Vitamin C deficiency: the most important questions and answers

Vitamin C Mangel: Die wichtigsten Fragen und Antworten

Vitamin C is an important water-soluble vitamin that is also a powerful antioxidant. It helps fight harmful free radicals and protect cells from oxidative damage. Vitamin C also plays a role in various other aspects of health including wound healing, bone formation, collagen synthesis and the development of connective tissues in the body.

A deficiency in this important vitamin can seriously damage your body, causing symptoms such as compromised immunity, gingivitis, and easy bruising. Conversely, enough can help ward off disease and infection, improve iron absorption, and even reduce the risk of painful conditions like gout.

This article is intended to give you an understanding of the essential functions of this vitamin, as well as the causes and consequences of a deficiency. In the following you will receive valuable tips on how to successfully treat a vitamin C deficiency or how to take preventive measures in this regard.

the essentials in brief

  • Vitamin C is a nutrient that is vital to health. In fact, a vitamin C deficiency can destroy almost everything from immune function to skin health to energy levels. In the long term, it can have even more serious consequences, including a higher risk of chronic diseases and certain health conditions.
  • Vitamin C is obtained from eating a wide variety of fruits and vegetables, including citrus fruits like oranges, kiwi, berries, and leafy greens. Many people get extra vitamin C from supplements. Your body cannot make its own vitamin C and it is important to have a steady supply of it in your diet as it is regularly flushed out of your body via the urine.
  • What Happens When Vitamin C Is Low? The deficiency disease associated with vitamin C is scurvy, which is characterized by symptoms such as bleeding gums, loose teeth, and skin rashes. The symptoms of a deficiency don't stop there, however. Some of the other common signs of vitamin C deficiency include fatigue, depression, swelling, and poor immune function.

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Definition: What is vitamin C?

Vitamin C is a water-soluble vitamin found in abundance in fruits and vegetables. It is an essential nutrient that people need to get from their diet or supplements.

citrus fruits

Citrus fruits like lemons are high in vitamin C. (Image source: Hayley Maxwell/unsplash)

Vitamin C, also known as ascorbic acid, is perhaps best known for its antioxidant properties - properties it retains due to its ability to donate electrons to oxidized molecules.

Background: What you should know about vitamin C deficiency

Before we pass on tips for solving vitamin C deficiency, you should learn some background information about this vitamin.

We want to answer these frequently asked questions for you in the following paragraphs.

What is the function of vitamin C in the body?

Vitamin C protects proteins, lipids and even DNA and RNA in your body, even at low levels, from reactive oxygen species produced during normal metabolism and from exposure to toxins (e.g. cigarette smoke and air pollution).

Vitamin C is also involved in the biosynthesis of collagen, carnitine and catecholamines. As such, vitamin C is involved in immune function, wound healing, fatty acid metabolism, neurotransmitter production, and blood vessel formation, among other key processes and pathways. (1)

Intravenous (IV) vitamin C has also shown promise in treating viral infections and cancer, while vitamin C is also involved in how your body processes other vitamins such as vitamin E, which it regenerates from its oxidized form. Vitamin C also makes iron more bioavailable from dietary sources because it improves gut absorption of non-heme iron.

Vitamin C in extremely high doses acts as an antiviral drug and actually kills viruses. Vitamin C can protect against respiratory diseases. In one study, people with the highest levels of vitamin C were 15% less likely to develop respiratory disease and 46% less likely to die from lung cancer than people with the lowest levels. (2)

Vitamin C is known for its support in lung defenses, which takes on new meaning amid the COVID-19 pandemic.

What is the daily requirement of vitamin C?

The recommended dietary intake for vitamin C varies according to age, gender and life stage of healthy people. Needs are fairly high in infancy, decrease slightly in childhood, and peak in early adulthood. Pregnancy and lactation increase a woman's need for vitamin C. Vitamin C is contained in breast milk and serves as an antioxidant for breast milk. (3)

People who smoke and drink usually have a higher vitamin C requirement.

The goal of following the recommended dietary intake is to maintain an optimal blood concentration of approximately 50 micromoles per liter of blood to prevent oxidation of low-density lipoproteins.

