Vitamin C

Dietary antioxidants such as beta carotene, ascorbic acid, and vitamin E are known as the least harmful and most holistically beneficial supplements with antioxidant potential. Vitamin C supplements are especially available over the counter because they are completely safe to consume.

All we know generally about vitamin C is that it can benefit poor wound healing and bleeding gums, ensure healthy skin, and boost immunity such as against the common cold. The supplements are more than just producers of connective tissue. They are the chosen by health professionals to improve iron absorption in iron deficiency anemia. Intravenous vitamin C supplements boost cardiovascular health and benefit breast cancer.

There is a lot more to maintaining an optimum vitamin C content, which we will be discussing in detail in this article.

Health Benefits of Vitamin C Supplementation

National Institutes of Health professionals have recommended the intake of vitamin C in addition to other antioxidant vitamin intakes for all ages as a milestone for national health. Diet and lifestyle these days are easily conducive to cardiovascular risk. Fruits and vegetables cannot make up for the needs of the body for antioxidant supplementation.

Here we have brought together all the health benefits of vitamin C supplements for various conditions and for normal, healthy individuals:

Role of Plasma Vitamin C against Viral and Bacterial Diseases

Vitamin C administration has been seen to improve the response of the body to bacterial and viral diseases in the body. Its role as a dietary supplement against virus-induced respiratory illnesses is of special importance.

Randomized clinical trials have shown that plasma vitamin C can considerably reduce the duration of respiratory infections such as colds and flu. Also, the severity of the symptoms is less in patients who took the supplements. However, research has not yet proved if vitamin C may altogether prevent or treat respiratory or viral infections such as the common cold.

The anti-inflammatory role and immune-boosting benefits of vitamin C play a vital role in holding back viral and bacterial diseases. This is how the supplements can prevent cold and flu from progressing into pneumonia or debilitating lung infections.

In a placebo-controlled trial, intake of vitamin C supplements reduced the incidence of viral respiratory illness by 8 percent in adults and 18 percent in children. Patients in the ICU report reduced plasma levels of vitamin C. And supplementation with vitamin C has shown a shortening of their duration on the ventilator.

These facts are important in understanding and managing the novel COVID-19 disease. A study involving 19 active COVID-19 patients revealed that 18 out of 19 patients had undetectable plasma levels of vitamin C.

Vitamin C may Reduce the Risk of Cancer

The meta-analysis of five randomized controlled trials showed that higher dietary vitamin C can have a multi-faceted link with all types of cancer risk and incidence. A study involving almost 45 thousand individuals showed a 26 percent reduction in cancer risk for every 50 μmol/L increase in the ascorbic concentration in the blood.

Plasma concentrations of vitamin C are closely interlinked with the risk and incidence of lung and breast cancer. Meta-analysis of 21 cohort and case-control randomized controlled trials proved that when a person begins smoking, the vitamin C levels in the body begin to decrease.

The same observation has been made in patients with lung cancer. Since smoking and lung cancer have a relationship of cause and effect, we can safely say that lung cancer development is also dependent on lower-than-normal serum levels of vitamin C.

Vitamin C intake has been linked to the incidence and survival of breast cancer. Its high intake has been shown to reduce the risk of breast cancer in high-risk individuals, such as those with a genetic predisposition and post-menopausal women. More than prevention of breast cancer, vitamin C intake is associated with reducing mortality and recurrence of the disease.

The most high-yield effect of vitamin C supplements in the treatment and management of cancer is their cytotoxic effect. Vitamin C catalyzes a series of reactions that result in the formation of hydrogen peroxide, which is toxic to cancer cells.

In one study, high-dose ascorbic acid also reported beneficial effects in improving the radiosensitivity of some cancer cells. Intravenous vitamin C has shown better results than oral ascorbic acid for such benefits.

Vitamin C Benefits your Skin in Multiple Ways

The most prominent benefit of vitamin C is because of its antioxidant effects. It is the most potent and the most abundant antioxidant and anti-inflammatory agent in the skin. Firstly, it protects against the skin damage induced by the reactive free radicals and the UV rays of the sun.

When UV rays of the sun fall on the skin, superoxide and peroxide agents are generated from the cell membranes of the skin cells. Vitamin C directly neutralizes these damaging agents.

