VITAMIN C - THE MASTER NUTRIENT

Fighter of Heart Disease and Diabetes

Heart disease, including heart attack, is the number one killer in the western world, accounting for 48% of all deaths in the U.S. Related conditions to heart disease, including stroke, account for an additional 10% of deaths. That means heart disease in one form or another contributes to almost 60% of all deaths(166)! And diabetics are more prone than non-diabetics to develop cardiovascular complications, which, as will be discussed later, may have a Vitamin C connection(123,167,223).

What contributes most to heart disease are clogged arteries or arteriosclerosis. And what causes clogged, plaque-filled arteries are high lipid and cholesterol levels. And what causes high cholesterol levels is eating too much saturated fat. And the way to reduce cholesterol levels is to reduce dietary intake of animal fats and dairy products, sources of saturated fat. And so the fable of the last 30 years or so goes on. Right? NOT NECESSARILY!!!!

Are you aware that a long term, large scale epidemiological study of the population of Framingham, Massachusetts, conducted by the National Institute of Health showed NO significant correlation between dietary cholesterol intake and blood cholesterol levels, and that at least 8 clinical trials conducted in the US, the UK and Scandinavia between 1965 and 1972 also showed that changing the amount of dietary cholesterol had NO significant effect upon heart disease(3,45,166,240)?

Eminent and erudite nutritional physicians such as Dr. George V. Mann of Vanderbilt University School of Medicine have added their voice, through such distinguished journals as the New England Journal of Medicine -"Foundations, scientists and the media....have promoted low fat, low cholesterol, polyunsaturated diets, and yet the epidemic continues unabated....the oil and spread industry advertises its products.....promises that make these foods seem like drugs...(166)"

Are you aware that in fact, according to published evidence by Professor John Yudkin, even as long ago as 1957, more than 30 years ago, there is a direct and highly significant correlation between the intake of sugar and heart disease in 15 countries. Clinical and epidemiological studies conducted by Yudkin confirmed that men eating high quantities of sugar were significantly at greater risk of developing heart disease than those with low sugar intakes(243-4). When has this been advertised in the media?

Several anomalies in the high fat-heart disease story also indicate that sugar, not fat is the main culprit(80), those including peoples such as Yemenite Jews(57), East African Masai and Sumburu tribes, all of whom ate a high-fat, low sugar diet and who didn't suffer from heart disease until sugar intake increased(166).

And are you aware that way back in the 1930's, that's 50 years ago, a link between Vitamin C and arteriosclerosis and heart disease had already been established(151,174,205)? Are you also aware that by 1953, 35 years ago, an intimate relationship between Vitamin C, cholesterol synthesis and atherosclerosis had already been documented(18,163,235), and that by 1957, it had been shown that atherosclerosis is reversible by Vitamin C(149, 236-9)? Even as early as 1947 it was suggested in a clinical article(211) that Vitamin C be used for treatment of heart disease. Furthermore, Vitamin C also possesses significant therapeutic impact upon diabetes and hypoglycemia. But is Vitamin C being widely dispensed by cardiovascular specialists and hospitals(76)?
Read today's newspapers. Page 1, Sept. 3, 1989, of the London Sunday Times "Poly Fats Bad for You". New Scientist, Sept. 9, 1989 "Media saturation fuels debate about fats in the diet". Full-page ad in London Observer, Sept. 10, 1989 "Polyunsaturates are Essential for Health", sponsored by the Flora Project (Flora is a brand of margarine).

What is going on here? Is it any wonder that everyone, including the public, is thoroughly confused about what is or isn't good for you. And while we are all bending over backwards to attempt to reduce cholesterol levels by not eating animal and dairy derived fats, is it really to no avail to our improved health. What are the facts, and how can we, as discriminating health-conscious individuals, cut through this massive gobbledy-goop of scientific and medical red tape? And, furthermore, who can we believe, with so many "experts" lining up on different sides of the heart disease question?

Having surveyed the historical literature concerning heart disease, cholesterol and Vitamin C, the author is appalled at this scandalous outrage of re-enforced ignorance and misinformation. Fifty years ago is a long time; even 30 years is long ago. But even today in 1989, the public is still being barraged by the media about fat and high cholesterol levels. Something has got to change. And that seems to point to a more highly critical and discerning consumer who is willing to question and doubt even their doctors. In actuality, sober reading of the clinical information about cholesterol, heart disease, and the impact of Vitamin C, is lucid, highly revealing, and offers food for thought and helpful suggestions for sufferers of heart-related conditions.

