A-The herpes simplex virus type-1 (HSV-1), which causes cold or canker sores, is circulating in about 25-40 per cent of the population. There is no cure for HSV-1. Once the herpesvirus enters your body, it forms a symbiotic ‘alliance’ with its host, living comfortably and chronically in your tissues and nerve cells. Most of the time, it is not virulent enough to cause systemwide infection (about 90-95 per cent of individuals with the HSV-1 are asymptomatic), but it is nevertheless strong enough to resist the immune system’s attempts to eradicate it.

Factors such as sun exposure, use of steroids, fatigue, cold weather, stress, arginine rich foods, pregnancy and the menstrual cycle can activate the virus and increase the chance of recurrent infections. Strengthening the immune system while avoiding or substantially reducing those factors which trigger an attack is one of the best ways to keep outbreaks from recurring.

Mild recurrences require no treatment in most cases. Every time a blister appears, there is the possibility of spreading it, for instance, through kissing and to other parts of the body, even the genitals (for example, if you touch the sore, then rub somewhere else). Good personal hygiene is essential during an outbreak.

Acyclovir (Zovirax), an antiviral drug introduced in 1979, is usually given to those with severe outbreaks, although a recent review showed that it is ineffective in recurrent infections (BMJ, 1996; 312: 6). Often it is given on a just in case basis. However, it does not prevent herpes from recurring or being transmitted from an infected person to others. For all its manufacturer’s claims, it can only lesson the painful period of herpes by 1.4 days, and the virus can become resistant with continued use.

Researchers are beginning to realise that herpes comes in two forms. The ‘immediate’ lesions appear within 48 hours of infection and comprise about one third of all herpes lesions and do not respond to acyclovir. The ‘delayed’ lesions appear after three to seven days and seem more responsive to the drug.

If taken orally, acyclovir has the potential to cause adverse reactions such as headache, itchy and sometimes scaly skin rashes, fatigue, confusional states, gastrointestinal upset, dizziness, vomiting and diarrhoea. It should not be used for herpes of the eye and is not recommended for children under the age of 12.

There are several alternative treatments. One natural treatment for cold sores as well as genital herpes is lemon balm (Melissa officinalis). Several clinical studies have provided impressive evidence of both a preventative and therapeutic effect against herpes simplex infection. Although lemon balm has been used for over 2000 years as a sedative, its importance increased in 1964 when water extracts of Melissa were discovered to have antiviral qualities as well.

One review reported on several studies of lemon balm in the treatment of cold sores. In one multicentre trial, 115 patients with cold sores of less than 72 hours’ duration were included in the study.

The patients were instructed to apply the Melissa containing cream to the lesions five times daily until healing of the lesion was complete. After four days, 60 per cent of patients had complete healing, which rose to 87 per cent after six days and 96 per cent after eight days.

Since other studies have determined that the natural recovery from herpes usually occurs within 10 to 14 days, the results from the study provided evidence that the Melissa cream promoted faster healing (Phytomed, 1994; 1: 25-31).

The Melissa extract used in the product is a 70:1 concentrate that has undergone a battery of quality control steps, including assessment of in vitro anti viral activity to insure potency. The antiviral assessment is critical. Rather than any single antiviral chemical, the Melissa extract in the formula contains several components that work together to prevent the virus from infecting human cells.

Besides lemon balm, a special witch hazel (Hamamelis virginiana) extract prepared to have a high proanthocyanidin content and low tannin content has been shown in laboratory studies to have an antiviral effect on HSV-1 (Planta Med, 1996; 62: 241-5). The extract or tincture can be applied neat on the sore.

There’s also evidence that lavender or tea tree oil, also applied neat to the lesion, may help clear up the infection (Aust J Pharmacol, 1988; 69: 276-8).

Olive leaf tincture (Tinctura olea foliorum) has been used in Europe for 75 years with no apparent ill effects. In a recent study, six subjects with genital herpes were given 2 ounces of olive leaf tincture every six hours. All subjects reported relief from their symptoms, and three claimed that their lesions had disappeared completely within 36-48 hours.

For the three subjects whose lesions remained, the dose was upped to 4 ounces, which resulted in additional improvement, but not a total resolution of the sores. Two of these individuals had recently acquired the herpesvirus and were probably experiencing a high level of viral shedding, while the third had recently gone off the Pill, which was thought to have possibly complicated the infection.

While using the tincture, the three subjects whose lesions healed were able to eat arginine rich foods, such as onions, corn and pork, which normally cause an outbreak, and still remain lesion free (Townsend Letter For Docs, May 1997: 110).

All subjects in the study had tried acyclovir, but found the olive leaf tincture to be superior.

Certain homoeopathic remedies may also be useful. For instance, herpetic eye infections can be successfully treated with infrequent, high potencies of Zincum sulphuricum (McFarland quoted in W Boericke, Pocket Manual of Homoeopathic Materia Medica, 9th edn, Philadelphia: Boericke & Tafel, 1927: 686). On other parts of the body, the topical application of the same remedy can reduce the symptoms quickly and inhibit recurrence (Br J Dermatol, 1981; 104: 191-213). Homoeopathic textbooks list more than 130 remedies for herpes simplex. According to WDDTY panel member Harald Gaier, one of the following clinically proven remedies depending upon your symptoms should also be considered: Acidum nitricum, Acidum sulphurosum, Arsenicum album, Cantharis vesicator, Cornus circinata, Glaphimia glabra, Hedera helix, Nepenthes distillatoria, Sarsaparilla, Tellurium or Urtica urens.

