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2009-07-24 Jeanne Drisko MD Cancer And Vitamin C

July 24, 2009, By Kirkham R. Hamilton, PA-C
© copyright 2009, Prescription 2000, Inc.
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KIRK HAMILTON: Welcome to Staying Healthy Today, a health-oriented radio show committed to bringing you key experts in the fields of nutrition, prevention and integrative medicine.

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Today's show topic is "How To Use Intravenous Vitamin C Safely And Effectively With Chemo And Radiation Therapy." Our guest today is Dr. Jeanne Drisko. Dr. Drisko is an M.D. and director of the program of Integrative Medicine at the University of Kansas Medical Center. Dr. Drisko teaches medical students, practices integrative medicine, and conducts clinical research at the university on the use of intravenous vitamin C in cancer, the safety of bioidentical and natural hormones, and trials to assess chelation therapy efficacy in cardiovascular disease treatment. Dr. Drisko also leads a fellowship program in integrative medicine for primary care physicians which was started in 2008. She is a graduate of the University of Kansas Medical School and board certified in diagnostic radiology. Presently, Dr. Drisko is the president of the American College for the Advancement of Medicine, a member of the Consortium of Academic Health Centers for Integrative Medicine, part of the Institute for Functional Medicine, part of the International Society for Nutrition and Cancer, and a member in the Women in Medicine and Science.

So, Dr. Drisko, thank you so much for taking the time to come and talk to us about what I think is a very exciting topic, vitamin C's use in the treatment of cancer.

DR. JEANNE DRISKO: Thank you Kirk very much. It's an honor for me to be invited to speak to you. I've followed your newsletters for many, many years and have found them extraordinarily useful.

KIRK HAMILTON: Well, you know, this is something that is very dear to my heart because a lot of patients are now calling our integrative medicine practice and saying, "Do you do vitamin C with cancer therapy?" What we do in our clinic is we don't treat cancer, but if someone wants to continue seeing their oncologist and doing whatever traditional therapy they are doing, we will add on vitamin C. But it brings up a lot of questions and some controversies. You are a leader in studying this topic in a very academic and clinical way. So I'm very excited that I can have you here to answer my own questions, not just those of patients and professional colleagues.

So with further adieu when did you get a connection between vitamin C and cancer initially?

DR. JEANNE DRISKO: Well I was really fortunate in my training in integrative medicine. I spent a year with Dr. Hugh Reardon at the Center for the Improvement of Human Functioning and he was one of the pioneers of the use of intravenous vitamin C, in that line of Pauling and Cathcart and the other well-known users of IV vitamin C. So I really got hands-on training and experience during my fellowship with him.

KIRK HAMILTON: Now, tell me. There's vitamin C orally and there's vitamin C intravenously. I know the most popular part of the program, or what people know about, is the IV vitamin C. Can you tell me the different ways that you might approach using intravenous vitamin C in cancer and oral vitamin C in cancer.

DR. JEANNE DRISKO: I think the most important thing to understand is that oral vitamin C is a vitamin. There's a very tight control in its absorption and in its very rapid excretion. So the blood level of vitamin C can never get over a very small threshold. But IV vitamin C is a drug and because it's injected directly into the bloodstream, it bypasses that tight control and so we can get blood levels of vitamin C many, many times over, like 20, 25 times more than what we could find with oral vitamin C.

KIRK HAMILTON: Well let's talk then about what would oral vitamin C do to either treat or prevent cancer, and then we'll talk about what IV vitamin C does and the different physiologies or biochemistries that come from that.

DR. JEANNE DRISKO: Yes there are very different biochemistries. The oral vitamin C, the actual vitamin, is a very wonderful, powerful, well-known antioxidant. It is also important for building up ground substances and tissues and making those stronger. However, the vitamin C when it's injected into the vein, is a pro-drug for hydrogen peroxide. The vitamin C crosses into the tissues around the cell called the extracellular space and in this extracellular space the vitamin C becomes what's called the ‘ascorbyl radical', so that all of a sudden it's not an antioxidant anymore, it's a pro-oxidant and it interacts with metal. We're not sure yet whether that might be iron or copper, that's yet to be determined, but after that interaction with that metal, it becomes hydrogen peroxide in that extracellular space. It is that hydrogen peroxide that attacks the abnormal cell. So it's very, very different from oral vitamin C.

