From: How to Live Longer and Feel Better
Chapter 14: Influenza and Other Infectious Diseases
Though people often diagnose themselves as having "the flu," influenza is not the same disease as the common cold. Some of the signs and symptoms, such as increased nasal secretion, are similar, but influenza is a highly contagious, potentially life-threatening disease. Like the common cold, it is caused by a virus. The influenza viruses belong, however, to a different family from the cold viruses, and the two diseases manifest themselves in some significantly different ways.
The incubation time for influenza (time from exposure to onset of symptoms) is short, about two days. The onset usually is sudden. It is marked by chills, fever, headache, lassitude and general malaise, loss of appetite, muscular aches and pains, and sometimes nausea, occasionally with vomiting. Respiratory symptoms, such as sneezing and nasal discharge, may be present but are usually less pronounced than with the common cold. Coughing, without production of sputum, may occur, and hoarseness sometimes develops. The fever usually lasts for two to four days. In mild cases the temperature reaches 101°F to 103°F (38.3°C to 39.4°C) and in severe cases as much as 105°F (40.6°C).
Treatment consists of rest in bed, continuing for twenty-four to forty-eight hours after the temperature has become normal. Antibiotics may be used to control bacterial infections. The diet should be light, with a large intake (3000 to 3500 milliliters [ml] per day, about 7 pints) of water and fruit juices. Except during a pandemic, when an especially virulent strain infects most of the population in a country or several countries, almost all of the patients recover completely.
Influenza is an old disease. Hippocrates in his book Epidemics described a disease raging at Perinthos in Crete about 400 B.C. in such a way as to permit its identification as influenza. An influenza epidemic was reported in 1557-1558, and a pandemic spread throughout Europe in 1580-1581. Other epidemics or pandemics broke out in 1658, 1676, 1732-1733, 1837, 1889-1890, 1918-1919, 1933, and 1957, and a mild one in 1977-1978.
The most serious influenza pandemic was that of 1918-1919. It swept over the whole world in three successive waves, May to July 1918, September to December 1918, and March to May 1919. It is thought to have arisen in Spain, and it was popularly called the Spanish flu (Collier, 1974). It broke out almost simultaneously in all the European nations and probably was rapidly spread because of the movements of troops and because of wartime conditions. The first wave did not reach some parts of the world, including South America, Australia, and many islands in the Atlantic and Pacific Oceans. The second wave, which caused most of the deaths, covered the whole world except the islands of St. Helena and Mauritius. Between 80 and 90 percent of the people in most countries contracted the disease, and about twenty million died. The disease was clearly not the same as ordinary influenza, because in 1918-1919 most of the deaths occurred among young people, whereas in the preceding and following years most of the deaths from influenza were among the old.
From 1892 to 1918 it was thought that influenza was caused by a bacterium, called Pfeiffer's bacillus, that had been isolated from sputum or blood of influenza patients.
Then in 1918 the French investigator Debre observed a similarity in the immune response of patients with influenza to those with measles, a viral disease, and concluded that influenza was probably also caused by a virus. Proof of this suggestion was immediately reported by Selter (1918) in Germany, Nicole and Lebailly (1918) in Tunis, and Dujarric de la Riviere (1918) in France. The proof was obtained by forcing infected sputum and blood through a filter with pores so fine that no bacteria could pass through them. It was found that the filtered liquid put in the nasal passage of monkeys and of human volunteers caused them to develop the disease, which was accordingly ascribed to a "filterable" virus, the particles of which are much smaller than bacteria.
Isolation of strains of influenza virus, permitting thorough studies of their properties to be made, was achieved in 1933 by the British investigators Wilson Smith, Christopher Andrewes, and Patrick Laidlaw. An account of their procedure was published by Andrewes in 1965. During the influenza epidemic of 1933 Andrewes and Smith, both of the British National Institute for Medical Research, were working on influenza when Andrewes became ill with the disease. Smith had him gargle with salt water and used the solution in an attempt to infect rabbits, guinea pigs, mice, hedgehogs, hamsters, and monkeys, but without success. Laidlaw, in the same institute, had been able to infect ferrets with dog distemper; he found that Andrewes's garglings introduced into the noses of ferrets caused them to become ill with the flu. Later a way was found to infect mice with influenza.