Finally, if you have nothing else in the house and you experience an outbreak, you can always try the old kitchen cupboard favourite by reaching for a cup of tea preferably Earl Grey. Folk wisdom has it that if you steep an Earl Grey tea bag for five minutes, cool it, then apply it to the lesion (repeating this several times a day), within four or five days, the lesions crust over and disappear, and don’t recur for several months (Spectrum, 1996; 52: 19).

Whatever alternative remedy you choose, it is vital for you to have an optimally functioning immune system to avoid herpes simplex virus (HSV) outbreaks (H Bader & N Souter, Patho physiology of Dermatologic Disease, New York: McGraw-Hill, 1984).

One often overlooked cause of immune suppression is food allergies. These can depress immune system function so, if you suffer from recurrent HSV-1 outbreaks, it is vital to rule these out.

You should also consider cutting sugar out of your diet. The white cells’ ability to fight infection will be dramatically reduced for six hours after consuming as little as 75 grams of any form of refined sugar-honey, table sugar, glucose, maltose, fructose or dextrose (Am J Clin Nutr, 1977; 30: 613; Dent Surv, 1976; 52: 46-8). Remember that drinking three glasses of unsweetened fruit juice will provide you with the same amount of sugar in the form of fructose.

It’s also a good idea to cut out chocolate and other foods rich in arginine.

Those who have a history of recurrent HSV cold sores are often iron deficient (Am J Clin Nutr, 1991; 53: 1087-101). They may also have abnormally low levels of the naturally occurring enzyme adenosine 51-monophosphate (AMP), important in cell synthesis of nucleic acid (JAMA, 1977; 237: 871-2). Although additional small doses of AMP may be beneficial, there is not enough data on its toxic effects to make widespread recommendations. What is known is that 75 milligrams of AMP can immediately bring on heart palpitations (CFS Forum, April 15, 1989; 2).

One experimental double blind study demonstrated that supplements of 200 milligrams of vitamin C and 200 milligrams of bioflavonoids four times daily, starting with the appearance of the characteristic tingling which proceeds an outbreak, can halve the time from onset to remission (Oral Surg, 1978; 45: 56-62).

Outbreaks can also be controlled by balancing levels of two amino acids, arginine and lysine, with the balance in favour of lysine (Dermatologica, 1987; 175: 183-90). Watch out, though, because large doses of lysine may raise your cholesterol levels.

Digestive enzymes also can help.

In one study, when particular enzymes (trypsin, chymotrypsin and papain) were compared to acyclovir in 90 volunteers with acute herpes infection, the supplements were found to work just as well as the

conventional drug in relieving pain and shortening the duration of attacks (Phytomed, 1995; 2: 7-15).

It is probably sensible to take a varied approach to controlling outbreaks, and include dietary changes, herbal or other medications and the avoidance of potential stressors in your life. It’s also wise to remember that HSV-1 outbreaks are often triggered by stress.

The most common type of facial palsy, it affects around 40,000 people in the US, 8000 in the UK, and one in 5000 worldwide, each year. It afflicts men and women equally and at any age, although it is more common with age. Diabetics, pregnant women and those with colds/flu or an upper respiratory tract infection are more susceptible to Bell’s palsy.

Its main feature is one-sided facial weakness or paralysis, with poor or no muscle control. Symptoms include involuntary facial twitches, difficulty in closing the affected eye and a corner-of-the-mouth droop. It can also produce dry eyes or excessive tearing, a dry mouth, taste disturbances and hearing problems.

What causes it?
Although the cause of the neural inflammation is still under debate, a likely culprit is the herpes simplex virus (HSV-1), which accounts for at least 60-70 per cent of cases. Almost everyone is exposed to the virus at some point through infected saliva by, for example, kissing, or sharing towels or cutlery. Most HSV-1 carriers aren’t even aware of it, as the virus can lie dormant in the body.

A weakened immune system – due to stress, infections or chronic autoimmune conditions, for example – is the most likely trigger for reactivating HSV-1. When this happens, antibodies are produced, leading to an inflammatory response.

The prognosis for Bell’s palsy is generally good. Around 75-80 per cent of cases will resolve without treatment (Am J Otol, 1982; 4: 107-11), with major improvements within three weeks. Patients with partial paralysis tend to have better outcomes, with 94 per cent making a full recovery (BMJ, 2004; 329: 553-7). However, those with complete facial palsy, severe nerve degeneration or who fall into the high-risk group (diabetics, pregnant women, over-60s) have poorer prognoses.

What doctors tell you
There is no standard treatment or cure for Bell’s palsy. Many doctors prescribe antiviral drugs or steroids, usually acyclovir or prednisone. However, a review of the available evidence shows no significant benefits from steroids (Cochrane Database Syst Rev. 2002; 1: CD-001942; Laryngoscope, 1984; 94: 1472-6), and mixed results with acyclovir (Cochrane Database Syst Rev, 2001; 2: CD-001869). As steroids come with a well-known list of side-effects, these risks need to be weighed against the fact that most cases of Bell’s palsy resolve on their own.

Another treatment, reserved only for those whose nerve damage is severe, is nerve decompression, where bone from the nerve’s route along the base of the skull is surgically removed to allow the nerve to heal. It is best done within two weeks of total facial paralysis (Laryngoscope, 1999; 109: 1177-88). However, this is a highly complicated procedure with an unpredictable success rate, and little evidence of substantial patient benefits to justify the risks (Acta Otolaryngol Suppl, 1988; 446: 101-5).

