Articles

Can Vitamin C Induce Abortion?

Editors Note: This is a guest contribution from two medical students, one from Chicago and one from Queensland. If you like their work, we’ll consider having them write more for us.

Authors:

Andrey Pavlov Jr.
UQ-Ochsner
University of Queensland School of Medicine

Igor Irvin Bussel
Chicago Medical School
Rosalind Franklin University of Medicine and Science

In hopes of joining the SBM movement as medical students, we wanted to take aim at a topic that has yet been finely dissected a la Novella or logorrheicly dismembered a la Gorski. Having realized that a fellow medical student, Tim Kreider, is already addressing integrative medicine on campus, we decided that we would attempt to find a controversial topic that has yet to be addressed on SBM. A serendipitous question from a friend sent us on a mission to explore the pseudo-scientific underbelly of the web and science-based rationale of the claim that vitamin C can induce abortion.

The World Wide Web is a stranger place than we can ever imagine. Most users are aware that they can’t believe everything they read on the Internet, yet they often feel like Sherlock Holmes when they find an esoteric and isolated clue to their own unique health puzzle. Recently, we were asked if there was a connection between vitamin C, menstruation and abortion. We were caught off guard by the question, finding it such a strange connection to make. The story, it seems, is that our friend had come down with a cold and taken mega doses of vitamin C to stave it off (another false belief, but not the subject here). A couple of days later her menses began and she was surprised since it was 4 days earlier than normal. She of course turned to Dr. Google and was quickly provided with numerous sources indicating that indeed, vitamin C would induce the start of a menstrual cycle and can even act as a “natural” abortefacient and a substitute for the ‘morning after’ pill. Being a bit more keen than your average Dr. Google user, she was surprised and continued searching, trying to find evidence to contradict these claims. Alas, she found nothingexcept more sites parroting and corroborating the claim. Then she realized she knew a couple of medical students and asked us what we thought. Our literature review turned up a slew of websites using the standard repertoire of trite pseudo-scientific tactics. Any attempt to find a credible source, validated claim, or independent consensus proved futile.

At the time of this writing, Google yielded over 400,000 results when searching for “vitamin C abortion” and around 45,000 results when searching “ascorbic acid abortion.” While both search queries resulted in about 38 entries on PubMed, nothing was found using Up-To-Date or Cochrane Collaboration. However, regardless of query terms, we could find no sites that refuted the claim of vitamin C as an abortefacient.
The top returned website references a Russian article written in 1966 by Samborskaia and Ferdman. This site will be the focus of our piece since it appears the most legitimate having a complete “references cited” section. This gives the illusion of credible research and bears thorough debunking. Sadly, the Russian article is the most relevant and “scholarly” article. The author of the site offers this analysis to support her claim:

The article is in Russian, and finding a copy was a problem… as was the language barrier. I had been corresponding with a lady from Slovak Republic (Slovakia) and mentioned the article. She went out looking for it, and was able to find a copy. She was able to translate it for me, and noted that the author did not specify the doses of ascorbic acid administered to the women, and the author also did not say specify how the women received the ascorbic acid; ie, liquid, injection, tablet.

The scientists who conducted the research, Samborskaia and Ferdman, came to the conclusion that high doses of Ascorbic Acid appeared to increase estrogen levels which contributed to the interruption of an otherwise normal pregnancy. 20 women who approached doctors requesting an abortion participated in the study. Research was conducted by ob/gyn L.I. Ivanyuta. The women ranged from 20 to 40 years of age. The article does not say if a positive pregnancy test was obtained from the participating women. We also don’t know how much ascorbic acid the women were given. They did however measure estrogen levels before and after treatment with ascorbic acid, finding that estrogen levels were higher after taking the ascorbic acid. Of the 20 women, 16 began menstrual type bleeding within 1 to 3 days from administration of ascorbic acid.

So the evidence cited here is from an article the author could not find, in a language she could not understand, translated by some unknown woman in Slovakia, with a sample size of 20, no known dosages or methods of administration, and even an admission that there was no documentation that all 20 women were even pregnant. Already riddled with biases, flaws, and fallacies, the author continues:

Also, in my own personal research, I’ve come into contact with numerous women who did confirm their pregnancies with a test, then used ascorbic acid (sometimes in conjunction with other herbs) to terminate those pregnancies successfully… While it can’t be considered scientific data, it is none-the-less proof that these home remedies do work for some women.

That which can’t be considered scientific data can’t be asserted as proof. This is a common failing in pseudo-scientific writings – an appeal to some other form of proof or “other ways of knowing.” The author continues with the empiric discussion:

It is said that on average 1 in every 4 pregnancies end in miscarriage. This would be 25% of all pregnancies. Statistics vary somewhat, and age is a factor, some say as few as 16% up to as much as 30% of all pregnancies end in miscarriage. A government website says 50% of all fertilized eggs die or are lost spontaneously – usually prior to the woman knowing she is pregnant, many of which do not implant in the uterine wall. In known pregnancies, they say that about 10% miscarry naturally and this normally happens between the 7th and 12th week of pregnancy. With this in mind, observations from my own research and data collection, about 45% of women with confirmed pregnancies are successful when using vitamin c (ascorbic acid) with the intention to end a pregnancy at home. This is well above the estimated rate of natural miscarriages (non-induced), so even if some of these women would of miscarried on their own without the steps they took to induce miscarriage at home (10% of known pregnancies miscarrying naturally or 1 in 4 pregnancies (known or unknown) ending naturally) these figures do not account for the increased rate of spontaneous abortion that I’m seeing through the data these women voluntarily provide.

The author cites a wide range of data on spontaneous abortion rates and concludes that “up to 30%” of all pregnancies end in miscarriage, though “a government website says 50% of all fertilized eggs die or are lost spontaneously”. From her own personal anecdotal “data” she finds that “45% of women with confirmed pregnancies are successful when using vitamin C… with the intention to end pregnancy at home.” For her, this is “well above” the estimated rate of “natural miscarriages” and therefore evidence that vitamin C works for this purpose. She further states that if the attempted vitamin C abortion does not work, it is important to go ahead and obtain a clinical abortion since even though the USDA does not list vitamin C as teratogenic, such a mega dose in an embryo has “too many unknowns” and one should not risk “having a messed up kid.” How can we ignore such sage medical advice and dutiful statistical analyses?

At least she can admit that “[n]atural or do-it-yourself does NOT mean it is SAFE [her emphasis].” That is about the only redeeming part to this travesty of medical advice. However, even the author’s own “statistics” indicate that, at best, there is only a very slight increase in the rate of abortion with vitamin C over spontaneous miscarriage. Considering the very small sample size, poor data quality, and complete lack of rigor it is safe to say this is either just completely false or normal noise with no statistical significance at all – not that we could even run a statistical analysis with the “data” we are given. Once again, the common pseudo-science tactic of asserting a statistical conclusion with no actual analysis rears its head.

Although we focus here on only one site devoted to this “naturalistic” nostrum, the remaining sites we found either reference this one, the original Russian article, or simply parrot the same piffle with no references at all. For example, NaturalMiscarriage.org has similar preposterous claims to the efficacy of many herbal abortefacients, including vitamin C, and even claims that in their respondent survey that 171 of 235 women (73%) who tried vitamin C had successful miscarriages. A few lines down we find that 93 of 118 women (79%) who tried “visualization and prayer” had a successful miscarriage. And apparently 38 of 46 women (83%) who tried avocados had a successful miscarriage – so we should clearly suggest avoiding guacamole at your church social if you are pregnant.

