I got a cold.

The ingredients cost about as much as a single dose of antibiotics.

"I obviously have no vested interest," he says. "Nobody's going to make money from this — so this is a very anti-capitalistic thing!

Didn't Linus Pauling advocate mega doses of Vitamin C decades ago?

 

[GravelRider]

I wonder how many simple and effective treatments we overlook because it won't make some company a few billion dollars?

I also wonder how long it takes for a pharmaceutical company to monetize this better with some "special" slow release formulation or other such nonsense.

 

[deleted162650]

I also wonder how long it takes for a pharmaceutical company to monetize this better with some "special" slow release formulation or other such nonsense.

They'll just combine the C, steroids, and thiamine in the same bag and give it some catchy name. Hell, maybe I'll do it and retire early. Who wants in on the ground floor?

 

[deleted171991]

I thought this was very interesting data and my Mother always said to take Vitamin C whenever I got a cold.

The ingredients cost about as much as a single dose of antibiotics.

"I obviously have no vested interest," he says. "Nobody's going to make money from this — so this is a very anti-capitalistic thing!

I always did the same thing (1 g of vitamin C up to 3-4 times/day) and got almost immediate symptomatic relief (when sucking on it). That's why I tend to believe Marik is right (besides being The Dr. Marik). I, for one, hope he's right, despite almost putting my subspecialty out of business.

Here's his evidence-based presentation, by the way, because we are scientists.

 

[KaoticMessiah]

It's a very good presentation, but until we get a randomized controlled trial, I'll take it with a gigantic grain of salt. Whenever something seems too good to be true, that's usually because it is. Sepsis and the resulting sequelae [and their prevention] is probably more complicated than a relative vitamin deficiency. I do find it interesting, however, that the CEO of his health system has bought into it enough to make it a system-wide treatment approach, which does say a lot to the veracity of the claims, I guess, because it's definitely not easy to get health systems to do much of anything that quickly.
That being said, it likely has very little harm and potentially a lot of benefit, so it'd definitely be worth trying, and some of my colleagues and I have discussed doing just a quick small little trial in our ICU's to see how it works.

I will eagerly anticipate the randomized trial.

 

[facted]

Agree about the RTC, but the initial data looks crazy. This is also Marik we're talking about, which gives this a level of seriousness...

 

[dhb]

I drink orange juice... never had sepsis

 

[Pooh & Annie]

They'll just combine the C, steroids, and thiamine in the same bag and give it some catchy name. Hell, maybe I'll do it and retire early. Who wants in on the ground floor?

Add some narcan to it n sell it in oral form. The narcan may be unnecessary and expensive (for reasons unclear to me), but that won't stop thousands of PCPs everywhere from prescribing it.

 

[pjl]

It's a very good presentation, but until we get a randomized controlled trial, I'll take it with a gigantic grain of salt. Whenever something seems too good to be true, that's usually because it is. Sepsis and the resulting sequelae [and their prevention] is probably more complicated than a relative vitamin deficiency. I do find it interesting, however, that the CEO of his health system has bought into it enough to make it a system-wide treatment approach, which does say a lot to the veracity of the claims, I guess, because it's definitely not easy to get health systems to do much of anything that quickly.
That being said, it likely has very little harm and potentially a lot of benefit, so it'd definitely be worth trying, and some of my colleagues and I have discussed doing just a quick small little trial in our ICU's to see how it works.

I will eagerly anticipate the randomized trial.

So low risk, sounds worth a trial immediately. Let us know your informal results. If I was doing ICU, I would definitely start a study.


Sent from my iPad using SDN mobile app

 

[deleted162650]

Is Vitamin C the new Xigris?

 

[Mman]

They'll just combine the C, steroids, and thiamine in the same bag and give it some catchy name. Hell, maybe I'll do it and retire early. Who wants in on the ground floor?

Instead of the banana bag, it'll be the orange-banana bag.

 

[Planktonmd]

Is Vitamin C the new Xigris?

Vitamin C is much cheaper!

 

[Planktonmd]

Do we know the dosages they use in their protocol?

 

[GravelRider]

Is Vitamin C the new Xigris?

Xigris was a scam drug by Eli Lilly. When the drug was not being used as widely as they were hoping, they funded a study saying that doctors were "rationing" care in the ICU...not because the drug had questionable data regarding its efficacy. They then tried to buy off the guideline writers so that hospitals and doctors who did not use Xigris would be penalized. Luckily, Xigris has been taken off the market.