Tina Tan

I am surprised that you accept blaming fat for disease. G. Taubes, in ‘The soft science of dietary fat’ (Science, 2001; vol 291), explains how a few members of Senator McGovern’s Select Committee on Nutrition and Human Needs made low-fat eating a dogma, despite the lack of evidence for it. – Margaret Moss, Nutrition and Allergy Clinic, Stockport

* I have found that vitamin B6, preferably in P5P [pyridoxal 5”-phosphate, the metabolically active coenzyme] form, is an effective means of curing mouth ulcers. – Richard Stenning

Five common STDs in women are:

• Chlamydia.
  
• Genital Herpes.
  
• Gonorrhea.
  
• Syphilis.
  
• Trichomoniasis.
  
• Acquired immune deficiency syndrome (AIDS) is often classified as a sexually transmitted disease, but can be passed through means other than sexual contact. So, although mentioned at times, it is not defined here. (See page 34 for information on AIDS).

STDs are on the rise. This may be due to:

• Liberal sexual attitudes.
  
• Increased number of single adults who have casual sex.
  
• Having multiple sex partners.
  
• Less use of barrier methods of birth control, such as condoms and diaphragms in the past years, especially during the pre-AIDS era.
  
• Failure to test for STDs during regular physical exams.

Each STD has its own set of symptoms and treatment:

Chlamydia is caused by different strains of the bacterium chlamydia trachomatis. It is the most common STD.
In women, symptoms include slight yellowish-green vaginal discharge, vaginal irritation, a frequent need to urinate and pain when urinating. There can also be chronic abdominal pain and bleeding between menstrual periods. In men, symptoms include burning or discomfort when urinating, a whitish discharge from the tip of the penis and pain in the scrotum. These symptoms can, however, be so mild that they often go unnoticed. It is estimated that 75% of women and 25% of men who have chlamydia have no symptoms until complications set in. If they do appear, they usually do so two to four weeks after being infected. The only sure way to know whether or not you have chlamydia is to be tested for it.

Treatment for chlamydia includes oral antibiotics such as doxycycline or azithromycin. Erythromycin is used if a woman is pregnant or allergic to other antiobiotics. Doctors should treat the infected person’s sexual partner even if he or she doesn’t show any symptoms. Sex should be avoided until treatment is completed in both the person affected and in their sex partners. If left untreated, chlamydia can cause a variety of serious problems including pelvic inflammatory disease and infertility in women and infection and inflammation of the prostate and surrounding structures in men. Infants born to mothers who have chlamydia are likely to develop pneumonia or a serious eye infection in the first several months of life as well as permanent lung damage later on.

Genital herpes is caused by the herpes simplex virus II. The herpes simplex virus I is another form of the herpes virus, but it is usually limited to the oral area and shows up as fever blisters or cold sores. Engaging in oral sex can spread oral herpes to the genitals and genital herpes to the mouth, lips and throat. Both herpes simplex viruses are spread by direct skin to skin contact from the site of infection to the contact site. Once you are infected, these viruses remain with you forever.

Symptoms occur, though, only during flare-ups. Symptoms of herpes simplex virus II include sores with blisters on the genital area and anus and sometimes on the thighs and buttocks. After a few days, the blisters break open and leave painful, shallow ulcers which can last from five days to three weeks. If infected for the first time, you may experience flu-like symptoms such as swollen glands, fever and body aches, but subsequent attacks are almost always much milder. These attacks may be triggered by stress, emotional distress, fatigue, menstruation, other illnesses or even by vigorous sexual intercourse. Itching, irritation and tingling in the genital area may occur one to two days before the outbreak of the blisters or sores. This period is called the prodrome. Genital herpes is contagious during the prodrome, when blisters are present and up to a week or two after they have disappeared. If a pregnant woman has an outbreak of genital herpes when her baby is due, a Caesarean section should be performed so the baby does not get infected during delivery. No cure exists for genital herpes.

Treatment includes the prescription medication Zovirax, in oral and/or topical ointment forms, as well as self-care procedures to treat herpes symptoms. (See “Self-Care Procedures for Genital Herpes on page 58). Medical care is especially helpful during the first attack of genital herpes. Self-care procedures may be all that is necessary during recurrent episodes.

[Note: Sores and blisters that look like herpes can be a side effect of taking certain prescription medicine in some people. One example is sulpha drugs which are often used to treat urinary tract infections. Consult your doctor if you suspect this.]

Gonorrhea, often called the clap, dose, or drip, is one of the most common infectious diseases in the world. Gonorrhea can be symptom-free. In fact, about 60 – 80% of infected women have no symptoms. The signs of gonorrhea can, however, show up within two to ten days after sexual contact with an infected person. In women, symptoms include mild itching and burning around the vagina, a thick, yellowish-green vaginal discharge, burning when urinating and severe lower abdominal pain, usually within a week or so after their menstrual periods. In men, symptoms include pain at the tip of the penis, pain and burning during urination and a thick, yellow, cloudy, penile discharge that gradually increases.

If ignored, gonorrhea can cause widespread infection and/or infertility. But gonorrhea can be cured with injections of specific antibiotics such as Ceflasporin. If you’ve been infected with a type of gonorrhea that’s resistant to penicillin, your doctor will have to use another antibiotic.

To treat gonorrhea successfully:

• You and your sex partner should take prescription medicine in order to avoid re-infection.
  
• Have follow-up cultures to determine if the treatment was effective

Syphilis, sometimes called pox or bad blood is one of the worst STDs. It can lead to heart failure, blindness, insanity or death if left untreated. It is caused by a bacterium called Treponema pallidum. You get this STD through direct contact with a sore or lesion on an infected sexual partner. An unborn child can also contract syphilis from an infected mother.

Syphilis can progress slowly, through three stages, over a period of many years. When detected early, however, syphilis can be cured. Be alert for the following symptoms:

• Primary stage – A large, painless, ulcer-like sore known as a chancre occurs two to six weeks after infection and generally appears around the area of sexual contact. The chancre disappears within a few weeks.
  
