Vitamin C a help or hindrance?

The conflicting medical advice on whether vitamin C can help the treatment of cancer is difficult for patients, as Andrea Fox discovered.

Michael Jameson and Bill Reeder are both fluent in the wintry language of cancer. But they speak in different dialects on the subject of vitamin C as a treatment for New Zealand's biggest killer.

Jameson, a clinical oncologist at New Zealand's busiest hospital, Waikato, is also a cancer researcher and teacher. Reeder is a qualified medical practitioner, a GP who prescribes non- pharmaceutical treatments along with mainstream medicine at his practice in Hamilton. He wants it made clear that whereas specialists such as Jameson "treat cancer", he "treats people with cancer". Neither doctor felt the earth move when New Zealand researchers announced last month they'd established that vitamin C has a role in controlling tumour growth. After all, the role of this vitamin in treating cancer has been debated for more than 50 years. Google "cancer and vitamin C" and you get seven million hits.

For Jameson, the experimental finding by a team from Otago University, published in the prestigious international journal Cancer Research, was "another small piece in a very big puzzle". For Reeder it was simply another - albeit welcome - verification that vitamin C is beneficial to the immune system, and therefore helpful in the treatment of people with cancer.

Predictably, Jameson says the research team's journal article was "much more balanced" than media reports about the findings.

Long story short, the Otago University researchers said that for tumours to be able to grow, they had to be able to generate a blood supply and vitamin C can inhibit that process. Jameson says what they showed for the first time, after analysing cancerous and normal tissue from women having surgery for cancer of the uterus, was that aggressive cancers had lower levels of vitamin C but the least aggressive cancers had quite high levels of vitamin C - "much more than would be expected in normal tissue".

So does this mean we members of the cancer club should be lining up for mega doses of vitamin C to complement chemotherapy and radiation therapy treatments? Not so fast, says Jameson. We could be undermining his work, making his treatments less effective. Go for it (with qualifications), says Reeder, a GP for 25 years before starting up in integrative medicine 10 years ago. At the very least, he says, it will help the side effects of invasive treatments and there's much clinical evidence that it helps protect normal cells during those procedures.

WHEN YOU'VE just been diagnosed with cancer - and particularly if it has snuck up on you to a reasonably advanced stage (late stage three or four) by the time you find out - this sort of conflicting advice from professionals is surely not what the doctor ordered.

Life has taken on a whole new kind of uncertainty. You're looking for rules and reasons, comforting facts and experienced professionals to tell you that if you do a, b and even c, the result will be x and y. But new entrants to the cancer club quickly learn there are few hard-and-fast rules and no guarantees.

Doctors like Jameson will make recommendations on a regime of treatments, usually involving chemotherapy or radiation therapy or pharmaceutical drugs or surgery or combinations of some or all, and they will try to ensure you fully understand what is involved and the functions and effects of procedures. Nurses, therapists and various other medical personnel will carry them out.

But ultimately the onus is on the patient to make the decision about their treatment regime. Cancer has caused such devastation for so long it has become a big business and there's no shortage of treatment advice. Predators lie in wait to exploit fear and well-meaning charlatans will also happily take your money. The internet - with the exception of the excellent Cancer Society website and cancer.org - is best avoided.

So division between medical professionals over whether to hit the vitamin C - hardwired into us as a dietary essential by our mothers - is a tough one to encounter when you are vulnerable, sick and probably scared silly. Are you missing out on a life-saving or life- prolonging opportunity by choosing one opinion over the other?

It's a real dilemma. I went to see Bill Reeder during my course of chemo and daily radiation treatments prescribed by Jameson as a prelude to major surgery. Reeder had been highly recommended by a sicker friend, also under Jameson's care, who had the full vitamin C works and says he's alive today because he did. Reeder wanted to give me intravenous vitamin C treatments - after I'd cleared it with Jameson. Jameson didn't approve. So I didn't. And I wonder to this day, still to get a five-year cancer-free status passport, if it was the right decision.

So what is Jameson's problem with vitamin C? He says he is not "dissing" it. He just needs to see some hard clinical evidence that it works against cancer - in people. So far the evidence is "extremely limited", he says.

"The results from studies to date in mice suggest it's worth studying this; doing clinical trials in people to see if it actually works. But the trouble is what looks good in cells growing in a plastic dish and what looks good in mice, commonly does not translate into what works in people."

Jameson, who has pioneered New Zealand clinical trials of the value of selenium in cancer treatment, says in low doses vitamin C acts as a vitamin. In high doses it acts as a pharmaceutical. "All these theories and promising observations in animals have to be taken into clinical trials to see if they translate. Some of the best, and most obvious, ideas in the world have fallen over when taken to clinical trial.

