Daily Vitamin C Consumption and Reported Cardiovascular Findings

Introduction

Doctor Pauling cites several studies in the medical and scientific literature showing beneficial effects of vitamin C used against colds.¹ But the staff of Nutrition Reviews, a technical journal, searched the medical and scientific literature and concluded in an article in the August 1967 issue: “There is no conclusive evidence that, in the absence of severe ascorbic acid depletion, ascorbic acid has any effect on the incidence, course, or duration of the common cold.”²

Since that time, there has been increasing evidence that there is indeed a relationship between vitamin C and the common cold. As a matter of fact, we reported earlier³ that there is a significant parallelism between daily vitamin C consumption and reported respiratory findings.

In brief, there is now suggestive evidence that vitamin C may be essential to the welfare of other systems. Accordingly, an attempt will be made in this report to answer the following five questions:

1. What is the frequency of reported cardiovascular findings in a presumably healthy population?
2. What is the daily vitamin C consumption in this same group?
3. Is there any relationship between the frequency of reported cardiovascular symptoms and signs and daily ascorbic acid intake?
4. What changes in the frequency of reported cardiovascular symptoms and signs occur following a one-year experimental period during which group nutritional improvement instruction sessions were conducted?
5. What are the possible significances of these findings?

Method of Investigation

In 1965, a multiple testing health program for members of the health professions was inaugurated under the auspices of the Southern Academy of Clinical Nutrition. In 1969, the project was extended to include a group designated as the Southern California Academy of Nutritional Research, and a third group was organized under the aegis of the Ohio Academy of Clinical Nutrition. In 1971, a fourth segment was added under the direction of the Northeast Academy of Clinical Nutrition. Finally, in 1972, a fifth group was started under the guidance of the Northern California Academy of Nutritional Research.

Eight hundred thirty-two dental practitioners and their wives were evaluated initially between 1965 and 1972 in terms of reported dietary patterns and reported clinical state. A clinical score for cardiovascular symptoms and signs was derived from the Cornell Medical Index Health Questionnaire.⁴ The daily vitamin C intake was obtained from a food frequency questionnaire.⁵ It became clear that many of the participants were consuming large amounts of refined carbohydrate foodstuffs, suboptimal amounts of protein and relatively small quantities of vitamins and minerals. The therapeutic regimen consisted of several brief nutritional seminars showing the dietary deficits and measures for dietary improvement. ^6,7

At each of the five examination visits, the age and sex were recorded. Table 1 is a summary of the age distribution at each session. Parenthetic mention should be made that the ten readings in the second decade represent children of the dental families.

 

Table 1. Age Distribution

On each occasion, each participant completed the Cornell Medical Index Health Questionnaire.4 Section C (13 questions) relates to the cardiovascular system. The distribution of positive (pathologic) responses for the five examination sessions is summarized in Table 2.

 

Table 2. Reported Cardiovascular Findings

At each visit, every subject completed the Dietronic Dietary Analysis.5 This is a dietary questionnaire based upon food consumption frequency. The completed form is submitted to a computer center, and a readout is provided. For purposes of this study, only the daily vitamin C intake was utilized. The distribution at each examination is shown in Table 3.

 

Table 3. Daily Vitamin C Consumption

Results

Question One: Table 2 summarizes the frequency of reported cardiovascular findings for the entire sample of 657 subjects at the initial examination and for all subjects at the four subsequent examination periods. For the moment, it will be noted that on the average, each subject initially reported 1.21 positive cardiovascular responses. Hence, in answer to the first question, reported cardiovascular symptoms and signs range from zero to nine with a mean of 1.21 in this particular and unique sample of the population.

Question Two: Table 3 outlines the daily vitamin C consumption for the entire sample of 657 individuals at the first analysis and for those at the four subsequent examinations. The mean intake initially is 294 mg/day. According to the Food and Nutrition Board of the National Research Council,⁸ the recommended intake for the male is 60 mg/day, and the requirement for the female is 55 mg/day. On this basis, about 95% of the subjects are consuming adequate amounts. Hence, according to the Recommended Dietary Allowances, and in answer to the second question, this group is consuming approximately four to five times more vitamin C than is officially recommended.