In fact, there had for a long time been evidence that some strains of influenza virus infect certain animals, as well as human beings. Observers had noted that in the 1732 epidemic horses seemed to be suffering from the same disease as people. The virus that caused the 1918-1919 pandemic has been shown to be antigenically identical with porcine influenza virus (swine-flu virus). The virus was not studied during the pandemic itself; the methods for doing so were not developed until fifteen years later. In 1935, however, Andrewes showed that persons twenty years old or older had a high concentration of antibodies against swine-flu virus in their blood, whereas children younger than twelve had none. The clear conclusion is that swine-flu virus was infecting children at some time between 1915 and 1923, presumably 1918-1919.
Thorough studies have led to the classification of influenza viruses into several types, each with many strains. The types are A (with subtypes AO, Al, and A2), B, and C. All nonhuman-flu viruses are of type A. A person who has recovered from an infection with one type of the virus is immune to it for some time but not to the others.
Some protection against influenza is provided by the injection of a vaccine. The vaccine is prepared by growing the virus on embryonated (fertile) eggs, removing the allantoic fluid, which contains the crop of virus particles, and inactivating them by treatment with formaldehyde. The inactivated virus is no longer infective; that is, it is no longer able to stimulate the cells of a human being or other host to produce additional virus particles. It is, however, able to act as an antigen, causing the host to produce molecules of its specific antibody. This antibody can combine with active virus particles and neutralize them, thus protecting the immunized person against the disease.
Vaccines are usually made with strains of viruses that are prevalent in the country at the time. Immunity from the vaccination lasts for about one year, after which booster doses extending the protection for another year may be given. The protection provided by vaccination is estimated to be 70 to 80 percent. Its failure may usually be ascribed to infection by a strain of virus differing from the strains used in making the vaccine; new strains seem to be continually arising. The partial protection provided by vaccination is considered to be especially important for old people and people with chronic diseases.
There are some possible side effects of the vaccination. Persons with a history of sensitivity to eggs should not be given the vaccine. Some persons suffer from local or systemic reactions to the vaccine, but immediate reactions followed by death are very rare. Because of the possible side effects, physicians usually advise their patients to be vaccinated only when there is a special reason. The imminence of an epidemic may constitute such a reason, especially for persons who, because of age or illness, are deficient in their natural protective mechanisms and for persons who are occupationally exposed, such as those in hospitals and clinics.
The importance of influenza is made clear by a 1973 report by Schmeck, based on unpublished data from the National Center for Health Statistics. In the ranking of diseases according to their impact on health in 1971, influenza and pneumonia (which often is a sequel in influenza) came first in days of disability in bed in 1971 (206,241,000), with upper respiratory infections second (164,840,000) and heart disease third (93,137,000). In deaths, influenza and pneumonia rank fourth (56,000), behind heart disease (741,000), cancer (333,000), and cerebrovascular disease (208,000).
The best protection against the flu is one's natural defense mechanisms. These defense mechanisms seem to have protected about one-sixth of the people during the 1918-1919 pandemic, presumably for the most part those people whose defense mechanisms were operating most effectively. There is much evidence, discussed in connection with the common cold, that a good intake of vitamin C improves the functioning of the natural defense mechanisms to such an extent that a much larger fraction of the population would resist the infection. The proper use of vitamin C, together with vaccination when its use is indicated, should be effective in preventing an influenza pandemic or serious epidemic.
In 1976 there was fear that another swine-flu epidemic like the one in 1918-1919 would occur. The United States federal government appropriated $165 million to subsidize the preparation of vaccines, and many million people were vaccinated. The serious epidemic did not occur. A sufficient number of the vaccinated persons suffered serious side effects from the vaccine to compel termination of the program. The worst of these side effects was the Guuillain-Sarre syndrome, a neuritis characterized by muscular weakness and sensory disturbances of the extremities.