The UV-protective role of Vitamin C indirectly also protects against photoaging of the skin. These UV rays can also damage the DNA of the skin cell nuclei and insert thymine dimers, which brings mutation. This mutation is the main culprit behind the debilitating disease Xeroderma pigmentosum.

Hence, vitamin C plays a protective role against skin cancers caused by UV damage. It can act as a potent anti-inflammatory agent for skin conditions such as acne and rosacea. It directly inhibits the NF-KB pathway, which generates the inflammation-causing agents.

By inhibiting the production of inflammatory agents such as the tumor necrosis factor-alpha, IL-1, IL-6, and IL-8, body vitamin C can reduce the inflammatory contributors of acne. This mechanism is not only beneficial for those with acne, but it also slows the aging of normal, healthy skin.

Vitamin C is the safest depigmentation agent your skin can use. Vitamin C hinders melanogenesis, unlike other depigmenting agents that damage and kill melanocytes. That means it only interacts with the process and does not cause permanent damage to important hormone-producing cells of the brain.

Vitamin C strengthens the skin barrier and, in this way, it also helps in wound healing. The main mechanism of skin-strengthening is stimulating collagen synthesis by directly stimulating collagen gene expression. Besides, Vitamin C formulations are available for topical use and are completely safe for consumption.

These benefits of vitamin C for the skin are not complementary. Rather, they are essential for normal skin development and health. That is why its deficiency is a risk factor for several skin diseases such as atopic dermatitis and porphyria cutanea tarda. Also, the supplements can help treat these diseases in addition to the herpes zoster and malignant melanoma of the skin.

Vitamin C Supplements Benefit the Eye

Age-related macular degeneration is a slow and chronic process associated with atherosclerosis, high blood pressure, age, and vitamin deficiencies. The central part of the retina undergoes slow degeneration and loses its optimal function.

Vitamin C can reduce the risk of cataracts in high-risk patients such as older adults. This happens by the collagen synthesis effects of vitamin C. Collagen strengthens the structure of the eye and provides stability against age-related macular degeneration.

Its adequate levels in the plasma would halt the generalized inflammation and atherosclerosis in the blood vessels and hence also prevent age-related macular degeneration.

Another mechanism of action of vitamin C is by fighting against the reactive oxygen species and the damaging free radicals. Actually, the blood vessels supplying the retina of the eye are end arteries. They have blind ends and do not give further branches in the retina. Once the damage occurs, the retinal tissues are damaged and die immediately, and there will be no way back.

Vision loss, risk of cataracts, and age-related macular degeneration all relate to chronic inflammatory conditions such as diabetes and hypertension. The lens of the eye itself is immersed in an ocular fluid rich in vitamin C. In both these situations, vitamin C has the same antioxidant and anti-inflammatory role.

Cognitive Benefits of Vitamin C Supplementation

Vitamin C plays an essential role in the collagen synthesis processes, strengthening the connective tissue throughout the body. It is also involved in the synthesis of some very important physiological compounds such as carnitine, cholesterol, amino acids, and proteins. But its main role that benefits cognitive function is its antioxidant effect.

Vitamin C oxidizes itself and neutralizes the reactive oxygen species and superoxide radicals. This way, it protects cellular DNA, membrane proteins, and lipids from the oxidative damage of the extremely damaging free radicals.

By these major effects, vitamin C protects the hippocampus against aging, oxidative damage, and loss of function and improves memory. There are various other mechanisms, too: vitamin C is directly involved in the maturation and differentiation of the neurons. It is a crucial cofactor involved in forming myelin sheaths of the nerves, speeding up the nerve impulse conduction across the neurons.

Vitamin C is also involved in synthesizing the important neurotransmitter dopamine for serotonin and then facilitates the release of neurotransmitters. These observations have led to the use of vitamin C in the diet and drug regimen for peripheral neuropathy.

Peripheral neuropathy is a condition characterized by damage to the nerves in the limbs, mostly found in late-stage diabetics. Since the retina of the eye is also considered a part of the central nervous system, the above-mentioned mechanisms also suggest its use for eye health.

Patients with Post-traumatic stress syndrome (PTSD) report low serum levels of vitamin C. And hence supplementation with ascorbic acid can help manage the syndrome better.