Question Three: Table 3 shows that 657 subjects participated at the initial examination and 225, 116, 64 and 12 at subsequent annual sessions, making a total of 1074 experiences. Figure 1 pictures the association between the frequency of reported cardiovascular symptoms and signs (on the abscissa) versus the daily vitamin C intake (on the ordinate). On a mean basis, there is a progressive decline in cardiovascular findings in parallel with an increase in daily vitamin C consumption. It is clear, in answer to the third question, that there is a low but statistically significant negative correlation coefficient (r = 0.096, P<0.01), meaning that the higher the daily vitamin C consumption, the fewer the cardiovascular findings.

Fig. 1. The relationship of the number of reported cardiovascular symptoms and signs (on the horizontal axis) versus mean daily reported vitamin C consumption (on the vertical axis). There is a low but statistically significant (r = -0.096, P <0.01) negative correlation coefficient, meaning that the greater the vitamin C consumption, the fewer the cardiovascular findings. 

 

Question Four: Following the initial survey, as previously noted, health education lectures were provided to the group, and these were repeated annually. This included discussions of the existing dietary patterns and possible changes that could and should be instituted. The recent book by Doctor Linus Pauling1 was, for example, included in the lecture materials. On an annual basis, the entire group was reexamined by the techniques (clinical and dietary) previously mentioned.

It is relevant to point out that well over three fourths, actually 77.8% of the group, increased the daily vitamin C intake between the first and second visit (Table 4). The changes between subsequent visits are also shown.

 

Table 4. Changes in Reported Daily Vitamin C Consumption

Table 2 tabulated the cardiovascular scores at each examination period. It will be noted that, initially, the mean cardiovascular score was 1.21; one year later, the average score was 0.91. The average values were 0.82, 0.92 and 0.58 for the third, fourth and fifth annual examinations, respectively. Thus, overall, there was a statistically significant decline in clinical symptoms and signs between the first and second examinations.

However, it should be pointed out that these findings represent the entire sample. One argument which can be justly raised is the fact that the initial and second year samples are substantially different. Part of the difference is attrition. However, part of the difference is due to the fact that one group studied had not yet returned for reexamination.

For these and other reasons, it was thought expedient to reexamine the data in terms of the changes in reported cardiovascular findings with regard to changes in vitamin C consumption. Specifically, 290 subjects (Group I), for whatever reason, decided to increase their daily ascorbic acid intake (Fig. 2). For this group, the mean initial daily vitamin C intake was 239 mg. One year later, the amount was 423 mg. Obviously, in this Group I, the t value (22.159) is highly significant (P <0.001). It will be noted (Fig. 2) that in this same group, the mean cardiovascular score decreased from 1.19 to 0.89 during the same experimental year. It is evident that this change is statistically significant (t = 3.939, P<0.001). 

Fig. 2. The relationships of change in daily vitamin C intake to change in cardiovascular state. In Group I, characterized by an increase in daily ascorbic acid, there is a significant reduction in cardiovascular symptoms and signs. In contrast, in Group II characterized by a decrease in vitamin C during the experimental period, there is no significant change in cardiovascular state. 

 

In contrast, 88 individuals (Group II), for whatever reasons, decided to reduce or, at least, not increase daily vitamin C intake. Figure 2 shows that the mean daily vitamin C consumption decreased from 409 to 318 mg/day. Obviously, by selection, this is a statistically significant change (t = 10.566, p<0.001). Interestingly enough, there was no statistically significant alteration in the reported cardiovascular picture (t = 1.884, P<0.050). 

Thus, in answer to the fourth question, the addition of vitamin C appears to contribute to the reduction in cardiovascular symptoms and signs.

