Dr. Richard Cheng, Cheng Integrative Health Center

Dr. Cheng’s anti-aging program, daily practical operations and specific nutritional supplements

This article is for informational purposes only. Please use under the guidance of a qualified and experienced doctor. This was originally written in Chinese and I google-translated it into English. I read through to make sure it is accurate, although the English expression may not be the best.

• diet
• sleep
• rest, relaxation
• exercise
• nutritional supplements

After getting up around 6-7 am, I drink a cup of black coffee.

I sit under a red- near infrared light (660nm + 850nm light) source. I usually shine my head or shoulders and upper arms under near-infrared light. I then scan the medical literature for any interesting updates.

Red light illuminates my eyes. I also listened to some news on American politics and culture, and received red light eye therapy (closed my eyes and looked at the light source for 3 minutes every morning).

About an hour after drinking coffee, I drink a morning anti-aging cocktail:

• 5-10 grams of vitamin C powder +  one bag of vitamin K2 + 25 mg (5 dropfuls of 1%) of methylene blue.

I usually don’t eat breakfast. I usuallly drink some black coffee.

Lunch: My first meal of the day is lunch, usually between 12noon and 2pm.  I usually have a big lunch with fatty meat, fish or eggs, cooked in butter, lard, coconut oil and olive oil. I also eat a little bit of leafy greens or cruciferous vegetables. I don’t have sugar at home and I don’t use sugar. I use glycine as a sweetener if desired.

My daily nutritional supplements (prepared in our clinic):

• Vitamin B1, 2 capsules daily (800 mg)
• Vitamin B2, 2 capsules daily (520 mg)
• Vitamin B3 (instant-release niacin), 4 – 6 capsules daily (2,000 – 3,000 mg)
• Vitamin C, 2 – 3 bags daily (10,000-15,000 mg)
• Vitamin D3, 30,000 IU daily
• Vitamin K2, 1 capsule daily (1000 mcg)
• Omega-3 Oil, 4,000 mg daily
• Dr. Cheng’s TotoCell Nutrition (one bag daily)
• Dr. Cheng Liver Detox, 1 bag daily
• Magnesium Glycinate, 2 capsules daily (1200 mg)
• Metformin, 2 tablets (1000 mg) daily
• GlyNAC, one bag

After lunch, I usually take a short break before returning to work

Dinner: I usually have a light, fat-burning (low-carb/keto) dinner around 6-7pm.

Exercise: I usually play badminton 2-3 times a week, 2-3 hours each time.

Before bed, I take another dose of methylene blue (25 mg) along with vitamin C (5 mg), GlyNAC, and butyric acid.

I usually go to bed around 11-12pm.

I would lie in bed and shine red and near-infrared light on my body until I fell asleep. I usually sleep well, staying up all night and not waking up until 6-7am.

• GERD is the leading cause of Barrett’s esophagus. Elevated oxidative stress is a key underlying biochemical feature (1, 2). Esophageal adenocarcinoma (EAC) is the leading form of esophageal malignancy in the United States and other industrialized countries. The incidence of EAC has increased rapidly over the past four decades. Barrett’s esophagus (BE) is the major precancerous lesion of EAC in which metaplastic columnar epithelium replaces the normal squamous mucosa of the lower esophagus. The main risk factors for BE and EAC are chronic gastroesophageal reflux disease (GERD), obesity, and smoking. During the BE-dysplasia-EAC sequence, esophageal cells bear a huge burden of reactive oxygen species (ROS) accumulation and oxidative stress. Although normal cells have a complete antioxidant mechanism to maintain a balanced anti-tumor physiological response, the antioxidant capacity of tumor cells is compromised due to the anti-oxidative response that promotes tumorigenesis. During tumor progression in the GERD-BE-EAC sequence, the accumulation of ROS induces DNA damage, lipid peroxidation, and protein oxidation. Tumor cells adapt to oxidative stress by generating tumor-promoting antioxidant responses that keep oxidative damage below lethal levels while promoting tumorigenesis, progression, and resistance to therapy (1).
• Low-carb/ketogenic diet improves gastroesophageal reflux disease (3). A ketogenic diet can improve heartburn symptoms in several ways. Losing weight has been shown to improve heartburn symptoms and acid reflux, and a ketogenic diet is one of the most effective ways to lose weight and maintain a healthy weight. Sugar has pro-inflammatory effects that may make digestive problems worse. Studies show that restricting sugar and carbohydrate intake (low-carb/fat-burning (ketogenic) diets) can improve heartburn symptoms and acid reflux (4, 5). A high-sugar diet requires normal pancreas function. If your pancreas can’t produce enough enzymes to process the excess sugar, the bacteria in your gut can become unbalanced. The result is an overgrowth of opportunistic bacteria that interferes with nutrient absorption and causes gas, bloating, and increased acidity. The ketogenic diet eliminates these grains and starchy carbohydrates that feed opportunistic bacteria (6, 7, 8). Certain carbohydrates, including grains and other starches, also ferment and produce gas, which can stress the lower esophageal sphincter. Some studies have involved interesting measurements, such as the 24-hour esophageal pH probe test, and concluded that ketosis may improve GERD and reflux symptoms. The antioxidant, anti-inflammatory, and nutritious foods commonly found on a ketogenic diet can be very beneficial in managing heartburn symptoms. The best keto foods for gut healing include bone broth, asparagus, garlic, and apple cider vinegar. Fermented foods like sauerkraut and kimchi can nourish the healthy bacteria in your gut and help restore balance. A lack of stomach acid can also cause the contents to back up into the esophagus. Your stomach needs enough acidity to digest food. Many people with acid reflux don’t make enough stomach acid (9).
• Plasma antioxidants such as selenium, vitamin C, β-cryptoxanthine, and lutein were significantly lower in patients with Barrett’s esophagus (10, 11).
• Dietary antioxidants, including vitamins C and E, beta-carotene, selenium, and zinc, can inhibit oxidation and prevent Barrett’s esophagus and esophageal cancer (12).