KIRK HAMILTON: I'm a little confused then. You have the argument against initially using vitamin C in that many chemotherapeutic or radiation approaches cause free radicals to be triggered, and that kills cancer cells as well as good tissue, and you wouldn't want to use an antioxidant. So why do you give oral vitamin C in the milieu of cancer treatment?

DR. JEANNE DRISKO: There's been a number of researches and Dr. Kedar N. Prasad is probably the most well-known in this regard on the study of oral antioxidants, vitamin E, CoQ10, vitamin C, the whole range of antioxidants (in cancer). There seems to be a benefit in adding these at a certain dose, not too little and not too much, but a very nice therapeutic window and it seems to protect the normal cells against the damaging effects of chemotherapy and/or radiation. So there is a growing body of evidence that demonstrates that the oral antioxidants given in a good dose can be helpful in treatment of cancer.

KIRK HAMILTON: So let me ask you this then. Let's just stay with vitamin C - because there's wide range of antioxidants and we can get levels that might get a little extreme - but just for vitamin C orally, what range do you try to stay in with vitamin C orally in the cancer patient.

DR. JEANNE DRISKO: With oral vitamin C the best way to determine the amount to use, we think, is looking at what comes out in the urine. We often look at plasma levels, blood levels, in patients that have cancer that come to us and really haven't had too much treatment at the time we first see them, and we find that their plasma levels may be okay, 0.2 or somewhere in that range. However when we check their urine, there's often no vitamin C found in that urine, which is of great concern because you need to absorb that vitamin C from the blood stream and get it around to all the tissues to do the reparative work and all the work that vitamin C does. If there's not enough spilling out in the urine, you may be deficient in your tissues.

KIRK HAMILTON: Do you have a ballpark dose range that you could give me that the average patient takes as oral vitamin C?

DR. JEANNE DRISKO: Well it depends. Again, we try and follow what's going on in the blood and in the urine. But everyone's an individual and if someone comes in and maybe they're finished with their chemotherapy, for example, and they're just in their recovery phase, they may not need as much vitamin C to get those tissue stores up. They may only be on 1000 or 2000 mg a day. Whereas some cancer patient need as much as 4000 mg several times a day or even more. And of course the best way that a lot of people determine the amount of vitamin C necessary is by using the bowel tolerance rule. Not everyone has the opportunity to do the kind of testing that I do here at the university, and so using the bowel tolerance rule of thumb is generally the best. You increase your vitamin C until you get a little GI upset, a little gassiness or a little bloating, and maybe a little diarrhea. Then when you get to that point, you know you're taking too much vitamin C and you back off. Back down maybe to 500 mg or 1000 mg. There's some people that are very, very ill, maybe with chronic illness like HIV, that can take very large doses of vitamin C, as much as 20,000 mg or 20 grams. Again, it's a very individual thing. There's no prescription here or "one size fits all."

KIRK HAMILTON: You would say, if I could paraphrase, is that when you're in an inflammatory state, or a state such as you're getting chemotherapy or radiation therapy, you might have higher requirements. Is that a correct statement?

DR. JEANNE DRISKO: Absolutely. You can just imagine all of these reactive processes in the tissues and you're trying to put out fires everywhere. You're going to use up a lot of those nutrients putting out the fires. So you're going to need more.

KIRK HAMILTON: And so the oral doesn't negate any of the chemotherapy or radiation's benefit in your opinion?

DR. JEANNE DRISKO: In my opinion, I have not seen that to be so. But, again, I think there is some evidence that Dr. Prasad has shown that if the doses of the antioxidants are too low, that can actually be a detriment in the treatment of cancer. So the very low doses that some oncologists recommend may actually be harmful.

KIRK HAMILTON: Let's switch over to IV vitamin C, because it's the one that I get the most questions about when a patient comes in. Tell us how you assess a patient when you're going to give them IV vitamin C and how you taper up in the dose or how you regulate that dose, and, an average patient coming in, how many times do they come into the clinic and how long do they stay?

