Intravenous High-Dose Vitamin C in Cancer Therapy

January 24, 2020,
by Lewis Cantley and Jihye Yun

Lewis Cantley received his Ph.D. from Cornell University and did his post-doctoral work at Harvard University. He was formerly a professor in the Departments of Systems Biology and Medicine at Harvard Medical School in Boston. He is current the Meyer Director and Professor of Cancer Biology at the Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine in New York City. Jihye Yun received her Ph.D. from Johns Hopkins University, School of Medicine under the mentorship of Bert Vogelstein and did her post-doctoral work with Lewis Cantley at Weill Cornell Medicine. She is currently an Assistant Professor and a CPRIT scholar at Baylor College of Medicine in Houston. 

The discovery and isolation of vitamin C was one of the most important advances in improving human nutrition. Scurvy, a severe vitamin C deficiency disease characterized by weakness, lethargy, easy bruising and bleeding, was particularly problematic for sailors on long voyages during the 16th century, where access to fresh fruits and vegetables was limited. In fact, scurvy was the leading cause of naval deaths between the 16th and 18th centuries, killing more sailors than all battles, storms and other diseases combined. It wasn’t until 1747 that Scottish naval physician James Lind demonstrated that consuming oranges and lemons cured and prevented scurvy. However, it took scientists nearly two more centuries to identify the nature of the curative substance contained in citrus fruits, now commonly known as vitamin C. The search for this elusive substance ended in 1932 when Albert Szent-Gyorgyi, a Hungarian biochemist, isolated and identified a 6-carbon carbohydrate, hexuronic acid, as the anti-scurvy factor. Shortly thereafter, Szent-Gyorgyi renamed it “a-scorbic acid”, a reference to its anti-scorbutic properties, and later went on to receive the Nobel Prize in Physiology and Medicine in 1937 for his discoveries. 

Today vitamin C is a popular dietary supplement, and due to improved accessibility to fruits, vegetables and vitamin supplements, disability and death from scurvy are rare. However, it is worth noting that a significant number of people even in developed countries are still vitamin C deficient. For example, approximately 7% of the US population has a plasma vitamin C concentration of less than 11 μM, that is considered scurvy. Vitamin C has many essential functions in our body in addition to its well-known role as an antioxidant. Thus, prolonged periods of sub-optimal vitamin C exposure could have adverse health effects, including an increased susceptibility to a plethora of diseases. In fact, the optimal dosage of vitamin C required to maximize its health benefits has been hotly debated ever since its discovery a century ago. Linus Pauling, a world-renowned chemist and two-time Nobel Prize Laureate, strongly advocated that megadose quantities of vitamin C (above 1 g intake per day) would prevent and treat many illnesses including the common cold and heart diseases. However, mainstream medicine has largely ignored or even ridiculed Pauling’s claim. This controversy is still very much alive today.

The controversial history of high-dose vitamin C in cancer treatment

Utilizing high doses of vitamin C as a cancer therapy is no exception to this controversy. Nearly 60 years ago Toronto physician William McCormick observed that cancer patients often presented with severely low levels of vitamin C in their blood and featured scurvy-like symptoms, leading him to postulate that vitamin C might protect against cancer by increasing collagen synthesis. In 1972, extending this theory, Ewan Cameron, a Scottish surgeon, hypothesized that ascorbate could suppress cancer development by inhibiting hyaluronidase, which otherwise weakens the extracellular matrix and enables cancer to metastasize. He began treating terminally ill cancer patients and published a case report of 50 patients in which some of the treated patients benefited from high dose vitamin C. 

Encouraged by the result, Cameron teamed up with Linus Pauling to conduct clinical trials involving terminal cancer patients. In 1976, they published a study of 100 patients with terminal cancer treated with ascorbate. Their disease progression and survival rates were compared to 1000 retrospective control patients who were matched with the vitamin C-treated patients regarding age, sex, type of cancer and clinical stage and who were treated by the same physicians in the same hospital, and in the same way except that they did not receive vitamin C. Although the study was not well designed by modern standards, mainly because they lacked the placebo-control group, the results demonstrated that patients treated with vitamin C had improved quality of life and a four-fold increase in their mean survival time. In a follow up study, Cameron and Pauling reported that 22% of vitamin C-treated cancer patients survived for more than one year compared to only 0.4% of control patients. A clinical trial in Japan independently showed a similar result. With these promising outcomes, interest in the potential of vitamin C for cancer therapy grew. However, double-blind randomized clinical trials directed by Charles Moertel of the Mayo Clinic failed to show any positive effects of high dose vitamin C in cancer patients, as reported in two papers in the journal of New England Journal of Medicine. Because the Mayo Clinic’s clinical trials were conducted more rigorously, people trusted the Mayo Clinic’s data and discredited the Cameron-Pauling trials, dampening the enthusiasm for vitamin C as a cancer therapy. 

So why did the Pauling and Mayo Clinic trials have different results? There are at least two crucial differences. First, the Mayo Clinic trials abruptly stopped the ascorbate administration, switching to traditional chemotherapy, when the patient developed signs of tumor progression. Thus, the overall median time of vitamin C treatment under the Mayo Clinic trials was only 2.5 months, while the Pauling and Cameron trials treated patients for the duration of the entire study period or as long as 12 years. Secondly, the Mayo Clinic trials administered 10 g of daily ascorbate to patients only orally, while the Cameron and Pauling trials administered their vitamin C both orally and intravenously. This difference in the two dosage routes proved highly consequential.

Rekindling vitamin C cancer therapy: oral vs intravenous administration  

Based on studies pioneered by Mark Levine’s group at the NIH in the 2000s, the oral vitamin C doses used in the Mayo Clinic studies would have produced peak plasma concentration of less than 200 μM. In contrast, the same dose given intravenously, as used in the Pauling studies, would produce peak plasma concentrations of nearly 6 mM, more than 25 times higher. When given orally, vitamin C concentration in human plasma is tightly controlled by multiple mechanisms acting together: intestinal absorption, tissue accumulation, renal reabsorption and excretion, and potentially even the rate of utilization. However, when ascorbate is administered intravenously or intraperitoneally the tight controls are bypassed, and pharmacologic millimolar plasma concentrations of vitamin C can easily be achieved. For example, a phase I clinical study revealed that ascorbate concentrations could safely reach 25-30 mM with intravenous infusion of 100 g of vitamin C. In this study, plasma concentrations around 10 mM were sustained for at least 4 hours which, based on preclinical studies, is sufficient to kill cancer cells. Given the fact that cancer patients were only treated with vitamin C orally in the Mayo Clinic studies, the studies do not disprove high dose vitamin C’s efficacy as a cancer treatment. 

This new knowledge has rekindled interest and spurred new research into the clinical potential of vitamin C. Consequently, over the past decade, there have been an increased number of phase I/II clinical trials and case reports testing the safety and efficacy of high dose vitamin C as a treatment for various cancer patients as a monotherapy or in combinational therapy. We will not discuss these clinical studies as there are already several reviews on the topic. Virtually all studies show improved quality of life for cancer patients by minimizing pain and protecting normal tissues from toxicity caused by chemotherapy. Additionally, vitamin C showed synergistic effects when combined with radiation and standard chemotherapies. Unfortunately, these studies were not designed as large-scale, randomized controlled trials and thus the efficacy of high dose vitamin C therapy remains to be determined.

Challenges of conducting a randomized controlled trial for vitamin C cancer therapy

There are at least three challenges that have thus far prevented large-scale, randomized controlled trials of vitamin C for cancer therapy. First, vitamin C is not patentable. Therefore, there is no financial incentive for pharmaceutical companies to support vitamin C clinical trials, and those that have been done have largely relied on government grants and small private donations. Second, as discussed above, vitamin C cancer therapy has a long history of controversy. Due to the Mayo clinical studies in the 1980s, many orthodox, mainstream clinicians have a prejudice against vitamin C therapy. Third, although many preclinical studies showed high dose vitamin C could kill cancer cells or retard tumor growth in vivo, vitamin C’s mechanisms of action have not been clear, making it hard to predict the pharmacodynamics, the rational design of combinational therapy, and biomarkers for patient stratification. Fortunately, a growing number of recent and rigorous preclinical studies have begun resolving the third challenge, which may also lead to overcoming the first and second barriers. Mechanistic insights into the action of pharmacological vitamin C will generate more explicit scientific hypotheses and allow clinicians to design better trials to investigate those hypotheses, ultimately leading to a definitive answer to the question: can the pharmacological administration of ascorbate benefit cancer patients? Recently, we discussed the potential mechanisms by which vitamin C may act in cancer patients in Nature Reviews Cancer. Here we will highlight one of the mechanisms discovered by our group that relates to Ras protein. 

High-dose vitamin C therapy for KRAS/BRAF mutant cancers

More than 80 years ago, the biochemist Otto Warburg observed that cancer cells consume more glucose and produce more lactate even in the presence of ample oxygen as compared with normal cells. This phenomenon, called aerobic glycolysis or the Warburg effect, has been exploited for visualizing tumors in the clinical setting by imaging their uptake of the radiolabeled glucose analog, [18F] fluoro-2-deoxyglucose (FDG), via Positron Emission Tomography (PET). Although the exact mechanism by which glucose reprograming contributes to tumorigenesis remains unclear, numerous genetic and pharmacological studies showed that this metabolic switch can be essential for cancer survival and proliferation. Thus, targeting glycolysis may offer cancer patients a more selective strategy to treat cancer. 

More than half of colorectal cancers (CRCs) harbor activating mutations in KRAS or BRAF, yet those cancers are the most refractory to current targeted therapies. Our group and others showed that oncogenic mutations in KRAS or BRAF contribute to the Warburg effect and the addiction to glucose in part by upregulating a glucose transporter, GLUT1, that allows cancer cells to take up glucose efficiently. These data suggest a strategy for targeting KRAS or BRAF mutant cancer by exploiting the selective expression of GLUT1 and the metabolic liability that comes with increased reliance on glycolysis. Indeed, by targeting these unique features in these cancer cells, we recently showed that high dose vitamin C could selectively kill KRAS or BRAF mutant CRC cells.