1. Peng D, Zaika A, Que J, El-Rifai W. The antioxidant response in Barrett’s tumorigenesis: A double-edged sword. Redox Biol. 2021 May;41:101894. doi: 10.1016/j.redox.2021.101894. Epub 2021 Feb 14. PMID: 33621787; PMCID: PMC7907897.
2. Han D, Zhang C. The Oxidative Damage and Inflammation Mechanisms in GERD-Induced Barrett’s Esophagus. Front Cell Dev Biol. 2022 May 26;10:885537. doi: 10.3389/fcell.2022.885537. PMID: 35721515; PMCID: PMC9199966.
3. Austin GL, Thiny MT, Westman EC, Yancy WS Jr, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006 Aug;51(8):1307-12. doi: 10.1007/s10620-005-9027-7. Epub 2006 Jul 27. PMID: 16871438.
4. Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle Intervention in Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2016 Feb;14(2):175-82.e1-3. doi: 10.1016/j.cgh.2015.04.176. Epub 2015 May 6. PMID: 25956834; PMCID: PMC4636482.
5. Newberry C, Lynch K. The role of diet in the development and management of gastroesophageal reflux disease: why we feel the burn. J Thorac Dis. 2019 Aug;11(Suppl 12):S1594-S1601. doi: 10.21037/jtd.2019.06.42. PMID: 31489226; PMCID: PMC6702398.
6. Damiano A, Handley K, Adler E, Siddique R, Bhattacharyja A. Measuring symptom distress and health-related quality of life in clinical trials of gastroesophageal reflux disease treatment: further validation of the Gastroesophageal Reflux Disease Symptom Assessment Scale (GSAS). Dig Dis Sci. 2002 Jul;47(7):1530-7. doi: 10.1023/a:1015815102175. PMID: 12141813.
7. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: a pilot study in European- and African-American obese women. Aliment Pharmacol Ther. 2016 Nov;44(9):976-988. doi: 10.1111/apt.13784. Epub 2016 Sep 1. PMID: 27582035; PMCID: PMC5048546.
8. Can Keto Help Heartburn? – Keto Lifestyle (ketogenic.com)
9. Wright, J. V., Lenard, L. (2001). Why stomach acid is good for you: Natural relief from heartburn, indigestion, reflux, and GERD. M. Evans.
10. Kubo A, Levin TR, Block G, Rumore GJ, Quesenberry CP Jr, Buffler P, Corley DA. Dietary antioxidants, fruits, and vegetables and the risk of Barrett’s esophagus. Am J Gastroenterol. 2008 Jul;103(7):1614-23; quiz 1624. doi: 10.1111/j.1572-0241.2008.01838.x. PMID: 18494834; PMCID: PMC2735568.
11. Clements DM, Oleesky DA, Smith SC, Wheatley H, Hullin DA, Havard TJ, Bowrey DJ. A study to determine plasma antioxidant concentrations in patients with Barrett’s oesophagus. J Clin Pathol. 2005 May;58(5):490-2. doi: 10.1136/jcp.2004.023721. PMID: 15858119; PMCID: PMC1770670.
12. Kang JH, Luben R, Alexandre L, Hart AR. Dietary antioxidant intake and the risk of developing Barrett’s oesophagus and oesophageal adenocarcinoma. Br J Cancer. 2018 Jun;118(12):1658-1661. doi: 10.1038/s41416-018-0113-y. Epub 2018 May 21. PMID: 29780162; PMCID: PMC6008398

Some of the research papers supporting the inclusion of methylene blue in cancer management.

• Mitochondrial dysfunction is a hallmark of cancer [1–5], various other chronic diseases [6–12] as well as aging [13,14].
• Methylene blue promotes mitochondria energy production by promoting more glycolysis and glutaminolysis to TCA cycle, lower ROS level. MB is a potent redox exchanger acting as an electron shuttle in the mitochondria, bypassing complexes I to III of the ETC and resulting in decreased ROS production [1]
• Aerobic glycolysis or Warburg effect in cancer is well known and has been proposed to be an adaptation mechanism to support the biosynthetic requirements of uncontrolled proliferation [15].
• Disruption of cytochrome c oxidase function induces the Warburg effect and metabolic reprogramming [16]. Methylene blue preserves cytochrome C oxidase activity [17]
• Methylene blue has been shown to kill or inhibit cancer cells in vitro, with or without PBM [18–25]
• MB was shown to be more effective in treating tumors in mice over traditional chemotherapy [26]
• MB, along PBM and toluidine blue has been shown to result in complete resolution of chemotherapy-resistant AIDS-related Kaposi’s sarcoma skin lesions [27]
• MB was discovered in 1876 and is the first synthetic drug for human use. Although MB is FDA approved for human use and has been in clinical use for more than 100 years, clinic
• has been used use for human cancer is limit
• The direct treatment of cancer in humans (only one article). While treating different types of cancer, the author asserted that MB reliably stopped pain secondary to cancer, improved general health, and added years of longevity. This was reported in 1907! [28]
• Another article asserted that MB was found to have anticancer effects over a century ago [29]
• The efficacy of an inexpensive and safe agent like MB in many different and even advanced medical conditions make it an ideal general add-on or even stand-alone treatment most of the time. Furthermore, its potent anti-cancer effects in vitro make it especially puzzling why straightforward clinical studies on cancer patients with MB alone or in combination with other agents have not been reported. Even the positive effects of the much-ignored vitamin C on cancer patients have been published in many articles, yet the wonderful properties of MB have been known much longer now than vitamin C. The literature even suggests that MB could play a positive role in the treatment of cancer patients [30]
• Methylene blue is generally safe without significant side effects [31] and inexpensive.