This pseudo-scientific claim has already failed from an evidence-based medicine perspective, but how about throwing a little science in the mix and conjecturing a prior probability? From the only article cited as reference to a human population, the mechanism is described as both “elevating estrogen levels to interrupt a normal pregnancy” and the “acid” of ascorbic acid (vitamin C) acting to disrupt the endometrium directly leading to the sloughing of menses. A quick PubMed search reveals four articles relating in at least some way to “vitamin C and abortion” in humans. One is a 2005 Cochrane review that examines multi-vitamin prenatal treatment as a prevention of miscarriage and stillbirth (not specifically vitamin C) and finds no relation between miscarriage and prenatal vitamin consumption. A 2011 update to the review holds the same conclusions. Two have no article or abstract available (one is in Polish from 1987 and the other in the Lancet from 1974). The last one is also a very small study (n=50) and found no causal relationship between vitamin C and spontaneous abortion. Furthermore, any biology undergraduate who passed physiology would know it is the drop in hormonal levels (including estrogen) that triggers the start of menses. Additionally, from a simple physiological point of view, the notion that ingesting a large amount of “acid” can alter the pH balance of the endometrium significantly enough for a physiological response is ludicrous. There is no mechanism by which vitamin C would be preferentially localized to the uterine wall and if the blood pH was changed enough to cause an endometrial sloughing, late menses would be the last of your worries.

In today’s political climate in America, especially in light of the recent vote to remove the federal funding for Planned Parenthood, having access to accurate medical advice based in science is important, regardless of your personal stance on the issue. Notably, based on a 2011 study in the American Journal of Obstetrics and Gynecology, 1.4% of 9,493 women surveyed, reported using vitamin C or herbal products to attempt to end a pregnancy. Though this is not an urgent danger to public health, others on the web have snagged onto this idea and have begun posting this same advice on forums such as eHow and women are actually seeking advice since these authors give the impression of authority on the matter. The startling thing is that there are simply no sources out there that say anything else about vitamin C and abortion – every searched source claimed efficacy of the method. The echo chamber of the Internet repeats the original assertion without any information to the contrary. For a person like our friend, there is little recourse except to assume that there must be some truth to this farcical claim. She had us to ask and it is our hope that this piece will give others a credible source to refute the claim that vitamin C induced abortion is legitimate.

Posted in: Clinical Trials, Science and Medicine

Leave a Comment (63) ↓

63 thoughts on “Can Vitamin C Induce Abortion?

  1. windriven says:

    “then used ascorbic acid (sometimes in conjunction with other herbs)”

    Ascorbic acid and other herbs? Does vitamin C grow as a tree or a shrub? I always thought it came from Costco. Does it grow in Slovakia?

    Nicely done, guys. I’d never heard of this particular nonsense.

    As an aside, do either of your programs offer ‘integrative’ or ‘complementary’ courses as part of your curriculum?

  2. daedalus2u says:

    One could look at hormone levels following megadoses of vitamin C, the endpoint doesn’t need to be miscarriage (which would be highly unethical in any prospective study). But the effects might be downstream of the hormones.

    Vitamin C is very effective at reducing nitrite to NO, and that is one of its physiological activities. The effects of hormones that cause menses probably do involve NO pathways and it is probably a drop in NO levels that trigger menses. Estrogen triggers nitric oxide synthase and increases NO levels, a drop in estrogen causes a drop in NO.

    It may not be a direct effect of vitamin C, but rather a sudden change in NO levels due to a rebound effect either from stopping taking the megadoses, or from a depletion of nitrite stores.

    In any case, it is probably an effect of regulatory pathways being perturbed by sudden, large magnitude changes in levels of essential physiological species, changes with time constants faster than physiology can compensate for. When physiology can’t compensate for things, it causes metabolic stress, which is responded to by inducing oxidative stress and low NO. Low NO would very likely accelerate menses and could also cause miscarriage. That is probably the mechanism by which stress does those things, via NO mediated pathways.

    If there is an effect of large doses of vitamin C on pregnancy, and if the effect is mediated through NO pathways as I have suggested, and if pregnant women do try to induce abortion by taking megadoses of vitamin C and the attempt is not successful, then (a lot of ifs in there, so be sure you take this with enough salt) there could be teratogenic effects on the fetus. The neural tube closes in the 3-5 week time frame, and neural tube closure and a lot of neuronal patterning involves NO and nitric oxide synthase. That could easily be disrupted and cause life-long changes in neuroanatomy.

    That could be the case for any type of herbal abortifacient, that if it is not successful the chances for birth effects would be greatly increased. Those birth defects might only show up as subtle changes in neuroanatomy.

  3. LovleAnjel says:

    It doesn’t appear that the one study cited had a control group, in which case you use it. There are herbs with active ingredients which induce miscarriage, so if the C id combined with those known abortifacients, I wouldn’t be surprised if a miscarriage resulted.

    This goes to show, access to birth control is not as widely available in this control as it should be.

    Sit and drink Pennyroyal Tea
    Distill the life that’s inside of me

  4. LovleAnjel says:

    Change first line to “can’t use it”.

    Oh, and invite the nice med students back for more columns. I liked the review of Google U results.

  5. GLaDOS says:

    Good jorb, studs! *thumbs up*

  6. Todd W. says:

    Nicely done! I’d never heard of this claim before. Thanks for covering it.

  7. “In today’s political climate in America, especially in light of the recent vote to remove the federal funding for Planned Parenthood, having access to accurate medical advice based in science is important, regardless of your personal stance on the issue.”

    Specifically, it may become crucial to have science-based methods to induce an abortion at home.

    I don’t remember hearing about Vitamin C as an abortifacient before, but if I were worried about a late period and lived in a region where medical or surgical abortions were difficult or impossible to obtain, I would certainly try it. It sounds easier and safer than throwing myself downstairs, getting into a scalding tub and drinking a bottle of whiskey, asking my boyfriend to dilate my cervix with clotheshanger wire or finding something heavy and punching myself in the belly with it for two hours a day until I miscarried.

    The Vitamin-C-causes-miscarriage story may not need to be countered. If it’s supposed to work within 3 days, you know whether or not it’s “worked” and you can try something else (like making an appointment with Planned Parenthood if possible, or cutting up and sterilizing some clotheshanger wire if not). From a public health perspective, ensuring access to safe and legal abortion is probably more important.

    See also this story about a pregnant woman in Iowa who sought health care after falling down stairs and who was arrested for falling down stairs while pregnant:
    http://news.change.org/stories/pregnant-iowa-woman-arrested-for-falling-down

    Yes, there actually is a criminal miscarriage law in Iowa. Other states are trying the same thing.

    Utah’s legislature recently tried to criminalize miscarriage, but the bill was vetoed.

    A Georgia representative has proposed a bill that includes the death penalty for a woman who has a miscarriage unless “there is no human involvement whatsoever in the causation of such event.”

    Vitamin C may or may not be an abortifacient, but there’s a reason women are keenly interested.

  8. Angora Rabbit says:

    First off, two thumbs up, fellows. I’d love to see you come back.

    Confession: I have an advantage as my research area is teratology and the effect of dietary agents upon development. So my first response on reading this excellent column was “Really!?” Then I dug into some references. And discovered there is the tiniest grain of truth to the claim.

