 Welcome, everyone, to today's Knowledge Break webcast. My name is Casey Farm, and I'm the Director of Alumni Relations for the College of Public Health and Human Sciences. I am absolutely delighted to be the host for today's talk, What You Need to Know about Vitamin C and COVID-19. I will introduce today's topic and speaker in a moment, but just to let you know, we have 132 people registered today, so it makes for a really great webcast. So thanks very much for joining us. And first, I'd like to start off with a big thank you to our donors, alumni, and everybody in Beaver Nation for tuning into our webcast today. We are extremely grateful for each and every one of you. Thank you very much. And I'd also like to thank our donor community for showing up for our students at this time. Through our Beaver's Care Initiative, over 1,500 donors have provided more than $753,000 to support students affected by COVID-19. These gifts are helping our students meet their very basic needs and stay on track to graduate. Thank you very much, donors, alumni, Beaver Nation. We really appreciate it. For more information and to join your fellow Beavers in this initiative, please visit beaverscare.org. Again, that is beaverscare.org. Now, for some logistics on today, this is the fourth webcast in the Oregon State University Foundation's Knowledge Break series of webcasts. If you look at the bottom of your screen, you will see a Q and A chat button. You are welcome to type out questions throughout the talk and at the end of the presentation, so our speaker will answer as many of them as he can before we run out of time. So be thinking right now. The Oregon State University Foundation is a 501c3 nonprofit dedicated to creating a better world by inspiring support of and for Oregon State University. You can find out more information about the OSU Foundation at osufoundation.org. Now, on to today's speaker, he and I just having a real casual conversation just between a couple of guys just enjoying today. So I'm really glad that you're here. Ever since Dr. Linus Pauling published vitamin C in the common cold back in 1970, vitamin C has been popularly accepted by the mainstream as a way to reduce the effects of a cold and boost the immune system. And with COVID-19 being a respiratory infection, people are wondering what if any effect vitamin C may have in overcoming this virus? Today's speaker is Dr. Alexander Michaels, although he wants me to call him Alex, so he's gonna get that request going forward. He's a researcher and communications officer at the Linus Pauling Institute where he handles clinical research trials. The Linus Pauling Institute is one of Oregon State University's research centers where it conducts cutting edge nutrition research and public health outreach. And for more than 40 years, LPI has worked to discover the basic mechanisms of aging, increasing health span by researching the effects of diet and promoting the principles of healthy living and healthy aging in the public arena. Now, without any further delay, I want to introduce to you Dr. Alex Michaels. Alex, over to you. All right, thanks, Casey. Thanks for that wonderful introduction. I'd also like to thank everybody at the OSU Foundation and the Alumni Association that helped make this possible, including Andrew Norwood, who came up with the great idea. He's our director of development at the Linus Pauling Institute and Isabel Nissen and Nancy Shanks for getting this on the way. And I'm going to share my screen so I can get started on my talk. So what you need to know about vitamin C and COVID-19, it's kind of a catchy title. But another possible title that I came up with is why is the vitamin C section always empty during a pandemic? Honestly, it's a very long and complicated story, but because of the time I've got, I'm going to just go into a short primer about vitamin C and what role it might be able to play. So I'm a biochemist by training. And so I think of vitamin C as something like this, a molecule, and there's a lot of fascinating aspects I can tell you about this molecule. But really what most people think about when they think about vitamin C is kind of one of two ways. The first is the foods they could be getting vitamin C from. And here you can see some vitamin C rich and some not so vitamin C rich foods, but I'll go into that later. And so that's the primary way that we promote, people get their vitamin Cs through fruits and vegetables. But the other way people think of vitamin C is supplements. And I'm going to address this as well. I mean vitamin C supplements are now commonplace and we see them everywhere, including shopping store aisles that sell out in the middle of cold and flu season, not just during this COVID-19 pandemic. But vitamin C is kind of taken on an interesting social media presence during this outbreak. We see a lot of messages on Facebook and Twitter, promoting vitamin C as being a cure for the coronavirus. It's cure or treatment or amazing effects of vitamin C. And I'm just going to try to address some of those today. And this, I just pulled off of the internet yesterday. This comes from the FDA and the FDA's Flickr page. I didn't know if you had a Flickr page until just now. But really what they're trying to do is crack down on these claims that supplement manufacturers are presenting that shows that vitamin C, they're claiming that vitamin C is going to stop a virus. And it's really not that simple. And the reason we're here and the reason we're talking about this, of course, is just because of the effects of Linus Pauling. And I'm going to talk about how Linus Pauling changed the landscape of vitamin C and why we think of it today the way we do. But before I get that far, I'm going to just talk a little brief outline of what vitamin C can do, especially can do in the immune system. So vitamin C has a lot of different roles in the body. It can do everything from help produce healthy collagen in tissues, which is why it helps, as I was talking about it with Isabelle right before this, it helps with collagen production in the skin. But it also can do a lot of other things, most of which are limited or what we call the enzymatic functions of vitamin C. So most of what you see on this page are what we call enzymatic functions. But for the purpose today's talk, I'm going to focus on two of them. I'm going to focus on the antioxidant functions of vitamin C and it's a more outstanding antioxidant in both human blood and in tissues and it's effects on the immune system. And instead of reinventing the wheel, I decided to go to the Lines Pauling Institute's Micronutrient Information Center webpage and I pulled this infographic off. So if you're