Vitamin C (Ascorbic Acid)

 

Vitamin C is a vitamin needed for normal growth and development; it used to maintain skin, tendons, ligaments, and blood vessels. It is particularly important for healing wounds and forming scar tissue, repairing and maintaining cartilage, bones, and teeth. It also aids in the absorption of iron in the diet.

 

Vitamin C is also an important antioxidant, a nutrient that blocks damage caused by free radicals, a destructive process implicated in most of the diseases associated with aging including arthritis, cardiovascular diseases and cancer. Furthermore, increased needs for Vitamin C have been identified in medical conditions including obesity and smoking. Therefore, Vitamin C is an important nutrient that must be included in substantial amounts as part of any healthy diet.

 

See also:

Vitamins & Minerals – Recommended Daily Intake

Supplements

Vitamin B12

Vitamin D

Minerals

Mitochondrial Dysfunction

NRF2 Activators

Nicotinamide Riboside

 

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Vitamin C (Ascorbic Acid)

While Vitamin C is the most potent antioxidant in the body, it is preferentially oxidized before other antioxidants including Vitamin E and therefore may be the most sensitive vitamin for measuring vitamin antioxidant status. However, although antioxidant benefits of Vitamin C and other antioxidants have been shown in lab studies, the significance of these findings remain unclear because it has not been possible to definitively attribute pathological processes to antioxidant deficiency, nor to lack of specific antioxidants.

 

Antioxidants, including Vitamin C, are well-documented to be capable of stabilising reactive oxygen species (ROS), which cause damage to membrane lipids and to the microcirculation. In patients with injuries, especially burns, high-dose vitamin C supplementation decreases vascular permeability, thereby limiting protein losses and swelling. Vitamin C diminishes lipid peroxidation, the process by which ROSs damage the vascular endothelial cells.

 

Since Vitamin C is a water-soluble vitamin, it is not significantly stored in the body. Total body stores in healthy humans are only about 1500 mg and severe deficiency is thought to occur when this falls below 300 mg. Since any daily surplus intake of Vitamin C is excreted through the urine, this also means an ongoing supply of Vitamin C is needed regularly in the diet.

 

Method of Vitamin C Administration

The effectiveness of any medication, vitamin or supplement is strongly influenced by the blood level achieved when it is administered. Blood levels following administration of Vitamin C are believed to make a difference in some conditions, especially in the treatment of cancer. Following ingestion, oral Vitamin C administration is typically less effective than intravenous administration, in part due to inferior Vitamin C absorption and bioavailability. Oral Vitamin C bioavailability is largely determined by the rates of intestinal absorption but further influenced by renal reabsorption and excretion. Vitamin C transporters are the primary mechanisms of intestinal absorption and renal reabsorption.  These transporter also facilitate entry of Vitamin C into cells and tissues which is required for Vitamin C to exert its effects.  Direct intravenous infusion of Vitamin C bypasses the dependency on intestinal absorption allowing for high circulating blood concentrations soon after administration.

 

Newer formulations of Vitamin C are available that enhance absorption of Vitamin C from the gut and likely into cells. One of these formulations is a liposomal formulation in which Vitamin C is encapsulated with lecithin, a phospholipid found in cell walls. Encapsulating Vitamin C with phospholipids allows the molecules to enter into cells more easily and also avoids the diarrhea often associated with high oral doses of Vitamin C. This formulation has also been shown to improve intestinal absorption and enhance blood levels after oral administration compared standard, un-encapsulated Vitamin C.  Research on humans with respect to clinical benefits of liposomal formulations is limited, however, although it is thought by some that liposomal formulation clinical benefits are enhanced (See: formulations, below).

 

Recommendations

Vitamin C provides many valuable benefits and daily intake should be adequate to maintain optimal serum levels above 60 μM  (10 mg/L) in order to reap maximum benefits. This can be achieved by daily consumption of five servings of a variety of fruits and vegetables or supplement with 250-500 mg/day of Vitamin C.

 

Vitamin C Deficiency

The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States.