The Cholesterol Story
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Consider cholesterol,the lipid substance, formula C27H46O. It is found in all bodily tissues, particularly in the brain, spinal chord, liver and bile. The liver manufactures cholesterol, quite a lot of it, about 3-4 g per day, from a variety of sources, including acetate, an organic salt generated during normal metabolism, dietary cholesterol, and bile acids reabsorbed from the intestines(166). There is actually a cholesterol cycle:

1. Cholesterol is synthesized in the liver;

2. Cholesterol, associated with a lipoprotein called "low-density lipoprotein (LDL)", is transported through the body's bloodstream. This is the stage of the cycle where cholesterol can attach to and be deposited in the linings of arteries.

3. Cholesterol, associated with another lipoprotein called "high-density lipoprotein (HDL)", is transported to the gall bladder where it is converted to bile acids, which are then eliminated via the intestines.

4. Some of the bile acids are reabsorbed from the intestines, reconverted to cholesterol and hence carry on with the cholesterol cycle.

The cholesterol that we consume in our diet obviously does constitute part of the cholesterol "pool" in the body; the recommended dietary levels of 250-300 mg would therefore constitute less than 10% of the total cholesterol amount made by the liver. Moreover, there is a feedback mechanism which will decrease the amount of newly synthesized cholesterol if we consume more cholesterol than normal(166). In the above-mentioned Framingham study, there was no difference in the total serum cholesterol levels of the men and women who consumed higher or lower amounts of cholesterol in their diet(166). Actually, the total amount of cholesterol in the blood is determined by the interaction of 4 factors:
1. The rate of cholesterol liver synthesis from acetate.

2. The rate of cholesterol obtained from food.

3. The rate of cholesterol converted to bile acids and excreted via the intestines.

4. The rate of bile acids reabsorbed and reconverted to cholesterol.

What becomes crucial in the cholesterol story is the BIOCHEMISTRY AND PROCESSING of cholesterol in our bodies. High serum cholesterol levels are dangerous, and ARE correlated with increased risk of heart disease. In a study conducted by the National Heart Institute, in which blood cholesterol levels were reduced by 8.5%, the death rate from heart disease was reduced by 25%(166). However, DIETARY source of cholesterol are not necessarily the principle contributors to total cholesterol levels, and altering DIETARY cholesterol intake alone does not necessarily produce lower cholesterol levels.

The biochemistry and function of the two lipoproteins, LDL and HDL are crucial in understanding the cholesterol cycle. LDL's, low-density lipoproteins, carry cholesterol throughout the bloodstream, enabling cholesterol to "stick" to cell linings. LDL's are "bad guys". HDL's, on the other hand, transport cholesterol back to the gall bladder, where it is converted to bile acid and excreted via the intestines. HDL's are therefore "good guys", because they are helping to eliminate cholesterol. A growing body of evidence now indicates that total cholesterol, LDL and HDL measurements are actually a more reliable index of our cholesterol "status" than simply total cholesterol measurements alone. High levels of cholesterol and LDL correlate with high risk of heart disease; high levels of HDL correlate with low risk of heart disease.

This is not to deny that the amount and type of fat consumed, whether saturated or polyunsaturated, is not an important parameter in the heart disease equation. The essentiality and benefit to health of certain types of polyunsaturated fats have received considerable attention in recent years as has the potentially increased rate of free radical formation with the use of polyunsaturated fats found in margarines. For a more detailed coverage of the fats and oils story, which is beyond the scope of this volume, the reader is enthusiastically referred to "Fats and Oils" by Udo Erasmus(74). For the sugar connection, Yudkin's "Sweet and Dangerous"(244) is highly recommended.

Thus far, the majority of health investigators have concentrated upon the dietary cholesterol factor in the heart disease equation(206). However, research into other aspects, such as increasing HDL levels and thus the elimination of cholesterol, increasing the synthesis of collagen, a major structural component of blood, and inhibiting the degradation of the lining of arteries, have yielded valuable information which has documented and corroborated the 1930's research which implicated Vitamin C deficiencies with heart valve and muscle lesions, and heart disease. In fact, there is now a considerable volume of clinical, biochemical and epidemiological evidence which attests to Vitamin C's important role in preventing, controlling and even reversing the number one killer - heart disease (5,15,18,29,31-2,58,69,76-8,81,131,189,190,195,209,216,223,230).