The measures to be taken for the prevention and treatment of influenza through use of vitamin C are essentially the same as for the common cold. For most people the regular intake of 1 gram (g) or more per hour should be begun. Also, a high intake of vitamin C should not be used as an excuse for continuing to work until exhaustion sets in. A person who may be contracting a cold or influenza should go to bed, rest for a few days, and take plenty of fluids along with vitamin C, to have a much greater chance of avoiding serious illness. If you have a fever for more than a couple of days, or a very high fever, be sure to call your physician.
A good intake of vitamin C should prevent a secondary bacterial infection from beginning. If it does begin, your physician can control it by a suitable regimen with antibiotics. Some physicians might inject large amounts of sodium ascorbate.
Persons at special risk, such as those with heart, lung, kidney; and certain metabolic diseases, including diabetes, may be advised to be vaccinated against influenza, as may also doctors, nurses, and others exposed to the virus to more than the usual extent. They should also take vitamin C; it will protect against the side effects of the vaccination, as well as against the disease.
If an attack of influenza begins and is not stopped by vitamin C, you should continue to take the vitamin in large amounts. It should make the attack a light one, of short duration.
OTHER DISEASES AND INFECTIONS
Vitamin C has value in preventing and treating not only the common cold and influenza but also other viral diseases and various bacterial infections. Its main mechanism of action is through strengthening the immune system, as was discussed in Chapter 12. It may also have a direct antiviral effect, in some way inactivating the virus. There are very few drugs that are effective against viral infections, so that the value of the indicated anti-viral action of vitamin C is especially great. Most bacterial infections can be treated successfully with the appropriate antibiotics or other drugs, but vitamin C also has value as an adjunct to this treatment.
In 1935 Dr. Claus W. Jungeblut, working in the College of Physicians and Surgeons of Columbia University, was the first person to report that vitamin C, in concentrations that can be reached in the human body by a high intake, inactivates poliomyelitis virus and destroys its power of causing paralysis. He and other investigators showed that the vitamin inactivates herpes virus, vaccinia virus, hepatitis virus, and others (references to the early work are given by Stone, 1972). Jungeblut, who died in 1976, lived long enough to see greatly increased interest and activity in the field in which he pioneered.
The antiviral effect of vitamin C has also been studied by Murata and coworkers. Using viruses that infect bacteria as their model, they showed that these viruses are neutralized by a free-radical mechanism.
Dr. Fred R. Klenner, a physician in Reidsville, North Carolina, was stimulated by Jungeblut's report to use vitamin C in the treatment of patients with poliomyelitis, hepatitis, viral pneumonia, and other diseases (Klenner, 1948 to 1974). His suggested dose of sodium ascorbate by intravenous infusion for viral hepatitis is 400 to 600mg per kilogram body weight; that is, 28 to 42 g for a 150-pound person, repeated every eight to twelve hours, and he has administered up to twice this amount for various viral diseases (Klenner, 1971, 1974).
In addition to the antiviral action of vitamin C, many investigators have reported that ascorbate inactivates bacteria. One of the earliest studies was that of Boissevain and Spillane (1937), who showed that an ascorbate concentration of 1 milligram (mg) per deciliter, which is easily reached in the blood, prevents the growth of cultures of the tuberculosis bacterium. Effectiveness of ascorbate in inactivating many other bacteria and their toxins has also been reported, including the toxins of diphtheria, tetanus, staphylococcus, and dysentery and the bacteria that cause typhoid fever, tetanus, and staphylococcus infections (references are given by Stone, 1972). The mechanism of the inactivation seems to be similar to that for viruses: attack by free radicals formed by ascorbat
Klenner (1971), McCormick (1952), and others have reported a considerable degree of success in treating various bacterial infections in humans with large doses of vitamin C. This success may be attributed to some extent to the direct inactivation of the bacteria, for which evidence is presented in Chapter 13, but I think that for the most part it results from the action of the vitamin in in-creasing the power of the natural protective mechanisms of the body (Cameron and Pauling, 1973, 1974).