 

Low dietary intake and plasma concentrations of the vitamin are common, even in advanced countries. In the NHANES survey in 2003-2004, mean plasma Vitamin C concentrations in people more than 6 years of age were 48 μM (8.5 mg/L) in males, and 54.8 μM (9.6 mg/L) in females. However, 8.2% of males and 6% of females had plasma Vitamin C concentrations < 11.4 μM (2 mg/L) , a concentration where symptomatic scurvy could occur. Among men, 18% of smokers but only 5.3% of non-smokers had such low values. Among women, 15.3% of smokers and 4.2% of non-smokers had similarly low values.

 

In 2009, the latest data on the status of Vitamin C deficiency in the US population were published. It concluded that the number of individuals with inadequate intakes of vitamin C was 31%. About 21 million Americans have serious Vitamin C deficiency, 66 million may develop Vitamin C deficiency depending upon their health habits and disease status, and less than 30 million Americans achieve optimal Vitamin C levels of 60-100 μM/L (10-17 mg/L.

 

Disease and Vitamin C

Some diseases may increase loss by oxidative degradation of the vitamin or through increased loss through the kidneys. Those with diabetes appear to have greater risk for Vitamin C deficiency although the reason for this is not fully understood.

 

Signs and Symptoms of Vitamin C Deficiency

Too little Vitamin C can lead to the following signs and symptoms of deficiency:

  1. Anemia
  2. Bleeding gums
  3. Decreased ability to fight infection
  4. Decreased wound-healing rate
  5. Dry and splitting hair
  6. Easy bruising
  7. Gingivitis (inflammation of the gums)
  8. Nosebleeds
  9. Possible weight gain because of slowed metabolism Rough, dry, scaly skin
  10. Swollen and painful joints
  11. Weakened tooth enamel

 

The severe form of Vitamin C deficiency, known as scurvy, is rare and mainly affects older, malnourished adults.

 

Vitamin C – Daily Needs

While early recommended daily allowances (RDA) for Vitamin C were based on the amount of Vitamin C needed to prevent scurvy, the life threatening severe form of  Vitamin C deficiency, with an added amount to ensure a margin of safety and to account for individual variability. Many countries have increased the RDA for Vitamin C in the past 15 years so that they are now similar to those in the United States, or even a little higher. As it stands, the daily amount of Vitamin C intake that is ideal for optimum health is not really known, but the current recommendations are as follows:

 

Dietary Reference Intakes for Vitamin C in adults:

  1. Men 19 y/o and older: 90 mg/day
  2. Women 19 y/o and older: 75 mg/day
  3. Pregnant women: 85 mg/day
  4. Breastfeeding women: 120 mg/day

 

Vitamin C Plasma Levels

Usual human Vitamin C plasma levels are in the range of 10 μM  (1.7 mg/L) to 70 μM  (12 mg/L): – occasionally higher, in those who take Vitamin C supplements. In general, dietary intake of only about 10mg/day of Vitamin C results in plasma Vitamin C concentrations of about 10 μM (1.7 mg/L) while consumption of 100 mg/day of Vitamin C will result in plasma Vitamin C concentrations of about 50 μM (9 mg/L), close to the plasma concentrations above which Vitamin C begins to be lost in the urine.  Daily doses of Vitamin C above 250-400mg/day have little additional effect on raising serum levels other than transiently (only increasing levels to about 60 μM or (10.5 mg/L)), with the surplus amount of Vitamin C being excreted by the kidneys. Daily consumption of five servings of a variety of fruits and vegetables will provide ample amounts of Vitamin C (approximately 200 -250 mg of Vitamin C).

Conversion of Units

to convert μM/L to mg/dL: multiply x 0.0176

to convert μM/L to mg/L: multiply x 0.176

 

 

Vitamin C Levels <11μM  (<1.9 mg/L)

When Vitamin C levels drop below 11 μM <(1.9 mg/L) the deficiency is severe enough to potentially precipitate symptoms of scurvy, including bleeding sums, loosening of teeth, nosebleeds and reduced ability to fight infection. Signs of scurvy began to appear about 40 days after Vitamin C withdrawal.