PTSD is the result of single prolonged stress (SPS), which has been seen to increase the level of oxidized glutathione and increase the lipid peroxidation in the hippocampus.

A study compared the vitamin C levels between the cognitively intact and the cognitively impaired groups of individuals. The results showed that cognitively intact or superior individuals had greater mean concentrations of vitamin C than the cognitively impaired ones.

Vitamin C may Control High Blood Pressures

According to the Johns Hopkins School University of Medicine, high vitamin C intake for two months reduced the systolic blood pressure by almost 4 points on average and the diastolic blood pressure by 1.5 points.

The doses used for this study were around 500 milligrams per day, whereas the recommended dietary intake for adults is 90 milligrams of ascorbic acid per day.

You see, vitamin C is a naturally found micronutrient and is water-soluble. Our body cannot retain or store for long times. So, to benefit from vitamin C for chronic diseases such as hypertension, it should be taken regularly.

Vitamin C cannot substitute blood pressure medications to treat high blood pressure. But the most effective therapy for high blood pressure is the lifestyle modifications such as diet and exercise, and vitamin C can heavily contribute there.

Hypertension, especially as a consequence of diabetes mellitus, can also speed up the age-related macular degeneration in the eye. Maintaining normal ascorbic acid concentrations throughout life can prevent and protect against such chronic inflammatory conditions and their complications.

Vitamin C may protect against Cardiovascular Diseases

The antioxidant and anti-inflammatory role of vitamins is extremely beneficial against the risk, morbidity, and mortality of the cardiovascular disease, and at the same time improves cardiovascular health in normal, healthy individuals. This is because ascorbic acid can prevent atherosclerosis and arterial stiffness and improve lipid profile and endothelial function by neutralizing reactive oxygen species.

Vitamin C has been seen to potentiate the production and effects of vasodilator nitric oxide (NO). Nitric oxide protects the blood vessels against vasoconstriction, myogenic spasms, and coagulation abnormalities.

Stroke, cardiovascular heart disease, and heart attacks are all directly linked to the antioxidant status of an individual. By protecting the blood vessels and heart vasculature against oxidative damage, dietary antioxidants, including vitamin C, can really help improve the quality of life and morbidity in patients with cardiovascular diseases.

A study followed a group of individuals for 10 years to conclude the association of plasma vitamin C concentrations with cardiovascular disease. It concluded that the individuals using synthetic or natural vitamin C sources had a 25 % lower risk of developing heart disease.

Its high dose, 500 mg of vitamin C daily, reported a greater reduction in the risk factors of heart disease and improved the overall cardiovascular health. An analysis of almost 200 studies concluded that taking vitamin C reduced the blood levels of LDL cholesterol by 7.9 mg/dL and triglycerides by 20 mg/dL.

For even more benefits against cardiovascular disease and generally improved cardiovascular health, some researchers suggest vitamin C intake, not supplements. Major food sources include fruits and vegetables, especially citrus fruits.

Women’s antioxidant cardiovascular study stated that antioxidant vitamins such as vitamin C, beta carotene, and vitamin E are especially helpful in post-menopausal women when it comes to cardiovascular health. Vitamin C sources should be an essential dietary routine in women of age above 45.

Benefits of Taking Vitamin C with Meals

Intake of vitamin C with foods rich in iron increases the absorption of iron by 67 %. Dietary supplements for iron are extremely expensive. But the same iron is life-saving for patients with iron deficiency anemia, road traffic accidents, extreme blood loss, and anemic infants.

Iron deficiency anemia is a severe condition in children and infants which interferes with the development of red blood cells in the body. Leukocyte vitamin C concentration drops predisposing the individual to the risk of severe infections.

Improving iron absorption by improving the vitamin C status is the first-line therapy in various patients with iron deficiency anemia. This measure improves their immune status at the same time.

People can develop iron deficiency anemia easily without noticeable signs and symptoms. Risky groups include:

• Pregnant and child-bearing women
• Athletes running for marathons
• Pure vegetarians
• Teenagers and rapidly growing children
• People who donate blood frequently

Other high-risk groups include those with celiac disease with impaired iron absorption. All these groups can benefit from synthetic vitamin C or food sources of ascorbic acid, mainly citrus fruits. Taking vitamin C with meals will help maximize iron absorption from your diet.