interested in kind of some of the same information, you can go to the Micronutrient Information Center and I'll talk about that in a moment. But one of the key features of the immune response and this is why we're talking about the antioxidant functions of vitamin C is that certain immune cells in the body this is in particular like neutrophils and to some degree macrophages, when they encounter a foreign substance, whether it's a bacteria or a virus, they try to engulf that foreign body and bombard it with reactive oxygen species. And this will kill and inactivate viruses and bacteria. But the problem is when the immune system goes, I guess you could say overboard and those reactive oxygen species can damage surrounding tissues. So we keep these antioxidants in our minds because antioxidant nutrients can protect the normal cells of your body from these effects of reactive oxygen species, this overproduction. So it also keeps an oxidative burst in check. So when a neutrophil has vitamin C, it protects the neutrophil from the oxidative burst. And so your immune system can keep going on and fighting other bacteria and viruses that it comes in contact with. Before we even knew all this, Linus Pauling back in 1970 wrote, as Casey mentioned, vitamin C in the common cold. And he was synthesizing decades of research that came before him on vitamin C. And he saw some just amazing effects when people were starting to take vitamin C supplements. Unfortunately, all those trials were relatively poorly controlled. If you think about randomized controlled trials today, they were not very good trials, but based on the limited knowledge that he was present or limited information that he was presented, he concluded that vitamin C could have remarkable effects on the common cold and later extended those remarks to influenza. And he thought that, at least published in this book, that the optimal dose of vitamin C that people could take could be somewhere between 250 milligrams and 10,000 milligrams of vitamin C per day. And it was really hard at the time to try to get into a handle on what the appropriate dose was. But this represented a fundamental shift. I mean, everyone asks the question, how much vitamin C should I be taking? And there's two ways to answer that question. One is, how much is going to prevent me from being in vitamin C deficiency, which is scurvy. And unfortunately, I don't have a lot of time to talk about scurvy today. And that's where the RDA is set, getting you above that deficiency range with an extra margin of protection. Or is it levels that promote optimum health? And Pauline was really interested in this optimum health question. How much of a nutrient, not just vitamin C, but any nutrient that the body encounters can produce the best of health? So when developing our recommendations for vitamin C, we kind of took that into account. And the way we do this is by looking at blood levels of vitamin C. And we use this as a proxy for how vitamin C is moving through the body. This graph is just here to demonstrate how complicated the relationship really is. Diet is, of course, all your vitamin C comes from the diet. We can't synthesize any vitamin C ourselves. And it goes into the bloodstream, but that circulates through and feeds our tissues. It also gets urinated out, and we can have some reabsorption mechanisms. But really we look at the blood as this nexus point for how vitamin C status is measured in the body. So here, I have to show some graphs. I am a biochemist. There has to be a few. We're looking at blood vitamin C concentrations as a effect or in its relationship to the daily amount of vitamin C that you take. And studies at the NIH have basically shown that at low levels of vitamin C intake, you really don't see much change in blood vitamin C status. And this is where you're really at overt deficiency. This is kind of near scurvy. You're probably very ill at this point or you're seeing some effects of vitamin C deficiency. And only once you get past a certain threshold amount, maybe 30 milligrams of vitamin C a day, do you see this increase where your blood levels of vitamin C will go up the more you take? And when they measured this at the NIH, they used this as criteria for determining the RDA. And this is why, well, and we believe that these low levels of vitamin C where you're on the steep part of this curve is where the enzymatic functions of vitamin C are getting their requirements. Enzymatic functions of vitamin C are kind of maxed out in this middle range when you're on the steep part of the curve. And then we start seeing some more of the antioxidant functions of vitamin C as we get further and further on. So just for reference, the RDA for men, which is 90 milligrams per day is listed here in the RDA for women, 75 milligrams a day part of the chart. So these RDAs are still in kind of that steep part of the curve, but easily attainable through a diet that has fresh fruits and vegetables. But if we back up a moment and we look at intakes that go beyond 100 milligrams per day, we see that this curve continues to rise. Now, it's not the same relationship we saw before, but it does flatten out a little bit. So it does mean that if you continue to take more vitamin C, you do still get higher blood levels of vitamin C, which suggests that we're getting more vitamin C to our tissues. And just for reference, the enzymatic and antioxidant functions for vitamin C, I drew the antioxidant function stopping, somewhere in the middle, but really they continue on probably past the end of this graph. We just don't really know where antioxidant functions are maximal. And a lot of people believe that there are other functions of vitamin C that could appear when you take higher doses. So when Pauling was talking about taking doses in excess of one gram, which is 1000 milligrams, there may be other functions for vitamin C that we're not, we don't really have a good handle on at the moment. But based on the available data, we've classified blood vitamin C levels in three different categories. Down at the low end, you've got deficiency. So this is the scurvy range where you are at increased risk for chronic diseases. Your body is having trouble satisfying the requirements of the enzymes that need vitamin C. Above that is kind of the inadequate range where you are still at risk for chronic diseases. You're probably not at risk for any scurvy-like symptoms or the severe symptoms, but kind of increased risk for other diseases. And then as we go further, we kind of, we define this optimal category where this plateau occurs and we get blood concentrations somewhere between, oh, let's say 50 and 80 micromolar. That's kind of where