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Vitamin C
Overview

Vitamin C is a water-soluble vitamin, meaning that your body doesn't store it. We get what we need, instead, from food. We need vitamin C for the growth and repair of tissues in all parts of our body. It helps the body make collagen, an important protein used to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is essential for healing wounds, and for repairing and maintaining bones and teeth.

Vitamin C is an antioxidant, along with vitamin E, beta-carotene, and many other plant-based nutrients. Antioxidants block some of the damage caused by free radicals, which occur naturally when our bodies transform food into energy. The build-up of free radicals over time may be largely responsible for the aging process and can contribute to the development of health conditions such as cancer, heart disease, and arthritis.

Evidence suggests that many people may be mildly deficient in vitamin C, although serious deficiencies are rare in industrialized countries. Smoking cigarettes lowers the amount of vitamin C in the body, so smokers are at a higher risk of deficiency. Signs of vitamin deficiency include dry and splitting hair; gingivitis (inflammation of the gums) and bleeding gums; rough, dry, scaly skin; decreased wound-healing rate, easy bruising; nosebleeds; and a decreased ability to ward off infection. A severe form of vitamin C deficiency is known as scurvy.

Low levels of vitamin C have been associated with a number of conditions, including high blood pressure, gallbladder disease, stroke, some cancers, and atherosclerosis (the build-up plaque in blood vessels that can lead to heart attack and stroke). Getting enough vitamin C from your diet (by eating lots of fruit and vegetables) may help reduce the risk of developing some of these conditions. The evidence that taking vitamin C supplements will help or prevent any of these conditions is lacking, however.

What is Vitamin C ?
Vitamin C is a water-soluble vitamin that is necessary for normal growth and development.
Water-soluble vitamins dissolve in water. Leftover amounts of the vitamin leave the body through the urine. That means you need a continuous supply of such vitamins in your diet.

Vitamin C is required for the growth and repair of tissues in all parts of your body. It is necessary to form collagen, an important protein used to make skin, scar tissue, tendons, ligaments, and blood vessels. Vitamin C is essential for the healing of wounds, and for the repair and maintenance of cartilage, bones, and teeth.

Vitamin C is one of many antioxidants. Vitamin E and beta-carotene are two other well-known antioxidants. Antioxidants are nutrients that block some of the damage caused by free radicals, which are by-products that result when our bodies transform food into energy.

The buildup of these by-products over time is largely responsible for the aging process and can contribute to the development of various health conditions such as cancer, heart disease, and a host of inflammatory conditions like arthritis. Antioxidants also help reduce the damage to the body caused by toxic chemicals and pollutants such as cigarette smoke.

The body does not manufacture vitamin C on its own, nor does it store it. It is therefore important to include plenty of vitamin C-containing foods in your daily diet.

Where it is found
All fruits and vegetables contain some amount of vitamin C. Foods that tend to be the highest sources of vitamin C include green peppers, citrus fruits and juices, strawberries, tomatoes, broccoli, turnip greens and other leafy greens, sweet and white potatoes, and cantaloupe.

Other excellent sources include papaya, mango, watermelon, brussels sprouts, cauliflower, cabbage, winter squash, red peppers, raspberries, blueberries, cranberries, and pineapples.

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Vitamin C & Bioflavonoids

Benefits / uses
Vitamin C plays a role in protecting against the following:
Heart Disease
Studies suggest that vitamin C, acting as an antioxidant, can slow down the progression of atherosclerosis (hardening of the arteries). It helps prevent damage to LDL ("bad") cholesterol, which then builds up as plaque in the arteries and can cause heart attack or stroke. Other studies suggest that vitamin C may help keep arteries flexible.

In addition, people who have low levels of vitamin C may be more likely to have a heart attack, stroke, or peripheral artery disease, all potential results of having atherosclerosis. Peripheral artery disease is the term used to describe atherosclerosis of the blood vessels to the legs. This can lead to pain when walking, known as intermittent claudication. But there is no evidence that taking vitamin C supplements will help.

High Blood Pressure
Population based studies (which involve observing large groups of people over time) suggest that people who eat foods rich in antioxidants, including vitamin C, have a lower risk of high blood pressure than people who have poorer diets. Eating foods rich in vitamin C is important for your overall health, especially if you are at risk for high blood pressure. The diet physicians most frequently recommend for treatment and prevention of high blood pressure, known as the DASH (Dietary Approaches to Stop Hypertension) diet, includes lots of fruits and vegetables, which are loaded with antioxidants.

Common Cold
Taking vitamin C supplements regularly (not just at the beginning of a cold) produces only a small reduction in the duration of a cold (about 1 day). The only other piece of evidence supporting vitamin C for preventing colds comes from studies examining people exercising in extreme environments (athletes such as skiers and marathon runners, and soldiers in the Arctic). In these studies, vitamin C did seem to reduce the risk of getting a cold.