 

[deleted162650]

Luckily, Xigris has been taken off the market.

Was it shown to be harmful, or just expensive and ineffective?

 

[BLADEMDA]

http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/0/11036.pdf

Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

 

[scudrunner]

Didn't Linus Pauling advocate mega doses of Vitamin C decades ago?

He sure did. Not sure what his regimen was.

 

[pjl]

http://journal.publications.chestnet.org/pdfaccess.ashx?url=/data/journals/chest/0/11036.pdf

Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

1.5 grams 4 times daily. It is worth reading the article.


Sent from my iPhone using SDN mobile app

 

[urge]

Conclusion
Our results suggest that the early use of intravenous vitamin C, together with corticosteroids and thiamine may prove to be effective in preventing progressive organ dysfunction including acute kidney injury and reducing the mortality of patients with severe sepsis and septic shock. Additional studies are required to confirm these preliminary findings.

Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study

I'm surprised Chest published this since basically all critical care trials with significant results have been debunked as hack jobs by dubious researchers. And this is not even a trial.

 

[facted]

I'm surprised Chest published this since basically all critical care trials with significant results have been debunked as hack jobs by dubious researchers. And this is not even a trial.

This is Paul Marik. The man is an ICU demigod.

 

[pgg]

This is Paul Marik. The man is an ICU demigod.

This vitamin C thing is interesting. But it's right there in the title ... "A Retrospective Before-After Study" ... there are a lot of ways bias and confounders slip into that kind of study.

It's interesting in the same way Lockheed Martin's Skunk Works telling us they'll have a commercial compact fusion reactor built and rolling around on the backs of trucks in just a few more years.

Yeah, right. But it's Skunk Works. Those guys built the SR-71, U-2, F117. It's hard to just blow them off.

I can't wait to see where Marik and Skunk Works go with these projects. Fascinating, world changing stuff, from people with real credibility. I expect to be disappointed by both though, truth be told. Hope I'm wrong.

 

[urge]

This is Paul Marik. The man is an ICU demigod.

Based on what? What is his claim to fame, other than being FFP's mancrush?

 

[OTCAwesome]

Was it shown to be harmful, or just expensive and ineffective?

Didn't help at all and was harmful, PROWESS trial showed increased risk of life threatening bleed compared to placebo (2.4% vs 1%)

 

[GravelRider]

Was it shown to be harmful, or just expensive and ineffective?

Didn't work.

The more interesting story was it brought to light how intertwined industry is with academia, "expert" panels, "ethics," and guidelines. Not that we didn't know that already, but the Xigris saga is a good example of it.

 

[GA8314]

Not to hijack this thread but I find it also very interesting that anabolic steroids (oxandrolone and nandrolone) have virtually been abandoned for treatment of cachexia and wasting in the critically ill...... I think it's an example of an entire class of very effective medications having been stigmatized to the point of disuse.

 

[Aether2000]

There are 16 published trials showing no effect of vitamin c on prevention or treatment of the common cold and several trials showing no effect on cancer despite Pauling's advocacy of daily 12,000 mg a day and 80,000 mg a day when a person felt a cold coming on.

Sent from my SM-G930U using SDN mobile

 

[deleted162650]

There are 16 published trials showing no effect of vitamin c on prevention or treatment of the common cold and several trials showing no effect on cancer despite Pauling's advocacy of daily 12,000 mg a day and 80,000 mg a day when a person felt a cold coming on.

Sent from my SM-G930U using SDN mobile

I would love to see just how much of that 80g/day of C ends up in the person's urine. I bet it's about 79g's.

 

[deleted820760]

Do we know the dosages they use in their protocol?

We do ascorbic acid 1500 mg IV every 6 hours at my hospital.

 

[facted]

There are 16 published trials showing no effect of vitamin c on prevention or treatment of the common cold and several trials showing no effect on cancer despite Pauling's advocacy of daily 12,000 mg a day and 80,000 mg a day when a person felt a cold coming on.

Sent from my SM-G930U using SDN mobile

I thought the same. I read the Cochrane review on VitC for colds and it's actually somewhat in favor. They discuss there's enough evidence and little harm that it's worth trying on an individual basis. I was kinda shocked actually.

 

[Onefellswoop87]

I would love to see just how much of that 80g/day of C ends up in the person's urine. I bet it's about 79g's.