we would like everybody to be. So if you talk to a lot of experts on vitamin C and ask them where they think, what intake should you have to be at your best? A lot of them agree that 200 milligrams per day is a fairly good level for most people to be at. And because that gives you the best chance of being in this optimal range of blood concentrations. But the Linus Pauling Institute recommends 400 milligrams per day. And the reason we do that is because this curve has been established based on healthy young individuals, men and women, but a really small amount. I mean, we're talking about only a dozen individuals make up the data for this curve. We don't really know what happens in different people with different chronic health conditions, different age groups, other underlying factors that may influence the shape of this curve. And so just to give that extra window, the Linus Pauling Institute recommends 400 milligrams per day. And this is for everyday intake. We're not talking about in the context of having a disease or the presence of an infection. That kind of changes things a little bit, but it really doesn't alter our recommendation because there's not enough information for us to go into very specific recommendations for every specific condition you may encounter. So how do we recommend you get that 400 milligrams per day? Well, obviously the best place to get your vitamins and minerals, and you've probably heard this a million times before, is from fruits and vegetables and whole foods. In the case of vitamin C, that can hold true more. Fresh fruits and vegetables are the best source of vitamin C, cooking tends to destroy vitamin C. Highly processed foods don't usually have vitamin C in them unless they're added. Meat's not a very good source of vitamin C. So if you're eating five servings of fruits and vegetables a day, you're doing fairly well. You probably are exceeding the RDA and you may be getting to that 200 to 400 milligram per day level. But of course, a lot of people turn to vitamin C, supplements, because they don't want to really think about am I getting 45 milligrams here and 90 milligrams there and add it all up. And so what I'm telling you is fruits and vegetables are a great idea no matter what, but supplements are always an option, as long as you take a few precautionary notes in mind. Vitamin C is unique among the vitamins and that is relatively safe when large doses are taken, but there is still a tolerable upper intake level set at 2000 milligrams per day. If you take levels that exceed, far exceed the RDA, even some people have reactions when they exceed levels that the Alliance Poly Institute sets, you may see things like excessive gas and intestinal gas floating in diarrhea. Usually these are only temporary and go away after you continue intake, so some people continue on no matter what. Other risks include a risk for kidney stones. There is some evidence to suggest that people who take vitamin C supplements each day have a slightly increased risk for kidney stones. So we do recommend that people who are prone to kidney stones, really think twice about taking vitamin C supplements, especially in high doses. There are some possible drug interactions and people with high iron levels do need to be careful because vitamin C does help promote iron intake, or iron uptake, I should say, iron absorption. Okay, so getting to the subject matter at hand, vitamin C, I mean, spoiler alert will not cure coronavirus. No amount of vitamin C you take is gonna prevent you from seeing the effects of infection. Once you get infected, you're going to have symptoms. Not everyone gets symptoms of coronavirus, but when you get a cold or you get influenza, it's going to show up. Now, whether or not vitamin C can help you with severe forms, we're not quite sure. I'll get to that in just a moment. And earlier I was watching Christopher McKnight Nicholson's talk on the flu pandemic of 1918. And I saw this, which was hand the flu a lemon, even back in the flu pandemic, they knew the power of vitamin C to help with the immune system. This is vitamin C in the form of lemons, of course. But this does suggest that there is some role at least healthy nutrition in fighting off a disease. Now, will eating a lemon stop you from getting influenza? Of course not. But it can help your immune system. And so going back to the Micronutrient Information Center, I'm gonna pull up this infographic again. There may be some benefits to getting more than the RDA for vitamin C in the immune system. There is some evidence to suggest that routine vitamin C supplementation can reduce the duration of a common cold. Can we extend this out to coronavirus? It's still unclear, although I will point out that four of the known coronaviruses present as common colds in people. This new one, COVID-19, which is part of the SARS family is a little bit of an unknown. So I can't really extrapolate to those, to the new viruses until they're tested. You have to do the testing before you can say anything for sure. And also routine supplementation with vitamin C can reduce cold occurrence in athletes, undergoing physical stress, marathon runner, skiers, people in very cold conditions see benefits to taking a routine vitamin C supplements. So according to the evidence, and I'm going to talk first, I mean, this part of the talk is really just talking about vitamin C is food and supplements. I'm going to get a little nuanced information after a short break. But according to the evidence on this part so far, is there data to say that vitamin C can stop you from getting COVID-19? No, it's really not been studied. So anyone who's telling you differently is grabbing data from other diseases and trying to use that in coronavirus. Can vitamin C be beneficial in a viral infection? Yes, vitamin C helps support a healthy immune system. When an immune system goes haywire or overloaded, vitamin C can help, but it's not alone in helping an immune system. There's lots of nutrients that go into the support of the immune system. Can vitamin C help you once you've contracted a virus? Perhaps. It can be most important in severe infections. And we'll talk about more about that in just a moment. But when your body's kind of, the infection has gone out of control, vitamin C may be more important. Should you get vitamin C every day? Of course, absolutely. Just like every vitamin, you should get some vitamin C every day. You don't necessarily have to take vitamin C supplements to get that level. You use this information that we've provided to decide what level is best for you. There are people contacting you every day that says thousands, sorry, thousands of people worldwide take one