 

Vitamin C Levels <20μM  (<3.5 mg/L)

Levels <20 μM (<3.5 mg/L) are likely to be deficient and may be associated with fatigue.

 

Those who need higher intakes of Vitamin C:

  1. Smokers or those exposed to secondhand smoke
  2. Pregnant or breastfeeding women
  3. Estrogen or birth control pill users
  4. People taking aspirin
  5. People with chronic infection (hepatitis, herpes, HIV etc.)

 

Conditions which may benefit from higher intake of Vitamin C:

  1. Acute post-operative and post-injury pain
  2. Chronic pain – Arthritis, Post-Herpetic Neuralgia, Chronic Regional Pain Syndrome (CRPS)
  3. Opioid Tolerance and Withdrawal
  4. Stress and conditions associated with increased oxidative stress
  5. Obesity
  6. Colds and Respiratory Infections
  7. Ischemic strokes
  8. Dental extractions
  9. Cancer
  10. Bone pain

 

(1) Pain

The Vitamin C deficiency disease scurvy is characterised by musculoskeletal pain and recent evidence indicates an association between suboptimal Vitamin C status and spinal pain. In addition, research suggests that Vitamin C administration can provide pain relief in some clinical conditions. Although the mechanism behind it is unclear, it is thought that Vitamin C  primarily exerts its pain-relieving effects mainly based on its antioxidant properties by neutralizing a wide range of ROS, thus protecting cells and tissues as well as nerves from oxidative damage.

 

Vitamin C also exhibits anti-inflammatory properties, decreasing biomarkers of inflammation such as C-reactive protein and other pro-inflammatory cytokines, e.g. tumor necrosis factor, interferon, and interleukins (See Neuroinflammation). The biochemical mechanisms by which Vitamin C decreases pro-inflammatory mediators are not known.

 

Also, Vitamin C is involved in neuromodulation as a cofactor for the synthesis of catecholamine neurotransmitters, including dopamine, serotonin and norepinephrine. It is noteworthy that both serotonin and norepinephrine reuptake inhibitors (SNRIs) such as duloxetine (Cymbalta) are effective for nerve pain.

 

It has also been proposed that the mechanism for Vitamin C is through its action as a cofactor for the biosynthesis of endogenous opioids such as the endorphins and endomorphins. Depletion of endomorphins occurs in  severe infection which can significantly deplete Vitamin C concentrations. Therefore, it is possible that depletion of Vitamin C during acute or chronic disease or trauma could contribute to pain symptoms due to sub-optimal biosynthesis of analgesic neurotransmitters and endorphins. Research indicating that Vitamin C administration can significantly decrease opioid requirements in surgical and cancer patients supports this theory. Overall, Vitamin C appears to be a safe and effective adjunctive therapy for acute and chronic pain relief in specific patient groups.

 

Arthritis

Antioxidant supplements have long been advocated for the treatment of rheumatoid arthritis (RA), osteoarthritis (OA) and other inflammatory arthritis, including the use of Vitamin C, Vitamin E and selenium. Characteristic of all inflammatory arthritic conditions is the breakdown of cartilage within the joints, leading to damage associated with wear and tear and the associated pain. Due to the important role Vitamin C plays in manufacturing and maintaining cartilage, it suggests that supplementation with Vitamin C should be helpful.

 

Unfortunately, research has not found definitive benefit in the routine use of Vitamin C or other vitamin supplements in the reduction of arthritis progression or pain. A 2003 European study of 133 patients with radiographically verified symptomatic osteoarthritis of the hip and/or knee joints were treated with 1 gram of Vitamin C per day for 2 weeks and the patients found out the Vitamin C to be effective but less than compared to NSAIDs.

 

That being said, for those who’s diet does not provided optimal levels of Vitamin C, supplementation with Vitamin C would be advised, particularly in light of the safety of Vitamin C and lack of negative consequences associated with Vitamin C supplementation.