    Lucille Hurley’s excellent text (sadly long out of print) “Developmental Nutrition” cites several older papers. I’ve not gone back to the original articles (have an overdue review article to finish) but can summarize what she says. She reports on a single clinical study that looked at 20 women who had a 10-15day delay in their menstrual periods. They took 6g ascorbic acid for 3 days for the purpose of terminating pregnancy. 16 of 20 had menstrual bleeding 1-3 days after the treatment. Urinary estrogen levels were elevated in 12 of the 16. The authors concluded that the ascorbate elevated circulating estrogen and led to termination. But as Lucille points out, there was no control group and no pregnancy test to confirm the women were pregnant. I suspect this might be the acorn from which an enormous and faulty oak has been grown.

    Guinea pigs given high dose ascorbate displayed infertility, fetal mortality and spontaneous abortions, although the mothers did not have overt symptoms.

    Although high dose ascorbate is not teratogenic in non-primate animals (according to my teratology references), there may be a deleterious effect on the child. High dose ascorbate can cause scurvy in the offspring by inducing mechanisms to prevent ascorbate toxicity in the fetus and offspring. Several cases of scurvy have been reported in women taking excessive ascorbate. This was corroborated in a guinea pig study that found scurvy in those mothers’ offspring.

    The references are (and I don’t know which are which because she lists the refs at the chapter’s end and doesn’t cite them in the text body):

    Martin MP, E Bridgeforth, WJ McGanity and WJ Darby. 1957. The Vanderbilt cooperative study of maternal and infant nutrition. X. Ascorbic acid. J Nutr 62:201-224.

    Norkus EP and P Rosso. 1975. Changes in ascorbic acid metabolism of the offspring following high maternal intake of this vitamin in the pregnant guinea pig. Ann NY Acad Sci 258:401-409.

    Teel HM, BS Burke, R Draper. 1938. Vitamin C in human pregnancy and lactation. Am J Dis Child 56:1004-1010.

  9. TsuDhoNimh says:

    Are we going to see clerks refusing to sell Vitamin C because their beliefs don’t allow them to

    *********
    On the writers and their skills: Overall good job, but some editing to smooth out the jumps between ideas would be welcome.

    Just read it out loud to yourselves and the lurching from idea to idea, and the slightly awkward sentence structure will become apparent.

  10. Alison Cummins “I don’t remember hearing about Vitamin C as an abortifacient before, but if I were worried about a late period and lived in a region where medical or surgical abortions were difficult or impossible to obtain, I would certainly try it. ”

    But what if vitamin C actually lowered the risk of early term miscarriages? Wouldn’t that be a kick in the pants?

    Home abortions are for people who don’t mind dying an excruciating death. The U.S. is screwed up right now & the anti-choicers (or the pro-excruciating death lobby) are only one small part of the general idiocy that is going on.

    I would offer recommendation of how to start fixing things, but I have no idea where to start.

  11. micheleinmichigan,

    RE kicks in the pants: Yep, it would. I’d try it anyway in those circumstances. Not because I’m particularly credulous, but because of limited options, wanting to try low-risk (even if probably low-benefit) things before moving on to very high-risk (with only moderate benefit) ones.

    “Home abortions are for people who don’t mind dying an excruciating death.”

    Home abortions are for people for whom the possibility of surviving and not bearing a child are worth the price of the lottery ticket.

    That’s one heavy lottery ticket.

    Remember menstrual extraction?
    http://en.wikipedia.org/wiki/Menstrual_extraction

  12. Alison – The crack about vitamin C was only to point out the ludicriness of putting women in the position of resorting to unproven methods, when we have perfectly good medical knowledge of proven methods.

    We are on the same page. My only point is that it is unethical to ban a voluntary safe procedure, when that procedure will inevitability be replaced with a less safe procedure that, because it is preformed without legal guidelines, comes without patient education, informed consent, etc.

  13. Josie says:

    I hadn’t heard of this before…but I would learn about it pretty quick if I were a a young woman who was late and desperate.

    Thank you for posting this entry. I am sure it will pop up in searches now done by young ladies trying to get out of an unwanted pregnancy.

    —-

    The proposed laws mentioned by other posters just seem ludicrous in the 21st century.

    In the early 90′s when I was working at the GW Hospital I thought it was weird that patients from Georgetown U hospital would get sent to us (on the down low) for their abortions when the prenatal testing turned up abnormal.

    Georgetown, being a Catholic hospital apparently couldn’t be expected to terminate a pregnancy, even one that would ultimately end in health problems for the mother or a profoundly disabled child.

  14. Harriet Hall says:

    Welcome to both of you! It’s really encouraging to know that there are critical thinkers in the new generation of doctors who not only understand science-based medicine but want to contribute to spreading the word.

  15. tanha says:

    Wait. Condemning high dose vitamin C during pregnancy is an example of Quakery/Pseudoscience? Um ok. This was pretty weak IMO.

    Writing was ok. But topic seemed irrelevant. I don’t think many people or CAM-proponents condemn vitamin C in this regard. Really, who cares? Are medical students really being bombarded with these sorts of questions and actually wasting their time “researching” this stuff? Get back into the cadaver lab and study the topics that are actually worth your time. Geeeeeez.

  16. Irvin Bussel says:

    Thank you for the kind words.

    We are honored to be able to contribute and proud that we were able to address this unexamined claim.

    We are thrilled by the response and will address the comments accordingly.

  17. Harriet Hall says:

    @tanha,

    That was uncalled for and unkind. And your first sentence doesn’t reflect the content of the article and doesn’t make sense, even after correcting “Quakery” to “Quackery.” The article was not about an example of CAM proponents condemning high dose vitamin C during pregnancy, but about a questionable claim that vitamin C could be used to cause an abortion.

    The article was a good example of the science-based medicine approach, evaluating whether a claim is plausible and is supported by credible evidence. The word quackery is not mentioned in the article, and quackery is not the main focus of this blog. Yes, medical students, like the rest of the SBM writers, are being bombarded with these sorts of questions, and we need to know how to do the research to answer them. We don’t ask how many people believe in something before deciding whether there is some critical mass of believers that would justify answering the questions.

  18. Andrey Pavlov says:

    First off, thank you to everyone for the positive comments and to TsuDhoNimh for the constructive criticism. This is my first foray into writing anything that wasn’t an assignment and I look forward to the possibility of doing more (and getting better). I know we both truly consider it to be an an honor to write here and keep spreading the critical thinking to as many people as we can.

    @tanha: I appreciate that this is not the most hot-button of topics (as noted in the conclusion) but I think we were far from “condemning” the use of vitamin C during pregnancy. The point was that it was being offered as evidence-based advice on how to terminate a pregnancy. As was noted by some of the commenters, a young woman would be likely to do a google search for “natural” abortefacients in situations where a safe and legal abortion was not an option to her (either due to law or family circumstances). The reality is that it likely does not have any real effect at all, but as has also been suggested, it could actually lead to birth defects/problems. So best case scenario is a delay in getting the medical attention a woman is seeking (which could lead it to becoming untenable) or worst case scenario is having some kind of serious problem with the pregnancy or the baby as a result.

    @daedalus: that is indeed a lot of “ifs” and makes for a nice hypothetical. As you well understand though, that doesn’t make for a clinical outcome, and even then I think such a recommendation as is our subject is still reckless.

    @Allison: I agree – the laws surrounding this issue are getting crazy and murky and making it harder to get safe and effective medical care. I’d never heard of “menstrual extraction” before but that is another reason to me for improving access, safety, and counseling for women seeking abortion.

    @angora: Thanks for the info regarding the possible teratogenicity. At least one part of the “advice” from that site seems reasonable, though of course I see it as even more reason to not try such a “home remedy.”

