VICTAS Trial Finds No Benefit of IV Ascorbic Acid for Sepsis
One of the sad things about hospital research of nutritional medicine, particularly vitamin C, is that rarely does the study demonstrate effectiveness. Years ago, when Pauling and Cameron wrote about ascorbic acid showing benefit in cancer patients, a Mayo Clinic surgeon, Charles Moertel, wrote that his trial with vitamin C did not show improved survival. In 2019 Dr. Alpha Fowler at the University of Virginia demonstrated that vitamin C shortened hospitalization and ICU time in patients with sepsis. Following a similar protocol established by Fowler, Dr. Jonathan Sevransky at Emory University carried out a multi-institutional placebo-blinded randomized study of vitamin C in treating sepsis.1 His VICTAS trial used a low dose of ascorbic acid, thiamine, and hydrocortisone (HAT protocol). Not surprisingly, there was no benefit in the treatment group compared to the placebo group in survival, amount of time in the ICU, and amount of time hospitalized. The study published in JAMA in February 2021, demonstrating an absence of vitamin C effectiveness in sepsis was accorded CME status for doctors reading the article and passing a quiz; the take away was there is no need to consider vitamin C in septic patients and, presumably, patients with major infections.
As Michael Passwater critiques in this issue of the Townsend Letter, the study was “designed to fail.” Among the major concerns noted by Passwater was the very low dose of ascorbic acid implemented in septic care. The study called for 1.5 grams of vitamin C to be administered intravenously every six hours for a period of four days. 1.5 grams! Really. This would be like administering 1 mg of Lasix to treat heart failure when typically, 40-80 mg is needed. Most integrative practitioners use 5-10 grams in a Meyer’s cocktail IV slow push in treating chronic fatigue or fibromyalgia. How could there have been any expectation that 1.5 grams of vitamin C would accomplish anything? When old-timer Fred Klenner, MD, treated infected patients with intravenous ascorbic acid, he would always use 25-50 grams in an IV drip over one to two hours. Robert Cathcart, MD, not only did the same with sick patients, he would not infrequently use 75-100 grams. As Passwater points out in his critique, the protocol was not initiated in septic patients until 15 hours had passed. Why did the study design call for such a lengthy delay in treatment with such a low dose of ascorbic acid?
Unfortunately, MDs seeking their CME accreditation will only walk away thinking that vitamin C offers no benefit in their treatment armamentarium. So much for ascorbic acid becoming a mainstay in hospital treatment for sepsis and infection. This is truly disgraceful. Who will step up to repeat this trial using 25-50 grams of ascorbic acid every six hours and requiring treatment to be initiated immediately? No one, unfortunately. Intravenous vitamin C will remain, of all things, a “renegade” therapy that only a few patients will have access to.
Cover Story: Dr. Lindsey Berkson on Kidney Disease
Dr. Devaki Lindsey Berkson is a recognized nutritional consultant who specializes in complex hormone and gastrointestinal case management. Dr. Berkson has served as a research fellow at the University of Texas at Austin as well as Distinguished Estrogen Scholar at the Center for Bioenvironmental Research. She serves in teaching CME for professionals at A4M and PCCA. Berkson has authored numerous books and presented at dozens of conferences here and abroad. Berkson authored a three-part article in the Townsend Letter beginning in August/September 2020 entitled “Estrogen Vindication,” citing the evidence about estrogen’s effectiveness and safety in bio-identical hormone treatment (see www.townsendletter.com). Dr. Berkson invites the readership to consult with her to help manage complex cases (www.drlindseyberkson.com).
Berkson has a unique take on kidney disease; for sixteen years she suffered with chronic kidney disease following a nephrectomy for kidney cancer. Berkson attributes her kidney cancer and subsequent renal disease to the damage that diethylstilbestrol (DES) did to her in-utero. Despite impeccable nutrition, exercise, mindfulness, herbal supplementation, and nephrology care, her CKD did not improve. Her kidney specialists were unable to offer any answers as to why her kidney functioning was deteriorating. Berkson’s academic mindset pushed her to research the medical literature for answers. Her research shocked her that there were far more means to assess kidney functioning than measurement of creatinine, BUN, and estimated glomerular filtration rate. For starters, elevation in potassium is an important marker for kidney dysfunction. But a half-dozen other biochemical markers, having relevance in assessment of kidney functioning, are not routinely tested. A big one is trimethylamine-N-oxide (TMAO). An elevation in TMAO not only impairs kidney functioning but also damages endothelium and the heart. For those individuals with elevated TMAO, a vegan diet is indicated. As Berkson discusses in her cover article, other biochemical factors ignored by nephrologists play an unappreciated role in impairing kidney functioning. Nutritional management of these factors not only may manage kidney disease but may even reverse it. Berkson’s chronic kidney disease is completely reversed.
Assessing Liver Function by Dr. Douglas Lobay
Readers of the Townsend Letter are familiar with Doug Lobay, ND’s writing. Recent articles include “The Canary in the Coal Mine or How to Improve Kidney Function” and “Practical Nutritional Supplement De-Prescribing,” both available on-line.2,3 A graduate of Bastyr College (University of Health Sciences) Dr. Lobay has been practicing naturopathic medicine for many years in Kelowna, British Columbia. Lobay is the author of several books, including Dr. Lobay’s Natural Health and Healing and Dr. Lobay’s Natural Medicine 101.
For those of us who may be a little bit rusty on liver physiology, Doug’s summary of liver functioning, particularly phase 1 and 2 biotransformation, is an easy-to-read review as well as a great synopsis to share with patients. One of the interesting aspects of liver testing has been the gradual increase in reference ranges for ALT and AST testing. Why should a normal ALT and AST be higher now than it was 30 years earlier? Could it be that a societal increase in obesity, occurring with an increase in metabolic syndrome and non-alcoholic fatty liver disease, has made a “normal” liver transaminase higher than the past? The point is that abnormal liver function is more prevalent, and we should be alert to assessing it in our patients. As Lobay writes in this issue’s article on liver disease, quoting his mentor, the late John Bastyr, who himself quotes a wise sage: “If all else fails, treat the liver.”
By all means take a gander at these Lobay articles online and others that he has written at www.townsendletter.com.
References
1. Sevransky JE, et al. Effect of Vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis. The VICTAS randomized clinical trial. JAMA. 2021. 325: 742-751.
2. Lobay D. The Canary in the Coal Mine or How to Improve Kidney Function. Townsend Letter. June 2020. https://www.townsendletter.com/article/443-canary-in-the-coal-mine-improving-kidney-function/
3. Lobay D. Practical nutritional supplement de-prescribing. Townsend Letter. May 2019. https://www.townsendletter.com/article/430-practical-nutritional-supplement-de-prescribing/