 

Post-Herpetic Neuralgia (Shingles)

In a 2010 study of patients with pain associated with shingles (Post-Herpetic Neuralgia), those with low plasma concentrations of Vitamin C who were treated with Vitamin C to restore plasma Vitamin C concentrations experienced decreased spontaneous pain.

 

Chronic Regional Pain Syndrome (CRPS) or Regional Sympathetic Dystrophy

Complex regional pain syndrome type I (CRPS-I), previously known as reflex sympathetic dystrophy (RSD), is common after surgically or non-surgically treated wrist fractures.  While reported rates for severe, chronic CRPS following these injuries are typically only 1% to 2%, it appears that milder cases are substantially more common in wrist fractures. There are 4 criteria used in the definition of CRPS: tenderness, vascular instability, stiffness and objective swelling of areas distinctive from the fracture site. In one study, about half of the patients with wrist fracture developed at least partial manifestations of CRPS. While CRPS may be transient in these circumstanes, patients with partial CRPS improve more rapidly than those with definitive CRPS.  By 5 months, most patients with partial CRPS had recovered completely while patients with definitive CRPS also improved, but about 65% still reported stiffness in hands and wrists at 5 months.

 

It has been shown that daily supplementation with 500 mg of Vitamin C per day for 50 days decreases the 1-year risk of CRPS-I after wrist fracture. As established by previous trials assessing multiple doses, a dosage of at least 500mg is required: lower dosages were not effective. Similarly, the effectiveness of Vitamin C in prevention of CRPS I in foot and ankle surgery has also been established.

 

(2) Opioid Tolerance and Withdrawal

Animal studies suggest that chronic administration of high doses of Vitamin C may reduce the development of opioid tolerance and physical dependence. While the mechanisms behind these actions are unknown, it has been shown that VItamin C modulates the synaptic action of the neurotransmitters dopamine and glutamate.

 

Human studies evaluating opioid withdrawal in heroin users are very limited. A preliminary study in 2000 evaluated very high dose Vitamin C (300 mg/kg body weight/day) in which Vitamin C-treated subjects experienced major withdrawal symptoms in only 10% to 16.6% of patients compared with 56.6% of patients not receiving Vitamin C.

It is suggested that Vitamin C, especially at high concentrations, may increase endorphin levels allowing for a reduction in withdrawal symptoms. A paper published in 2012 discusses multiple experiences, largely anecdotal, of clinicians successfully incorporating various high dose Vitamin C treatment regimens to reduce symptoms of opioid withdrawal. One can conclude that high doses of oral Vitamin C may reduce the withdrawal syndrome in heroin addicts but further studies are needed in order to estimate dose effects and clarify its mechanisms of action in the withdrawal syndrome. More importantly, studies are needed to evaluate the use of Vitamin C for reducing opioid withdrawal in other populations, including non-addicted pain patients with high levels of opioid tolerance.

 

At this point in time, supplementing with Vitamin C may arguably benefit someone experiencing opioid withdrawal but the doses required to achieve benefit, if at all, are unknown.

 

(3) Stress, Including Chronic Pain

The adrenal glands are known to have very high concentrations of Vitamin C and they secrete Vitamin C in response to ACTH, secreted by the brain in response to stress. ACTH stimulates the adrenal cortex to produce the hormone cortisol, a stress hormone. Vitamin C secretion is rapid, starting and ending within minutes of release of ACTH. This finding suggests that times of increased stress, including chronic, poorly controlled pain, may trigger greater need for Vitamin C.

 

Conditions of Oxidative Stress and the Immune System

Vitamin C is a potent antioxidant and contributes to the protection of cells from the damaging effects of endogenously produced or exogenous reactive oxygen radicals and reactive nitrogen species, e.g. during immune activation. Vitamin C has been shown to protect immune cells (neutrophils and lymphocytes) from reactive oxygen species generated during the immune response against infectious agents. Vitamin C prevents oxidative damage to lipids, proteins, and DNA, which has been implicated as a major contributing factor in the development of chronic diseases such as cardiovascular disease and cancer. Vitamin C also provides indirect antioxidant protection by regenerating other biologically important antioxidants such as glutathione and Vitamin E to their active state.