  19. Ed Whitney says:

    Good job indeed! One other thing the Cochrane Review did mention is that “women taking vitamin supplements may be more likely to have a multiple pregnancy.” Even if there were some observational data showing an association between vitamin supplements and spontaneous abortion, this would be a potential confounder to control for; multiple pregnancies are more likely to be high risk, and women with a multiple pregnancy are more likely to get vitamin supplements. Multiple pregnancy is associated with the exposure (vitamin C) and with the outcome (pregnancy loss). Assuming that vitamin C does not cause multiple pregnancy, the latter would meet the definition of a confounder. Assuming that we are talking about vitamins given as part of prenatal care, the third criterion for a confounder looks like a safe bet.

  20. Andrey Pavlov says:

    My longer comment is currently in moderation, but thank you for the kind words Dr. Hall

  21. nybgrus says:

    @windriven: yes, I do have an integrative medicine component to my medical school. I attempted to have a conversation with the professor after lecture one day in which he credulously defended acupuncture but when I started speaking intelligently on the topic (thanks to Ben Kavousi’s posts here) he suddenly had a meeting he needed to attend. His lectures tend to be the typical – CAM/Western medicine dichotomy, the use of pharmocognosy and exercise/nutrition as evidence of “alternative” credulity, and even a little flirtation with energy healing, meditation, etc. Luckily it is a pretty small component, and I think many students don’t give it too much thought. The problem as I see it though, is that this gives a foothold to grow and, more importantly, it teaches many a student not to think too critically on topics like these. If you come out of med school and need to do your own research on something, you may remember “Oh yeah, that was taught to us like that… must be OK” and not find cause to delve deeper. That is what I perceive to be the real and more immediate danger of it.

  22. Anthro says:

    Two thumbs up.

  23. windriven says:

    @nybgrus

    These integrative medicine programs are becoming ubiquitous. Three cheers to you for questioning your professor! And I absolutely agree that these programs give quackery a foothold – the the ultimate detriment of the profession and the patients.

    Keep up the struggle!

  24. nybgrus says:

    d’oh! I intended to post here under my own name and did not realize I had accidentally switched back and forth. My comments sans ‘nym are still in moderation so I will let those go through and for future responses here I will stick to that but wanted to let that be known lest confusion be sown. My apologies!

  25. daijiyobu says:

    Welcome. Perhaps beginnings aren’t as necessary to scrutinize as their intentions, I’ll venture. The movement quickens…

    -r.c.

  26. GLaDOS says:

    tanha,

    When you is in way over you head on the Internets, you best be backin it up outta there.

    Sincerely
    Your Daddy

  27. CLK says:

    Holy Moly!!
    Do I know about this one. Alt abortion stuff was a big deal when I was in college. I was part of a women’s collective that trained each other to do menstrual extractions. We were preparing for the revolution. Or the grid collapse. Or something else really really intense to come along and eliminate access to abortion.
    We also did all kinds of herbal “research” and there was the vitamin c thing.
    The herbs are a no brainer. There are well documented abortificants out there, and the truth is you have to basically make yourself deathly ill for them to work. What I remember from the vitamin c method was that you needed to take a huge dose- 3 grams every few hours up to 30 grams daily, to the point of explosive bowels for it to work, per rumor.
    I can definitely speak to the effectiveness of menstrual extraction and certain herbs. The only people I knew who tried Vitamin C had no success or gave up because they felt too ill from it. It seemed everyone knew someone it worked for, you just never actually met those people in real life.

    Then there was Plan B, methotrexate/ misoprostil medical abortions and RU-486 and I moved on.
    But I’m ready for the revolution, and maybe a better option than that coat hanger.

  28. A couple of things –

    Firstly – I think this is a very nice first run for both the authors and I would like to see more from them. In this particular article, I would have liked to see a bit more on plausibility, but that is probably just personal preference. I would also encourage the use of some sort of sub-headers or other organizational device to help readers locate themselves within the article. The massive blocks of texts in the more lengthy articles are a big difficult to visually manage onscreen sometimes.

    Secondly – I’m not a science person, so I’m sure I have just enough knowledge to be dangerous, but I’ll throw out a couple of ways that it occurred to me that vitamin c could have an effect on fertility (encourage or discourage fertility).

    Perhaps this is only useful to know the thoughts that other laypeople might have, so that you can address them. What they heck, I haven’t had the opportunity to look stupid yet today.

    Firstly, a number of years ago, during fertility treatment, I was researching (googling) the role of Antiphospholipid antibodies in recurrent pregnancy loss. As I recall the theory was that the ATP antibodies cause excess clotting, which discouraged functional implantation of the fertilized egg. Also, my FIL is on blood thinners due to a heart condition. I’ve been told that he has to be careful to regulate some of his vitamin intake (I think C is one of them) because some nutrients can increase or decrease the effectiveness of the blood thinners.

    Sooo, (long shot, but that’s the google U mindset) if vitamin C effects blood clotting (either as a blood thinner or to increase clotting), then it could either increase or decrease fertilized egg implantation. There

    Also, something to do with antioxidant, free radicals and recurrent pregnancy loss. Here’s a incomprehensible (to me) paper summary – http://www.ncbi.nlm.nih.gov/pubmed/10767402

  29. Andrey Pavlov says:

    michele: thank you for the kind words and the constructive criticism. I always love reading your comments precisely because you are not a “science person” as you say. Often, we get inured in our own jargon and forget when we are not being clear to those not well versed in our field. And please, you never look stupid. Stupid is when you claim things thinking you know them well. The fact that you can even preface your statements that way indicates your intelligence.

    The topics you bring up are not exactly my field of expertise but in doing some reading I will attempt to offer a bit a clarity.

    aPL antibodies (not sure where the ATP comes in – perhaps a typo?) attack the cell membrane and do indeed lead to a hypercoagulable state. Essentially it just makes you very much more likely to have a clot, which in pregnant women can lead to miscarriage from a clot being in the placenta or affecting the uterus in some way. To my knowledge there is no treatment for this besides anti-coagulants such as aspirin, warfarin, heparin, etc depending on the severity.

    As for your FIL, being on a blood thinner for a heart condition most likely means he has atrial fibrillation and most likely means it is warfarin. The reason he has to be careful with what he eats, including vitamins, is that warfarin works by blocking vitamin K which is necessary for making some of your clotting proteins work. If he has a diet high in vit K then this will make the drug less effective. Warfarin is also very much bound to protein (99%) in the blood and so if he takes a drug or eats something that also bind protein like that it will displace the warfarin and make to much of an effect. From a quick search it seems that vitamin C can decrease the effectiveness of warfarin, but it seems that high doses are needed (>1g/day) and that the data is sparse and it doesn’t seem to be that big an effect.

    However, to my knowledge vitamin C would not affect blood clotting in normal people and would have no effect on aPL antibody issues.

    The article you cited was an interesting one, and indeed a bunch of gobbledygook to most people. Essentially what it is saying is that in people with recurrent abortions, levels of anti-oxidant type molecules in the blood tend to be lower than in matched controls. However, it is not the inherent lowering of these markers that is the issue, it is the underlying process that is causing the abortions, and a marker of that is increased oxidative stress in the body as measured by these blood tests. They further say that it would seem that having recurrent spontaneous abortions further increases the oxidative stress level in a vicious loop. Since the underlying issues are autoimmune, luteal phase issues, or unexplained (the patients with anatomical issues did not have the same oxidative stress measurements, as we would expect) then it would seem to me that giving an antioxidant such as vitamin C might help to prevent the abortions, but to what extent I couldn’t say. In my experience (doing oxidative stress research on fruit flies vis-a-vis anti-aging pharmaceuticals) and from my readings my understanding is that vitamin C and other anti-oxidants do not have the clinical benefits one would expect in terms of aging and morbidity (a la the “oxidative stress theory” of aging) so I think the effects would be minimal at best.

