But official reports published by clinicians fighting Covid-19 state that disordered blood clotting is present in most infected patients severely affected. (1)

In the case of Coronavirus infection, we do not know if this disordered coagulation increases the risk of severe disease, or if the virus increases the risk of disordered coagulation. But what we do know from the influenza virus infection is that it helps the virus become more aggressive, amplifying viral replication. (2)

Of course, we also know that pre-existent cardiovascular disease increases the risk of severe infection, that the infection in itself can associate cardiovascular complications, and that the treatment of the infection can cause cardiovascular side effects. (3)

However, this disordered coagulation occurs, indicating a severe prognosis in patients infected with Coronavirus. (4)

But many people with multiple comorbidities including pre-existing cardiovascular disease and many of the elderly take anticoagulant medication. And many dietary supplements and herbal remedies interact with this anticoagulant medication.

Dietary supplements with vitamins E and K, omega-3 fatty acids, selenium, coenzyme Q-10 or arginine impacts blood clotting. (5,6)

Vitamin D supplements can act as a double-edged sword when it comes to their cardiovascular effect, studies showing that both hypovitaminosis through insufficient dietary intake and hypervitaminosis by taking vitamin D supplements when you are not deficient can have a harmful cardiovascular impact. (7) And the current scientific evidence shows that vitamin D supplements protects against respiratory infections only those with vitamin D deficiency. (8)

Related to vitamin C supplements, the current scientific evidence contradicts both the harmful impact of vitamin C supplements on blood coagulation and the effectiveness of vitamin C supplements in preventing respiratory infections.

• The harmful impact on blood coagulation is assumed based on individual case reports not on objective evidence. (9, 10)
• The only people for whom there is evidence of minimal efficiency in the prevention of colds are athletes and soldiers, but also in their case the therapeutic dose is 200 mg per day, five times less than the gram taken by the majority of people trying to increase their immunity. (11)

There are numerous herbal remedies that can associate coagulation disorders, increasing the risk of thrombosis or bleeding in people on anticoagulant treatment, including: aloe, echinacea, ginseng, ginger, chamomile and alfalfa. (12,13)

Obviously, there is no need to worry about drinking a chamomile tea in the morning. But the safety of using herbal remedies containing concentrated extracts of such plants is not proven in patients under anticoagulant treatment. (14)

There are also foods that in the case of excessive consumption can influence blood coagulation, such as: cranberries, garlic, spinach, arugula, green salad, valerian, nettles, asparagus, cauliflower, cabbage and broccoli. However, scientific evidence shows that patients under anticoagulant treatment should only consume these moderately, not exclude them. (15)

On the other hand, during the current period it would be prudent to avoid the use of dietary supplements and herbal remedies that can interfere with blood clotting because – as opposed to these foods that should not be excluded – dietary supplements and herbal remedies have a much higher content of active substances.

A higher concentration of active substances does not mean a better impact, but a stronger impact. And – although most believe that dietary supplements and herbal remedies do not have side effects because they are natural – these products can have side effects, as this stronger impact can also be negative. (16)

As I wrote in the article about Coronavirus, immunity is a much more complex system than it seems when talking about immunity while having a Corona.

The link between immunity and nutrition is a complicated tango, (17) optimizing immunity requiring long term healthy eating, (18) high quality sleep, (19) and the life-long practice of physical exercise. (20)

Dietary supplements and herbal remedies are not without side effects because they are natural. (21)

Their side effects are less acknowledged because they are less evaluated in comparison to medicines, being produced and marketed according to legal regulations different from those for medicines, regulations that do not require rigorous testing in the elderly or in people with multiple comorbidities – that is, exactly those who are at higher risk today. (22)

What healthy people risk when taking all kinds of supplements to increase immunity is liver toxicity. (23)

What the elderly and people with multiple comorbidities under anticoagulant treatment risk when taking all kinds of supplements to increase immunity alongside their medication is liver toxicity and disordered coagulation. (24)

Because abnormal blood clotting is one of the red flags indicating severe prognosis in people infected with Coronavirus, at least until the current state of things comes to peace, it is more prudent to optimize immunity through healthy eating, proper sleep and physical exercise.

References

(1) Tang, Ning, et al. “Abnormal Coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia.” Journal of Thrombosis and Haemostasis (2020).

(2) Yang, Yan, and Hong Tang. “Aberrant coagulation causes a hyper-inflammatory response in severe influenza pneumonia.” Cellular & molecular immunology 13.4 (2016): 432-442.

(3) Driggin, Elissa, et al. “Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic.” Journal of the American College of Cardiology (2020).

(4) Han, H., et al. “Prominent changes in blood coagulation of patients with SARS-CoV-2 infection.” Clinical chemistry and laboratory medicine (2020).