 

Post-Operative Pain

Vitamin C has functions relevant to postoperative pain management and functional improvement although little research has yet evaluated the effectiveness of Vitamin C on improving surgical outcomes. A recent 2017 1-year prospective, randomized, placebo-controlled, double-blind study evaluated postoperative outcomes after single-level lumbar fusion (PLIF). Vitamin C treatment was initiated on the first postoperative day and administered each following morning for 45 days at a dose (?) of 500mg or 1000mg/day. While postoperative pain intensity was not significantly different at 1 year after surgery with Vitamin C supplementaion, Vitamin C was associated with improved functional status  and reduced pain after PLIF surgery during the first 3 postoperative months.

 

Additional research has shown that supplementation with Vitamin C significantly reduces post-operative pain and decreases morphine consumption after laparoscopic cholecystectomy (gall bladder removal). In addition, the blood concentration of Vitamin C decreases after surgery, suggesting the requirement for Vitamin C increases in surgical patients. Other clinical and/or experimental reports have suggested that Vitamin C leads to functional improvements of damaged nerves. These observations can be explained by a greater demand for Vitamin C caused by increased oxidative stress.

 

Therefore there is reasonable expection of benefit and good safety data to suoport the recommendaton of supplementation with Vitamin C, 500 mg – 1000 mg/day in the pre-operative as well as post-operative period for the possibility that Vitamin C may reduce the intensity of postoperative pain and improve functional outcomes.

 

Due to a lack of research to date to strongly support the benefit for the use of Vitamin C in the post-operative environment, there is a wealth of theoretical benefits based on the known mechanisms for Vitamin C. Furthermore, there is good safety data for supplementing with Vitamin C. Thus the argument for  peri-operative supplementation with Vitamin C appears sound.

See: Surgical Pain, Post-Operative

(4) Obesity

The prevalence of low serum Vitamin C levels in higher in obesity, with more extreme lower levels associated with greater obesity. Lower levels of Vitamins B6, Vitamin D and Vitamin E are also noted to be lower in obesity. Whether these lower levels reflect dietary and/or lifestyle habits,  greater systemic inflammation known to be associated with obesity, or reduced serum concentrations due to reduced liver production of transport proteins (such as albumin), increased turnover of antioxidant vitamins, or a shift in tissue distribution is not established. However, due to lower serum levels as well as a proposed greater degree of oxidative stress known to be present with obesity, it appears likely that greater intake amounts of Vitamin C with obesity would be prudent.

 

(5) Colds and Respiratory Infections

The question of whether Vitamin C is effective in the prevention or treatment of the “common cold” has been raised multiple times over the last few decades. Research has provided good evidence that   Vitamin C used for the prophylaxis or the treatment of common cold at doses of 200 mg or more per day had no effect on the incidence of common cold, but had a modest effect in reducing the duration (by 8% in adults, 13% in children) and severity of symptoms of cold.

 

In those who undergo severe extreme physical exertion and/or exposure to significant cold stress, the risk of developing a cold may be reduced significantly, up to 50% in one study. Following exercise, increased reactive oxygen species are produced that may exceed antioxidant defense, resulting in oxidative damage and the stimulation of an inflammatory response that may be offset by supplemental Vitamin C.

 

In summary, Vitamin C probably does not prevent colds for most people, but for some people there may be mild or modest preventative effect on duration of a cold, especially those who are heavy exercisers. 

 

Treatment of common cold with Vitamin C is believed to be ineffective.  However, there appears to be small but significant benefits for duration and severity in those on regular vitamin C prophylaxis point to a role for vitamin C in respiratory defense mechanisms. Elderly patients hospitalized with acute respiratory infections (pneumonia; chronic bronchitis) showed a better overall status when receiving 200 mg/day of vitamin C over 4 weeks.

