Vitamin C Levels in Critically Ill COVID-19 Patients


Conclusion

SARS-CoV-2 is an RNA virus capable of causing systemic, life-threatening disease in humans. Severe disease is characterized by hyper-inflammation, hyper-coagulation, and hypoxia. The virus produces proteins that knockdown two major pillars of the innate immune system, interferon and selenoproteins. Selenoprotein knockdown impairs antioxidant capacity and hemostasis (anticoagulation and clotting). The virus also damages RBC structure, which combined with loss of antioxidant capacity, impairs management of oxygen, carbon dioxide, and nitric oxide throughout the body. Additionally, consumption of NAD by the virus depletes cells of a vital energy source.

Restoring and maintaining healthy levels of ascorbic acid, selenocysteine, vitamin D, and NAD is critical in the battle against SARS-CoV-2. In treatment, as well as in research, it is important to remember that nutrients do not work optimally alone. Selenium, vitamin D, magnesium, and vitamin K2 are interdependent. Vitamin C, selenium, and vitamin E are interdependent. Niacin and NAD are also dependent on adequate intracellular selenoproteins and vitamin C levels. Single nutrient studies and interventions will miss essential synergies and confounding variables regardless of the sample size.

In critical illness, large doses of vitamin C can be helpful in resuscitation efforts. In the setting of septic vascular collapse, intravenous co-administration of vitamin C and cortisol helps the body repair damaged blood vessels quickly. Ongoing large doses of vitamin C are needed to fuel white blood cells, regain antioxidant capacity throughout the body, and counteract its rapid consumption. Frequent dosing to maintain a steady state is better, because ascorbic acid has a short half-life. Early intervention is better, because activated white blood cells are dependent on a high level of ascorbic acid. Taking gram quantities with each meal, and increasing intake to bowel tolerance during illness, is helpful. When ill, it is necessary to take ascorbic acid throughout the day, much more than can be absorbed in one sitting.

New research techniques, and new viruses improve our understanding of biochemistry and biology and reinforce a longstanding concern – inadequate nutrition remains global and public health enemy #1.

Recommended Adult Doses to Reduce Risk of Serious Infection:24-30 

  • Vitamin C, 500-1000 mg, 3 times daily (more to bowel tolerance if sick)
  • Vitamin D, 5,000 IU/day
  • Vitamin K2, 100 mcg/day
  • Niacin / niacinamide 200 – 1000 mg/d (in divided doses, start with smaller doses, increase over weeks)
  • Magnesium 400 mg/d (in malate, citrate, chelate, or chloride form)
  • Zinc, 20 mg/day
  • Selenium 200 mcg/day


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Michael E. Passwater, son of author and columnist Dr. Richard Passwater, is certified by the American Society for Clinical Pathology as a medical technologist, a specialist in immunohematology, and is a diplomate in laboratory management. He has worked in clinical laboratories for 29 years and has previously written “Do the Math: “MATH+” Saves Lives” and “The VICTAS Trial: Designed to Fail,” both published by the Orthomolecular Medicine News Service.

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