maanantai 10. helmikuuta 2020

Vitamin C Protects Against Coronavirus

"Some physicians would stand by and see their patient die rather than use ascorbic acid (Vitamin C) because in their finite minds it exists only as a vitamin."


VITAMIN C HAS BEEN KNOWN TO CURE OVER 30 MAJOR DISEASES FOR OVER 70 YEARS

- If so, why haven't you heard more about it? 
- Why haven't more doctors used Vitamin C as medicine? 

 


 
Progress takes time, unfortunately. Fresh fruit was known to cure scurvy by 1753, yet governments ignored the fact for nearly 100 years. Countless thousands died in the meantime. The 19th century doctor who first advocated washing one's hands between patients died ignored and in disgrace with the medical profession. Toxic mercury was used as medicine into the twentieth century. And so it has been. 
 

The first physician to aggressively use vitamin C to cure diseases was Frederick R. Klenner, M.D. beginning back in the early 1940's.

Dr. Klenner consistently cured chicken pox, measles, mumps, tetanus and polio with huge doses of the vitamin. While vaccines are now available for these illnesses, please remember this was not the case in the 1940's. 

 



The following is a list of the conditions that Dr. Klenner successfully treated with aggressive vitamin C therapy: 

 
Pneumonia
Encephalitis
Herpes Zoster (shingles)

Herpes Simplex
Mononucleosis
Pancreatitis
Hepatitis
Rocky Mountain Spotted Fever
Bladder Infection
Alcoholism
Arthritis
Some Cancers
Leukemia
Atherosclerosis
Intervertebral Disc
High Cholesterol
Corneal Ulcer
Diabetes
Glaucoma
Schizophrenia
Burns and secondary infections
Heat Stroke
Radiation Burns

Heavy Metal Poisoning (Mercury, Lead), Venomous Bites (insects, snakes), Multiple Sclerosis, Chronic Fatigue, Complications of Surgery



This seems like an impossible list of vitamin C cures. At this point, you can either dismiss the subject or investigate further. Dr. Klenner chose to investigate. 


The result?
He used massive doses of vitamin C for over forty years of family practice. He wrote dozens of medical papers on the subject.  A complete list of them is in the Clinical Guide to the Use of Vitamin C, edited by Lendon H. Smith, M.D., Life Sciences Press, Tacoma, WA (1988).

It is difficult to ignore his success, but it has been done. 

Dr. Klenner wrote: "Some physicians would stand by and see their patient die rather than use ascorbic acid (Vitamin C) because in their finite minds it exists only as a vitamin." 
 
Vitamin C is remarkably safe even in enormously high doses. Compared to commonly used prescription drugs, side effects are virtually nonexistent. It does not cause kidney stones. In fact, vitamin C increases urine flow and favorably lowers the pH to help keep stones from forming.  William J. McCormick, M.D. used vitamin C since the late 1940's to prevent and treat kidney stones. Vitamin C does not significantly raise oxalate levels, and uric acid stones have never resulted from its use, either.

Said Dr. Klenner: "The ascorbic acid/kidney stone story is a myth."

How much vitamin C is an effective therapeutic dose? Dr. Klenner gave up to 300,000 milligrams (mg) per day.

Generally, he gave 350 to 700 mg per kilogram body weight per day. That is a lot of Vitamin C. 

But then again, look at that list of successes. 
Dr. Klenner emphasized that small amounts do not work.

He said, "If you want results, use adequate ascorbic acid (Vitamin C)." 

 
If you want to learn more about the therapeutic uses of vitamin C, the following books are recommended:
How To Live Longer and Feel Better, by Linus Pauling, Ph.D.,
The Healing Factor: Vitamin C Against Disease, by Irwin Stone
The Vitamin C Connection, by Emanuel Cheraskin, M.D. et al
Clinical Guide to the Use of Vitamin C, by Lendon H. Smith, M.D.
Vitamin C: The Real Story, by Steve Hickey, Ph.D. and Andrew w. Saul (reviewed at http://www.doctoryourself.com/realstory.html

This book is also available in Spanish, Polish, Japanese, and Chinese.

YOU CAN READ BOTH THE CLINICAL GUIDE and THE HEALING FACTOR FOR FREE. 


 

Dr. Klenner's Clinical Guide to the Use of Vitamin C is posted in its entirety at http://www.seanet.com/~alexs/ascorbate/198x/smith-lh-clinical_guide_1988.htm

  

 Frederick R. Klenner, M.D., F.C.C.P
Nutritional docs  The Vitamin C Conspiracy


The complete text of Irwin Stone's book The Healing Factor is posted for free reading at http://vitamincfoundation.org/stone/



More in-depth information, especially for physicians and other health professionals, is readily available within the papers of
William J. McCormick, M.D. ,
Linus Pauling, Ph.D,
Abram Hoffer, M.D., and
Robert F. Cathcart III, M.D.  


The free online archive of the The Journal of Orthomolecular Medicine is also recommended. 

Revised and copyright 2019; copyright C 2005 and prior years Andrew W. Saul. 

Andrew Saul is the author of the books FIRE YOUR DOCTOR! 

How to be Independently Healthy 
(reader reviews at http://www.doctoryourself.com/review.html ) and  

DOCTOR YOURSELF: Natural Healing that Works. 
(reviewed at http://www.doctoryourself.com/saulbooks.html


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Vitamin C Protects Against Coronavirus

Published on January 27, 2020





FOR IMMEDIATE RELEASE

(OMNS January 26, 2020) The coronavirus pandemic can be dramatically slowed, or stopped, with the immediate widespread use of high doses of vitamin C.
Physicians have demonstrated the powerful antiviral action of vitamin C for decades. There has been a lack of media coverage of this effective and successful approach against viruses in general, and coronavirus in particular.
It is very important to maximize the body’s anti-oxidative capacity and natural immunity to prevent and minimize symptoms when a virus attacks the human body. The host environment is crucial. Preventing is obviously easier than treating severe illness.
But treat serious illness seriously. Do not hesitate to seek medical attention. It is not an either-or choice. Vitamin C can be used right along with medicines when they are indicated.
“I have not seen any flu yet that was not cured or markedly ameliorated by massive doses of vitamin C.” (Robert F. Cathcart, MD)
The physicians of the Orthomolecular Medicine News Service and the International Society for Orthomolecular Medicine urge a nutrient-based method to prevent or minimize symptoms for future viral infection. The following inexpensive supplemental levels are recommended for adults; for children reduce these in proportion to body weight:
Vitamin C: 3,000 milligrams (or more) daily, in divided doses.
Vitamin D3: 2,000 International Units daily. (Start with 5,000 IU/day for two weeks, then reduce to 2,000)
Magnesium: 400 mg daily (in citrate, malate, chelate, or chloride form)
Zinc: 20 mg daily
Selenium: 100 mcg (micrograms) daily
Vitamin C [1], Vitamin D [2], magnesium [3], zinc [4], and selenium [5] have been shown to strengthen the immune system against viruses.
The basis for using high doses of vitamin C to prevent and combat virus-caused illness may be traced back to vitamin C’s early success against polio, first reported in the late 1940s.[6] Many people are unaware, even surprised, to learn this. Further clinical evidence built up over the decades, leading to an anti-virus protocol published in 1980.[7]
It is important to remember that preventing and treating respiratory infections with large amounts of vitamin C is well established. Those who believe that vitamin C generally has merit, but massive doses are ineffective or somehow harmful, will do well to read the original papers for themselves. To dismiss the work of these doctors simply because they had success so long ago sidesteps a more important question: Why has the benefit of their clinical experience not been presented to the public by responsible governmental authorities, especially in the face of a viral pandemic?
Read the full press release at Orthomolecular.com

References:

1. Vitamin C:
Case HS (2018) Vitamin C questions answered. Orthomolecular Medicine News Servicehttp://orthomolecular.org/resources/omns/v14n12.shtml.
Gonzalez MJ, Berdiel MJ, Duconge J (2018) High dose vitamin C and influenza: A case report. J Orthomol Med. June, 2018, 33(3). https://isom.ca/article/high-dose-vitamin-c-influenza-case-report.
Gorton HC, Jarvis K (1999) The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. J Manip Physiol Ther, 22:8, 530-533. https://www.ncbi.nlm.nih.gov/pubmed/10543583
Hemilä H (2017) Vitamin C and infections. Nutrients. 9(4). pii:E339. https://www.ncbi.nlm.nih.gov/pubmed/28353648.
Hickey S, Saul AW (2015) Vitamin C: The real story. Basic Health Pub. ISBN-13: 978-1591202233.
Levy TE (2014) The clinical impact of vitamin C. Orthomolecular Medicine News Servicehttp://orthomolecular.org/resources/omns/v10n14.shtml
OMNS (2007) Vitamin C: a highly effective treatment for colds. http://orthomolecular.org/resources/omns/v03n05.shtml.
OMNS (2009) Vitamin C as an antiviral http://orthomolecular.org/resources/omns/v05n09.shtml.
Taylor T (2017) Vitamin C material: where to start, what to watch. OMNShttp://www.orthomolecular.org/resources/omns/v13n20.shtml.
Yejin Kim, Hyemin Kim, Seyeon Bae et al. (2013) Vitamin C is an essential factor on the anti-viral immune responses through the production of interferon-α/β at the initial stage of influenza A virus (H3N2) infection. Immune Netw. 13:70-74. https://www.ncbi.nlm.nih.gov/pubmed/23700397.
2. Vitamin D:
Cannell JJ, Vieth R, Umhau JC et al. (2006) Epidemic influenza and vitamin D. Epidemiol Infect. 134:1129-1140. https://www.ncbi.nlm.nih.gov/pubmed/16959053.
Cannell JJ, Zasloff M, Garland CF et al. (2008) On the epidemiology of influenza. Virol J. 5:29. https://www.ncbi.nlm.nih.gov/pubmed/16959053.
Ginde AA, Mansbach JM, Camargo CA Jr. (2009) Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Arch Intern Med. 169:384-390. https://www.ncbi.nlm.nih.gov/pubmed/19237723.
Martineau AR, Jolliffe DA, Hooper RL et al. (2017) Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 356:i6583. https://www.ncbi.nlm.nih.gov/pubmed/28202713.
Urashima M, Segawa T, Okazaki M et al. (2010) Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 91:1255-60. https://www.ncbi.nlm.nih.gov/pubmed/20219962.
von Essen MR, Kongsbak M, Schjerling P et al. (2010) Vitamin D controls T cell antigen receptor signaling and activation of human T cells. Nat Immunol. 11:344-349. https://www.ncbi.nlm.nih.gov/pubmed/20208539.
3. Magnesium:
Dean C. (2017) The Magnesium Miracle. 2nd Ed., Ballantine Books. ISBN-13: 978-0399594441.
Levy TE (2019) Magnesium: Reversing Disease. Medfox Pub. ISBN-13: 978-0998312408
4. Zinc:
Fraker PJ, King LE, Laakko T, Vollmer TL. (2000) The dynamic link between the integrity of the immune system and zinc status. J Nutr. 130:1399S-406S. https://www.ncbi.nlm.nih.gov/pubmed/10801951.
Liu MJ, Bao S, Gálvez-Peralta M, et al. (2013) ZIP8 regulates host defense through zinc-mediated inhibition of NF-кB. Cell Rep. 3:386-400. https://www.ncbi.nlm.nih.gov/pubmed/23403290.
Mocchegiani E, Muzzioli M. (2000) Therapeutic application of zinc in human immunodeficiency virus against opportunistic infections. J Nutr. 130:1424S-1431S. https://www.ncbi.nlm.nih.gov/pubmed/10801955.
Shankar AH, Prasad AS. (1998) Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 68:447S-463S. https://www.ncbi.nlm.nih.gov/pubmed/9701160.
5. Selenium:
Beck MA, Levander OA, Handy J. (2003) Selenium deficiency and viral infection. J Nutr. 133:1463S-1467S. https://www.ncbi.nlm.nih.gov/pubmed/12730444.
Hoffmann PR, Berry MJ. (2008) The influence of selenium on immune responses. Mol Nutr Food Res. 52:1273-1280. https://www.ncbi.nlm.nih.gov/pubmed/18384097.
Steinbrenner H, Al-Quraishy S, Dkhil MA et al. (2015) Dietary selenium in adjuvant therapy of viral and bacterial infections. Adv Nutr. 6:73-82. https://www.ncbi.nlm.nih.gov/pubmed/25593145.
6. Klenner FR. The treatment of poliomyelitis and other virus diseases with vitamin C. J South Med Surg 1949, 111:210-214. http://www.doctoryourself.com/klennerpaper.html.
7. Cathcart RF. The method of determining proper doses of vitamin C for treatment of diseases by titrating to bowel tolerance. Australian Nurses J 1980, 9(4):9-13. http://www.doctoryourself.com/titration.html
Source: https://healthimpactnews.com/2020/vitamin-c-protects-against-coronavirus/


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The Ebola virus can be destroyed naturally – despite what you’ve been told 



https://graviolateam.blogspot.com/2014/10/the-ebola-virus-can-be-destroyed_27.html



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THE FENTON REACTION: pro-oxydant role of vitamin C

 

  • THE DOUBLE FACED CHARACTER OF VITAMIN C
  • THE FENTON REACTION
  • ASCORBIC ACID AND THE FENTON REACTION
  • VITAMIN C PRO-OXYDANT ACTIVITY DAMAGE
  • ASCORBIC ACID AND ITS PRO OXIDANT ACTIVITY AS A THERAPY



https://graviolat.blogspot.com/2020/02/the-fenton-reaction-pro-oxydant-role-of.html



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The Use of Vitamin C as an Antibiotic


FRED R. KLENNER, M.D.


Reidsville, North Carolina


VITAMIN C—the foundation of the oxidation redux system now through greater dosage
reveals its outstanding qualities as a non-toxic antibiotic.


(Introduction)

On the 11th of December 1621 Edward Winslow, 1 one of the Pilgrim Fathers, writing to a friend in England who was about to make the trip to the new world gave this advice:­“Bring juice of lemons; and take it fasting. It is of good use.” Three hundred and eleven years later, 1932, and also in December, Waugh and King 2 found that this “important” lemon juice contained a six carbon chain acid which is now known as vitamin C. Ascorbic acid is related to the hexuronic acids which in turn are derivatives of the simple sugars ( Youmans 1941 3).

The value of this vitamin as an essential factor for life is universally known and accepted. The importance of vitamin C as an antibiotic and as the pre-cursor of antibody formation lack scientific appreciation because of its simplicity, and because of the reluctance on the part of the medical profession to employ it in massive doses administered like other antibiotics­around the clock. Allergy has become a major problem since the advent of the mold-derived drugs. Hippocrates did declare that the highest duty of medicine to be to get the patient well. He further declared that, of several remedies physicians should choose the least sensational.
  To understand the antagonistic properties of vitamin C against the virus bodies and also against the chemical ferments of micro-organisms­the toxins and exotoxins, one must go beyond its present academic status as a factor essential for life. A striking phenomena of vitamin C is the similarity of response either to correct pathology due to a deficiency of this compound, or to correct the pathology caused by the action of the virus bodies and other similar toxins and ferments. Within a few hours after adequate vitamin C therapy is instituted by needle one will find in the deficiency syndrome that fibroblasts are beginning to form normal connective tissue and that capillary buds are invading blood clots and other types of hemorrhagic areas ( Youmans 1941 3). 

Likewise when employed as an antibiotic definite clinical response is made evident by a climbing white blood count, drop in fever and general all around improvement of the patient within the same time schedule.
For many years it has been the accepted thought of the medical world that the forcing of citrus fruit juice in infections of the chest and upper respiratory areas, particularly by virus bodies, was valuable in that it produced alkalinity of the body fluids by way of its residue, the alkaline ash. This premise held that in this alkaline state greater phagocytic possibilities was allowed the leukocytes in destroying bacteria. This theory, although correct for the usual bacterial flora, was never too plausible for virus diseases since a leukopenia rather than a leukocytosis exist in these conditions. In the 1948 poliomyelitis epidemic in North Carolina we observed a greater response to vitamin C given by mouth when rutin was added. 2 
The alkaline ash here serving as a barrier to the loss of vitamin C by way of the kidneys. Vitamin C is excreted by glomerular filtration and is resorbed by the tubules. There is a maximum rate at which the tubules can resorb, so it is real economy to keep the urine alkaline. 

Hawley and her associates (1936 4) reported that the quantity of vitamin C excreted may be varied by merely changing the acid-base balance of the food intake.




(Early Clinical Usage of Vitamin C) 

Our interest with vitamin C against the virus organism began ten years ago in a modest rural home. Here a patient who was receiving symptomatic treatment for virus pneumonia had suddenly developed cyanosis. He refused hospitalization for supportive oxygen therapy. X-Ray had been considered because of its dubious value and because the nearest department equipped to give such treatment was 69 miles distant. Two grams of vitamin C was given intramuscularly with the hope that the anaerobic condition existing in the tissues would be relieved by the catalytic action of vitamin C acting as a gas transport aid in cellular respiration. This was an old idea; the important factor being that it worked. Within 30 minutes after giving the drug (which was carried in my medical bag for the treatment of diarrhea in children) the characteristic breathing and slate-like color had cleared. Returning six hours later, at eight in the evening, the patient was found sitting over the edge of his bed enjoying a late dinner. Strangely enough his fever was three degrees less than it was at 2 P.M. that same afternoon. This sudden change in the condition of the patient led us to suspect that vitamin C was playing a role of far greater significance than that of a simple respiratory catalyst. A second injection of one gram of vitamin C was administered, by the same route, on this visit and then subsequently at six hour intervals for the next three days. This patient was clinically well after 36 hours of chemotherapy. From this casual observation we have been able to assemble sufficient clinical evidence that prove unequivocally that vitamin C is the antibiotic of choice in the handling of all types of virus diseases. Furthermore it is a major adjuvant in the treatment of at other infectious diseases. This experimental “strike” on vitamin C as an antibiotic opened a new avenue of approach to the problem of dealing with the virus bodies. With a great deal of enthusiasm we decided to try its effectiveness with all of the childhood diseases. Measles was singled out more so than the others because of the knowledge that it was a small virus like the one causing poliomyelitis. It was reasonable to assume that if measles could be controlled then Poliomyelitis, too, would have a drug that could prevent as well as cure the disease. 

The use of vitamin C in measles proved to be medical curiosity. For the first time a virus infection could be handled as if it were a dog on a leash. In the Spring of 1948 measles was running in epidemic proportions in this section of the country. Our first act, then, was to have our own little daughters play with children known to be in the “contagious phase.” When the syndrome of fever redness of the eyes and throat, catarrh, spasmodic bronchial cough and Koplik spots had developed and the children were obviously sick, vitamin C was started.
In this experiment it was found that 1000mg every four hours, by mouth, would modify the attack. 