gram, two grams, an upwards of vitamin C and see miraculous effects. They ask me often, should I stop taking this? Am I doing myself harm? You have to decide that for yourself, but if you want to continue taking it and you see the benefits, continue to take it. But we don't recommend those levels on a routine basis. And bottom line, we have no idea if vitamin C supplements are going to be useful against COVID-19. A lot of people are recommending them just as a prophylactic and helping your immune system stay at its strongest, but until we do the studies and we do more studies on vitamin C, even at the Lions Paulings Institute, we will not know these answers. So anyone else is telling you differently is probably trying to sell you some. So at the end here, I'd like to give, and I'm gonna do a short break for questions, but at the end, I'd like to plug the Micronutrient Information Center on the Lions Pauling Institute webpage. This can be found on our homepage under the Micronutrient Information Center link or at lpi.organstate.edu slash mic. And the Micronutrient Information Center is a source of scientifically accurate information on vitamins, minerals and phytochemicals and health and disease conditions. And basically think of it as an evidence-based database similar to Wikipedia, where you can search any vitamin mineral or phytochemical. We don't have a complete database of phytochemicals, but it's growing every day. And here's the vitamin C page on the Micronutrient Information Center. It's one of the heavily trafficked pages on our website. And we also have things like info cards and infographics that you can download and like this one on vitamin C, that's for the acid and with our recommendations and the safety notes. And at this point, I'm gonna stop here for questions like Casey come back on and then I'll continue on with a short bit about IV vitamin C. I'm back from my void, Alex. It was nice to see you. It's too bad I had all these scurvy related questions and you talked about it early on, but you don't have time to keep it. Okay, well, no, I'm sorry. As we're waiting for some questions to come in, I have a couple for you. Every time I take vitamin C, not me personally, just hypothetically, I think a vitamin C supplement, I may get heartburn. Am I having a bad reaction? What is that in reference to? Yeah, I think a lot of people take vitamin C in the form of ascorbic acid, which is an easily available form of vitamin C to find, but it is an acid. And so some people, when they take the acidic form, do get heartburn, especially if they take large amounts of it. So what we recommend in that case is that people try a buffered form. It's called buffered vitamin C, but these are usually mixed mineral ascorbates. There's some calcium, there's magnesium forms. These help with the heartburn. So that's usually, it's not a, I wouldn't consider it a bad reaction, but just kind of your reacting to too much acid in your stomach. All right, thank you. We have one. Are there other vitamins or supplements that may have some benefits to preventing illness or COVID? Well, I can't talk about COVID specifically because really there's very little research on vitamins, mineral supplements. There's a lot of interesting information out there. We've put a few pieces of information on our website and I'll talk about that in just a moment, but, but obviously there is the foundation of the immune system relies on a lot of different vitamins and minerals. Ones that I'll highlight in particular besides vitamin C or vitamin D, you may be hearing a lot about that soon or have heard about it already. Zinc is another one that you should be paying attention to. And things like fish oils or DHA is it can help when the immune system, when inflammation levels get high and the immune system is challenged. Does your weight factor and how many milligrams you take daily? That's a good question. Actually, that is one of those things that we don't know much about. These people who were surveyed by the NIH to form that curve that I showed were all of healthy weight. We do think that people who are severely overweight or obese do have lower vitamin C levels just because of the general stress of being overweight. But slightly overweight is it changed the curve? We really don't know. That's one of those reasons we decided to set our intake or recommendations for 400 milligrams instead of 200. We don't know what that curve looks like for everyone. I want to take a couple more questions. Is the addition of rose hips in over the counter vitamin C beneficial? That's a tough one. So rose hips were one of, so the person who discovered or characterized vitamin C as a molecule also was looking at some flavonoids that went around. So rose hips is full of flavonoids and vitamin C. And he thought those flavonoids were beneficial to vitamin C's effects. There really hasn't been any careful studies to look at that. Some people say flavonoids can help with vitamin C uptake and other people say it can inhibit. So I'd say research is split on that subject, whether or not it's helpful. Whether or not the rose hip flavonoids are helpful on their own, I'm not sure. Okay, let's do one more and then we'll get back to your talk before we have some more questions. So if you're still out there thinking that we still have another segment to go. Does the vitamin C uptake decrease as you age and should you think about increasing your intake as you age? All of our evidence so far says, yes, the intake should increase. Our recommendation is still set at 400 milligrams a day for all age groups just because you're hopefully far above those age-related effects when you're taking 400 milligrams per day. But there is some indication, I did my work on aging and vitamin C transport. There are some indications that absorption goes down. So I'd say, if you feel like it's a good idea for you and you don't have any other risk factors that come into play, yeah, increase your vitamin C intake as you get older. If you exceed 400 milligrams today, just do a caution. Excellent, thanks for the questions so far. We'll get to some more here in just a little bit. Alex, I'm gonna go back to my cave so you can go back to your presentation. I'll talk to you a little bit. All right, all right. I'm gonna talk about something a little bit more, a little different than what I was just talking about before. And this is going to be about intravenous vitamin C. Now, so you may have heard of intravenous vitamin C in relation to lots of different things. In particular, it's been showing up with COVID-19 treatment. And everyone, either people have heard about it and say, oh, that's what Lyon's pollen used to treat cancer