Cancer
Results of many population based studies (evaluating groups of people over time) suggest that eating foods rich in vitamin C may be associated with lower rates of cancer, including skin cancer, cervical dysplasia (changes to the cervix which may be cancerous or precancerous, picked up by pap smear), and, possibly, breast cancer.

Osteoarthritis
Vitamin C is essential for the body to make collagen, which is a part of normal cartilage. Cartilage is destroyed in osteoarthritis (OA), putting pressure on bones and joints. In addition, some researchers think free radicals -- molecules produced by the body that can damage cells and DNA -- may also be involved in the destruction of cartilage. Antioxidants such as vitamin C appear to limit the damage caused by free radicals. Taking nonsteroidal anti-inflammatory drugs can lower your levels of vitamin C. If you take these drugs regularly for OA, you might want to take a vitamin C supplement.

Age-related Macular Degeneration
Vitamin C (500 mg) appears to work with other antioxidants, including zinc (80 mg), beta-carotene (15 mg), and vitamin E (400 IU) to protect the eyes against developing macular degeneration (AMD), the leading cause of legal blindness in people over 55 in the United States. The people who seem to benefit are those with advanced AMD.

Pre-eclampsia
Some studies suggest that taking vitamin C along with vitamin E may help prevent pre-eclampsia in women who are at high risk. Pre-eclampsia, characterized by high blood pressure and too much protein in the urine, is a common cause of pre-term births.

Asthma
Some show that low levels of vitamin C are more common in people with asthma, leading some researchers to think that low levels of vitamin C might increase the risk for this condition. Other studies seem to show that vitamin C may help reduce symptoms of exercise-induced asthma.
Other
Vitamin C may also be helpful for:
arw Boosting immune system function
arw Maintaining healthy gums
arw Improving vision for those with uveitis (an inflammation of the middle part of the eye)
arw Treating allergy-related conditions, such as asthma, eczema, and hay fever (called allergic rhinitis)
arw Reducing effects of sun exposure, such as sunburn or redness (called erythema)
arw Alleviating dry mouth, particularly from antidepressant medications (a common side effect from these drugs)
arw Healing burns and wounds
arw Decreasing blood sugar in people with diabetes

When to take/Types to take
Vitamin C supplement are best taken with meal. However, if an individual has a reason to take mega-doses (to combat a cold, for example), then 1000-2000 mg can be taken every two hours or so; even without food. In this instance, however, the individual would be better off using a mineral ascorbate form of vitamin C, which is less likely to induce gastrointestinal difficulties.

Besides a standard tablet or capsule, vitamin C is also available as a crystalline powder, and as chewable tablets or wafers. The chewable form of Vitamin C is particularly appropriate for children.

Since vitamin C is water soluble, most adults would be well served by using a timed release form of Vitamin C is more likely to provide better absorption over a period of several hours.

bioflavonoids greatly increases vitamin C's bioavailability and rate of absorption

Doses
Vitamin C should be consumed every day because it is not fat-soluble and, therefore, cannot be stored for later use.
Infants and Children
0 - 6 months: 40 milligrams/day (mg/day)
7 - 12 months: 50 mg/day
1 - 3 years: 15 mg/day
4 - 8 years: 25 mg/day
9 - 13 years: 45 mg/day
Adolescents
Girls 14 - 18 years: 65 mg/day
Boys 14 - 18 years: 75 mg/day
Adults
Men age 19 and older: 90 mg/day
Women age 19 year and older: 75 mg/day

Side Effects
Vitamin C toxicity is very rare, because the body cannot store the vitamin. However, amounts greater than 2,000 mg/day are not recommended because such high doses can lead to stomach upset and diarrhea.
Too little vitamin C can lead to signs and symptoms of deficiency, including:


arw Dry and splitting hair


arw Gingivitis (inflammation of the gums)


arw Bleeding gums


arw Rough, dry, scaly skin


arw Decreased wound-healing rate


arw Easy bruising


arw Nosebleeds


arw Weakened tooth enamel


arw Swollen and painful joints


arw Anemia


arw Decreased ability to fight infection


arw Possible weight gain because of slowed metabolism

Possible Interactions:
If you are being treated with any of the following medications, you should not use vitamin C supplements without first talking to your health care provider:
Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) -- Both aspirin and NSAIDs can lower the amount of vitamin C in the body because they cause more of the vitamin to be lost in urine. In addition, high doses of vitamin C can cause more of these drugs to stay in the body, raising the levels in your blood. Some very early research suggests that vitamin C might help protect against stomach upset that aspirin and NSAIDs can cause. If you regularly take aspirin or NSAIDs, talk to your doctor before taking more than the recommended daily allowance of vitamin C.