Smaller doses allowed the disease to progress.  
When 1000mg was given every two hours all evidence of the infection cleared in 48 hours. If the drug was then discontinued for a similar period (48 hours) the above syndrome returned. We observed this of and on picture for thirty days at which time the drug (vitamin C) was given 1000 mg every 2 hours around the clock for four days. This time the picture cleared and did not return. These little girls did not develop the measles rash during the above experiment and although exposed many times since still maintain this “immunity.” Late cases were given the vitamin by needle. 
The results proved to be even more dramatic. Given by injection the same complete control of the measles syndrome was in evidence a 24 and 36 hour periods, depending entirely on the amount employed and the frequency of the administration. Aborting of these cases before the development of the rash apparently gives no interference to the development of immunity. Recent progress on the rapidity of growth (a development) of the virus bodies by means of the electronic microscope makes intelligent the failure experienced by earlier workers when employing vitamin C on the virus organism (or bodies). 

Unless the virus is completely destroyed, as demonstrated in the experiments with the virus using measles, the infection will again manifest itself after a short incubation period. Small, single daily doses do not even modify the course of the infection.





This would seem to disprove the opinion of Thomas M. Rivers (1941 6) when he writes,
“On the other hand, a few investigators (Heaslip, McCormick, Stern, Tebbutt & Helms) have recorded what might be considered very poor evidence, obtained by observations on human beings, that vitamin C deficiencies play a role in susceptibility to poliomyelitis. ” The accuracy of Rivers’ evaluation of these works relating these observations seems questionable when he states ( 1941 6) that Sabin ( 1939 7 ) definitely demonstrated that Jungeblut’s (1937 8, 9) claim that Vitamin C deficiency increases the susceptibility of the experimental animals to infantile paralysis is not valid.

Jungeblut ( 1937 9) stated that the parenteral administration of natural vitamin C during the incubation period of poliomyelitis in monkeys is always followed by a distinct change in the severity of the disease; that after the fifth day of the disease LARGER doses are required. He realized, at that early date, that for fast progressing infection such as results from the R.M. strain, very large doses must be given; for the Aycock virus with its slower infection potential small amounts of vitamin C would suffice. During the 1948 Polio epidemic North Carolina it was our humble privilege to observe and report ( 1949 10) that a “period of septicemia did exist in the first few days of poliomyelitis.” It was our impression that time that the virus multiplied on a living tissue, the blood, and that the time to destroy the virus was during this “incubation period” which varies more with the virus strain, its virulence and power of multiplication than with the size of the initial dose.

Bodian and Horstmann (1952 11) confirmed our observation of the existence of a viremia phase in poliomyelitis, demonstrating that the virus was freely present in the blood of chimpanzees during the preparalytic period of the disease.
 

One of the most unfortunate mistakes in all of the research on poliomyelitis was Sabin’s UN-SCIENTIFIC attempt to confirm Jungeblut’s work with vitamin C against the Polio virus in monkeys. Jungeblut in infecting his rhesus monkeys used the mild “droplet method” and then administered vitamin C by needle in varying amounts up 400 mgm/day. Even this method did not give him absolute control over the degree of infection that would result. However, his antibiotic (vitamin C) remained relatively constant. With almost infinitesimal amounts, as we at present recognize, he was able to demonstrate in one series that the non-paralytic survivors was six times as great as in the controls.
On the other hand, Sabin, in infecting his monkeys did not follow the procedure given by Jungeblut whose experiments he was attempting to repeat, but instead employed a more forceful method of inoculation which obviously resulted in sickness of maximum severity. Sabin further refused to follow Jungeblut’s suggestion as to the dose of vitamin C to be used. By Sabin’s actual report the amount given was rarely more than 35 per cent of that used by his associate. Sabin makes this significant statement ( 1939 7), “One monkey was given 400 mgm of vitamin C for one day at the suggestion of Jungeblut who felt that large doses was necessary to effect a change in the course of the disease.”   Yet on the basis of Sabin’s work the negative value of vitamin C in the treatment of virus diseases has been for years accepted as final.


For some unexplained reason vitamin C has been “tied up” with scurvy to the exclusion of its many other functions.  
Those who would have us believe that this vitamin serves no other purposes argue that there is no evidence to substantiate the claim that malnutrition plays a definite role in susceptibility to the virus infections. We are invited to read what Aycock wrote in 1937 concerning “the tendency of poliomyelitis to occur in children who are large, healthy, and well nourished.” What is important we are not told. 

Of course, Polio, like any other childhood disease, is not dependent on specific personalities or certain constitutional types. The real reason for it developing and doing so in varying degrees is due to some other cause. Surely measles doesn’t limit its attack to the frail, unstable child or adult.

The exact incidence of vitamin C deficiency is unknown. No accurate way of determining whether a deficiency of vitamin C exists in the body tissues has been developed ( Thewlis Clinic 1953 12).

There is increasing evidence to indicate that a relatively large number of persons have hypovitaminosis C (Vitamin C deficiencies) and that these include individuals whose diets are generally considered satisfactory ( Youmans 1953 3).

The National Research Council recommends 75 mgm./day as the minimum requirement (1945). This is only a measure of the amount necessary to prevent gross disease and is not a measure of the amount needed to maintain good health. Kline and Eheart (1944 13 ) reported wide variations in the need for vitamin C in normal individuals.


Jolliffe (1945 14 ) suggested that the optimum requirements may actually be ten or more times the recommended minimum daily requirements.

Under certain conditions 1000 mg. to 3000 mg. per day were found by Kyhos et a1 (1945 15) to be necessary to keep the body saturated. There is a wide individual variation in the renal threshold for vitamin C. Many patients receive as much as 1500 mg. of vitamin C per day without significant urinary loss ( Shaw l945 5).

All of us have witnessed “nose bleed” in certain children sick with measles who prior to taking the disease were apparently healthy. Epitaxis (nose bleed) is one of the signs of scurvy. Is this true scurvy?

Crandon (1940 16 ) states that scurvy develops slowly in man. He found the vitamin C level of the blood plasma to be zero for 90 days before there was frank clinical evidence and that this was as long as 132 days before the first signs appeared. He reported that 1000 mg. of vitamin C was given daily for two weeks to clear skin petechiae. I have, many times, stopped nose bleed in children, sick with measles, with one single dose of 2 gms. Vit. C.


Dolldorf (1945 17 ) reported that many conditions may be present in the body that call for a greater supply of vitamin C. He lists fever, infection, physical stress, gastrointestinal disorders, diarrhea, anorexia, and vomiting along with many others. It is of more than academic interest to observe that all of the above listed conditions are usually found in severe cases of poliomyelitis.

One wonders whether or not these are manifestations of vitamin C deficiencies or true findings of the Polio syndrome. Certainly we do see several, if not all, of these symptoms associated with other childhood diseases. We have also found that like epitaxis all of the above mentioned conditions can be relieved with one or two injections of vitamin C, the amount ranging from one to four grams depending on the age of the patient. These manifestations represent acute vitamin C loss and is Nature’s way to ask for help. There exists a possible avenue of escape from this clinical pattern and that is to watch for the sign post that reveal pre-existing chronic vitamin C deficiencies.

Shaw (1945 5 ) states that food deposits on our teeth and dental tartar represents this condition. People who find that they are counted in this group should supplement their diet with at least two grams of vitamin C each day, or drink not less than three, 200 c.c. size, glasses of orange juice for the same period.






(Case Studies) 

To support our findings that massive doses of vitamin C is a potent antibiotic several case histories follow:­
Case I­Measles in a ten-months-old baby. The infant had a fever of 105(R) F, redness of eyes and throat, catarrh, spasmodic bronchial cough and Koplik spots. 


1000 mg. of vitamin C was given intramuscularly every four hours. 
After 12 hours the fever was 97.6 (R) F., the conjunctivitis and red throat had cleared, there was no cough. 


The sudden drop in the fever curve was thought to be explainable on one of three grounds:  
1) Common night drop. 
2) Due to the antibiotic action of vitamin C. 
3) Even if the vitamin C injections had been continued, a moderate rise might have occurred in the late afternoon of the second day, granting a highly virulent organism and a poorly resisting host. 

To determine which of these deductions was valid, vitamin C was discontinued for a period of eight hours. At this point the rectal temperature reading was 103.4 F. Vitamin C therapy was resumed and instead of the expected 8 P.M. climb, the fever was down to 99.2 (R) 
-The 1000 mg. injections were continued as before, the baby made an uneventful recovery and was discharged 60 hours following hospital admission. No measles rash developed. Four years have now elapsed and there has been no measles.


Case II­ - A case of virus pneumonia with typical consolidation of an entire lung field.


Patient colored female, age 28. 
Relative gave history of chills, fever, head and chest cold for past 14 days. In stupor when first seen, eye lids closed, a white foam at the mouth which she periodically tried to spit out. Fever by axilla 106.8 (corrected). Dehydration was much in evidence, breath sounds diminished to absent, tactile fremitus increased over the entire right side. The sulfa drugs, penicillin and streptomycin with supportive treatment had been exhausted by the referring physician. 
Four grains of vitamin C was given intravenously along with 1000 c.c. dextrose 5 in saline solution.
Temperature dropped to 100 (Ax.) corrected within eleven hours. 
Four hours later, vitamin C was resumed, the dose ranging from 2 to 4 grams every two to three hours depending upon the response. 
After 72 hours the patient was awake, sitting up in bed and taking fluids freely by mouth.  
There was no fever at this time, nor for the remainder of the, time in hospital. 
Vitamin C was continued for two weeks; the frequency was cut to every 12 hours, two grams at a dose. The rational of this continued use of vitamin C was to assist the body to clear up the debris in the right lung field. 
Although the patient was clinically recovered, it required three months to clear the lung by X-ray. In this Nature was merely duplicating a stage in the metamorphosis of the frog in getting rid of its tadpole tail.