(5) Shea, M. Kyla, and Sarah L. Booth. “Vitamin E: Interactions with Vitamin K and Other Bioactive Compounds.” Vitamin E in Human Health. Humana Press, Cham, 2019. 261-269.

(6) Stanger, Michael J., et al. “Anticoagulant activity of select dietary supplements.” Nutrition reviews 70.2 (2012): 107-117.

(7) Zechner, Christoph, and Dwight A. Towler. “Vitamin D: Cardiovascular Effects and Vascular Calcification.” Vitamin D. Academic Press, 2018. 549-570.

(8) Martineau, Adrian R., et al. “Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.” bmj 356 (2017): i6583.

(9) Feetam, Celia L., R. H. Leach, and M. J. Meynell. “Lack of a clinically important interaction between warfarin and ascorbic acid.” Toxicology and applied pharmacology 31.3 (1975): 544-547.

(10) Sattar, Adil, Jane E. Willman, and Raghu Kolluri. “Possible warfarin resistance due to interaction with ascorbic acid: case report and literature review.” American journal of health-system pharmacy 70.9 (2013): 782-786.

(11) Hemilä, Harri, and Elizabeth Chalker. “Vitamin C for preventing and treating the common cold.” Cochrane Database of Systematic Reviews 1 (2013).

(12) Ulbricht, C., et al. “Clinical evidence of herb-drug interactions: a systematic review by the natural standard research collaboration.” Current drug metabolism 9.10 (2008): 1063-1120.

(13) Cho, William CS. “Herb-drug interactions: systematic review, mechanisms, and therapies.” (2015).

(14) Cordier, Werner, and Vanessa Steenkamp. “Herbal remedies affecting coagulation: a review.” Pharmaceutical biology 50.4 (2012): 443-452.

(15) Violi, Francesco, et al. “Interaction between dietary vitamin K intake and anticoagulation by vitamin K antagonists: is it really true?: a systematic review.” Medicine 95.10 (2016).

(16) Posadzki, Paul, Leala K. Watson, and Edzard Ernst. “Adverse effects of herbal medicines: an overview of systematic reviews.” Clinical medicine 13.1 (2013): 7.

(17) Venter, Carina, et al. “Nutrition and the Immune System: A Complicated Tango.” Nutrients 12.3 (2020): 818.

(18) Goldsmith, Jason R., and R. Balfour Sartor. “The role of diet on intestinal microbiota metabolism: downstream impacts on host immune function and health, and therapeutic implications.” Journal of gastroenterology 49.5 (2014): 785-798.

(19) Faraut, Brice, et al. “Immune, inflammatory and cardiovascular consequences of sleep restriction and recovery.” Sleep medicine reviews 16.2 (2012): 137-149.

(20) Jang, Tae-Yeong, and Bong-Woo Chang. “Meta-analysis of the Influence of then Elderly Regular Exercise on their Immunity.” Journal of Digital Convergence 15.5 (2017): 339-344.

(21) Stickel, Felix, and Daniel Shouval. “Hepatotoxicity of herbal and dietary supplements: an update.” Archives of toxicology 89.6 (2015): 851-865.

(22) Navarro, Victor J., and M. Isabel Lucena. “Hepatotoxicity induced by herbal and dietary supplements.” Seminars in liver disease. Vol. 34. No. 02. Thieme Medical Publishers, 2014.

(23) García-Cortés, Miren, et al. “Hepatotoxicity by dietary supplements: a tabular listing and clinical characteristics.” International journal of molecular sciences 17.4 (2016): 537.

(24) Gardiner, Paula, Russell S. Phillips, and Allen F. Shaughnessy. “Herbal and dietary supplement-drug interactions in patients with chronic illnesses.” American family physician 77.1 (2008): 73-78.

Articolul Dietary supplements affecting blood clotting apare prima dată în Nutrition Services | Nutritionist Dr. Diana Artene.

On December 30, 2019, in a small fish and meat market where 1500 worked, in a crowded Chinese city with 11 million inhabitants, some workers got sick. And because they felt quite sick, each decided to go see a doctor in the hope that they still could somehow spend the New Year’s Eve in the family. And this is how the Wuhan on-call doctors got to see these patients suffering from a type of pneumonia that was not very responsive to traditional treatments. (1)

They scratched their heads for days and nights and tried their best to deal with the weird flu until – January 7, 2020 – when dr. Shi Zhengli’s team, a local virologist, informed them that the strange disease is a zoonosis caused by a virus from the Coronavirus family which normally affects bats.

We do not know if the pandemic declared on Wednesday by the World Health Organisation (WHO) broke out because the use of soap is one of the behaviours that distinguish people from animals or because some people have started to eat vampire bats. However, as direct descendants of father Dracula, we should take the stories of humans eating vampires at least with a grain of salty garlic.