Hepatitis is inflammation of the liver caused by infections or toxic agents. It usually causes jaundice, a yellowness of the skin and the whites of the eyes resulting from an excess of bile pigments in the blood. Toxic substances such as carbon tetrachloride and various drugs, as well as heavy metals, may cause toxic hepatitis. Vitamin C is of some value in preventing toxic hepatitis because it has rather general detoxifying capability by hydroxylating or glycosylating toxic organic compounds and by combining with heavy metals.
Infectious hepatitis may be caused by viruses or bacteria, usually by viruses introduced by fecally contaminated food or water. The usual treatment is bed rest for three weeks or more. Serum hepatitis (hepatitis B, inoculation hepatitis) is caused by a different virus, hepatitis-B virus, and is usually transmitted to the patient by blood transfusions or use of unsterile hypodermic needles or dentists' drills. The incubation time is one to five months. Serum hepatitis occurs mostly in older people. It is more serious than infectious hepatitis, with mortality as high as 20 percent in some studies.
Dr. Fukumi Morishige in Japan became interested in vitamin C while he was a medical student: his thesis was on the value of the vitamin in accelerating the healing of wounds. When he became a thoracic surgeon and the head of a hospital in Fukuoka, Japan, he gave moderately large doses of vitamin C to some surgical patients who had received blood transfusions. He noticed that these patients did not develop serum hepatitis, whereas similar patients who did not receive the supplementary vitamin had a 7 percent incidence of the infection. In 1978 he and Murata reported their observations on 1537 surgical patients who had received blood transfusions in Torikai Hospital in Fukuoka between 1967 and 1976. Of the 170 patients who received little or no vitamin C, 11 developed hepatitis, an incidence of 7 percent, whereas of the 1367 patients who received from 2 to 6 g of vitamin C per day only 3 cases (all non-B) occurred, an incidence of only 0.2 percent. These numbers indicate that 93 patients were saved from the suffering and danger of hepatitis by the vitamin C (Morishige and Murata, jl 1978).
A high intake of vitamin C protects the liver in several ways. It detoxifies poisonous substances that might cause toxic hepatitis. By this effect, it also helps to prevent damage to the liver from cigarette smoking and overindulgence in alcoholic drinks. By making the immune system more effective, it helps to prevent and control viral and bacterial infections of the liver.
The physician who has had the. greatest amount of experience with vitamin C and viral diseases is Dr. Robert Fulton Cathcart III, of Los Altos, California.
Cathcart was for several years an orthopedic surgeon. In his practice he implanted in many patients a hip joint prosthesis, a metal ball attached to a spike that fits inside the upper end of the femur and replaces the round part of this upper leg bone. This prosthesis had been developed by Austin Moore, an English investigator. Cathcart was troubled by the failure of the implant in many of the patients because of erosion of the hip socket into which the ball fits. He decided to find out why the prosthesis was not more successful. He examined many human hip bones and noticed that the ball at the top of the femur is not spherical but spheroidal, and he designed a new pros-thesis conforming more closely to the shape of the femur. Many thousands of the Cathcart prostheses have now been implanted.
In 1971, shortly after my book Vitamin C and the Common Cold was published, Cathcart wrote me to tell how he had read the book and by following its recommendations had succeeded in controlling the serious respiratory infections and infections of the inner ear that had plagued him since childhood. He reported that a single dose of 8 g of vitamin C taken at the first sign of a cold usually stopped it, although often additional doses were needed.
He was so much impressed by the effectiveness of vitamin C that he gave up his practice as an orthopedic surgeon and became a general practitioner, specializing in the treatment of infectious diseases (Pauling, 1978). By 1981 he was able to report on his observations on 9000 patients treated with large doses of vitamin C (Cathcart, 1981).