Case III - ­A case of encephalitis following measles and mumps. 


This was a lad of eight years first seen with a fever of 104 F. He was lethargic, very irritable when molested as in simple physical examination. His mother said he had gradually developed his present clinical picture over the preceding four or five days. His first symptom was anorexia which became complete 36 hours before his first visit. He next complained of a generalized headache, later he became stuporous. Although very athletic and active, he voluntarily took to his bed. He was given 2000 mg. of vitamin C intravenously and allowed to return home because there was no available hospital accommodations.

His mother was asked to make an hourly memorandum of his conduct until his visit set for the following day. Seen 18 hours after the initial injection of vitamin C, the memorandum revealed a quick response to the antibiotic ­ after two hours he asked for food and ate a hearty supper, then played about the house as usual and then, for several hours, he appeared to have completely recovered. Six hours following the initial injection, he began to revert to the condition of his first visit. When seen the second time temperature was 101.6 F, he was sleepy but he would respond to questions. 

The rude irritability shown prior to the first injection of vitamin C was strikingly absent. A second injection of 2000 mg. was given intravenously and 1000 mg. of  “C” prescribed every two hours by mouth. The next day he was fever- and symptom-free. As a precautionary measure a third 2000 mg. was given with directions to continue the drug by mouth for at least 48 hours He has experienced no residual cerebral pathology a determined by examination five years following this episode. (Similar cases seen in the interim have shown more dramatic response when the drug was given by needle every two to four hours.)


Case IV­ - POLIOMYELITIS. 

A boy of eight years was brought to my office with a history of having had “flu” for a period of one week. Four days before this office visit he developed photophobia, conjunctivitis, sore throat back-of-the-eyes type headache, nausea and vomiting. The headache was of such intensity that adult doses of aspirin given by his mother had no effect. While on the examining table the boy was either rubbing his neck or the left side or holding his head between his hands, begging for something to relieve his pain. The fever was 104.x (Ax.) F. He was tender in the lumbar region and he has a drawing sensation referred to the hamstring attachment at the left knee. Two grams (2000 mg.) of vitamin C was given intravenously while in the office. He was sent to the local hospital where he received, promptly, a second injection of 2 grams of the vitamin, after which it was given every four hours. Six hours after commencing therapy the neck pain was gone, the headache completely relieved (he did not receive pain relieving medication), he could tolerate the ceiling light, his eyes were dry and the redness was definitely clearing. Nausea and vomiting had disappeared, the fever was down to 100.6 (Ax.) F., and he was sitting up in “a straight positioned bed” in a jovial mood while he drank a glass of limeade. He was discharged from the hospital after receiving 26 grams of vitamin C in 48-hour period, clinically well. Vitamin C was continued by mouth, 1500 mg. every two hours taken with citrus fruit juice. 

This schedule was followed for one week after which time a change was made to Vitamin B1, 25 mg. before meals and bed hour. Vitamin B1 was given in view of McCormick’s (1938-1939 18) theory that inflammatory and degenerative diseases of the nervous system [are] due to an avitaminosis of this particular vitamin. Vitamin B1 in these cases should be continued for a period of at least three months as nerve tissue is slow in recovering from even mild damage.





(Taking Vitamin C)
The amount of vitamin C for optimum effect will vary greatly with the individual. The type of the disease and the degree of toxemia (or viremia) are important guides in determining the dosage. Although the usual dose of vitamin C is calculated on the basis of 65 mg. per Kg. of body weight, and given every two to four hours by needle, under certain conditions larger single injections can be use to good advantage. In using “C” as an adjuvant in the treatment of infections caused by the more common bacteria the single 250 mgm. per Kg. of body weight injection behaves like other synergistic drug combinations. Likewise when treating an upper respiratory infection, this one single massive “shot” will precipitate the pathology. A report from the Thewlis Clinic (1953 12 ) is interesting in this respect:­“Upper respiratory tract infections may severely tax the vitamin C reserve. It is usually during or following a cold that patients have epitaxis or cough up blood streaked sputum. Local inflammation and depletion of vitamin C may be responsible for this hemorrhagic tendency. On numerous occasions, we have observed a dramatic alleviation of symptoms of a upper respiratory tract infection after an injection of 500 mgm. of ascorbic acid (vitamin C).” Vitamin C response when taken by mouth is not predictable.


Wright and Lilienfeld (1936 19 ) reported that the scorbutic state could develop even though the patient was taking large doses of vitamin C by mouth. In the opinion of Musser (1945 20 ) poor absorption and equally poor storage are cardinal factors in leading to vitamin C deficiencies. It was our privilege to observe this mechanism in one of our daughters several years ago. She had contracted chicken-pox. Vitamin C was started on this child when the macules first put in their appearance. In spite of the fact that she was given 24 grams every 24 hours there was no interruption in the progress of the disease. Itching was intense. One gram administered intravenously stopped the itch within 30 minutes and she went on to peaceful sleep for the next eight hours. Although feeling fine, a second injection was given at this time, following which there were no new macules and recovery was fast and uneventful. In the past few years we have noted that in chicken-pox when massive injections are employed there [are] no repeating waves of macules, and the usual seven to nine days required for crusting is reduced to less than twenty-four hours. Large doses parenterally are effective when oral administration fails ( Youmans 1945 3).


It is not uncommon to find a patient sick with a virus disease that is also being subjected to the effects of the toxins of a “secondary invader.” This problem of mixed infection is usually found in virus pneumonia and infectious mumps. The mouth, nose and naso-pharynx represent “living space” for many micro-organisms. Therefore it is possible to have parotitis secondary to buccal surgery without virus contamination, but it is never possible to have infectious parotitis (mumps caused by the virus organism) without secondary invading pathogenic organisms. In treating virus pneumonia and “Virus” mumps it is necessary either to give one or two injections of penicillin long with the vitamin C or comparable sulfa therapy. In one case of mumps it would seem from an academic point of view that Aureomycin would serve this purpose better since it does have antibiotic possibilities with the large virus organisms. The antibiotic power of vitamin C can also be augmented by other biochemical fractions. One of these is a colloidal solution of denatured proteolytic enzyme called “PROTAMIDE.”

In Herpes Simplex and Herpes zoster this “enzyme” proved to be of definite value, and in Herpes Zoster (Shingles) did influence the dorsal nerve root pain. Of course it is common knowledge that vitamin C, especially when injected intramuscularly, possesses these same anti-neuritic properties. Vitamin C, itself, can also called a “cousin” of the proteolytic enzymes. This suggested that vitamin C and protamide should be used at he same time. The clinical results justified this assumption. Cures were obtained in from one to three days. Vitamin C was given as usual, but protamide was limited to one ampoule per day. 

The same “improved” results were obtained in influenza and definite synergistic action was seen in one case of poliomyelitis in a boy of ten years. Calcium, too, is a good adjuvant especially in treating influenza. In vivo calcium duplicates the chemical behavior of vitamin C in many respects. Whether the virus has some destructive influence over the calcium ions is a mater of debate. From our experience it would seem that he inclusion of at least one 10 c.c. vial of calcium gluconate or calcium levulinate in the treating of a virus infection is good therapeutics. Levulinate must be injected at a slower rate than Gluconate. Calcium gluconate can be injected intramuscularly, in adults, if veins are at a premium, but it must be placed deep in the gluteal muscle. Vitamin C and D.C.A. 2 mg. to 5 mg. (the latter once/day) proved to have definite value against the influenza virus in recent tests.

We reported in 1951 and 1952 that a constant laboratory finding in virus infections was a positive, qualitative Benedict’s reaction. It is necessary to make a correction of that finding. This Benedict’s reaction was based on the admission urine specimen of patients admitted to our local hospital. About six months ago it came to my attention that this particular urine specimen is collected anytime from the admission of the patient to the hospital until some 18 hours thereafter. 
This, obviously, nullifies the laboratory report since medication given to the patient in the interim could alter the chemical findings. Vitamin C being a powerful reducing agent could account for some of the Benedict urine reports. It, therefore, makes void the contention that this laboratory test is an index when to discontinue the use of vitamin C. The deduction, however, is correct. We have ascertained during the past six months that this glycosuria ranges from a quantitative increase over the patient’s normal range, to a qualitative 2 plus. The majority of severe virus infections will show a strong trace Benedict’s qualitative reaction. Individual kidney threshold for sugar and/or vitamin C is probably a factor in the higher readings.

Pathologic changes due to excessive amounts of vitamin C are unknown.
Plasma concentrations twenty times normal have been obtained without any ill effects ( Youmans 1941 3). 