    In summary, there are some cases where vitamin C can have effects on clotting and oxidative stress, but those appear to be minimal and they would help reduce the risk of abortion, not stimulate it to happen.

    Sorry if that was long and/or unclear – I am happy to try and clarify any points if you would like.

  30. AAbraham says:

    Great article! I found it to be both enlightening and entertaining.

    @ Harriet Hall, thank you for your eloquent response to tanha. A good medical education is much more than simply memorizing anatomical structures and whatever lecture notes are being spoon fed to the students. The fact that these students are curious, analytical, and understand the fundamentals of evidence based science will only help them in their future careers. These types of questions are indeed being asked of doctors and surgeons on a regular basis and students should begin to learn how to sort through the wealth of information and misinformation on the web to provide their patients with accurate and helpful advice based on available, valid research findings.

  31. daedalus2u says:

    Michelle, stress is an oxidative stress state. I don’t like the terminology used in that paper, I think it is actually wrong. A state of oxidative stress is a state regulated by physiology, it is not set by consumption of dietary levels of antioxidants. All long term placebo controlled diet studies with supplemental antioxidants have shown essentially no positive effects. Some have shown slight negative effects.

    If dietary levels of supplemental antioxidants are not affecting a state of oxidative stress, then a state of oxidative stress is not regulated by dietary levels of antioxidants.

    There are short term studies that show effects, and there are long term diet studies that show effects, but all the long term diet studies are with self-selected diets. My hypothesis is that diet selection is an important part of the physiology that regulates the body’s state of oxidative stress. If you are in a high stress state, and your body “wants” a state of oxidative stress, better to avoid all those antioxidants in green leafy vegetables and just get lots of good energy sources, lots of fat and lots of sugar. If people in a state of oxidative stress choose a diet devoid of antioxidants, of course there will be an association of a diet rich in antioxidants and good health, but the causal relationship is that the good health caused the selection of the “good” diet.

    If you consume excess antioxidants, your body has to destroy them metabolically by generating superoxide (which the body has unlimited capacity to do). That may be the mechanism of the vitamin C miscarriage effect. Consume a gigantic quantity of vitamin C, your body gears up to destroy it, you stop taking it and the excess superoxide causes the miscarriage.

  32. Andrey Pavlov says:

    I think you are going a bit cart-before-the-horse, daedalus.

    Vitamin C is water soluble and thus excreted, not destroyed via superoxide. Whilst the mechanism is not elucidated (at least not in the paper I am about to cite) it appears that bioavailability also decreases at higher doses. Saturation occurs at ~200mg orally and doses above that show significantly decreased bioavailability and increased excretion of intact vitamin C. Tissue and cell concentrations also plateau along with the plasma concentration. While the study group with healthy young men, the normal pharmacokinetics of vitamin C would lead me to disagree with your conclusion.

    Full text article from Proceedings of the National Academy of Sciences

  33. Andrey Pavlov aka nybgrus
    Thanks for the insightful and informative rundown. It’s good to know that there is very little risk of regular doses of C effecting fertility either negatively or positively.

    My fil has had a-fib. Thanks for the rundown on warfarin. It was especially helpful, as I have never fully understood the reasoning behind the dietary concerns. My mil explained the concerns, but she is not big into curiosity about the mechanisms behind a “rule”.

    Regarding ATP, something like a typo, mental glitch, but aPL is what I meant.

    D2U – I don’t think I quite understand. If your health is understress your should NOT eat a diet rich in vitamin C? I thought antioxidants were good for healing.

    *this message was typed on my iPad keyboard, which is like using a rake to dig a grave. Sorry for any mistakes, must get wireless key board.

  34. Irvin Bussel says:

    @michele

    Don’t get discouraged with the iPad keyboard. The learning curve is very quick and you will adapt faster than you can imagine. I had the same issue with the iPhone and iPad, but now it has become second nature. Hold off on the keyboard for a bit if you can and work through the pain period. It will be worth it.

    Stress, adaptation, and homeostasis are tightly regulated processes. These systems involve inflammation and repair. The human organism has a tightly regulated anti-oxidant system that is essential to function and even exploits oxidant molecules in killing bacteria and signaling cascades. So the story is not as simple that oxidants = bad while antioxidants = good.

    I spent several years as a researcher in the evolutionary biology and pharmacology of aging. Anti-oxidants were all the rage due to some fascinating basic science findings that I won’t bore you with. Though it seems that dietary antioxidants are not the panacea once believed and can even be harmful.

    http://jama.ama-assn.org/content/297/8/842.full.pdf

    There is no simple answer to your question about stress, inflammation, and anti-oxidant responses. But it is a very fascinating topic and for now I’d like to direct you to a new documentary about the work of Dr. Sapolsky on stress.

    http://killerstress.stanford.edu/

    I hope my thoughts were not too disjointed but I didn’t want my lack of sleep to inhibit contributing to the conversation :)

  35. daedalus2u says:

    Michelle, antioxidants are only good when and where physiology needs them to be and then only at the right amounts depending on what physiology is trying to do. For example, superoxide is a necessary regulatory product of mitochondria. It is there to regulate the local level of NO. A few percent of O2 consumption goes into superoxide. When mitochondria don’t generate enough superoxide, they open up the mitochondrial transition pore and let cytochrome c escape. This increases the generation of superoxide from the respiration chain.

    Andrey, I disagree. I don’t disagree that there is regulation of the amounts absorbed and retained. The setpoints of that regulation depends on the levels of the metabolic task the ascorbic acid is being called on to do. To the extent that ascorbate regulates levels of free radicals, supra-physiological levels of ascorbate will increase the production rate of free radicals until it matches that free radical setpoint.

    The paper you linked to only tested doses up to 2500 mg/day. CLK talks about 30,000 mg per day, an order of magnitude higher.

    The paper you linked to did show increased urate excretion. Uric acid is made by xanthine oxidoreductase from xanthine. During that oxidation superoxide is formed. In plasma, ascorbic acid is oxidized by redox active metals such as iron, and urate greatly slows down that reaction.

    http://www.ncbi.nlm.nih.gov/pubmed/1962559

    Ascorbic acid with redox metals and O2 will generate free radicals.

    To the extent that other antioxidant pathways are regulated by free radicals via the NF-E2 related factor and the Antioxidant Response Element, supraphysiological doses of one antioxidant will down regulate the activity of others.

    I appreciate that the “conventional wisdom” is that dietary antioxidants are doubleplusgood, but so far there have been no large, long duration, blinded clinical trials that have shown that. If you can find one I would be happy to look at it, but the last time I checked, every single one did not show positive effects.

  36. oderb says:

    @pavlov

    You are incorrect. Vitamin C saturation does not occur until at least 400 mg orally and well beyond that intravenously.

    See the work of Hickory as discussed at http://www.lewrockwell.com/sardi/sardi144.html

  37. Andrey Pavlov says:

    @michele: my pleasure. And yes, you’ve discovered my secret identity. I’m new to this blog thing.

