When I was in University, there was a story going around that two students made a friendly wager to see who could go the longest subsisting on a diet of the cheap student-staple; macaroni and cheese. So the story goes that the competition came to a screeching halt when one of the students developed fatigue, swollen gums, and leg pain. He went to the hospital, where he was diagnosed with scurvy, an illness caused by Vitamin C deficiency. Now, whether this is a true story or an apocryphal tale passed down to scare new students moving into their halls of residence into eating properly, is yet to be determined at the hallowed halls of this top-ranking university but, what it does serve to illustrate is that scurvy isn’t necessarily a sailor-specific condition.
Vitamin C – beyond Scurvy
Before the discovery of vitamin C in 1928 made scurvy a disease of the past, vitamin C deficiency disease was a major cause of illness, afflicting some two million sailors, whose diets were lacking in this nutrient.[1] (It was for this reason that the “winner” of the bet reportedly earned himself the nickname “Pirate!”)
Although most mammals can synthesise vitamin C (ascorbic acid) within their bodies, humans cannot – along with apes, bats, and guinea pigs.[3],[2] This means we must consume vitamin C in our diets (and sometimes in supplement form).
Although most people associate it with immune support,[4],[5] vitamin C also plays an integral role in connective tissue health. Vitamin C promotes the synthesis of osteoblasts (the cells that produce bone) and stimulates chondrocytes (the cells that make cartilage), thereby supporting the joints and bones. It further enhances bone and joint health by acting as a powerful antioxidant, thereby protecting the tissues. Ascorbic acid is likewise an essential cofactor for the synthesis of collagen and elastin, the substances that make our tissues both strong and flexible (and keep our skin from sagging with age). Vitamin C thus helps fortify the walls of the blood vessels,[6] protect the nerves,[7] and heal the skin.[8]
Vitamin C for bone density and Osteoporosis
Several studies have demonstrated vitamin C’s effect in supporting bone mineral density (BMD) and preventing osteoporosis.[9],[10],[11],[12] This news is of particular relevance to people above the age of 50, as research suggests that roughly half of all women and one in four men age 50 and older will suffer an osteoporosis-related bone fracture.[13]
On the cellular level, bone density and integrity is greatly influenced by the delicate balance of osteoclasts, the types of cells that resorb (break down) bone, and osteoblasts, the cells that make new bone.
The conventional treatment for osteoporosis often includes bisphosphonate drugs, which have been shown to suppress osteoclast function and thus slow bone degradation, but which have not been shown to stimulate osteoblast formation. Vitamin C, however, supports both sides of the equation. In addition to suppressing osteoclast function, vitamin C has also been shown (in animal studies) to support osteoblastogenesis, the production of more of the cells that create bone.[14]
In addition to suppressing osteoclast function, vitamin C has also been shown (in animal studies) to support osteoblastogenesis, the production of more of the cells that create bone.
Antioxidant nutrients like resveratrol and maritime pine bark extract have likewise been shown to reduce osteoclast breakdown of bone and improve osteoblast function.[15],[16]
In a survey of 1,196 postmenopausal women aged 50 years and older, higher dietary vitamin C intake was positively associated with BMD, especially in women with vitamin D deficiency. The researchers also found that the women who had osteoporosis ate diets significantly lower in vitamin C than the women without the disease.[17]
In another cross-sectional study, 189 postmenopausal Korean women were asked to complete a questionnaire regarding their consumption of various food groups and nutrients, and the women’s BMD was then calculated (lumbar spine, femoral neck, and total hip). The women who ate diets rich in vitamin C were more likely to have a higher lumbar spine and total hip T-scores (a measurement of bone density). Frequent vegetable consumption was also associated with higher femoral neck and total hip T-scores.[18]
Vitamin C and arthritis
Osteoarthritis (OA) is among the most prevalent joint diseases and a major cause of disability among the elderly.[19]
In addition to vitamin C’s ability to structurally support the bones, it also reduces tissue changes that contribute to OA by acting as an antioxidant.[20] This is because oxidative stress degrades cartilage and causes dysfunction of chondrocytes (the cells that make cartilage).[21]
If oxidative stress can cause OA, and if vitamin C is a powerful antioxidant, could vitamin C then play a role in OA prevent or treatment? Quite likely: Research has shown that vitamin C intake not only reduces the risk of cartilage loss but also decreases the risk of developing OA.[22],[23],[24]
Research has shown that vitamin C intake not only reduces the risk of cartilage loss but also decreases the risk of developing osteoarthritis.