Because the panic and the brain work in shifts, Coronavirus managed to divide the planet in two:

1. either you are scared – and you just realised that soap was invented
2. either you are rational – and you look in dismay at how seemingly mentally healthy people started to queue up to buy soap

Well… there is also the third category: the careless people continuing to live their lives like nothing happens on the planet.

This article is not a call to carelessness, it is a call to reason.

Because panic amplifies irrational behaviours whose consequences can unbalance us all, it is important to see the situation as it is: neither better, nor worse than it is.

The problem is complicated not only by the fact that fear freezes the brain, but also by the fact that the very brain humans operate on comes with at least one factory defect:

The more we read and hear about a thing that rarely happens the more we expect it to happen despite knowing deep in our minds that it rarely happens – which is called  “availability bias“. (2)

The more we hear about Coronavirus, the more it looks like it sits and looks at us through the kitchen window like a vampire – ready to jump and grab us by the shoulders to suck out our lungs.

Researchers warned us for years and years that the way pandemic infectious diseases are communicated and managed has a major financial impact, the perception of risk having a more harmful impact than the disease itself. (3)

In the rare times when we would still decide to use our neocortex, we could look at Chinese officials report which shows that:

• 81% of infected people had only mild respiratory symptoms if at all, more than half presenting without having a fever
• 14% of infected people developed severe respiratory disease, needing Intensive Care
• and the 5% of the infected people that developed severe respiratory disease who put their lives at risk were sick and old, most very sick and very old (4)

Despite official reports showing that most people who get infected only develop mild respiratory disease, on Wednesday – March 11, 2020, WHO declared the current global situation a pandemic because the number of cases reached 118,000 worldwide, of which 4,291 have died.

Risk perception doubled since pandemic has been declared in spite of the fact that even in Italy – the most affected country besides China – official reports show that 91% of infected people have only mild disease.

The majority of people do not understand what a pandemic actually means, although the flu regularly reaches pandemic levels and although most – even those very ill or exposed – usually ignore it and refuse to get vaccinated.

But what we know from the former pandemics we went through is that the most harmful impact is generated by people’s perception of risk, affecting mainly the economy of the countries not the health of the people.

Pandemic does not mean that the disease has changed or that it became more aggressive.

Pandemic means that many people are affected worldwide.

It shows the disease is highly contagious, not highly aggressive.

– How many of us haven’t had a cough or a fever this winter?

According to the report published by WHO on March 12, Coronavirus mortality is 3.6% – a simplistic figure obtained by dividing the number of deaths by the number of officially known cases.

And this simplistic figure built on the known cases is the root of all mathematical speculations that feed people’s panic. But it’s a fake number.

Although the 3.6% mortality rate looks enormous when compared to the minuscule 0.1% mortality rate of the flu, most experts remain quite calm stating that if you compare apples with pears lice come out when the aliens no longer land in Antarctica because Tuesday is blue.

Most infectious disease experts remain calm because of the 118.000 people officially infected with Coronavirus those who got severely affected were either very old or already very sick before catching up the virus, having multiple other diseases besides the last drop of corona.

And most mathematics experts remain calm because without proper testing the powerful stage effect – obtained by the fervent media coverage of the shiny 3.6% COVID-19 mortality as “huge” when compared with the 0.1% flu mortality – cannot wipe out the only two things we actually know despite the global madness:

1. of 100 people infected with Coronavirus 96,4 survive 
2. the 3.6% mortality figure is a fake number because it is based on the number of officially known cases not on the actual number of cases

Just that not all mathematicians remain calm, some mathematicians making statistical estimates based – maybe – on accepting the fact that in general the masses of panicked people behave irrationally, and individually many people do not care enough about other people to respect minimum common sense recommendations.

It seems that common sense is not that common.

Besides the low incidence of common sense, the mathematicians who don’t remain calm quote the exponential growth bias – another bias that usually affects human’s thinking. According to this thinking flaw, most people do not understand that a small problem can grow exponentially, so they ignore it. (5)

But the mathematicians that remain calm in this global madness state that Coronavirus pandemics doesn’t present exponential growth and that the prediction models built on exponential growth mathematical models can be misused in pandemics. (6)

So, today we witness a world of panic inflated by assumptions psychologically complicated by the media spot light on the horror stories that try to justify the global problem built mathematically on predictions over which even mathematicians don’t agree upon.

Because of insufficient testing:

• and, because the majority of infected people don’t even have a fever, we cannot know that the known number of cases is the number of cases
• and, because the mortality figure is obtained by dividing the number of deaths to the number of known cases, the mortality figure would be very different if we would know the actual number of cases
• and, because of the induced panic, the mathematically built worldwide problem will end up costing us all financially as the economy will take the actual fall (7)

Based on the fact that current statistics confirm the initial Chinese report proving that more than 80% of the people who get infected with Coronavirus have no or only mild symptoms – purely mathematically – the total number of worldwide cases could be 5 times higher than the officially known number.