1. Luo Y, Ma J, Lu W. The Significance of Mitochondrial Dysfunction in Cancer. Int J Mol Sci. 2020 Aug 5;21(16):5598.
2. Hsu CC. Role of mitochondrial dysfunction in cancer progression – PMC [Internet]. [cited 2023 May 6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950268/
3. Guerra F. Mitochondrial Dysfunction: A Novel Potential Driver of Epithelial-to-Mesenchymal Transition in Cancer – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/29250487/
4. Seyfried T. Cancer as a mitochondrial metabolic disease – PMC [Internet]. [cited 2023 May 6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4493566/
5. Seyfried T. Cancer as a metabolic disease | Nutrition & Metabolism | Full Text [Internet]. [cited 2023 May 6]. Available from: https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-7-7
6. Diaz-Vegas A, Sanchez-Aguilera P, Krycer JR, Morales PE, Monsalves-Alvarez M, Cifuentes M, Rothermel BA, Lavandero S. Is Mitochondrial Dysfunction a Common Root of Noncommunicable Chronic Diseases? Endocr Rev. 2020 Mar 16;41(3):bnaa005.
7. Mitochondrial Dysfunction: A Common Hallmark Underlying Comorbidity between sIBM and Other Degenerative and Age-Related Diseases – PMC [Internet]. [cited 2023 May 6]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290779/
8. Duarte-Hospital C, Tête A, Brial F, Benoit L, Koual M, Tomkiewicz C, Kim MJ, Blanc EB, Coumoul X, Bortoli S. Mitochondrial Dysfunction as a Hallmark of Environmental Injury. Cells. 2021 Dec 30;11(1):110.
9. Galvan DL, Green NH, Danesh FR. The hallmarks of mitochondrial dysfunction in chronic kidney disease. Kidney International. 2017 Nov 1;92(5):1051–7.
10. The Key Role of Mitochondrial Function in Health and Disease – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/37107158/
11. Wang Y. Mitochondrial dysfunction in neurodegenerative diseases and the potential countermeasure – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/30889315/
12. Tyrrell D. Age-Associated Mitochondrial Dysfunction Accelerates Atherogenesis – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/31818196/
13. Miwa S. Mitochondrial dysfunction in cell senescence and aging – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/35775483/
14. New hallmarks of ageing: a 2022 Copenhagen ageing meeting summary – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/36040386/
15. Liberti MV, Locasale JW. The Warburg Effect: How Does it Benefit Cancer Cells? Trends Biochem Sci. 2016 Mar;41(3):211–8.
16. Srinivasan S, Guha M, Dong DW, Whelan KA, Ruthel G, Uchikado Y, Natsugoe S, Nakagawa H, Avadhani NG. Disruption of cytochrome c oxidase function induces the Warburg effect and metabolic reprogramming. Oncogene. 2016 Mar 24;35(12):1585–95.
17. Methylene Blue Preserves Cytochrome Oxidase Activity and Prevents Neurodegeneration and Memory Impairment in Rats With Chronic Cerebral Hypoperfusion – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/32508596/
18. Anticancer activity of methylene blue via inhibition of heat shock protein 70 – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/30257315/
19. Combination photodynamic therapy of human breast cancer using salicylic acid and methylene blue – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/28499173/
20. Wb G, A T, Dm C, M R, Cw V. Inactivation of bladder tumor cells and enzymes by methylene blue plus light. The Journal of urology [Internet]. 1987 Nov [cited 2023 May 6];138(5). Available from: https://pubmed.ncbi.nlm.nih.gov/3669192/
21. Methylene blue and photodynamic therapy for melanomas: Inducing different rates of cell death (necrosis and apoptosis) in B16-F10 melanoma cells according to methylene blue concentration and energy dose – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/34798348/
22. Lee YS, Wurster RD. Methylene blue induces cytotoxicity in human brain tumor cells. Cancer Lett. 1995 Jan 27;88(2):141–5.
23. Methylene blue photodynamic therapy induces selective and massive cell death in human breast cancer cells – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/28298203/
24. Methylene blue-mediated photodynamic therapy enhances apoptosis in lung cancer cells – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/23708127/
25. Methylene blue-mediated Photodynamic Therapy in human retinoblastoma cell lines – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/34304071/
26. Lai B. [Antitumor effect of methylene blue in vivo] – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/2806052/
27. Tardivo JP, Del Giglio A, Paschoal LH, Baptista MS. New photodynamic therapy protocol to treat AIDS-related Kaposi’s sarcoma. Photomed Laser Surg. 2006 Aug;24(4):528–31.
28. Slack HR. Methylene Blue in the Treatment of Cancer. Atlanta J Rec Med. 1907 May;9(2):79–83.
29. Brown J. Treatment of cancer with antipsychotic medications: Pushing the boundaries of schizophrenia and cancer – PubMed [Internet]. [cited 2023 May 6]. Available from: https://pubmed.ncbi.nlm.nih.gov/35970416/
30. Yang SH, Li W, Sumien N, Forster M, Simpkins JW, Liu R. Alternative mitochondrial electron transfer for the treatment of neurodegenerative diseases and cancers: Methylene blue connects the dots. Prog Neurobiol. 2017 Oct;157:273–91.
31. Bistas E. Methylene Blue – StatPearls – NCBI Bookshelf [Internet]. [cited 2023 May 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557593/

