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Letters to the Editor Issue 279

by Letters(more info)

listed in letters to the editor, originally published in issue 279 - June 2022

New Research Offers Hope for Former Footballers at Risk of Dementia

A new research study will investigate possible ways to reduce dementia risk in former professional footballers.

The £1.3 million, four-year BrainHOPE study – led by the University of Glasgow, in collaboration with the University of Edinburgh, Imperial College London and the wider PREVENT Dementia research collaborators – builds on the ground-breaking observations of the FIELD study, which found risk of dementia and related disorders among former professional footballers was around three and a half times higher than expected.

BrainHOPE [Optimising Brain Health Outcomes in former Professional and Elite footballers] – jointly funded by The Football Association and FIFA – will use brain imaging and a range of tests to compare brain health in mid-life former footballers to general population control subjects already recruited to the PREVENT Dementia study. 

In addition, in a world’s first, researchers will explore whether any differences in brain health among footballers might benefit from management of known dementia risk factors designed to try and their reduce risk. 

To do this, BrainHOPE will recruit in total 120 former professional footballers aged 40-59 years to compare against 700 general population controls. The effectiveness of Brain Health Clinic management will then be explored within the footballer subjects, with the brains scans and tests repeated again after two years.

Prof Willie Stewart, BrainHOPE lead, Consultant Neuropathologist and Honorary Professor at the University of Glasgow, said:

“This is an incredibly important study, and we are grateful to the FA and FIFA for their support to allow it to proceed. Our findings from the FIELD study show there is reason to worry about lifelong brain health in former footballers. BrainHOPE is designed to identify tests that might detect problems early on and, more importantly, possible ways to try and reduce dementia risk for former footballers.”

Prof Craig Ritchie, BrainHOPE co-lead, Chair of the Psychiatry of Ageing and Director of Edinburgh Dementia Prevention at the University of Edinburgh, and lead on the PREVENT Dementia Programme, said:

“­­­­­­­­­­­­­This is such an important study aligned to the main PREVENT Dementia Programme and solidifies an exceptionally strong academic collaboration between Universities of Edinburgh and Glasgow and Imperial College London. This work will help us understand in detail the association between playing football and brain health and in doing so have a great impact on the wellbeing of current and retired players.”

Charlotte Cowie, Head of Performance Medicine at the FA, said:

“The launch of the BrainHope study is another important step in building our understanding of the long-term health of former professional footballers. Forming part of the wider Prevent Dementia study, this research will help us further understand the links between the game and neurodegenerative diseases and also potential early interventions which could help reduce risk or speed of developing dementia.”

The 2019 FIELD study – led by Professor Willie Stewart, University of Glasgow – remains the largest study to date looking in detail at the risk of neurodegenerative disease in any sport, not just professional footballer players.

The study compared health records of 7,676 former Scottish male professional football players who were born between 1900 and 1976 against those of more than 23,000 matched individuals from the general population. Neurodegenerative disease risk among former football players relative to matched controls was then calculated for a range of player positions and career lengths and for decade of birth.

In parallel work led by Prof Stewart, a specific pathology linked to brain injury exposure, known as chronic traumatic encephalopathy (CTE), has been described in a high proportion of the brains of former contact sport athletes, including former amateur and professional footballers.

Interested in Participating

Former professional football players interested in participating in this ground-breaking research should contact https://preventdementia.co.uk/prevent-sports/

Further Information

For more information contact Elizabeth McMeekin or Ali Howard in the University of Glasgow Communications and Public Affairs Office on Tel: 0141 330 4831 or 0141 330 6557; or Elizabeth.mcmeekin@glasgow.ac.uk  or ali.howard@glasgow.ac.uk  

 

 

‘Brain-Age’ Biomarkers Predict Stroke Recovery more Accurately than Chronological Age

Stroke experts have identified how radiomics, an emerging image-quantifying technology, can be used to extract biomarkers from clinical brain MRI scans in stroke patients and estimate a patient’s relative ‘brain age’.[1] The technique demonstrates that using relative brain age, rather than chronological age, can enhance stroke surveillance and improve predictions on post-stroke recovery.

The study, presented recently at the European Stroke Organisation Conference (ESOC 2022) analysed 4,163 ischaemic stroke patients across the US and Europe. It showed how stroke patients with ‘older-appearing’ brains, characterized by a higher predicted brain age than chronological age, were more likely to suffer from hypertension, diabetes mellitus, or have a history of smoking or prior stroke.