Occasionally there may be a sensitivity to common foods rich in vitamin C and constitutional idiosyncrasies to ascorbic acid due exist. These minor complications are Diarrhea, Induration (only when intramuscular injections are given too close to the surface), Endothelial irritation, Venous thrombosis (only when the concentration of the solution is 500 mg. per c.c. or greater), Syncope (only in patients over 50 years of age if the injection is made too rapid), Rash and vulvitis and puritis. This last factor was seen in ½ of 1% of children given massive therapy of the vitamin by mouth over a long period of time. Derma medicone ointment will control these symptoms. The vitamin should be discontinued by mouth, if this occurs, and given by needle. We have found that a No. 23 G needle ¾ inch long is ideal for intravenous use and a No. 22 G needle one inch long for the intramuscular routes. A needle 1½ inches long if the latter route is employed in adults.


http://www.whale.to/v/c/klenner1.html

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lauantai 8. helmikuuta 2020

Ethanol vehicles pose significant risk to health, new study finds

  • E85 vehicles reduce atmospheric levels of two carcinogens, benzene and butadiene, but increase two others - formaldehyde and acetaldehyde.
  • E85 increased ozone-related mortalities in the United States by about 200 deaths per year compared to gasoline.
  • This ES&T study was partially supported by NASA.

 


Ethanol vehicles pose significant risk to health, new study finds



Ethanol is widely touted as an eco-friendly, clean-burning fuel. But if every vehicle in the United States ran on fuel made primarily from ethanol instead of pure gasoline, the number of respiratory-related deaths and hospitalizations likely would increase, according to a new study by Stanford University atmospheric scientist Mark Z. Jacobson.

His findings are published in the April 18 online edition of the journal Environmental Science & Technology (ES&T).

"Ethanol is being promoted as a clean and renewable fuel that will reduce global warming and air pollution," said Jacobson, associate professor of civil and environmental engineering. "But our results show that a high blend of ethanol poses an equal or greater risk to public health than gasoline, which already causes significant health damage."


Gasoline vs. ethanol
For the study, Jacobson used a sophisticated computer model to simulate air quality in the year 2020, when ethanol-fueled vehicles are expected to be widely available in the United States.
"The chemicals that come out of a tailpipe are affected by a variety of factors, including chemical reactions, temperatures, sunlight, clouds, wind and precipitation," he explained.
"In addition, overall health effects depend on exposure to these airborne chemicals, which varies from region to region. Ours is the first ethanol study that takes into account population distribution and the complex environmental interactions."
In the experiment, Jacobson ran a series of computer tests simulating atmospheric conditions throughout the United States in 2020, with a special focus on Los Angeles. "Since Los Angeles has historically been the most polluted airshed in the U.S., the testbed for nearly all U.S. air pollution regulation and home to about 6 percent of the U.S. population, it is also ideal for a more detailed study," he wrote.
Jacobson programmed the computer to run air quality simulations comparing two future scenarios:
  • A vehicle fleet (that is, all cars, trucks, motorcycles, etc., in the United States) fueled by gasoline, versus
  • A fleet powered by E85, a popular blend of 85 percent ethanol and 15 percent gasoline.

  • Deaths and hospitalizations

    The results of the computer simulations were striking.
    "We found that E85 vehicles reduce atmospheric levels of two carcinogens, benzene and butadiene, but increase two others—formaldehyde and acetaldehyde," Jacobson said. "As a result, cancer rates for E85 are likely to be similar to those for gasoline. However, in some parts of the country, E85 significantly increased ozone, a prime ingredient of smog."
    Inhaling ozone—even at low levels—can decrease lung capacity, inflame lung tissue, worsen asthma and impair the body's immune system, according to the Environmental Protection Agency. The World Health Organization estimates that 800,000 people die each year from ozone and other chemicals in smog.
    "In our study, E85 increased ozone-related mortalities in the United States by about 200 deaths per year compared to gasoline, with about 120 of those deaths occurring in Los Angeles," Jacobson said. "These mortality rates represent an increase of about 4 percent in the U.S. and 9 percent in Los Angeles above the projected ozone-related death rates for gasoline-fueled vehicles in 2020."
    The study showed that ozone increases in Los Angeles and the northeastern United States will be partially offset by decreases in the southeast. "However, we found that nationwide, E85 is likely to increase the annual number of asthma-related emergency room visits by 770 and the number of respiratory-related hospitalizations by 990," Jacobson said. "Los Angeles can expect 650 more hospitalizations in 2020, along with 1,200 additional asthma-related emergency visits."
    The deleterious health effects of E85 will be the same, whether the ethanol is made from corn, switchgrass or other plant products, Jacobson noted. "Today, there is a lot of investment in ethanol," he said. "But we found that using E85 will cause at least as much health damage as gasoline, which already causes about 10,000 U.S. premature deaths annually from ozone and particulate matter. The question is, if we're not getting any health benefits, then why continue to promote ethanol and other biofuels?
    "There are alternatives, such as battery-electric, plug-in-hybrid and hydrogen-fuel cell vehicles, whose energy can be derived from wind or solar power," he added. "These vehicles produce virtually no toxic emissions or greenhouse gases and cause very little disruption to the land—unlike ethanol made from corn or switchgrass, which will require millions of acres of farmland to mass-produce. It would seem prudent, therefore, to address climate, health and energy with technologies that have known benefits."
    https://news.stanford.edu/news/2007/april18/ethanol-041807.html

    This ES&T study was partially supported by NASA.

    ______



    Cover of The Nexus of Biofuels, Climate Change, and Human Health

    The Nexus of Biofuels, Climate Change, and Human Health: Workshop Summary.

    One of the major reasons for encouraging the use of biofuels has been the positive effects their use is expected to play in reducing greenhouse gases and also air pollutants, with concomitant improvements in health. The speakers in the workshop’s fourth session offered details on how the production and use of biofuels should affect greenhouse gas levels, air quality, and health.

    BIODISTALLATE FUELS AND EMISSIONS

    In the first presentation, S. Kent Hoekman, research professor in the Division of Atmospheric Sciences at the Desert Research Institute, discussed biodistillate fuels and emissions. The term biodistillate is a more general term than biodiesel, he explained, and it includes not only biodiesel but also related biofuels.

    Background

    Hoekman began by offering some basic background on biodiesel and other biodistillate fuels, beginning with the drivers. “Why are we interested in biodiesel? I think today the simplest and most direct answer is because it’s the law.” In particular, the U.S. Environmental Protection Agency (EPA), in implementing several congressional mandates, has requirements for the use of renewable fuels divided into conventional biofuels, cellulosic biofuels, biomass-based diesel, and other advanced biofuels.
    The ultimate drivers for the use of biofuels—that is, the reasons behind the political decision to impose requirements for the use of biofuels—include concerns about greenhouse gas emissions, the desire to develop renewable or sustainable energy sources, the desire to develop secure domestic fuel supplies, and an interest in rural development. Interestingly, Hoekman said, neither air quality concerns nor health concerns have been major factors in the push to increase the use of biofuels. “They are somewhat important, but they have not been the main drivers.”

    Terminology

    Next, Hoekman went over some basic terminology related to biofuels in order to clarify exactly what is meant by various terms. According to ASTM International, biodiesel fuel refers to “mono-alkyl esters of long-chain fatty acids derived from vegetable oils and animal fats.” The term can also refer to trans-esterified triglycerides or to fatty acid methyl esters (FAMEs), which are both closely related to ASTM’s definition. Biodiesel fuel is sometimes referred to as B100.
    Renewable diesel is produced from the same feedstocks as biodiesel, Hoekman said, but it is produced through hydroprocessing technologies so that the product is a hydrocarbon (HC), not an ester. It is also referred to as “green diesel.”
    Co-processed renewable diesel is a form of renewable diesel that is produced by adding vegetable oils or animal fats to feedstocks that are being hydrotreated to produce diesel fuel, creating a single product that is a mixture of bio and fossil HCs.
    Cellulosic biodiesel fuel, or synthetic biodiesel, is produced by pyrolysis or gasification of lignocellulosic feedstocks, such as grasses and woods. The resulting liquid generally requires rather considerable additional processing or upgrading before it can be blended into petroleum fuel stock.

    Biodistillate Production Technologies

    A variety of different production methods are used to produce the different types of biodistillates. Hoekman illustrated them with a single figure that showed the feedstocks, processing methods, and resulting fuels (see Figure 4-1).
    FIGURE 4-1. Biodistillate production technologies beginning with feedstock used, processing technology used, fuel produced, and chemical type.

    FIGURE 4-1

    Biodistillate production technologies beginning with feedstock used, processing technology used, fuel produced, and chemical type. NOTE: ag = agricultural, FAME = fatty acid methyl ester, F-T = Fischer-Tropsch, HC = hydrocarbon, H2 = molecular hydrogen, (more...)
    Hoekman pointed out that, as the figure indicates, there are many different types of fats and oils that can be used to produce biodistillates. “And this is an abbreviated list shown here,” he said. The line at the top of the figure represents the traditional biodiesel production pathway that uses methanol in a trans-esterification pathway to produce biodiesel and glycerin. “We haven’t heard a lot about that,” he said, “but glycerin is the main byproduct of biodiesel production. About one-tenth as much glycerin is produced as biodiesel.” None of the rest of the production pathways produces glycerin, he noted. Furthermore, he noted that other than the biodiesel produced in that first production pathway, the rest of the fuels produced are HCs. It is only biodiesel that is oxygenated.
    At present, he said, biodiesel remains by far the most commonly produced biodistillate. In the United States, soy oil is the main feedstock used to produce biodistillates, with some waste cooking oil, sunflower oil, and other oils used as well. In Europe, the main feedstock is rapeseed, while in much of the rest of the world palm oil is the dominant feedstock.
    In the United States production of biodiesel is at an all-time high, with more than 1 billion gallons produced in 2011 and 2012, up from next to nothing a decade earlier. To put that in context, Hoekman said, the total U.S. petroleum diesel fuel production is about 60 billion gallons per year, and gasoline is about double that amount.