Indicators used to estimate this requirement include the vitamin's ability to provide neutrophils with antioxidant protection against reactive oxygen species generated during phagocytosis; prevent DNA and chromosome damage; improve immune function; Facilitate collagen metabolism and carnitine biosynthesis; and maintain periodontal health. (4)

Old Men Women
0-6 months 40 mg 40 mg
7-12 months 50 mg 50 mg
1-3 years 15 mg 15 mg
4-8 years 25 mg 25 mg
9-13 years 45 mg 45 mg
14-18 years 75 mg 65 mg (pregnancy - 80mg
breastfeeding -115g)
19+ years 90 mg 75mg (pregnancy - 85mg
breastfeeding -120g)

A tolerable upper intake limit of 2,000 milligrams per day was set to reduce the risk of gastrointestinal complications commonly associated with higher doses of vitamin C, such as diarrhea. However, there is no scientific evidence that vitamin C given in doses up to 10 grams per day in adults is toxic or harmful.

What types of vitamin C are there?

There are basically three types of vitamin C:

  • Pure ascorbic acid
  • Natural Vitamin C
  • mixed forms

The nutritional supplement market is exploding. Vitamin C supplements are in demand. The two types of vitamin C are often mistaken for the same thing. The difference lies in the production or in the event. In the following section, the individual advantages and disadvantages are described so that you can keep an overview in the confusion of the possibilities.

Pure ascorbic acid

Pure ascorbic acid only looks like natural vitamin C from a chemical point of view, i.e. from the outside. Important plant substances and enzymes are missing. These are important for absorption and tolerability. Furthermore, the pure ascorbic acid is isolated and concentrated, so that an excess can quickly arise.

Advantages
  • Used as a preservative
  • cheaper
Disadvantages
  • natural plant substances and enzymes are missing
  • Poorly absorbed by the body
  • Isolated and concentrated, so excess quickly
  • The pure ascorbic acid is mainly used in the food industry. There it serves as a stabilizer and preservative (abbreviation: E 300). For example, it is added to fruit juices and other sweetened drinks or preserves. Another plus can be found in the production. Since the ascorbic acid only needs two additional components during production in the laboratory, production is cheaper than the natural complex.

    Natural Vitamin C

    Natural vitamin C is found in fruits and vegetables. It is a complex as it contains natural enzymes, vital substances, bioflavonoids. These substances contribute to a high bioavailability. This means that the natural vitamin C is well absorbed and tolerated.

    It should be noted that vitamin C is heat and light sensitive. Conscientious storage is imperative - this applies to food supplements and food.

    Advantages
    • Higher bioavailability easily usable by the body
    • Not isolated (= complex contains enzymes, vital substances, bioflavonoids)
    • Longer duration of action
    • Easier to tolerate
    Disadvantages
  • Does not tolerate heat
  • sensitive to light
  • Finally, natural sources of vitamin C should be mentioned. It can be found in acerola berries, rose hips, citrus fruits, kiwi, mango, potatoes, cabbage or parsley. Food should be eaten fresh and, if possible, raw.

    mixed forms

    In addition to the two variants, there is also a third: the mixed form. These preparations combine the advantages of the natural complex with the inexpensive ascorbic acid. The pure ascorbic acid is added to keep the price down.

    The advantages and disadvantages depend on the mixing ratio. Basically, one can say that a natural complex is healthier, but it is not affordable for everyone in the long term.

    Advantages
    • cheaper
    • Also complex, depending on the mixing ratio
    • Higher bioavailability
    • Longer duration of action
    Disadvantages
  • Does not tolerate heat
  • Any other additives
  • It should be noted that superfluous release agents or preservatives are often added to the mixed forms. If possible, when choosing the preparation, the one with the fewest additives should be used.

    What are the causes of vitamin C deficiency?

    Vitamin C deficiency is particularly uncommon in developed countries. However, it can often be caused by malnutrition or a poor diet that lacks ingredients like fresh fruits and vegetables. Conditions such as anorexia or an overly restrictive diet can also lead to a deficiency.

    Other possible causes of vitamin C deficiency are underlying health conditions that affect nutrient absorption, such as Crohn's disease and ulcerative colitis. Smoking can also increase the risk of deficiency, which is why smokers need a higher amount of vitamin C per day to meet their needs.

    What foods contain vitamin C?