Acetaminophen (Tylenol) -- High doses of vitamin C may lower the amount of acetaminophen passed in urine, which could cause the levels of this drug in your blood to rise.

Aluminum-containing antacids -- Vitamin C can increase the amount of aluminum your body absorbs, which could cause the side effects of these medications to be worse. Aluminum-containing antacids include Maalox and Gaviscon.

Barbiturates -- Barbiturates may decrease the effects of vitamin C. These drugs include phenobarbital (Luminal), pentobarbital (Nembutal), and seconobarbital (Seconal).

Chemotherapy drugs -- As an antioxidant, vitamin C may interfere with the effects of some drugs taken for chemotherapy; however, some researchers speculate that vitamin C might help make chemotherapy more effective. If you are undergoing chemotherapy, do not take vitamin C or any other supplement without talking to your oncologist.

Nitrate medications for heart disease -- The combination of vitamin C with nitroglycerin, isosorbide dinitrate (Isordil), or isosorbide mononitrate (Ismo) reduces the body's tendency to build up a tolerance to these medications so that they no longer work. If you take nitrate medications, talk to your doctor about whether you should take vitamin C.

Oral contraceptives (birth control pills) and hormone replacement therapy (HRT) -- Vitamin C can cause a rise in estrogen levels when taken with these drugs, particularly if you are deficient in vitamin C to begin with and start taking supplements. Oral estrogens can also decrease the effects of vitamin C in the body.
Protease inhibitors -- Vitamin C appears to slightly lower levels of indinavir (Crixivan), a medication used to treat HIV and AIDS.

Tetracycline -- Some evidence suggests that taking vitamin C with the antibiotic tetracycline may increase the levels of this medication; it may also decrease the effects of vitamin C in the body. Other antibiotics in the same family include minocycline (Minocin) and doxycycline (Vibramycin).

Warfarin (Coumadin) -- There have been rare reports of vitamin C interfering with the effectiveness of this blood thinning medication. In recent follow-up studies, no effect was found with doses of vitamin C up to 1,000 mg per day. However, if you take warfarin or another blood thinner, talk to your doctor before taking vitamin C or any other supplement.

Research studies / References

arw Afkhami-Ardekani M, Shojaoddiny-Ardekani A. Effect of vitamin C on blood glucose, serum lipids & serum insulin in type 2 diabetes patients. Indian J Med Res. 2007;126(5):471-4.


arw Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.


arw Audera C, Patulny RV, Sander BH, Douglas RM. Mega-dose vitamin C in treatment of the common cold: a randomised controlled trial. Med J Aust. 2001;175(7):359-362.


arw Braun BL, Fowles JB, Solberg L, Kind E, Healey M, Anderson R. Patient beliefs about the characteristics, causes, and care of the common cold: an update. J Fam Pract. 2000;49(2):153-156.


arw Canter PH, Wider B, Ernst E. The antioxidant vitamins A, C, E and selenium in the treatment of arthritis: a systematic review of randomized clinical trials. Rheumatology. 2007;46(8):1223-33.


arw Cook NR, Albert CM, Gaziano JM, Zaharris E, MacFadyen J, Danielson E, Buring JE, Manson JE. A randomized factorial trial of vitamins C and E and beta carotene in the secondary prevention of cardiovascular events in women: results from the Women's Antioxidant Cardiovascular Study. Arch Intern Med. 2007;167(15):1610-8.


arw Daniel TA, Nawarskas JJ. Vitamin C in the prevention of nitrate tolerance. Ann Pharacother. 2000;34(10):1193-1197.


arw Douglas RM, Chalker EB, Treacy B. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2000;(2):CD000980.


arw Dwyer JH, Merz NB, Shirocre AM, et al. Progression of early atherosclerosis and intake of vitamin C and vitamin E from supplements and food. The Los Angeles Atherosclerosis Study. 41st Annual Conference on Cardiovascular Disease Epidemiology and Prevention -- Abstract P77. Circulation. 2001;103:1365d.


arw Gandini S, Merzenich H, Robertson C, Boyle P. Meta-analysis of studies on breast cancer risk and diet: the role of fruit and vegetable consumption and the intake of associated micronutrients. Eur J Cancer. 2000;36:636-646.


arw Head KA. Natural therapies for ocular disorders, part two: cataracts and glaucoma. Altern Med Rev. 2001;6(2):141-66.


arw Institute of Medicine. Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. Washington, DC: National Academy Of Sciences. 2002. Accessed Sept. 14, 2007.


arw Kaur B, Rowe BH, Ram FS. Vitamin C supplementation for asthma (Cochrane Review). Cochrane Databse Syst Rev. 2001;4:CD000993.


