维生素C的第三幅面孔
The Third Face of Vitamin C
Robert F.Cathcart M.D
翻译：蓝山
摘要
口服维生素C的肠耐受极限量随疾病的毒性的增加而增加。一种疾病如单核细胞增多症的肠耐受极限量，每24小时可达到200克而不会引起腹泻。在许多疾病进程中，当给予接近肠耐受极限量的阈限量时，常会取得显著改善或痊愈。在某些方面来说，是自由基清除剂的还原当量清除自由基，而非自由基清除剂本身。在清除自由基方面，抗坏血酸可以非常有用，因为病人通常可以耐受足够的量以提供足够还原当量去清除几乎所有由严重疾病进程产生的自由基。在此水平上，维生素C功能是随机的，其益处是来自其自身携带的还原当量。取决于自由基是疾病存在的基础或只是症状的部分原因，疾病将会被治愈或只是改善。这些作用在采用静脉注射时甚至更为惊人。
关键字：维生素C， 抗坏血酸， 急性诱发性坏血病， 肠耐受极限量， 滴定至肠耐受极限量， 抗坏血酸效应，自由基清除剂， 还原当量
介绍
每24小时使用大至200克或更多的抗坏血酸，连续23年，病例超过20,000人的临床经验，显示它对所有涉及自由基的疾病的临床有用性。对维生素C的持续争议主要因为使用不足够的维生素C用于清除自由基。实在矛盾得很，在预防和治疗坏血病中微量使用的维生素C的毫无争议，固化了许多人的思维，反对其创新性的使用。
我已发现维生素C在很高剂量水平尤其有用。它的用途在三个完全不同的领域，我将描述它们为维生素C的三个面孔。
1． 预防坏血病的维生素C（大到每日65毫克）。
2． 预防急性诱发性坏血病的维生素C，
3． 和增强维生素C功能（每日1~20克）。
4． 提供还原当量的维生素C（每日30~200克或更多）。
你可能会批评我大剂量使用维生素C的正确性，但Klenner以前已成功使用这样的大剂量。 Irwin Stone、 Irwin Stone 、 Linus Pauling，和以及最近Archie Kalokerinos 的著作，已支持我的许多观察报告。很明显，获得负面或含糊的结论的研究，是不足够的维生素C被使用。在一些研究，用量几乎未接近足够量，戏弄调查者有统计学上意义，但无觉察得到的有益效果。
我的早期发现是，一个胃肠道健康的人的抗坏血酸肠耐受极限量大约比例于其疾病的毒性程度。肠耐受极限量是口服抗坏血酸至几乎导致但未导致腹泻的数量。正常时，一个病人每24小时可耐用受10~15克抗坏血酸，如普通感冒，可耐受30~60克；严重感冒可耐受100克；流感可耐受150克；而单核细胞增多症或病毒性肺炎，则可耐受200克或更多（1，2）。在这些病变中显著临床效果只有在肠耐受极限量或更高水平时才出现。我把病人确定肠耐受极限的合适量的过程叫滴定至肠耐受极限。这种在绝大多数耐受抗坏血酸的病人（也许超过80%的病人）的肠耐受极限量的增加是不变的。显著临床效果只在其服用至接近肠耐受极限量的阈限剂量才会明显。我称这种益处为抗坏血酸效应。
大多数病人从每小时小量把抗坏血酸粉末溶于水中口服开始，后来，在病人学会准确估计取得临床效果的必要用量之后，相当份量的片剂或胶囊将会使用。如果病人不能耐受口服足够的量，以及疾病的严重性所需，采取静脉注射抗坏血酸钠。
失败常和个体服用合适足够量困难有关，现在，我已用22年去收集临床经验及仔细考虑这种现象。
我要强调这种增加肠耐受极限量和疾病毒性增加的重要性，在这个剂量时，病人自我经历的解毒过程的感觉是不会错误的。
这种效果在耐受者是如此可靠和惊人，使得这事实十分清楚无误：某些十分重要，但尚未被广泛接受的机理，正在发生着。
三个面孔
维生素C可能通常发挥电子供给者的作用。在最低水平（第一面），作为一种预防坏血病的维生素C是必要的。它对一些已相当清楚的代谢功能是不可或缺的，并且几乎无争议。
在第二水平（第二面孔），维生素C仍作为一种维生素使用，但大剂量是必须的，以维持其基本的维生素C功能，因为在病变或受伤的有过量自由基的组织，这种维生素被快速破坏。如果这种维生素C得不到补充，我描述这种缺乏导致的状态为：急性诱发性坏血病（1，2）。正如最近在各种著作的评估所见，有足够多的维生素C被紧张和疾病耗竭的证据。
