Vitamin C is the most famous supplement in history, largely due to Linus Pauling's 1970 book "Vitamin C and the Common Cold," which claimed megadoses could prevent and cure colds, cancer, and heart disease. The cancer and cardiovascular claims have been refuted by large trials. The cold claims were partially correct — there is a real but modest effect — but the megadose framing is not supported by modern evidence.
The Hemilä 2013 Cochrane review is the definitive assessment: 29 trials with 11,350 participants. Routine supplementation did not reduce cold incidence in the general population (RR 0.96). But in a subgroup of 642 marathon runners, skiers, and soldiers in sub-arctic exercises, the pooled RR was 0.50 — a 50% reduction. The benefit is specific to brief periods of severe physical stress.
For duration, regular supplementation shortened colds by 8% in adults and 13.6% in children. Therapeutic use started after symptoms began showed no significant benefit in the Cochrane analysis — though the 2023 Hemilä meta-analysis found that vitamin C decreased severe symptom severity by 15%, with no effect on mild symptoms. This suggests that if vitamin C helps therapeutically, it helps with the miserable part of a cold, not the sniffles.
The absorption kinetics explain why megadoses are inefficient. Intestinal absorption is saturable via sodium-dependent vitamin C transporters (SVCT1). At 30–200 mg doses, 70–90% is absorbed. At 1000 mg, absorption drops to ~50%. At 12 g, ~16%. Unabsorbed ascorbic acid draws water into the bowel, causing osmotic diarrhea — the body's natural brake on excessive intake.
Practical guidance: 200–500 mg split BID for daily supplementation (better absorption than 1000 mg once daily). If you're an athlete or facing severe physical stress, 500–1000 mg/day prophylactically. At cold onset, some evidence supports 6–8 g/day in divided doses started within 24 hours — but the therapeutic evidence is weaker than the prophylactic evidence.
Keystone references: Hemilä & Chalker 2013 (Cochrane Database Syst Rev, PMID 17636648 — definitive Cochrane review); Hemilä & Chalker 2023 (BMC Public Health, PMID 38082300 — severity meta-analysis); Carr & Maggini 2017 (Nutrients, PMID 29099763 — immune mechanism review).