patients or they just look at me with a confused look on their face and go, what? You're injecting vitamin C into people's veins? Yes, people do this. Now, whether or not it's beneficial, depends on where you stand on the data. But intravenous vitamin C is not as crazy as it sounds. Now, the reason you would go for intravenous vitamin C and you would do this hopefully in a clinical setting with a supervision of a medical provider, but you can get blood levels of vitamin C much higher with intravenous administration than you could with taking any supplement. I know there's no axes on this graph or no details on this graph, but honestly, the levels of blood vitamin C that we see can exceed supplements by anywhere between 10 to 100 times higher concentrations that we see in the blood. And those high levels of vitamin C can have effects that are not observable when taking vitamin C supplements. And we don't exactly know how it may be working in cancer, so we can't really tell you how it may be working in infectious diseases, but we do have some evidence to suggest that it might be beneficial under certain conditions. And I'm going to turn to work on sepsis that has been done recently that basically used vitamin C. We don't know if it's the blood concentrations that they're achieving through intravenous vitamin C injections or if it's just that they're getting vitamin C in there rapidly when people are in crisis, but sepsis really gives us an idea of framework in which we could evaluate COVID-19. And the lessons from sepsis are that, plasma vitamin C levels, when patients get into a critical cytokine storm, which is just a huge inflammation overload, plasma vitamin C levels in these patients plummet. They go down very rapidly. And that suggests there's a lot of oxidative stress going on, a lot of free radical damage occurring. And there may be even some hypoxia effects especially when you're put on a ventilator and your lungs have lots of inflammation, oxygen is not getting in there. It's postulated that vitamin C infusions can help with not only the free radical damage and the oxidative stress, may tampen down the cytokine storm in sepsis, but they might also have effects on some of this hypoxia response. Vitamin C can play a role in all of these arenas. But whether or not it works and can go into, for COVID-19 patients is kind of a black box. That said, clinicians are going for it. Some clinicians in some parts of the country are trying to use high doses of vitamin C to help combat the virus, especially the severe forms. But I need to stress this, even with all of the headlines that are coming out about IV vitamin C, we have no data whether or not to say this is effective. I'm really hopeful that it will be shown. And I've been in touch with colleagues from all over the country on vitamin C, who are very hopeful that vitamin C will be shown to be effective. There's hopefully case reports and clinical studies coming, but until then we can't really recommend intravenous vitamin C for anything. It's just something we should be watchful of and hope that these clinicians show good effects when they're using vitamin C in their patients. And to address a lot of these questions, we came up with a page on our website giving the basics of IV vitamin C and if it's effective in COVID-19. Again, it's coming to the same conclusions that I just stated. We really don't know what's going on, but we would love to see data and we're really hopeful that it shows some positive effects. In some cases it could be a game changer, but until we have the data we cannot say for sure. So I know Casey's gonna come on in just a moment and ask a few more questions from the audience, but if you have anything that I haven't, oh, I'm sorry, I turned off my screen a little too early. You can email us at lpiatorganstate.edu or go to our website. I monitor this email address along with others. We will get to any question that we do not get to today and I will personally answer any vitamin C email that is sent to me. All right. All right, Alex. Let's get to some questions that we had come in that during the registration process before we get back to some of our live ones. I'm gonna add a little addition into this one. They talk about, please describe any differences in response to vitamin C that has been found in the food versus supplements, but also, can you talk about intravenous vitamin C as well? Well, let's start with food and supplements. So there's been a lot of debate going back and forth over the years on whether food or supplements are the best form of vitamin C. Some people also take this to a natural versus synthetic debate. I'll start with food versus supplements. So far, we've seen no difference. Food versus supplements both contribute to your blood levels of vitamin C. And the thing about getting vitamin C from food, though, is that you're getting a lot of other vitamins and minerals at the same time. And so it's a win-win when you get it from fruits and vegetables. When we're talking about synthetic versus natural, that's kind of a different story. In some cases, for some vitamins, that's an issue, but for vitamin C, it's really not. Synthetic vitamin C and natural vitamin C are the exact same molecule. They're both ascorbic acid. You shouldn't worry about getting one source versus the other or thinking they're not comparable. When we go to intravenous vitamin C, yeah. There's no supplement on the market today that can compare or no amount of food that you can eat to get the same blood levels of vitamin C that you can get with intravenous. It just bypasses the absorption mechanisms in the intestine. And your vitamin C levels, I mean, essentially go through the roof. The funny thing is that you can inject large amounts of vitamin C in people's veins and you should only do this in a clinical setting with the assistance of a medical provider. But strangely enough, if all the precautions are taken, it's relatively safe. It's kind of astounding that you can take 100 grams of the substance or 50 or 25 grams and see no ill effects. Interesting, interesting. Another question is one brand better than another when it comes to supplements. Oh, that's a pretty good question because it's one that I'm probably asked the most often along with what brands do you recommend? I'd have to say that I don't think any formulation has been shown to be significantly better than another. Linus Pauling was a big advocate of just taking ascorbic acid all by itself and there's nothing wrong with that. There has been some evidence to show that some formulations like calcium ascorbate are a little less absorbed and some data out there that suggests that say, liposomal vitamin C