Patients with older appearing brains were also less likely to achieve a favourable post-stroke outcomes in comparison with their younger-looking counterparts.

Led by Dr Martin Bretzner from Harvard Medical School (Boston, USA), the research team considered that whilst chronological age measures the amount of time a person has lived, it is less likely to precisely capture how well a patient has aged. By estimating the age of a patient’s brain, this novel biomarker provides insight into the resilience of a brain to time and cardiovascular risk factors, and how well patients recover from stroke.

The technique – radiomics – leverages advanced mathematical analysis to explore neuroimaging data available to clinicians, allowing experts to predict patients’ relative brain age compared to other stroke survivors and analyse their overall brain health.

“Age is one of the most influential determinants of post-stroke outcomes, but little is known about the impact of neuroimaging-derived biological ‘brain age’”, commented Dr Martin Bretzner. “Our results show that quantifying relative brain age in stroke patients can be beneficial in assessing a patient’s brain health globally, and useful in predicting how well the patient will recover from a stroke. It would also be very easy to communicate on this biomarker with clinicians and patients, as everyone instinctively understand the negative implications of an accelerated brain ageing process.”

The study found that relative brain age impacted stroke outcomes independently from chronological age and stroke severity. Having previously suffered from a stroke was the most influential clinical factor that impacted relative brain age, followed by diabetes.

According to research, one in four stroke survivors will have another stroke[2] and yet up to 80 per cent might be prevented with the right treatments and lifestyle changes.[3] The number of people living with stroke is estimated to rise by 27% between 2017 and 2047 in the European Union, mainly due to an increase in the number of people over 70.[4]

“These findings stress the importance of minimising cardiovascular risk factors and also highlights how cardiovascular health and brain health are tightly intertwined”, added Dr Bretzner. “Identifying potentially modifiable risk factors that impact brain health by using radiomics and relative brain age as a biomarker could lead to the development of stroke prevention interventions and aid recovery.”

“We hope that this research will serve as a support to identify fragile stroke patients that require more intensive prevention techniques, treatments and surveillance in the future.”

About the Study Author

Dr Martin Bretzner is a researcher from the Mass General Brigham, Harvard Medical School, Neurology, Boston, United States, and an interventional neuroradiologist at the Lille University Hospital. This study was funded by the ISITE-ULNE foundation, Mass General Brigham hospital, the French Society of Neuroradiology, the French Society of Radiology, the Thérèse and René Planiol Foundation.

About ESO

The European Stroke Organisation (ESO) https://eso-stroke.org/ is a pan-European society of stroke researchers and physicians, national and regional stroke societies, and lay organizations, founded in December 2007. The ESO is an NGO comprised of individual and organizational members. The aim of the ESO is to reduce the burden of stroke by changing the way that stroke is viewed and treated. This can only be achieved by professional and public education and making institutional changes. ESO serves as the voice of stroke in Europe, harmonizing stroke management across the whole of Europe and taking action to reduce the burden.

Four Facts on Stroke

  1. In 2017, there were 1.12 million first strokes in the EU, 9.53 prevalent stroke cases and 460,000 stroke-related deaths;[4]
  2. In 2017, there were 7.06 million disability adjusted years lost due to stroke in the EU;[4]
  3. By 2047 it has been estimated there will be an additional 40,000 strokes per year in the EU (a rise of 3%);[4]
  4. 80% of premature heart disease and stroke is preventable.[5]

References

  1. Radiomics derived brain age predicts functional outcome after acute ischemic stroke, presented at the European Stroke Organisation Conference, 5 May 2022.
  2. https://www.stroke.org/en/life-after-stroke/preventing-another-stroke
  3. https://actionplan.eso-stroke.org/domains/secondary-prevention/
  4. https://www.ahajournals.org/doi/10.1161/STROKEAHA.120.029606
  5. https://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/data-and-statistics

Further Information

For more information or to arrange an expert interview, please contact Luke Paskins or Sean Deans on luke.paskins@emotiveagency.com, sean.deans@emotiveagency.com or press@eso-stroke.org, or call +44 (0) 208 154 6396.

