Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
Content uploaded by Andrew William Campbell
Author content
All content in this area was uploaded by Andrew William Campbell on Jun 20, 2015
Content may be subject to copyright.
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
Campbell—Vitamin C
8 ALTERNATIVE THERAPIES, MAY/JUNE 2015 VOL. 21,3
Vitamin C: It Isn’t Just for Cancer Anymore
EDITORIAL
Most of us are familiar with vitamin C, a water-
soluble vitamin and antioxidant. As a food
additive, vitamin C—commonly called ascorbic
acid—is widely used to prevent oxidation. Our bodies
neither make nor store vitamin C, so we must obtain it from
an external source. Almost all fruits and vegetables contain
some quantity of vitamin C. It is the most widely taken
nutritional supplement and is available in several forms as
tablets, capsules, crystals, and drink mixes, among others.
Overdose of vitamin C is very rare, as one would have to
consume several kilos of it to reach lethal dose, 50% (LD50).
Large doses of vitamin C can cause a temporary bout of
indigestion.1
Vitamin C is absorbed in the intestinal tract and
transported via glucose mechanisms. Large quantities of
sugar in the intestines or in the blood can slow the absorption
of vitamin C.2 Cooking can diminish the content of vitamin C
in vegetables by 60% due to enzymatic destruction, especially
with longer cooking times or the use of copper cooking
materials.3 Vitamin C is an essential micronutrient in a
number of physiologic processes and a cofactor in 8 known
enzymatic reactions, including several for collagen synthesis.
ese last ones cause the most severe symptoms of scurvy
when there is a vitamin C deciency.4 According to the
National Institutes of Health, the daily recommended dietary
allowance for vitamin C is 90 mg in men and 75 mg in
women, a woefully low and inadequate dosage, as the
following studies show.5
Scurvy as a result of a lack of vitamin C has been known
for more than 260 years. It was the primary cause of death
among sailors during long sea voyages. In 1499, Vasco da
Gama lost 116 of his crew of 170 due to scurvy, and in 1520,
Magellan lost 208 of 230.6 Dr James Lind of the Royal Navy
was the rst to discover the connection between the lack of
fresh vegetables and fruits and scurvy. During a sea voyage,
he gave one group of sailors 2 oranges and 1 lime daily,
whereas the other group received the standard rations of
vinegar, cider, or seawater. e citrus fruits prevented
scurvy, and Dr Lind published his work in 1753.7 Also
remarkable is that this was the rst controlled experiment in
medicine. At rst, fruits were boiled to produce a juice, as
fresh fruits were expensive to keep on board. However, this
destroyed the vitamin C, so the discovery was abandoned for
40 years. In 1795, limes became standard rations at sea, as
they could easily be found in the British Colonies of the West
Indies, resulting in the nickname “limey.” A few years later,
Captain James Cook sailed to the Hawaiian Islands and
beyond without the loss of a single life on board to scurvy, an
unheard of achievement, for which the British Admiralty
awarded him a medal.8,9
DOES VITAMIN C HELP WITH COLD SYMPTOMS?
ere has been an ongoing debate between conventional
medicine and complementary and alternative medicine
(CAM) about the use of vitamin C in patients suering from
what is commonly known as a “cold.” A recent study
published by the Federation of American Societies for
Experimental Biology (FASEB) showed that nearly 25% of
US adults have below adequate levels of vitamin C and that
6% can be classied as decient. is deciency is
underdiagnosed in the general population, as the symptoms
are vague: fatigue, malaise, and depression. e authors
conducted a placebo-controlled, double-blind, randomized
study for 8 weeks to measure the eect of 1000 mg of vitamin
C in a group of men during the peak of the cold season. e
results showed that cold symptoms were 4 times higher in
the group that did not receive vitamin C supplementation, as
was the incidence of colds. is shows a measurable health
advantage to taking a relatively moderate dose of vitamin C.10
e signs and symptoms of vitamin C deciency are anemia,
gingivitis, poor wound healing, easy bruisability, epistaxis,
arthritis, and rough scaly skin.11,12
Vitamin C Lowers Lipids
A study published in the Journal of Scientic Research
showed how vitamin C supplementation can lower both
cholesterol and low-density lipoprotein (LDL) cholesterol.