Interestingly, GLUT1 not only transports glucose but also transports dehydroascorbic acid (DHA), the oxidized form of vitamin C. Subsequently, we observed that CRC cells harboring KRAS or BRAF mutations uniquely increased uptake of DHA via GLUT1 when treated with vitamin C. The increased DHA uptake in mutant cells produced oxidative stress, increasing the level of reactive oxygen species (ROS) in cells because intracellular DHA was rapidly reduced back to vitamin C at the expense of glutathione (GSH), a master antioxidant in cells. In turn, we found that elevated ROS activated poly (ADP-ribose) polymerase (PARP), a DNA repair enzyme, consuming large amounts of cellular NAD+ as its cofactor. The depletion of NAD+ resulted in the inactivation of glyceraldehyde 3-phosphate dehydrogenase (GAPDH) because GAPDH requires NAD+ as a cofactor. Inhibiting GAPDH in highly glycolytic KRAS or BRAF mutant cells ultimately led to an energy crisis and cell death not seen in their KRAS and BRAF wild-type counterparts. Finally, we showed that high-dose vitamin C therapy reduced both the number and size of tumors in KRAS or BRAF mutant mice as compared to mice without these mutations, confirming that vitamin C selectively targets KRAS or BRAF mutant tumors in mouse models of colon tumors. In short, ascorbate functions as a “Trojan horse” through its conversion to DHA, and insidiously enters cancer cells via GLUT1 to promote the generation of intracellular ROS, which ultimately kills the cancer cell.

Although our study showed that DHA is the pharmaceutically active agent, reduced ascorbate (not directly DHA) is used for preclinical and clinical anti-cancer studies because ascorbate has a significantly longer plasma half-life than DHA (>60 min vs a few min). Moreover, the reduced ascorbate can be efficiently oxidized to DHA in tumors’ extracellular fluids where high level of ROS usually exists. Given that KRAS and BRAF mutations are not only restricted to colorectal cancer, vitamin C may be benefit other types of tumors. For example, 90% of pancreatic cancers and approximately 30% of lung cancers have KRAS mutations. These KRAS mutant tumors also have high GLUT1 expression and are linked to altered glucose metabolism similar to CRC. Therefore, high dose vitamin C may benefit other types of tumors harboring KRAS/BRAF mutations. Based on these results, Weill Cornell Medicine is currently conducting a Phase II clinical trial to examine the effects of intravenous high dose vitamin C in the treatment of KRAS-mutant cancers, and Sun Yat-sen University Cancer Center in China are conducting placebo-controlled, randomized Phase III clinical trials in colorectal cancer patients in combination of chemotherapy. 

While KRAS and BRAF mutations are certainly two of the most frequently mutated oncogenes in human cancer, they are not the only mutations known to affect glucose metabolism and sensitivity towards ascorbate therapy. For example, we and others have found that renal cancer cells (RCC) with loss of VHL (Von Hippel-Lindau), a tumor suppressor that destabilizes HIF1A via ubiquination, are significantly sensitive to ascorbate treatment compared to VHL-proficient cells. RCC-VHL null cells have increased HIF1A transcriptional activity, which not only increases GLUT1 expression, but also deregulates many other glycolytic enzymes to induce metabolic reprograming. Additionally, cancers with increased levels of DNA damage, such as those that have been treated with radiation or those with mutations in BRCA genes, are more reliant on DNA repair mediated by PARP. Pharmacologic vitamin C might selectively impair such cancers by depriving them of the NAD+ necessary for PARP activity.

Concluding Remarks

Vitamin C as a cancer therapy has had a controversial past. What has been intriguing are small clinical trials that suggest some responses, but with no clear rationale for why cancers should respond to vitamin C or a path forward for explaining which patients are most likely to respond.  Now a growing number of preclinical studies are showing how high-dose vitamin C might benefit cancer patients. Importantly, these preclinical studies provide a clear rationale and potential biomarkers that may help personalize the therapeutic approach and identify patient populations that are likely to respond to high-dose vitamin C therapy. Since the mechanisms of action of vitamin C are becoming better defined, we can propose vitamin C combinations in a more rational, hypothesis-driven manner. In addition, given the current high financial cost of new cancer drugs, it seems rational to improve the effectiveness of current therapies by studying their clinical interactions with vitamin C. In our view, the implementation of this treatment paradigm could provide benefit to many cancer patients.

Acknowledgements 

This work was supported by the US National Institutes of Health (NIH) grant (R35 CA197588), Stand Up to Cancer–American Association for Cancer Research grant (SU2C-AACR-DT22-17), and the Damon Runyon Cancer Research Foundation. Lewis Cantley is a founder and member of the senior advisory boards of Agios Pharmaceuticals and Petra Pharmaceuticals, which are developing novel therapies for cancer. The Cantley laboratory also receives financial support from Petra Pharmaceuticals.

High-Dose Vitamin C (PDQ®)–Patient Version

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Vitamin C | COVID-19 Treatment Guidelines

Last Updated: April 21, 2021

Vitamin C (ascorbic acid) is a water-soluble vitamin that is thought to have beneficial effects in patients with severe and critical illnesses. It is an antioxidant and free radical scavenger that has anti-inflammatory properties, influences cellular immunity and vascular integrity, and serves as a cofactor in the generation of endogenous catecholamines.^1,2 Because humans may require more vitamin C in states of oxidative stress, vitamin C supplementation has been evaluated in numerous disease states, including serious infections and sepsis. Because SARS-CoV-2 infection may cause sepsis and acute respiratory distress syndrome (ARDS), the potential role of high doses of vitamin C in ameliorating inflammation and vascular injury in patients with COVID-19 is being studied.

Recommendation for Non-Critically Ill Patients With COVID-19

• There is insufficient evidence for the COVID-19 Treatment Guidelines Panel (the Panel) to recommend either for or against the use of vitamin C for the treatment of COVID-19 in non-critically ill patients.

Rationale

Because patients who are not critically ill with COVID-19 are less likely to experience oxidative stress or severe inflammation, the role of vitamin C in this setting is unknown.

Clinical Data on Vitamin C in Outpatients With COVID-19

Oral Ascorbic Acid Versus Zinc Gluconate Versus Both Agents Versus Standard of Care

In an open-label clinical trial that was conducted at two sites in the United States, outpatients with laboratory-confirmed SARS-CoV-2 infection were randomized to receive either 10 days of oral ascorbic acid 8,000 mg, zinc gluconate 50 mg, both agents, or standard of care.³ The primary end point was the number of days required to reach a 50% reduction in the patient’s symptom severity score. The study was stopped early by an operational and safety monitoring board due to futility after 40% of the planned 520 participants were enrolled (n = 214).

Patients who received standard of care achieved a 50% reduction in their symptom severity scores at a mean of 6.7 days (SD 4.4 days) compared with 5.5 days (SD 3.7 days) for the ascorbic acid arm, 5.9 days (SD 4.9 days) for the zinc gluconate arm, and 5.5 days (SD 3.4 days) for the arm that received both agents (overall P = 0.45). Nonserious adverse effects occurred more frequently in patients who received supplements than in those who did not; 39.5% of patients in the ascorbic acid arm, 18.5% in the zinc gluconate arm, and 32.1% in the arm that received both agents experienced nonserious adverse effects compared with 0% of patients in the standard of care arm (overall P < 0.001). The most common nonserious adverse effects in this study were gastrointestinal events.

The limitations of this study include the small sample size and the lack of a placebo control. In outpatients with COVID-19, treatment with high-dose zinc gluconate, ascorbic acid, or a combination of the two supplements did not significantly decrease the number of days required to reach a 50% reduction in a symptom severity score compared with standard of care.

Recommendation for Critically Ill Patients With COVID-19

• There is insufficient evidence for the Panel to recommend either for or against the use of vitamin C for the treatment of COVID-19 in critically ill patients.

Rationale

There are no controlled trials that have definitively demonstrated a clinical benefit for vitamin C in critically ill patients with COVID-19, and the available observational data are inconclusive. Studies of vitamin C regimens in sepsis patients and ARDS patients have reported variable efficacy and few safety concerns.

Clinical Data on Vitamin C in Critically Ill Patients

Intravenous Vitamin C Alone in Patients With COVID-19

A pilot clinical trial in China randomized 56 adults with COVID-19 in the intensive care unit to receive intravenous (IV) vitamin C 24 g per day or placebo for 7 days. The study was terminated early due to a reduction in the number of cases of COVID-19 in China. Overall, the study found no differences between the arms in mortality, the duration of mechanical ventilation, or the change in median sequential organ failure assessment (SOFA) scores. The study reported improvements in oxygenation (as measured by the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen [PaO₂/FiO₂]) from baseline to Day 7 in the treatment arm that were statistically greater than those observed in the placebo arm (+20.0 vs. -51.9; P = 0.04).⁴

Intravenous Vitamin C Alone in Patients Without COVID-19

A small, three-arm pilot study compared two regimens of IV vitamin C to placebo in 24 critically ill patients with sepsis. Over the 4-day study period, patients who received vitamin C 200 mg/kg per day and those who received vitamin C 50 mg/kg per day had lower SOFA scores and lower levels of proinflammatory markers than patients who received placebo.⁵

In a randomized controlled trial in critically ill patients with sepsis-induced ARDS (n = 167), patients who received IV vitamin C 200 mg/kg per day for 4 days had SOFA scores and levels of inflammatory markers that were similar to those observed in patients who received placebo. However, 28-day mortality was lower in the treatment group (29.8% vs. 46.3%; P = 0.03), coinciding with more days alive and free of the hospital and the intensive care unit.⁶ A post hoc analysis of the study data reported a difference in median SOFA scores between the treatment group and placebo group at 96 hours; however, this difference was not present at baseline or 48 hours.⁷

Intravenous Vitamin C Plus Thiamine With or Without Hydrocortisone in Critically Ill Patients Without COVID-19

Two small studies that used historic controls reported favorable clinical outcomes (i.e., reduced mortality, reduced risk of progression to organ failure, and improved radiographic findings) in patients with sepsis or severe pneumonia who received a combination of vitamin C, thiamine, and hydrocortisone.^8,9 Subsequently, several randomized trials in which patients received vitamin C and thiamine (with or without hydrocortisone) to treat sepsis and septic shock showed that this combination conferred benefits for certain clinical parameters. However, no survival benefit was reported. Two trials observed reductions in organ dysfunction (as measured by change in SOFA score on Day 3)^10,11 or the duration of shock¹² without an effect on clinical outcomes. Three other trials, including a large trial of 501 sepsis patients, found no differences in any physiologic or outcome measures between the treatment and placebo groups.^13-15

See ClinicalTrials.gov for a list of clinical trials that are evaluating the use of vitamin C in patients with COVID-19.

