Although convention requires therapeutic benefit in cancer patients be measured by increased survival times, I (and the patients and their relatives) am much more impressed by enhanced quality and dignity of their remaining days. Although chemotherapy is so widely used in the United States, it offers no survival benefit in the great majority of adult cancers (22), and is associated with much iatrogenic misery. Patients given ascorbate are spared all that, but in addition they enjoy a very positive benefit. From the earliest days, I was constantly impressed by the rapidly improved vigor and sense of well-being reported by these patients, yet could not stress this in our publications because we could not offer any biochemical explanation. Now I can report that a few of these dying cancer patients assumed levels of athletic activity that were quite unbelievable considering their diagnosis (23, 24).
The answer lies in the molecule carnitine, and the discovery by Hughes that vitamin C is an essential co-factor in its biosynthesis (25). As we have already seen, cancer patients are invariably depleted of circulating and tissue reserves of the vitamin, therefore their carnitine synthesis will be impaired, as Hughes demonstrated in the guinea pig (24). The only known function of carnitine is the transport of fatty acids across the mitochondrial membrane of muscle cells (including gastrointestinal and cardiac muscle cells) where they are oxidized to provide muscle energy. It seems a very reasonable assumption that depleted muscle carnitine could account for all the systemic features of the cancer illness - lassitude and muscle weakness, muscle wasting and weight loss, anorexia and frequently troublesome constipation, terminal overwhelming weakness, and finally death itself. It also explains why these ill patients report such a remarkable improvement in energy and well-being within a week or two of commencing supplemental ascorbate.