The Vitamin C Heart Disease Connection
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Clinical and epidemiological studies demonstrate that Vitamin C plays a vital role in the prevention, control and even reversibility of atherosclerosis, the "deposition of hard yellow plaques of lipoid material in the intimal layer of the arteries, resulting in arterial degeneration and thickening".

Historically, during the 1930's and 1940's, researchers noted that Vitamin C deficiencies in guinea pigs led to heart valve and muscle lesions, myocardial degeneration, arteriosclerosis, inflamed heart valves, myocarditis, pericarditis and coronary thrombosis(151,163,174,205,211); in other words, Vitamin C was linked to atherosclerosis. During the 1950's, the Vitamin C was shown to be related to cholesterol metabolism - Vitamin C deficiency led to increased cholesterol synthesis, feeding animals an increased cholesterol diet reduced Vitamin C levels and Vitamin C supplementation decreased cholesterol levels(149,235-8). In 1957, it was discovered (with guinea pigs) that Vitamin C could even reverse atherosclerosis(239)!

Now, more than 30 years later, our understanding at the biochemical level, of how Vitamin C protects against heart disease has advanced, along with a concomitant array of epidemiological evidence. Vitamin C has been shown tomodulate cholesterol metabolism in the following ways(83-8,157-9,193-6,215):

1. Vitamin C increases the rate at which cholesterol is removed by its conversion to bile acids and excretion via the intestines;

2. Vitamin C increases HDL levels. High HDL levels are correlated with low risk of heart disease;

3. Vitamin C, through its laxative effect, accelerates elimination of waste, thereby acting to decrease the re-absorption of bile acids and thence their reconversion to cholesterol.

Clinical studies have shown that Vitamin C reduces serum cholesterol and triglyceride levels in individuals with high levels. Ginter(85) showed that 1 g/day Vitamin C led, after 3 months, to a decline in plasma cholesterol levels by 10% and triglycerides by 40%. Another study(78) showed that 3 g/day Vitamin C decreased cholesterol by 18% and triglycerides by 12% after 3 weeks. Vitamin C does not reduce cholesterol or triglycerides levels in individuals who are within "normal" values(118), suggesting that Vitamin C acts in a homeostatic way to promote equilibrium.

It has been known for over 50 years that Vitamin C is essential for the synthesis of collagen(166). Collagen, a superhelical protein, composed of amino acids glycine and hydroxyproline, is one of the most important buttresses to the body's architectural integrity. Collagen is fibrous and strong, forming the connective tissue essential to strong bones, teeth, skin, muscle, blood vessels, indeed all body parts(177). Extensive biochemical research has revealed that Vitamin C is required for almost every step involved in the complex synthesis of collagen. Deficiencies of Vitamin C lead to a weakening of the structural foundation of all body parts, including blood vessels, the heart and heart muscle(14). The intimate involvement of Vitamin C with collagen synthesis is certainly a factor in C's positive effect in protecting against heart disease(201,203).

At the molecular level, Dr. Anthony Verlangieri, director of the Atherosclerosis Research Laboratories at the University of Mississippi and co-workers have been researching, for twenty years, the mechanisms behind Vitamin C's therapeutic effect upon atherosclerosis(219). Dr. Verlangieri has shown that Vitamins C and E is required for the synthesis of a substance called glycosaminoglycan (GAG), a crucial ingredient for the "cement" which holds arterial cells in place(224). Deficiencies of Vitamins C lead to deterioration of the cell lining, resulting in arterial lesions, which then can fill up with cholesterol, causing atherosclerosis(223). The mechanisms of Vitamin C's role in GAG synthesis have been elucidated by Verlangieri's group.

It turns out that sulfate groups play a critical role in supporting the strength of the GAG matrix(10,157). High sulfate levels are correlated with low cholesterol levels; low sulfate levels with high cholesterol(220). Removal of sulfate groups by an enzyme called Aryl Sulfatase B leads to degradation of the GAG matrix. Vitamin C has been shown to inhibit this enzyme and thence prevents the removal of sulfate group of the GAG matrix(223). These methodical and rigorous studies at the molecular level support the theory that one of the key elements in preventing and controlling atherosclerosis is the maintenance of structural integrity of cell and arterial linings. Vitamin C, involved directly in collagen synthesis and in the inhibition of Aryl Sulfatase B, obviously is an important factor in supporting the structural integrity of the body tissues. Additional elegant studies, initially with rabbits(224) and more recently using non-invasive ultrasound techniques in monkeys(222), have also demonstrated that arteries with high Vitamin C levels have lower cholesterol levels and that Vitamins C and E can actually reverse the disease process of atherosclerosis(230)! (Fig. 4)