    Biodistillate Properties and Composition

    Biodiesel and renewable biodiesel differ from petroleum-based diesel in a number of ways. One of the most important is the presence of oxygen. Neither petroleum diesel nor renewable biodiesel contains oxygen, while biodiesel is roughly 11 percent oxygen by weight. Another important difference can be found in the energy content of the different fuels. Petroleum diesel has a high energy content of 130,000 BTU per gallon. Biodiesel is 6 to 7 percent less—121,000 BTU per gallon for biodiesel and 122,000 BTU per gallon for renewable biodiesel.
    With respect to the chemical composition of the various types of diesel fuel, two critical factors influence the physical properties and performance attributes of the fuels, including their emissions. The first is the length of carbon chains in the molecules of the fuels. In conventional diesel the chains are typically 12 to 24 carbons long, although some molecules are somewhat shorter or somewhat longer. Biodiesel, being made from fatty acids, tends to have molecules with carbon chains that are 16 or 18 carbons in length. The second important factor is the degree of unsaturation, which is, roughly speaking, a measure of how many fewer hydrogen atoms a molecule with a certain number of carbon atoms has than it could have if the carbon atoms were arranged to maximize the number of hydrogen atoms in the molecule. The degree of unsaturation is important, Hoekman explained. Having too much unsaturation makes for an oxidatively unstable product, while having too little unsaturation results in a product with poor low-temperature performance—that is, it tends to “wax up” when the temperature drops. Compared to biodiesel, conventional diesel has lower unsaturation overall, and it has more branching of the HCs, he said. “Those are important for physical and chemical properties.”
    Different oil feedstocks lead to biodiesels with different chemical compositions. For example, soybean oil is dominated by linoleic acid entities, consisting of an 18-carbon chain with two double bonds. “That’s rather highly unsaturated in terms of fuel stability,” Hoekman said. By contrast, rapeseed is mainly oleic acid, a molecule with an 18-carbon chain but only one double bond, so it is not so highly unsaturated.

    Emissions Standards and Controls

    Diesel engine and vehicle emissions are regulated by the EPA as well as by some states, most notably California, Hoekman said. Different sets of standards are defined for different applications and purposes. For example, there are different emissions standards for different engine sizes—light-duty, medium-duty, and heavy-duty application—and, in fact, each of these categories has subsets with their own sets of standards. There are also different standards for on- and off-road applications. Off-road applications make up a significant part of diesel fuel usage, he said, and they include railroads, mining, and farming.
    Historically, four different types of emissions have been regulated for diesel uses: HC, carbon monoxide (CO), nitrogen oxide (NOx), and particulate matter (PM). Of those four, Hoekman said, the latter two have been of the greatest concern and have been under regulatory scrutiny for the longest time, principally for reasons related to air quality.
    The emissions standards are not static sets of numbers, he said. They have been steadily evolving. In particular, emissions standards have become much more stringent during the past 25 years, and the maximum allowable emissions of NOx and PM have been reduced by almost two orders of magnitude during that time. For example, in the late 1980s, NOx was regulated at 10.5 grams per brake horsepower-hour; today, the standard is 0.2 grams per brake horsepower-hour. Similarly, the standard for PM went from 0.6 to 0.01 grams per brake horsepower-hour.
    Those emission standards apply only to new engines and vehicles, he noted. They are not automatically applied to fleet vehicles already in use, and fleet turnover is very slow, particularly for heavy-duty diesel vehicles.
    The large reductions in emissions required by the standards have been achieved by a combination of engine improvements and improvements in emission control systems. Engine improvements have included the adoption of high-pressure, common-rail fuel injection; variable injection timing; and electronic monitoring and control systems. A recently developed emission control system used to reduce particulate emissions is the particulate trap. Particulate traps require regeneration, Hoekman noted, and there have been some issues regarding the regeneration of those traps. To control NOx, engines are now being built with selective catalytic reduction systems. These use urea injection to reduce NOx to molecular nitrogen. Those are significant changes that have taken place in just the past couple of years, he said.
    Another change that has made it possible to dramatically reduce emissions has been the introduction of ultra-low-sulfur diesel (ULSD). “The primary reason for having that is to enable satisfactory long-term operation of those sophisticated emission control systems,” Hoekman said. “It’s analogous to getting the lead out of gasoline so that catalytic control systems can function properly.”

    Effect of Biodiesel on Engine Emissions

    The traditional understanding of how using biodiesel in an engine affects tailpipe emissions comes from a 2002 EPA draft report (2002) that was “rather famous but never officially published in a final version,” Hoekman said. That report showed that as the blending level of biodiesel is increased from B0 (0 percent) all the way to B100 (100 percent), there are significant reductions in HC, CO, and PM emissions, while there is a slight increase in NOx emissions. “That increase in NOx has been a source of tremendous controversy in a lot of studies over the years,” Hoekman said. In most real-world applications, he noted, biodiesel is used at low concentrations, usually B5 to B20. So, it is in that range that it is most important to understand what happens to emissions.
    Recently, the Desert Research Institute, working on behalf of the Coordinating Research Council, conducted an updated literature review in order to examine more recent and comprehensive information concerning the effects of using biodiesel on engine emissions. The review, which Hoekman was a part of, examined more than 1,000 literature sources and analyzed the data with various sorting and statistical analysis methods.
    Focusing just on the data for NOx emissions, Hoekman noted that there was “tremendous scatter” in the data. That is, there was no smooth curve that could describe what happened to the emissions as the percentage of biodiesel increased from 0 to 100 percent; instead, the data points were scattered all over the graph. This was not particularly surprising, he observed, because the data were from a wide range of literature sources. The various studies were done under a very wide range of conditions, with many different forms of biodiesel blended into different base fuels, and many other differences as well. And the data scatter was just as large for HC, CO, and PM emissions, he noted.
    Still, it was possible to discern a trend in the NOx emissions. The data showed an upward trend in NOx as the percentage of biodiesel increased in the category of heavy- and medium-duty engine dynamometer emissions. However, the trend was the opposite for the category of heavy- and medium-duty chassis dynamometer emissions. The main difference between the tests lies in where the dynamometer is mounted during the test—coupled directly to an engine that is independent of a vehicle, versus coupled to the power train of a vehicle through the drive wheel or wheels without removing the engine from the frame of the vehicle. This difference in observed NOx effects, depending on the testing methodology used, is one illustration of why it is so difficult to determine the “true impacts” of fuel changes on engine emissions when applied across the entire vehicle fleet, Hoekman said.
    The study found significant decreases in HC, CO, and PM emissions with increasing percentage of biodiesel, which were in “reasonably good agreement” with the earlier EPA findings. “So, I think this is probably the best idea you can get as to the impact of biodiesel use on emissions across the whole fleet,” Hoekman said.

    Emissions from B20 Fuel

    Hoekman then focused specifically on the issue of emissions from B20 fuel because “that’s the upper end of the most common range of biodiesel usage levels.”
    He discussed a study by , in which the results were broken down by engine class: medium- and heavy-duty engine, medium- and heavy-duty engine on a chassis, and light-duty engine. Overall, there were large reductions in HC, CO, and PM emissions, with a slight increase in NOx emissions, although there was a large scatter in the results. The results in the study by  (HC, –17.4; CO, –14.1; PM, –17.2; NOx, +1.8) generally agreed quite well with the results from the earlier EPA study () (HC, –21.1; CO, –11.0; PM, –10.1; NOx, +2.0).
    Given that the review involved more than 1,000 individual studies, Hoekman said, it was possible to sort the studies according to various criteria, including the feedstock used for the biodiesel (soy oil, rapeseed oil, yellow grease, palm oil), the base fuel into which the biodiesel was mixed (No. 2 diesel, ULSD, California Air Resources Board [CARB] certified diesel), the engine year (as a proxy for the certification levels for the emissions and, particularly, the NOx certification level), and the test cycle load (light, medium, heavy).
    When Hoekman and his colleagues examined how these different criteria affected the emissions levels from the various biofuels, they found that there was so much data scatter in the results that it was difficult to detect significant effects across the whole fleet. To illustrate, he showed graphs of how B20’s effects on emissions varied by the type of feedstock used, the type of base fuel, the engine year, and the test cycle load. In each case, the error bars were larger than the effect sizes, so it was impossible to conclude that any of these factors had an influence on how B20 affected emissions.
    Moving on, Hoekman spoke briefly about mobile source air toxic (MSAT) emissions from biodiesel. There are dozens of MSATs, but those of greatest interest with respect to biodiesel are polycyclic aromatic HCs, aldehydes (formaldehyde, acetaldehyde, proprionaldehyde, and acrolein), and the total PM discussed previously. Oxygenated organics, such as biodiesel, might be expected to produce higher levels of oxygenated MSATs, Hoekman said, but there is very little relevant experimental data that address this issue. The existing data suggest that the use of biodiesel does not consistently increase emissions of these MSATs, he said.
    Hoekman concluded his presentation with a number of general observations about biofuels emissions. First, he said, although biodiesel—the FAME version—is currently the dominant form of biodistillate being produced, he believes that in the future the nonoxygenated biodistillates are likely to grow in use and perhaps even become the dominant form of biodistillate.
    Recent reviews of the biodiesel literature have confirmed what the EPA and others have been saying for many years—that the use of biodiesel reduces emissions of HC, CO, and PM while increasing NOx emissions by a small amount. Although data on the emissions of renewable biodiesel—that is, the non-oxygenated, HC biodistillates—are sparse, it does appear that renewable diesel provides emission reduction benefits that are just as big as, if not bigger than, those from biodiesel.
    Exhaust emission standards for diesel engines and vehicles have become much more stringent during the past 25 years, which has resulted in the development of advanced emission control systems that reduce emissions dramatically, much more so than a change in the fuel composition to include biodistillate fuels.
    Determining the effects of fuel-type fleet-wide emissions is difficult because of the variability of engine and vehicle types, test cycles, emissions control systems, and other factors. The variability in the data prevents drawing firm conclusions about the effects of biodiesel feedstock, base fuel type, the engine model year, or the test cycle on diesel emissions when using B20. In the case of aldehyde emissions, although the data are sparse, the use of biodiesel does not appear to affect the emissions in a consistent or significant way. The effects of biodiesel on polycyclic aromatic HC emissions are hard to ascertain, but the few data that exist suggest little effect, if any.
    Finally, Hoekman offered a recommendation. The various advanced diesel emission control systems, such as the selective catalytic reduction device and the particulate trap, have been in use for only a couple of years, he reiterated. “I believe that additional research and study monitoring is needed to assess the long-term effects of biodiesel and its impurities on the performance of those systems. If those systems fail over a shortened lifetime, that would have significant effect.”