DR. JEANNE DRISKO: Well, it's an interesting question because again that depends on the type of cancer that the patient has or maybe how serious their state is. If they're at the beginning of their treatment, or if their oncologist has given them permission to come to us after their treatment. It's a very individual decision, but generally the first thing we do is make sure that it's safe to give them the IV vitamin C. You have to check the G6PD enzyme in the blood stream. It's a common blood test, it's not anything fancy, anybody can get that test drawn at a local lab. If you have a low level of G6PD and you get intravenous vitamin C, you are going to have breakdown or hemolysis of the red blood cells. So that is, in my mind, the number one contraindication for getting intravenous vitamin C.

KIRK HAMILTON: Can I quickly add just a caveat? Have you ever had in the years you've been giving vitamin C, a low G6PD?

DR. JEANNE DRISKO: I have had patients that have had low G6PD, but I will not infuse them. And I know when Dr. Reardon was alive, he did have a couple of patients that had low G6PD, and he gave them a very, very, very low dose of vitamin C just to help their immune system. But he would not treat them with high doses. There have been patients treated that I know of in the CAM community, Complementary and Alternative Medicine community, where the G6PD was not checked and those patients had pretty significant hemolysis. They had blood in the urine and other signs of bleeding, so it's the number one contraindication.

KIRK HAMILTON: Well I have to throw in my own personal experience. I've been doing this 25 years and have given thousands of IVs of vitamin C ranging anywhere from 10 grams up to 100 grams, and you know most clinicians give vitamin C on a routine basis for viruses and colds and flus and things, don't check G6PD deficiency. I've read about it (G6PD deficiency) for years and I actually had a patient who came in and we were going to taper up his vitamin C and I started on a very low dose of 10 grams, and then went up to 30, I think. And all of a sudden - they were from an outside HMO, and they ended up getting an anemia, a very severe hemolytic anemia and it turns out he was of Mediterranean descent. So I had that one experience in 25 years and so I check it now all the time.

DR. JEANNE DRISKO: Yes, it only takes once.

KIRK HAMILTON: It only takes once. Let's get back...I got off track there, but back to IV vitamin C, how you test, how you assess to give what dose to the patient, how frequently they get it, and how they do?

DR. JEANNE DRISKO: The other thing I want to mention just for safety sake is that there is a connection with patients that have oxalate kidney stones and not getting IV vitamin C, because the vitamin C goes into that oxalate pathway and can promote oxalate stones. So those patients we don't give IV vitamin C to either. But I have had patients have other types of stones that have received vitamin C and have received it safely.

And then on to the dose escalation. I'm glad you mentioned that because that's a very important thing. If we have a cancer patient we don't jump in at 50 grams or 75 grams. We will start with a lower dose like 15 grams and gradually build up, 15, 25, and if they do well with 25, then we'll go on up to 50 grams in the infusion. What we look for is a blood level, a plasma ascorbate or plasma vitamin C level, and it's a very fussy test. It has to be drawn immediately after the IV is turned off, the sample has to be sheltered from light, and it has to be processed immediately and frozen immediately. It's what's called a ‘critical frozen' test. If it isn't handled appropriately, or it isn't drawn at the right time, the blood test will come back with a lower level of vitamin C than is really there. So people often get this lower level and keep increasing the vitamin C thinking they're not getting up to that right dose. So the plasma level, I just want to reemphasize, has to be done appropriately. With that being said, we usually look for 350 to 400 mg/dl in the blood for ascorbate or vitamin C and then we know we've hit a good target range. Cancers that are blood types of cancers like a lymphoma or leukemia, generally require about 50 grams per treatment. Then the more aggressive tumors - let's say we have an ovarian cancer tumor. We're seeing those patients may need between 75 and 100. Then some of the worse tumors like pancreatic cancer, we've found that those patients require as much as 100 to 125 grams of IV vitamin C for treatment to get that blood level up. We also base our number of infusions per week on the aggressiveness of the tumor. If someone is disease-free and has been for some time, we might give it once a week. If they're in active treatment and active disease, we will go two times a week if it isn't too aggressive of a cancer. If it seems to be pretty aggressive we will go with three times a week. Now I have had some patients that had the ability to get the IV vitamin C five days a week and I want to tell you it's very safe. They didn't have any untoward effects, but we're not sure yet if it's necessary to receive it five days a week. Those are some of the questions we're asking now with our research.

