2010;119(3):753-765. 2017;9(11). Allergy Asthma Clin Immunol. Compared to standard-of-care, this intervention cocktail more than halved the mean duration of vasopressor use (18.3 h versus 54.9 h) and reduced the odds of mortality by nearly 90% (156). (PubMed), 208. Present Knowledge in Nutrition. Vitamin C, through its antioxidant functions, has been shown to protect leukocytes from self-inflicted oxidative damage (14). 1951;113:628-631. Dr. Pauling, for whom the Linus Pauling Institute has great respect, based his own recommendations for vitamin C largely on theoretical arguments. Although trials do not currently support the use of high-dose supplementation with vitamin C in cataract prevention, there is a consistent inverse association observed between high daily intake of fruit and/or vegetables (>5 servings/day) and risk of cataract (113). Two large prospective cohort studies assessed the relationship between dietary and supplemental vitamin C intakes and mortality. A randomized, double-blind, placebo-controlled trial in more than 14,000 older men participating in the Physicians Health Study II (PHS II) found that vitamin C supplementation (500 mg/day) for an average of eight years had no significant effect on the incidence of or mortality from any type of stroke (53). 1999;281(15):1415-1423. Gut. JAMA. Eur J Cardiovasc Prev Rehabil. Arch Med Sci. Hemila H, Chalker E. Vitamin C for preventing and treating the common cold. Johansen JS, Harris AK, Rychly DJ, Ergul A. Oxidative stress and the use of antioxidants in diabetes: linking basic science to clinical practice. Am J Clin Nutr. Oregon State University, Copyright 2000-2023 Linus Pauling Institute. (PubMed), 203. (PubMed), 134. 2015;122(13):1740-1747. Patients are advised to discuss with their oncologist before using vitamin C supplements (200, 201). Vitamin C and the Common Cold. 1982;23:35-47. Effect of Helicobacter pylori and its eradication on gastric juice ascorbic acid. Zhang S, Hunter DJ, Forman MR, et al. Administration of a 1-gram (g) vitamin C infusion one hour prior to the angioplasty reduced the concentrations of oxidative stress markers and improved microcirculatory perfusion compared to placebo (130). Int J Cancer. (PubMed), 148. (PubMed), 72. Nature. Cochrane Database Syst Rev. Vitamin C: should we supplement? 2000;31(10):2287-2294. (PubMed), 193. 2017;21(1):300. (PubMed), 104. Notably, this study had several limitations (54), including no measurement of vitamin C status and the recruitment of a well-nourished study population. Myint PK, Luben RN, Wareham NJ, Khaw KT. 2017;13(3):558-567. 2010;21(11):1745-1757. Milan SJ, Hart A, Wilkinson M. Vitamin C for asthma and exercise-induced bronchoconstriction. Scurvy is rare in developed countries because it can be prevented by as little as 10 mg of vitamin C daily (32). (PubMed), 131. Al-Khudairy L, Flowers N, Wheelhouse R, et al. 2009;16(1):93-98. SVCT-2 in breast cancer acts as an indicator for L-ascorbate treatment. 2004;15(12):3225-3232. Adv Nutr. In a small, longitudinal biomarker study in 32 individuals with probable AD, a higher CSF-to-plasma vitamin C ratio at baseline was associated with a slower rate of cognitive decline at one year of follow-up (103). One trial found that vitamin C supplementation (1 g/day) for 14 weeks reduced the risk of asthma attacks precipitated by respiratory infection. (PubMed), 7 Panush RS, Delafuente JC, Katz P, Johnson J. Modulation of certain immunologic responses by vitamin C. III. A three-year randomized controlled trial in 160 patients with documented coronary heart disease and low blood HDL concentrations found that a combination of simvastatin (Zocor) and niacin increased HDL concentration, inhibited the progression of coronary artery stenosis (narrowing), and decreased the frequency of cardiovascular events, such as myocardial infarction and stroke(202). Phase I clinical trial of i.v. Sesso HD, Buring JE, Christen WG, et al. 2010;29(3):215-217. Food and Nutrition Board, Institute of Medicine. Such a reduction falls within the range of assay variability and is unlikely to be clinically significant (121). Juraschek SP, Guallar E, Appel LJ, Miller ER, 3rd. Infection with the bacteria, Helicobacter pylori (H. pylori), is known to increase the risk of stomach cancer and is associated with lower vitamin C content of stomach secretions (74, 75). Although a primary source of dietary vitamin C, consumption of fruit and vegetablesassessed by food frequency questionnairewas not found to be associated with a lower risk of congestive heart failure (49). Can J Cardiol. 