    Vitamin C is widely found in fruits and vegetables. Although citrus fruits are synonymous with vitamin C, the highest levels of vitamin C (per 100-gram serving) are found in guavas, kiwis, and peppers. Vitamin C is easily destroyed by excessive heat and water, as well as exposure to air.

    Cooking food destroys about 25 percent (or more) of the vitamin C found in food.

    Animal muscle meat, for the most part, is a very poor source of vitamin C. Organ meats such as cooked beef spleen, lung, and thymus contain moderate amounts (50 milligrams or less per serving) of vitamin C, but these cuts of meat are rarely eaten by the public.

    A commonly consumed cut like corned beef brisket contains about 27 milligrams per serving when raw. However, boiling will significantly reduce this, especially since corned beef needs to cook in a water bath for several hours.

    Groceries Vitamin C per 100g
    acerola 1700 mg
    rose hip 1250 mg
    sea ​​buckthorn berry 450 mg
    guava 273 mg
    Blackcurrant 177 mg
    paprika 120 mg
    broccoli 115 mg
    Cauliflower 112 mg
    Kale 105 mg
    Rowan (rowan fruit) 100 mg

    Of more than 950 beef items listed in the USDA's Food and Nutrition Database, only 21 contain any vitamin C at all, and most contain negligible amounts that would be lost in cooking.

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    What are the symptoms of vitamin C deficiency?

    The classic manifestation of severe vitamin C deficiency is scurvy, characterized by bleeding, swollen gums, poor wound healing, joint pain and bruising. Clinical features of scurvy appear after 84 to 97 days of vitamin C deficiency. (5)

    As scurvy progresses, it can cause shortness of breath, dry eyes, joint swelling, weakness, fatigue, and depression.

    Taking less than 10 milligrams of vitamin C daily can cause scurvy.

    Interestingly, some disease states induce vitamin C status at scurvy levels. The prevalence of deficiencies varies by population. The rate is just 7 percent for people living in the United States, and more than 73 percent for people living in parts of Central Asia.

    Interestingly, a population-based, cross-sectional study of nearly 150 patients admitted to a major teaching hospital in Canada found that 60 percent of the patients had suboptimal plasma levels of vitamin C and 19 percent were deficient, with levels approaching those of scurvy. (6)

    In addition to scurvy, the most well-known vitamin C deficiency disease, other symptoms of vitamin C deficiency are: fatigue, impaired wound healing, chronic pain, swelling, weak bones, poor immune function, corkscrew hair, weight gain, rough skin, shortness of breath, depression, bleeding gums, loose teeth, anemia, easy bruising, dry skin, red patches of skin, spoon-shaped fingernails.

    How does a vitamin C overdose manifest itself?

    Although not very common, high doses of vitamin C in supplement form can cause "vitamin C toxicity," which is characterized by a number of side effects. Possible negative side effects of vitamin C can include digestive problems such as diarrhea, nausea or abdominal cramps, as well as insomnia, excessive iron intake and possibly kidney stones.

    When too much of this vitamin builds up in the body, vitamin C side effects can potentially include:

    • Digestive problems such as diarrhea, nausea or abdominal cramps
    • heartburn
    • Headache
    • insomnia / insomnia
    • Skin flushing and redness
    • accumulation of iron

    In rare cases, kidney stones, increased oxidative stress, and excessive iron intake develop. While eating foods that provide vitamin C is not dangerous and does not cause overdose, taking vitamin C supplements in very high doses can be problematic.

    Usually, treatment with an overdose of vitamin C is not necessary because the body can excrete vitamin C in the urine fairly quickly.

    However, sometimes an overdose/toxicity can lead to complications if it persists. Some people taking high doses of vitamin C may develop problems due to iron accumulation, urine becoming too acidic, and the antioxidant balance in the body being disrupted.

    Certain people are more likely to experience vitamin C side effects if they are taking medications that may interact with vitamin C or if they have a medical condition that affects the absorption of this vitamin. In supplement form, especially in high doses, vitamin C can interact with a number of drugs.