Other Considerations

It is important to note that high circulating concentrations of vitamin C may affect the accuracy of point-of-care glucometers.^16,17

References

1. Wei XB, Wang ZH, Liao XL, et al. Efficacy of vitamin C in patients with sepsis: an updated meta-analysis. Eur J Pharmacol. 2020;868:172889. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31870831.
2. Fisher BJ, Seropian IM, Kraskauskas D, et al. Ascorbic acid attenuates lipopolysaccharide-induced acute lung injury. Crit Care Med. 2011;39(6):1454-1460. Available at: https://www.ncbi.nlm.nih.gov/pubmed/21358394.
3. Thomas S, Patel D, Bittel B, et al. Effect of high-dose zinc and ascorbic acid supplementation vs usual care on symptom length and reduction among ambulatory patients with SARS-CoV-2 infection: the COVID A to Z randomized clinical trial. JAMA Netw Open. 2021;4(2):e210369. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33576820.
4. Zhang J, Rao X, Li Y, et al. Pilot trial of high-dose vitamin C in critically ill COVID-19 patients. Ann Intensive Care. 2021;11(1):5. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33420963.
5. Fowler AA, 3rd, Syed AA, Knowlson S, et al. Phase I safety trial of intravenous ascorbic acid in patients with severe sepsis. J Transl Med. 2014;12:32. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24484547.
6. Fowler AA, 3rd, Truwit JD, Hite RD, et al. Effect of vitamin C infusion on organ failure and biomarkers of inflammation and vascular injury in patients with sepsis and severe acute respiratory failure: the CITRIS-ALI randomized clinical trial. JAMA. 2019;322(13):1261-1270. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31573637.
7. Fowler AA, 3rd, Fisher BJ, Kashiouris MG. Vitamin C for sepsis and acute respiratory failure–reply. JAMA. 2020;323(8):792-793. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32096845.
8. Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest. 2017;151(6):1229-1238. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27940189.
9. Kim WY, Jo EJ, Eom JS, et al. Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: propensity score-based analysis of a before-after cohort study. J Crit Care. 2018;47:211-218. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30029205.
10. Fujii T, Luethi N, Young PJ, et al. Effect of vitamin C, hydrocortisone, and thiamine vs hydrocortisone alone on time alive and free of vasopressor support among patients with septic shock: the VITAMINS randomized clinical trial. JAMA. 2020;323(5):423-431. Available at: https://www.ncbi.nlm.nih.gov/pubmed/31950979.
11. Chang P, Liao Y, Guan J, et al. Combined treatment with hydrocortisone, vitamin c, and thiamine for sepsis and septic shock: a randomized controlled trial. Chest. 2020;158(1):174-182. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32243943.
12. Iglesias J, Vassallo AV, Patel VV, Sullivan JB, Cavanaugh J, Elbaga Y. Outcomes of metabolic resuscitation using ascorbic acid, thiamine, and glucocorticoids in the early treatment of sepsis: the ORANGES trial. Chest. 2020;158(1):164-173. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32194058.
13. Hwang SY, Ryoo SM, Park JE, et al. Combination therapy of vitamin C and thiamine for septic shock: a multi-centre, double-blinded randomized, controlled study. Intensive Care Med. 2020;46(11):2015-2025. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32780166.
14. Moskowitz A, Huang DT, Hou PC, et al. Effect of ascorbic acid, corticosteroids, and thiamine on organ injury in septic shock: the ACTS randomized clinical trial. JAMA. 2020;324(7):642-650. Available at: https://www.ncbi.nlm.nih.gov/pubmed/32809003.
15. Sevransky JE, Rothman RE, Hager DN, et al. Effect of vitamin C, thiamine, and hydrocortisone on ventilator- and vasopressor-free days in patients with sepsis: the VICTAS randomized clinical trial. JAMA. 2021;325(8):742-750. Available at: https://www.ncbi.nlm.nih.gov/pubmed/33620405.
16. Hager DN, Martin GS, Sevransky JE, Hooper MH. Glucometry when using vitamin C in sepsis: a note of caution. Chest. 2018;154(1):228-229. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30044741.
17. Food and Drug Administration. Blood glucose monitoring devices. 2019. Available at: https://www.fda.gov/medical-devices/in-vitro-diagnostics/blood-glucose-monitoring-devices. Accessed March 26, 2021.

High-dose vitamin C: Can it kill cancer cells?

I’ve heard that vitamin C might be an alternative cancer treatment. What can you tell me about it?

Answer From Karthik Giridhar, M.D.

Interest in using very high doses of vitamin C as a cancer treatment began as long ago as the 1970s when it was discovered that some properties of the vitamin may make it toxic to cancer cells. Initial studies in humans had promising results, but these studies were later found to be flawed.

Subsequent well-designed, randomized, controlled trials of vitamin C in pill form found no such benefits for people with cancer. Despite the lack of evidence, some alternative medicine practitioners continue to recommend high doses of vitamin C for cancer treatment.

More recently, vitamin C given through a vein (intravenously) has been found to have different effects than vitamin C taken in pill form. This has prompted renewed interest in the use of vitamin C as a cancer treatment.

There’s still no evidence that vitamin C alone can cure cancer, but researchers are studying whether it might boost the effectiveness of other cancer treatments, such as chemotherapy and radiation therapy, or reduce treatment side effects.

There are still no large, controlled clinical trials that have shown a substantial effect of vitamin C on cancer, but some preliminary studies do suggest there may be a benefit to combining standard treatments with high-dose IV vitamin C. Until clinical trials are completed, it’s premature to determine what role vitamin C may play in the treatment of cancer.

With

Karthik Giridhar, M.D.

Feb. 27, 2020

Show references

1. Shenoy N, et al. Ascorbic acid in cancer treatment: Let the Phoenix fly. Cancer Cell. 2018; doi:10.1016/j.ccell.2018.07.014.
2. Vitamin C. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Jan. 22, 2020.
3. Ngo B, et al. Targeting cancer vulnerabilities with high-dose vitamin C. Nature Reviews Cancer. 2019; doi:10.1038/s41568-019-0135-7.
4. Clinical trials search for vitamin C AND cancer. ClinicalTrials.gov. https://clinicaltrials.gov/ct2/results?cond=&term=cancer+AND+vitamin+C&cntry=&state=&city=&dist=. Accessed Jan. 22, 2020.
5. Padayatty SJ, et al. Vitamin C: Intravenous use by complementary and alternative medicine practitioners and adverse effects. PLOS One. 2010; doi:10.1371/journal.pone.0011414.
6. Carr AC, et al. The effect of intravenous vitamin C on cancer- and chemotherapy-related fatigue and quality of life. Frontiers in Oncology. 2014; doi:10.3389/fonc.2014.00283.

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High-dose Vitamin C (Ascorbic Acid) Therapy in the Treatment of Patients with Advanced Cancer

Abstract

Vitamin C (ascorbic acid, ascorbate) has a controversial history in cancer treatment. Emerging evidence indicates that ascorbate in cancer treatment deserves re-examination. As research results concerning ascorbate pharmacokinetics and its mechanisms of action against tumor cells have been published, and as evidence from case studies has continued to mount that ascorbate therapy could be effective if the right protocols were used, interest among physicians and scientists has increased. In this review, high-dose vitamin C therapy in cancer treatment is re-evaluated.

Vitamin C (ascorbic acid, ascorbate) has been well documented to reduce the incidence of most malignancies in humans (1). What has been hotly debated is whether vitamin C has any therapeutic effect in the treatment of cancer. Cameron and Pauling reported in 1976 and 1978 that high-dose vitamin C (typically 10 g/day, by intravenous infusion for about 10 days and orally thereafter) increased the average survival of advanced cancer patients and for a small group of responders, survival was increased to up to 20 times longer than that of controls (2, 3). Other researchers reported benefit consisting of increased survival, improved well-being and reduced pain (4, 5). However, two randomized clinical trials with oral ascorbate conducted by the Mayo Clinic showed no benefit (6, 7). These negative results dampened, but did not permanently extinguish, interest in ascorbate therapy or research. Some research groups conducted rigorous research, particularly in the area of administering mega-doses of ascorbate intravenously (8).

Intravenous administration was found to increase plasma ascorbate concentrations by an order of magnitude compared to what may be achieved orally (9). This may explain the discrepancy between Cameron and Pauling’s success and the negative results observed at the Mayo Clinic. As research results concerning ascorbate pharmacokinetics and its mechanisms of action against tumor cells have been published, and as evidence from case studies has continued to mount that ascorbate therapy could be effective if the right protocols were used, interest among physicians and scientists has increased (10).

In this review, high-dose vitamin C therapy in cancer treatment is re-evaluated.

Historical Background of High-dose Vitamin C Therapy

Ascorbate is one of the early unorthodox therapies for cancer, based on two hypotheses but without supporting data. Nearly 50 years ago, McCormick postulated that ascorbate protects against cancer by increasing collagen synthesis (11, 12). In 1972, Cameron and Rotman hypothesized that ascorbate could have anticancer action by inhibiting hyaluronidase and thereby preventing cancer spread (13). These hypotheses were subsequently popularized by Cameron and Pauling (14). Cameron and Campbell initially published case reports of 50 patients, some of whom seemed to have benefited from high-dose ascorbate treatment (15). Although the rationale was not clear, intravenous as well as oral ascorbate was used in most patients.

Cameron and Pauling then published the results of 100 patients with terminal cancer, in whom conventional therapy was no longer considered useful, and who were treated with 10 g ascorbate intravenously for 10 days followed by 10 g orally indefinitely. The ascorbate-treated patients were compared to 1,000 retrospective controls who had similar disease, but did not receive ascorbate or any other definitive anticancer therapy. The patients who received ascorbate survived 300 days longer than the controls (2, 3).

A prospective study was then conducted from 1978 to 1982 and the results of 294 patients treated with ascorbate and 1,532 controls were reported. The patients were not randomized but received ascorbate or palliative therapy, depending on the admitting physician. The treated patients had a median survival of 343 days against 180 days for the controls (16). Smaller studies have also reported benefits of ascorbate (4, 5) with increased survival and well-being, and reduced pain. However, none of these studies were randomized or placebo controlled. Consequently, they have not been accepted by the scientific community.

To test whether ascorbate was effective, Charls Moertel of the Mayo Clinic conducted two randomized placebo controlled studies of a hundred patients each with advanced cancer. The patients randomized to the treatment group were given 10 g of oral ascorbate, and neither study showed any benefit (6, 7).

Because Moertel’s studies were taken as definitive, ascorbate treatment was considered useless. However, Cameron’s protocol administered vitamin C both orally and intravenously, whereas the latter was exclusively oral and in retrospect, the route of administration may have been key (17). Emerging knowledge suggests that the role of ascorbate in cancer treatment should be re-examined. The evidence falls into two categories: clinical data on dose concentration relationships and laboratory data describing potential cell toxicity at high concentrations of ascorbate in cell lines.