• Secondary stage – Within a month after the end of the primary stage, a widespread skin rash appears, cropping up on the palms of the hands, soles of the feet and sometimes around the mouth and nose. The rash has small, red, scaling bumps that do not itch. Swollen lymph nodes, fever and flu-like symptoms may also occur and small patches of hair may fall out of the scalp, beard, eyelashes and eyebrows.
  
• Latent stage – Once syphilis reaches this stage, it may go unnoticed for years, quietly damaging the heart, central nervous system, muscles and various other organs and tissues. The resulting effects are often fatal.

If you’ve been exposed to syphilis or have its symptoms, see a doctor or consult your county health department. Treatment for syphilis in its early stages consists of a single injection of long-lasting penicillin. If the disease has progressed further, you’ll require three consecutive weekly injections. If you’re allergic to penicillin, you’ll receive an alternative antibiotic, to be taken orally for two to four weeks. After treatment, you should have a blood test at 3, 6 and 12 months to be sure the disease is completely cured. Once treatment is complete, you’re no longer contagious.

Unlike most sexually transmitted diseases, trichomoniasis is caused by a parasite rather than by bacteria or a virus. The trichomoniasis parasite can be present in the vagina for years without causing symptoms. If they do occur, typical symptoms for women include vaginal itching and burning, a greenish-yellow vaginal discharge, and burning or pain when urinating. Sexual Intercourse can be painful. In men, symptoms include mild itching and irritation of the penis, pain during intercourse and discomfort when urinating. Men who have trichomoniasis usually don’t experience any symptoms, though, and may unknowingly infect their sexual partners.

Trichomoniasis is diagnosed by examining a drop of vaginal fluid under a microscope. The oral medication metronidazole (brand name Flagyl), is used to treat trichomoniasis. If you’re a woman, don’t take this drug during the first three months of pregnancy. Avoid drinking alcohol for 24 hours before, during and 24 hours after taking the metronidazole. The combination causes vomiting, dizziness and headaches. Sexual partners of an infected person should also be treated to prevent getting infected again, or spreading the infection further.

Do you have a large, painless ulcer-like sore (chancre) in the genital area, anus or mouth? Did you have such a sore 2 to 6 weeks ago that healed, but now experience flu-like symptoms such as fever, headache, general ill-feeling and/or a skin rash of small, red, scaling bumps that do not itch?
Does your sex partner have any of these problems? A whitish discharge from the penis. Burning or discomfort when urinating. Pain and swelling in the scrotum. Pain during intercourse. Irritation and itching of the penis.
Do you have any of these problems? Itching and burning around the vagina. A vaginal discharge. This could be slight, cloudy or greenish-yellow in color with an offensive odor. Burning or pain when urinating. The need to urinate often. Discomfort in the lower abdomen. Abnormal bleeding from the vagina. Bleeding between menstrual periods.
Do you have sores and/or painful blisters on the genital area, anus or tongue and is this the first time you have had this? Do you have a low-grade fever, headache, general muscle ache and an over-all ill feeling? Have you had sexual relations with someone who had sores or blisters on their genital area, anus or tongue, or was experiencing genital itching, irritation and tingling?
For persons who have already been diagnosed with genital herpes: Are you experiencing severe pain and blistering and/or are you having frequent attacks? For pregant women only: Are those sores present and are you close to your delivery date?
Do genital sores appear only after taking a recently prescribed medicine?
Are you symptom-free, but worried about having contracted a sexually transmitted disease from someone you suspect may be infected? Do you want to rule out the presence of a sexually transmitted disease because you have had multiple sex partners and you are considering a new sexual relationship, planning to get married or pregnant?

• There’s only one way to guarantee you’ll never get a sexually transmitted disease: Never have sex.
  
• Limiting your sexual activity to one person your entire life is a close second provided your partner is also monogamous, and neither of you have an STD.
  
• Avoid sexual contact with persons whose health status and practices are not known.
  
• Discuss a new partner’s sexual history with him or her before beginning a sexual relationship. Be aware, though, that persons are not always honest about their sexual history.
  
• Latex condoms and the female Reality condom can reduce the spread of STDs when used properly and carefully. They do not eliminate the risk entirely.
  
• Plan ahead for safe sex. Practice what you’ll say. Learn to use condoms properly.
  
• Both women and men should carry condoms and insist that they be used every time they have sexual relations. Using spermicidal foams, jellies, creams (especially those that contain Nonoxynol 9) and a diaphragm, can offer additional protection when used with a condom. Use water-based lubricants such as K-Y Brand Jelly. Don’t use oil-based or “Petroleum” ones such as Vaseline. They can damage latex condoms.
  
• Wash the genitals with soap and water before and after sexual intercourse.
  
• Seek treatment for STDs if you know your sex partner is infected.
  
• Ask your doctor to check for STDs every six months if you have multiple sex partners even if you don’t have any symptoms.
  
• Don’t abuse drugs and limit alcohol consumption. These practices lower your inhibitions and can make you more prone to having unsafe sex

Self-Care Procedures for Genital Herpes

• Bathe the affected genital area twice a day with mild soap and water. Gently pat dry with a towel or use a hair dryer set on warm to dry lesions and kill surface viruses. Using Aveeno (colloidal oatmeal soap or bath treatments) may also be soothing.
  
• Take a hot bath if you can tolerate it. This may help to inactivate the virus and promote healing. Use sitz baths to soak the affected area. You can get a sitz bath device from medical supply stores or hospital pharmacies.
  
