Vitamins and Sepsis – In the News Again

Everyone knows that vitamins are good for us. One of the most commonly known vitamins is vitamin C. It is readily available through the food we eat and supplements on store shelves. Humans need vitamin C (also known as ascorbic acid) because not only does it help form body tissue, like blood vessels and muscle, it helps your body heal when you are injured or sick.

Over the years, some people came to believe that if some vitamin C is good for you, a lot must be even better. Scientist Linus Pauling heavily promoted this in the 1970s and 80s. One of Pauling’s most popular claims was vitamin C could prevent or cure the common cold. Unfortunately, clinical studies haven’t backed up his claims.

Pauling also believed that people who took vitamin C in “optimum amounts” could live 25 years or more longer. He said the vitamin, “…cuts down the probability of developing cancer, or heart disease or diabetes, or infectious diseases.” This claim was also not backed up through clinical research.

Vitamin C and Sepsis

Since Pauling’s promotion of vitamin C, several people have picked up the thread that it could help prevent or cure illnesses. Paul Marik, MD, believed the vitamin could play an important role in treating patients with severe sepsis. Marik is a critical care physician at Eastern Virginia Medical School (EVMS). He treated 50 patients with severe sepsis with a combination of vitamin C, thiamine, and corticosteroids. Only four of the patients died and Marik wrote up his experiment to share with others. [Please see editor’s note below]

This was seemingly good news. Vitamin C is easily available and affordable. If it could treat severe sepsis, it would save countless lives, limbs, and resources. But several clinical trials could not back up Marik’s findings. While it was true that only four of Marik’s patients died, there could be other explanations.

Researchers didn’t give up though and there were more clinical trials looking at vitamin cocktails. Last month, a study looking at over 500 patients with lung or heart dysfunction caused by sepsis, found again that a vitamin C cocktail did not reduce the number of days the patients were on a ventilator or on medications to raise their blood pressure. This was the largest study so far on using the vitamin as sepsis treatment.

In a segment on NPR, Marik, argued that studies like this one do not back up his findings because he now believes that vitamin C should be given by IV in the emergency department, to avoid delays. Studies in emergency departments are difficult to run, however, although according to Marik, researchers in Belgium are working on such a trial.

Vitamin C and COVID-19

As researchers try to find a cure or treatment for COVID-19, they turned to vitamin C too. Studies that look at treatment for COVID-19 are particularly interesting to those who study sepsis, because severe COVID-19 is viral sepsis.

One study published on February 12, 2021, looked at symptoms of patients diagnosed with COVID-19 but not hospitalized. They received either:

• High-dose vitamin C
• High-dose zinc
• A combination of vitamin C and zinc
• Neither

The results showed there were no differences in how long the COVID-19 symptoms lasted in any of the four groups.

Give It Anyway?

In online debates and editorial comments about sepsis and the lack of available treatments, many commenters state they believe doctors should offer vitamin C cocktails as a sepsis or COVID-19 treatment, with an attitude of it can’t harm you but it might help you. Christopher Seymour, MD, an associate professor of critical care medicine at the University of Pittsburgh, disagreed.

“What if the drug has no demonstrable treatment benefit but doesn’t show any harm? Should we just give it with the hope that if the, quote, “kitchen sink” is thrown at the patient, there will be a benefit? I don’t think so, in part because that distracts us from the science and the clinical care that actually might be making a difference,” he said in the NPR report.

The Take Away

What should the public take away from this debate? The main message is that at this point, there is no definite proof that the vitamin is helpful in treating patients with severe sepsis, nor in preventing or shortening COVID-19 symptoms. Physicians, like Seymour, fear that by placing so much emphasis on an unproven treatment, even if not harmful, could keep researchers and doctors from looking for treatments that will work. “If you focus on something that might work, sometimes you take your eye off the ball and don’t focus on something that you know works,” he said.

Editor’s Note: The study described in the article “Early use of high-dose vitamin C is beneficial in treatment of sepsis” was retracted by the journal on October 5, 2022.

Want to learn more about COVID-19 and sepsis? Click here for more information.