KIRK HAMILTON: When I was 28 I had the chicken pox virus and I was very sick. I got IV vitamin C every day for seven days between 60 and 100 grams, and, I took 40,000 orally with no diarrhea or whatever, and then eventually, as I got over it, I tapered back.

So one of the things I want to ask is when those patients are getting vitamin C at those doses, and I know that you just add magnesium and that's it. This is a very important clinical point because some people add B vitamins and things like...We're all used to the (vitamin) cocktails, and you advise against that. So that's number one. Why? And then, two is how do patients feel as they're getting the vitamin C? Do they ever feel washed out? What do they feel?

DR. JEANNE DRISKO: Those are two very important questions. I'll answer the second one first. How the patients feel can depend on how fast they infusion is running. If the infusion is running in too quickly, the patients can feel nauseated. They can have a headache, they just don't feel quite right. They can get shaky. We think that might be a shift of calcium or a change in blood sugar, although we measure blood sugar frequently, not with fingerstick but with lab analysis and we haven't really found a wide variation in blood sugar, so I think it might be more a calcium shift. But anyway we give our infusions at 0.5 grams/minute. So if you have a 50 gram infusion, that's about 100 minutes. You just double the dose and that's the number of minutes the I.V. should go in. When patients get their infusion and it's not too fast and it's not too high, they generally feel very, very good. They're getting through their chemotherapy more effectively. They are having more energy. But there are some patients that are toxic and I think when we're liberating some of their toxins from their system, they can feel sick and a little, as you say, "washed out."

And I've forgotten what the first question is now. You'll have to repeat it.

KIRK HAMILTON: Sorry I asked you two different strains there. It had to do with the fact that many practitioners for years have put into the I.V. B vitamins and maybe glutathione and other things, and you make a strict point in saying that, what I got from reading your literature, was that the B vitamins may negate the production of hydrogen peroxide, which is the real reason for giving the C in the first place, correct?

DR. JEANNE DRISKO: We have some unpublished data in cancer patients, and we were measuring the hydrogen peroxide production in the urine, or the excretion of the hydrogen peroxide in the urine. There were a couple of patients that had very high spikes in their B vitamins that their hydrogen peroxide formation was very low, or at least the excretion was very low in the urine. So we were concerned. I discussed this with Dr. Mark Levine at the NIH and we decided that perhaps it might be related to pyridoxine. We're not sure. We have much more research to do in this area, but just to be on the safe side, because we are trying to generate hydrogen peroxide, we do not add B vitamins to the mix. The lower doses in the Myer's cocktail, I think that's that an important thing to add because often those patients that get the Myer's are either infected or they have fibromyalgia or are fatigue patients. We know that there's a benefit in getting the B vitamins. Now the question about the glutathione. If we're making hydrogen peroxide, we wouldn't want to give glutathione at the same time because it's going to quench the hydrogen peroxide. So that (glutathione) we give on alternate days because we do give glutathione to patients that have neuropathy or they have some indication that glutathione may be of benefit to them. We will give it on opposite days from the vitamin C.

KIRK HAMILTON: Corn vitamin C versus beet vitamin C. I know there‘s some alternative therapy cancer specialists who recommend beet vitamin C.

DR. JEANNE DRISKO: Yes. You know Kirk I've talked this over quite a bit with Dr. Levine at the NIH and I honestly think it's a medical myth. I've looked at the certificates of analysis and had independent companies analyze both the corn and the beet derived (vitamin C) and there's no residue in the product that would suggest that there's corn residue, that someone who's allergic would have a problem with it. I have had patients that I know have IgG sensitivity to corn, which is not an allergy by the way, and I give them the corn derived vitamin C, and it's very effective. I have questions about this. Again this is my personal bias, not something I've researched.