and it's just a little bit of data but liposomal vitamin C might be a little better absorbed and liposomal just for the sake of the audience. Liposomal is kind of a fat encapsulated vitamin C and so it's theorized that fat encapsulation allows it to absorb into the intestines faster and better than just straight absorption. Whether or not that hasn't conclusively been shown but is that a better form of vitamin C to take? They're all about equivalent. I mean, honestly at the end of the day when you look at the different forms it doesn't really matter. So when they talk about here in the potency standards is that something that you really need to watch out for? That's the real thing you should be paying attention to when it comes to the forms of supplements don't matter but the purity and potency is what you should really be paying attention to. USP verified supplements or NSF verified supplements are one way of finding out that your supplement's been verified by a third party. Other sources include like labdoor.com is one that we use every once in a while to they rank and test supplements to make sure that they're meaning supplement claims. Also, ConsumerLab, consumerlab.com is another independent company that tests supplements and basically see if they meet their standards. Consumer Reports also does some of this as well just to see if there's anything that's listed on the label that may not be good for you if they match, if everything matches and if there's any contaminants in the supplements. So a reputable company is probably more important than the form of vitamin C that you're taking. Okay, I know you started to kind of talk about this with Linus Pauling, one question that we have is playing the Scorbic acid the best way to take it or in a mixture? I'd say whatever works for you but so some people think sodium is Scorbate because as I said before, the mineral salts can be gentler on your stomach. The only thing that I would caution about sodium and Scorbic acid is, or sodium is Scorbate rather, is that it strangely can oxidize a little faster. I mean, the fact that it's more neutral promotes its oxidation. So if you mixed up a drink, for example, sodium is Scorbate and left it on the shelf versus one that's a Scorbic acid, the acid will actually preserve the vitamin C better than the sodium form. So if you're drinking it right away, no big deal but if you're letting it sit for any given time, the sodium is Scorbate will actually start to oxidize on your counter. So I'd say whichever works best for you given that information. All right, do you know of any other nutrients that have their RDAs based on a similar parallel of optimum intake? Yeah, most, I mean, it's hard to go through every single RDA. We don't have that kind of time? Yeah, we don't have that kind of time. But I wish we did, no. But most RDAs are set to based on what's called an EAR, Estimated Average Requirement. So it's the amount that your body needs. And that is a fancy way of saying avoids deficiency with an added buffer on top of that. So really, it just depends on the data. They look at the data for each nutrient and try to see if they can estimate a requirement that your body needs and see from that if they can extrapolate an RDA. RDAs are not the same thing as optimum intake because the definition of optimum is so vague. It just depends on what you're measuring. We haven't really been able to determine an optimum intake level for vitamin C. This is why Pauling said the optimum intake could be anywhere between 250 milligrams to 10,000 milligrams because it's too hard to define optimum. Most people have to figure that out for themselves. So if all these people out there who are currently taking large doses of vitamin C, say 2,000, 3,000, 4,000 milligrams, do I tell them to stop? No, I don't because I do warn them of the safety issues with high doses of vitamin C. But if they think they're in better health for taking it, I can't argue with that. I can't argue with your personal experience. However, we don't necessarily as a routine measure, routine recommendation, tell people to take that much. There's no evidence to suggest that it's going to be beneficial for everyone to take large amounts. And if we think back to one of your slides early on and some of the side effects, when we do get back on plane, when that is a thing for the vast majority of us, if you're shot gunning an emergency, some of those side effects aren't very fun for an airplane full of people. So just be really careful about how you're doing that. Am I right? I mean, a lot of people say, I've been taking emergency every day or twice a day since this thing started, am I gonna do myself some harm? And honestly, I asked them, well, are you seeing any negative effects to taking that much? Are you going to the bathroom a lot? Or are you having some uncomfortable situations when you're talking to people? And when they say, no, I feel fine. I'm like, okay, I mean, if you think it's good for you, just keep doing it. Excellent. A couple more questions have come in. I take 1,000 milligrams time release form. Is this a good source for constant blood level? I'd say probably. Some people suggest taking 500 milligrams twice a day. Some people suggest taking 200 milligrams at various intervals throughout the day or just when you're not eating a bunch of fruits and vegetables, take your supplement at whatever other time or when you're not eating those fruits and vegetables. I think time release formulas, yeah, that would probably keep you at an optimal level throughout the day. We don't know, I should caution though, is it important to keep it optimal levels throughout the day? We're not quite sure. There's really very little evidence on this, but we hope that it gives you maximum protection throughout a day as long as you do it consistently. Do you recommend a single 400 milligram dose per day or should I take 200 milligrams twice a day to increase absorption? Yeah, so I mean, that goes kind of back to the previous question. I'd say 200 milligrams twice, I mean, 200 milligram doses are considered to be 100% bioavailable. When we get into levels that go beyond 200 milligrams, the bioavailability does go down and there is data to support that. Does it go down so much that I'd say never take a 400 milligram dose? No, no, but 200 milligrams twice a day would be based on the data, optimal, yeah. You'd be at maximum absorption each time you took it. As long as you can ease them out, maybe two hours or more. Okay, I have one personally for a common cold. You know, I was listening to one of your talks on a radio program up in Portland. I won't say who or what, I don't wanna give any free airtime on our