    To be safe, vitamin C should not be taken without medical supervision if you are taking any of these medicines:

    • Certain cancer treatments (possibly chemotherapy)
    • Hormone replacement therapy/birth control pills that contain estrogen
    • aspirin
    • Statins / drugs to control cholesterol levels
    • niacin
    • aluminum
    • Blood thinning medications such as warfarin (Coumadin)
    • Antipsychotics (such as luphenazine or prolixin)
    • The antiretroviral drug called Crixivan

    In summary, the side effects of vitamin C are usually of little concern since vitamin C is not stored in the body and excess amounts are excreted. In general, overdosing on water-soluble vitamins isn't easy, but it's still important to stay within the safe limit of 2,000 milligrams per day.

    Vitamin C deficiency: effective approaches to treatment and prevention

    With proper treatment, many symptoms of vitamin C deficiency can be easily resolved within a few weeks. For example, problems such as hair loss associated with vitamin C deficiency, impaired wound healing, and dry skin often resolve soon after vitamin C deficiency is diagnosed and treatment is started.

    To avoid a possible vitamin C deficiency, you can take some preventive measures. These are broken down in more detail in the following paragraphs.

    change nourishment

    The easiest and most effective treatment for vitamin C deficiency is to simply start by changing your diet. Fruit and vegetables are particularly rich in vitamin C and can usually provide enough for your daily needs with just a few servings.

    healthy food

    Vitamin C is very sensitive to heat and light. Therefore, eat foods containing vitamin C as fresh as possible and do not store them for long. (Image source: Dan Gold / unsplash)

    In fact, including a variety of healthy, nutrient-dense, whole foods in your diet can help ensure you're getting enough of this essential vitamin each day to prevent vitamin C deficiency and weight gain, compromised immunity and anemia, among other deficiency symptoms.

    Eating a healthy, balanced diet can virtually eliminate the risk of vitamin C deficiency diseases for most people and reduce short-term symptoms like skin changes, bleeding gums, and easy bruising within a few weeks.

    Take preparations & dietary supplements

    In some cases, supplementation may also be recommended to treat a deficiency. Adult men and women are recommended to consume at least 90 milligrams and 75 milligrams of vitamin C per day, respectively. However, these needs are increased in both smokers and pregnant or breastfeeding women.

    If you suspect that you may have a vitamin C deficiency, it is best to consult a trusted doctor to determine the best course of treatment for you.

    Conclusion

    Vitamin C deficiency is relatively rare in developed countries but still affects more than 1 in 20 people. Because humans cannot manufacture vitamin C or store it in large amounts, it must be consumed regularly to avoid deficiency, ideally through fresh fruits and vegetables.

    There are many signs and symptoms of deficiency, most of which are related to impaired collagen production or insufficient antioxidant consumption. Some of the earliest signs of a deficiency are fatigue, red gums, easy bruising and bleeding, joint pain, and rough, bumpy skin.

    As the deficiency progresses, bones can become brittle, nail and hair deformities can develop, wounds can take longer to heal, and the immune system suffers. Inflammation, iron deficiency anemia, and unexplained weight gain may be other signs to look out for. Fortunately, deficiencies are usually resolved once vitamin C levels are restored.

    Individual proofs(6)

    1. Dahl, Helen, and Miklos Degré (1976) "The effect of ascorbic acid on production of human interferon and the antiviral activity in vitro" Acta Pathologica Microbiologica Scandinavica Section B Microbiology 84B, no. 5 (August 2009): 280–84. Source
    2. Myint PK, Wilson AM, Clark AB et al. Plasma vitamin C concentrations and risk of incident respiratory diseases and mortality in the European Prospective Investigation into Cancer-Norfolk population-based cohort study. Eur J Clin Nutr 73, 1492-1500 (2019) Source
    3. Elisia, I., and DD Kitts. Quantification of hexanal as an index of lipid oxidation in human milk and association with antioxidant components J Clin Biochem Nutr 49, no. 3 (November 2011): 147-52. Source
    4. Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and Recommendations for Vitamin C Intake. JAMA. 1999;281(15):1415-1423. Source
    5. Robert E Hodges MD James Hood MD John E Canham MD Howerde E Sauberlich PhD Eugene M Baker PhD Clinical manifestations of ascorbic acid deficiency in man The American Journal of Clinical Nutrition, Volume 24, Issue 4, April 1971, Pages 432-443 Source
    6. Gan, Runye, Shaun Eintracht, and L. John Hoffer. Vitamin C Deficiency in a University Teaching Hospital Journal of the American College of Nutrition 27, no. 3 (June 2008): 428-33 Source
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