Cathcart makes it his practice to establish for each of his patients their bowel-tolerance intake of vitamin C—the amount of vitamin C taken by mouth that is a little less than the amount that has a troublesome laxative effect. He found that vitamin C is most effective as an adjunct to appropriate conventional therapy, when needed, if it is ingested at the bowel-tolerance intake. This intake is different for different people and different for the same person at different times. Cathcart observed that the bowel-tolerance intake is usually very large for seriously ill patients and becomes smaller as the patient's health improves. He was astonished that for some severely ill patients the bowel-tolerance limit was more than 200 g per day. Within a few days, as the disease was controlled, the limit would fall toward the normal values, 4 to' 15 g per day.
Having thus established a standard for administering vitamin C to his patients in a manner responsive to their biochemical individuality, Cathcart has accumulated a wealth of experience with this orthomolecular treatment of many different kinds of infection. He indicates that vitamin C has little effect on acute symptoms until doses of 80 to 90 percent of bowel tolerance are reached. He also has stated that suppression of symptoms in some instances may not be total but usually is very significant, and often the amelioration is complete and rapid.
It is known that many stressful conditions cause destruction of vitamin C and consequently low concentrations of the vitamin in the blood and other tissues, unless it is replaced by a high intake of the vitamin. Among these conditions are infectious diseases, cancer, heart disease, surgery, injury, cigarette smoking, and mental and emotional stress. The low level of vitamin C is called hypoascorbemia by Irwin Stone and induced scurvy or anascorbemia by Cathcart. Unless rectified, it leads to exacerbation of the trouble affecting the person. There is the possibility that the mechanism of the observed increased morbidity and mortality of men and women following the death of a spouse is the destruction of vitamin C by the stressful situation. This may be explained by extra demand for ascorbic acid in the adrenal glands for manufacture of the stress hormone, adrenalin, as shown in Chapter 8.
The possible consequences of induced anascorbemia have been described by Cathcart (1981) in the following words:
The following problems should be expected with in-creased incidence with severe depletion of ascorbate; disorders of the immune system such as secondary infections, rheumatoid arthritis and other collagen diseases, allergic reactions to drugs, foods and other sub-stances, chronic infections such as herpes, or sequelae of acute infections, and scarlet fever; disorders of the blood coagulation mechanisms such as hemorrhage, heart attacks, strokes, hemorrhoids, and other vascular thromboses; failure to cope properly with stresses due to suppression of the adrenal functions such as phlebitis, other inflammatory disorders, asthma, and other allergies; problems of disordered collagen formation such as impaired ability to heal, excessive scarring, bed sores, varicose veins, hernias, stretch marks, wrinkles, perhaps even wear of cartilage or degeneration of spinal discs; impaired function of the nervous system such as malaise, decreased pain tolerance, tendency to muscle spasms, even psychiatric disorders and senility; and cancer from the suppressed immune system and carcinogens not detoxified; etc. Note that I am not saying that ascorbate depletion is the only cause of these disorders, but I am pointing out that disorders of these systems would certainly predispose
to these diseases and that these systems are known to be dependent upon ascorbate for their proper function.
Not only is there the theoretical probability that these types of complications associated with infections or stresses could result from ascorbate depletion, but there was a conspicuous decrease in the expected occurrence of complications in the thousands of patients treated with oral tolerance doses or intravenous doses of ascorbate. This impression of marked decrease in these problems is shared by physicians experienced with the use of ascorbate such as Klenner (1949, 1971) and Kalokerinos (1974).
Infectious mononucleosis (glandular fever) is an acute infection that affects mainly young people and is some-times epidemic in schools and colleges. It is characterized by swelling lymph nodes throughout the body and the appearance of abnormal lymphocytes in the blood. The patients, after an incubation period of five to fifteen days, have vague symptoms of headache, fatigue, fever, chills, and general malaise. Secondary throat infections and liver damage by clogging with lymphocytes some-times occur, as well as problems with the spleen, nervous system, heart, and other organs. The disease sometimes runs its course in one to three weeks but often is troublesome for several months.