Intravenous ascorbic acid can also benefit people undergoing hemodialysis with acute or chronic kidney failure. Their kidneys are too damaged to produce enough erythropoietin, and improving vitamin C status can help the body use the maximum of its resources.

Vitamin C may Reduce Uric Acid Levels

According to the  Centers for Disease Control and Prevention (CDC), gout is a condition characterized by increased uric acid levels in the blood, which then deposit in the joint cavities. For gout, anything that can reduce the levels of urates in the body will help manage and treat gout.

A cohort study that followed its sample individuals for 20 years and involved 47000 men studied how vitamin C and ascorbic acid levels in the blood relate to the risk, incidence, and morbidity of gout. The study found that taking antioxidant supplementation such as vitamin C, vitamin E, and beta-carotene reduced the risk of gout in susceptible individuals.

Another study conducted in 2018 found that individuals who took more vitamin C than the recommended dietary allowance had lower uric acid levels than those who did not. These results suggest the use and efficacy of antioxidant vitamins such as ascorbic acid, vitamin E, and ascorbic acid for a better quality of life for gout patients.

Apart from gout patients, vitamin C reduces urate levels in normal, healthy individuals, as concluded by a study conducted in 2011. If you eat a lot of meat, you can use sources of vitamin C alongside to escape the adverse effects of excess urate in the body.

According to the nutrition examination survey, gout is an inflammatory disease closely linked to the diet and foods. Once it sets in, it rapidly progresses to disability. But antioxidant supplements such as oral vitamin C can help a great deal slow the process down.

Also, because this disease utilizes and depletes the vitamin C levels, testing ascorbic acid in the body may help assess the progression and stage of the disease as well.

Oral Vitamin C Helps Boost Immunity

This is probably the most documented health benefit of taking the water-soluble vitamin C. Vitamin C may boost and strengthen the immunity of your body at various levels and in various mechanisms.

Firstly, ascorbic acid supplementation directly increases the production of white blood cells, especially differentiated T lymphocytes. Oral vitamin or intravenous ascorbic acid can increase the production of double-positive T cells from the cells of the bone marrow, which is quite high-yield in immunocompromised individuals.

Plasma vitamin C levels not just increase the production and number of active immune cells it also helps their function by fighting some of their battles. For instance, plasma vitamin C can fight and neutralize the reactive oxygen species and other damaging free radicals. And this not just protects the cells and their membranes but also preserves the white blood cell content for bigger battles.

The above two functions can be performed by any dietary vitamin or antioxidant supplements with antioxidant effects such as vitamin E or beta-carotene compounds. A unique effect of vitamin C is their role in the skin barrier.

Lower vitamin C concentrations have been associated with low wound healing, a weak skin barrier, and an increased risk of skin infection. As discussed above, ascorbic acid is a crucial part of the collagen biosynthesis pathway. Hence, low vitamin C levels result in weak gums and fragile skin barriers.

In addition to strengthening the physical skin barrier, Vitamin C can strengthen the skin defences with their antioxidant properties. These two mechanisms are the backbone of wound healing in the skin and the prevention of infection.

Recommended mg of Vitamin C

Dietary reference intakes for different ages are different. Recommended dietary vitamin C intake level for an infant up to 12 months of age falls in the range of 25 to 30 mg per day. And breast milk is enough to satisfy the Vitamin C needs of an infant.

If the baby cannot be breastfed, it is important to feed him fortified artificial feed with adequate vitamin C levels. Its intake is important for the infant for blood cell production, fighting off infection, and adequate growth.

For children of age up to 8 years, the recommended dietary intake is around 35 mg per day. A high dose may be required in some cases, such as when kids of this age present with iron deficiency anemia.

For teens of age up to 18 years, it is recommended that the daily intake should be around 40 mg per day. High doses are safe, but an upper intake level of 1800 mg per day has been suggested.

For adults of age up to 70 years, RDI levels of 45 mg per day have been suggested. Vitamin C is not only important for adults to prevent major cardiovascular events and age-related macular degeneration, but it also provides a holistic uplifting of general health as well.

The recommended dosage of vitamin C supplements increases for pregnant and lactating mothers, and it can hardly be fulfilled with fruits and vegetables.