Clinical Pharmacokinetics of Vitamin C

Clinical data show that when ascorbate is given orally, fasting plasma concentrations are tightly controlled at <100 μM (18). As doses administered orally exceed 200 mg, absorption decreases, urine excretion increases and ascorbate bioavailability is reduced (17, 18). In contrast, because intravenous injection bypasses the intestinal absorption system, it results in plasma concentrations elevated to high levels.

The study of Padayatty et al. (9) provided valuable information regarding plasma vitamin C concentrations with different routes of administration and revealed that peak plasma vitamin C concentrations in healthy volunteers were significantly higher after administration of intravenous rather than oral doses and the difference increased according to the dose. At a dose of 1.25 g vitamin C, the mean peak values from intravenous administration were 6.6-fold higher than the mean peak values from oral administration. Pharmacokinetic modeling predicted peak plasma vitamin C concentrations of 220 μM (0.2 mM) for the maximum tolerated oral dose of 3 g every 4 hours (15) and 15,380 μM (15 mM) for a 100-g intravenous dose. The peak predicted urine concentrations of vitamin C from intravenous administration were 140-fold higher than those from the maximum oral dose as intravenous-administered ascorbate is cleared within a few hours. In the light of these results, it is likely that higher plasma concentrations were achieved in Cameron and Pauling’s studies (2, 3), which used both intravenous and oral administrations, than in Moertal et al.’s studies (6, 7), in which only oral administration was used, which may have, in turn, contributed to the observed discrepancy in therapeutic outcomes reported.

Some clinicians have infused more than 10 g of ascorbate in cancer patients and achieved plasma concentrations of 1 to 5 mM (19). However, their call to restudy its effect in cancer using intravenous ascorbate has gone unheeded. It is now clear that intravenous administration of ascorbate can yield very high plasma levels, while oral treatment does not (Figure 1).

Moreover, vitamin C accumulates in solid tumors to concentrations higher than in surrounding normal tissue (20-22). This phenomenon favors the positive outcome of high-dose intravenous vitamin C therapy in cancer patients.

Reported complications of intravenous ascorbate are unusual, but include rare cases of hemolysis in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency and oxalate nephropathy (23). Adverse effects may also occur in patients with iron overload and renal failure.

Mechanisms of Antitumor Effects of Vitamin C

Ascorbate was originally considered as an adjuvant with favorable biological response modifying properties. Cameron and Pauling suggested that it increased extracellular collagen production and strengthened the extracellular matrix, thus walling in tumors (24).

Laboratory data show that ascorbate is toxic to a variety of cancer cell lines (25-27). Extracellular concentrations as low 100-200 μM are toxic to some cell lines, but many types of malignant cells are killed only at concentrations approaching the mM range (19) (Figure 1).

As established by seminal studies by Chen et al. (28, 29), in concentrations higher than 1 mM, ascorbate can cause a build-up of hydrogen peroxide (H₂O₂), which is preferentially toxic toward tumor cells. The important points of their research results are described below.

Figure 1.

Peak plasma vitamin C concentrations after oral or intravenous (IV) administration of vitamin C and cytotoxic effect of pharmacological vitamin C concentrations on tumor and normal cells. Plasma vitamin C concentrations that cause toxicity to cancer cells in vitro can be achieved clinically by intravenous, but not oral, administration of ascorbate.

For most cancer cell lines, ascorbate concentrations causing a 50% decrease in cell survival (EC₅₀ values) are less than 5 mM, but, normal cells (lymphocyte, monocyte, fibroblast etc.) are insensitive to 20 mM ascorbate. Cell death such as apoptosis, pyknosis and necrosis are dependent only on extracellular but not intracellular ascorbate. The killing of cancer cells is dependent on extracellular H₂O₂ formation with the ascorbate radical as an intermediate. Ascorbate generates detectable levels of H₂O₂ in the extracellular medium only in the presence of 0.5-10% serum. Moreover, H₂O₂ generation is dependent on time and ascorbate concentration. Human whole blood inhibits H₂O₂ and ascorbate radical generation from ascorbate. H₂O₂ is presumably destroyed by plasma catalase and red blood cell glutathione peroxidase (GP), so that no H₂O₂ is detectable.

Consequently, Chen et al. (28, 29) suggested that ascorbate at pharmacological concentrations in the blood may be a pro-drug for H₂O₂ delivery to tissues, with major therapeutic implications.

The mechanism of cytotoxicity to cancer cells remains unsolved. Possibilities include stimulatory effects on apoptotic pathways, accelerated pro-oxidant damage that cannot be repaired by tumor cells and increased oxidation of ascorbate at high concentrations in the plasma to the unstable metabolite dehydroascorbic acid, which in turn can be toxic. It remains possible that toxicity is an artifact of cell culture (30), perhaps due to contamination of media by iron (31) or other cations resulting in excessive oxidation.

Resent researches suggest that H₂O₂ plays a vital role as a cytotoxic mediator in high-dose vitamin C therapy. Chen et al. (28, 29) revealed that pharmacological ascorbate concentrations are linked to H₂O₂ formation. In vitro, killing is mediated by H₂O₂ rather than ascorbic radicals and H₂O₂ formation results in selective cytotoxicity. The H₂O₂ formed from pharmacological ascorbate concentrations diffuses into cells (32) and tumor cells are killed by exposure to H₂O₂ for ≤30 min (33-37). The H₂O₂ within the cells may cause breaks in DNA and mitochondria and the mitochondria in some cancer cells may have increased sensitivity to H₂O₂ (35, 38, 39). A proposed mechanism of the antitumor effects of vitamin C is shown in Figure 2.

Additional Functions of Vitamin C

Vitamin C has been shown to reduce the general toxicity and cardiotoxicity of adriamycin with no reduction in the antitumor activity, in fact, producing a prolongation of life (40). Vitamin C has been shown to increase the tumoricidal

action of cisplatin, dacarbazine, tamoxifen, doxorubicin and paclitaxel (41, 42). Combined administration of vitamins C and K simultaneously potentiated the therapeutic effect of six different chemotherapy agents (43).

Figure 2.

Proposed mechanism of antitumor effects of vitamin C. The administration of more than 10 g of ascorbate is proposed to achieve plasma concentrations of 1 to 5 mM. At this time, vitamin C at high plasma concentration may function as a pro-oxidant. This occurs in the presence of free transition metals, such as copper and iron, which are reduced by ascorbate and, in turn, react with hydrogen peroxide (H₂O₂), leading to the formation of highly reactive and damaging hydroxyl radicals. As normal tissue receives adequate blood flow and is rich in antioxidant enzymes (e.g. catalase, glutathione peroxidase; GP) in the blood, any H₂O₂ formed will be immediately destroyed. Meanwhile, tumor tissue is often associated with reduced blood flow and antioxidant enzymes, and consequently formed H₂O₂ remains active leading to cell damage and death.

The combined use of vitamin C with chemotherapy is even more desirable when one considers all the beneficial actions of vitamin C on immune function, tissue repair, detoxification, and the fact that cancer patients are diagnosed with scurvy at a rate more than 10 times greater than non-cancer patients (44).

Moreover, vitamin C plays an important role in natural immune enhancement. Although vitamin C has been shown to be antiviral and antibacterial, its main effect is via improvement in host resistance. Many different immunostimulatory effects have been demonstrated, including enhancing lympho-proliferative response to mitogens and lymphotrophic activity and increasing interferon levels, antibody responses, immunoglobulin levels, secretion of thymic hormones, and integrity of ground substance (45, 46). Vitamin C also has direct biochemical effects similar to those of interferon (47).

Safety Issues of Vitamin C

Vitamin C has been reported to have perhaps the lowest toxicity of all vitamins (48). Diarrhea and intestinal distension or gas are the most common complaints when it is consumed at higher dosages. Additionally high doses of vitamin C have been shown to have the following effects (48): to increase the urinary excretion of calcium, iron and manganese; to increase the absorption of iron; to raise urinary oxalate or uric acid levels, but only in an extremely small subgroup of the population; and to alter many routine laboratory parameters (e.g. serum B12, aminotransferases, bilirubin, glucose and stool occult blood). The clinician must take these effects into consideration when administering mega-doses of ascorbate intravenously.

Evidence indicates that patients who show no prior signs or history of renal malfunction are unlikely to suffer ill effects to their renal systems as a result of intravenous ascorbate (49). In cases where there are preexisting renal problems, however, caution is advised since it was reported that a kidney stone formed in one patient with a history of stone formation and a patient with bilateral urethral obstruction and renal insufficiency suffered acute oxalate neuropathy (50). A full blood chemistry and urinalysis work-up is thus recommended prior to the onset of intravenous ascorbate therapy.

Campbell and Jack (51) reported that one patient died due to massive tumor necrosis and hemorrhaging following an initial dose of intravenous ascorbate. It is thus recommended

that treatment start at a low dose and be carried out using slow drip infusion. Fatal hemolysis can occur if a patient has G6PD deficiency. It is thus recommended that G6PD levels be assessed prior to the onset of therapy.

Table I.

Ongoing clinical traials of intravenous vitamin C therapy in USA (March 25, 2008).

The treatment is contraindicated in situations where increased fluids, sodium, or chelating may cause serious problems. These situations include congestive heart failure, edema, ascites, chronic hemodialysis, unusual iron overload and inadequate hydration or urine void volume (52).

The observations that ascorbate is an antioxidant and that it preferentially accumulates in tumors have raised fears that ascorbate supplementation would compromise the efficacy of chemotherapy. Clinical evidence of this is scarce at present and in fact, several reports have shown benefits of combining ascorbate with chemotherapy (53). The accumulation of ascorbate in tumors is considered a pharmacological advantage in high-dose intravenous therapy, as this modality is based on gaining sufficient ascorbate concentrations for tumor toxicity.

Clinical Studies

The overall plausibility of ascorbate administered intravenously as a cancer therapy is enhanced by recent insights into clinical pharmacokinetics and in vitro cancer-specific cytotoxicity of vitamin C. However, the clinical effectiveness of high-dose intravenous vitamin C therapy in patients with cancer has not been clarified. One way to increase the clinical plausibility of alternative cancer therapies is rigorous, well-documented case reporting, as laid out in the US National Cancer Institute (NCI) Best Case Series Program (http://www.cancer.gov/cam/bestcase_intro.html). Such case series might identify alternative therapies that merit further investigation (54, 55).