We take an integrative approach to disease management especially cancer. Most cancers are caused by carcinogens (toxins). The classic genetic mutation theory of cancer stipulates that carcinogens cause genetic mutations which eventually lead to cancer. However, toxins can cause not only genetic mutations, but also damage many other important biomolecules and cellular organelles, particularly mitochondria. Mitochondria are cell’s energy powerplant and a regulatory center for cell growth and death. We believe cancer is the result of the imbalance of the increasing damaging effects of toxins (carcinogens) and the decreasing protective effects of anti-toxin nutrients. When such imbalance reaches a tipping point, cancer ensues. We also believe treatments aiming at only cancer killing will not deliver results as these approaches only look at the cancer cell, ignoring the more important part, the whole body, our disease fighting defense. Studies upon studies of the FDA approved chemo drugs of the past 20 years show cancer patients do not receive significant benefits (neither improvement of quality of life, nor life extension) from these cytotoxic drugs in a global scale (1). We believe on the one hand, while killing or controlling cancer cell remains an important goal, we need to avoid debilitating “casualties” of those toxic cancer chemotherapies. On the other hand, we need to boost our own cancer fighting immunity by repairing the damages done by those toxins and by other unhealthy lifestyle choices made in the past.

• Lifestyle (spiritual, attitude, sleep, exercise etc)
• Diet:
  • Restricted Ketogenic Diet, Intermittent Fasting
• Nutrition, Orthomolecular nutrition: 
  • Mitochondrial nutrition, antioxidants: High dose Vit C, D3, niacin, methylene blue, NIR light therapy
• Toxins, Detox: Fat soluble vs. water soluble toxins, Chemical and heavy metal toxins, Elimination of toxins, Detox
• Hormonal Balance: Thyroid, adrenal, sex hormones
• Regenerative Medicine (cell and stem cell therapy, etc).
• Others, e.g., lose dose naltrexone (LDN)

1. Studies of the Past ~20 Years Show: Cancer Chemo Drugs Do Not Offer Significant Benefits. http://www.drwlc.com/blog/2022/03/06/studies-of-the-past-20-years-show-cancer-chemo-drugs-do-not-offer-significant-benefits/

Topic:  Unlocking the Potential of Methylene Blue

Time: Apr 4, 2023 10:00 AM US Time (EST)
Apr 4, 2023   4:00 PM Hungary Time
Apr 4, 2023 10:00 PM China Time

Meeting ID: 965 9382 2890
Passcode: MB123

Guests:

• Dr. Laszlo Tretter, Professor of Biochemistry, Semmelweis University, Hungary.
• Thomas E. Levy, M.D., J.D., Consultant, Riordan Clinic.

Host: Richard Z. Cheng, M.D., Ph.D.

Abundant research suggests that methylene blue has the following biological properties. Why wonder? Come join us.

Top 10 benefits of methylene blue + near-infrared (NIR) light:

1. Antidote for chemical poisoning and drug overdose
2. The greatest antimalarial drug ever discovered?
3. Antiviral Warrior
4. Effects on Alzheimer’s and Parkinson’s diseases
5. Boosts Brain Power and Enhances Cognitive Abilities
6. Antidepressant, improve sleep, reduce night anxiety
7. Is hope for autism?
8. Powerful pain relief function
9. Promotes Heart Health
10. Adjuvant cancer therapy

Selected references:

1. Sváb G, Kokas M, Sipos I, Ambrus A, Tretter L. Methylene Blue Bridges the Inhibition and Produces Unusual Respiratory Changes in Complex III-Inhibited Mitochondria. Studies on Rats, Mice and Guinea Pigs. Antioxidants (Basel). 2021 Feb 16;10(2):305. doi: 10.3390/antiox10020305. PMID: 33669457; PMCID: PMC7920423.
2. Tretter L, Horvath G, Hölgyesi A, Essek F, Adam-Vizi V. Enhanced hydrogen peroxide generation accompanies the beneficial bioenergetic effects of methylene blue in isolated brain mitochondria. Free Radic Biol Med. 2014 Dec;77:317-30. doi: 10.1016/j.freeradbiomed.2014.09.024. Epub 2014 Sep 30. PMID: 25277417.
3. Levy, T. Resolving cold with methylene blue. Feb. 4, 2023. http://orthomolecular.org/resources/omns/v19n08.shtml

Anti-Aging Lab Testing

• Complete blood count, urinalysis and fecal analysis
• Comprehensive metabolic panel
  • liver and renal function
  • lipids, fasting blood glucose, fasting insulin, HbA1c
• Full thyroid function panel, including autoantibodies and reverse T3 (rT3)
• Vitamin D3
• hsCRP, homocysteine (hcy), ferritin (ferritin)
• Bone Densitometry (BDX)
• Coronary artery calcium ion deposition score (CAC)
• Men: PSA and testosterone levels
• Heavy Metal panel
• Environmental Chemical Toxins panels
• Organic Acid Test (detection of effects on metabolism and liver detoxification function)
• Stress hormone test
• Comprehensive sex hormone testing
• Others

Many, if not all, vitamins and micronutrients do not work alone in our body. They work in synergistic, antagonistic or interdependent manners. While the synergistic and antagonistic actions are well known, the interdependent manner is much less known. Here are some examples of this “interdependency”