另外，最近关于维生素C的广泛研究已集中于使用大于最少维生素C推荐用量而增强的维生素C的某些功能（20）。奇怪地，大于最少用量的维生素C的任何用途，仍被临床医生忽视。这水平是介于每日10~20克，其益处因人而异。
在这第二水平，正如Pauling（11）,更近Hemil（20）作评议的研究的所示，可能会有感冒发生率轻微减少，但更多的是，感冒的并发症及持续时间的明显减少。我个人来说，告诉我自读Pauling的著作及服用维生素C后，多年来未曾得过感冒的病人的数量（当然不是全部）是相当多的。不少患有慢性感染的人第一次治好了这些病。抗生素和这些剂量的维生素C起协同作用，惊人数量的老年人得益于如此大剂量的维生素C，因而，可能普遍患有如Irwin Stone描述的临床亚急性坏血病（10）。
常常介于每24小时30~100克或更多。需要理解的最重要概念是，偶然用到这些水平的时候，维生素C发挥第一水平和第二水平的所有功能，并且，其大多数是用作其携带的还原当量而被甩掉（3）。使用这些份量，可以用其还原当量饱和身体，中和过剩的自由基，以及驱使一个还原态的氧化还原电位进入病变组织。由自由基调节的炎症可被清除或显著减轻，在许多有过敏或自身免疫疾病的病人，可使其体液免疫得到控制，而细胞免疫得到加强（19）。取决于自由基是疾病的基础或只是症状的部分原因，具体疾病被治愈或只是改善。
自由基涉及的疾病的范围继续增加， 心血管疾病、癌症、创伤、热或辐射烧伤、外科手术、过敏、自身免疫疾病 、衰老、现在都已包括在内。想出一个和自由基无关的疾病，比想出一个有关的疾病更困难。进步的营养师定期给予维生素C、维生素E、B—胡萝卜素、硒、NAC、等，用以对抗自由基。我当然同意这种做法，然而，这里有一个重要的概念被忽略了。实质是如果你把一桶水泼向大火，是水把火扑灭，而不是桶本身，是自由基清除剂携带的还原当量清除自由基，而不是自由基清除剂本身。
大多数被非酶类自由基清除剂使用的还原当量，并非来自消化吸收的自由清除剂，而是通过糖酵解、柠檬酸循环、辅酶Ⅱ、FADH2、谷胺酰胺等产生。通过消化吸收而获得的膳食性自由基清除剂只占这些清除剂整个生命历程中携带还原当量的一小部分。在它们第一次清除自由基后，这些自由基清除剂必须再被补充在线粒体制造的还原当量。
考虑以下医案：在这个研究的早期，一个23岁、98磅体重，有严重单核细胞增多症的
姑娘，声称每2小时服用2茶匙的抗坏血酸，在2日内服完了整整一磅的抗坏血酸而无产生腹泻。她在3~4日内感觉几乎痊愈，虽然她仍要每天服用10~30克的抗坏血酸，持续二个月。后来，我的所有消化道功能良好的病人都出现类似反应，同时在疾病的急性期，有相同的肠耐受极限量增加。
我相信口服过量抗坏血酸引起的大便溏泻是因为抗坏血酸在直肠产生的高渗性所至。水被增加的渗透压吸进直肠，导致良性腹泻。由于毒性疾病，抗坏血酸在病变组织被快速破坏，导致其从消化道快速吸收。口服的所有抗坏血酸中，到达不了直肠的部分，不会引起腹泻。静脉注射抗坏血酸钠并不会引起腹泻，同时，在静脉注射进行时，会提高口服抗坏血酸的肠耐受极限量。由于在血液和直肠的高渗透性，在肠壁两边的抗坏血酸的渗透压更接近，因而，没有腹泻出现。如果腹泻是由其他代谢过程引起，静脉注射抗坏血酸可引起腹泻。
应当注意到，某些病理性腹泻，抗坏血酸有止泻作用。也许，在这些病例中，肠道自由基增加了对抗坏血酸的破坏。然而，在大多数毒性的系统性疾病，没有任何理由相信，这种增加的抗坏血酸的破坏直接出现在肠道，因此，认为这种增加的破坏直接发生于体内是一个稳妥的推测。
对口服抗坏血酸的肠耐受极限量的增加提供了一个有趣并相当有用的测量一种疾病的毒性的尺度。可能它是自由基参与一种疾病的程度的参照指标。我描述一个在其高峰期可耐受口服100克抗坏血酸的感冒为“100克的感冒 ”。
慢性感染而胃肠功能正常的病人可服用大剂量的抗坏血酸。我的一个慢性疲劳症病人在过去12个月只有靠服用了65磅的抗坏血酸才能维持正常生活。在22年内，我个人因为慢性过敏，也许加上慢性EB病毒感染，已经服用了361kg（797磅或我体重的4.3倍）的抗坏血酸。
