What to know about Vitamin C

Vitamin C is a water-soluble vitamin that has a number of biological functions.

Broccoli, red peppers, currants, Brussels sprouts, parsley, potatoes, citrus fuit, and strawberries are good sources of vitamin C.

Although scurvy (severe vitamin C deficiency) is uncommon in Western societies, many doctors believe that most people consume less than optimal amounts. Fatigue, easy bruising, and bleeding gums are early signs of vitamin C deficiency that occur long before frank scurvy develops. Smokers have low levels of vitamin C and require a higher daily intake to maintain normal vitamin C levels. Women with preeclampsia have been found to have lower blood levels of vitamin C than women without the condition. Women who have lower blood levels of vitamin C have an increased risk of gallstones. People with kidney failure have an increased risk of vitamin C deficiency. However, people with kidney failure should take vitamin C only under the supervision of a doctor.

Anemia (if deficient) Athletic performance (if deficient, or to reduce pain and speed up muscle strength recovery after intense exercise) Bronchitis Bruising (for deficiency) Burns (in combination with vitamin E for prevention of sunburn only) Capillary fragility Common cold/sore throat Gingivitis (periodontal disease) (for deficiency only) Glaucoma Heart attack (for deficiency) High cholesterol (protection of LDL cholesterol) Infection Infertility (male) (for sperm agglutination) Reflex sympathetic dystrophy (prevention) Scurvy Stress Sunburn (oral, in combination with vitamin E) Wound healing Asthma Atherosclerosis Athletic performance (for exercise recovery) Autism Cataracts Childhood intelligence (for deficiency) Cold sores Dysmenorrhea (plus vitamin B3 [niacin] and rutin) Endometriosis (in combination with vitamin E) Gastritis Gingivitis (periodontal disease) (in combination with flavonoids) Gout Immune function Infertility (female) Influenza Iron-deficiency anemia (as an adjunct to supplemental iron) Lead toxicity Pancreatic insufficiency Parkinson’s disease (in combination with Vitamin E) Pre- and post-surgery health (if deficient) Preeclampsia (in combination with vitamin E; for high risk only) Pregnancy support (if the diet is low in vitamin C) Schizophrenia Skin ulcers Sprains and strains Sunburn (topical, in combination with vitamin E) Type 1 diabetes Type 2 diabetes Age-related cognitive decline Alcohol withdrawal support Amenorrhea Anemia (for thalassemia if deficient) Bipolar disorder/manic depression Boils (recurrent furunculosis) Childhood diseases Chronic obstructive pulmonary disease (COPD) Colon cancer (reduces risk) Ear infections (recurrent) Eczema Gallstones Halitosis (if gum disease and deficient) Hay fever Heart attack (for those not deficient) Hepatitis High blood pressure HIV support (oral and topical) Hives Hypoglycemia Leukoplakia Low back pain Macular degeneration Menopause Menorrhagia (heavy menstruation) Morning sickness Peptic ulcer Progressive pigmented purpura (in combination with rutoside) Prostatitis (acute bacterial prostatitis, chronic bacterial prostatitis) Retinopathy (in combination with selenium, vitamin A and vitamin E) Sickle cell anemia Sinusitis Tardive dyskinesia Urinary tract infection Vitiligo