 

(6) Ischemic Stroke

Free radicals, or reactive oxygen species (ROS) have been implicated in brain injury after ischemic stroke. Research indicates that there is a rapid increase in the production of ROS immediately after acute ischemic stroke that rapidly overwhelm antioxidant defences, causing further tissue damage. Furthermore, these ROS can damage the cells (neutrophils and lymphocytes) involved in repairing the tissue damage related to the stroke. Current treatment to protect the brain against severe stroke damage are inadequate and researchers have begun to investigate antioxidant strategies to reduce this oxidative injury including the use of antioxidant Vitamins C and E, as well as the polyphenol resveratrol (See Resveratrol).

 

(7) Dental Extractions

The potential benefit of Vitamin C in facilitating the recovery from oral surgery has not been well studied but was investigated in 452 consecutive tooth extraction patients. The 277 patients who were prescribed vitamin C post-surgically exhibited significantly more rapid healing than the 175 control subjects who received none. The incidence of “dry socket,” a painful and troublesome extraction complication, was over five times lower in those who received vitamin C.  Age, sex, occupation and health history were not statistically correlated with healing rates. Vitamin C may enhance dental healing by stimulating the immune system and hastening the proper formation of scar tissue.

 

(8) Cancer

The protective role of Vitamin C against cancer was first hypothesized in the 1950s, but Cameron and Linus Pauling in the 1970s suggested its therapeutic effect in their report of increased survival in patients with advanced cancer when treated with intravenous (IV) Vitamin C. However, when higher doses of oral Vitamin C were tested, they failed to produce similar benefits.

 

Research suggests that Vitamin C plays an effective role in reducing pain and improving quality of life in patients with cancer and that it is safe and tolerable. Furthermore, studies have shown that intake of high-dose Vitamin C significantly decreases opiate dependence and morphine requirements in the treatmemt of cancer-related pain.  The effect of high-dose Vitamin C (50mg/kg) on opiate consumption postoperatively in the patients with colon cancer showed that the Vitamin C infusion decreased postoperative pain during the first 24h and reduced the consumption of morphine in early postoperative period.

  

The therapeutic uses of high dose (50mg/kg) intravenously administered Vitamin C achieves blood levels at pharmacologic concentrations not possible with oral intake.  Doses of up to 100 g of Vitamin C given intravenously have been used for several decades in treating infections, cancer and other conditions. These pharmacologic ascorbate concentrations have antitumor activity in animal studies and in early studies in patients with metastatic pancreatic cancer, survival was doubled  but only retrospective controls were used. Phase II and Phase III studies have not yet been conducted to test benefit of intravenously administered vitamin C in patients with cancer. While intravenously administered vitamin C appears safe, without any apparent ill effect (except in those with renal impairment or glucose 6 phosphate dehydrogenase deficiency), rigorous trials are still needed.

 

(9) Bone Pain

Calcitonin has been used for decades as a treatment for osteoporosis and other diseases involving acceler- ated bone turnover. Calcitonin also has a direct analgesic benefit for bone pain and has been utilised for improving the pain of acute vertebral fractures, malignant bone metastases, Paget’s disease, and complex regional pain syndrome. Vitamin C is likely to be required as a cofactor for the synthesis of calcitonin. The analgesic properties of calcitonin appear to be independent of its effects on bone resorption and are possibly achieved through enhanced release of endorphins. Therefore, Vitamin C may provide analgesia both indirectly, through calcitonin-dependent modulation of endorphins, and directly through enhanced synthesis of endomorphins.

Food Sources

Although all fruits and vegetables contain some amount of Vitamin C, the best food sources of Vitamin C are uncooked or raw fruits and vegetables. Daily consumption of five servings of a variety of fruits and vegetables will provide ample amounts of Vitamin C (approximately 200 -250 mg of Vitamin C).