单核细胞增多症急性期的病人的非酶类自由基清除剂的转化率。然而，任何人都可获得这个印象，所有非酶类自由基清除剂在1日内可能都要被再还原多次。
一个比拟
假设你有一个农场，在农场的一边有一仓库，而另一边有一个水井。一天，仓库失火，邻居提着水桶在水井和仓库之间列成一座水桶桥，当水井被子抽干时，仍在灭火。
我的抗坏血酸使用，就像上千的邻居从周围赶来，每人提着一桶他自己的水，把他们的水泼向你的大火一次，然后离开。
小结
因为在耐受抗坏血酸者中，对抗坏血酸的增加的肠耐受极限量，大约和他们的疾病的毒性成正比，在病情严重的病人中，必然有别于标准的维生素C功能的某些事情发生在抗坏血酸上。不同疾病的改善，有时甚至痊愈看来和自由基对特定疾病的存在的重要性直接有关。
在许多疾病过程中，在接近肠耐受极限量的剂量时突然出现的效果，提示一个还原态的氧化还原电位只在那些水平才会被挤进受疾病累及的组织。这个只在高剂量水平才出现的抗坏血酸效应也有提示性的意义，即某些有别于标准维生素C功能的机理正涉及。这种抗坏血酸效应更符合氧化还原化学原理。
由非酶类自由基清除剂提供的用于中和自由基的总的还原当量，只有小部分来自消化吸收的营养素性自由基清除剂，抗坏血酸是独特的，因为身体可耐受足够数量的抗坏血酸以提供必要的可以清除被严重毒性疾病过程产生的自由基的还原当量。维生素C因其携带的还原当量而被甩掉。只有这种方式，被大多数毒性疾病过程产生的自由基才可以被快速清除。
http://www.orthomed.com/faces.htm
Bowel tolerance to orally ingested ascorbic acid increases with the toxicity of diseases. Bowel tolerance with a disease such as mononucleosis may reach 200 or more grams per 24 hours without it producing diarrhea. A marked clinical amelioration or cure is achieved in many disease processes when threshold doses near bowel tolerance are given. In a sense, it is the reducing equivalents carried by free radical scavengers that quench free radicals, not the free radical scavengers themselves. Ascorbic acid can be dramatically useful in quenching free radicals because it is usually tolerated in amounts necessary to provide the reducing equivalents necessary to quench almost all the free radicals generated by severe disease processes. Vitamin C functions are incidental at these dose levels; the benefit is from the reducing equivalents carried. To the extent that free radicals are either essential to the perpetuation of a disease or just part of the cause of symptoms, the disease will be cured or just ameliorated. These effects are even more dramatic from intravenous sodium ascorbate.