• Apply ice packs on the affected genital area for 5-10 minutes. This may help relieve itching and inflammation.
  
• Wear loose fitting pants or skirts. Avoid wearing pantyhose and tight fitting clothing. These could irritate the inflamed area. Wear cotton, not nylon underwear.
  
• Squirt tepid water over the genital area while urinating. This may help decrease the pain.
  
• Take a mild pain reliever such as aspirin, acetaminophen, ibuprofen or naproxen sodium.
  

  [Note: Do not give aspirin or any medication containing salicylates to anyone under 19 years of age or younger, unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
  

• A local anesthetic ointment such as Lidocaine can help during the most painful part of an attack. Check with your doctor before using it.
  
• Ask your doctor about using the antiviral drug acyclovir (brand name Zovirax). This is available as both a topical ointment and oral medicine.
  

  [Note: The oral form may help prevent outbreaks of herpes for persons who have multiple recurrences. This can be taken daily for many years.]
  

• To avoid spreading the virus to your eyes, don’t touch your eyes during an outbreak.
  
• Avoid sexual intercourse:
  
  • At the first sign of a herpes outbreak. This may be evident by the feeling of tingling and itching in the genital area which takes place before blisters are noticeable.
    
  • When active lesions are present.
    
  • One to two weeks after they have disappeared.
  
  
• Exercise regularly and eat a well balanced diet to reduce your risk of getting infections.
  
• Avoid stressful situations. Stress can trigger recurrences of herpes. Use relaxation exercises to deal with stress.

In recent years, the C of this much-publicized vitamin has also stood for controversy. With Linus Pauling and others claiming that vitamin C has the potential to prevent and treat the common cold, flus, and cancer, all of which plague our society, concern has arisen in the medical establishment about these claims and the megadose requirements needed to achieve the hoped-for results. Some studies suggest that these claims have some validity; however, there is more personal testimony from avid users of ascorbic acid than there is irrefutable evidence. There has also been some recent research that disproves the claims about treatment and prevention of colds and cancer with vitamin C. However, in most cases, studies showing vitamin C to be ineffective used lower dosages than Dr. Pauling recommended. Overall, vitamin C research is heavily weighted to the positive side for its use in the treatment of many conditions, including the common cold.

C also stands for citrus, where this vitamin is found. It could also stand for collagen, the protein “cement” that is formed with ascorbic acid as a required cofactor. Many foods contain vitamin C, and many important functions are mediated by it as well.

Vitamin C is a weak acid and is stable in weak acids. Alkalis, such as baking soda, however, destroy ascorbic acid. It is also easily oxidized in air and sensitive to heat and light. Since it is contained in the watery part of fruits and vegetables, it is easily lost during cooking in water. Loss is minimized when vegetables such as broccoli or Brussels sprouts are cooked over water in a double boiler instead of directly in water. The mineral copper, in the water or in the cookware, diminishes vitamin C content of foods.

Ascorbic acid was not isolated from lemons until 1932, though the scourge of scurvy, the vitamin C deficiency disease, has been present for thousands of years. It was first written about circa 1500 B.C. and then described by Aristotle in 450 B.C. as a syndrome characterized by lack of energy, gum inflammation, tooth decay, and bleeding problems. In the 1700s, high percentages of sailors with the British navy and other fleets died from scurvy, until James Lind discovered that the juice of lemons could cure and also prevent this devastating and deadly disease. The ships then carried British West Indies limes for the sailors to consume daily to maintain health, and thus these sailors became known as “limeys.” Other cultures of the world discovered their own sources of vitamin C. Powdered rose hips, acerola cherries, or spruce needles were consumed regularly, usually as teas, to prevent the scurvy disease.

In earlier times, humans consumed large amounts of vitamin C in their fresh and wholesome native diet, as apes (another species that does not make vitamin C) still do. Most other animals, except guinea pigs, produce ascorbic acid in the liver from glucose, and in relative amounts much higher than we get from our diets today. For this reason, Dr. Pauling and others feel that our bodies need somewhere between 2,000 and 9,000 mg. of vitamin C daily. These amounts seem a little high to me, given the basic food values of vitamin C. Some authorities feel we need 600–1,200 mg. daily based on extrapolations from the historical herbivore, early-human diet. These levels can be obtained today by eating sufficient fresh food; a diet that includes foods with high levels of vitamin C can provide several grams or more per day.

Ascorbic acid is readily absorbed from the intestines, ideally about 80–90 percent of that ingested. It is used by the body in about two hours and then usually out of the blood within three to four hours. For this reason, it is suggested that vitamin C supplements be taken at four-hour intervals rather than once a day; or it may be taken as time-released ascorbic acid. Vitamin C is used up even more rapidly under stressful conditions, with alcohol use, and with smoking. Vitamin C blood levels of smokers are much lower than those of nonsmokers given the same intakes. Other situations and substances that reduce absorption or increase utilization include fever, viral illness, antibiotics, cortisone, aspirin and other pain medicines, environmental toxins such as DDT, petroleum products, or carbon monoxide, and exposure to heavy metals such as lead, mercury, or cadmium. Sulfa antibiotics increase elimination of vitamin C from the body by two to three times.

Some ascorbic acid is stored in the body, where it seems to concentrate in the organs of higher metabolic activity. These include the adrenal glands (about 30 mg.), pituitary, brain, eyes, ovaries, and testes. A total of about 30 mg. per pound of body weight. We likely need at least 200 mg. a day in our diet to maintain body stores—much more if we smoke, drink alcohol, are under stress, have allergies, are elderly, or have diabetes.