 

Fruits with the highest sources of vitamin C include:

  1. Cantaloupe
  2. Citrus fruits and juices, such as orange and grapefruit Kiwi fruit
  3. Mango
  4. Papaya
  5. Pineapple
  6. Strawberries
  7. Raspberries, blueberries, and cranberries
  8. Watermelon

 

Vegetables with the highest sources of vitamin C include:

  1. Broccoli, Brussels sprouts, and cauliflower
  2. Green and red peppers
  3. Spinach, cabbage, turnip greens, and other leafy greens Sweet and white potatoes
  4. Tomatoes and tomato juice
  5. Winter squash

 

Vitamin C Supplementation & Side Effects

Serious side effects from too much Vitamin C are very rare, because the body cannot store the vitamin and excretes surplus Vitamin C through the kidneys. However, ingesting amounts greater than 2,000 mg/day are not recommended because doses this high can lead to stomach upset and diarrhea. Also, large doses of Vitamin C supplementation are not recommended during pregnancy  because they can lead to vitamin C deficiency in the baby after delivery.

 

Chewable Vitamin C

Chewable Vitamin C tablets (or wafers) reduce salivary pH from 7 to about 4.5 in two and a half minutes,  creating an acidic environment for teeth. While in healthy subjects, no changes in the teeth were seen after one week of Vitamin C consumption even in the absence of brushing, it is may be that chronic consumption of chewable or effervescent Vitamin C may erode dental enamel.

 

Liposomal Vitamin C

Liposomal formulations are commercially available but are significantly more expensive than standard Vitamin C.  For a home method of making Liposomal Vitamin C: Making Liposomal Vitamin C.

   

Vitamin Fortification

Many breakfast cereals and other foods and beverages are fortified with vitamin C. Fortified means a vitamin or mineral has been added to the food. Checking the product labels reveal how much vitamin C and other nutrients have been added to the product.

 

Cooking

Cooking Vitamin C-rich foods or storing them for a long period of time reduces Vitamin C content. Microwaving and steaming Vitamin C-rich foods, instead of  boiling them in water, may reduce cooking losses. Exposure to light can also reduce Vitamin C content so, for example, orange juice sold in a carton instead of a clear bottle would be preferred.

 

 

References

Vitamin C – Overviews

  1. Vitamin C Sources
  2. Vitamin C (Ascorbic acid) Summary – University of Maryland
  3. Vitamin C – MedlinePlus
  4. Vitamin C physiology – the known and the unknown and Goldilocks – 2016
  5. Fruit, vegetable and vitamin C intakes and plasma vitamin C – cross-sectional associations with insulin resistance and glycaemia in 9–10 year-old children – 2015
  6. Vitamins C and E – Beneficial effects from a mechanistic perspective – 2011
  7. The pecking order of free radicals and antioxidants: lipid peroxidation, alpha-tocopherol, and ascorbate. – PubMed – NCBI – 1993
  8. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. 2006 – PubMed – NCBI
  9. Vitamin C – Intravenous Use by Complementary and Alternative Medicine Practitioners and Adverse Effects – 2010

  

Vitamin C – Liposomal and Nanoparticles

  1. Making Liposomal Vitamin C
  2. Use of Lipid Nanocarriers to Improve Oral Delivery of Vitamins – 2019
  3. Liposomal-encapsulated Ascorbic Acid – Influence on Vitamin C Bioavailability and Capacity to Protect Against Ischemia–Reperfusion Injury – 2016
  4. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries – A Systematic Review – 2018
  5. Vitamin_C_A_Concentration-Function_Approach_Yields Vitamin C pharmacokinetics: implications for oral and intravenous use. – PubMed – NCBI – 2004

 

Vitamin C – Arthritis

  1. The antioxidant vitamins A, C, E and selenium in the treatment of arthritis -2007
  2. [Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over t… – PubMed – NCBI – 2003

Vitamin C – Chronic Regional Pain Syndrome (CRPS)/Reflex Sympathetic Dystrophy (RSD)

  1. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture – A systematic review and meta-analysis – 2017
  2. [Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures]. – PubMed – NCBI
  3. Complex regional pain syndrome – recent updates – 2013
  4. Give vitamin C to avert lingering pain after fracture – 2008
  5. Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures – a randomised trial – 1999
  6. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. – PubMed – NCBI – 2009