Keywords: vitamin C, ascorbate, acute induced scurvy, bowel tolerance, titrating to bowel tolerance, the ascorbate effect, free radical scavengers, reducing equivalents.
A clinical experience prescribing doses of ascorbic acid up to 200 or more grams per 24 hours to over 20,000 patients during the past 23 year period has revealed its clinical usefulness in all diseases involving free radicals. The controversy continues over the value of vitamin C mainly because inadequate doses are used for most free radical scavenging purposes. Paradoxically, the non controversial use of minute doses of vitamin C in the prevention and treatment of scurvy has set the minds of many against more creative uses.
I have found vitamin C exceptionally useful in a very high dose range. Its usefulness is in three such distinct realms that I will describe them as the three faces of vitamin C.
1. vitamin C to prevent scurvy
(up to 65 mg/day.)
2. vitamin C to prevent acute induced scurvy (1,2)
and to augment vitamin C functions
(1 to 20 grams/day.)
3. vitamin C to provide reducing equivalents
(30 to 200 or more grams/day.)(3)
One might criticize the wisdom of my use of these massive doses but Klenner had successfully utilized them previously (4,5 6,7 ). The works of Irwin Stone (8,9,10 ), Linus Pauling (11,12,13), and Archie Kalokerinos (14) have supported many of my observations. It was apparent that in all the studies yielding negative or equivocal results, inadequate doses were used. In some studies, doses barely bordering on adequate, tease the investigator with statistically significant but not very impressive beneficial results.
My early discovery was that the bowel tolerance to ascorbic acid of a person with a healthy GI tract was somewhat proportional to the toxicity of their disease (15). Bowel tolerance doses are the amounts of ascorbic acid tolerated orally that almost, but not quite, cause diarrhea. A patient who could tolerate orally 10 to 15 grams of ascorbic acid per 24 hours when well, might be able to tolerate 30 to 60 grams per 24 hours if he had a mild cold, 100 grams with a severe cold, 150 grams with influenza, and 200 grams or more per 24 hours with mononucleosis or viral pneumonia (1,2). Marked clinical benefits in these conditions occur only at the bowel tolerance or higher levels. I named the process whereby the patient determined the proper dose as titrating to bowel tolerance. These increases in bowel tolerance in the vast majority of patients normally tolerant to ascorbic acid (perhaps 80% of patients) are invariable. The marked clinical benefits are noted only when a threshold dose, usually close to the bowel tolerance dose, is consumed. I call this benefit the ascorbate effect.
Most patients are started at first with hourly doses of ascorbic acid powder dissolved in small amounts of water. Later, after the patient has learned to accurately estimate the dose necessary to achieve the ascorbate effect, comparable doses of tablets or capsules are also used. Where patients are intolerant to adequate amounts of ascorbic acid orally and the severity of the disease warrants it, intravenous sodium ascorbate is used.
Failures are related to individual difficulties in taking the proper adequate doses. I now have had 22 years to gather clinical experience and to reflect on this phenomenon (16,17,18,19).
I want to emphasize the importance of this increasing bowel tolerance with increasing toxicities of diseases. The sensation of detoxification one experiences at these doses is unmistakable.
The effect is so reliable and dramatic in the tolerant patient as to make obvious the fact that something very important, that has not been widely appreciated before, is going on.
Vitamin C probably always functions by being an electron donor. At the lowest dose level (the first face), it is necessary as a vitamin to prevent scurvy. It is essential for certain metabolic functions which are well described and mostly non controversial.
At a second level (the second face) vitamin C is still used as a vitamin but larger doses are necessary to maintain its basic vitamin C functions because the vitamin is destroyed rapidly in diseased or injured tissues where there is an overabundance of free radicals. I described the resulting state of deficiency, if the vitamin C is not replaced, as acute induced scurvy (1,2). There is ample evidence of this depletion of vitamin C by stress and disease as recently reviewed in the literature (20).