Vitamin C is a very complex and important vitamin. The recommended amounts vary more widely than those for any other nutrient, ranging from 100–80 or 100 grams daily, depending on the condition. C is also the most commonly supplemented vitamin among the general public, because of either the popular press or its good effect, or because of the other common C—the “cold.”

Sources: The best-known sources of vitamin C are the citrus fruits—oranges, lemons, limes, tangerines, and grapefruits. The fruits with the highest natural concentrations are citrus fruits, rose hips, and acerola cherries, followed by papayas, cantaloupes, and strawberries. Good vegetable sources include red and green peppers (the best), broccoli, Brussels sprouts, tomatoes, asparagus, parsley, dark leafy greens, cabbage, and sauerkraut. There is not much available in the whole grains, seeds, and beans; however, when these are sprouted, their vitamin C content shoots up. Sprouts, then, are good foods for winter and early spring, when other fresh fruits and vegetables are not as available. Animal foods contain almost no vitamin C; though fish, if eaten raw, has enough to prevent deficiency symptoms.

Natural vitamin C supplements are usually made from rose hips, acerola cherries, peppers, or citrus fruits. Vitamin C can be synthesized from corn syrup, which is high in dextrose, much as it is made from glucose in most other animals’ bodies. Synthetic ascorbic acid, though it can be concentrated for higher doses than natural extracts, is still usually made from food sources. Sago palm is another fairly new source of vitamin C supplements. It is used primarily as a lower allergenic source than the corn-extracted ascorbic acid.

Functions: One important function of vitamin C is in the formation and maintenance of collagen, the basis of connective tissue, which is found in skin, ligaments, cartilage, vertebral discs, joint linings, capillary walls, and the bones and teeth. Collagen, and thus vitamin C, is needed to give support and shape to the body, to help wounds heal, and to maintain healthy blood vessels. Specifically, ascorbic acid works as a coenzyme to convert proline and lysine to hydroxyproline and hydroxylysine, both important to the collagen structure.

Vitamin C also aids the metabolism of tyrosine, folic acid, and tryptophan. Tryptophan is converted in the presence of ascorbic acid to 5-hydroxytryptophan, which forms serotonin, an important brain chemical. Vitamin C also helps folic acid convert to its active form, tetrahydrofolic acid, and tyrosine needs ascorbic acid to form the neurotransmitter substances dopamine and epinephrine. Vitamin C stimulates adrenal function and the release of norepinephrine and epinephrine (adrenaline), our stress hormones; however, prolonged stress depletes vitamin C in the adrenals and decreases the blood levels. Ascorbic acid also helps thyroid hormone production, and it aids in cholesterol metabolism, increasing its elimination and thereby assisting in lowering blood cholesterol.

Vitamin C is an antioxidant vitamin. By this function, it helps prevent oxidation of water-soluble molecules that could otherwise create free radicals, which may generate cellular injury and disease. Vitamin C also indirectly protects the fat-soluble vitamins A and E as well as some of the B vitamins, such as riboflavin, thiamine, folic acid, and pantothenic acid, from oxidation. Ascorbic acid acts as a detoxifier and may reduce the side effects of drugs such as cortisone, aspirin, and insulin; it may also reduce the toxicity of the heavy metals lead, mercury, and arsenic.

Vitamin C is being shown through continued research to stimulate the immune system; through this function, along with its antioxidant function, it may help in the prevention and treatment of infections and other diseases. Ascorbic acid may activate neutrophils, the most prevalent white blood cells that work on the frontline defense in more hand-to-hand combat than other white blood cells. It also seems to increase production of lymphocytes, the white cells important in antibody production and in coordinating the cellular immune functions. In this way also, C may be helpful against bacterial, viral, and fungal diseases. In higher amounts, ascorbic acid may actually increase interferon production and thus activate the immune response to viruses; it may also decrease the production of histamine, thereby reducing immediate allergy potential. Further research must be done for more definitive knowledge about vitamin C’s actions in the prevention and treatment of disease.

Uses: There are a great many clinical and nutritional uses for ascorbic acid in its variety of available supplements. C for the common cold is indeed used very widely; its use in the treatment of cancer is more controversial, probably because of the seriousness of the disease and the political environment within the medical system—anything nutritional or alternative in regard to cancer therapy is looked upon with skepticism by orthodox physicians. For the prevention of cancer, there is reason for more optimism about the usefulness of vitamin C (as well as the other antioxidant nutrients—vitamin E, selenium, beta-carotene, and zinc) because of its effect in preventing the formation of free radicals (caused mainly by the oxidation of fats), which play a role in the genesis of disease.

Given the functions of vitamin C alone, it has a wide range of clinical uses. For the prevention and treatment of the common cold and flu syndrome, vitamin C produces a positive immunological response to help fight bacteria and viruses. Its support of the adrenal function and role in the production of adrenal hormones epinephrine and norepinephrine can help the body handle infections and stress of all kinds. Because of this adrenal-augmenting response, as well as thyroid support provided by stimulating production of thyroxine (T4) hormone, vitamin C may help with problems of fatigue and slow metabolism. It also helps counteract the side effects of cortisone drug therapy and may counteract the decreased cellular immunity experienced during the course of treatment with these commonly used immune-suppressive drugs.