    @daedalus: I also agree that the “conventional wisdom” regarding antioxidants is overblown at best and could well be downright false. In my research I have found that it is indeed true that VC and metals can produce ROS in vivo. And I also agree that the body can and will change the setpoint levels for VC as needed for whatever biological process is going on. However, I have yet to see any evidence, or know of any mechanism, by which excess VC would hang around to produce ROS to the point of clinical manifestation (i.e. induce abortion) instead of merely being less absorbed and excreted wholesale in the urine. As you said yourself, “The setpoints of that regulation depends on the levels of the metabolic task the ascorbic acid is being called on to do.” ergo if the metobolic tasks of the body at the time do not “call upon” more VC then it wont be absorbed and it will be excreted more – not let to increase to the point where ROS via metalloprotien/O2 interaction would become a significant factor.

    You are also correct in noting the doses (and indeed the sample size is small – in my searches I couldn’t find any really big studies) but the plasma levels plateau at only ~20% of the max dose in the study. I suppose that a sigmoidal distribution of the pharmacokinetics is possible, but I doubt this based upon the fact that VC is absorbed via a sodium dependent transport that exibits zero order kinetics.

    Even so, I don’t dispute that hyper-doses of VC could lead to increased ROS formation over baseline, but based upon what I know and have researched I just don’t think that it is a clinically relevant increase – barring perhaps some very peculiar metabolic disorder as a pre -existing condition.

    @oderb: the saturation level is of course slightly variable and subject to transient fluctuation. As indicated by the article I cited:

    Plateau plasm avitaminC was close to maximum at 200mg daily (Fig. 1C), but at higher doses bioavailability did not decrease proportionally (Table 2). The explanation could be vitaminC urinary excretion.

    Transient spikes in plasma concentration would be likely to occur until renal excretion caught up to mega- or hyper-doses.

    However, the article that you cite used liposomal VC delivery, which is quite different. And the comment in the discussion about the lethality of VC in such concentrations doesn’t seem to have born fruit – I couldn’t find a follow up study (granted I am not doing an exhaustive search but I’d imagine something of that kind of impact would come up relatively easily) using VC as anything but an adjunct to standard chemotherapy.

    But still, even taken at face value, there doesn’t seem to be any clinical relevance to it.

  38. The vitamin C-and-abortion topic was very well presented, and comments are awesome. The new writers should stick around.

    Regarding the A word, I guess I should not be shocked anymore, but I still am. Despite the extensive efforts regularly practiced beyond the call of duty, and beyond compensation, medicine practitioners generally get in line with the pro-choice view, even as far as to revise the Hippocratic Oath.

    An 8-week-old human being is an 8-week-old human being. It is helpless and voiceless, and utterly dependent on the rest of us.

    Figuring out medical-sounding ways to re-title this human, and kill off this human, is barbaric. De-humanizing the class of people you want to kill is a time-honored human tradition. The “revolution” will be when we see this as a human rights issue, which it is. These are our fellow human beings we are talking about, and killing off.

    The “religious zealot” defense did not hold up for very long when it was thrown at the abolitionists. no one looks back now and disusses how slavery was OK, but there were plently of people in the “free” states” who acepted the status quo while slavery was legal in the “slave states.”

    An interesting read is the Lincol-Douglas debate, where Douglas presents the popular pro-choice view, and strievs to pocket Lincoln as essentially an abolitionist, despite the pleasant ways that Lincoln tried to portray a pro-choce view. Lincoln would have appreciated rhetoric such as “safe, legal, and rare.” When you find yourself revising the Hippocratic Oath, you might want to stop and take pause.

    A nice SBM blog entry one day might be to explore what that developing fetus is, if it is not a unique, alive human being. And, to explore the various explanations medical people use to describe the blob of flesh, and the various theories as to when it becomes “human,” or achieves “personhood,” or becomes entitled to be covered by whatever civil rights might apply to any person in general.

  39. Scott says:

    An 8-week-old human being is an 8-week-old human being.

    Fundamentally, the dispute is over whether an 8-week-old fetus is actually a “human being” entitled to all the rights and protections thereof. Stating it in these terms therefore completely ignores the entire question…

  40. Harriet Hall says:

    Every sperm is sacred… :-)
    More than one high-minded anti-abortionist has been known to compromise his principles when his own daughter faced an unwanted pregnancy, particularly after rape or after failure of conscientious birth control. The rights of the fetus are weighed against the rights of a woman not to be forced to bear a child against her will. Abortion is wrong, but sometimes preventing abortion is wronger. Moral principles frequently conflict with each other, and simplistic absolutist fiats are not the answer. The crusaders thought a higher cause trumped “thou shalt not kill.”

  41. daedalus2u says:

    Harriet, or wife, as in Bob Barr.

    If human beings can experience brain death, how can something without a brain be a human being?

  42. @andrey pavlov – whoops, sorry didn’t realize it was supposed to be secret. I will forget the connection between the two entities. And it will bring me fond memories of Raising Arizona, “We’re using code names…”

  43. Irvin Bussel – Thanks so much for the links. I’m curious to look into them when I have time.

    Personally, I try to keep my dietary regiment simple and do not hope too much for big results, beyond smaller portions = less weight, fruits and veggies are good for you, so you should eat some each day, sort of thing.

    The article just got some wheels spinning, so I thought I would speculate.

    I’m not one to take vitamins, but it is nice to know that a bag of really good oranges or someone slipping a vitamin C supplement into my smoothies isn’t going to change much in the fertility department (it’s really not something that one wants unpredictable changes with.)

  44. Andrey Pavlov says:

    I just noticed that I missed an important word in my last comment – “And the comment in the discussion about the lethality of VC in such concentrations” should contain the words “cancer cells” there, but I reckon most people figured that out from context. My apologies – I had a 9 hour “women’s and men’s health” day and was responding after dinner when my mind was shutting down.

    @meds: Thank you for the comments. It was our goal in the article not to have it be about pro-choice or pro-life issues but merely about the science of the VC claim. That debate I will gladly leave to the others at this blog.

    @michele: not really supposed to be a secret and I was mostly jesting… still, I suppose it would have been nice to have some “Oracian” mystique. I guess if I ever have to go that route, I will need to pick a new ‘nym :-) Probably not a bad thing since “nybgrus” lacks panache anyways. Besides, I don’t think I should be ashamed of anything I had written on this blog (or others) whilst cloaked in the anonymity of the intertubes… should I?

  45. Calli Arcale says:

    Josie:
    “Georgetown, being a Catholic hospital apparently couldn’t be expected to terminate a pregnancy, even one that would ultimately end in health problems for the mother or a profoundly disabled child.”

    This is not surprising to me. My mother-in-law had a baby who died in the womb. She had a hard time even finding a hospital willing to extract the deceased fetus, and went a year before the pain was too unbearable and she was able to find someone (in South Dakota, no less) who would actually perform dilation & curetage (so-called partial-birth abortion, which was the only way to remove this corpse from her womb). He was only willing because she had developed an infection — the fetus was rotting. Thanks to that, my husband grew up with a mother, and a few years later, got a brother as well.

    MedsVsTherapy:

    Harriet Hall hits the nail on the head: “Abortion is wrong, but sometimes preventing abortion is wronger.” Abortion is an option of last resort, or at least it should be. Making it illegal will not stop it. (It certainly didn’t in Ireland.) I actually know a few people who have had abortions. One was “elective”, in the sense that her health was not in imminent peril, but seriously, who is in a position to judge whether the woman is making the right choice? Especially when there are edge cases? I am pro-choice, in the sense that I think the decision has to be made by a woman and qualified medical personnel, and if they judge that abortion is the less-bad option, then it should go ahead. Yes, this will be abused. But I think the alternative is worse, and this way we have the chance to develop a grown-up perspective on pregnancy and childbearing for a change.