Additionally, the recent extensive research on vitamin C has concerned itself with certain functions that may be augmented by higher than minimal doses of vitamin C (20). Strangely, any usefulness of these larger than minimal doses of vitamin C remain mostly neglected by clinicians. This level is from about 1 to 20 grams a day. Benefits vary from person to person.
At this second level, as in studies reviewed by Pauling (11) and more recently by Hemil„ (20), there may be expected a slight decrease in the incidence of colds but a more significant reduction in the complications and the duration of colds. Personally, I am impressed by the number of patients (but certainly not all) who tell me that they have not had a cold for years since reading Pauling's book and taking vitamin C. Patients with chronic infections frequently have those infections cured for the first time. Antibiotics work synergistically with these doses. A surprising number of elderly persons benefit from doses of this magnitude and may indeed have what Irwin Stone described as chronic subclinical scurvy (10).
The third level of doses (the third face) is virtually undiscussed in the literature but is the most interesting. These doses range usually from 30 to 200 grams or more per 24 hours. The most important concept to understand is that while incidentally at these dose levels the vitamin C performs all the functions of levels one and two, it is mostly thrown away for the reducing equivalents it carries (3). With these doses it is possible to saturate the body with reducing equivalents, neutralize the excessive free radicals, and drive a reducing redox potential into involved tissues. Inflammations mediated by free radicals can be eliminated or markedly reduced. In many instances patients with allergies or autoimmune disease have their humeral immunity controlled while their cellular immunity is augmented (19). To the extent that free radicals are either essential to the perpetuation of a disease or just part of the cause of symptoms, the disease will be cured or just ameliorated.
The list of diseases involving free radicals continue to grow. Infections, cardiovascular diseases, cancer, trauma, burns both thermal and radiation, surgeries, allergies, autoimmune diseases and aging are now included. It is more difficult to think of a disease that does not involve free radicals. Progressive nutritionists routinely give vitamin C, vitamin E, beta carotene, selenium, NAC, etc. to counter free radicals. I certainly agree with this practice. However, there is one important concept neglected.
In the spirit that if you throw a bucket of water on a fire, it is the water that puts the fire out, not the bucket; it is the reducing equivalents carried by the free radical scavengers that quench the free radicals, not the free radical scavenger itself.
Most of the reducing equivalents utilized by non enzymatic free radical scavengers do not come from the ingested free radical scavengers but come through glycolysis, the citric acid cycle, NADPH, FADH2, glutathione, etc. Dietary free radical scavengers carry in on ingestion only a small percentage of the total reducing equivalents carried by those scavengers during their lifetime in the body. After their first pass neutralizing free radicals, the free radical scavenger must be recharged with reducing equivalents made available in the mitochondria.
Consider the following: Early in this study a 23-year-old, 98-pound librarian with severe mononucleosis claimed to have taken 2 heaping tablespoons every 2 hours, consuming a full pound of ascorbic acid in 2 days without it producing diarrhea. She felt mostly well in 3 to 4 days, although she had to continue about 20 to 30 grams a day for about 2 months. Subsequently, all my young mononucleosis patients with excellent GI tracts have responded similarly and have had equivalent increases in bowel tolerance during the acute stage of the disease.
I believe that the loose stools caused by excessive doses of ascorbic acid orally ingested is due to a resulting hypertonicity of ascorbate in the rectum. Water is attracted into the rectum by the increased osmotic pressure and results in a benign diarrhea. With toxic illnesses, the ascorbate is destroyed rapidly in the involved tissues resulting in a rapid absorption from the gut. Of the ascorbate, what does not reach the rectum, does not cause diarrhea. Intravenous sodium ascorbate does not cause diarrhea and, in fact, increases bowel tolerance to orally ingested ascorbic acid while the IV is running. With hypertonicity of the ascorbate both in the blood and in the rectum, the osmotic pressure of the ascorbate is more equal on both sides of the bowel wall so no diarrhea results. If the diarrhea was cause by other metabolic processes, diarrhea would be caused by intravenous ascorbate.