Men and women were randomly selected to receive either
500 mg of vitamin C, a relatively low dose, or a placebo
capsule for 30 days. Lipid proles were recorded before and
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
Campbell—Vitamin C ALTERNATIVE THERAPIES, MAY/JUNE 2015 VOL. 21, 3 9
aer the completion of the 30-day trial. ere was signicant
reduction in total cholesterol and LDL cholesterol, but no
eects on high-density lipoprotein (HDL) cholesterol, very
low–density lipoprotein (VLDL) cholesterol, or triglycerides,
and there was no dierence in the eects between men and
women.13
Vitamin C Helps in Men With Heart Failure
Higher plasma levels of vitamin C reduce the risk of
heart failure in older men, in both those with and without
myocardial infarctions. However, elevated intake of vitamin
E was associated with increased heart failure risk. In a group
of 3919 men aged 60 to 79 years and followed for 11 years,
this study showed there was a signicant decrease in heart
failure in those men with higher plasma levels of vitamin C.
is is an important fact because in the United States we have
10
000 Baby Boomers retiring every day. Heart failure aects
more than 5.1 million Americans and is the leading cause of
hospitalization for those older than age 65 years.
Approximately one-half of people diagnosed with heart
failure die within 5 years.14-16
Vitamin C Reduces Serum Uric Acid Levels
Hyperuricemia is a known and well-established risk
factor for gout. e risk for gout increases with successively
higher levels of serum uric acid, with a 10-fold increase in
those patients with a serum uric acid level greater than
9 mg/dL. Hyperuricemia is associated with a number of
diseases, including hypertension, renal disease, obesity,
metabolic syndrome, obstructive sleep apnea, stroke, vascular
dementia, and preeclampsia.17
Treatment to prevent the recurrence of gout has 2 viable
arms: either reducing uric acid synthesis with xanthine
oxidase inhibitors or by increased uric acid secretion via
probenecid. Both drug regimens are eective in preventing
gout ares but carry considerable side eects proles. e
dietary approach to lower uric acid provides an alternative:
One must reduce meat, poultry, and seafood consumption;
alcohol, especially beer; saturated fats; and high-fructose
corn syrup. However, vitamin C has uricosuric properties as
demonstrated by in vivo, in vitro, and animal studies. A
recent randomized trial in patients with acute ischemic
stroke showed that a daily intravenous infusion of 500 mg of
vitamin C for 10 days resulted in a signicant reduction of
serum uric acid compared with placebo infusion.18
A meta-analysis of the eects of vitamin C on serum
uric acid levels by randomized, controlled trials was
conducted. e median dosage of vitamin C was 500 mg, the
median study duration was 30 days, and the median trial size
ranged from 8 to 184 participants. Pretreatment and
posttreatment measurements were conducted on serum uric
acid levels. e conclusion was that vitamin C signicantly
lowered serum uric acid levels in patients. Vitamin C
administration was not shown to have any adverse eects in
any of the trials included in this meta-analysis.19
Vitamin C Helps in Pediatric Major Depressive Disorder
Approximately 8% of children and adolescents suer
from depression.20 Until age 15 years, there is no gender
dierence; however, aer this age, the rate of depression
among females doubles.21 e diagnosis of children with
major depressive disorder (MDD) follows the criteria set in
the Diagnostic and Statistical Manual of Mental Disorders,
fourth edition, text revision (DSM-IV-TR), yet there are
considerable challenges due to multiple comorbid factors,
including academic and psychosocial issues, increased risk
for suicide, self-harm, and substance abuse.22-25 Treatment is
limited and oen ineective, there is a delay in therapeutic
benets, and oen it is poorly tolerated.26,27 Of the prescription
medications approved for use in children, uoxetine, a
selective serotonin reuptake inhibitor (SSRI), is the most
commonly used.28 However, the use of SSRIs has dropped by
20% in the United States starting in 2004 due to warnings
issued by the Food and Drug Administration of increased
suicide risk.29.30
e above has brought an increased interest in vitamin
C due to the psychological abnormalities that are characteristic
of vitamin C deciency.31-33 Recent studies have shown that
vitamin C reduces the severity of MDD in both children and
adult patients, and it improves mood in healthy individuals.34-36
Another study showed a 35% reduction in mood
disturbance in hospitalized patients treated with 1 g of
vitamin C.37 A recent 6-month, randomized, double-blind,
placebo controlled study in pediatric MDD was conducted,
with one group receiving uoxetine (10-20 mg) daily and 1 g
of vitamin C daily, with the control group receiving uoxetine
and a placebo. ere was a signicant decrease in depressive
symptoms in the group receiving uoxetine and vitamin C,
and no adverse eects were observed.38
CONCLUSION
Vitamin C supplementation is inexpensive, safe, and
helps in a number of medical conditions as described in the
studies earlier. It should be recommended a great deal more
than it currently is, especially in conventional medicine, and
the daily recommended dose is too low and inadequate and
should be revised. ere are a number of benecial uses that
space for this editorial does not allow me to cover, including
in signicantly alleviating symptoms of women undergoing
chemotherapy and/or radiation therapy for breast cancer and
reducing the risk of gliomas of the brain.39,40 We hope we can
not only continue using this benign yet very helpful
supplement, but that all health care practitioners would
recommend it more oen in appropriate situations with
patients.