Some case reports of apparent responses of malignant disease to intravenous vitamin C therapy have appeared (53, 54). However, they were reported without sufficient detail or with incomplete follow-up for evaluation and without conforming to the NCI Best Case Series guidelines, which include four criteria for optimal cases. First, a definitive diagnosis of cancer is required which must be documented through a tissue biopsy or fine-needle aspiration, or in the case of some leukemias and a few other cancer types by appropriate blood testing. Second, there must be documented disease response such as radiographic evidence, or through other validated indicators of tumor response (such as M protein level in patients with multiple myeloma) during treatment with the alternative therapy. Measurement of the tumor(s) before treatment and during or after treatment is required. Third, an absence of confounders is necessary, the patient should not have received concurrent treatments with known therapeutic potential (e.g. chemotherapy or radiation therapy). There should be sufficient time between the end of any conventional anticancer therapy and the beginning of an alternative therapy to minimize the probability that a response was due to the conventional therapy. Fourth, the treatment history must be documented, the conventional and alternative therapies must be described, dates of interventions, and responses of the tumor to all interventions received by a patient during the period in question must be recorded.

Recently, Padayatty et al. reported well-documented cases of advanced carcinomas in accordance with NCI Best Case Series guidelines (56). In all three cases, high-dose intravenous vitamin C therapy effectively reduced the progression of a malignant tumor and improved the health status of these patients. Unfortunately, information on the plasma vitamin C concentrations of these patients is not available to establish a causal relationship between the route of administration, the resultant effective concentrations, and the observed therapeutic effect. However, in the light of recent clinical pharmacokinetic findings and in vitro evidence of antitumor mechanisms, these case reports indicate that the role of high-dose intravenous vitamin C therapy in cancer treatment should be reassessed.

In the USA, some clinical trials of high-dose vitamin C therapy are currently in progress (Table I). The accumulation of more study results on high-dose vitamin C therapy is badly needed.

Conclusion

If unambiguous benefit can be shown even in a few cases, the use of ascorbate should be explored in more controlled studies. After all, even a small benefit is worthwhile as ascorbate is nontoxic and inexpensive, in contrast to the many chemotherapeutic agents in use. If the results show a clear lack of benefit, the use of ascorbate as a chemotherapeutic agent in cancer should be abandoned.

The role of serendipity in science should not be underestimated. In cancer treatment we currently do not have the luxury of jettisoning possibly effective and nontoxic treatments. We should revisit promising avenues, without prejudice and with open minds, and conduct studies without allowing desperation to diminish scientific rigor.

Acknowledgements

We wish to thank Tokiko Hakamata for help in preparing the manuscript.

• Received May 28, 2008.
• Revision received July 31, 2008.
• Accepted August 18, 2008.

• Copyright© 2009 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved

Pilot trial of high-dose vitamin C in critically ill COVID-19 patients | Annals of Intensive Care

Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia – Full Text View

At the end of 2019, patients with unexplained pneumonia appeared in Wuhan, China. At 21:00 on January 7, 2020, a new coronavirus was detected in the laboratory, and the detection of pathogenic nucleic acids was completed at 20:00 on January 10. Subsequently, the World Health Organization officially named the new coronavirus that caused the pneumonia epidemic in Wuhan as 2019 new coronavirus (2019-nCoV), and the pneumonia was named severe acute respiratory infection (SARI). Up to February 4, 2020, over 20000 cases have been diagnosed in China, 406 of which have died, and 154 cases have been discovered in other countries around the world. Most of the deaths were elderly patients or patients with severe underlying diseases. SARI has caused global concern and emergency.

Statistics of the 41 patients with SARI published in JAMA initially showed that 13 patients were transferred into the ICU, of which 11 (85%) had ARDS and 3 (23%) had shock. Of these, 10 (77%) required mechanical ventilation support, and 2 (15%) required ECMO support. Of the above 13 patients, 5 (38%) eventually died and 7 (38%) were transferred out of the ICU. Viral pneumonia is a dangerous condition with a poor clinical prognosis. For most viral infections, there is a lack of effective targeted antiviral drugs, and symptomatic supportive treatment is still the current main treatment.

Vitamin C, also known as ascorbic acid, has antioxidant properties. When sepsis happens, the cytokine surge caused by sepsis is activated, and neutrophils in the lungs accumulate in the lungs, destroying alveolar capillaries. Early clinical studies have shown that vitamin C can effectively prevent this process. In addition, vitamin C can help to eliminate alveolar fluid by preventing the activation and accumulation of neutrophils, and reducing alveolar epithelial water channel damage. At the same time, vitamin C can prevent the formation of neutrophil extracellular traps, which is a biological event of vascular injury caused by neutrophil activation. Vitamins can effectively shorten the duration of the common cold. In extreme conditions (athletes, skiers, art workers, military exercises), it can effectively prevent the common cold. And whether vitamin C also has a certain protective effect on influenza patients, only few studies have shown that vitamin C deficiency is related to the increased risk and severity of influenza infections. In a controlled but non-randomized trial, 85% of the 252 students treated experienced a reduction in symptoms in the high-dose vitamin C group (1g / h at the beginning of symptoms for 6h, followed by 3 * 1g / day). Among patients with sepsis and ARDS, patients in the high-dose vitamin group did not show a better prognosis and other clinical outcomes. There are still some confounding factors in the existing research, and the conclusions are different.

Therefore, during the current epidemic of SARI, it is necessary to study the clinical efficacy and safety of vitamin C for viral pneumonia through randomized controlled trials.

90,000 Vitamin C for the prevention and treatment of colds

The common cold is the main reason for doctor visits in high-income countries and absenteeism from work and school. There are more than 200 viruses that can cause symptoms of the common cold, including runny nose – discharge and nasal congestion, flushing , sneezing, sore throat, coughing, and sometimes headache, fever, and eye redness. Symptoms vary from person to person and from colds to colds. Since the common cold is usually caused by one of the respiratory viruses, antibiotics are useless and therefore other potential treatment options are significant public health interest.

Vitamin C was proposed for the treatment of respiratory infections after being isolated in the 1930s, and became especially popular in the 1970s when Nobel laureate Linus Pauling concluded from earlier placebo-controlled trials that Vitamin C can prevent and relieve colds. More than two dozen new clinical trials have since been conducted. Vitamin C has been widely marketed and used as a preventive and therapeutic agent.

This review is limited to placebo-controlled trials testing 0.2 g / day or more of vitamin C. Regular intake of vitamin C had no effect on the incidence of colds in the general population, based on 29 comparisons from clinical trials involving 11,306 participants. However, regular vitamin C intake had a modest but consistent effect of reducing the duration of cold symptoms, based on 31 comparisons from studies of 9745 cold episodes.In five studies with 598 participants exposed to short periods of extreme physical stress (including marathon runners and skiers), vitamin C reduced the risk of colds by half. Published clinical trials did not report adverse effects of vitamin C.

Trials of high doses of vitamin C administered therapeutically after onset of symptoms have not shown consistent effects on the duration and severity of cold symptoms; however, only a few therapeutic clinical trials have been performed and none have investigated children, although the prophylactic effect of vitamin C was greater in children.One large clinical trial with adults reported benefits of an 8 gram therapeutic dose at the onset of symptoms (colds), and two therapeutic clinical trials reported beneficial effects using five days of (vitamin C) supplementation. More clinical trials needed to resolve the possible therapeutic role of vitamin C, which means the administration of (vitamin C) immediately after the onset of symptoms (cold).

Myths and truths about vitamin C

The benefits of vitamin C are not only in strengthening the body’s immune defenses, fighting various viruses, but also maintaining our beauty.The fact is that ascorbic acid takes part in the synthesis of natural collagen, which is responsible for the elasticity of the skin and our youth.

The vitamin was first obtained in America in 1932, and a year later its exact formula was derived, which made it possible to obtain synthetic ascorbic acid.

Confirmed facts include the following vitamin C data:

• has an anti-cellulite effect, therefore it is widely used in the fight against excess weight;
• participates in the synthesis of collagen fibers;
• strengthens the immune system, which is necessary to resist pathogenic microorganisms;
• has a powerful antioxidant effect;
• takes part in metabolic processes;
• has a beneficial effect on the functions of the nervous system;
• participates in the elimination of cholesterol, heavy metals (copper, lead) from the body;
• takes part in the regulation of synthesis, transformation of melanin (with hypovitaminosis, pigment spots become more noticeable).

We have to “extract” ascorbic acid from citrus fruits, namely lemons, grapefruits and oranges. However, not everyone knows that the amount of ascorbic acid is much higher in currants, kiwi, rose hips, as well as sweet peppers and herbs.

In addition, you can saturate the body with vitamin C by eating walnuts, which are also enriched with omega-3 fatty acids. In winter, it is recommended to eat sauerkraut, which is also a source of this vitamin.

In addition to food, ascorbic acid can be obtained from pharmaceutical preparations such as Ascovit, Ascorbic acid, Vitamin C. They are available both in lozenges and effervescent forms. However, do not forget that a natural vitamin (from products) is much more useful than in preparations.

Now let’s dwell on the false claims about ascorbic acid. The first myth includes information that vitamin C cures colds, flu and SARS. Indeed, it helps to strengthen the immune defense, however, it has proven to be very effective in the prevention of diseases.

If the disease has already developed, it is impossible to cure only with a vitamin.

In this case, you may need antipyretic, antiviral drugs, as well as medicines for cough, nasal congestion, sore throat.

The studies have shown that the intake of ascorbic acid during ARVI does not significantly affect the course of the pathology. However, the vitamin accelerates recovery and relieves a person of the residual manifestations of the disease, that is, it helps to completely heal.

Another myth says that ascorbic acid reduces the risk of cancer. Such conclusions were made on the basis of the ability of the vitamin to strengthen the immune system, increase the body’s resistance to diseases. However, studies have shown that the level of ascorbic acid in the body does not affect the development of oncopathology.

If you follow this theory, “anti-cancer” properties can be attributed to all vitamins, since hypovitaminosis weakens the immune system, makes it more susceptible to diseases, and replenishment of vitamin reserves, on the contrary, strengthens the body.

The next myth concerns the information that everyone needs vitamin C, it must be consumed in large quantities. Indeed, ascorbic acid is necessary for each of us, however, the daily requirement for it should be taken into account.

For children under 6 years of age, 50 mg / day is sufficient, for adolescents – about 75 mg / day, and for adults – no more than 100 mg / day is recommended.

It is important to remember that excessive consumption of the vitamin can irritate the mucous membrane of the digestive tract, thereby increasing the risk of developing peptic ulcer disease.In addition, the excess intake of ascorbic acid in the body is accompanied by an increase in the level of oxalates, which leads to kidney stones.