Because of ascorbic acid’s role in immunity, its antioxidant effect, the adrenal support it provides, and probably its ability to make tissues healthy through its formation and maintenance of collagen, vitamin C is used to treat a wide range of viral, bacterial, and fungal infections and inflammatory problems of all kinds. I have used vitamin C successfully in many viral conditions, including colds, flus, hepatitis, Herpes simplex infections, mononucleosis, measles, and shingles. Recently, vitamin C has been shown in some studies to enhance the production and activity of interferon, an antiviral substance produced by our bodies. To affect these conditions, the vitamin C dosage is usually fairly high, at least 5–10 grams per day, but it is possible that much smaller doses are as effective. Vitamin C is also used to treat problems due to general inflammation from microorganisms, irritants, and/or decreased resistance; these problems may include cystitis, bronchitis, prostatitis, bursitis, arthritis (both osteo- and rheumatoid), and some chronic skin problems (dermatitis). With arthritis, there is some suggestion that increased ascorbic acid may improve the integrity of membranes in joints. In gouty arthritis, vitamin C improves the elimination of uric acid (the irritant) through the kidneys. Ascorbic acid has also been helpful for relief of back pain and pain from inflamed vertebral discs, as well as the inflammatory pain that is sometimes associated with rigorous exercise. In asthma, vitamin C may relieve the bronchospasm caused by noxious stimuli or when this tight-chest feeling is experienced during exercise.

Vitamin C’s vital function in helping produce and maintain healthy collagen allows it to support the body cells and tissues and bring more rapid healing to injured or aging tissues. Therefore, it is used by many physicians for problems of rapid aging, burns, fracture healing, bedsores and other skin ulcers and to speed wound healing after in-jury or surgery. Peptic ulcers also appear to heal more rapidly with vitamin C therapy. The pre- and postsurgical use of vitamin C supplementation can have great benefits. With its collagen function, adrenal support, and immune response support, it helps the body defend against infection, supports tissue health and healing, and improves the ability to handle the stress of surgery. Vitamin A and zinc are the other important pre- and postsurgical nutrients shown by research to reduce hospitalization time and increase healing rates, thereby preventing a number of potential complications.

Vitamin C is also used to aid those withdrawing from drug addictions, addictions to such substances as narcotics and alcohol, as well as nicotine, caffeine, and even sugar—three very common addictions and abuses. High-level ascorbic acid may decrease withdrawal symptoms from these substances and increase the appetite and feeling of well-being. For this reason, it may be helpful in some depression and other mental problems associated with detoxification during withdrawal. Vitamin C also may reduce the effects of pollution, likely through its antioxidant effect, its detoxifying help, and its adrenal and immune support; specifically, it may participate in protecting us from smog, carbon monoxide, lead, mercury, and cadmium.

Vitamin C is a natural laxative and may help with constipation problems. In fact, the main side effect of too much vitamin C intake is diarrhea. For iron-deficiency anemia, vitamin C helps the absorption of iron (especially the nonheme or vegetable-source iron) from the gastrointestinal tract. In diabetes, it is commonly used to improve the utilization of blood sugar and thereby reduce it, but there is no clear evidence that regular vitamin C usage alone can prevent diabetes. There are some preliminary reports that ascorbic acid may help prevent cataract formation (probably through its antioxidant effect) and may be helpful in the prevention and treatment of glaucoma, as well as certain cases of male infertility caused from the clumping together of sperm, which decreases sperm function.

Vitamin C has a probable role in the prevention and treatment of atherosclerosis and, thereby, in reducing the risks of heart disease and its devastating results. It has been shown to reduce platelet aggregation, a factor important in reducing the formation of plaque and clots. Ascorbic acid has a triglyceride- and cholesterol-reducing effect and, more important, may help to raise the “good” HDL. This action needs further investigation, though the research is supportive so far. I haven’t even mentioned the prevention of scurvy, which really takes very little vitamin C, about 10 mg. per day. This disease used to be a big concern and was often fatal unless the victim ate some citrus or other fresh fruit and vegetables containing a small amount of vitamin C.

I do not really want to approach the cancer and vitamin C issue; it deserves a book by itself. However, if we closely analyze the functions (antioxidant, immune support, interferon, tissue health and healing) that vitamin C performs in the body, along with the still mysterious influences of higher-dose ascorbic acid intake, we can see how vitamin C may have a positive influence in fighting and preventing cancer, our greatest twentieth-century medical dilemma.

Deficiency and toxicity: For most purposes, vitamin C, or ascorbic acid, in its many forms of use is nontoxic. It is not stored appreciably in our body, and most excess amounts are eliminated rapidly through the urine. However, amounts over 10 grams per day that some people use and some doctors prescribe are associated with some side effects, though none that are serious. Diarrhea is the most common and usually is the first sign that the body’s tissue fluids have been saturated with ascorbic acid. Most people will not experience this with under 5–10 grams per day, the amount that is felt to correlate with the body’s need and use. Other side effects include nausea, dysuria (burning with urination), and skin sensitivities (sometimes sensitivity to touch or just a mild irritation). Hemolysis (breakage) of red blood cells may also occur with very high amounts of vitamin C. With any of these symptoms, it is wise to decrease intake.

There is some concern that higher levels of vitamin C intake may cause kidney stones, specifically calcium oxalate stones, because of increased oxalic acid clearance through the kidneys due to vitamin C metabolism. This is a rare case, if it does exist, and I personally have not seen, nor do I know any doctors who have seen, kidney stone occurrence with people taking vitamin C. Only people who are prone to form kidney stones or gout should give this any thought. If there is concern, supplementing magnesium in amounts between half and equaling that of calcium intake (which should be done anyway with calcium supplementation) would reduce that risk, at least for calcium-based stones. I usually suggest using a buffered vitamin C preparation with calcium and magnesium, which alleviates this concern.

As far as deficiency problems go, the once fairly common disease called scurvy is very rare these days. However, early symptoms of scurvy or vitamin C deficiency are more likely in formula-fed infants with little or no C intake or in teenagers or the elderly who do not eat any fresh fruits and vegetables. Smokers with poor diets and people with inflammatory bowel disease more often have lower vitamin C blood levels. Other people commonly found to be low in ascorbic acid include alcoholics, psychiatric patients, and patients with fatigue.