 

 

Healthcare Professionals Sought to Share Experiences of Supporting Mental Health of New Mums

A Leeds Beckett University PhD researcher is looking for healthcare professionals to take part in a study into the online provision of mental health support for new mums. Lauren McSorley, who is studying for a PhD in Psychology within the Leeds School of Social Sciences at Leeds Beckett, is exploring the benefits and challenges of supporting women in an online capacity – as well as the potential improvements that could be introduced.

Lauren explained:

“I am looking to talk to healthcare professionals who offer online support to new mothers regarding their mental health and wellbeing. This could be through online forums, social media groups, support networks or charities.

“The research will help to provide an understanding of how online wellbeing support for new mothers can potentially be improved or adapted in order to best support women with their postnatal mental health concerns. The findings will be important for both healthcare professionals and parenting website and forum providers.”

Participants are invited to join a virtual focus group, using MS Teams, with a small group of between four and seven healthcare professionals. Each group will last approximately one hour. Alternatively, one-to-one virtual sessions can be set up. Participants need to be UK residents aged 18+.

To take part, please complete the registration form at: https://bit.ly/3Fi0HxR

Participants will receive a £20 Love2Shop voucher as a thank you for sharing their experiences. All responses will be treated confidentially and anonymously.

Lauren’s current research forms part of a series of studies which she hopes will be used to inform and shape recommendations for healthcare professionals to best support the mental health of new mothers.

In 2021, Lauren conducted a survey to explore how and why mums use online forums, and remote methods of support, to care for their postnatal mental health and wellbeing and to support their experience of becoming a mother.

Notes to Editors

  • Leeds Beckett University is ranked among the 10 most successful universities in the UK for widening participation and ensuring higher education is accessible to people from all backgrounds;
  • The university was awarded silver status in the Teaching Excellence Framework for its high quality teaching;
  • Leeds Beckett has 28,000 students and is investing £200m in university facilities;
  • The university contributes an estimated £624m to the economy each year.

Contact Information

Carrie Braithwaite, Research & Enterprise Communications Executive
Leeds Beckett University
Tel: 0113 812 3027
c.braithwaite@leedsbeckett.ac.uk

 

 

Obesity Stigma: A Barrier To Life-Saving Cancer Screening Services “Providing a supportive environment which is weight-friendly, is crucial”

A study has found that people living with obesity are failing to access vital cancer screening services due to fears of stigma and judgement surrounding their condition. Healthcare researchers at the University of Sunderland set out to explore the impact of obesity and obesity stigma on the uptake of three main cancer-screening services: breast, cervical, and colorectal, from both the patients and healthcare professionals’ perspective, within community and general practice settings. The research team included Professor Yitka Graham, Professor Catherine Hayes, Julie Cox, Kamal Mahawar, Ann Fox and Dr Heather Yemm. [1]

Analysing studies over the last 10-years, across Europe, Australia and the United States, the researchers found that many healthcare providers hold strong negative views and attitudes toward people with obesity who present in healthcare settings, with evidence that such viewpoints can influence perceptions about the patient, judgment, behaviour toward the patients, and influence decision-making on treatment.

Several studies highlighted disparities in the population living with obesity; a study of breast screening participation in women aged 50–64 years found that both women, underweight or obese, had significantly higher levels of non-participation with mammography compared with normal weight women. Another study showed a decrease in cervical screening linked to increased body size. Meanwhile, men of a normal weight are more likely than men who are overweight or obese to have undergone colorectal screening.

What was apparent from the research was the evidence that the higher a woman's BMI was, the statistically less likely she was to engage and uptake with cancer screening services. Factors preventing screening included embarrassment, negative body image, and imaging with medical equipment. The review argues that more research is now needed to improve the uptake of cancer screening services, and that more education is considered for health professionals around weight prejudice, which they say is often unconscious. They believe this may help increase the incidence of early diagnosis of potential cancers and improve health outcomes for people living with obesity.

Lead researcher, Professor Yitka Graham, Head of the Helen McArdle Nursing and Care Research Institute, Health Services Research at the University of Sunderland, said:

“Obesity is a known risk factor for the development of cancers, there is also an acknowledged stigma across society towards people living with obesity, which can influence health behaviors and deter seeking help, such as cancer screening. Healthcare professionals’ attitudes and views toward people living with obesity may also affect the patient–professional interface and treatment.”