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Useful about vitamin C

I. What is it?

Ascorbic acid, vitamin C or just ascorbic acid. Vitamin C was first isolated 85 years ago, but controversy around it is still hotly debated by experts.The benefits of ascorbic acid have been unambiguously and repeatedly proven, the versatility of its use continues to open up new reasons for research.

II. What foods contain ascorbic acid?

Undoubtedly, the best source of vitamins and nutrients is natural food, plant products. Traditional sources of ascorbic acid are rose hips, red bell peppers, black currants, sea buckthorn, strawberries, citrus fruits, kiwi, cabbage, green peas, green onions and potatoes.

III. Why then do you need to take extra vitamin C?

Despite the plentiful list of food sources, a deficiency of ascorbic acid still occurs. For example, due to the fact that we often subject fruits to heat treatment.

IV. How much vitamin C should you take daily?

The minimum daily intake of ascorbic acid should be at least 100 mg for men and 80 mg for women. During pregnancy and lactation, it is recommended to increase it in consultation with the doctor.For people who are constantly engaged in physical labor and sports, the dose is significantly increased up to 1000 mg.

V. Does vitamin C help with colds and acute respiratory viral infections?

At the first symptoms of colds, a loading dose of vitamin C is needed. Scientists, members of the Cochrane Society for Evidence-Based Medicine, have repeatedly studied the entire pool of scientific papers ¹ , which investigated the effect of taking ascorbic acid in the treatment of colds. The vast majority of studies show that taking high doses of vitamin C can shorten the duration of the illness and the severity of the common cold.

VI. Is it enough to take ascorbic acid, which is sold in the form of pills or in jars in the form of pills?

No, since the content of the active substance in the pills and sweets in the rolls, which are familiar to us since childhood, are usually much lower than the medicinal doses.

VII. What kind of vitamin C should you choose in this case?

When taking pharmacy vitamins, two factors play an important role: ease of use and quick results. The most modern solution is an effervescent tablet with a vitamin C content of 250 mg and 1000 mg.

VIII. What are the benefits of effervescent tablets?

The effervescent tablet just needs to be dissolved in a glass of lukewarm water. The advantage of the effervescent form is that, due to the release of carbon dioxide, ascorbic acid is absorbed faster into the walls of the stomach. Almost all the volume contained in the tablet is absorbed. Thus, the result from the application will be noticeable within a few days.

IX. What are the contraindications?

When taking Vitamin C in doses of 1000 mg and 250 mg, you must strictly follow the instructions, because this is a drug that has a number of contraindications.

¹ Harri Hemilä, Elizabeth Chalker. Vitamin C for preventing and treating the common cold. 2013

90,000 Vitamin C for the prevention and treatment of colds: myth or reality?

Original Source Article “Vitamin C for Preventing and Treating the Common Cold” Published on The Cochrane Collaboration, an international non-profit organization

Date of publication of the article: January 31, 2013

Authors: Hemilä H., Chalker E.

Translation: Moroz Yu.V., doctor – clinical pharmacologist of the Road Clinical Hospital.

The Cochrane Collaboration is an international, independent, not-for-profit organization whose members seek and summarize the results of all randomized clinical trials of therapeutic and diagnostic interventions ever conducted in order to objectively evaluate the effectiveness of diagnostic interventions and treatments.

The organization is named after the English epidemiologist Archie Cochran, who first called for evaluating the effectiveness of all therapeutic interventions by summarizing (systematic review) the results of all clinical trials.

Since 1999, the Russian branch of the Cochrane Collaboration has been operating.

The common cold is a leading cause of doctor visits, work and school absenteeism in high-income countries. There are over 200 viruses that can cause cold symptoms, including a runny nose, sneezing, sore throat, cough, and sometimes headache, fever, and eye redness. Symptoms vary from person to person and from disease to disease. Colds are usually caused by one of the respiratory viruses, so antibiotics are useless (they act on bacteria, not viruses).

The use of vitamin C for the treatment of respiratory infections has been considered since the 1930s. It became especially popular in the 1970s when Nobel laureate Linus Pauling discovered evidence from earlier placebo-controlled studies on the effectiveness of vitamin C in preventing or relieving symptoms of the common cold. In the future, new tests were repeatedly carried out.

The data below is based on placebo-controlled studies using vitamin C at a dose of 0.2 grams per day or more.

Based on 29 comparative studies involving 11,306 people, no relationship was found between regular intake of vitamin C and the incidence of the common cold, 31 comparative studies involving 9,745 people showed a small but consistent reduction in the duration of cold symptoms.

According to the results of five studies with the participation of 598 people who were exposed to extreme physical activity for a short time (marathon runners and skiers), a significant reduction in the risk of colds was found with the intake of vitamin C.

Several studies have shown that the use of high doses of vitamin C after the onset of cold symptoms does not affect the duration or severity of illness.

One large study has shown that 8 grams of vitamin C is effective for the first symptoms of a cold, and 2 studies have shown that vitamin C is effective for 5 days.

It should be noted that no side effects of vitamin C have been reported in published studies, and there are no clinical studies of the efficacy of prophylactic vitamin C in children.

Despite this, vitamin C is still widely sold and used as a prophylactic and therapeutic agent, therefore further additional research is needed to confirm the therapeutic effect of vitamin C at the first symptoms of a cold.

Vitamin C for colds: what happens if you take a shock dose of ascorbic acid for a cold

High dosages of this vitamin (2000 mg or more) can lead to kidney stones, cause nausea, vomiting and allergic reactions.

One of the causes of kidney stones is an excessive intake of vitamin C, as a result of which the excess reaches the kidneys and is converted into calcium oxalate, from which stones are formed. Some people are also allergic to vitamin C, so it’s best to stay away from it.

But how much ascorbic acid is contained in citrus fruits, for example, how much vitamin C is in lemon? One 100-gram lemon contains 53 mg of vitamin C, a medium-sized orange contains 70 mg, and a grapefruit 78 mg.Knowing the dosage of ascorbic acid in the most popular citrus fruits, you can revise their amount in your diet and increase or decrease your intake of these products.

Low intake of vitamin C, less than 75 mg for women and 90 mg for men, can lead to a decrease in immunity and an increased risk of infection. If the pathogen has already entered the body, then the immune cells begin to use much more vitamin C – thus its amount is reduced. Therefore, if you do not replenish the reserves of ascorbic acid, then nutritional deficiencies can occur.

Acute lack of vitamin C leads to the appearance of a disease such as scurvy. It results in bleeding of the gums and loosening of the teeth, hemorrhage in the joint cavity and impaired collagen synthesis, as a result of which the connective tissue loses its strength. When treating scurvy, it is necessary to take a large amount of vitamin C.

Ascorbic acid strengthens the immune system and reduces the duration of colds, but it should be used only in recommended doses.

Now you know all the secrets of vitamin C. A, what about other beneficial minerals and trace elements, for example, vitamin D3? One of our most popular articles is devoted to its properties. Read all about vitamin D3: what is it for, does it increase immunity and what is the risk of its lack.

Improving immunity is possible not only with vitamin C. There are many more ways to strengthen the immune system. Therefore, we present to your attention the material on how to increase immunity with just 7 simple steps.

apteka24.ua is the first online pharmacy you can trust.

This editorial was checked for accuracy by the family doctor of the Medical Plaza Medical Center – First Viktor Stanislavovich .

Sources

Vitamin C in the Prevention and Treatment of the Common Cold / NCBI

Can Vitamin C Help My Cold? / WebMed

Common colds: Does vitamin C keep you healthy? / NCBI

Vitamin C / Oregon State University

Vitamin C and Immune Function / NCBI

Vitamin C for the Common Cold / WebMed

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90,000 Vitamin C and where it is contained

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A powerful antioxidant and immunomodulator: the beneficial properties of vitamin C

Vitamin C and where it is contained – all about the benefits and harms for the body

A powerful antioxidant and immunomodulator: the beneficial properties of vitamin C

Vitamin C is one of the most important for life organism. What are the benefits and harms of vitamin C for the health of women and men, what products contain, as RIA Novosti, 09/03/2021