Discussion

Question Five: Two interdependent points bear on the response to this final question. First, in the last analysis, health or disease is a function of the environment and the organism’s capacity to cope with the external milieu. The latter ingredient is termed host resistance and susceptibility. Analytically,⁹ resistance may be viewed as any agent which, when administered, tends to discourage the development of disease. When absent, however, it encourages disease. For example, vitamin B1 (thiamin) may be regarded as a resistance agent for its administration tends to discourage the development of beri-beri, and its absence causes it. In a sense, therefore, resistance agents are pluses. In contrast, a susceptibility agent invites disease when present and discourages the development of disease when it is withdrawn. Thus, sugar is to be viewed as a susceptibility agent because its introduction tends to encourage dental caries, and its absence exerts a prevention action.¹⁰ Hence, susceptibility agents are minuses. Parenthetic mention should be made that an agent is never a resistance factor for one disease and a susceptibility factor for another.^10-13 Since vitamin C is known as a resistance agent for scurvy, it would seem that it should be a resistance agent for other syndromes. If sugar is a susceptibility factor in the mouth, it is likely the same for the whole body.

The other relevant point is the recognition that chronic disease is characterized by a long and insidious incubation period. For example, early in the development of the syndrome, there may be one or two seemingly unrelated symptoms and signs such as infrequent shortness of breath and slight chest ache (Fig. 3). This is the box on the left. At this point, no textbook syndrome is evident. Hence, the symptom and/or sign is treated symptomatically. With time, the number of clinical findings increase and begin to localize in specific sites, organs or systems. This is the center box. At this point, no textbook designation is still possible. Hence, the patient is treated in one of three ways. First, each symptom and sign is treated separately. Second, if too many symptoms and signs prevail, a psychiatric diagnosis is made. Finally, in the third instance, the patient is put under observation. This is a polite way of telling the patient to go home and develop more findings so that he can fit the textbook picture of a particular syndrome. This is the box on the right. This is just as true in the case of cardiovascular pathosis as of any other system. The frequency of cardiovascular symptoms and signs utilized in this study represents the very beginning of the problem and is pictured in Figure 3 as the box on the left.

Fig. 3. The genesis of disease. With advancing age, there is usually a progressive increase in symptoms and signs. At first, there is an isolated symptom and/or sign shown in the box on the left. With time, the symptoms and signs increase in number and begin to localize in sites or symptoms as shown by the box in the middle. Finally, the clinical picture is clearcut enough (box on the right) to justify a typical textbook designation such as schizophrenia.

 

With these two interdependent points in mind, it is well to evaluate vitamin C as a resistance or susceptibility agent with regard to the early development of cardiovascular pathosis. Figure 4 attempts to pictorially portray this situation. Shown on the ordinate is the mean daily vitamin C consumption. The group characterized by no cardiovascular findings consumed, on the average, 338 mg vitamin C daily (the stippled bar). In contrast, the group characterized by one or more cardiovascular symptoms and signs consumed a mean of 323 mg vitamin C per day. The difference is statistically not significant (t = 1.406, P >0.100). A restudy (Fig. 5) of 0 versus 2+ cardiovascular symptoms and signs shows a significant distinction (t = 2.196, P<0.050). Thus, in answer to the final question, the evidence suggests that vitamin C may be viewed as a resistance agent for cardiovascular disease because its addition tends to reduce the possibility of pathosis.

Fig. 4. The relationship of reported daily vitamin C consumption (as judged by the food frequency technique) and the frequency of reported cardiovascular findings. The group of subjects with no cardiovascular symptoms or signs (stippled column) shows a higher daily mean vitamin C intake (338 mg) than the group with 1+ cardiovascular findings (black column). However, the distinction is not statistically significant.

Fig. 5. The relationship of reported daily vitamin C consumption (as judged by the food frequency technique) and the frequency of reported cardiovascular findings. The group of subjects with no cardiovascular symptoms or signs (stippled column) shows a higher daily mean vitamin C intake (338 mg) than the group with 2+ cardiovascular findings (black column). Hence, by definition, vitamin C may be regarded as a resistance agent since its addition discourages disease.

 

Mention should be made that an earlier paper³ described the relationship of daily reported vitamin C consumption and reported respiratory findings. A comparison of that report with the findings here suggests that, in general, the parallelisms between vitamin C and the respiratory system are more significant than those reported here between vitamin C consumption and the cardiovascular state.