1. B vitamins cannot do their job without enough omega-3s, and vice versa: https://foodforthebrain.org/campaigns/alzheimers-prevention/omega-3-and-b-vitamins/#:~:text=associated%20with%20Alzheimer’s.-,B%20vitamins%20found%20not%20to%20work,omega%2D3%20and%20vice%20versa&text=Also%2C%20at%20the%20end%20of,benefit%20from%20the%20B%20vitamins.
2. Young, L.M.; Gauci, S.; Arnoldy, L.; Martin, L.; Perry, N.; White, D.J.; Meyer, D.; Lassemillante, A.-C.; Ogden, E.; Silber, B.; Scholey, A.; Pipingas, A. Investigating the Effects of a Multinutrient Supplement on Cognition, Mood and Biochemical Markers in Middle-Aged Adults with ‘Optimal’ and ‘Sub-Optimal’ Diets: A Randomized Double Blind Placebo Controlled Trial. Nutrients 2022, 14, 5079. https://doi.org/10.3390/nu14235079
3. Liao S, Omage SO, Börmel L, Kluge S, Schubert M, Wallert M, Lorkowski S. Vitamin E and Metabolic Health: Relevance of Interactions with Other Micronutrients. Antioxidants (Basel). 2022 Sep 9;11(9):1785. doi: 10.3390/antiox11091785. PMID: 36139859; PMCID: PMC9495493.
4. Vit D and K on bone health: https://www.foodandnutritionjournal.org/pdf/vol10no3/Nutrition_Vol10_No3_840-857.pdf
5. Non drug intervention on glaucoma: Fahmideh F, Marchesi N, Barbieri A, Govoni S, Pascale A. Non-drug interventions in glaucoma: Putative roles for lifestyle, diet and nutritional supplements. Surv Ophthalmol. 2022 May-Jun;67(3):675-696. doi: 10.1016/j.survophthal.2021.09.002. Epub 2021 Sep 23. PMID: 34563531.

Cardiovascular diseases (CVDs) are the leading cause of death, killing some 18 million people globally, costing more than $320 billion annually in the USA alone. About 2/3 of these deaths are due to heart attacks and strokes, with atherosclerosis the key pathology. Although the causes of CVDs continue to be debated, it is generally accepted in the literature that atherosclerotic CVDs are inflammatory diseases with elevated oxidative stress. Oxidative stress is due to the imbalance of excessive oxidants (toxins) and deficient antioxidants. The resulting deficiency of vitamin C, a primary antioxidant, leads to impairment of collagen synthesis. Collagen plays a critical role in the integrity of arterial walls. Collagen deficiency results in arterial wall damage and an inflammatory response leading to atherosclerosis and associated pathologies including coronary artery stenosis and occlusion.

Based on the review and analysis of decades of research, we have previously proposed an integrative orthomolecular medicine approach that includes healthy lifestyle, nutritional supplementation with a focus on high dose vitamin C and other antioxidants, and toxin avoidance and removal (detox). We report here that with this protocol we have reversed two cases of atherosclerotic CVDs. Existing evidence and clinical experience suggest that atherosclerosis is preventable and reversible.

[The above 32 minute presentation inaugurates the new video arm of the Orthomolecular Medicine News Service. The Orthomolecular Medicine Educational Video Service is free-access, peer-reviewed, and non-commercial.
https://www.youtube.com/channel/UC1dbpz2xB3jhAAyjvLn2yOQ/about
Videos will also be posted on Brighteon at https://www.brighteon.com/channels/OMES
Your comments, corrections and suggestions are invited and may be made directly to <DrCheng@drwlc.com> .]

A brief review of the Safety and Effectiveness of Vitamins C and D in Covid-19 Treatment

This is for information exchange only, not to be used without the supervision of a trained and experienced physician.

Cytokine storm has recently been recognized as the key pathology responsible for the severe symptoms of Covid-19 and other viruses and non-viral agents. The underlying biochemical cause of cytokine storm is excessive oxidative stress. Cytokine storm and its associated oxidative stress appears to be a universal non-specific mechanistic pathway common among many causative agents, for example viruses, that leads to severe clinical disease.

A biochemical sequence known as “lipid peroxidase chain reaction” (LPCR) plays a critical role in oxidative stress and cytokine storm. Prevention and blocking the occurrence of cytokine storm/oxidative stress appears to be a logically sound and effective strategy to prevent the severe symptoms of Covid-19. If this could be performed world-wide, it could reduce the devastating medical, economic and societal impact of the Covid-19 pandemic. Preventing or blocking LPCR and the excessive oxidative stress requires intact antioxidant systems, especially the antioxidant vitamins and nutrients, including vitamins C, E, CoQ10, alpha lipoic acid, glutathione and niacin (to promote NADP+/NADP), selenium and others. Insufficiency or absence of any of these antioxidant agents may render these antioxidant systems ineffective, which may be responsible for the inconsistent results of antioxidant therapies in the literature. Here we propose an integrative and systematic therapy that includes these antioxidant vitamins, minerals, and nutrients. The “universal and non-specific nature” of cytokine storm/oxidative stress makes possible a pre-emptive treatment to prevent or block cytokine storm/oxidative stress induced by severe diseases, even before full recognition of the underlying causative agent. This is very significant because it allows us to potentially prevent and block a pandemic of a new virus or a new viral mutant when it happens without requiring the extended time needed to develop a specific drug or vaccine treatment. With the seemingly endless mutations of SARS-Cov-2, we may still have time to apply this strategy to break the Covid-19 pandemic¹.

Vitamin C

1. Safety of high dose vitamin C.

Vitamin C, when taken by mouth or intravenously, is very safe, even at high doses. “Vitamin C has low toxicity and is not believed to cause serious adverse effects at high intakes. The most common complaints are diarrhea, nausea, abdominal cramps, and other gastrointestinal disturbances due to the osmotic effect of unabsorbed vitamin C in the gastrointestinal tract” , according to the NIH Office of Dietary Supplements².