Yup, generally, vitamin supplementation just gives you expensive urine.

 

[GravelRider]

If the American diet didn't consist mainly of worthless crap and processed garbage, vitamin supplementation wouldn't be a thing. If you have a diet high in mixed fruits and vegetables there is no need for vitamins.

Now in critically ill patients, the enteral feeding options mainly take macronutrients, like protein, fat, and carbs into account. So, I do wonder if there could be a benefit to vitamin supplementation in this population.

 

[Hoya11]

I would love to see just how much of that 80g/day of C ends up in the person's urine. I bet it's about 79g's.

Vit C at high doses can form renal stones. Everything in moderation.

 

[Aether2000]

However there is evidence Vitamin C may be protective against chronic renal disease (reduces the incidence), and protects against diclofenac induced nephropathy and contrast induced nephropathy. There is also evidence high sodium intake increases risk while potassium intake decreases the risk of nephropathy.
Micronutrient Intakes and Incidence of Chronic Kidney Disease in Adults: Tehran Lipid and Glucose Study.
Farhadnejad H1, Asghari G2, Mirmiran P3, Yuzbashian E4, Azizi F5.
Author information

Abstract
The aim of this study was to investigate the associations between micronutrient intakes and the 3.6-year incidence of chronic kidney disease (CKD) in adults. This cohort study was conducted, within the framework of the Tehran Lipid and Glucose Study, on 1692 subjects, aged ≥30 years, without CKD at the baseline. Dietary intakes were collected using a valid and reliable food-frequency questionnaire. Anthropometrics and biochemical measurements were taken. Chronic kidney disease was defined as eGFR < 60 mL/min/1.73 m². The mean age of participants was 43.3 ± 11.4 years. In the fully adjusted model, individuals in the top quintile of folate (OR: 0.44, 95% CI: 0.24-0.80), cobalamin (OR: 0.57, 95% CI: 0.34-0.93), vitamin C (OR: 0.38, 95% CI: 0.21-0.69), vitamin E (OR: 0.45, 95% CI: 0.22-0.92), vitamin D (OR: 0.39, 95% CI: 0.21-0.70), potassium (OR: 0.47, 95% CI: 0.23-0.97) and magnesium (OR: 0.41, 95% CI: 0.22-0.76) had decreased risk of CKD, and in the top quintile of sodium (OR: 1.64, 95% CI: 1.03-2.61), subjects had increased risk of CKD, in comparison to the bottom quintile. No significant associations were found between the intakes of other micronutrients. High intake of several micronutrients including vitamins C, E, D, cobalamin, folate, magnesium, and potassium was associated with a decreased risk, while sodium was associated with an increased risk of incident CKD.

 

[BLADEMDA]

I thought the same. I read the Cochrane review on VitC for colds and it's actually somewhat in favor. They discuss there's enough evidence and little harm that it's worth trying on an individual basis. I was kinda shocked actually.

Zinc lozenges.

As for Vitamins in the USA many need a multivitamin because their diet consists of hamburgers, fries, bacon and beer.

 

[deleted162650]

Keep in mind though that most foods in the US are already heavily fortified. Check out the side of a cereal box. It's like Fruit Loops and an MVI all in one.

 

[lunaire]

A bit late to the party, but here's the full protocol:

vit C IV 1500 mg Q6H
Thiamine IV 200mg Q12H
Hydrocortisone IV 50mg Q6H

Do the full protocol if you want to actually implement this for hemodynamic instability. Steroids and vit C appears to be synergistic. Vit C and thiamine deficiency may go hand in hand, and both affects cardiac function somewhat.

 

[urge]

A bit late to the party, but here's the full protocol:

vit C IV 1500 mg Q6H
Thiamine IV 200mg Q12H
Hydrocortisone IV 50mg Q6H

Do the full protocol if you want to actually implement this for hemodynamic instability. Steroids and vit C appears to be synergistic. Vit C and thiamine deficiency may go hand in hand, and both affects cardiac function somewhat.

I'll toss some Viagra into it to give it some extra oomph.

Remember what happened to those Fiat 500 cars when one of those pills got into the gas tank? Exactly.

 

[epidural man]

I wonder how many simple and effective treatments we overlook because it won't make some company a few billion dollars?

I also wonder how long it takes for a pharmaceutical company to monetize this better with some "special" slow release formulation or other such nonsense.