2000;71(2):530-536. Most experimental and clinical research uses ascorbic acid or its sodium salt, called sodium ascorbate. 1999;10(4):840-845. Twenty-five years. In another AD mouse model that was lacking the ability to synthesize vitamin C, supplementation with a high versus low dose of vitamin C reduced amyloid deposition in the cortex and hippocampus and limited blood-brain barrier impairments and mitochondrial dysfunction (99). Subcellular Biochemistry. (PubMed), 136. Yokoyama T, Date C, Kokubo Y, Yoshiike N, Matsumura Y, Tanaka H. Serum vitamin C concentration was inversely associated with subsequent 20-year incidence of stroke in a Japanese rural community. Some, yet not all, studies in animal models such as vitamin C-deficient guinea pigs or genetically scorbutic rats found an increased uptake of vitamin C in peripheral circulation and specific organs in the presence of flavonoids. (PubMed), 78. Anticancer Res. As shown in Table 3, different fruit and vegetables vary in their vitamin C content, but five servings (2 cup-equivalents) of a variety of fruit and vegetables should average out to about 150 to 200 mg of vitamin C, especially if vitamin C-rich fruits are consumed. (PubMed), 86. The information is made available with the understanding that the author and publisher are not providing medical, psychological, or nutritional counseling services on this site. Ramos C, Brito R, Gonzalez-Montero J, et al. Cochrane Database Syst Rev. Tessier F, Moreaux V, Birlouez-Aragon I, Junes P, Mondon H. Decrease in vitamin C concentration in human lenses during cataract progression. Pharmacokinetic studies in older adults have not yet been conducted, but there is some evidence suggesting that the efficiency of one of the molecular mechanisms for the cellular uptake of vitamin C declines with age (208). Hemila H, Suonsyrja T. Vitamin C for preventing atrial fibrillation in high risk patients: a systematic review and meta-analysis. 1996;155(6):1847-1851. In 2004, a pooled analysis of nine prospective cohort studies found that supplemental vitamin C intake (400 mg/day for a mean of 10 years), but not dietary vitamin C intake, was inversely associated with CHD risk (46). Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. 1990;265(5):2584-2587. Acta Pathol Microbiol Scand B. A meta-analysis of observational studies found that a reduced risk of age-related cataract with higher dietary vitamin C intakes in case-control studies and with higher circulating vitamin C concentrations in cross-sectional studies. Cigarette smoking during pregnancy causes intrauterine growth restriction and preterm birth, among other pregnancy complications (90, 91), and is the primary cause of childhood respiratory illness (92). 21. (PubMed), 180. These observations need to be confirmed in larger, well-designed trials. The European Investigation into Cancer and Nutrition (EPIC)-Norfolk prospective cohort study investigated the relationship between vitamin C status and incident heart failure in healthy adults (9,187 men and 11,112 women, aged 58.1+/-9.2 years) (49). 2018;10:18. 