"I can accept that people feel greatly enthusiastic about it [vitamin C] and believe at least it won't do any harm," he says. "But that's not necessarily true."

Jameson says vitamin C is an antioxidant. "Therapeutic radiation works by generating free radicals in cells from oxygen. You need oxygen in the tissue to generate the free radicals that damage the DNA and cause cancer cells to die. Vitamin C will mop up those free radicals and stop the radiation working. It is potentially counteractive - you get less-toxic, but less- effective, treatment.

"So before people start using this wholesale with cancer treatments, we need to do a lot more research to ask if it in some way makes cancers less aggressive without compromising how well treatments are working. The last thing you want to do is cause cancers to stop growing when you are giving treatment that works best on cancers that are growing and dividing."

AN EXAMPLE of too much of a good thing being bad for you is a clinical trial of beta carotene, the strong coloured red-orange pigment and inactive form of vitamin A found in plants and fruits.

Jameson says a large Scandinavian clinical trial gave beta carotene from carrots, apricots and vitamin E to 30,000 men who smoked to see its effects on lung cancer. The men showed no benefits and those who had enough beta carotene in their blood before they started taking extra in the trial showed a higher rate of lung cancer. "So not only wasn't it effective," he said, "it was actively harmful. The best comment I heard off the back of that study was that 'nature packages things better than pharmaceutical companies' - and that includes nutriceuticals. The 'some is good so more must be better' [thinking] is not necessarily true. Similarly, just because something is 'natural' it must be harmless is not true."

Jameson acknowledges it is frustrating for cancer patients when he douses their excitement over a new study finding. "We say more research is needed and that is a very slow, painstaking process because we want to continue to get outcomes for people, with fewer side effects and better results overall, and these things take a long time, many years and a lot of money."

But Jameson is frustrated too - by people who recommend high doses of intravenous vitamin C "without systematically gathering the data on what happens to the people they are treating, how effective it is, and if it helped in any particular way".

"Without that data, we don't know if it's helping, hindering or having any effect at all. There's a huge lack of good quality data and anecdotes don't cut it . . . you, as a patient, don't know which is the best treatment option for you, and I, as an oncologist, don't know if there are any options out there for you that are better than I have to offer. I'm on a salary, I get no commissions for supplying you with certain treatments. So if the guy down the road giving you intravenous vitamin C can get better results than I can achieve . . . I'm very happy for people to do that. But without the data I can recommend only what I know.

"The bottom line is people are investing their time, hope and money in a huge variety of treatments and unless each of us collects data, we are not serving our patients properly."

For that matter, does Jameson track what happens to his former patients after treatment? Apparently yes - by updating his database every six months from the national register of deaths. He also compares Waikato Regional Cancer Centre treatment results against international models.

REEDER SAYS Jameson's call is valid. He would "love" to be able to produce more robust data about vitamin C results from his practice but he does not have the resources. He can only refer people with cancer to 50 years of international collective observations, writings, and clinical studies about its efficacy - and his own observations of patients. "Vitamin C isn't expensive, so there aren't commercial sponsors [of clinical trials]. We will never get studies done."

Reeder does not claim vitamin C is a cure for cancer. "It is a useful adjunctive therapy." He prescribes vitamin C in intravenous as well as oral form, as part of a support treatment regime for cancer patients. He says he does not advocate high doses at the peak of mainstream treatment and encourages patients to discuss the vitamin C option with their cancer specialists. Intravenous vitamin C treatments are $170 each. Reeder recommends up to three a week for two to three months, reducing, depending on the results, to one a week and then an oral course, which costs "a few dollars a day". The treatments are not subsidised.

Reeder says vitamin C protects normal cells from the toxic blast of chemotherapy drugs and effects of radiation, reduces pain and side effects from mainstream cancer treatments, lifts wellbeing and assists healing. It is a powerful support for the immune system, an anti-stress nutrient, an anti- toxin and a "universal" therapy for relieving many chronic illnesses because of its anti-toxin effects, he says.

Reeder concedes that massive doses of vitamin C can produce a "pro- oxidant" effect - considered a "bad thing by mainstream medicine". But he says researchers have also discovered that heavy doses can cause the body to release hydrogen peroxide which is "lethal" to cancer cells, without being too harmful to normal cells.

"A lot of international clinics use vitamin C right through [mainstream treatment] and say there is no evidence of harm, in fact they say it increases the benefits. Others of us are more conservative." High doses of vitamin C can produce gastric side effects but a new highly absorbent delivery mechanism now available counters these successfully.

Reeder says his patients with cancer report feeling much better and "anecdotally, survival seems to be better long term". His dearest wish is for an institute - "a centre of excellence for integrated cancer support" - to be established in New Zealand, where cancer therapists in mainstream and complementary medicine work alongside each other, running trials and studies "to find the truth".

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