Vitamin C can also be safely administered at high doses of up to 1.5 g/kg body weight, when properly used under an experienced physician. “Studies have shown that vitamin C can be safely administered to healthy volunteers or cancer patients at doses up to 1.5 g/kg…” according to the National Cancer Institute, NIH³. For a 170-pound person, up to 115 grams of vitamin C can be safely given intravenously.

2. Vitamin C has immune-enhancement properties.
   1. Reduces oxidative stress, as an antioxidant^{4 5 6}
   2. Reduces inflammation⁶
   3. Supports epithelial barrier function (e.g., alveolar membranes) and endothelial barrier protection⁷
   4. Supports differentiation and maturation of T cells and NK cells⁸
   5. Enhances microbial killing and antibody production^{8 9}
   6. Enhances migration of immune cells to sites of infection^{8 9}
   7. Impaired chemotaxis observed in severely infected patients⁶
   8. Protects immune cells from oxidative burst (rapid release of ROS)⁶
   9. Promotes programmed cell death (cell death)⁶
3. Vitamin C deficiency is common, especially in Covid-19 patients
   12. “The available evidence indicates that vitamin C hypovitaminosis and deficiency is common in low- and middle-income countries and not uncommon in high income settings.”¹⁰ Vitamin C deficiency is also common in the Western countries^{11 12}. Insufficiency and deficiency of micronutrients including vitamin C and D are also rampant in the US. A recent US national nutrition survey found “Specifically, 45% of the U.S. population had a prevalence of inadequacy for vitamin A, 46% for vitamin C, 95% for vitamin D, 84% for vitamin E, and 15% for zinc.”¹³
   13. Lower plasma vitamin levels are associated with greater risk of organ failure and death in patients with septic shock¹⁴
   14. The average plasma vitamin C concentrations in COVID-19 patients were five times lower than in healthy volunteers¹⁵
   15. Vitamin C levels are undetectable in more than 90% of COVID-19-associated ARDS patients¹⁶
   16. Vitamin C intake of at least 2-3 g/day may be required to maintain normal plasma vitamin C levels during viral infection¹²
   17. Covid-19 patients had significantly lower plasma vitamin C levels than controls, longer hospital stays, and higher mortality¹⁷
4. Clinical studies show effectiveness of Vitamin C in Covid-19 treatment.
   18. A review of twelve studies, including five “gold standard” randomized controlled trials, shows that this simple vitamin saves lives when given in the right dose¹⁸. Vitamin C can prevent a serious Covid infection. The current level of evidence from the RCTs suggests that intravenous vitamin C intervention may improve oxygenation parameters, reduce inflammatory markers, decrease days in hospital and reduce mortality, particularly in the more severely ill patients. High doses of oral vitamin C supplementation may also improve the rate of recovery in less severe cases. No adverse events have been reported in published vitamin C clinical trials in COVID-19 patients¹⁹. Vitamin C has been shown to be effective in the prevention and treatment of various other viral infections¹². Despite the fact that vitamin C is safe, now proven effective, inexpensive and widely available, it is not widely accepted nor promoted by medical authorities or hospitals.  In some instances, high dose vitamin C usage is even prohibited, allegedly due to medical reasons.
   19. Beneficial aspects of high-dose intravenous vitamin C in patients with severe COVID-19 pneumonia: a retrospective case series²⁰.
       19. High-dose intravenous vitamin C for the treatment of patients with moderate to severe COVID-19.
       20. Improvements in inflammatory response and immune and organ function are beneficial.
   20. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis²¹.
       3. Daily IV infusions of 3.5 and 14 g of vitamin C for four days significantly reduced multiorgan failure scores, with the higher dose showing twice as much reduction in failure scores as the lower dose.
   21. Vitamin C improves the disease and shortens ICU stay²².
   22. Vitamin C may shorten duration of mechanical ventilation in critically ill patients²³
   23. In this RCT, hospitalized elderly patients with acute respiratory infection received 200 mg of vitamin C orally per day for 4 weeks. Taking vitamin C can reduce the severity of disease and reduce mortality²⁴.

Vitamin D

1. Supports transcription of antimicrobial peptides that have activities against various bacteria, viruses, and fungi ^{25 26 27}.
2. Induces autophagy (cleaning out of damaged or unnecessary cellular components) thereby enhancing clearance of viruses and viral constituents²⁸.
3. Modulates innate and adaptive immune activity²⁹.
4. Regulates growth and differentiation of several types of immune cells³⁰.
5. Suppresses over-expression of pro-inflammatory cytokines³⁰.
6. Supports gut integrity and gut microbial balance³¹.
7. Helps maintain the integrity of epithelial tight junctions which decreases risk of infection and pulmonary edema³².
8. Helps maintain TH1:TH2 immune balance²⁸ by reducing TH1 and inducing TH2 immune responses²⁶ (Bae & Kim, 2020).