KIRK HAMILTON: Tell me how do traditional oncologists receive your work? You work in an academic center number one, and number two, the surrounding community.

DR. JEANNE DRISKO: It's been a very interesting journey. I have been here at KU Medical Center in Kansas City a little over 11 years now. In the beginning there was a lot of push-back, a lot of negativity. But over time I was allowed to do more and more, and the research has helped. The partnership with multiple faculty here at the medical center, both oncologists and neurologists and gastroenterologists, and you know, the whole team here, it's been really a wonderful thing. They've actually helped me write my studies and really helped me grow in my abilities in doing clinical research. I'm very thankful for that partnership, and they do allow their patients to come here and they do allow them to get the IV vitamin C. The gynecologic oncologists will send their patients here to get the IV vitamin C as the fluid loading dose and then go down and get Paclitaxel or Carboplatin or whatever chemotherapy they're going to get the same day.

KIRK HAMILTON: Tell me, there might be a layperson or a physician listening to this...how does the physician or clinician get your protocols for this approach?

DR. JEANNE DRISKO: We have a very strict policy. There are some people that have been, I think, careless with this. They'll post their protocols on websites and it's out there. Unfortunately I have known lay people, just family members, getting these protocols and getting the IV vitamin C and giving it at home themselves without really understanding what they're doing and there have been some problems with that. I had to help a gentleman who was infusing his wife with very high doses of IV vitamin C to back down from this and he had gotten this protocol from a website. So what I do is I require that if anyone wants the protocol they have to fax to our office on their letterhead from their office the request for the protocol, and then we'll either email it or fax it to them.

KIRK HAMILTON: Can you give the website (http://integrativemed.kumc.edu/ivvitaminc.htm) and if you know the number off the top of your head that'd be great.

DR. JEANNE DRISKO: Yes, I do know - the fax number is 913-588-0012.

KIRK HAMILTON: Before we wrap up here, I know we've talked a lot about IV vitamin C and oral vitamin C - If you could give a brief overview of the diet you recommend and some of the lifestyle things, and then we'll end because it's been excellent.

DR. JEANNE DRISKO: I think that it's (lifestyle) extraordinarily important in this whole approach to cancer care. It can't just be one treatment or another. You really have to approach the whole person. You have to understand what they're eating, how they're eating, and what they're doing in their life with their family members and know if there's toxicity there. So we really try and counsel the patients in a global fashion. But we're very fortunate here. We have a demonstration kitchen and a registered dietician, Lisa Markley, who trained and got her masters at Bastyr, as you know, is a naturopathic college. She's very in tune with the whole foods approach and the green type of kitchen. She is teaching our patients hands on how to eat and we adhere to a whole foods diet, no processed sugars, no sugars at all because we believe in the Warburger fact that glucose feeds cancer cells, sugars feeds cancer cells. So no booze, no Ensure, but a lot of good fruits and vegetables, and good quality protein. You do need some protein during cancer care because you have to rebuild tissue. You have to rebuild blood cells. That's very important, and then just trying to make sure that the environment they're in is clean and safe.

KIRK HAMILTON: In closing do you see a day where this is a normal part of the cancer approach - that a person walks in and they get traditional oncology treatment and receive their IV nutrients of whatever they are, and a whole food diet and vitamins and minerals? Is that day far off?

DR. JEANNE DRISKO: Kirk, from your mouth to God's ear. We hope that happens. Yes, I'd like to see that happen and I think we are providing a model for that here at the University of Kansas Medical Center.

KIRK HAMILTON: Well, I could go on and on and on. But I'm going to close. I just want to thank you so much, Dr. Drisko, for sharing this excellent work. I want to thank you for being a pioneer in bringing it to an academic center because for the clinician out on the field, you do the best you can to read research and then you just have to try. When someone is doing it in an academic center and is kind of ‘cleaning up' the process, so to speak, I greatly, greatly appreciate it. So, thank you so much. I want to thank also the audience for listening today on this edition of Staying Healthy Today Radio. And remember, until next time, Stay and Be Well.

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