2016(5):Cd004073. Evans RM, Currie L, Campbell A. 2013;5(12):5161-5192. Ye Z, Song H. Antioxidant vitamins intake and the risk of coronary heart disease: meta-analysis of cohort studies. Depletion and reaccumulation. Vitamin C requirements are likely to be increased in this population due to the hypermetabolic response driven by the systemic inflammatory reaction (152, 153). Cancer Chemother Pharmacol. (PubMed), 20. (PubMed), 56. Chen Q, Espey MG, Sun AY, et al. Nutr J. Periprocedural myocardial injury that occurs in up to one-third of patients undergoing otherwise uncomplicated angioplasty increases the risk of morbidity and mortality at follow-up. The recommended dietary allowance (RDA) for vitamin C is based on the amount of vitamin C intake necessary to maintain neutrophil vitamin C concentration with minimal urinary excretion of vitamin C and is proposed to provide sufficient antioxidant protection (Table 2) (35). Symptoms of scurvy include subcutaneous bleeding, poor wound closure, and bruising easily, hair and tooth loss, and joint pain and swelling. The general idea is that cholesterol is a natural mechanism of repair in the blood. The role of vitamin C as a cofactor is also related to its redox potential. (PubMed), 140. 2010;12(2):209-217. Early Hum Dev. Conversely, a 2008 meta-analysis of 14 cohort studies concluded that dietary, but not supplemental, vitamin C intake was inversely related to CHD risk (47). (PubMed), 185. Association between plasma vitamin C concentrations and blood pressure in the European prospective investigation into cancer-Norfolk population-based study. 2014;3(2):45-54. "Vitamin C" Vitamin C and Cancer - Dr. Linus Pauling - How To Live Longer and Feel Better - Vitamin C Dr. Linus Pauling and Dr. Abram HofferVitamin C, Vita. J Alzheimers Dis. Nutr J. Khaw KT, Bingham S, Welch A, et al. 200. 2013;173(5):386-388. Lee SH, Oe T, Blair IA. I've never used his regimen in this regard, but it should help. (PubMed), 110. This highlights the fact that limitations associated with dietary assessment methods such as food frequency questionnaires may be overcome by using biomarkers of nutrient intake (50, 51). A 2018 meta-analysis of randomized controlled trials investigating the effect of antioxidant vitamin supplementation in patients with type 2 diabetes found that most improvement in markers of oxidative stress and blood glucose control could be attributed to vitamin E(145). 2013;32(12):1508-1517. Nutr Rev. Angioplasty involves temporarily inserting and inflating a tiny balloon into the clogged artery to help restore the blood flow to the heart. Vitamin supplementation for preventing miscarriage. 2003;90(2):148-154. 194. A 2013 systematic review identified 11 randomized controlled studies that evaluated the effect of vitamin C on asthma (eight trials) or exercise-induced bronchoconstriction (three trials) (180). Dawson EB, Evans DR, Harris WA, Teter MC, McGanity WJ. Jane Higdon, Ph.D. Another pilot multicenter trial found better lung function during the first week of life and lower risk of wheezing through one year of age in infants whose smoking mothers were randomized to receive vitamin C (500 mg/day) rather than a placebo during pregnancy (95). If you wish to check foods for their vitamin C content, search USDA's FoodData Central. (PubMed), 93. Arthritis Res Ther. 1999;181(4):1026-1035. Ester-C should not be confused with ascorbyl palmitate, which is also marketed as "vitamin C ester" (see below). 2007;6:41. 66 auditorium with a talk on Vitamin C and Heart Disease. Harding AH, Wareham NJ, Bingham SA, et al. Unlike plants and most animals, humans have lost the ability to synthesize vitamin C endogenously and therefore have an essential dietary requirement for this vitamin (see The Recommended Dietary Allowance). 2016;9:25-30. Impaired blood-brain barrier integrity may affect the brains ability to retain vitamin C and thus to maintain a high CSF-to-plasma vitamin C ratio. Limitations inherent to dietary assessment methodology, such as recall bias, measurement error, and residual confounding, may account for some of the inconsistent associations between vitamin C intake and CHD risk. 307 Linus Pauling Science Center J Emerg Med. 2009;29(3):809-815. In this latter trial, a greater decline in the Mini Mental State Examination (MMSE) score was observed in the supplemented group, however, the significance of this observation remains unclear. See also the section on Cancer in the Symposium on Vitamin CPart of the LPIs 9th International Conference on Diet and Optimum Health. Hypertension. (PubMed), 90. 2018;20(2):145-166. 