arw Keligman: Nelson Textbook of Pediatrics, 18th ed. Philadelphia, PA: Saunders Elsevier. 2007.


arw Khaw KT, Bingham S, Welch A, et al. Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet. 2001;357:657-63.


arw Kompauer I, Heinrich J, Wolfram G, Linseisen J. Association of carotenoids, tocopherols, and vitamin C in plasma with allergic rhinitis and allergic sensitization in adults. Public Health Nutr. 2006;9:472-9.


arw Kurowska EM, Spence JD, Jordan J, Wetmore S, Freeman DJ, Piche LA, Serratore P. HDL-cholesterol-raising effect of orange juice in subjects with hypercholesterolemia. Am J Clin Nutr. 2000;72(5):1095-1100.


arw Laight DW, Carrier MJ, Anggard EE. Antioxidants, diabetes and endothelial dysfunction. Cardiovasc Res. 2000;47:457-464.


arw Langlois M, Duprez D, Delanghe J, De Buyzere M, Clement DL. Serum vitamin C concentration is low in peripheral arterial disease and is associated with inflammation and severity of atherosclerosis. Circulation. 2001;103(14):1863-1868.


arw Levine M, Wang Y, Padayatty SJ, Morrow J. A new recommended dietary allowance of vitamin C for healthy young women. PNAS. 2001;98(17):9842-9846.


arw Lonn E. Do antioxidant vitamins protect against atherosclerosis? The proof is still lacking. J Am Coll Cardiol. 2001;38:1795-8.


arw Lykkesfeldt J, Christen S, Wallock LM, Chang HH, Jacob RA, Ames BN. Ascorbate is depleted by smoking and repleted by moderate supplementation: a study in male smokers and nonsmokers with matched dietary antioxidant intakes. Am J Clin Nutr. 2000;71(2):530-536.


arw Mares-Perlman JA, Lyle BJ, Klein R, et al. Vitamin supplement use and incident cataracts in a population-based study. Arch Ophthalmol. 2000;118:1556-63.


arw Masaki KH, Losonczy KG, Izmirlian G. Association of vitamin E and C supplement use with cognitive function and dementia in elderly men. Neurology. 2000;54:1265-1272.


arw Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.


arw Ohnishi ST, Ohnishi T, Ogunmola GB. Sickle cell anemia: a potential nutritional approach for a molecular disease. Nutrition. 2000;16:330-8.


arw Padayatty SJ, Levine M. Reevaluation of ascorbate in cancer treatment: emerging evidence, open minds and serendipity. J Am Coll Nutr. 2000;19(4):423-425.


arw Ram FS, Rowe BH, Kaur B. Vitamin C supplementation for asthma. Cochrane Database Syst Rev. 2004;(3):CD000993.


arw Rock CL, Michael CW, Reynolds RK, Ruffin MT. Prevention of cervix cancer. Crit Rev Oncol Hematol. 2000;33(3):169-185.


arw Seaton A, Devereux G. Diet, infection and wheezy illness: lessons from adults. Pediatr Allergy Immunol. 2000;11 Suppl 13:37-40.


arw Shinke T, Shite J, Takaoka H, Hata K, Inoue N, Yoshikawa R, Matsumoto H, Masai H, Watanabe S, Ozawa T, Otake H, Matsumoto D, Hirata K, Yokoyama M. Vitamin C restores the contractile response to dobutamine and improves myocardial efficiency in patients with HF. Amer Heart J. 2007;154(4):645.e1-8.


arw Takkouche B, Regueira-Mendez C, Garcia-Closas R, Figueiras A, Gestal-Otero JJ. Intake of vitamin C and zinc and risk of common cold: a cohort study. Epidemiology. 2002;13(1):38-44.


arw Taylor A, Jacques PF, Chylack LT Jr, et al. Long-term intake of vitamins and carotenoids and odds of early age-related cortical and posterior subcapsular lens opacities. Am J Clin Nutr. 2002;75(3):540-549.


arw Tofler GH, Stec JJ, Stubbe I, Beadle J, Feng D, Lipinska I, Taylor A. The effect of vitamin C supplementation on coagulability and lipid levels in healthy male subjects. Thromb Res. 2000;100(1):35-41.


arw Yokoyama T, Date C, Kokubo Y, Yoshiike N, Matsumura Y, Tanaka H. Serum vitamin C concentration was inversely associated with subsequent 20-year incidence of stroke in a Japanese rural community. The Shibata study. Stroke. 2000;31(10):2287-2294.


arw You WC, Brown LM, Zhang L, et al. Randomized double-blind factorial trial of three treatments to reduce the prevalence of precancerous gastric lesions. J Natl Cancer Inst. 2006;98:974-83.