Summary

Eight hundred thirty-two dental practitioners and their wives were studied on one occasion in terms of reported daily vitamin C consumption and reported cardiovascular symptoms and signs. A portion of this group was reexamined annually over a five-year period. From this group it was learned that 290 subjects were found to increase their vitamin C intake while 88 reduced their ascorbic acid consumption. Five points are apparent. First, there is a low but statistically significant negative correlation between daily vitamin C intake and cardiovascular findings. In other words, as vitamin C intake rises, cardiovascular symptoms and signs decline. Second, following group nutritional seminars, cardiovascular symptoms and signs decline during subsequent years. Third, during this same time period, vitamin C consumption rises. Fourth, a significant reduction in cardiovascular findings occurred in the group characterized by an increase in vitamin C intake. In contrast, the group demonstrating a decrease in ascorbic acid consumption did not show a statistically significant reduction in cardiovascular findings. Finally, the evidence suggests that vitamin C may be viewed as a resistance agent for cardiovascular disease because its introduction tends to discourage the appearance of cardiovascular symptomatology. However, the vitamin C versus heart relationship is not as sharply defined as an earlier reported correlation between ascorbic acid intake and respiratory state.

 

Emanuel Cheraskin was born in Philadelphia, Pennsylvania, on June 9, 1916. He received his M.D. from the University of Cincinnati, College of Medicine in 1943. Nine years later he received his D.M.D. at the University of Alabama, School of Dentistry at Birmingham. From 1944-1945 he was a Captain in the United States Medical Corps. Presently, Dr. Cheraskin is Consultant, Northeast Academy of Clinical Nutrition. He is a member of various Professional organizations, including the International College of Angiology and the American Dental Association. He has received various honors and scientific recognitions, such as Consultant of Oral Medicine, Veterans Administration Hospital; editorial board member of the Journal of Orthomolecular Medicine; also listed in Who’s Who in America 1973.

 

References Cited:

1. Pauling, L.: Vitamin C and the Common Cold. San Francisco. W. H. Freeman and Company, 1970.
2. Buyer, B.: “Vitamin C as a cold remedy proposed anew.” The National Observer, 23 November 1970.
3. Cheraskin, E., Ringsdorf, W. M., Jr., Michael, D. W. et al: “Daily vitamin C consumption and reported respiratory findings.” Int. J. Vit. Nutr. Res., 43:1, 42-55, 1973.
4. Brodman, K., Erdmann, A. J., Jr. and Wolff, H. G.: Cornell Medical Index Health Questionnaire: Manual. New York: Cornell University Medical College, 1949.
5. Abramson, J. H., Slome, C. and Kosovsky, J. N.: “Food frequency interview as an epidemiological tool.” Amer. J. Public Health, 53:1093-1101, 1963.
6. Cheraskin, E. and Ringsdorf, W. M., Jr.: New Hope for Incurable Diseases. New York: Exposition Press, 1971.
7. Cheraskin, E., Ringsdorf, W. M., Jr. and Clark, J. W.: Diet and Disease. Emmaus, Pa.: Rodale Books, 1968.
8. Food and Nutrition Board. Recommended Dietary Allowances. Publication #1694. Seventh revised edition. Washington: National Academy of Sciences, 1968.
9. Schneider, H. A.: “Nutrition and resistance-susceptibility to infection;” 31:174-182, 1951.
10. Cheraskin, E. and Ringsdorf, W. M., Jr.: “What does the dental family eat? A study of refined carbohydrate consumption.” J. Alabama Dent. Ass., 56:32-39, 1972.
11. Cheraskin, E., Ringsdorf, W. M., Jr., Michael, D. W. et al: “The exercise profile.” J. Amer. Geriat. Soc., 21:208-215, 1973.
12. Cheraskin, E. and Ringsdorf, W. M., Jr.: “The mental illness proneness profile.” Alabama J. Med. Sci., 10:32-45, 1973.
13. Cheraskin, E. and Ringsdorf, W. M., Jr.: “The oral proneness profile.” (In preparation.)
14. Cheraskin, E., Ringsdorf, W. M., Jr., Michael, D. W. et al: “The pluses and minuses of the syndrome of sickness.” J. Amer. Soc. Prev. Dent., 1: 26-28, 44-48, 58, 1971.