Kamal Mahawar, Consultant Bariatric Surgeon at South Tyneside and Sunderland NHS Foundation Trust, Visiting Professor and External Advisory Board Member of the Helen McArdle Nursing and Care Research Institute commented

“The findings of this review show that excess weight is a barrier to accessing cancer screening services for both sexes. The review highlighted the importance of healthcare professionals to understand the concerns and fears of people living with obesity when attending for cancer screening, whether perceived or real, for example, feeling stigmatized, and make every attempt to ensure that facilities are weight-friendly, from equipment, language used, and overall environment.”

Collaborator Dr Julie Cox, Consultant Radiologist at County Durham and Darlington NHS Foundation Trust, Visiting Professor and External Advisory Board Member of the Helen McArdle Nursing and Care Research Institute, said:

“The review also identified that many healthcare professionals were not comfortable or experienced in undertaking screening procedures with people living with obesity, and that education on techniques for performing screening interventions with this population, along with learning how to deal with refusals and other barriers, and providing a supportive environment which is weight-friendly, is crucial.”

The study was funded by the Northern Cancer Alliance (NCA), and it is the latest example of quality research taking place at the University of Sunderland. This week it was announced that over 70% of published research carried out at Sunderland has been rated as either world-leading or internationally excellent in the 2021 Research Excellence Framework (REF) results.

Sheron Robson, NCA Programme Manager for the Early Diagnosis Workstream, said:

“Understanding barriers to cancer screening is key to increasing uptake.  If people living with obesity are worried about being stigmatised, they will be less likely to attend screening programmes. Screening leads to early diagnosis, which means better prognosis, and this review will inform future service development.”

Rates of obesity have tripled globally since 1975, and as of 2016, the World Health Organisation estimated there were 650 million people living with obesity. By 2030, the rates are predicted to increase to one in five women and one in seven men, meaning over one billion people across the globe will be living with obesity. The study was carried out before the Covid-19 pandemic, and the wider impact of the pandemic on cancer screening services is currently in the early stages. The risks associated with obesity and related deaths in the context of Covid-19 and social distancing rules may be a further contributing factor to an already low uptake of screening services in the population living with obesity.

The Northern Cancer Alliance is a multi-agency collaborative of providers, commissioners and third sector organisations, working together to increase cancer survival across the North East and North Cumbria. The Northern Cancer Alliance achieves this by reducing inequalities, improving outcomes for everyone affected by cancer and delivering the best possible patient experience.

About the University of Sunderland

The University of Sunderland is a life-changing institution. It welcomes all with talent into higher education and supports students in reaching their potential through its strategic ambitions to be student-focused, professions-facing and society-shaping.

The University has around 23,500 students based at campuses in Sunderland, London and Hong Kong, as well as through global learning partnerships in 15 countries and online learning. The University is proud of its positive contribution to economic and social change. Its graduates leave equipped with the knowledge, skills, confidence and connections to make a positive difference in the wider world. 

Find out how the University of Sunderland can change lives at www.sunderland.ac.uk

Reference

  1. Yitka Graham, Catherine Hayes, Julie Cox, Kamal Mahawar, Ann Fox, Heather Yemm. A systematic review of obesity as a barrier to accessing cancer screening services. Obesity Science and Practice. 14 April 2022. https://doi.org/10.1002/osp4.60    

Further Information

Please contact  Helen Franks on Tel: 07786807586;L  pressoffice@sunderland.ac.uk

 

 

Why Does Science Still Ignore Vitamin C? – From Colds to Covid, Ascorbate has long been Marginalized

by Pim Christiaans

For more than 20 years, Dr Harri Hemilä, biochemist, physician and epidemiologist, has been analyzing research conducted with vitamin C. In 2017, ORTHO magazine had an interview with him. [1] At that time, the interest in vitamin C was mainly about the common cold. Now it also concerns another virus infection, Covid-19. Has anything changed since then? The near-total lack of interest within medical science for vitamin C still exists. And apparently, medical professors don't give a damn about the vitamin, as if it were a career killer.

Since 2002, Hemilä has considered it his professional duty to analyze studies conducted on vitamin C and to publish the analyses. What is the common thread after more than a hundred scientific publications, of which twelve were published in the years 2020 and 2021, and three in 2022? Well, one of these three reveals that common thread. In a review article of 27 pages in the open access magazine Life, [2] Hemilä unfolds his experiences and explains them in a long telephone conversation with ORTHO. The title of the article speaks volumes: "Bias against Vitamin C in Mainstream Medicine: Examples from Trials of Vitamin C for Infections." Remarkable. It turns out that prejudices ("bias") are a major common thread in the medical scientific world.