dime. But talk a little bit about vitamin C in the common cold. Is there a point in time in the process of, you know, when I catch a cold that I'm taking vitamin C that it's too late or at any point in time, is it doing me some kind of good is sometimes better than others in that process? I'd say the evidence suggests that taking vitamin C early on before you get the cold is the most beneficial. It won't stop that cold from happening. I mean, as I told Isabel just last week, no amount of vitamin C you take is gonna stop anyone from sneezing in your face. That'd be nice if it would. Yeah, correct. You get a virus because of a variety of different factors, not just because of you're missing one nutrient. Yes, everything that goes into your immune system, all the vitamins and minerals that are part of your immune system form that barrier or form that protection mechanism. But there's a lot of other things that go into that, including what you're exposed to or what your habits are if you're washing your hands, if you're touching your face. So vitamin C is just one little piece to that puzzle. Now, there is some evidence to suggest that you take vitamin C before you get a cold, it could reduce the severity or duration, or it's mostly the duration of the cold. Most people do load up on vitamin C after they start to get sick. And unfortunately, there's not a lot of good data on that. A lot of people swear it works. And I can't argue with that. If you feel the slight tingling of a cold and you start loading in on vitamin C and that cold goes away, the problem with that kind of, in terms of scientific data, do you know if you were gonna get that cold in the first place? Or if it was just gonna go away on its own? Well, there's no way to control for that. So people err on the side of caution and just take the vitamin C and just hope for the best. Also, when it comes to kind of this homeostasis, when your body has had a little, or inflammation gets out of control and you've gone out of homeostasis is what it's called. The inflammation is just raging through your body. And this is what we see a lot of times with things like sepsis and some degree with COVID-19, could extra vitamin C help camp down that inflammation? Yeah, it's possible. So if you have a really bad cold, could that vitamin C be helping? It could. It's just the problem. We don't really have a lot of good data to support that. So keep taking the vitamin C. How much you should be taking? That's the unknown. Alex, is there a particular reason why that aspect hasn't been studied very much? Is it boring for scientists without it is? No, it's not boring for some vitamin C scientists love this kind of stuff. So we would love to do these studies. Actually, to hit the nail right on the head, it's funding. Vitamin C is considered to be kind of old news. Right after Alliance Pauling came out with his book on vitamin C and the common cold, there was a slew of studies on vitamin C and the common cold and trying to either support Alliance Pauling's theories or push them down and say, no, no, no, that's not how this is working. The problem is all of those studies were not well performed. If you look at the number of quality studies on vitamin C that exist today, there's only a handful. So the reason we can't really say a lot of definitive statements about vitamin C in this disease or that disease or COVID-19 or influenza or common cold is because one, those studies are hard to do. We don't even know what the common cold is half the time. There's so many viruses that can go into a common cold. And two, doing a good study is really hard. And we're only at the point now where scientists who study vitamin C could really conduct a quality study on the topic. So if, but now the public opinion is kind of turned either, they're either for vitamin C and that's old news or they're against vitamin C and said, that's old news. It's never showed to do anything important. We really need to get the message out there that there's still a lot to learn about vitamin C. And this is why the intravenous forms of vitamin C are so exciting because it's showing that you shouldn't disregard this old data. There are some little nuggets of information that we should follow. Now we could have some really interesting successes if we do this right. So you and I need to start making vitamin C HIP. So, you know, because it's a funding opportunity, right? Like how do we make this thing go viral, viral, right? Right. Yeah, thank you. I'm sure there's plenty of people who are on this are rolling their eyes right now, that's for you. What part of the immune system is strengthened by vitamin C? What is the mechanism of action? Do we know? That's a hard one to answer in a short period of time, but I mean, I did talk about some immune cells using reactive oxygen species as an attack mechanism. That is one aspect when those reactive oxygen species kind of go out of control or the inflammation, or inflammation goes out of control, reactive oxygen species are part of that. And so antioxidants get in the way of those reactive oxygen species and kind of tamp it down or prevent the deleterious effects of those oxidants. But there are, you know, a lot of papers out there trying to understand how vitamin C works in the immune system beyond this antioxidant bowl. We do see in some studies that vitamin C seems to have an effect on T cells and to some degree B cells. So therefore can influence other different immune cells and may have some effects on acquired and innate immunity that we don't quite understand right now. Some of it is about developing, you know, the antibodies towards a pathogen that comes in does, but most of what we understand about vitamin C and immunity really comes from avoiding deficiency. So the studies that need to occur at this point, first of all, we also have to get out of animal models because humans and vitamin C is a completely different relationship than animals and vitamin C. Most animals on the most animals, especially that we use for scientific research can synthesize their own vitamin C. So their relationship with vitamin C is completely different. It's not a vitamin for them. Higher order primates and humans cannot synthesize their own vitamin C. So we need to get it from the diet and that changes how our body responds to it. So we need to focus on human studies and we also need to focus on these specific questions like how it works in the immune system to really get answers to say. I mean, on some level, some people say, eh, it just works, you know, keep taking it. But we're scientists, we really like to dive in deep. Yeah, that doesn't seem like, you know, that's an answer that's to the fly with