2001;292(5524):2083-2086. (PubMed), 53. Liu C, Russell RM. The Pauling therapy is a combination of the specific orthomolecular nutrients - ascorbic acid, lysine and proline - that are proven to combat coronary heart disease at the specific dosages recommended by Linus Pauling. At the Linus Pauling Institute, we have based our vitamin C recommendations on the current body of scientific evidence, which is significantly greater than it was at Pauling's time but remains incomplete owing to the many diverse functions of vitamin C in the human body that have yet to be fully understood. Bjog. 307 Linus Pauling Science Center A comprehensive review of the literature found no credible scientific evidence that supplemental vitamin C promotes oxidative damage under physiological conditions or in humans (206). Levine M, Wang Y, Padayatty SJ, Morrow J. Crit Care Med. The lens of the eye focuses light, producing a clear, sharp image on the retina, a layer of tissue on the inside back wall of the eyeball. Matsuzawa Y, Kwon TG, Lennon RJ, Lerman LO, Lerman A. Prognostic value of flow-mediated vasodilation in brachial artery and fingertip artery for cardiovascular events: a systematic review and meta-analysis. 2013(1):Cd000980. Christchurch, New Zealand, Reviewed in December 2018 by: It should also be noted that the Linus Pauling Institute's recommendation is strictly directed towards prevention of disease in healthy individuals, not treatment of disease. 2005;135(7):1673-1677. Phase I clinical trial to evaluate the safety, tolerability, and pharmacokinetics of high-dose intravenous ascorbic acid in patients with advanced cancer. Intakes of vitamins A, C, and E and use of multiple vitamin supplements and risk of colon cancer: a pooled analysis of prospective cohort studies. A new recommended dietary allowance of vitamin C for healthy young women. 2013;33:45-70. Once plasma vitamin C concentrations reach saturation, additional vitamin C is largely excreted in the urine. Nutrition Forum 2:33-36, 1985. Linus Pauling Institute 6 Kennes B, Dumont I, Brohee D, Hubert C, Neve P. Effect of vitamin C supplements on cell-mediated immunity in old people. Cigarette smoking during pregnancy and risk of preeclampsia: a systematic review. Natural and synthetic L-ascorbic acid are chemically identical and there are no known differences regarding biological activities or bioavailability(186). If you are not getting enough Vitamin C to produce collagen for tissue repair, when your arteries become injured they cannot heal properly. Related to this oxidation -reduction ( redox) potential, two major functions of vitamin C are as an antioxidant and as an enzyme cofactor (1). The effect of vitamin therapy on the progression of coronary artery atherosclerosis varies by haptoglobin type in postmenopausal women. 2006;27(11):2250-2257. 2011;26(3):309-318. (PubMed), 159. 1977;47(3):248-257. 2012;64(2):245-254. Buijsse B, Jacobs DR, Jr., Steffen LM, Kromhout D, Gross MD. Proc Natl Acad Sci U S A. 2012;7(1):e29794. (PubMed), 43. Effect of oral vitamin C supplementation on serum uric acid: a meta-analysis of randomized controlled trials. Corvallis: Oregon State University Press; 2006:105-111. Cancer Res. Improved endothelial function was observed with daily vitamin C doses above 500 mg (39). Curhan GC, Willett WC, Speizer FE, Stampfer MJ. (PubMed), 35. It is not known whether supplemental vitamin C could improve markers of glycemic control in subjects at risk of diabetes. Cochrane Database Syst Rev. 2010;51(6):963-964. Alberts B, Bray D, Lewis J, Raff M. Differentiated cells and the maintenance of tissues. Front Physiol. One hundred percent absorption efficiency is observed when ingesting vitamin C at doses up to 200 mg at a time. Vitamin C/Professional handout/Interactions with drugs. (PubMed), 126. (PubMed), 152. In addition, hypovitaminosis C is common in critically ill patients, especially in those with septic shock, and persists despite enteral/parenteral nutritional therapy providing recommended amounts of vitamin C (152). (PubMed), 64. Am J Clin Nutr. Am J Clin Nutr. Am J Epidemiol. However, cases have occurred in children and the elderly on very restricted diets (33, 34).
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