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MOSCOW, April 7 – RIA Novosti. Vitamin C is one of the most important for the life of the body. What are the benefits and harms of vitamin C for the health of women and men, which foods contain, how and how much to take, and also how to determine vitamin C deficiency – in the material RIA Novosti. The effect of vitamin C on the human body Vitamin C, or ascorbic acid, is an organic compound that is one of the main substances for human health.It is necessary for the normal functioning of bone tissue, strengthens the immune system, has a powerful antioxidant effect, accelerates the process of removing heavy metals from the body, reduces the risk of heart attack, participates in the synthesis of collagen, as well as a number of hormones, and helps with colds. Thinns or thickens the blood “Vitamin C thinns the blood,” nutritionist Veronika Khovanskaya told RIA Novosti. “It prevents the formation of blood clots that can lead to heart attacks.”Thanks to this action, ascorbic acid reduces the load on the heart, improves the condition with varicose veins and blood clotting. What foods contain vitamin C? reduces the amount of nitrosamines – toxic substances that are formed in the stomach. A sufficient supply of ascorbic acid in the body protects it from viral diseases, normalizes the process of hematopoiesis, promotes better absorption of iron, and regulates metabolism.Vitamin C controls blood cholesterol levels. According to the nutritionist, ascorbic acid helps: Vitamin C is also taken on the recommendation of a doctor for visual impairment, colds, high blood pressure, heart failure and cancer. it is the absence of ascorbic acid in human food that causes scurvy – a disease in which gums begin to bleed, teeth fall out, bones become weaker.Long-term intake of vitamin C is useful for the prevention of cardiovascular diseases, gout, reduces the risk of stroke, protects the body from the harmful effects of free radicals. Including more ascorbic acid in the diet should be for those who play sports and lead an active lifestyle, because it increases physical strength. In case of a cold, getting enough vitamin C into the body is necessary for the prevention and treatment of respiratory diseases. It increases immunity, prevents the death of T cells that resist infection, and also promotes their division, helps leukocytes and phagocytes to cope faster with viruses and bacteria.If the body has enough ascorbic acid, it reduces the incidence of colds, which is especially important in the off-season, when people develop vitamin deficiency. For the skin Vitamin C has powerful antioxidant properties, due to which it slows down the aging of the skin, makes it smoother, more radiant, helps with pigmentation and post-acne. Due to these properties, ascorbic acid is often included in the composition of facial care products. With regular use, such cosmetics stimulate the production of collagen in the dermis, fights all manifestations of photoaging, protecting against premature appearance of wrinkles.The harm of vitamin C and contraindications When uncontrolled use and exceeding the daily norm, vitamin C can cause a rash on the skin, abdominal pain, increased gas production, dizziness, insomnia. When prescribing ascorbic acid, there are a number of restrictions – it cannot be used by people with diabetes, diseases of the gastrointestinal tract (gastritis, ulcers), increased blood clotting and a tendency to thrombus formation, renal failure, allergies. Benefits of Vitamin C for Women Ascorbic acid is considered a vitamin of beauty, youth and health.It not only enhances the protective functions, helps against viruses, but also rejuvenates the body internally and externally by stimulating collagen production. For women, it is useful in the fight against age-related skin changes, pigmentation. In addition, vitamin C helps to remove toxins and toxins from the body, regulates metabolism, improves the menstrual cycle, improves brain function, and increases energy levels. During pregnancy According to the World Health Organization, taking vitamin C during pregnancy reduces the risk of placental abruption and premature prenatal rupture of the membranes.Research also notes that ascorbic acid reduces the likelihood of developing anemia during gestation. Despite this, in general, ascorbic acid does not affect premature birth, stillbirth, and intrauterine growth retardation. Consult a physician before use. Vitamin C Tablets Vitamin C comes in the form of a powder that dissolves in water, pills and tablets. Each form differs in the speed with which the substance is absorbed. In the form of tablets, ascorbic acid enters the body more slowly than powder, because it must be absorbed in the gastrointestinal tract.However, it is better for people with gastrointestinal disorders to take vitamins in capsules, if there are no contraindications, because the powder form irritates the mucous membrane of the internal organs. How to take vitamin C correctly and its compatibility Preparations with vitamin C should be taken orally after meals. It is important to consider that ascorbic acid is not combined with some other vitamins and medications. If combined with antibiotics, the risk of side effects increases. With long-term intake of calcium chloride and corticosteroids, the level of vitamin C in the body decreases.At the same time, the substance combines well with vitamins A, E, B5 and B9.How to determine vitamin C deficiency Among the early signs of vitamin C deficiency, the following can be distinguished: bleeding gums, long skin regeneration, hair loss and slow growth, frequent joint pain and colds. drowsiness and tiredness during the day, frequent nosebleeds. In addition, the lack of ascorbic acid affects the skin – it becomes dull, dry, wrinkles form on it faster, and the nails begin to exfoliate and break.Daily doses Vitamin C enters the human body with food and medicines, while for an adult, the daily dose should not exceed 90 mg. Dosage of ascorbic acid for different ages: Overdose Do not exceed the daily dose of vitamin C, otherwise it will cause health problems. Long-term use of high doses will lead to impaired absorption of vitamin B12, the formation of kidney stones, an increase in the concentration of uric acid, disruption of the gastrointestinal tract and the nervous system, and skin rashes may appear.If an excess of ascorbic acid occurs during pregnancy, then there is a possibility that the newborn will experience rebound scurvy. How to quickly remove vitamin C from the body Corbic acid is a water-soluble vitamins that are quickly absorbed and also quickly excreted from the body. In case of an overdose, you should temporarily abandon foods high in vitamin C and stop drinking multivitamins. Vitamin C in Coronavirus Vitamin C does not protect the body from infection with coronavirus, but it can reduce concomitant inflammation, neutralize infection, shorten the time of illness and protect against complications.However, you should not be too zealous – an overdose can lead to serious health problems. You should consult your doctor before taking.

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MOSCOW, April 7 – RIA Novosti. Vitamin C is one of the most important for the vital functions of the body. What are the benefits and harms of vitamin C for the health of women and men, which foods contain, how and how much to take, and also how to determine vitamin C deficiency – in the material RIA Novosti.

The effect of vitamin C on the human body

Vitamin C, or ascorbic acid, is an organic compound that is one of the main substances for human health.It is necessary for the normal functioning of bone tissue, strengthens the immune system, has a powerful antioxidant effect, accelerates the process of removing heavy metals from the body, reduces the risk of heart attack, participates in the synthesis of collagen, as well as a number of hormones, and helps with colds.

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Thins or thickens the blood

“Vitamin C thins the blood,” nutritionist Veronika Khovanskaya told RIA Novosti.”It prevents the formation of blood clots that can lead to heart attacks.” Thanks to this action, ascorbic acid reduces the load on the heart, improves the condition with varicose veins and blood clotting.

Which foods contain vitamin C

Foods high in vitamin C (per 100 grams):

• –

  Rosehip – 650 mg;

• –

  sea buckthorn – 200 mg;

• –

  sweet pepper (Bulgarian) – 200 mg;

• –

  black currant – 200 mg;

• –

  Kiwi – 180 mg;

• –

  dried porcini mushrooms – 150 mg;

• –

  parsley – 150 mg;

• –

  Brussels sprouts – 100 mg;

• –

  dill – 100 mg;

• –

  broccoli – 89 mg;

• –

  cauliflower – 70 mg.

April 3, 09:00 hOZhSix foods with the most vitamin C

The benefits of vitamin C

Vitamin C normalizes the functioning of the nervous and cardiovascular systems, reduces the amount of nitrosamines – toxic substances that are formed in the stomach. A sufficient supply of ascorbic acid in the body protects it from viral diseases, normalizes the process of hematopoiesis, promotes better absorption of iron, and regulates metabolism. Vitamin C controls blood cholesterol levels.

According to the nutritionist, ascorbic acid helps:

• –

  produce collagen;

• –

  to heal wounds;

• –

  to maintain healthy cartilage, bones and teeth;

• –

  Neutralize free radicals, inhibit aging.

Vitamin C is also taken on the recommendation of a doctor in case of visual impairment, colds, high blood pressure, heart failure and cancer. April 6, 06:00 AM The product is named that prevents the formation of cancer cells

For prevention

The healing properties of vitamin C were learned in 1932 year, when chemist Albert Szent-Györgyi proved that it is the absence of ascorbic acid in human food that causes scurvy – a disease in which gums begin to bleed, teeth fall out, bones become weaker.Long-term intake of vitamin C is useful for the prevention of cardiovascular diseases, gout, reduces the risk of stroke, protects the body from the harmful effects of free radicals. Including more ascorbic acid in the diet should be for those who play sports and lead an active lifestyle, because it increases physical strength.

“If a person smokes, then he should attend to the replenishment of vitamin C, since when smoking 1 cigarette, about 25 mg of vitamin is lost,” said Veronika Khovanskaya.

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For colds

The intake of a sufficient amount of vitamin C is necessary for the prevention and treatment of respiratory diseases. It increases immunity, prevents the death of T cells that resist infection, and also promotes their division, helps leukocytes and phagocytes to cope faster with viruses and bacteria. If the body has enough ascorbic acid, it reduces the incidence of colds, which is especially important in the off-season, when people develop vitamin deficiency.

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For skin

Vitamin C has powerful antioxidant properties, due to which it slows down the aging of the skin, makes it smoother, more radiant, helps from pigmentation and post-acne. Due to these properties, ascorbic acid is often included in the composition of facial care products. With regular use, such cosmetics stimulate the production of collagen in the dermis, fights all manifestations of photoaging, protecting against premature appearance of wrinkles.

The harm of vitamin C and contraindications

With uncontrolled use and exceeding the daily norm, vitamin C can cause a skin rash, abdominal pain, increased gas production, dizziness, insomnia. When prescribing ascorbic acid, there are a number of restrictions – it cannot be used by people with diabetes, diseases of the gastrointestinal tract (gastritis, ulcers), increased blood clotting and a tendency to thrombus formation, renal failure, allergies.

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The benefits of vitamin C for women

Ascorbic acid is considered a vitamin of beauty, youth and health.It not only enhances the protective functions, helps against viruses, but also rejuvenates the body internally and externally by stimulating collagen production. For women, it is useful in the fight against age-related skin changes, pigmentation. In addition, vitamin C helps to remove toxins and toxins from the body, regulates metabolism, improves the menstrual cycle, improves brain function, and increases energy levels. April 3, 04:00 AM The American dentist lists the most useful foods for teeth

During pregnancy

According to the World Health Organization, taking vitamin C during pregnancy reduces the risk of placenta detachment and premature prenatal rupture of membranes.Research also notes that ascorbic acid reduces the likelihood of developing anemia during gestation. Despite this, in general, ascorbic acid does not affect premature birth, stillbirth, and intrauterine growth retardation. Consult a physician before use.

Vitamin C tablets

Vitamin C is available in powder form, which dissolves in water, pills and tablets. Each form differs in the speed with which the substance is absorbed.In the form of tablets, ascorbic acid enters the body more slowly than powder, because it must be absorbed in the gastrointestinal tract. However, for people with gastrointestinal disorders, it is better to take vitamins in capsules, if there are no contraindications, because the powder form irritates the mucous membrane of the internal organs.

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How to take vitamin C correctly and its compatibility

Preparations with vitamin C should be taken orally after meals.It is important to consider that ascorbic acid is not combined with some other vitamins and medications. If combined with antibiotics, the risk of side effects increases. With long-term intake of calcium chloride and corticosteroids, the level of vitamin C in the body decreases. At the same time, the substance combines well with vitamins A, E, B5 and B9.

“Your daily dose of vitamin C is discussed with your doctor, but there are some tricks that can help you get more benefits,” said the nutritionist.- For example, women are better off consuming red meat with orange or cranberry sauce – a large amount of vitamin C helps the absorption of iron. Basically, vitamin C interacts normally with other vitamins, but B12 does not like partnerships and eliminates all the benefits of ascorbic acid. But vitamin E, on the contrary, increases its effectiveness in tandem with vitamin C. ”

How to determine vitamin C deficiency

Early signs of vitamin C deficiency include the following: bleeding gums, long skin regeneration, hair loss and slow growth, frequent joint pain and colds, drowsiness and fatigue during the day, frequent bleeding from the nose.In addition, the lack of ascorbic acid affects the skin – it becomes dull, dry, wrinkles form on it faster, and the nails begin to exfoliate and break.

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Daily doses

Vitamin C enters the human body with food and medicines, while for an adult, the daily dose should not exceed 90 mg. Dosage of ascorbic acid for different ages:

• –

  babies up to 6 months – 40 mg;

• –

  babies 7-12 months – 50 mg;

• –

  children 1-3 years old – 40 mg;

• –

  children 4-8 years old – 45 mg;

• –

  children 9-13 years old – 50 mg;

• –

  girls 14-18 years old – 65 mg;

• –

  youths 14-18 years old – 75 mg;

• –

  men 19 years of age and older – 90 mg;

• –

  women 19 years and older – 75 mg.