And this would mean nothing bad if we’d had the discipline and the responsibility to respect the minimum recommended prevention.

What we know is that the risk of getting the disease is high, not that the risk of mortality from this disease is high.

A higher number of cases does not mean that the disease is more aggressive.

A higher number of cases means the disease is more contagious.

More contagious does not mean more aggressive.

Aggressivity is about the probability of dying from the disease not about just getting the disease.

COVID-19 is contagious. SARS was aggressive.

Theoretically, we are required to do the least possible: to stay in the house when we have respiratory symptoms or when we know that we’ve just traveled back from areas affected by the virus, not to kiss the elderly and to wash our hands. But for common sense recommendations to be effective you have to have common sense. And because many do not have common sense, prolonging the application of these initially minimum recommendations, cumulatively will end up highly expensive for all.

Each pandemic is different depending on:

• disease factors: how contagious it is and how aggressive it is
• human factors: like the age and state of health or hygiene
• health system factors: such as adequate access to protective equipment, the capacity of intensive care units and the fact that physicians and other unprotected medical personnel can become the first line of victims of others’ panic and lack of common sense
• science factors: how fast researchers can come up with:
  • diagnostic kits able to accurately identify affected individuals
  • effective treatments for the current outbreak
  • vaccines to prevent future ones

If the disease induced by the Coronavirus infection is more contagious but 80% of the infected people just cough, most without even having a fever, then the global number of cases could be 590.000, and mortality 0.7%.

And yes, 0.7 is still 7 times higher than the 0.1 flu mortality, but this does not erase the fact that from 100 Coronavirus-infected people 99.3 will be ok.

But you cannot say anymore that 99.3 of 100 infected people will be ok after the economic consequences of the assumptions you officially trumpeted began to emerge, exactly as you patchily did in 2003 with the far more aggressive SARS. (8)

Aligned with the many thinking biases described by Tversky and Kahneman in the 1970s, once they take an official stance most people tend to continue to defend it even when their own evidence contradicts them. And those managing the COVID-19 pandemic are people too. So the global madness will continue based on the only factor they can pin down: the high contagiousnessț impact on the exponential growth.

But the evolution of the disease does not show exponential growth.

When the reality of the disease contradicts you but the economic consequences of the wrong statistic presumptions you made have begun to appear, you cling to any evidence that might justify what you assumed:

• the population at higher risk
• and the fall of the medical system

To protect yourself from the economic consequences of the panic created globally, of the 100 infected that mostly have nothing you fervently put the spot light on the only 1 that’s doing worse and hope that no one with sufficient economic and political power will grab you by the collar to ask why the hell do you put the spot light on this 1 when 99.3 are fine.

Just that treating the population at higher risk and the resources required for the medical system to keep working cost money and all systems risk to fall including the medical system when there will be no money because we neglected economy while trying to preserve health.

The disease induced by Coronavirus is mainly mild.

Without proper testing, mortality seems higher than influenza’s but officially available mortality figures don’t indicate an exponential growth.

People that were already damaged by advance age or advanced disease before Coronavirus will be more affected.

Health care systems that were already damaged before the Coronavirus will be more affected.

Officially, WHO recommends:

• to greet each other at least one meter distance
• to cough in the elbow
• to stay home if we feel ill
• to wash our hands
• and to clean up our homes and spaces

Officially, WHO doesn’t even recommend to wear a mask without first having cough or a fever, specialists recommending them only to those having symptoms and to those taking care of them because:

• most masks available on the market are not appropriate
• most people who have access to appropriate masks do not use them properly
• and because the actual number of masks and other protective medical devices available on the planet is limited, even the medical personnel risking to remain without them due to the panic created in the general population

However, in spite of the fact that unlike the flu Coronavirus doesn’t seem to severely affect children and teenagers and in spite of the available analyses of past pandemics showing that school closure has tripled economic harm in countries such as England, France, Belgium and the Netherlands (9), the UNICEF and WHO stands is the quoted reason behind the closure of schools.

– Who cares that school closure and the absenteeism generated by panic worsens the economic impact? (10)

Ignoring the fact that everyone’s access to any medical treatment decreases if our financial capacity drops down to caves levels, we close schools to protect the 3.6 grandparents out of those 100 grandparents over the age of 80 or with more illnesses than they can carry assuming they might get infected by their grandchildren who’d go to school.

And while schools are deserted to protect the vulnerable grandparents, the parks are full with vulnerable grandparents taking their grandchildren out to have some fun like in a global unplanned holiday.