Cathcart has reported success in treating mononucleosis with large oral doses of vitamin C (see table on page 173). Here are his comments:
Acute mononucleosis is a good example because there is such an obvious difference between the course of the disease, with and without ascorbate. Also, it is possible to obtain laboratory diagnosis to verify that it is mononucleosis being treated. Many cases do not require maintenance doses for more than 2 to 3 weeks. The duration of need can be sensed by the patient. I had ski patrol patients back skiing on the slopes in a week. They were instructed to carry their boda bags full of ascorbic acid solution as they skied. The ascorbate kept the disease symptoms almost completely suppressed even if the basic infection had not completely resolved. The lymph nodes and spleen returned to normal rapidly and the profound malaise was relieved in a few days. It is emphasized that tolerance doses must be maintained until the patient senses he is completely well, or the symptoms will recur.
HOW MUCH TO TAKE
Usual bowel-tolerance doses Vitamin C (Cathcart, 1981)
||Grams (1,000 mg)
|Hay fever, asthma
|Environmental and food allergy
|Bum, injury, surgery
|Anxiety, exercise, and other mild stresses
|Acute anterior uveitis
During recent years a new disease has been recognized, acquired immune deficiency syndrome, usually called AIDS. It seems to be a viral disease, mainly transmitted by fecal matter during sexual contact but some-times by blood transfusions. The patients are mainly promiscuous homosexual men, but there are some others, including a few children and infants. The patients develop secondary infections and a form of cancer, Kaposi's sarcoma, and the disease often results in death.
The success of vitamin C in controlling other viral diseases suggests that it be tried with AIDS. Dr. Ewan Cameron, Dr. Robert F. Cathcart, and I separately during the last three years made this proposal to appropriate medical groups, but with no response.
One study has been published. Cathcart (1984) examined ninety AIDS patients who had sought medical care from other physicians and who also took high doses of ascorbate on their own initiative, and he also treated twelve AIDS patients with high doses (50 to 200 g per day) of oral and intravenous ascorbate. From his limited observations he has concluded that vitamin C suppresses the symptoms of the disease and can reduce the incidence of secondary infections. It is evident that additional work along this line is needed. [see efforts this year in this direction by Dr. Matthias Rath]
CHEMOTAXIS OF PHAGOCYTES
Chemotaxis of phagocytes is an important part of the immune mechanism (Chapter 12). Chemokinesis is increased movement of the cells, either directed or random, in response to a chemical stimulus, and chemotaxis is increased movement in the right direction, toward the place where they are needed, such as the focus of an infection. Neutrophils are the leucocytes that are most chemotactically responsive—they arrive first at an inflammatory focus, followed by other phagocytic white blood cells.
There are many different causes of abnormal chemotaxis of phagocytes (Gallin, 1981). Many responsible genetic abnormalities are so serious that staphylococcus and other infections and skin problems appear in the first days of life, and most of these infants do not live very long. In several diseases, including rheumatoid arthritis and cancer, substances are released by the diseased tissues into the blood that interfere with the mobility of phagocytes.
Many investigators have reported that an increased intake of vitamin C improves the chemotactive response of phagocytes. One of many examples is Anderson (1981), who reported that 1 g of vitamin C per day gave improved neutrophil mobility in children with chronic granulomatous disease. Similar improvement has been reported in patients with asthma and tuberculosis. Patrone and Dallegri (1979) concluded that "Vitamin C represents the specific therapy for primary defects of phagocytic function in persons with recurrent infections."
The question of phagocytic function invites a digression here from infections to genetic disease. Patients with the recessive genetic disease called Chediak-Higashi disease suffer frequent and severe pyogenic (pus-forming) infections that result from abnormal chemotactic responsiveness of neutrophils and other phagocytic cells. These cells are able to move by means of the contraction of actin-myosin fibrils (similar to those in muscle) located in the front edge of the cell. Good locomotion of the cell is permitted by its structure, its stabilization by rods, called microtubules, that extend from the central region to the periphery. The genetic abnormality in Chediak-Higashi disease involves an abnormality in the protein tubulin that by aggregation forms the microtubules.