Andrew W. Campbell, MD
Editor in Chief
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
Campbell—Vitamin C
10 ALTERNATIVE THERAPIES, MAY/JUNE 2015 VOL. 21,3
REFERENCES
1. Pauling L. Vitami n C , t he Comm on Col d, and the Fl u. San Francisco, CA: W. H.
Freeman and Company; 1976.
2. Wils on JX . Regulatio n of vitam in C transpor t. Annu Rev Nutr. July
2005;25:105-125.
3. Roig M, Rivera Z, Kennedy J. A model study on rate of degra dation of
L-ascorbic acid during processing using home-produced juice concentrates. Int
J Food Sci Nutr. 1995;46(2):107-115.
4. Padayatty S, Katz A, Wang Y, et al. Vitamin C as an antioxidant: evaluation of
its role in disease prevention. J Am Coll Nutr. 2003;22(1):1-35.
5. Nati onal Institu tes of Health . Vitamin C: Fact shee t for c onsumers.
http://od s.od.ni h.gov/factsh eets/VitaminC-Con sumer/. Rev ised June 24,
2011. Accessed March 24, 2015.
6. Lamb J. Preserving the Self in the South Seas, 1680-1840. Chicago, IL: University
of Chicago Press; 2001:117.
7. Lind J. A Treatise of the Scurvy. London, United Kingdom: A. Millar; 1753.
8. Singh S, Edzard E. Trick of Treatment: e Undeniable Facts About Alternative
Medicine. New York, NY: W. W. Norton & Company; 2008:15-18.
9. Cook J. The Journals of Captain Cook. Be aglehole J, ed. Suffol k, United
Kingdom: Boydell Press; 1999.
10. Johnson C, Barkyo umb G , Sc humacher S. Vitamin C supplementat ion ( 1000
mg/d) increased physical activity and reduced cold symptoms in young men
with adequate-to-low vitamin C status. FASEB J. 2014;28(1):1.
11. Escott-Stump S, ed. Nutri tion a nd Di agnosis -Relate d Care . 6th ed. Philadelphia,
PA: Lippincott Williams & Wilkins; 2008.
12. Fragaaki s A, omson C. e Health Professional’s Guide to Popular Dietary
Supplements. 3rd ed. Chicago, IL: American Dietetic Association; 2007.
13. Gaur G, Dixit A. Comparative study of vitamin c on serum lipid prole in
healthy male and female human subjects. J Sci Res. 2012;4(3):775-781.
14. Wannamethee S, Bruckdorfer K, Shaper AG, Papacosta O, Lennon L, Whincup
PH. Plasma vitamin c but not vitamin e is associated with reduced risk of heart
failure in older men. Circ Heart Fail. 2013;6(4):647-654.
15. Go A, Mozaarian D, Roger VL, et al. Heart disease and stroke statistics—2013
update: a report from the American Heart Association. Circulation.
2013;127(1):e6-e245.
16. Heiden reich P, Trogdon J, Khaviou OA, e t al. Forecasti ng the future of
cardiovasc ular disease in t he United States: a policy stateme nt from the
American Heart Association. Circulation. 2011;123(8):933-944.
17. Feig DI, Kang DH, Johnson RJ. Uric acid and cardiovascular risk. N Engl J Med.
2008;359:1811-1821.
18. Lagowska-Lenard M, Stelmasiak Z, Bartosik-Psujek H. Inuence of vitamin C
on markers of oxidative stress in the earliest period of ischemic stroke.
Pharmacol Rep. 2010;62(4):751-756.