The disease is mild and the spread might end if 76% of transmissions would stop. (11) But adding to the fact that the vulnerable population seems to mock our efforts to protect them, some of the people officially diagnosed as being infected with Coronavirus do not respect the fact that by leaving the house others will be infected.

Just like for years, as a mother, I had to deal with the consequences of other parents bringing their sick children to school despite the risk of infecting other children – of a mild flu – now we witness in dismay how people at risk and people officially infected or people who traveled back from high risk areas of the globe just casually go outside, enjoying the spring warm weather.

We respectfully stay home to protect the vulnerable population, while the vulnerable population casually goes out to the beach, having barbecues, meeting their friends at the mall then panically buying everything that falls into their hands, sitting at endless queues for food and soap.

We stay home although we could work.

Old people and those diagnosed with or at risk of a coronavirus infection are walking the streets spending their last dime on beans, vitamins and soap resting assured that the Easter Bunny and Santa Claus will take care of them when they will eventually run out of money.

– What are you going to eat a month from now if you spend all your money today on perishables?

– Face masks and soap?

Reading official reports, during the past few weeks I wondered if we globally went batshit crazy …

Not that I complain of the light traffic in Bucharest or of the joy of my children generated by the unplanned holiday that gradually translated to boredom. But Coronavirus has filled my Inbox with two types of emails:

1. some making the same demand: “What should I buy to increase my immunity?“
2. and some making the same offer: “What can we sell you to increase your immunity?“

Like at the market: demand and supply.

And if the answer to the second question is a simple SPAM report thinking “the mother of the idiots is always pregnant“, the answer to the first question seems somewhat more complicated because the vast majority of people think this is THE time when you have to take something to increase your damn immunity.

Obviously, the vast majority of people does not want to address the fact that eating fast food and drinking soda drinks on the run (12) during stressful days followed by nights with low quality, insufficient sleep (13) decreases immunity.

The vast majority of people has no idea what “immunity” is, the subliminal message passed on from one good doer to another being that you have to take vitamins, antioxidants or something.

Most believe that “immunity” is bought at the pharmacy.

Just that only “immunity” is bought at the pharmacy.

Immunity without quotation marks depends on the healthy eating (14), on the regular life-long practice of sports (15, 16), on the high quality sleep (17), and even on the well-being and overall happiness level of your life (18). So yes, it seems damn tricky to increase immunity so suddenly now with this Coronavirus sneaked out of the dark Chinese vampires’ caves in the fast food-sedentary-stressful-unhappy life.

Just that, although we are encouraged to take all sorts of stuff to somehow defend ourselves against this dark virus, the only two things you can actually do to increase your immunity specifically against Coronavirus are:

1. to get infected with Coronavirus
2. to get vaccinated with a vaccine specifically created against this virus

We have no vaccine yet.

And exactly as everybody wants to go to heaven, but nobody wants to die, there isn’t anybody who’d want to get infected.

Without getting sick and without the vaccine, the only thing you can increase by taking all sorts of vitamins, plants and miracle natural remedies is is the non-specific part of the immune system, the innate immunity.

But increased non-specific immunity does not specifically defend you against Coronavirus or against anything else for that matter.

Non-specific immunity is called “non-specific” because it is non-specific.

And increasing non-specific immunity does not mean improved health.

Increased non-specific immunity means deregulated immune system, bone and gastrointestinal inflammatory disease, allergies, autoimmunity. (19)

And it is absolutely pointless to take any magic plant or vitamin for the purpose of increasing non-specific immunity.

Non-specific immunity is directly increased by stress, sedentariness, insufficient sleep and by the very western diet by their pro-inflammatory effects. (20)

Immunity without quotation marks is a much more complex system than it seems when talking about immunity while having a Corona.

The upside of the Coronavirus story is that it has managed to increase interest in seemingly uninteresting products. Like soap.

The downside is that if this global panic continues, we will not die of Coronavirus but of poverty.

It all started at the market and it will all end at the market.

I’m not sure if it’s like at the small fish and meat market in Wuhan where some of the 1500 workers got infected, but all this seems kind of an expensive trade that ignores the fact that in order to have something to sell someone still has to actually work.

References

(1) Phelan, Alexandra L., Rebecca Katz, and Lawrence O. Gostin. “The novel coronavirus originating in Wuhan, China: challenges for global health governance.” Jama 323.8 (2020): 709-710.

(1) Phelan, Alexandra L., Rebecca Katz, and Lawrence O. Gostin. “The novel coronavirus originating in Wuhan, China: challenges for global health governance.” Jama 323.8 (2020): 709-710.