Thousand Versus Half a Million

In the article, Hemilä shows, among other things, that the authors of the COVID-A to Z Study wrongly conclude that vitamin C is ineffective against Covid-19, because the data they rely on incorrectly show otherwise. [3] This will be discussed in more detail below.

Hemilä is pleased that Life has published his extensive article on the prejudice against vitamin C for everyone to read. [2] However, he is under no illusions about its impact: "According to the counter on Life's website, more than a thousand people have read my article. The COVID-A to Z Study on JAMA's website also has a counter. And it was at half a million the last time I looked."

In the Life article, Hemilä refers to articles by scientists who note that since the beginning of the last century, doctors and medical scientists have been writing about and discussing nutritional supplements with disdain. According to these researchers, over-the-counter vitamin pills undermined the authority of doctors, because they allowed the patient to self-treat. Moreover, it was not possible to patent nutrients, so there was little to gain for the pharmaceutical industry. And in the second half of the twentieth century, the discovery of patentable antibiotics overshadowed the promising effects of vitamin C against infectious diseases.

It was not until the end of the 1960s that there was renewed interest in the vitamin when Linus Pauling got involved. This led to a series of relatively large studies that, according to Hemilä, supported the effectiveness of vitamin C. Nevertheless, scientific interest in the vitamin fell again in the late 1970s. Hemilä points to the so-called "Karlowski Study" as the main cause, along with two other articles from 1975.

Start of the Problem

In 1975, five years after the publication of Linus Pauling's book Vitamin C and the Common Cold, the scientific journal JAMA published the results of the Karlowski Study, a double-blind randomized placebo-controlled trial of vitamin C. [4] Although colds in the group of subjects who took 6 grams of vitamin C were 17% shorter, the authors attribute this outcome entirely to a placebo effect. Hemilä did not agree with this, and in 1996 subjected the data to a thorough re-analysis. [5] Astonished, he concluded that the data in fact do show a real, physiological effect of vitamin C and that the placebo explanation is incorrect. He caught the authors making all kinds of mistakes. For example, 42% of the recorded colds were apparently omitted from the subgroup analysis without further explanation - an unforgiveable sin within the statistics. The data indicate a dose-response effect: the tested dose of 6 grams per day is twice as effective as the tested dose of 3 grams per day. Hemilä calculates that if you draw the line, a study with 12 grams of vitamin C would have been the obvious choice. Such a study, however, never materialized, partly due to the discouraging placebo explanation of the Karlowski Study.

He compares the Karlowski-Study to a zombie: "Although liquidated long ago, it refuses to disappear into the grave and continues to leave a trail of destruction through scientific literature." Hemilä's skilful disassembly of the Karlowski Study has never been disproved, but nevertheless has had little impact. According to him, this study has remained by far the most influential study on vitamin C and the common cold. The vitamin C skeptics couldn't have it any better. There is a good chance that if a skeptical scientist mentions evidence on vitamin C, he will refer to this study.

Recent Studies Ignore Evidence

Even now, according to Hemilä, studies are published with negative conclusions in their summaries, while the data on which they are based imply a very different conclusion. A good example of this is the 'CITRIS-ALI study' that was published in JAMA in 2019. [6]

In that study, participants were 167 patients in the ICU with sepsis and acute respiratory distress syndrome (ARDS). They received intravenous vitamin C (50 mg/kg body weight every 6 hours) or a placebo for four days. The researchers conclude: "A 96-hour infusion of vitamin C showed no significant improvement in organ dysfunction scores, nor did it alter markers of inflammation and vascular damage, compared to placebo." but did not mention a major result: a strong decrease in mortality. Hemilä checked this and explained that during the first four days (when the vitamin C was administered) the mortality in the vitamin C group decreased by 81%. "The main clinically relevant result of the CITRIS-ALI trial was mortality and the measurement of a dozen biomarkers should not distract from that," said Hemilä.

A Second Study

As a second example, Hemilä provided the previously mentioned COVID-A to Z-Study, which was published in JAMA Network Open in 2021. [3] The aim of that study was to evaluate the effect of 8 grams per day of vitamin C in 520 ambulatory Covid-19 patients. However, the study was terminated prematurely due to the slow influx of patients. This slowness led, as the researchers had mentioned, to a state of "futility." [3] Therefore, in this aborted study, the number of patients remained at 214.