19. Juraschek, S, Miller E, Gelber AC. Eect of oral vitamin C supplementation on
serum uric acid: a meta-analysis of randomized controlled trials. Arthritis Care
Res. 2011; 63(9):1295-1306.
20. Eapen, Valsamma. Strategies and challenges in the management of adolescent
depression. Curr Opin Psychiatr y. 2012;25(1):7-13.
21. Hank in B, Abra mson, L, Moffit t TE, Sil va PA, McGe e R, Ange ll KE.
Dev elopment of dep ression f rom pread olesce nce to young adu lthood:
emerging gender dierences in a 10-year longitudinal study. J Abnorm Psychol.
1998; 107(1):128-1140.
22. American Psychiatri c Association. Diagnostic and Statistical Manual of Mental
Disorders. 4th edition. Washington, DC: American Psychiatric Association; 2000.
23. Goodyer I, Herbert J, Secher SM, Pearson J. Short-term outcome of major
depression: I. Comorbidity and severity at presentation as predictors of
persistent disorder. J Am Acad Child Adolesc Psychiatry. 1997;36(2):179-187.
24. Hughes C, Preskorn S, Weller E, Weller R, Hassanein R, Tucker S. e eect of
concomitant dis orders in childhood depression on predic ting treatment
response. Ps ychopharmacol Bul l. 1990;26(2):235-238.
25. Birmaher B, Arbelaez C, Brent D. Course and outcome of child and adolescent
major depressive disorder. Child Adolesc Psychiatr Clin N Am. 2002;11(3):619-637.
26. Holtzheimer P, Nemero C. Advances in the treatment of depression. NeuroRx.
2006;3(1):42-56.
27. Calles JL. Depression in children and adolescents. Prim Care.
2007;34(2):243-258.
28. Boylan K, Romero S, Birmaher B. Psychopharmacologic treatment of pediatric
major depressive disorder. Psychopharmacolog y (Berl). 2007;191(1):27-38.
29. Bridge J, Salary CB, Birmaher B, Asare AG, Brent DA. e risks and benets of
antidepressant treatment for youth depression. Ann Med. 2005;37(6):404-412.
30. US Food and Drug Administration. Labeling change request letter. http: //
www.fda.gov/downloads/Drugs/DrugSafety/InformationbyDrugClass/
UCM161641.pdf. Revised January 26, 2005. Accessed March 24, 2015.
31. Kinsman R, Hood J. Some behavioral eects of ascorbic acid deciency. Am J
Clin Nutr. 1971;24(4):455-464.
32. Milner C: Ascorbic acid in chronic psychiatric patients: a controlled trial. Br J
Psychiatry. 1963;109:294.
33. Chang C, Chen M, Wang TE, Chang WH, Lin CC, Liu CY. Scurvy in a patient
with depression. Dig Dis Sci. 2007;52(5):1259-1261.
34. Cocchi P, Silenzi M, Calabri G, Salvi G. Antidepressant eect of vitamin C.
Pediatrics. 1980;65(4):862-863.
35. Zhang M, Robitaille L, Eintracht S, Hoer LJ. Vitamin C provision improves
mood in acutely hospitalized patients. Nutriti on. 2011;27(5):530-533.
36. Gosn ey M, Hammon d H, Shenkin A, Allsu p S. Effec t of micronut rient
supplementation on mood in nursing home residents. Gerontology.
2008;54(5):292-299.
37. Evans-Olders R, Eintracht S, Hoer LJ. Metabolic origin of hypovitaminosis C
in acutely hospitalized patients. Nutriti on. 2010;26(11-12):1070-1074.
38. Amr M, El-Mogy A, Shams T, Vieira K, Lakhan SE. Ecacy of vitamin C as an
adjunct to flu oxetine therapy in pediatric major depress ive disorde r: a
randomized, double-blind, placebo-controlled pilot study. Nut r J . March
2013;12:31.
39. Zhou S, Wang, Tan Y, Qiu L, Fang H, Li. Association between vitamin c intake
and glioma risk: evidence from a meta-analysis. Neuroepidemiology.
2015;17;44(1):39-44.
40. Vollbra cht C, Schnei der B, Leendert V, Weiss G, Auerbach L, Beut h J.
Intravenous vitamin C administration improves quality of life in breast cancer
patients during chemo-/radiotherapy and aercare: results of a retrospective,
multicentre, epidemiological cohort study in Ge rmany. In Viv o.
2011;25(6):983-990.