Some people develop diarrhea after as little as a few grams of vitamin C per day, while others are not bothered by ten times this amount. Strong scientific evidence to define and defend an upper tolerable limit for vitamin C is not available. A review of the available research concluded that high intakes (2–4 grams per day) are well-tolerated by healthy people. However, intake of large amounts of vitamin C can deplete the body of copper an essential nutrient. People should be sure to maintain adequate copper intake at higher intakes of vitamin C. Copper is found in many multivitamin-mineral supplements. Vitamin C increases the absorption of iron and should be avoided by people with iron overload diseases (e.g., hemochromatosis, hemosiderosis). Vitamin C helps recycle the antioxidant, vitamin E. It is widely (and mistakenly) believed that mothers who consume large amounts of vitamin C during pregnancy are at risk of giving birth to an infant with a higher-than-normal requirement for the vitamin. The concern is that the infant could suffer “rebound scurvy,” a vitamin C deficiency caused by not having this increased need met. Even some medical textbooks have subscribed to this theory. In fact, however, the concept of “rebound scurvy” in infants is supported by extremely weak evidence. Since the publication in 1965 of the report upon which this mistaken notion is based, millions of women have consumed high amounts of vitamin C during pregnancy and not a single new case of rebound scurvy has been reported. A preliminary study found that people who took 500 mg per day of vitamin C supplements for one year had a greater increase in wall thickness of the carotid arteries (vessels in the neck that supply blood to the brain) than those who did not take vitamin C. Thickness of carotid artery walls is an indicator of progression of atherosclerosis. Currently, no evidence supports a cause-and-effect relationship for the outcome reported in this study. The vast preponderance of research suggests either a protective or therapeutic effect of vitamin C for heart disease, or no effect at all. People with the following conditions should consult their doctor before supplementing with vitamin C: glucose-6-phosphate dehydrogenase deficiency, iron overload (hemosiderosis or hemochromatosis), history of kidney stones, or kidney failure. It has been suggested that people who form calcium oxalate kidney stones should avoid vitamin C supplements, because vitamin C can be converted into oxalate and increase urinary oxalate. Initially, these concerns were questioned because of potential errors in the laboratory measurement of oxalate. However, using newer methodology that rules out this problem, recent evidence shows that as little as 1 gram of vitamin C per day can increase the urinary oxalate levels in some people, even those without a history of kidney stones. In one case, 8 grams per day of vitamin C led to dramatic increases in urinary oxalate excretion and kidney stone crystal formation causing bloody urine. People with a history of kidney stones should consult a doctor before taking large amounts (1 gram or more per day) of supplemental vitamin C. Despite possible therapeutic effects of vitamin C in people with diabetes at lower intakes, one case of increased blood sugar levels was reported after taking 4.5 grams per day. Certain medicines may interact with vitamin C. Refer to drug interactions for a list of those medicines.

The recommended dietary allowance (RDA) for vitamin C in nonsmoking adults is 75 mg per day for women and 90 mg per day for men. For smokers, the RDAs are 110 mg per day for women and 125 mg per day for men. Most clinical vitamin C studies have investigated the effects of a broad range of higher vitamin C intakes (100–1,000 mg per day or more), often not looking for (or finding) the “optimal” intake within that range. In terms of heart disease prevention, as little as 100–200 mg of vitamin C appears to be adequate. Although some doctors recommend 500–1,000 mg per day or more, additional research is needed to determine whether these larger amounts are necessary. Some vitamin C experts propose that adequate intake be considered 200 mg per day because of evidence that the cells of the human body do not take up any more vitamin C when larger daily amounts are used. Some scientists have recommended that healthy people take multi-gram amounts of vitamin C for the prevention of illness. However, little or no research supports this point of view and it remains controversial. Supplementing more results in an excretion level virtually identical to intake, meaning that consuming more vitamin C does not increase the amount that remains in the body. On the basis of extensive analysis of published vitamin C studies, researchers at the Linus Pauling Institute at Oregon State University have called for the RDA to be increased, but only to 120 mg. This same report reveals that “. . . 90–100 mg vitamin C per day is required for optimum reduction of chronic disease risk in nonsmoking men and women.” Thus, the multiple gram amounts of vitamin C taken by many healthy people may be superfluous. The studies that ascertained approximately 120–200 mg daily of vitamin C is correct for prevention purposes in healthy people have typically not investigated whether people suffering from various diseases can benefit from larger amounts. In the case of the common cold, a review of published trials found that amounts of 2 grams per day in children appear to be more effective than 1 gram per day in adults, suggesting that large intakes of vitamin C may be more effective than smaller amounts, at least for this condition.