Are there any Side Effects of Vitamin C Intake?

Supplemental vitamin C is completely safe for consumption in the recommended dosages for the respective age groups in healthy individuals. In fact, ascorbic acid is counted among the safest nutrient intakes in the form of supplements.

Firstly, vitamin C is a water-soluble supplemental vitamin. Besides, vitamin C supplements have a wide range for the upper intake level. The liver doesn’t store a large amount of it, and the kidneys get rid of it all the time. So, you won’t have to worry about the side effects of vitamin C intakes if you are taking them in a moderate, recommended dosage range.

A common perception about vitamin C administration is that when the deficiency happens, the person gets scurvy. At the same time, taking more of it will cause kidney stone formation. neither of these is entirely true nor is entirely false. We will establish this in a later discussion.

Sources of Vitamin C

Fresh fruits and vegetables are the richest sources of vitamin C. They should be taken raw because vitamin C cannot survive with its antioxidant properties in heat, such as when cooked.

The following are the most popular and richest sources:

• Indian gooseberry
• Citrus fruits such as oranges, lemons, tomatoes
• Green leafy vegetables, mainly broccoli
• Kiwifruit, strawberries, and cantaloupes
• Potatoes
• Papayas
• Red and green peppers

Fruit juices are also a good source along with some animal sources which include animal liver. Because animals synthesize their own ascorbic acid and it is stored in the liver, meat lovers can enjoy ascorbic acid supplementation with raw animal liver, raw fish, and eggs.

As mentioned before as well, taking vitamin C with meals, such as having a citrus fruit juice or green peppers, is the best way to maximize the absorption of the nutrients from the meal. Plant sources of vitamin c are more abundant and easily available. To use the animal sources, you may need to eat raw animal products, which is so not easy!

Signs and Symptoms of Vitamin C Deficiency

Low vitamin C content can present with the following signs and symptoms:

• Its inadequate intake for three to five months will result in keratosis pilaris, which is a condition characterized by loss of connective tissue in the skin. You will develop chicken skin with bumps in the areas of arms, legs, and buttocks.
• Severe lack of vitamin C is associated with cognitive deficit, mood changes, and depression. A meta-analysis of several randomized controlled trials proved that scurvy is directly associated with cognitive impairment and depression in the patients.
• Low levels result in the person feeling tired, fatigued, and weak all the time. Due to the interaction of the ascorbic acid with the neurotransmitters of the brain, low levels result in excessive lethargy.
• Dry and damaged skin with a dull complexion can also present as a sign of low vitamin C levels.
• One major and a commonly known sign of severe deficiency of vitamin C is that the skin bruises easily. Blood vessels hemorrhage with just a slight push, and you see blood seeping beneath the skin, forming a bruise.
• Healthcare professionals specifically prescribe high doses of vitamin C for patients of surgery and road traffic accidents because its deficiency can immediately lead to poor wound healing and superimposed infection.
• Joints are a connective-tissue-rich region of the body. Severe deficiency of vitamin C leads to weak joints that ache on walking a small distance. Joints may bleed and present with swelling.
• Severe deficiency can also result in impaired bone growth in children and weak bones in adults.
• Bleeding gums on the slightest touch and subsequent tooth loss are major consequences of deficiency.
• Lack of vitamin C results in the individual experiencing more frequent episodes of common cold and flu, and they last for longer durations as well. The risk and morbidity of respiratory infections drastically increase with its deficiency because there is a decline in the general immunity of the body.
• Deficient people may experience unexplained weight gain due to increased inflammation and slowed metabolism of the body.

What will happen if I take too much Vitamin C?

Cases of vitamin C overload in the body are rare. The tolerable upper intake level is around 1200 to 15oo mg per day for adults. And the symptoms begin to appear only when the intake exceeds 2000 mg per day.

Excess vitamin C in the body is only possible in the case of intentional intoxication. If someone takes oral supplements exceeding 2000 mg per day, the following may occur:

1. Patients with chronic kidney disease can easily build up too much vitamin C in the body because of impaired clearance. And it can also lead to kidney stones at the same time. Healthcare providers hence should observe discretion in prescribing vitamin C supplements to a patient with kidney stones or kidney disease.
2. Kidney stones are a later representation of taking too many vitamin C supplements. Early signs and symptoms present as diarrhea and nausea.
3. Vitamin C cannot harm your body for long unless the overdose continues. Meanwhile, it can cause iron overload as we know that vitamin C supplementation drastically increases the absorption of iron from meals.
4. People taking vitamin C supplementation for age-related macular degeneration may also have borderline diabetes. For reasons that are not known, overdose can worsen diabetes mellitus.