    Many abortions are done because of a problem with the baby, or an expected problem with the baby. In the case of an anencephalic, this is simple; the baby cannot live outside the womb and has no experience of anything, so there is not really any value in forcing the mother to go through the entire pregnancy if she’s not willing. It is not always so simple; I don’t think it’s right to abort a Down’s baby (especially since the genetic tests really only indicate a risk, not a diagnosis) and I definitely don’t think it’s right to abort for the purpose of sex selection.

    Many other abortions are done because of a problem with the mother. Some cases are easy: mother has first-trimester eclampsia, which means she’s going to die before the baby’s old enough to be born, unless an abortion is performed. (Only cure for eclampsia is ending the pregnancy, either by abortion or by live birth.) There are a lot of gray cases. A 12-year-old mother has a much higher chance of complications and preterm birth than a 25-year-old mother, but it is far from certain that things will go badly. And then there’s the mental health argument; is it possible for some women to be so traumatized by pregnancy that it does them irreparable harm, and does this outweigh the considerations for the baby? That one’s a particularly difficult one to answer. And there are the obvious ones — it’s pretty silly to terminate a pregnancy on the health concern of having stretch marks.

    And some abortions are done for “elective” reasons — i.e. the mother and baby are fine, this doesn’t look riskier than any other pregnancy; the mother just doesn’t want to be a mother. These are also on a spectrum. It may be cruel to make a rape victim carry her rapist’s child (though I’ve read an interview with one rape victim who loves her child conceived that way, even though it was a stranger rape, because she sees her child as the one good thing that came out of it — obviously she’s got an unusually strong mental constitution). Some women fear the shame of being an unwed mother (and the common prolife tactic of describing a baby as their punishment for immoral behavior doesn’t exactly help), even in America today. Some fear becoming destitute. Some have a family already and do not feel they can support another child and also feel they would not be able to give a child up for adoption. (It is not that unusual for biological mothers to change their minds. It’s hard to let go of a child once you’ve had a chance to look into its eyes.) And some genuinely fear for their lives if anyone discovers that they have become pregnant (a group which probably overlaps significantly with the “rape victims” group) — it is worth mentioning that women are higher risk of domestic violence while pregnant than at any other time. Suddenly one begins to understand (even if one isn’t ready to condone) such a woman choosing to have an abortion.

    So we’ve got obvious “yeah, that’s understandable” and “yeah, that’s wrong” and unfortunately a very large gulf of gray cases between them. Who is to decide what’s justifiable and what’s murder? I don’t think it’s something the law is well-suited to decide. As long as abortion remains the provenance of medical professionals, we can make sure women have the best information available. We also desperately need to improve health education; many of these pregnancies are the result of misinformation and naivety, and we also need to improve education at all ages so that prospective parents know they don’t have to be terrified of becoming parents, and to know what options exist if they do not feel it is the right time for them to be parents. We cannot achieve that by moralizing at them.

    *steps off soapbox*

    About vitamin C and abortion — people will try anything. Part of me wonders how long before someone tries to sell a homeopathic abortifacient….

  46. MedsVsTherapy – If one your children requires a kidney transplant, it may be virtuous to provide that kidney (given a correct match). But I never heard anyone suggesting we make a law requiring that parents or grandparents donate their kidneys when needed.

  47. GLaDOS says:

    Despite the extensive efforts regularly practiced beyond the call of duty, and beyond compensation, medicine practitioners generally get in line with the pro-choice view, even as far as to revise the Hippocratic Oath.

    And why might that be?

    Perhaps because it is easier to dismiss the suffering of (aka “dehumanize”) a young woman with an unwanted pregnancy when you don’t chat with her face-to-face.

  48. daedalus2u says:

    I think that all women who go through with it see it as the least bad of a number of bad alternatives.

    That happens to be the way I look at chemotherpy and radiation treatments too. They are treatments that no one “wants”, they are just the least bad of a number of bad alternatives.

    Only the woman knows what the alternatives are and how bad they will be. If people were really “pro-life”, they would work to make those other alternatives less bad. But they don’t. They only try to make abortion more bad without making any of the alternatives to abortion less bad.

  49. “We could find no sites that refuted the claim of vitamin C as an abortefacient.”
    “Cite” for citation, and “site” for website.

  50. Andrey Pavlov says:

    @Calli: excellent soap box. I will refrain from addressing the ethical portion, but I would like to say that indeed you can definitively diagnose Down’s (or any other such genetic disease) in utero via karyotyping from an amniocentesis or chorionic villus sampling. The clues leading up to such a test (nuchal translucency, HCG levels, etc) increase the likelihood of such a diagnosis but are not definitive. That is why the karyotype is done. The questions raised would be: 1) Why do the karyotype if there is no chance (legally or individually from the parents) that there would be termination, and 2) if the argument is made that Down’s kids can live full, happy, and reasonably productive lives, ergo termination because of said genetic abnormality would be unacceptable, what about termination of Edwards or Patau (trisomy 18 and 13, respectively?) which are both much more debilitating and have severely limited life expectancies? Where is the line drawn? These are rhetorical questions which I do not claim to have answer to, but are certainly cogent in the development of reasoning for such legislation and should inform decision making processes.

    @daedalus: I think it rather arrogant to assert so forthrightly something which, by definition, a male can never fully appreciate. While I think you may be right in many cases, there are numerous cases where there is extreme regret after termination. I would stipulate that this makes a case for better education and understanding of options, better options to be made available (societally), and thus was (in part) the impetus for our piece.

    @meds: And now I now appreciate Dr. Gorski’s annoyance first-hand. The correct usage is known and used. Anything more salient to offer?

  51. Can vitamin C interrupt implantation of a fertilized egg? It is surprising that studies are pretty much non-existent on this, when more than 1% of a survey of women indicate that they have tried this.

    When I do lit searches, and when I teach budding evidence-based-medicine practitioners how to approach research questions, one strategy I believe is: before you head off to pubmed, spend some time specifying what a study would look like that would answer your question.

    I think a central question is: Can vitamin C interrupt implantation of a fertilized egg by causing earlier menstrual sloughing? This leads to an easier-to-answer question: Can vitamin C lead to an earlier menses for a given cycle, and if so, then by how many days?

    If an earlier sloughing can be provoked by some dose of vitamin C, then it would be a reasonable strategy for interfering with implantation of a blastocyte.

    The Russian study, I think, was of women who suspected that they were pregnant. But for my question, you don’t need women who suspect pregnancy (recruiting accomodating males for that study might not be too difficult).

    Angora Rabbit, above, cited a citation of a similar study of women who were already “late.” Limits in that were noted, and details look sketchy.

    But you could study this without too much difficulty.

    You would just need a cohort of women who happen to have fairly reliable menstrual cycles. Measure timing to get a baseline. Then, in an A/B design, give them the vitamin C dose, at whatever the supposedly optimal time might be in the ovulation cycle, and measure the number of days from one menses onset until the next menses onset . Test whether the days are relatively fewer with vitamin C versus no vitamin C.

    To be varied would be the dose and the timing.

    If the timing were right, if you could hurry the sloughing, you would interfere with implantation, and end the pregnancy.

    In pubmed, I crossed “vitamin C” or “ascorbic acid” with “menstrual” or “menses.”