    Discussion

    Following Hoekman’s presentation, there was a discussion period devoted to just his talk. The first question, which came from an audience member, was whether any work had been done to study the effect that contaminants in biofuels might have on health. In particular, the question concerned biofuels produced from things such as frying oils used for french fries and other foods, which could have a variety of contaminants.
    Hoekman replied that he was not sure if any data exist concerning the health effects of such contaminants. However, he noted that there is a rather long and stringent list of specifications for biodiesel fuel—as there is for petroleum-based diesel—because the diesel engines are expected to run for half a million miles or even longer on these fuels without breaking down. “The feeling is if there are excessive levels of salts or metals, they may impede the performance of emission control systems,” he said. “They may use some of the capacity of the trap, thereby reducing its overall efficiency.”
    In a follow-up question, Hoekman was asked about the difference between more versus less unsaturated feedstocks for biofuels. Plant-derived biofuels can vary in how unsaturated they are, depending on which plants they are derived from. So the question was whether that difference could lead to a difference in emissions from the biofuels.
    Hoekman answered that there has been quite a lot of work looking at how the extent of unsaturation affects total emissions and, especially, NOx emissions. The results have been somewhat equivocal, he said, but there is some evidence that the higher the unsaturation, the more NOx emissions there may be. However, he added, “what’s much more important with respect to unsaturation is the physical property—the oxidative stability of the fuel. Can you keep it out in the marketplace? Is it an acceptable fuel regardless of what happens when you burn it?”
    In response to a question about whether automotive manufacturers are willing to warranty engines used with a biodiesel mix, Hoekman said that his understanding is that most manufacturers of heavy-duty engines now accept up to B20. In fact, he said, the international standards organization ASTM has developed standards for biodiesel in the range of B6 to B20. “So, in that range, I believe biodiesel is accepted by all the U.S. heavy-duty engine manufacturers,” he said. However, he did not know whether manufacturers of light-duty vehicles have yet reached the same point.

    REGIONAL IMPACTS OF BIOFUELS ON HEALTH AND CLIMATE CHANGE IN BRAZIL

    In the next presentation, Elliott Campbell, an assistant professor at the School of Engineering at the University of California Merced Energy Research Institute, moved from the micro-level issue of tailpipe emissions to the macro-level question of how the use of biofuels might affect health and climate change on a regional scale.
    To begin, Campbell noted that much of the current discussion related to the effects of biofuels on climate change concerns those changes on the global scale. It concerns issues such as carbon cycle in the use of biomass feedstock and land-use change. But there is also emerging interest in examining the effects of biofuels use at a regional scale—for example, in studying how the broad use of E85 (a fuel with 85 percent ethanol and 15 percent gasoline) might affect air quality in a region such as Los Angeles and surrounding areas () or looking at the regional climate impacts from the widespread use of second-generation cellulosic biofuels products (). Noting that there has been quite a bit of this sort of work done on the regional scale in the United States, he said that his talk would be focused instead on some emerging analysis of the regional climate and health impacts of biofuels production in Brazil.

    Background

    He began by providing some basic background on biofuels in Brazil. As can be seen in the top section of Figure 4-2, the consumption of liquid fuels has steadily increased during the past decade, as has the production, and in recent years production and consumption have been approximately equal. As can be seen in the bottom section of the figure, hydroelectricity produces a large majority of the country’s electricity, with fossil fuels a distant second. Nuclear power accounts for a very small percentage of the total electric power and is a smaller proportion than renewable energy sources other than hydroelectricity and nuclear. Two energy-related concerns in Brazil are the export of biofuels and diversifying local electric power production.
    FIGURE 4-2. Energy in Brazil: (a) liquid fuels production and consumption (2002–2014); (b) electricity generation, by fuel type (2001–2011).

    FIGURE 4-2

    Energy in Brazil: (a) liquid fuels production and consumption (2002–2014); (b) electricity generation, by fuel type (2001–2011). SOURCE: EIA, 2012.
    Brazil produces large amounts of sugarcane whose sugar is used in the production of ethanol, and one issue of importance to Brazilian policy makers is what to do with the parts of the sugarcane plant that are not converted into ethanol. At present, Campbell said, about half of the sugarcane crop is subjected to pre-harvest burning, which makes the harvesting process much easier and less expensive and also returns nutrients to the soil. However, it produces massive amounts of air pollution during the time of the pre-harvest burning, and it is also wasting a large amount of energy that could be captured and used elsewhere.
    Reducing the amount of pre-harvest burning would lead to much larger quantities of available sugarcane residue, which could be turned into energy in two ways: it could be burned in electricity-generating plants, or it could be turned into cellulosic ethanol. Converting the residue into electricity has greater greenhouse gas benefits than using the residue to produce ethanol, he said, and, furthermore, converting the residue into electricity could have a massive impact on Brazilian energy security.

    The Level of Direct Emissions

    After providing that brief overview, Campbell took a more careful look at the emissions caused by the field burning of sugarcane (). One way to understand these direct emissions, he said, is to use a bottom-up approach that combines emissions factors from the GREET (Greenhouse Gases, Regulated Emissions, and Energy Use in Transportation) model from Argonne National Laboratory, maps of sugarcane production, and basic conversion factors generated from other agronomic and life-cycle assessment data. When the calculations are done, they show that field burning does indeed release massive amounts of various gases: CO, volatile organic compounds, NOx, PM, and carbon dioxide. So, field burning is a very important component of the direct emissions associated with the production of biofuels, he concluded.
    During the past decade, he said, the emissions of various gases have grown despite the move to mechanization, and he illustrated this with a figure that showed emissions over time in the Brazilian state in which most of the sugarcane production takes place (see Figure 4-3). This increase in emissions is due to the expansion of the areas in which sugarcane is grown, so that even with growing mechanization, the amount of field burning has been increasing.
    FIGURE 4-3. Estimated life-cycle emissions of ethanol in Brazil from crop year 2000 to 2008 (crop year is from April to January the following year).

    FIGURE 4-3

    Estimated life-cycle emissions of ethanol in Brazil from crop year 2000 to 2008 (crop year is from April to January the following year). NOTE: (a) Emissions of volatile organic compound (VOC), nitrogen oxide (NOx), particulate matter less than 10 microns (more...)
    Researchers have used various methods to estimate the direct emissions from field burning, Campbell said. One such method has been remote sensing from satellites. This is a convenient method because it makes it possible to get estimates from many different sugarcane-growing regions with relatively little additional effort over what it takes to get estimates from just one area. However, the top-down data from such satellites have proven to significantly underestimate the emissions versus the bottom-up estimates.
    “One important question is ‘Why the difference?,’ because we would love to be able to use the remote sensing data,” Campbell said. There are a number of factors at play. One is that the remote sensing comes up with significantly different estimates for the size of the burned areas than the bottom-up approach. There are also major differences in the estimates of the fuel load (the amount of biomass per unit area) and the emission factors (total emissions per kilogram of biomass).

    Regional Health and Climate Impacts

    With a growing understanding of the emissions from pre-harvest burning, the next question is, What might the health and climate impacts of these emissions be? To answer that question, Campbell said, one begins by trying to understand what the change in air quality is—not just how the emissions change, but how atmospheric species change in concentration and how those concentrations vary in space and time. The next steps in quantifying the human health effects are to determine the exposed populations, estimate the health effects, and determine a health baseline incidence. “You can try to gather these data at a variety of spatial scales in Brazil,” he said, including city-level, province-level, or country-level data.
    There are a number of studies that estimate the health effects of various levels of atmospheric pollution, Campbell noted, “and the change in the atmospheric concentration comes from these regional atmospheric models that I talked about previously.” To illustrate, he showed a map of PM levels in Brazil in January, during the sugarcane growing season, and in May, when the pre-harvest burning takes place.
    Combining models of this sort with estimates of the health effects for various levels of PM in the atmosphere, it is possible to derive estimates of the health effects of the pre-harvest burning of sugarcane based on the following approach: health effect = (air quality change) × (exposed population) × (health effect estimate) × (health baseline incidence). In looking at annual mortality changes, “you get somewhere between 20 and 4,000 deaths per billion gallons of ethanol,” Campbell reported. To put these numbers into perspective, it is helpful to review a study that compared deaths associated with operating gasoline-fueled vehicles versus those fueled with a blend of 85 percent ethanol (E85) based on modeling for 2020.  found that E85-fueled vehicles increase ozone-related mortalities by about 185 deaths per year, which corresponds to a 4 percent increase over the U.S. projected death rate of operating gasoline vehicles. Campbell noted that there is obviously much uncertainty in the exact number of deaths from the air quality effects of the pre-harvest burning, but from this preliminary analysis there appears to be significant potential for the health impacts to be quite large.
    Estimating climate effects caused by the emissions from pre-harvest burning is even more difficult. “It requires advanced climate modeling,” Campbell said, “but if you use climate forcing factors based on emissions for black carbon from the fields and from the boilers at the ethanol refineries, the climate forcing per unit energy of ethanol for sugarcane can increase from what we think it is now to something that may exceed regulatory thresholds.”