(2) Tversky, Amos, and Daniel Kahneman. “Availability: A heuristic for judging frequency and probability.” Cognitive psychology 5.2 (1973): 207-232.

(3) Smith, Richard D. “Responding to global infectious disease outbreaks: lessons from SARS on the role of risk perception, communication and management.” Social science & medicine 63.12 (2006): 3113-3123.

(4) Wu, Zunyou, and Jennifer M. McGoogan. “Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.” Jama (2020).

(5) Levy, Matthew R., and Joshua Tasoff. “Exponential-growth bias and overconfidence.” Journal of Economic Psychology 58 (2017): 1-14.

(6)Chowell, Gerardo, and Cécile Viboud. “Is it growing exponentially fast?–impact of assuming exponential growth for characterizing and forecasting epidemics with initial near-exponential growth dynamics.” Infectious disease modelling 1.1 (2016): 71-78.

(7) Ayittey, Foster Kofi, et al. “Economic impacts of Wuhan 2019‐nCoV on China and the world.” Journal of Medical Virology (2020).

(8) Lee, Jong-Wha, and Warwick J. McKibbin. “Globalization and disease: The case of SARS.” Asian Economic Papers 3.1 (2004): 113-131.

(9) Keogh-Brown, Marcus Richard, et al. “The macroeconomic impact of pandemic influenza: estimates from models of the United Kingdom, France, Belgium and The Netherlands.” The European Journal of Health Economics 11.6 (2010): 543-554.

(10) Smith, Richard D., Marcus R. Keogh-Brown, and Tony Barnett. “Estimating the economic impact of pandemic influenza: an application of the computable general equilibrium model to the UK.” Social science & medicine 73.2 (2011): 235-244.

(11) Read, Jonathan M., et al. “Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic predictions.” medRxiv (2020).

(12) Tall, Alan R., and Laurent Yvan-Charvet. “Cholesterol, inflammation and innate immunity.” Nature Reviews Immunology 15.2 (2015): 104-116.

(13) Prather, Aric A. “Sleep, stress, and immunity.” Sleep and Health. Academic Press, 2019. 319-330.

(14) Childs, Caroline E., Philip C. Calder, and Elizabeth A. Miles. “Diet and Immune Function.” (2019): 1933.

(15) Duggal, Niharika A., et al. “Can physical activity ameliorate immunosenescence and thereby reduce age-related multi-morbidity?.” Nature Reviews Immunology 19.9 (2019): 563-572.

(16) Jang, Tae-Yeong, and Bong-Woo Chang. “Meta-analysis of the Influence of then Elderly Regular Exercise on their Immunity.” Journal of Digital Convergence 15.5 (2017): 339-344.

(17) Ganz, Freda DeKeyser. “Sleep and immune function.” Critical care nurse 32.2 (2012): e19-e25.

(18) Ayling, Kieran, Kanchan Sunger, and Kavita Vedhara. “Effects of brief mood-improving interventions on immunity: a systematic review and meta-analysis.” Psychosomatic medicine 82.1 (2020): 10-28.

(19) Statovci, Donjete, et al. “The impact of western diet and nutrients on the microbiota and immune response at mucosal interfaces.” Frontiers in immunology 8 (2017): 838.

(20) Poutahidis, Theofilos, et al. “Microbial reprogramming inhibits Western diet-associated obesity.” PloS one 8.7 (2013): e68596.

Articolul Coronavirus – batshit crazy spring rolled Devil’s baby apare prima dată în Nutrition Services | Nutritionist Dr. Diana Artene.

But the intracytoplasmic ROS level determines whether the cell progresses in the cell replication cycle or not, lower levels leading to cell cycle progression while higher ones leading to cell cycle arrest and cell death (Cairns, Harris and Mak, 2011).

Also, studies show that malignant cells have a higher tolerance for ROS than normal cells – Szatrowski and Nathan, 1991. So, to impede malignant cells survival and proliferation we need a higher level of intracytoplasmic ROS level.

And although vitamin C can act both as a pro-oxidant and antioxidant depending on the dosage, we do not know if the clinic impact of vitamin C administration is beneficial for patients with curable cancers during active oncology treatment and not during palliative care (Schumacker, 2006; Grasso et al., 2014).

Active oncology treatment with intention to cure makes the difference in what a cancer patient can or cannot take, and while there still are chances of healing antioxidants administration can decrease treatment efficacy.  

Up to now, no randomised controlled trial has proven that vitamin C has a beneficial impact in cancer patients without metastasis during chemotherapy or  radiotherapy done with intention to cure, the only benefits being increased quality of life and decreased palliative treatment toxicity in terminal cancer patients – Unlu et al., 2015; Li, Zhang and Tang, 2016

All studies showing antioxidants administration benefits are either case studies, animal studies, cell studies, studies done on incurable cancer patients or observational studies on cancer risk factors. Still the scientific interest is high, many researchers trying to prove that the improved quality of life or the decreased toxicity could be beneficial also for patients during active treatment and not only during palliation.

