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Lancet Letter

--- Dr. Robert F. Cathcart, M.D. ---
--- Allergy, Environmental, and ---
----- Orthomolecular Medicine ----- 
------- Orthopedic Medicine -------
--- 127 Second Street,  Suite 4 ---
--- Los Altos,  California, USA ---
---- Telephone:   650-949-2822 ----
---- Fax:         650-949-5083 ----
Copyright (C), 1994 and prior years, Dr. Robert F. Cathcart.
Permission granted to distribute via  the internet  as long 
as material is distributed in its entirity and not modified.

Dr. Robert F. Cathcart III, MD. Letter to the Editor. The Lancet, Jan 27, 1990; 335:p235.

Sir,-Dr. Buhl and colleagues speculate that treatment with glutathione or a close analogue might be useful in HIV infection; if it is the agent's antioxidant function that is relevant, a variety of compounds might be helpful. Reduced glutathione (GSH) is a major antioxidant, free-radical scavenger in cells. Ordinarily, one function of GSH is to reduce dehydroascorbate back to ascorbate. However, when concentrations of ascorbate are very high, ascorbate can reduce oxidized glutathione (GSSG) to GSH.

Since 1983 I have prescribed large doses of ascorbate to over 250 HIV-positive patients, including ones with AIDS or AIDS-related complex (ARC). The sicker these patients are, the more ascorbic acid in water they will tolerate orally before it produces diarrhoea. A healthy person can usually tolerate no more that 10- 15 g, divided in four to six doses over 24 hours, before diarrhoea begins but symptom-free HIV-positive patients regularly tolerate 20-40 g, ARC patients 25-60 g, and AIDS patients 30-200 g daily without diarrhoea. Doses of 100-200 g are tolerated only in patients acutely ill, such as those with acute Pneumocystis carinii pneumonia (PCP). Oral doses are encouraged to be every hour at first but the frequency will vary with the "toxicity" of the disease. The patient titrates the dose until it relieves the toxic symptoms or almost produces diarrhoea. During a crisis, doses may be taken every 15 min, but when the patient is completely symptom- free, doses may be taken only six times a day.

The depletion of CD4+ T-cells is slowed, stopped, or sometimes reversed for several years when doses close to tolerance are maintained consistently. The incidence of allergic reactions to antibiotics used in the treatment of PCP is much reduced. Lymphadenopathy is rapidly reduced and survival seems to be prolonged, the stage of rapid depletion of CD4+ T-cells being delayed. Patients report an almost complete elimination of malaise except during acute complications.

When patients are unable to take massive doses orally (eg, because they have an ulcer, oesophagitis, gastritis, or colitis, or because of acute illness as in PCP), then intravenous sodium ascorbate (no preservatives, pH 7.0) 60 g in 500 ml ringer's lactate over 3-4 hours one to three times a day is administered. Oral ascorbic acid is administered to tolerance at the same time.

The diarrhoea is thought to be due to the hyperosmotic concentration of the ascorbate reaching the rectum. Intravenous ascorbate does not produce diarrhoea and it increases oral tolerance. I think this tolerance is caused by utilization of ascorbate as a free-radical scavenger when scavengers such as glutathione are exhausted. The "toxicity" is, I think, the feeling a patient has when overwhelmed by free radicals.

Content (C) 1995 and prior years, Dr. Robert F. Cathcart.

Dr. Cathcart


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