But Hemilä explained that this premature stopping was unjustified, because the effects of vitamin C were actually greater than the researchers had anticipated. [2] The researchers had expected a 1.0 day reduction in the duration of Covid-19, but they found a reduction of 1.2 days. Hemilä calculated that the recovery percentage in the vitamin C group was 70% greater than in the control group. None of this was reflected in the abstract of the article. The researchers, in turn, concluded that vitamin C did not significantly reduce the duration of symptoms. How can this difference between the facts found and the conclusions of the research be explained? Hemilä does not need to look far: one of the authors of the COVID-A to Z-Study declared in the "Conflict of Interest" statement that she has carried out paid consultancy work for Gilead Sciences." [3] This pharmaceutical company is the producer of Remdesivir, the first virus-inhibiting drug that was approved by the FDA for the treatment of Covid-19. Hemilä writes in his Life article: "What motivation does such a researcher have to find out whether a very cheap nutrient is actually effective against Covid-19 when an expensive drug available is available from a company for which she is a consultant?"

Timing Purely Coincidental

In February 2020, a team led by Harri Hemilä published a meta-analysis in the Journal of Intensive Care on the effect of vitamin C on the duration of artificial respiration given to ICU patients. [7] The timing was purely coincidental, but could not be better: the SARS-CoV-2 virus had only just started to spread from Wuhan and would cause death and destruction in the rest of the world in the months that followed. Hospitals' intensive care units everywhere were overloaded by Covid-19 victims, some of whom had to be on artificial ventilation for an unusually long time. The article's analysis seemed to imply a benefit from treatment with vitamin C. Hemilä and colleagues had collected data from eight studies involving a total of 685 patients who had ended up in ICU for a variety of reasons. Their calculations indicated that vitamin C had shortened the duration of artificial respiration by an average of 14%. In the most critically ill patients who had been on the ventilator the longest, vitamin C had actually reduced the duration by 25%.

More about Vitamin C and Covid-19

The big question now is whether lives would have been saved if the vitamin had been given as standard to all Covid-19 patients in the ICU from the start of the pandemic as a precaution? Very likely, but we'll never know. In any case, Hemilä's hopeful article received little attention. The field has not rushed to start the bigger and better research studies called for in the last paragraphs.

In a telephone interview, Hemilä reacted resignedly to this finding: "It is a very big step to add vitamin C to the treatment protocol for Covid patients in ICUs. Based on our publication, it is too early for that. The studies we had to rely on were small and therefore of poor quality. However, there is very strong evidence for a biological effect of vitamin C, which justifies better and larger studies. In the meantime, you could assuredly give it to patients -- because vitamin C is cheap, and safe even in doses of tens of grams administered orally or intravenously. This is again confirmed by a 2010 review of vitamin C researchers, including the first and last authors of researchers from the most respected institute in the US, the National Institutes of Health (NIH). [8]

Two quotes from Harri Hemilä:

Hemilä is not an uncritical apologist for Linus Pauling's views:

"Pauling had a point, but he was too optimistic about vitamin C," he says. "Unlike Pauling, I don't think that an ordinary, healthy person would benefit from taking more than 500 mg of vitamin C per day. For the elderly, he recommended something like 10 grams of vitamin C per day, and I see no justification for that. But if people are sick, the dose can be increased considerably. That should be better investigated." About twenty years ago, he considered setting up a clinical trial with vitamin C himself, but he quickly abandoned that plan:

"You need a lot of doctors for such a project and the doctors I approached were not interested. People who matter in science just don't care. I then decided that it makes more sense to continue to focus on analyzing existing data"

Reviews and Meta-Analysis

In his most recent meta-analysis, Hemilä showed that vitamin C increases left ventricular ejection fraction in cardiac patients.[9] He is also the lead author of a number of authoritative meta-analyses on vitamin C for the Cochrane Database of Systematic Reviews: within the medical science field the conclusions of 'Cochrane reviews' are often taken as the most reliable evidence.