Who can Develop Vitamin C Deficiency?

Vitamin C is a dietary vitamin with antioxidant properties. It is abundantly available in our daily diet, mainly fruits and vegetables. Fruits and vegetables, however, should be taken raw since vitamin C loses its functional structure during heating and cooking.

So, mainly the following groups of individuals are at risk of developing low vitamin C levels:

• The deficiency is a very common occurrence in people going through dialysis. Dialytic vitamin C clearance and generalized inflammation deplete its levels in the body.
• Malnutrition is the biggest cause of developing low vitamin C levels throughout the world. Diets with low levels of vitamin C quickly predispose the body to develop the signs and symptoms of deficiency.
• Individuals who eat just the needful but do not incorporate fresh fruits and vegetables. Raw fruits and vegetables are the most abundant and probably the only authentic dietary source, apart from the supplements.
• You are eating fruits and vegetables, but they are always cooked or steamed. Cooking and heating kill the functional vitamin C in the body. This case, too, is a risk factor for developing the deficiency.
• Smoking is another factor that increases the risk of developing the deficiency. Smokers have low vitamin C levels in the body because they use them up faster.
• Severe and chronic alcoholism gives rise to vitamin C deficiency faster than anything else. It can occur in various ways: increased urine excretion of ascorbic acid, decreased absorption due to chronic diarrhea consequent to alcoholism, malnutrition, and a diet with low vitamin C levels due to self-neglect.
• People with burns or who have gone through a major surgery may also develop the signs or symptoms of deficiency because such stress situations use up the circulating vitamin C content of the body.

Uses of Intravenous Vitamin C

Vitamin C is an antioxidant vitamin that absorbs readily and has almost zero side effects. In some scenarios, its intravenous form may be the preferred form of antioxidant vitamin supplementation. Some experts also use intravenous vitamin c supplementation for self-neglecting patients who won’t take oral supplements daily.

By and large, the following are some scenarios where health professionals use intravenous vitamin c supplementation:

• Healthcare professionals use high-dose vitamin C injections for rapid wound healing. Intravenous injections of 200 mg of vitamin C are given daily for a week to sustain high doses of ascorbic acid in the blood. This helps in rapid recovery, severe blood loss in an accident, or healing of the wounds of surgery.
• Dietary supplements or high vitamin C intakes may be prescribed for fat burning and weight loss as well.
• High doses of vitamin C are injected in immunocompromised patients such as those with AIDS. Such patients are at high risk of developing infection and vitamin C can help boost immunity.
• Intravenous supplementation of vitamin C can be used to back the role and effects of chemotherapy for cancer.
• Patients who present with some chronic disease such as arthritis or gout may use high-dose vitamin C supplementation for an improved quality of life.
• Bleeding gums and frequent tooth loss can benefit from the collagen-producing and ant-oxidant properties of high-dose vitamin C supplementation.
• Professionals prescribe high doses of vitamin C supplementation to those at risk for developing cardiovascular disease risk. The high dose can generally improve cardiovascular health as well in normal, healthy individuals.

Forms of Oral Supplemental Vitamin C

Common forms of synthetic vitamin C include sodium ascorbate, calcium ascorbate, and other mineral ascorbic acid forms. Antioxidant vitamin C often comes in combination with other antioxidants and vitamin supplementations such as beta carotene. Such antioxidant vitamins, when combined, provide a synergistic effect.

All forms of vitamin C are present in natural sources such as fresh fruits and vegetables, especially green peppers and citrus fruits.

The Bottom Line

Taking around 40 mg of Vitamin C from a young age will help fight inflammation and improve growth. More than the recommended dose in mg of vitamin C is only prescribed by your healthcare provider in certain conditions such as those discussed above. Too much vitamin C is a rare occurrence as is the risk of low levels. Otherwise, opt for supplements that have minimum side effects.