The symptoms of scurvy are produced primarily by the effects of the lack of ascorbic acid on collagen formation, causing reduced health of the tissues. The first signs of depletion may be related to vitamin C’s other functions as well, where deficiency could lead to poor resistance to infection and very slow wound healing. Easy bruising and tiny hemorrhages, called petechiae, in the skin, general weakness, loss of appetite, and poor digestion may also occur. With worse deficiency, nosebleeds, sore and bleeding gums, anemia, joint tenderness and swelling, mouth ulcers, loose teeth, and shortness of breath could be experienced. During growth periods, there could be reduced growth, especially of the bones. The decrease in collagen may lead to bone brittleness, making the bones more fragile. The progression and health of the teeth and gums are also affected. In breastfeeding women, lactation may be reduced. With the elderly, vitamin C deficiency could enhance symptoms of senility. The bleeding that comes from capillary wall fragility may lead to clotting and increased risk of strokes and heart attacks.

An important note is that many medical problems have been found to be associated with low blood levels of vitamin C. These problems include various infections, colds, depression, high blood pressure, arthritis, vascular fragility, allergies, ulcers, and cholesterol gallstones.

Most of these symptoms and problems can be easily avoided with minimal supplementation of vitamin C or a diet well supplied with fresh fruits and vegetables. Since the average diet has much less vitamin C than that of our ancestors, it is important for us to be aware of our ascorbic acid intake.

Requirements: The RDA for adults is considered to be 60 mg. We need only about 10–20 mg. to prevent scurvy, and there is more than that in one portion of most fruits or vegetables. Infants need 35 mg.; about 50 mg. between ages one and fourteen and 60 mg. afterward are the suggested minimums. During pregnancy, 80 mg. are required; 100 mg. are needed during lactation. Realistically, between 100–150 mg. daily is a minimum dosage for most people.

Vitamin C needs, however, are increased with all kinds of stress, both internal (emotional) and external (environmental). Smoking decreases vitamin C levels and increases minimum needs. Birth control pills, estrogen for menopause, cortisone use, and aspirin also increase ascorbic acid requirements. Both nicotine and estrogen seem to increase copper blood levels, and copper inactivates vitamin C. In general, though, absorption of vitamin C from the intestines is good. Vitamin C (as ascorbic acid) taken with iron helps the absorption of iron (and many minerals) and is important in treating anemia, but the iron decreases absorption of the ascorbic acid. Overall, it is probably best to take vitamin C as it is found in nature, along with the vitamin P constituents (discovered later)—the bioflavonoids, rutin, and hesperidin. These may have a synergistic influence on the functions of vitamin C, although there is no conclusive research on humans to support this theory.

Vitamin C is the most commonly consumed nutrient supplement and is available in tablets, both fast-acting and time-released, in chewable tablets, in powders and effervescents, and in liquid form. It is available as ascorbic acid, L-ascorbic acid, and various mineral ascorbate salts, such as sodium or calcium ascorbate. One of my favorite formulas, which was developed by Stephen Levine at Nutricology in San Leandro, California, is a buffered powder made from sago palm that contains 2,350 mg. of vitamin C per teaspoon, along with 450 mg. of calcium, 250 mg. of magnesium, and 99 mg. of potassium. It gets into the body quickly and is very easy on and often soothing to the stomach and intestinal lining. The potassium-magnesium combination can often be helpful for fatigue, and this formula is a good vehicle for fulfilling calcium needs.

Vitamin C works rapidly, so the total amount we take over the day should be divided into multiple doses (four to six) or taken as a time-released tablet a couple of times a day. When increasing or decreasing vitamin C intake, it is best to do so slowly because our body systems become accustomed to certain levels. Some nutritionists describe a problem of rebound scurvy in infants, especially when a high amount is taken by the mother during pregnancy but then the infant gets very little after birth and so suffers some deficiency symptoms. I have seen nothing confirming this in the literature. Overall, though, it is probably wise to reduce vitamin C intake slowly after taking high amounts, rather than to drop abruptly.

My basic suggestion for vitamin C use is about 2–4 grams per day with a typical active and healthy city lifestyle. Based on previous levels in our native diets, Linus Pauling feels that the optimum daily levels of vitamin C are between 2,500 and 10,000 mg. Clearly, requirements for vitamin C vary and may be higher according to state of health, age (needs increase with years), weight, activity and energy levels, and general metabolism. Stress, illness, and injuries further increase the requirements for ascorbic acid. Many authorities suggest that we take at least 500 mg. of vitamin C daily to meet basic body needs.

During times of specific illnesses, especially viral infections, doctors who use megadose vitamin C treatment suggest at least 20–40 grams daily, some of it intravenously. Vitamin C has been used safely and effectively in dosages of 10 grams or more dripped slowly (over 30–60 minutes) into the blood to reach optimum tissue levels before excretion, so as to bathe the cells in vitamin C. Some doctors prescribe what is called “bowel tolerance” daily intake of vitamin C—that is, increasing the oral dose until diarrhea results and then cutting back. This level can vary greatly from a few grams to 100 grams or more. The claim is that our body knows what we need and will respond by changing the water balance in the colon when we have had enough. Physician Robert Cathcart has used vitamin C this way in his practice for years to treat many problems, with claimed good success; yet, I do not have the experience to make an adequate conclusion. This practice does, however, add further mystery to the vitamin C controversy. More research is definitely needed regarding ascorbic acid, and new discoveries will likely be made.