a lot of the scientific community. Oh, it just works. Let's just go with it. Yeah, no, it does, yeah. Fine. I like this question. This seems like this would come from somebody when you're in school that's very rebellious when you have someone that's a vitamin C expert, they're like, well, what about vitamin D? What about vitamin D? So is there any thoughts on vitamin D? Is there any evidence that vitamin C is more important with certain underlying conditions? So we got someone who wants to know about one letter up. Okay, so I mean, like I said, there's a lot of vitamins and minerals that go into the network that supports the immune system. Vitamin C is only one of them. Vitamin D is also fairly important in many aspects of immune system, especially against microbes, against bacterial infections, and also tamping down some of that over, you know, out of control inflammation. There's some really exciting papers coming out right now. A lot of them are pre-print, so I'm not gonna talk about them in too much detail. Let's say vitamin D deficiency, which is fairly common throughout the world, compared to vitamin C deficiency, which is fairly rare. Vitamin D deficiency can influence how COVID-19 or may influence how COVID-19 acts in the body. I won't go any further than that because I'm not a vitamin D expert, but it does suggest that vitamin D is not something we should ignore. And if I had Adrian Gombart from the Linus Pauling Institute here right next to me, I'd put him on the camera right now and ask any vitamin D questions that you might ask. Maybe I could twist his arm and get him to speak next time. Before we wrap up, are there anything, last little bits, Alex, whether they're myths or just common misunderstandings about vitamin C that we haven't talked about either in your presentation or from the questions today that you really wanna make sure that people know about or just some last little bits of information that you wanna make sure that they walk away from. Yeah, I mean, vitamin C is not a miracle drum. It's not a miracle cure for anything. It is important to get enough of it and decide for yourself how much enough is. But also understand that the book isn't closed on vitamin C. We need to do more research. We need to get more quality studies done before we can start convincing people of its value beyond the RDA. I mean, most people are focused on the RDA, but there may be value in going beyond the RDA for vitamin C and we really need to convince people of that. And the only way to do that is quality human studies. Don't believe everything you hear about vitamin C and COVID-19, talk to an expert on vitamin C to get the real information. And I would say look for scientifically accurate, verified information to understand what's going on. And also, contact the Linus Pauling Institute if you have any questions. I mean, we don't just cover vitamin C. Obviously we cover lots of different vitamins and minerals. There are experts at the Linus Pauling Institute ready to take your questions. Anytime you give them, we always respond. We try to give as useful information as we can. We can't give medical advice, but if you've got a nutrition related question and you just wanna know a little bit more about that mineral or phytochemical and the foods that you're eating, send us an email, lpi at OregonState.edu. I've got one more question for you because I wanna see really like how much depth and breadth your knowledge really has. I like this one. We have some of that writes in, aren't humans and guinea pigs similar to each other in the lack of vitamin C production? Can we learn from them? Actually, I think that shows the depth of the- Oh, we got some smart people out there for sure. Guinea pigs have lost the ability to synthesize vitamin C. They are one of the few animals that, I mean, there's fruit bats, guinea pigs, some fish, some bird species that can't synthesize vitamin C. So they all lost it for different reasons. So I try not to lump them all into one big category, but yes, there are some other animals out there, but your dog, your cat, your horse, your chicken, they all can synthesize vitamin C. So we can't treat them all the same. Whether vitamin C supplements are gonna benefit your dog, well, that's another question I'd love to answer someday. But we can't lump them all into the same paradigm. We have to treat them differently. Well, we'll do a part two webinar where we talk about pet vitamin C with Kirby. We'll do all of that. So if you didn't know that you're gonna walk away with how we interact with guinea pigs and how we're very similar and what can we learn from them? Now you do. So you know what, I'm gonna give this for Kim. Thank you for the question. You deserve the individual shout out, so thanks, Kim. And thank you again to everybody for the great questions. Alex, thank you very, very much for joining us today. The messages that you shared with us are not only very interesting and intriguing and relevant, but I think that you were able to dispel some myths, definitely some things that I've heard about over the years, so we really appreciate that. And thanks for your time today, Alex. Yeah, thank you, Casey. Just a couple of last housekeeping items you will receive, you all out there will receive a survey about today's lecture shortly after we are done. Please take the time to fill it out. It helps us know if we're meeting the needs as an audience and how we can make our webcast in the future even better. And so if you want more of Alex and I, feel free. If that's what really does it for you, then we'll be back, absolutely. We're here for on course, but we very much appreciate your honest feedback. Thank you. So our next webcast is scheduled for Tuesday, May 26th at 11 a.m., where we will welcome Paige Clark and she's the director of alumni relations and professional development for the College of Pharmacy. And we'll be here to discuss how your pharmacists can best help you navigate the confusing landscape during these confusing times, twice the confusion. So hopefully we'll be able to kind of clear that up. And so if you're interested in that or other future events from Oregon State, University, we have many more great resources for making the most of your time at home or wherever you're at today. And that could be found at the Beaver Lodge. It is the digital hub of the OSU Alumni Association. Today's webcast will also be posted there. And we invite you to share it and the entire Knowledge Break series of webcasts with your family, friends, other beavers, whoever you want. We really appreciate it. And all are welcome to visit the Beaver Lodge at OSUalum.com. 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