April 5, 02:30 am EOI Named foods that improve bowel function

Overdose

Do not exceed the daily dose of vitamin C, otherwise it will cause health problems. Long-term use of high doses will lead to impaired absorption of vitamin B12, the formation of kidney stones, an increase in the concentration of uric acid, disruption of the gastrointestinal tract and the nervous system, and skin rashes may appear. If an excess of ascorbic acid occurs during pregnancy, then there is a possibility that the newborn will develop rebound scurvy.

“The harm from an overdose of vitamin C can be in the form of heartburn, headache, nausea, cramps or diarrhea,” added Veronika Khovanskaya. “If you have diabetes, you should also strictly adhere to your doctor’s recommendations, as vitamin C can slightly raise blood sugar levels.”

How to quickly remove vitamin C from the body

Ascorbic acid belongs to water-soluble vitamins that are quickly absorbed and also quickly excreted from the body. In case of an overdose, you should temporarily abandon foods high in vitamin C and stop drinking multivitamins.

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Vitamin C with coronavirus

Vitamin C will not protect the body from coronavirus infection, but can reduce concomitant inflammatory processes, neutralize infection, reduce illness and protect against complications … However, you should not be too zealous – an overdose can lead to serious health problems. You should consult your doctor before taking.

Vitamin C

Vitamin C (ascorbic acid) was first obtained in 1928 from lemon juice. And after 4 years, scientists were able to establish that it is the lack of ascorbic acid in the body that leads to the appearance of scurvy. Since then, large-scale studies of the vitamin have been carried out, which have helped to identify its physicochemical properties, benefits for the body and sources of production.

Properties

Ascorbic acid is a white powder, sour taste, practically odorless. It is soluble in water, alcohol, decomposes at high temperatures and under the influence of light, but tolerates freezing.

The substance is necessary for the regeneration and renewal of bone and connective tissues, the fight against the formation of free radicals. Vitamin plays the role of a coenzyme and a reducing agent in metabolic processes.

Only L-ascorbic acid can participate in chemical processes (it is it that is called vitamin C or a dietary supplement E 300). It does not accumulate in the body, it is excreted in the urine. The compound is irreplaceable, that is, it is not synthesized in the human body, therefore, a constant supply of vitamin from the outside is needed.

This is the most unstable water-soluble vitamin, which is often the reason for its deficiency – heat treatment (especially in the presence of iron, magnesium or copper), long-term storage reduces the amount of active components supplied with food.

Determination of the recommended dose

At the moment, there is no exact data on the dependence of the need for vitamin C on body weight, its surface area, energy metabolism, and metabolic characteristics. This makes it difficult to justify the appropriate differentiated recommendations regarding the intake of vitamin C.

In a child (per 1 kg of body weight), the need for vitamin is higher than in an adult, which is associated with the growth and development of organs and structures.In women, the need increases during pregnancy and lactation.

Climatic conditions have a great influence on the need for ascorbic acid. The need for the conditions of the Far North has sharply increased. Vitamin C prevents the development of maladaptive meteoneurosis, accelerates human acclimatization, is an adaptogen that helps to increase the body’s nonspecific resistance .. [S3]

The recommendations for daily vitamin C requirements are based on the possible relationship of ascorbic acid with the energy requirements of the body.Taking into account individual variations, a criterion is proposed for calculating 25 mg per 1000 kcal.

• a man aged 20-40 years, not engaged in physical labor (I group of labor intensity) and living in a city with a developed communal economy, which requires 2800 kcal, needs 70 mg of ascorbic acid;

• a non-mechanized worker (IV group) of the same age, living in the same conditions, who requires 3700 kcal, needs 93 mg of ascorbic acid;

• for a person engaged in very hard manual labor and needing 4500 kcal, 120 mg of vitamin C is required.

A larger amount of vitamin C is needed for various pathological conditions, when the consumption of ascorbic acid in the body is increased, or its assimilation is impaired. In severe weather conditions, rates increase by 30-50%.

Effects on the body and norms

Vitamin C is a powerful antioxidant. Its purpose is to protect internal organs and tissues from damage of various etiologies, to prevent the formation of malignant tumors.But the benefits of the vitamin for the body do not end there:

• The compound helps to strengthen the immune system, reduces the strength of inflammatory processes, helps to remove tokins.
• With the participation of vitamin C, redox processes occur, protein is synthesized, including collagen.
• Ascorbic acid is also required for skin regeneration and wound healing.
• Antioxidant effect is manifested in the fight against free radicals, inhibition of the formation of cancer cells.
• Ascorbic acid has a beneficial effect on energy processes, increasing endurance.
• Vitamin strengthens blood vessels, normalizes the permeability of their walls, reduces the risk of atherosclerosis.
• The concentration of vitamin C in the body affects the state of the nervous system, stress resistance.

Scientists have not yet come to a consensus on the exact amount of vitamin C a person needs. The table shows data on the minimum daily intake of ascorbic acid for people of different ages.

Most of all, the vitamin is needed by children during the period of active growth, athletes, pregnant and lactating women, smokers, people living in cold or hot climates.The need increases during illness, stress, when taking oral contraceptives.

The World Health Organization adheres to the recommendation: 2.5 mg of vitamin per 1 kg of body weight.

Ascorbic acid deficiency: signs, consequences

Distinguish between hypovitaminosis and vitamin deficiency. With hypovitaminosis, the concentration of the vitamin decreases, in children, against the background of a deficiency, abnormal development of the bone tissues of the legs and ribs may begin.The main symptoms of hypovitaminosis in adults:

• bruising without bruising;
• slow wound healing;
• fragility of hair, nails;
• bleeding gums;
• dry skin;
• frequent colds;
• joint pain;
• chronic fatigue, depressive conditions;
• overweight gain.

Lack of vitamin C is detected in most people during the autumn and winter periods.When these symptoms appear, you should consult a specialist in order to prescribe the intake of drugs containing vitamin C. You can compensate for the deficiency with the help of dietary supplements.

Prolonged hypovitaminosis can turn into vitamin deficiency, when the vitamin in the body is practically absent, scurvy develops. The condition requires treatment under the supervision of a physician.

Excess vitamin

A vitamin surplus is extremely rare, since it does not accumulate in the body, it is easily excreted.However, the symptoms of hypervitaminosis can be as follows:

• nausea, vomiting, diarrhea, heartburn;
• cramps, bloating;
• headaches, sleep disturbances;
• allergic reactions;
• the appearance of kidney stones.

If these signs appear, you should stop taking vitamins and consult a doctor.

Possible complications of overdose

Vitamin C is prescribed with caution when:

• Taking salicylic acid, since the simultaneous use can provoke an increase in acidity and the development of stomach ulcers, gastritis.

• Increased blood clotting, the threat of thrombosis. Vitamin is beneficial for varicose veins – it strengthens the walls of blood vessels and stimulates the production of collagen. At the same time, the compound increases the concentration of prothrombin and platelets, increasing clotting and the risk of thrombus formation. Therefore, the intake of ascorbic acid in this case must be agreed with the doctor.

• Diabetes mellitus type 2. High doses of vitamin (1 g or more) suppress insulin secretion.At the same time, the beneficial properties of the vitamin are manifested in prophylactic dosages. Patients with diabetes are advised to take dosages that cover the daily requirement, but refrain from exceeding.

• Urolithiasis. There are studies showing a link between the vitamin and the formation of kidney stones. People prone to urolithiasis can limit themselves to the introduction of vitamin-rich foods into the menu.

• Taking estrogen medications.With prolonged combination of hormonal agents with a vitamin, the concentration of estrogen in a woman’s blood increases. As a result, the menstrual cycle may be disrupted, body weight may increase, hair and skin condition may worsen.

Sources of vitamin

The largest amount of ascorbic acid is found in vegetables, fruits, berries, and herbs. Their advantage is that these products, for the most part, do not need heat treatment, which is detrimental to the vitamin.Contrary to popular belief, citrus fruits are not the most fortified fruits – they only round out the top twenty.

The vitamin C content is shown in the table.

It should be remembered that the amount of active components is influenced not only by heat treatment, but also by the duration of contact with oxygen.To reduce the loss of vitamins, vegetables and fruits are recommended to be cut immediately before eating, while cooking, put in boiling water without peeling. Roasting is preferable as it heats up faster and the cooking time is shorter.

Preventive and therapeutic use of vitamin C

With a slight vitamin deficiency, the doctor adjusts the diet by introducing the maximum amount of sources of ascorbic acid into the diet. With a more severe deficiency, additives are prescribed in the form of soluble tablets, dragees, powders.By their properties, they are no different from a natural vitamin. In cases of acute shortage, the drug is administered by intramuscular injection.

To prevent the development of hypovitaminosis, the daily dose of ascorbic acid is:

• for adults – 50-100 mg;
• for children – 25-75 mg;
• for pregnant and lactating women – 25-75 mg for the first 2 weeks, then 100 mg.

The duration of the course, the frequency of taking the drug is prescribed by the doctor.

Therapeutic doses of vitamin C depend on the severity of the disease. For colds, they are 2-3 times higher than preventive ones.

Studies have shown that a loading dose of a vitamin does not affect the duration or intensity of colds. But during this period, the body consumes ascorbic acid more actively, so it is important to maintain it at a normal level.

Reception mode

Complex dietary supplements or ascorbic acid in a monopreparation is taken orally during or immediately after a meal.This is how the compound is absorbed most efficiently and helps to better assimilate nutrients from food. It is advisable to take the supplement at the same time of day.

If the supplement is in the form of a chewable lozenge or lozenge, it is recommended to rinse your mouth with water after ingestion to prevent the acid from destroying the tooth enamel.

Application in cosmetology

Due to its antioxidant and anti-aging properties, vitamin C is actively used in cosmetology.Ingestion systemically affects the entire body, and external cosmetics with ascorbic acid help:

• Accelerate cell renewal and healing, relieve inflammation.

• Eliminate hyperpigmentation, refresh complexion.

• Improve microcirculation, stimulate collagen production.

• Increase turgor, smooth out fine wrinkles.

• Strengthen local immunity, protect the skin from aggressive external factors.

For skin care, creams, masks, patches and other products with ascorbic acid are produced. It is also effective to use homemade masks based on berries and fruits.

Interaction with other vitamins

Vitamin C actively interacts with other components:

• Enhances the activity of vitamins A, E, B5, B9.

• Improves the absorption of iron and calcium.

• Destroyed by vitamins B1, B12 and K.

• Removes copper from the body.

For prophylactic intake, it is convenient to choose multivitamin complexes and dietary supplements, in which the optimal combinations and dosages are selected that cover the daily need of a person.