Question Four: Following the initial survey, as previously noted, health education lectures were provided to the group. This included discussions of the existing dietary patterns and possible changes that could and should be instituted. On an annual basis, the entire group was reexamined by the techniques (clinical and dietary) previously mentioned. It is relevant to point out that well over three-fourths, actually 78.8% of the group increased the daily vitamin C intake between the first and second visit (Table 3, p. 221). The changes between subsequent visits are also shown.

Table 1: Reported respiratory findings

*Statistically significant difference of the means.

1.05. The mean values were 0.69, 1.11, and

0.58 for the third, fourth and fifth annual examinations respectively. Thus, overall, there was a statistically significant decline in clinical symptoms and signs between the first and second and the second and third examinations. It was thought desirable to examine those subjects (n=83) who participated in each of the first three examination periods. Figure 2 (p.222) summarizes the mean reported respiratory symptoms and signs (on the ordinate) at the first, second and third examination periods (on the abscissa). Additionally, the sample has been divided into those who, at the third visit, were consuming less than 400 mg of vitamin C per day (37 subjects pictured on the dotted line) versus those who were ingesting 400+ mg of ascorbic acid per day (46 participants shown by a continuous line).

First, on a mean basis, there is a reduction in respiratory complaints in both sub-groups. This, it should be recalled, is consistent with the observations reported earlier in Table 1. Second, on an average basis, the reduction in respiratory findings is greater in those who, at the third examination, are consuming the greater amounts (400+ mg) of vitamin C. Third, there appears to be no statistically significant difference (t=1.507, p>0.100) at the start of the study. Fourth, while the groups are not substantially different at the start, they become progressively more different at the second (t=2.831, p<0.010) and at the third examination (t=3.905, p<0.001). Finally, there are no statistically significant differences in the lower (<400 mg) ascorbic acid intake group between visits as shown by a t=1.535, p>0.100 and a t=1.303, p>0.200. In sharp contrast, there are very clear-cut decrements in the group characterized by the greater daily vitamin C consumption at the third visit. This is underlined by the t=2.963, p<0.005 and a t=3.490, p<0.001. Thus, in answer to the fourth question, the most notable reduction

Table 2. Daily vitamin C consumption

Daily vitamin C First visit Second visit Third visit Fourth visit Fifth visit intake (mg)

<53,17 2 0 00 55-605 0 0 00 >60 505 169 116 64 12

Total 527 171 116 64 12

Mean 237 320 388 472 550

S. D . 1 714 177 200 158 111 t 8.046 2.931 3.114 2.061 P < 0.005* < 0.005* < 0.005* > 0.050

Minimum 15 42 71 139 297 Maximum 881 923 1120 885 719 Range 866 881 1049 746 422

*Statistically significant difference of the means.

Vitamin C Symptoms and Respiratory Symptoms

Figure1. Relationship of daily vitamin C intake versus number of respiratory symptoms and signs in respiratory symptoms and signs seems to occur in the group characterized by the greater daily ascorbic acid intake.

r = -0.089 P<001* 332

[n=410] In= 220) [n=126] [n=134] 0 123+

number of reported respiratory findings *statistically significant correlation coefficient August 1972

Table 3. Changes in reported daily vitamin C consumption

Question Five; The obvious next point is to ascertain the changes in vitamin C intake during the same experimental periods. Figure 3 (p. 223) pictorially portrays the daily ascorbic acid consumption (on the y-axis) at the three visitation periods (the x-axis).

Five points warrant special consideration. First, there is a progressive increase in the reported daily vitamin C intake in both groups. This supports the earlier reported data in Table 2. Interestingly enough, this is also quite in accord with clinical findings just reported in Figure 2. Second, on an average basis, the increase in daily vitamin C intake is greater in those who, at the third examination are consuming the greater amounts (400+ mg) of ascorbic acid. This is also in parallel with the observation reported elsewhere (Figure 2). Thus, the greater reduction in respiratory findings occurred in the group with the final higher vitamin C intake (400+mg/ day). Third, there appears to be no statistically significant difference (t=1.591, p>0.100) at the start of the study. It should be noted that this follows a similar pattern earlier mentioned (Figure 2). Fourth, while the groups are not substantially different at the start, they diverge at the second (t=2.581, p<0.025) and at the third examination (t=11.568, p<0.001). Again, it should be underlined that this corresponds to previous clinical observations (Figure 2). Finally, there are statistically significant differences in the lower (<400 mg C daily) group between visits as shown by a t=4.141, p<0.001 and a t=3.078, p<0.005. However, greater statistically significant differences are shown in the group consuming 400+ mg of vitamin C daily. This is represented by a t=5.118, p<0.001 and a t=9.901, p<0.001. Hence, in response to question five, the more significant increase in ascorbic acid consumption appears to occur in the group who, at the third examination, is consuming the greater amounts of daily vitamin C.