Tons...

Dr Esselstyn showed you can reverse heart disease (no drug does this, not even exercise) with diet changes. Dr Ornish has repeated these studies.

There have been two studies showing that early exposure to diary proteins (think formula) increased risk of type I diabetes by 15x.

Large epidemiological study from somewhere in the great state of Cali - showed that pescatarians have an Odds ratio of all-case mortality of .82, and your are half as likely to get a cancer. That is just a simple change of diet.

Does anybody pay attention?

Nope.

In fact, most people actually get pissed off when you say this stuff....a very strange response indeed, but one I have noticed is quit consistent.

 

[twoliter]

Tons...

Dr Esselstyn showed you can reverse heart disease (no drug does this, not even exercise) with diet changes. Dr Ornish has repeated these studies.

There have been two studies showing that early exposure to diary proteins (think formula) increased risk of type I diabetes by 15x.

Large epidemiological study from somewhere in the great state of Cali - showed that pescatarians have an Odds ratio of all-case mortality of .82, and your are half as likely to get a cancer. That is just a simple change of diet.

Does anybody pay attention?

Nope.

In fact, most people actually get pissed off when you say this stuff....a very strange response indeed, but one I have noticed is quit consistent.

Have the studies been crossmatched and critiqued? I don't know what studies your referring to, but I imagine pescatarians are less likely to smoke and more likely to exercise regularly. I assume there are other lifestyle differences in strictly breastfed and not. I can see how those can be some pretty poor studies. I'm not necessarily disagreeing with the conclusions, but they can be questioned.

 

[deleted162650]

I think eating a lot of fish carries some risk. A lot of heavy metals and other pollutants get passed up the food chain and concentrated in the larger pelagics (tuna swordfish, etc.) to the point that many departments of fish and game recommend not eating more that a couple servings per week.

 

[epidural man]

Have the studies been crossmatched and critiqued? I don't know what studies your referring to, but I imagine pescatarians are less likely to smoke and more likely to exercise regularly. I assume there are other lifestyle differences in strictly breastfed and not. I can see how those can be some pretty poor studies. I'm not necessarily disagreeing with the conclusions, but they can be questioned.

Heavily critiqued. You tell people not to buy a hamburger, and the world falls apart. Remember when Oprah said something against the beef industry? She was crucified in the press. It's crazy.

Regarding the studies about diet, they were very large - so any of those variables where likely accounted for.

But read them for yourself (attached).

It's crazy how people want to defend eating meat.

 

[facted]

Heavily critiqued. You tell people not to buy a hamburger, and the world falls apart. Remember when Oprah said something against the beef industry? She was crucified in the press. It's crazy.

Regarding the studies about diet, they were very large - so any of those variables where likely accounted for.

But read them for yourself (attached).

It's crazy how people want to defend eating meat.

Didn't read the second one, but the first one points out what was mentioned above. The veggie group was more educated, exercised more, smoked far less, and drank alcohol far less than those who ate meat.

 

[epidural man]

Didn't read the second one, but the first one points out what was mentioned above. The veggie group was more educated, exercised more, smoked far less, and drank alcohol far less than those who ate meat.

Yet even among them (vegetable eaters), the pescatarians did far better than the vegetarians, vegans, and lacto-ovo-vegetarians.

 

[deleted162650]

Yet even among them (vegetable eaters), the pescatarians did far better than the vegetarians, vegans, and lacto-ovo-vegetarians.

Yes. Because eating animals is good for you.

 

[VA Hopeful Dr]

Heavily critiqued. You tell people not to buy a hamburger, and the world falls apart. Remember when Oprah said something against the beef industry? She was crucified in the press. It's crazy.

Regarding the studies about diet, they were very large - so any of those variables where likely accounted for.

But read them for yourself (attached).

It's crazy how people want to defend eating meat.

Maybe its just because I'm young and reasonably recently out of residency, but I don't know that many physicians who advocate eating meat. We're all pretty aware that its bad for you.

 

[epidural man]

Maybe its just because I'm young and reasonably recently out of residency, but I don't know that many physicians who advocate eating meat. We're all pretty aware that its bad for you.

I wish this were true.

 

[pgg]

Maybe its just because I'm young and reasonably recently out of residency, but I don't know that many physicians who advocate eating meat. We're all pretty aware that its bad for you.