Vitamin C

Overview

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin needed by the body for hundreds of vital metabolic reactions. The vitamin C deficiency disease, scurvy, is prevented by adequate intake of ascorbic acid (“ascorbic” literally means “without scurvy”). As a dietary supplement, vitamin C is consumed by more people than any other vitamin, mineral or herbal product. Good food sources of vitamin C include all citrus fruits (oranges, grapefruit, lemons) as well as many other fruits and vegetables such as strawberries, tomatoes, broccoli, Brussels sprouts, peppers and cantaloupe. Vitamin C is a fairly “fragile” vitamin and can be easily destroyed by cooking or exposure of food to oxygen. Dietary supplement containing vitamin C are generally promoted as an antioxidant, and specifically to prevent colds, boost immunity, and reduce the risk of certain cancers.

As a water-soluble vitamin, ascorbic acid performs its antioxidant functions within the aqueous compartments of the blood and inside cells and can help restore the antioxidant potential of vitamin E (a fat-soluble antioxidant). Vitamin C also functions as an essential cofactor for the enzymes involved in the synthesis of collagen – the chief structural protein in connective tissues such as bones, cartilage and skin. As such, vitamin C is often recommended for wound healing and as an added ingredient in supplements designed for healthy skin.

As a preventive against infections such as influenza and other viruses, vitamin C is thought to strengthen cell membranes, thereby preventing entrance of the virus to the interior of the cell. Support of immune cell function is also a key role performed by vitamin C and an effect which may help fight infections in their early stages. The combined effects of cellular strengthening, collagen synthesis and antioxidant protection are thought to account for the multi-faceted approach by which vitamin C helps to maintain health.

Comments

As a dietary supplement, vitamin C is the most popular single nutrient supplement. It is typically included in all multivitamin blends, but at widely varying levels. As a single nutrient supplement, typical doses range from 100-500mg per tablet. The body, however, can only absorb and retain about 250mg of vitamin C at one time – the rest is quickly washed out in the urine. This means that the most effective approach to supplementing with vitamin C is to take it in divided doses throughout the day.

Vitamin C is one of the least expensive dietary supplements available – with a monthly supply costing no more than a few dollars. Beware of expensive “natural” forms of ascorbic acid, as there is no reliable evidence to show that these forms (derived from rose hips or acerola and containing varying levels of bioflavonoids in addition to ascorbic acid) are any better absorbed or utilized by the body compared to synthetic vitamin C (but this is not the case with vitamin E, where the natural form is clearly superior to the synthetic form).

Scientific Support

As a way to prevent or reduce the symptoms associated with the common cold, over 100 vitamin C studies have been conducted. In several of the largest studies, no effect on common cold incidence is observed, indicating to many scientists that vitamin C has no preventive effects in normally nourished subjects (Douglas et al. 2004). However, a number of smaller targeted studies, conducted in subjects under heavy acute physical stress, show that vitamin C decreases the incidence of the common cold by half (Douglas et al. 2004). In other studies, healthy subjects consuming low levels of vitamin C (below 60mg/day), have a cold incidence that is about one-third lower following vitamin C supplementation (Wolters et al. 2004).

In general, regular vitamin C supplementation at levels at or slightly above 1,000mg/day has consistently reduced the incidence and duration of colds (although the degree of benefit has varied significantly). For example, in some of the larger studies, duration of infection was reduced by only about 5%, but absentee reports were reduced by nearly 20% (Fletcher et al. 2003). At least 3 controlled studies have shown an 80% reduction in the incidence of pneumonia among vitamin C users (Sasazuki et al. 2005). In one large study (over 700 students), vitamin C (1000mg per hour for the first 6 hours followed by 3000mg per day), reduced cold and flu symptoms by 85% (Audera et al. 2001).

In most cases, it appears that while the most important and dramatic preventive effects of vitamin C supplementation will be experienced by individuals with low vitamin C intakes, those with average daily consumption from foods may also benefit from supplemental levels. In support of an elevated vitamin C intake, an expert scientific panel recently recommended increasing the current RDA for vitamin C from 60mg to at least 100-200mg per day. This same panel also cautioned that taking more than 1,000mg of vitamin C daily could have adverse effects (read more under Safety) and recommended that “whenever possible, vitamin C intake should come from fruits and vegetables” (at least five servings of fruits and vegetables daily). The current RDA of 60mg per day was established in 1980, but since the last RDA review (in 1989), scientists have learned a great deal more about the functions of vitamin C in the body and the need for elevated vitamin C consumption.