Question Six: It is not easy to provide a quick and simple answer to this particular

Figure 2. The changes in reported respiratory symptoms and signs (in the vertical axis) at three annual examination periods (on the horizontal axis) in. those who, at this third examination, arc consuming < 400 (dotted line) versus 400+ (continuous line) milli grains vitamin C per day. On a mean basis, there is a decline in respiratory findings in both groups. However, the decrements are statistically significant only in the group characterized by the greater vitamin C intake.

[-15%]

_P>O.100

141

mean

reported

respiratory

0.59

symptoms

and

Vitamin C Symptoms and Respiratory Symptoms

Figure 3. The changes in reported vitamin C intake (on the ordinate) at three annual examination periods (on the abscissa) in those who, at the third examination, are con suming < 400 (dotted line) versus 400+ (continuous line) milligrams vitamin C per day. On a mean basis, there is a rise in vitamin C consumption in both groups. However, the increments are more statistically significant in the group characterized by the greater vitamin C intake.

<400 mg vitamin C per day [n=37] ^○○○ 400+ mg vitamin C per day [n=46] [percentage change]

141

_daily [-12%] t = 1.303 vitamin C

P>O.001* ^[-53%]

0.28

t= 3.490

196

239

question for a number of reasons. First, this is not basically a vitamin C study but rather a multiple testing program in which diet and clinical state have be en related. Second, while many individuals increased their ascorbic acid intake, some of these subjects also altered their diets in other ways. For example, it was learned that the refined carbohydrate consumption in the group was very high and that a significant number of the participants reduced their refined carbohydrate intake. Hence, the dietary changes were multifactorial. Notwithstanding, in answer to the sixth question, the evidence presented (Figures 2 and 3) suggests extraordinary parallelisms between the initial clinical and dietary patterns and their subsequent courses.

Question Seven: It is well to evaluate vitamin C as a resistance or susceptibility agent with regard to the early development of respiratory pathosis. Figure 4 (below) attempts to pictorially portray this situation. Shown on the ordinate is the mean daily ascorbic acid consumption. The group characterized by no respiratory findings consumed, on the average, 332 mg vitamin C daily (the lighter bar). In contrast, the category characterized by respiratory symptoms and signs consumed a mean of 299 mg of ascorbic acid per day. This difference is statistically significant (t=2.585, p<0.010). Thus, in answer to the final question, the evidence suggests that vitamin C must be viewed as a resistance agent for respiratory disease because its addition tends to reduce the possibility of pathosis.

Summary and Conclusions

Five hundred and twenty-seven dental practitioners and their wives were studied on one occasion in terms of reported daily vitamin C consumption and respiratory symptoms and signs. From this group, 83 subjects were reexamined one and two years later following group nutritional seminars. Several points are apparent. First, there is a statistically significant negative correlation between daily vitamin C intake and respiratory findings. In other words, as ascorbic acid consumption rises, respiratory symptoms and signs decline. Second, following group nutritional seminars, respiratory findings decreased during the next two years. Third, during this same time period, vitamin C consumption rises. Fourth, the most significant change in respiratory symptoms and signs occurred in the group characterized by the greater increase in ascorbic acid intake. Finally, the evidence suggests that vitamin C may be viewed as a resistance agent for respiratory disease because its introduction tends to minimize the appearance of respiratory symptomatology.

References

1. Cheraskin E, Ringsdorf WM Jr, Michael DW, Hicks BS: Daily vitamin C consumption and reported respiratory findings. Int J Vit Nutr Res, 1973; 43/1: 42-55.

Figure 4. Relationship of reported daily vitamin C consumption.

t = 2.585

[n= 410] [n=480] 0 1+

number of reported respiratory findings *statistically significant difference of the means August 1972.