He became best known for his Cochrane review on vitamin C and the common cold. [10] The conclusion is that vitamin C can reduce the severity and duration of a cold, albeit to a modest degree: with a daily intake of at least 1 gram of vitamin C per day an infection with a respiratory virus lasts on average 8% shorter in adults and 18% shorter in children. In 2017 he told ORTHO that you can see these results as a "proof of concept" of the effectiveness of vitamin C against respiratory infections. [1] The small but significant effect proves that vitamin C has an influence on viral infections, and there are indications that the effect is greater at higher doses. Hemilä also published meta-analyses on the effects of vitamin C on pneumonia ("therapeutic supplementation with vitamin C is reasonable") [11] and vitamin C on the length of stay in IC patients: [12] this appears to be on average 8% shorter under the influence of moderate doses of vitamin C.

Against Viral and Bacterial Infections

Hemilä has gradually become very well established in reference to his knowledge about vitamin C, especially with regard to infectious diseases. We should take the opinion of such a person seriously during a disruptive pandemic caused by a virus. For example, the article "Vitamin C and COVID-19," published in the journal Frontiers in Medicine in early 2021. [13] In that article, he reviewed the evidence from about a hundred animal studies that have shown that vitamin C can alleviate a wide range of viral and bacterial infections. In mice with sepsis and acute respiratory distress syndrome (ARDS), high-dose vitamin C administration decreased pro-inflammatory genes, improved epithelial barrier function and improved alveolar fluid clearance. According to Hemilä, vitamin C has a number of biological properties that are important in light of Covid-19 and a weakened immune system: the vitamin stimulates the proliferation and function of T lymphocytes and Natural Killer lymphocytes and increases the production of interferon, which are important functions of the immune system.

Low Blood Levels

An important indication of the usefulness of vitamin C in the treatment of Covid-19 is the fact that patients in critical condition who end up in intensive care often have greatly reduced blood levels of vitamin C. [13] And a vitamin C deficiency is often associated with pneumonia: "While 0.1 grams of vitamin C per day can maintain a normal plasma level in a healthy person, much higher doses (1-4 grams per day) are needed for critically ill patients to raise plasma vitamin C levels to the normal range. Therefore, high vitamin C doses may be needed to compensate for the increased metabolism to reach normal plasma levels."

Sepsis and ARDS Patients

Hemilä acknowledges in the article that there are currently no large double-blind random-controlled trials that provide direct evidence for an effect of vitamin C against Covid-19. [13] Weighing his words on a gold platter, however, he states that pending more and larger studies, high-dose vitamin C administration is already known to be helpful for Covid patients. After all, the vitamin is cheap and safe. He makes a suggestion based on his own review from 2017: "In patients suffering from a viral respiratory infection, 6 to 8 grams of oral vitamin C was significantly more effective than 3 to 4 grams per day. In recent studies of sepsis and ARDS patients, the dose of intravenous vitamin C was 7 to 14 grams over 3 to 4 days." [14]

Currently Hemilä finds that his call to utilize vitamin C has been little heeded. The fact that doctors have not started to give vitamin C to Covid-19 victims en masse can be explained by the appalling lack of good and large-scale studies. But why have they not been implemented? When asked about the state of affairs regarding the science of vitamin C and Covid-19 during the interview, he answered: "I can't say exactly because there is so much published that I can't keep up with it. Most of it is of low quality."

The Chinese Vitamin C Trial (2020)

As early as mid-2020, Hemilä was asked as a reviewer to comment on the protocol of a Chinese double-blind randomized placebo-controlled study.[15] The intention of the study was that 308 Covid-19 patients in the ICU would receive 24 grams daily of vitamin C or a placebo by infusion for a week. However, the execution of the experiment largely failed because of the draconian lockdown measures of the Chinese government, and too few patients ended up in the ICU. It eventually became a 'pilot study' with 56 patients: the duration of artificial respiration did not decrease in the vitamin C group. [16] According to Hemilä, however, the number of test subjects was too low to draw clear conclusions. After the interview, he sent in an e-mail:

"You asked about the state of affairs about vitamin C and Covid. See what you find when you type [vitamin C] and [Covid-19] on PubMed." The scientific search engine turns out to cough up sixteen reviews and four clinical studies. Hemilä, disappointed wrote: "That says enough. And most of it is junk."

How it Started

How can the half-baked treatment of vitamin C be explained? Harri Hemilä explains it based on his own experiences over the years. His fascination for the vitamin started in the 1970s when he saw Linus Pauling on television. The two-time Nobel laureate has just published his book Vitamin C and the Common cold. In it, he argued, based on the studies available at the time, that the common cold can be treated with high doses of C. A few weeks later, a Swedish professor appeared on Finnish television. "A very arrogant man," Hemilä recalls. "He had a bottle of vitamin C tablets with him and said, "This is junk without any effect." But he had no factual arguments or study results to support his negative statements."