Ten years ago it was discovered that vitamin C enhances neutrophil chemotaxis (Goetzl et al., 1974). Several investigators have reported that increased intake of vitamin C by Chediak-Higashi patients protects them against infections, although it does not correct the abnormality in the tubulin molecules (Boxer et al., 1976, 1979; Gallin et al., 1979). This clear example of the value of vitamin C in controlling infectious diseases in these patients emphasizes its importance for the immune system.
Kartagener's disease is a recessive genetic disorder with low incidence (one in thirty thousand to forty thou-sand births) and an astonishing collection of manifestations. It is characterized by chronic bronchitis and infections of the sinuses and middle ears and a tendency to have chronic headache. Male patients are sterile and have immobile spermatozoa; many patients show situs inversus, with the heart on the right side and some or all of the other internal organs in the right-left reflected positions.
These facts raise the question of how the large-scale chirality of the human body is determined. Why do most people have the heart on the left side? What has gone wrong with the patients with Kartagener's disease who have situs inversus?
In the discussion of right-handed and left-handed amino acids in Chapter 9 it was pointed out that the proteins in the human body are all built of L-amino acids. One of the principal ways of folding the polypeptide chains (linear sequences of amino-acid residues) in proteins is the alpha helix. The alpha helix is required by the handedness of the L-amino-acid residues to be a right-handed helix, like an ordinary screw. The diameter of an amino acid is only about one hundred-millionth of that of a human being, but a segment of alpha helix may be one hundred times as long, thus carrying the message of handedness to structures as large as one-millionth of the diameter of the body.
Another way of transferring chirality to larger structures was discovered in 1953, when I pointed out that a globular protein molecule, built of perhaps ten thousand atoms, could have two mutually complementary sticky patches on its surface such as to cause it to combine with similar molecules to produce a large helix in the form of a tube (Pauling, 1953). Such a structure, in units such as the microtubules, can carry handedness throughout a
The spermatozoon normally swims by using its tail as a propellor, with a corkscrew motion. The corkscrew (helix) might be either right-handed or left-handed. Its handedness in a nonnal spermatozoon is determined by little protuberances, called dynein arms, which stick out from the tail to either the right or the left. These dynein arms are missing from the spermatozoa of patients with Kartagener's disease; the tails then do not know which way to twist, the spermatozoa do not swim, and the patients are sterile (Afzelius, 1976).
In the same way the cilia in the bronchi are unable to wave back and forth to keep the bronchi clear, and the patients are accordingly especially susceptible to bronchitis and associated infections. The tendency to have chronic headaches may result from a defect of the cilia of the epithelial membrane lining the ventricles of the brain and the canal of the spinal cord.
The nature of the structures that determine the chirality of the organs, placing the heart on the left side, is not known, but it is likely that they resemble the dynein arms of the sperm tails. Their abnormality for Kartagener patients might leave the positioning of the heart and other organs to chance, so that half of them would show situs
These patients have abnormal neutrophil chemotaxis that is related to a microtubule abnormality. There is the possibility that their resistance to bacterial infection might benefit from an increased intake of vitamin C, as do the patients with Chediak-Higashi disease, but this has not yet been demonstrated.
I have been astonished, as have other people, that in the last quarter of the twentieth century a single substance would be recognized to be helpful no matter what disease a person is suffering from. The reason that vitamin C is such a substance is that by its involvement in many biochemical reactions in the human body it makes the body's natural defenses more powerful, and it is these natural defenses that provide most of our resistance to disease. Our bodies can fight disease effectively only when we have in our organs and body fluids enough vitamin C to enable our natural protective mechanisms to operate effectively. The amount required is, of course, much larger than the amount that has been recommended by the authorities in medicine and nutrition in the past.
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