Safety / Dosage

As a water-soluble vitamin, ascorbic acid C is extremely safe even at relatively high doses (because most of the excess is excreted in the urine). At high doses (over 1,000mg/day), some people can experience gastrointestinal side effects such as stomach cramps, nausea, and diarrhea. In addition, vitamin C intakes above 1,000mg/day may increase the risk of developing kidney stones in some people. Although the RDA for vitamin C has recently been raised from 60mg to 75-90mg (higher for men), it is well established that almost everybody can benefit from higher levels. For example, the vitamin C recommendation for cigarette smokers is 100-200mg per day because smoking destroys vitamin C in the body (Schectman et al. 1991). The vitamin C deficiency disease, scurvy, can be prevented by consumption of as little as 10mg daily of vitamin C, but somewhat higher levels are prudent during exposure to stress (physical or psychological) or infection (like a sick friend of family member).

Although vitamin C is well absorbed, the percent absorbed from supplements decreases with increasing dosages and optimal absorption is achieved by taking several small doses throughout the day (100-200mg/dose for a total daily intake of 200-1,000mg). Full blood and tissue saturation is typically achieved with daily intakes of 200-500mg per day (in 2-3 divided doses).

References

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2.Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001 Oct 1;175(7):359-62.

3.Douglas RM, Hemila H, D'Souza R, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000980.

4.Fletcher AE, Breeze E, Shetty PS. Antioxidant vitamins and mortality in older persons: findings from the nutrition add-on study to the Medical Research Council Trial of Assessment and Management of Older People in the Community. Am J Clin Nutr. 2003 Nov;78(5):999-1010.

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9.Jacob RA, Aiello GM, Stephensen CB, Blumberg JB, Milbury PE, Wallock LM, Ames BN. Moderate antioxidant supplementation has no effect on biomarkers of oxidant damage in healthy men with low fruit and vegetable intakes. J Nutr. 2003 Mar;133(3):740-3.

10.Jialal I, Grundy SM. Effect of combined supplementation with alpha-tocopherol, ascorbate, and beta carotene on low-density lipoprotein oxidation. Circulation. 1993 Dec;88(6):2780-6.

11.Johnston CS, Meyer CG, Srilakshmi JC. Vitamin C elevates red blood cell glutathione in healthy adults. Am J Clin Nutr. 1993 Jul;58(1):103-5.

12.Kim MK, Sasazuki S, Sasaki S, Okubo S, Hayashi M, Tsugane S. Effect of five-year supplementation of vitamin C on serum vitamin C concentration and consumption of vegetables and fruits in middle-aged Japanese: a randomized controlled trial. J Am Coll Nutr. 2003 Jun;22(3):208-16.

13.Klipstein-Grobusch K, Geleijnse JM, den Breeijen JH, Boeing H, Hofman A, Grobbee DE, Witteman JC. Dietary antioxidants and risk of myocardial infarction in the elderly: the Rotterdam Study. Am J Clin Nutr. 1999 Feb;69(2):261-6.

14.Lykkesfeldt J, Christen S, Wallock LM, Chang HH, Jacob RA, Ames BN. Ascorbate is depleted by smoking and repleted by moderate supplementation: a study in male smokers and nonsmokers with matched dietary antioxidant intakes. Am J Clin Nutr. 2000 Feb;71(2):530-6.

15.Malvy DJ, Favier A, Faure H, Preziosi P, Galan P, Arnaud J, Roussel AM, Briancon S, Hercberg S. Effect of two years' supplementation with natural antioxidants on vitamin and trace element status biomarkers: preliminary data of the SU.VI.MAX study. Cancer Detect Prev. 2001;25(5):479-85.

16.Meydani SN, Leka LS, Fine BC, Dallal GE, Keusch GT, Singh MF, Hamer DH. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial. JAMA. 2004 Aug 18;292(7):828-36.

17.Nyyssonen K, Parviainen MT, Salonen R, Tuomilehto J, Salonen JT. Vitamin C deficiency and risk of myocardial infarction: prospective population study of men from eastern Finland. BMJ. 1997 Mar 1;314(7081):634-8.

18.Record IR, Dreosti IE, McInerney JK. Changes in plasma antioxidant status following consumption of diets high or low in fruit and vegetables or following dietary supplementation with an antioxidant mixture. Br J Nutr. 2001 Apr;85(4):459-64.

19.Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S. Effect of vitamin C on common cold: randomized controlled trial. Eur J Clin Nutr. 2005 Aug 24.

20.Schectman G, Byrd JC, Hoffmann R. Ascorbic acid requirements for smokers: analysis of a population survey. Am J Clin Nutr. 1991 Jun;53(6):1466-70.

21.Valero MP, Fletcher AE, De Stavola BL, Vioque J, Alepuz VC. Vitamin C is associated with reduced risk of cataract in a Mediterranean population. J Nutr. 2002 Jun;132(6):1299-306.

22.Wolters M, Hermann S, Hahn A. Effects of 6-month multivitamin supplementation on serum concentrations of alpha-tocopherol, beta-carotene, and vitamin C in healthy elderly women. Int J Vitam Nutr Res. 2004 Mar;74(2):161-8.

EDITOR'S NOTE: This monograph can be found in The Health Professional's Guide to Dietary Supplements (Lippincott, Williams & Wilkins) by Shawn M. Talbott, PhD and Kerry Hughes, MS.