    Indirect Emissions

    In addition to the direct emissions from pre-harvest burning, there are also indirect emissions caused by indirect land-use change, meaning, in essence, a change in the use of land from forest or some other non-cultivated land to cultivated cropland. Such land-use change generally involves the clearing of forest or other land, which in turn involves cutting down and burning trees or other vegetation, which releases carbon and other elements into the atmosphere.
    Calculations show that rangeland converted to biofuels production in Brazil led to a significant amount of PM released into the atmosphere, Campbell said, but that the conversion of forest to rangeland accounted for far more emissions.
    When the indirect emissions from indirect land-use change are included in the calculations for total emissions in the life-cycle of sugarcane ethanol, a very different picture emerges. For PM (in particular, PM2.5, which refers to particles less than 2.5 micrometers in diameter), including indirect land-use change in the calculations may nearly double the estimated emissions due to the production of biofuels. To put this in perspective, Campbell compared the indirect emissions of PM from biofuels production to the emissions of PM caused by Amazonian deforestation. “Adding a billion gallons of ethanol is potentially on the order of all the emissions from deforestation in roughly the last decade,” he said.
    In summing up his presentation, Campbell offered the following takeaway messages:
    • The emerging trade regime for biofuels, with Brazilian biofuels being exported to developed nations, presents important “leakage” challenges with respect to regional health and climate impacts.
    • Previous burning estimates may underestimate the burned area by a factor of four.
    • Sugarcane regional health impacts are potentially much larger than those of other biofuels, although a great deal of work remains to produce better estimates.
    • The regional climate impacts from biofuels production may mean that sugarcane ethanol, instead of providing a significant reduction in climate impacts relative to the fossil fuels that it replaces, is actually causing climate warming, at least at a regional scale.
    Finally, Campbell offered several research recommendations:
    • Regional climate and health impacts research should focus on Brazil, given the potential for relatively high impacts there.
    • The critical research gaps that should be addressed include top-down studies of burned area (in order to resolve the difference from bottom-up estimates), observation-based emissions factors (because they vary widely), and three-dimensional atmospheric modeling.
    • Integrate research and policy to address leakage issues for regional impacts (e.g., air quality, aerosol forcing) in addition to the current focus on global impacts (e.g., carbon dioxide).

    Discussion

    Campbell’s presentation was followed by a discussion period. Christopher Portier, director of the National Center for Environmental Health, Centers for Disease Control and Prevention, began by asking whether Campbell’s climate forcing model with which he examined the effects of field burning included carbon black. It only included carbon, Campbell replied, which is one of the weaknesses of that analysis. There have been some very simple ballpark estimates of the climate forcing of carbon black that have been public, he said, and applying those estimates implies that field burning “can potentially exceed some thresholds for life-cycle greenhouse gas emissions.” However, Campbell said, what is really needed is to run a regional climate model “because the climate forcing from these species varies so much depending on the domain, the time of year, the timing of the emissions, all of these kinds of factors.” Thus, the jury is definitely still out on the effects of these carbon black emissions.
    Carlos Santos-Burgoa from the Pan American Health Organization asked whether there were any changes that could be made to the sugarcane ethanol production process that would improve the emissions.
    One approach would be to continue reducing the amount of pre-harvest burning, Campbell said. There has been a pretty dramatic shift over the past decade away from pre-harvest burning and toward mechanization. “Brazil has a voluntary program that’s trying to move toward those better cultivation approaches,” he said, “but it’s unclear what the future trends would be if sugarcane cultivation expanded rapidly to try and meet demand for export of biofuels.”
    Roundtable member Bernard Goldstein referred to Campbell’s statement that the residue-based ethanol made in Brazil and shipped to the United States has little impact on the energy security of the United States but would have massive impact on Brazil’s energy security if it were not exported. Goldstein then suggested that economists would likely respond to this situation by saying that energy security is not being priced appropriately.
    Al McGartland responded that the EPA does include an analysis of energy security in the ethanol regulations when it sets a mandate. There are a variety of security benefits to ethanol production, he said, including making the economy less vulnerable to the price of oil and potentially decreasing military expenditures in the Middle East if imported petroleum is less vital to the national interest. The value of these security benefits “is not a trivial number” for the United States, he said, although he was not familiar with the case of Brazil.
    Goldstein then asked if it is correct that a drop in the price of oil would mean there would be less of a push for biofuels. McGartland replied that this is the case. Right now, biodiesel would not be made without a mandate because it costs more than petroleum-based diesel, but if the price of regular diesel fuel went up enough, biodiesel would be made without a mandate.
    Goldstein next asked how to get air pollution and other health issues considered more in the discussion concerning biofuels. Stephen Reynolds suggested that life-cycle assessments (LCAs) might offer a way in. “The whole concept of life-cycle assessments has become pretty popular these days,” he noted. “In fact, it’s mandated by certain regulatory agencies that some form of LCA must be done to evaluate the broader impacts of fuels or other technology introductions.” These LCAs have tended to focus more on greenhouse gases and energy balances and not so much on “mobile-source air toxics,” Reynolds said. So, one place to start getting more attention to health issues in the discussion on biofuels would be to work to get more consideration of toxic emissions in LCAs.
    An audience member elaborated on the importance of persuading decision makers—and especially the economists who advise them—that air quality needs to be taken into account as a serious policy concern. “I think that air quality is one of a class of health-related issues that traditionally have been marginalized,” he said, “in part because although economists will pay lip service to issues of health and productivity, I’m not sure that the current economic theory really believes it.” The result is that economic models often minimize or leave out health considerations. If people are removed from a labor market that is already glutted with free labor, for example, that does not have much overall economic impact. Thus, more work needs to be done to health and productivity and economic development. “Some progress is being made in health and productivity studies of the type that are being done in industry to relate health promotion to productivity,” he said, “but that so far has been very narrow and very rich-country-oriented. I think we need a far more robust economic approach.”
    Another audience member immediately challenged those comments. “With all due respect to the last speaker, most of what he said is really quite wrong from an economics perspective. The environmental economics community … would never think about valuing health in the way that was described. We know that it is absolutely wrong to think about the benefits from loss of life or illness as something as simple as lost life years or lost productivity. It’s wrong from an economic analysis perspective. It feels in-the-gut wrong, and it is wrong. So, I don’t want to give you a big long lecture, but that notion is really not an accurate depiction of the state of the field.”
    In reality, the commenter said, the benefits of improved human health are very well understood as belonging in cost-benefit analysis, and there are many studies doing this.
    Goldstein offered a relevant anecdote. Forty years ago, as a young investigator at the U.S. Office of Management and Budget (OMB), he gave a talk about the effects of sulfur dioxide and mentioned the infants who had died in the London great smog event of 1952. “I was asked by the OMB economists whether they were male infants or female infants, and when I looked horrified, and … asked why would that be a question, it was pointed out that females did not contribute to gross domestic product, but males did. So, OMB has come a long way.”

    REFERENCES

    • Campbell E. Regional impacts of biofuels on health and climate change; Presentation at the Institute of Medicine Workshop on the Nexus of Biofuels Energy, Climate Change, and Health; Washington, DC. 2013.
    • Georgescu M, Lobell DB, Field CB. Direct climate effects of perennial bioenergy crops in the United States. Proceedings of the National Academy of Sciences of the United States of America. 2011 10.1073/ pnas.1008779108. [PMC free article] [PubMed]
    • EIA (U.S. Energy Information Administration). Brazil. 2012. [July 29, 2013]. Available at http://www​.eia.gov/countries/cab​.cfm?fips=BR.
    • EPA (U.S. Environmental Protection Agency). A comprehensive analysis of biodiesel impacts on exhaust emissions: A draft technical report. 2002. [October 10, 2013]. (EPA420-P-02-001). Available at http://www​.epa.gov/otaq​/models/analysis/biodsl/p02001.pdf.
    • Hoekman SK. Biodistillate fuels and emissions in the United States; Presentation at Institute of Medicine Workshop on the Nexus of Biofuels Energy, Climate Change, and Health; Washington, DC. 2013.
    • Jacobson MZ. Effects of ethanol (E85) versus gasoline vehicles on cancer and mortality in the United States. Environmental Science and Technology. 2007;41:4150–4157. [PubMed]
    • Robbins C, Hoekman S, Ceniceros E, Natarajan M. Effects of biodiesel fuels upon criteria emissions. 2011. (SAE Technical Paper 2011-01-1943). [Cross Ref]
    • Tsao CC, Campbell JE, Mena-Carrasco M, Spak SN, Carmichael GR, Chen Y. Increased estimates of air-pollution emissions from Brazilian sugar-cane ethanol. Nature Climate Change. 2012;2:53–57.
    Copyright 2014 by the National Academy of Sciences. All rights reserved.

    https://www.ncbi.nlm.nih.gov/books/NBK196452/

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