Vit D in Covid-19

• Serum vitamin D3 levels < 27 ng/ml: significant increase in Covid-19 mortality. Vit D3 > 30 ng/ml. the mortality rate is close to zero.
• Large study of >1.4 million people (54 studies) again shows: low blood vitamin D levels associated with higher risk of Covid-19 infection, ICU admission and mortality³³
• The 2-year survey of 662,835 U.S. military veterans concluded that vitamin D3 and vitamin D2 supplementation reduced the risk associated with COVID-19 infection by 20% and 28%, and reduced the risk of death from COVID-19 infection within 30 days. The associated risk reductions were 33% and 25%.³⁴
• 50,000 IU per day x 5 days in COVID-19 patients resulted in less inflammation and shorter recovery times compared to patients receiving 1000 IU/day³⁵.
• Combined with standard care, early high-dose vitamin D therapy avoids ICU admission in COVID-19 patients³⁶.
• “The mean vitamin D3 dose was 35,291 ± 21,791 IU per day…We found a very weak relationship between oral doses of vitamin D3 and subsequent calcium levels, both in serum and 24-hour urine.”³⁷

Intervention of Covid-19:

Case 1. Mr. W, an 80-year-old man in China with history of type 2 diabetes, hypertension, brain infarction and Alzheimer’s disease, has been in ICU for Covid-19 pneumonia, high fever (~39.5 C) for 20 days, with standard hospital care including auxiliary oxygenation, without much improvement.  The family sought our consultation. We recommended our Integrative Orthomolecular Covid-19 Treatment Protocol. He improved quick with the high fever gone the same night and never came back. His inflammatory markers and other lab parameters improved.  He was off auxiliary oxygenation and moved from ICU to a regular ward on day 3. The family was pleasantly surprised.

Case 2. A 4-year-old boy was diagnosed of Covid-19 pneumonia with high fever of 39 C. There was no bed available at the hospital. The mother sought our consultation and we recommended our Integrative Orthomolecular Covid-19 Treatment Protocol. The boy improved significantly the next morning with fever gone, with some residual respiratory symptoms. By the 2^nd day, the boy was happy and playful. The mother thanked us profusely and called the Protocol “miraculous”.

Case 3. We previously reported a case of rapid recover from severe Covid-19 (1). Briefly, Robert, a 60-year-old man with diabetes, was admitted into an ICU at a local hospital with severe Covid-19 pneumonia. His lab showed very high inflammatory markers (ferritin, D dimer, CRP) as well as reduction of oxygen saturation. We offered the same protocol (adjusted to the hospital requirement). The patient recovered quickly.

Case 4. A diabetic whose blood sugar has been stable on a low-carb diet, suffered a stroke and was intubated 2 weeks after receiving 2 doses of the Covid-19 vaccine. He later developed pneumonia with a fever. The family consulted me and I recommended similar antiviral and antioxidant therapies with detailed guidance and follow-up. Within 3-4 days, his fever subsided.

Intervention of Non-Covid cases:

Case 5. Acute liver failure. Dr. F is a professor of music and an old friend of mine in the United States. About a year ago, her 80-year-old mother was admitted to the ICU with acute liver failure. Dr. F received a notice that his mother was critically ill. Her journey back to China to visit her mother was extremely difficult due to Covid travel restrictions. She consulted with me and I recommended a comprehensive antioxidant regimen (similar to the one described above). I also discussed options with her mother’s attending physician. In just 2-3 days, her mother has improved and was transferred from the ICU to the general ward, and later discharged to home care. Her mother is in good health and continues to receive antioxidant therapy including vitamin C.

The following is what we have been using for our clients (primarily in China. For information exchange only.  The information here should not be used without a qualified physician’s supervision).

Integrative Orthomolecular Covid-19 Prevention Protocol.

1. Vitamin C, 3,000mg – 10,000mg/day, divided into 2-3 times.
2. Or liposomal vitamin C (Liposomal-Vit C), 1-2 grams / day.
3. Vitamin D3, 5,000 IU/day; blood vitamin D3 levels of 50 – 100 ng/ml are recommended.
4. Zinc, 30 mg/day.
5. Magnesium ions, 500-1000 mg/day.
6. 1-3% hydrogen peroxide atomized inhalation, 5-15 minutes, return from going out or have suspicious contact.
7. Cheng TotoCell Nutrition (with high levels of all vitamins plus mitochondrial and micronutrients)
8. Vitamin E, 400 – 2000 IU/day.
9. Quercetin (promoting the virus-killing effect of zinc) 500 mg, 3-4 times/day.
10. Melatonin (melatonin 5 – 20mg/night), a powerful immune booster

Integrative Orthomolecular Covid-19 Treatment Protocol.

1. Vitamin C, 1,000 – 3,000 mg/hour (first to diarrheal dose).
   1. Or liposomal vitamin C (Liposomal-Vit C), 1-2 grams/time, 1-4 times a day. Or IV: 30-60 g/day.
2. Vitamin D3, 50,000IU/day x 5-7 days; then, 5,000 IU/day; after 1-2 months, blood vitamin D3 (50-100 ng/ml).
3. Liposomal Glutathione (Liposomal-GSH), 1-2 g/day
4. Zinc, 50-100 mg/day x 7-10 days.
5. Magnesium, 500-1000 mg/day.
6. 1-3% hydrogen peroxide atomized inhalation, 5-15 minutes, 3-4 times/day.
7. Melatonin (melatonin 5 – 20mg/night), a powerful immune booster.
8. Cheng TotoCell Nutrition (with high amounts of all vitamins plus mitochondrial and micronutrients)
9. Vitamin E, 400 – 2000 IU/day.
10. Quercetin (promoting the virus-killing effect of zinc) 500mg, 3-4 times/day.
11. Other: healthy lifestyle habits, sun exposure, exercise, other antioxidants.