Vitamin C – Common Colds

  1. Vitamin C for Preventing and Treating the Common Cold – 2005
  2. Vitamin C for preventing and treating the common cold – Update 2007- PubMed – NCBI

 

Vitamin C – COVID 19

  1. Low level of Vitamin C and dysregulation of Vitamin C transporter might be involved in the severity of COVID-19 Infection – 2021

 

 

Vitamin C – Dental Extractions

  1. VITAMIN C AND DENTAL HEALING on JSTOR

 

Vitamins – Obesity

  1. Vitamin status in morbidly obese patients – a cross-sectional study – 2008
  2. Plasma ascorbic acid concentrations and fat distribution in 19,068 British men and women in the European Prospective Investigation into Cancer and Nutrition Norfolk cohort study – 2005

Vitamin C – Opioid Withdrawal

  1. Ascorbic acid (vitamin C) effects on withdrawal syndrome of heroin abusers. – PubMed – NCBI -2000
  2. Attenuation-of-Heroin-Withdrawl-Syndrome-by-the-Administration-of-High-Dose-Vitamin-C-2012

Vitamin C – Pain

  1. An Insight and Update on the Analgesic Properties of Vitamin C- 2018
  2. The Efficacy of Vitamin C on Postoperative Outcomes after Posterior Lumbar Interbody Fusion: A Randomized, Placebo-Controlled Trial – 2017
  3. [Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over t… – PubMed – NCBI – 2003
  4. Efficacy of vitamin C in preventing complex regional pain syndrome after wrist fracture – A systematic review and meta-analysis – 2017
  5. [Vitamin C and prevention of reflex sympathetic dystrophy following surgical management of distal radius fractures]. – PubMed – NCBI
  6. Complex regional pain syndrome – recent updates – 2013
  7. Give vitamin C to avert lingering pain after fracture – 2008
  8. Effect of vitamin C on frequency of reflex sympathetic dystrophy in wrist fractures – a randomised trial – 1999
  9. Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery. – PubMed – NCBI – 2009
  10. The effect of vitamin C on morphine self-administration in rats – 2014
  11. Plasma vitamin C is lower in postherpetic neuralgia patients and administration of vitamin C reduces spontaneous pain but not brush-evoked pain. – PubMed – NCBI – 2009
  12. The vitamin C controversy. Clin J Pain. 2010
  13. Treatment with ascorbic acid and a-tocopherol modulates oxidative-stress markers in the spinal cord of rats with neuropathic pain – 2017
  14. Vitamin C in the critically ill – indications and controversies – 2018
  15. The role of vitamin C in the treatment of pain – new insights – 2017

Vitamin C – Serum Levels

  1. National Nutrition Survey – U.S – NHANES – 2016
  2. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 – NHANES. – PubMed – NCBI
  3. Use of Saliva Biomarkers to Monitor Efficacy of Vitamin C in Exercise-Induced Oxidative Stress – 2017
  4. Serum levels of vitamin C in relation to dietary and supplemental intake of vitamin C in smokers and nonsmokers. – PubMed – NCBI
  5. Plasma ascorbic acid concentrations and fat distribution in 19,068 British men and women in the European Prospective Investigation into Cancer and Nutrition Norfolk cohort study – 2005
  6. Fruit, vegetable and vitamin C intakes and plasma vitamin C – cross-sectional associations with insulin resistance and glycaemia in 9–10 year-old children – 2015

 

Vitamin C – Smoking

  1. The influence of smoking on vitamin C status in adults – 1989
  2. Serum levels of vitamin C in relation to dietary and supplemental intake of vitamin C in smokers and nonsmokers. – PubMed – NCBI
  3. Estimating ascorbic acid requirements for cigarette smokers. 1993- PubMed – NCBI
  4. Smoking habits and coenzyme Q10 status in healthy European adults – 2015

Vitamin C – Stroke (Ischemic)

  1. Oxidative stress and pathophysiology of ischemic stroke: novel therapeutic opportunities. 2013 – PubMed – NCBI

 

 

Emphasis on Education

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

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