It should be noted that in some cases of pathological diarrhea, ascorbic acid stops the diarrhea. Presumably in these cases some of the increased destruction of ascorbate is from free radicals in the bowel. However, in most toxic systemic diseases there is no reason to believe that the destruction of the additional ascorbate occurs directly in the bowel, so it is a safe hypothesize that this increased destruction occurs in the interior of the body.
The increased tolerance to ascorbic acid orally provides an interesting and somewhat useful measure of the toxicity of a disease. Probably it is somewhat a measure of the free radicals involved in a disease. I describe a cold that at its maximum makes it possible for a patient to just tolerate 100 grams of ascorbic acid orally without diarrhea, a "100 gram cold." Patients, appearing to be well, who have a tolerance over 20 to 25 grams per 24 hours probably have some subclinical condition which is being hidden by their own free radical scavenging system.
Patients with chronic infections (and a normally strong stomach) can ingest enormous amounts of ascorbic acid. One of my chronic fatigue patients is functional only because of his ingestion of 65 pounds of ascorbic acid in the past 12 months. In 22 years, I, personally, have ingested approximately 361 kilos ( 797 lbs ) ( 4.3 times my body weight ) of ascorbic acid because of chronic allergies and perhaps chronic EBV.
Considering the reducing equivalents carried by such amounts of ascorbic acid, one can only guess at the turnover rate of the non enzymatic free radical scavengers in a patient acutely ill with a 200 gram mononucleosis. However, one gains the impression that all the non enzymatic free radical scavengers would have to be rereduced many times a day.
Suppose you owned a farm and on one end of the property there was a barn and on the other end of the property there was a water well. One day the barn catches fire and neighbors come with buckets to set up a bucket brigade between the water well and the barn and are putting out the fire when the well goes dry.
My use of ascorbate is like thousands of neighbors coming from miles around, each with a bucketful of their own water, throwing their own water on your fire once, and then leaving.
Because of the invariable (in patients tolerant to ascorbic acid) increasing bowel tolerance to ascorbic acid in patients roughly in proportion to the toxicity of their disease, there has to be something happening to ascorbate in the sick patient other than its being used as vitamin C in the classic sense. The amelioration or sometimes cure of different diseases appears related to the importance of free radicals in the perpetuation of the paticular disease.
The sudden marked benefit in many disease processes which is achieved at doses near to the bowel tolerance level suggests that a reducing redox potential is forced into the affected tissues only at those dose levels. This ascorbate effect only at the high dose levels is also suggestive that something other than classic functions of vitamin C is involved. This ascorbate effect is more compatible with principles of redox chemistry.
Only a small percentage of the total reducing equivalents donated by non enzymatic free radical scavengers to neutralize free radicals, come in on the ingested nutritional free radical scavengers. Ascorbate is unique in that the body can tolerate doses adequate to supply the necessary reducing equivalents to quench the free radicals generated by severely toxic disease processes. The vitamin C is thrown away for the reducing equivalents it carries. Only in this way can the large amounts of free radicals generated by the most toxic disease processes be rapidly quenched.
参考书目REFERENCES
Dr. Cathcart Bibliography
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Medical Hypotheses 1981; 7:1359-76.
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W.H. Freeman and Company, San Francisco, 1970.
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W.H.Freeman and Company, San Francisco, 1976.
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W.H. Freeman and Company, New York, 1986.
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Keats Publishing, Inc., New Canaan, 1981.
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Editor, Medical Tribune, June 25, 1975.
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immunedeficiency syndrome (AIDS).
Medical Hypotheses 1984; 14(4): 423-33.
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antioxidant free radical scavenger.
Medical Hypotheses 1985; 18:61-77.
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Lancet 1990; 335(8683);235.
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normally unprimed state of antibodies.
Medical Hypotheses 1986;21(3): 307-21.
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Br J Nutr 1992; 67:3-1