For instance, some researchers say cancer patients have vitamin C deficiency and therefore supplementing it would stimulate immune system and increase the quality of life of the patients, without separating either patients during active treatment from patients during palliation  or the many types of cancer.

– But what cancer patients have vitamin C deficiency?

And although many naturopaths or complementary medicine practitioners would say “all”, the study that led to this popular assumption only analysed 50 terminal cancer patients of which only 15 had low vitamin C levels. Can we just delete the other 35 and extrapolate that “cancer patients have vitamin C deficiency”? – Maryland et al., 2005

The time of diagnosis is essential when it comes to antioxidants intake impact, and there are 3 distinct periods of time:

1. before diagnosis – cancer prevention – when daily moderate intake of antioxidants naturally found in fruits, vegetables, raw seeds, legumes, lean meat, fish, whole dairy and eggs contributes up to a point to a decreased cancer risk
2. early stage diagnosis – active oncology treatement with intention to cure – when oncology nutrition is strictly personalised based on malignant metabolism, tumour localisation, treatment stage and patient comorbidities. And I would like to underline that we cannot cure cancer through nutrition, be it oral or iv, and that during active oncology treatment the main goal is treatment efficacy and not decreased treatment toxicity or increased quality of life.  During active treatment we have no proof that antioxidants have any beneficial impact on treatment efficacy.
3. late stage diagnosis or when the disease has advanced and it reached an incurable stage – palliation – when the main goals are decreased treatment toxicity or increased quality of life. And this is the only period of time when antioxidants might be useful.

Some researchers go as far as to say that the only moment when cancer patients can be administrated antioxidants without decreasing healing chances is during scientific trials – Wilson et al., 2014

Even the chemotherapy with which vitamin C is compared by complementary / integrative medicine practitioners is palliative chemotherapy not curative active treatment. – Gourgou-Bourgade et al., 2012

Chemotherapy side effects are very popular and thickly underlined by these practitioners, but most don’t also mention alternative treatments side effects because their providers are not obliged by law to prove neither their efficacy nor their safety. And of course “they are natural thus they don’t have side effects”. Cocaine is also natural.

Malignant cellular biology is extremely complex. There is a huge difference between destroying some malignant cells in a Petri dish and destroying a self-born and grown tumour in a living organism.

To understand the difference between destroying some malignant cells in a Petri dish and destroying a self-born and grown tumour in a living organism imagine trying to destroy a wasp nest.

The fact that we catch some wasps in a jar and we kill them with substance X does not mean that the whole nest will be destroyed:

• the nest might have such a complex internal structure that some wasps might not come in contact with substance X, otherwise effective if contact would occur;
• the wasps we killed in the jar with substance X might be of different age or specie than the wasps in the nest;
• and some wasps might not be in the nest when we administered the substance, thus being able to go and build another nest elsewhere.

Cancer is a heterogenous mass of cells in different stages of cell cycle able not to die. And avoiding apoptosis is very complicated, involving a whole lot of genetic modifications that make malignant cells unpredictable and very adaptable.

Assuming that vitamin C is beneficial simply because it is an antioxidant or because it might act as a pro-oxidant sounds logic and natural, and low cost, and low importance because of the supposed lack of side effects, but up to now it is just a potentially risky assumption.

– Then why it is given intravenously in high doses in some centres even alongside neoadjuvant chemotherapy, treatment also widely practiced by many naturopaths or other integrative/complementary medicine practitioners?

Maybe because 40 years ago the Nobel laureate for chemistry Linus Pauling argued that high-dose vitamin C heals or prevents cancer, the same as 400 years ago the Pope used to say that the Earth was flat. So you should had been completely out of the box to even think it is round.

– What made Pauling sustain with such vehemence vitamin C for cancer treatment?

In the ’70 Pauling and Cameron published two apparently randomised controlled studies in which they managed to highly increase the survival of terminal cancer patients to whom they administered intravenously at first and orally thereafter high doses of vitamin C – Pauling and Cameron, 1976; Pauling and Cameron, 1978

But dr. William DeWys – the head of research at US National Cancer Institute at the time – has severely criticised the validity of these studies results (Cabanillas, 2010) because:

1. the study has been restrospective and not randomised
2. and because around 20% of the patients retrospectively selected to be included in the control arm died just few days after they have been considered incurable, dr. DeWys arguing that this led to an artificially increased survival time for the vitamin C group.