Hemilä was studying biochemistry at the time and he asked himself who is right: Pauling or the skeptical professor? "I started collecting all the articles about vitamin C and infections. I didn't understand how it was possible that the important reviews judged the vitamin so negatively, while you could conclude from the results of studies that C is actually effective."

About Pim Christiaans

Pim Christiaans is journalist, magazine maker and author of health books in the Dutch language. He writes about scientific developments in the field of healthy aging at his website www.lifeunlimited.nl . Christiaans has no financial ties with or interests in companies that manufacture or sell nutritional supplements.)

Translated from Dutch and reprinted in English with permission of the author and Orthomoleculair Magazine, April 2022. Those seeking permission to reprint or translate may contact the magazine's publisher Gert Schuitemaker (ortho@ortho.nl)

References

  1. Christiaans P (2017) Vitamine C tegen verkoudheid. Orthomoleculair Magazine. 5:184-189. https://docplayer.nl/154405845-Vitamine-c-tegen-verkoudheid-opnieuw-op-een-rij-gezet-door-finse-wetenschapper.html
  2. Hemilä H, Chalker E (2022) Bias against Vitamin C in Mainstream Medicine: Examples from Trials of Vitamin C for Infections. Life 12:62. https://pubmed.ncbi.nlm.nih.gov/35054455.
  3. Thomas S, Patel D, Bittel B, et al. (2021) Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection: The COVID A to Z randomized clinical trial. JAMA Netw Open. 4:e210369. https://pubmed.ncbi.nlm.nih.gov/33576820
  4. Karlowski TR, Chalmers TC, Frenkel LD, et al. (1975) Ascorbic acid for the common cold: A prophylactic and therapeutic trial. JAMA 231:1038-1042. https://pubmed.ncbi.nlm.nih.gov/163386
  5. Hemilä H (1996) Vitamin C, the placebo effect, and the common cold: A case study of how preconceptions influence the analysis of results. J Clin Epidemiol. 49:1079-1084. https://pubmed.ncbi.nlm.nih.gov/8826986
  6. Fowler AA, Truwit JD, Hite RD et al. (2019) Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA 322:1261-1270. https://pubmed.ncbi.nlm.nih.gov/31573637
  7. Hemilä H, Chalker E (2020) Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis. J Intensive Care 8:15. https://pubmed.ncbi.nlm.nih.gov/32047636
  8. Padayatty SJ, Sun AY, Chen Q, et al. (2010) Vitamin C: Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects. PLoS ONE 5(7):e11414. https://pubmed.ncbi.nlm.nih.gov/20628650
  9. Hemilä H, Chalker E, de Man AME (2022) Vitamin C May Improve Left Ventricular Ejection Fraction: A Meta-Analysis. Front Cardiovasc Med. 9:789729. https://pubmed.ncbi.nlm.nih.gov/35282368
  10. Hemilä H, Chalker E (2013) Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013(1):CD000980. https://pubmed.ncbi.nlm.nih.gov/23440782
  11. Hemilä H, Louhiala P. Vitamin C for preventing and treating pneumonia. Cochrane Database Syst Rev 2013; 8:CD005532. https://pubmed.ncbi.nlm.nih.gov/23925826
  12. Hemilä H, Chalker E (2019) Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients 2019; 11:708. https://pubmed.ncbi.nlm.nih.gov/30934660
  13. Hemilä H, de Man AME (2021) Vitamin C and COVID-19. Front Med. 7:559811. https://pubmed.ncbi.nlm.nih.gov/33537320
  14. Hemilä H (2017) Vitamin C and infections. Nutrients 9:339. https://pubmed.ncbi.nlm.nih.gov/28353648
  15. Liu F, Zhu Y, Zhang J, et al. (2020) Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial. BMJ Open 10:e039519. https://pubmed.ncbi.nlm.nih.gov/32641343
  16. Zhang J, Rao X, Li Y, et al. (2021) Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Ann. Intensive Care 11:5. https://pubmed.ncbi.nlm.nih.gov/33420963

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Acknowledgment Citation

Republished from  Click here to see a web copy of this news release: https://orthomolecular.acemlna.com/p_v.php?l=1&c=238&m=238&s=c7ae1002d2f579a22c16a1b89c854212

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