    I saw nothing coming close to the study I wanted to find. That was kind of surprising. No one has given a cohort of women vitamin C to see if menses can be brought on earlier?

    The ethical problem would be the possibility of actually ending a pregnancy that otherwise would have progressed naturally. So, you might have to conduct the study with a cohort of women who would promise to swear off men for a while.

  52. daedalus2u says:

    Andrey, I thought I was pretty clear that I was not second guessing women as to the choices they made. I don’t see how that makes me arrogant. Maybe I was misunderstood.

  53. Andrey Pavlov says:

    daedalus: perhaps I was being too sensitive in what you were saying. It seemed to me you were being a bit absolutist and neglected some other factors in such a decision, but I apologize if I read too much into your comment. In re-reading it you could have simply been focused on one area and just not included other considerations which is reasonable. My apologies, since that seems to be the case.

    meds: You are correct. However, there is no plausible mechanism by which it would lead to that earlier sloughing of menses. Furthermore, the crux of the “advice” given on the sites reviewed was that it could end an already established pregnancy, not merely prevent implantation. All the data and mechanisms postulated failed our analysis and since 1% of women try this method thinking that it will work (and as much more than a “morning after pill”) it is still quite reasonable to say that indeed it does not work in this way. You are correct that the study you speak of could be done and evaluated. However, based upon the research to date, the physiology known, etc it would seem clear to me that even if VC could induce an earlier menses and thus have theoretical potential as a morning after pill alternative, it would have to be in extremely high doses (the effects of which we dont know and would have to study), it would likely have a relatively low rate of efficacy (certainly lower than 90-95%), and may well not work mid-cycle but could simply shorten the cycle by a few days at the end. Overall, the a priori assumption would lead to a reasonably low Bayesian probability which makes me question why even bother doing this sort of research when we already have an established, effective, and quite well understood morning after pill already in place? It seems more important to educate those 1% that VC is not a viable alternative and if they are looking for those effects to turn to already established and safe methods.

  54. “1% of women try this method thinking that it will work”

    I’d suggest that 1% of women try it hoping it might work.

    “It seems more important to educate those 1% that VC is not a viable alternative and if they are looking for those effects to turn to already established and safe methods.”

    Only if lack of education about relative effectiveness is the reason they are trying vitamin C.

    I can think of other reasons:

    > Cost.

    > Stigma against abortion and thinking that if a natural method is used then it’s not a real abortion.

    > Stigma against abortion and not wanting to have to tell anyone.

    > Poor availability of medical/surgical abortion where one lives.

    If these are more significant reasons for trying Vitamin C than lack of education about its relative effectiveness, then supporting Planned Parenthood will be more effective than education about Vitamin C in directing women first to safe, effective methods.

  55. Jan Willem Nienhuys says:

    In the Netherlands vitamin C as abortifacient is unknown. Of course, abortion is legal here, and when it is done in a clinic, the cost are covered by the state on the basis of the law about special health costs. I searched Google for abortus + vitamin + C in Dutch and after 100 sites I only had found three, and all three were products of automatics translation from English into funny Dutch.

    So the presence of well regulated possibilities for medically assisted abortion (and state financial assistance) makes that such funny superstitions don’t arise.

  56. Calli Arcale says:

    Meds:

    Can vitamin C interrupt implantation of a fertilized egg? It is surprising that studies are pretty much non-existent on this, when more than 1% of a survey of women indicate that they have tried this.

    I have heard tell that studies are also pretty much non-existent on whether or not birth control pills can do this, despite the fact that they routinely claim that they do. I’m not sure if that’s true or not, but it does seem that there may not be much evidence on anything’s affect on implantation.

    I imagine part of the trouble is that this would be very hard to study even in animals, and totally unethical to study in humans (not to mention impractical, given the relatively slow reproductive rate of humans). You’d probably need to create embryos in a dish and then drop them into uteruses of the same species to see how frequently they successfully implant, while giving the study drug to some of the animals, and see whether the implantation rate is higher in the control group. Given how many in vitro pregnancies fail naturally, you’d need a very large study group. It could be done, but I think it would be pretty expensive — and perhaps difficult to get funded, given current sentiments about abortion.

  57. “However, there is no plausible mechanism by which it would lead to that earlier sloughing of menses.”

    Vitamin C has some role in the menstrual cycle. It is unlikely, but still possible, that some dose at some well-timed point, might have an effect. I just heard some cancer-research talks, and the mere presence of some detectable molecule was enough to encourage speculation.

    Lancet, volume 297, Issue 7690, 16 January 1971, Pages 110-112. Preliminary Communication: RELATIONSHIP OF HUMAN ASCORBIC-ACID METABOLISM TO OVULATION
    H. S. Loh and C. W. M. Wilson

    “Abstract: Ascorbic-acid excretion has been measured daily in the first morning specimen of urine in five ovulating and five non-ovulating females who were receiving 500 mg. ascorbic acid each morning at breakfast throughout the menstrual cycle. Basal body-temperatures were taken daily before the subjects got out of bed. The ascorbic-acid excretion reached a peak and then diminished three days before ovulation. It increased at the time of ovulation. Two smaller post-ovulatory peaks also occurred. Control subjects did not show comparable fluctuations in ascorbic-acid excretion. The pattern of ascorbic-acid excretion closely resembles the excretion of luteinising hormone at the time of human ovulation.”

  58. Artour says:

    In my view, it is unlikely that vitamin C can induce spontaneous abortions. However, during the first years of the Buteyko breathing method in the 1960′s, Russian MDs discovered that quick breathing retraining makes the immune system hypersensitive and it can easily reject an embryo at the state when it is not yet attached to the womb of the mother (the first trimester of the pregnancy). More info:
    http://www.normalbreathing.com/l-buteyko-pregnancy-abortion.php

  59. Chris says:

    Artour, that is the most ridiculous spamming of your breathing method yet!

  60. Andrey Pavlov says:

    Especially considering that you are insinuating that the embryo does not implant until the 2nd trimester. That would certainly be rather interesting, now wouldn’t it?

  61. “I have heard tell that studies are also pretty much non-existent on whether or not birth control pills can do this, despite the fact that they routinely claim that they do.”

    Can this happen with birth control pills?

    For brevity, just the PMID ID: 8774274: “These alterations in epithelial and stromal integrin expression suggest that impaired uterine receptivity is one mechanism whereby OCs exert their contraceptive actions.”

  62. Artour might endorse Betaki breathing both for fertility problems, and to prevent pregnancy. That is how CAM is superior to SBM.

  63. Calli Arcale says:

    MedsVsTherapy — yes, that’s about all the more I’ve ever seen on it. The science seems to say it’s plausible that hormonal contraception would prevent implantation, but nobody’s ever looked at whether or not it actually does.

    Food for thought: Plan B (emergency high-dose contraception taken after unprotected intercourse) is not always successful. This could mean the “prevents implantation” thing is bollocks, or simply that it’s only partially effective at that — equivocal, in other words.

    Multiple pregnancies of different gestational ages are rare but not unheard of — even actual pregnancy hormones (which are stronger than the artificial ones used in contraception) are apparently not universal protections against implantation — perhaps the only reason these pregnancies are rare is that nearly all women stop ovulating while pregnant.

    It is plausible that it could reduce the effectiveness of implantation, I won’t deny that. I just don’t see where it’s been shown that it actually does, which makes the medical claim a bit dodgy in my opinion. They should stick with the “prevents ovulation” argument, really.

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