Then, in 1981, Murata et al. published a study with similar retrospective design – study widely quoted at the proof that Pauling and Cameron were actually right.  – Murata, Morishige and Yamaguchi, 1981

But neither Pauling and Cameron’s studies nor Murata’s were randomised controlled trials, but restrospective ones without causal value. And what we also need to underline is that:

• all 3 studies were done on terminal cancer patients with diverse forms of cancer
• most patients died anyway within less than a year, so randomised or not, vitamin C for sure did not cure them

The hypothesis that curing cancer is as easy, simple and natural as vitamin C administration was later on contradicted by the very death of Pauling himself – who died of lung cancer in 1994 despite administering 18 g vitamin C daily.  So in his case, taking vitamin C did not prevent cancer, and did not help him cure cancer after diagnosis.

Unlike these retrospective studies, the 2 randomised controlled studies done at Mayo Clinic showed that a daily oral administration of 10g of vitamin C is of no benefit for cancer patients – Creagan et al., 1979, Moertel et al., 1985.

But the results of these studies have been disputed based on vitamin C pharmacokinetics, vitamin C supporters arguing that the antitumor effect can be obtained only through intravenous administration. – Padayatty et al., 2004

But, even for intravenous administration there are at least 3 more but:

1. despite the fact that the RDI for vitamin C is 60 mg, the supposed antitumor effect is not obtained even at doses as high as 70 g/m² administred intravenously – Hoffer et al., 2008; Stephenson et al., 2013
2. vitamin C administration can decrease oncology treatment efficacy:
   • antioxidants can decrease chemotherapy and radiotherapy efficacy – Bairati et al., 2005; Lawenda et al., 2008; Heaney et al., 2008
   • vitamin C inhibits the antitumor effect of bortezomib in patients with multiple myeloma or lymphoma – Perrone et al., 2009
3. Vitamin C does have side effects – beside gastrointestinal discomfort (diarrhea, bloating) vitamin C administration can:
   • increase iron absorption – being contraindicated in patients with hemochromatosis – Stotts and Bacon, 2017
   • increase the risk of renal oxalates lithiasis in men – being contraindicated in patients with a history of oxalic nephropathy or renal insufficiency – Massey et al., 2005; Ferraro et al., 2016
   • have a prothrombotic and procoagulant impact – being contraindicated in patients with cardiovascular disease at risk of thrombosis – Kim et al., 2015; Mohammed et al., 2017

Vitamin C is not as pink as pseudo-oncology industry would like patients to believe and the fight against cancer is far more complicated than simply taking vitamins.

In final stages, during palliative care, decreasing treatment toxicity and increasing quality of life are primary.

But during active oncology treatment for curable cancer we want the patient to feel good or we want the patient to be cured?

References

Bairati, Isabelle, et al. “Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients.” Journal of clinical oncology 23.24 (2005): 5805-5813.

Cabanillas, Fernando. “Vitamin C and cancer: what can we conclude-1,609 patients and 33 years later.” PR Health Sci J29.3 (2010): 215-217.

Cairns, Rob A., Isaac S. Harris, and Tak W. Mak. “Regulation of cancer cell metabolism.” Nature Reviews Cancer 11.2 (2011): 85-95.

Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A 1976; 73 (10): 3685–3689.

Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: reevaluation of prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A 1978; 75 (9): 4538–4542.

Gourgou-Bourgade, Sophie, et al. “Impact of FOLFIRINOX compared with gemcitabine on quality of life in patients with metastatic pancreatic cancer: results from the PRODIGE 4/ACCORD 11 randomized trial.” Journal of clinical oncology31.1 (2012): 23-29.

Grasso, Carole, et al. “Pharmacological doses of daily ascorbate protect tumors from radiation damage after a single dose of radiation in an intracranial mouse glioma model.” Frontiers in oncology 4 (2014).

Ferraro, Pietro Manuel, et al. “Total, dietary, and supplemental vitamin C intake and risk of incident kidney stones.” American Journal of Kidney Diseases 67.3 (2016): 400-407.

Heaney, Mark L., et al. “Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs.” Cancer research 68.19 (2008): 8031-8038.

Hoffer, L. J., et al. “Phase I clinical trial of iv ascorbic acid in advanced malignancy.” Annals of Oncology (2008): mdn377.

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Kim, Keunyoung, et al. “High-Dose Vitamin C Injection to Cancer Patients May Promote Thrombosis Through Procoagulant Activation of Erythrocytes.” Toxicological Sciences 147.2 (2015): 350-359.

Lawenda, Brian D., et al. “Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy?” Journal of the national cancer institute 100.11 (2008): 773-783.

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Mohammed, Bassem M., et al. “Impact of high dose vitamin C on platelet function.” World journal of critical care medicine 6.1 (2017): 37.

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Articolul Vitamin C for cancer patients? apare prima dată în Nutrition Services | Nutritionist Dr. Diana Artene.