References:

1. Cheng, R. A Hallmark of Covid-19: Cytokine Storm/Oxidative Stress and its Integrative Mechanism. http://orthomolecular.org/resources/omns/v18n03.shtml (2022).
2. Office of Dietary Supplements – Vitamin C. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/.
3. Intravenous Vitamin C (PDQ®)–Health Professional Version – NCI. https://www.cancer.gov/about-cancer/treatment/cam/hp/vitamin-c-pdq (2013).
4. Richard Cheng MD PhD. Oxidative Stress, Ignored Key Pathology of Covid-19. (2021).
5. Cheng, Richard Z. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Medicine in Drug Discovery 5, 100028 (2020).
6. Milani, G. P., Macchi, M. & Guz-Mark, A. Vitamin C in the Treatment of COVID-19. Nutrients 13, 1172 (2021).
7. Gröber, U. & Holick, M. F. The coronavirus disease (COVID-19) – A supportive approach with selected micronutrients. Int J Vitam Nutr Res 92, 13–34 (2022).
8. Iddir, M. et al. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients 12, 1562 (2020).
9. Cerullo, G. et al. The Long History of Vitamin C: From Prevention of the Common Cold to Potential Aid in the Treatment of COVID-19. Front Immunol 11, 574029 (2020).
10. Rowe, S. & Carr, A. C. Global Vitamin C Status and Prevalence of Deficiency: A Cause for Concern? Nutrients 12, 2008 (2020).
11. Gröber, U. & Holick, M. F. The coronavirus disease (COVID-19) – A supportive approach with selected micronutrients. Int J Vitam Nutr Res 92, 13–34 (2022).
12. Holford, P. et al. Vitamin C-An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19. Nutrients 12, E3760 (2020).
13. Reider, C. A., Chung, R.-Y., Devarshi, P. P., Grant, R. W. & Hazels Mitmesser, S. Inadequacy of Immune Health Nutrients: Intakes in US Adults, the 2005-2016 NHANES. Nutrients 12, E1735 (2020).
14. Borrelli, E. et al. Plasma concentrations of cytokines, their soluble receptors, and antioxidant vitamins can predict the development of multiple organ failure in patients at risk. Crit Care Med 24, 392–397 (1996).
15. Xing, Y. et al. Vitamin C supplementation is necessary for patients with coronavirus disease: An ultra-high-performance liquid chromatography-tandem mass spectrometry finding. J Pharm Biomed Anal 196, 113927 (2021).
16. Chiscano-Camón, L., Ruiz-Rodriguez, J. C., Ruiz-Sanmartin, A., Roca, O. & Ferrer, R. Vitamin C levels in patients with SARS-CoV-2-associated acute respiratory distress syndrome. Crit Care 24, 522 (2020).
17. Sinnberg, T. et al. Vitamin C Deficiency in Blood Samples of COVID-19 Patients. Antioxidants (Basel) 11, 1580 (2022).
18. Holford, P., Carr, A. C., Zawari, M. & Vizcaychipi, M. P. Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence. Life (Basel) 11, 1166 (2021).
19. Carr, A. C. Vitamin C in Pneumonia and Sepsis. in Vitamin C: New Biochemical and Functional Insights (eds. Chen, Q. & Vissers, M. C. M.) (CRC Press, 2020).
20. Zhao, B. et al. Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study. Ann Palliat Med 10, 1599–1609 (2021).
21. Fowler, A. A. et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med 12, 32 (2014).
22. Hemilä, H. & Chalker, E. Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients 11, (2019).
23. Hemilä, H. & Chalker, E. Vitamin C may reduce the duration of mechanical ventilation in critically ill patients: a meta-regression analysis. J Intensive Care 8, 15 (2020).
24. Hunt, C., Chakravorty, N. K., Annan, G., Habibzadeh, N. & Schorah, C. J. The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int J Vitam Nutr Res 64, 212–219 (1994).
25. Vyas, N. et al. Vitamin D in Prevention and Treatment of COVID-19: Current Perspective and Future Prospects. J Am Coll Nutr 40, 632–645 (2021).
26. Bae, M. & Kim, H. The Role of Vitamin C, Vitamin D, and Selenium in Immune System against COVID-19. Molecules 25, 5346 (2020).
27. Mitchell, F. Vitamin-D and COVID-19: do deficient risk a poorer outcome? Lancet Diabetes Endocrinol 8, 570 (2020).
28. Malaguarnera, L. Vitamin D3 as Potential Treatment Adjuncts for COVID-19. Nutrients 12, 3512 (2020).
29. Radujkovic, A. et al. Vitamin D Deficiency and Outcome of COVID-19 Patients. Nutrients 12, 2757 (2020).
30. Sulli, A. et al. Vitamin D and Lung Outcomes in Elderly COVID-19 Patients. Nutrients 13, 717 (2021).
31. Charoenngam, N. & Holick, M. F. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients 12, 2097 (2020).
32. Shakoor, H. et al. Immune-boosting role of vitamins D, C, E, zinc, selenium and omega-3 fatty acids: Could they help against COVID-19? Maturitas 143, 1–9 (2021).
33. Chiodini, I. et al. Vitamin D Status and SARS-CoV-2 Infection and COVID-19 Clinical Outcomes. Front Public Health 9, 736665 (2021).
34. Gibbons, J. B. et al. Association between vitamin D supplementation and COVID-19 infection and mortality. Sci Rep 12, 19397 (2022).
35. Ohaegbulam, K. C., Swalih, M., Patel, P., Smith, M. A. & Perrin, R. Vitamin D Supplementation in COVID-19 Patients: A Clinical Case Series. Am J Ther 27, e485–e490 (2020).
36. Entrenas Castillo, M. et al. Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study. J Steroid Biochem Mol Biol 203, 105751 (2020).
37. Amon, U., Yaguboglu, R., Ennis, M., Holick, M. F. & Amon, J. Safety Data in Patients with Autoimmune Diseases during Treatment with High Doses of Vitamin D3 According to the ‘Coimbra Protocol’. Nutrients 14, 1575 (2022).