Fig. 4. Effect of Vitamins C and E Upon Arterial Stenosis (narrowing)(230)

Vitamin C Prolongs Life - Epidemiological Evidence
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Epidemiological studies provide the nitty gritty proof of which factors are statistically correlated with the hypothesis in question. Several epidemiological studies performed with Vitamin C, in America, the UK and throughout Europe, provide evidence that Vitamin C has an important protective effect against heart disease. In fact, one study by Chope & Breslow(55) revealed that Vitamin C supplementation was the most important factor in decreasing the death rate.

A study by Gey et al(82), recently presented at the Third Conference on Vitamin C, surveyed the plasma levels of Vitamin C of populations at different risks from heart disease throughout Europe, including Southern Italy, Switzerland, Northern Ireland, Scotland and two regions in Finland. The results, shown in Fig. 5, were highly revealing and demonstrated the important protective factor that Vitamin C represents against ischemic heart disease (IHD). In South Italy and Switzerland, where Vitamin C levels were adequate, the heart disease mortality was low. In Northern Ireland, where Vitamin C levels were on the borderline between adequate and marginally deficient, the heart disease mortality was medium. In Scotland, where heart disease mortality was high, Vitamin C levels actually delved into the region of being at risk at overt scurvy. This study also showed the protective effect of Vitamin E against heart disease.

Fig. 5. Vitamin C and Heart Disease Mortality in European Countries(82)

Vitamin C to Replace Triple Bypass Surgery?
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The research data has certainly been accumulating in favour of Vitamin C's powerful effects in reducing cholesterol and LDL, increasing HDL levels, actually reversing the atherosclerotic process, and in decreasing mortality from heart disease in a variety of populations from western countries. Will we be seeing the day when safe, inexpensive Vitamin C may replace dangerous, and expensive surgical treatments such as open heart surgery arising from arteries clogged up with cholesterol? In this instance, surely the saying "an ounce of prevention is worth a pound of cure" is more than apt when it comes to Vitamin C and heart disease.

The Diabetes Connection
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Diabetics are at greater risk of suffering the complications of heart disease and atherosclerosis. Despite the life-saving effects of insulin in preventing diabetic coma, diabetics suffer secondary complications such as blindness and atherosclerosis. These complications include a 25-fold greater incidence of retinal artery disease, a 7-fold greater incidence of kidney and a high incidence of coronary arterial conditions(221,223).

One explanation for this high incidence of cardiovascular disease amongst diabetics invokes the molecular similarity of glucose and Vitamin C, discussed in Chapter 2. It is recalled that in diabetes, there is an insufficient level of the hormone insulin to uptake glucose from the blood into cells. Therefore, although the diabetic may have extremely high glucose levels in the blood and urine, his or her cells may actually be starved for glucose, which need insulin to transport glucose into the cell.

Since Vitamin C is structurally very similar to glucose, one of the transport mechanisms of Vitamin C into the cells has been suggested to be via the insulin transport mechanism. If, as in diabetes, glucose concentrations are very high, then Vitamin C will be "out-competed" by glucose and will simply not get into the cells. As stated by Pecoraro & Chen(167) who were investigating competition for membrane transport between glucose and ascorbic acid at the most recent Vitamin C International Conference: "these results are consistent with the hypothesis that chronic hyperglycemia may be associated with intracellular deficits of leukocyte AA, an impaired acute inflammatory response, and altered susceptibility to infection and faulty wound repair in patients with diabetes". This cellular deficiency in Vitamin C, with its concomitant effects - increased cholesterol levels, increased atherosclerosis, degeneration of heart and arterial tissues - contribute to the above-named complications experienced by diabetics(191).

Vitamin C is said to be a potentizer of insulin, in that less insulin is needed to control blood sugar when Vitamin C is given in combination(180,198). If it is true that the complications of diabetes are the result of cellular Vitamin C deficiency, then treatment aimed at increasing Vitamin C levels in diabetics ought to yield beneficial therapeutic effects. There has already accumulated a considerable clinical literature linking Vitamin C with insulin action(11-13,95,169,171,200). Continued research into the interactions of Vitamin C and insulin may yield a safe and inexpensive way to control diabetes and to prevent the development of the tragic cardiovascular complications suffered by millions of diabetics.