In addition to preventing OA, vitamin C may also slow the progression of the disease in those already afflicted. Of the pathological changes seen in OA – changes like inhibited cell growth and cell death, increased oxidative stress, and proteoglycan loss – all were reduced in rats with OA upon taking vitamin C. Surprisingly, however, the 100 mg/kg dosage was more efficient than the 200 or 300 mg/kg dosages, suggesting that high doses aren’t necessarily more effective.[25] In another rat study, vitamin C was found to have a synergistic effect with platelet-derived growth factor injections, preventing OA progression more than the growth factors alone.[26]
Vitamin C for oral health
Vitamin C has also been shown to be of value in preventing periodontitis, a condition in which inflammation of the tissue around the teeth can result in gum shrinkage and loosening (or even loss) of the teeth. We have previously blogged about how oral health is rapidly being linked to systemic health so looking after teeth and gums is now believed to be key in preventing linger term chronic disease.
Mouth/Body/Health Connection: Why We Shouldn’t Ignore the Oral Microbiome
In one study of 10,930 Korean adults age 19 years and older, those with inadequate dietary vitamin C intake were 1.16 times more likely to have periodontitis than those with sufficient intake.[27]
Those with inadequate dietary vitamin C intake were 1.16 times more likely to have periodontitis than those with sufficient intake.
In another study examining periodontal health in smokers, it was found that smokers who ate diets rich in fruits, vegetables, and vitamin C were less likely to develop PD after scaling and root planing (a treatment to manage periodontal disease).[28]
Vitamin C Supplements
Although nowadays most of us aren’t at risk of developing scurvy (barring any ill-contrived bets, that is), even slightly low vitamin C levels can still carry negative implications for our health, and mild to moderate vitamin C deficiencies are still common.
Thankfully, many fruits are rich in vitamin C, such as citrus fruits, strawberries, cantaloupe, and currants. Fresh vegetables, like Brussels sprouts, lettuce, cabbage, peas, collard greens, and asparagus are likewise good sources.[29]
Vitamin C supplements are also readily available, with buffered preparations such as ascorbate forms of vitamin C being gentler on the digestive system than the forms such as ascorbic acid. Bioflavonoids are also often included in vitamin C supplements to enhance absorption.
However, there’s a new vitamin C kid on the block that may have even better bioavailability and absorption capacity.
A liquid vitamin C uses only naturally pure ingredients to provide a high absorption form of Vitamin C in pure essential phospholipids. One specific brand (Qualiâ-C) goes one step further using non-GMO sunflower lecithin so is soya-free.
What’s unique about Qualiâ-C is the soy-free liposome delivery system, which uses unilamellar liposomes (i.e. single bilayer) that are 2 to 8 times smaller than other Vitamin C liposome delivery products.
Benefits of this advanced liposomal delivery system include:
- Faster absorption starting in the mouth, as the liquid vitamin C is drunk, throughout the upper intestines.
- The smaller liposomal delivery system may also help escort vitamin C into cells and tissues.
- Perhaps most importantly, the liver and spleen’s filtration systems do not scavenge the smaller liposomes in the liquid vitamin C allowing longer retention in the body.
- Small liposomes avoid gastrointestinal side effects (e.g. laxative action) that can occur with high oral doses of some forms of vitamin C.
- The resulting product is easy to pour liquid instead of a strong tasting ‘gunk’ that can result from soy-based liposome products.
- Soy-free product.
So there really is a vitamin C supplement for all the family! In terms of supporting bone and joint health then Vitamin C also combines particularly well with other connective-tissue supportive nutrients like calcium, magnesium, zinc, copper, manganese, selenium, and boron.
If you want any more information in the area of bone support then please enjoy the Nutrigold education article on Preventing Osteoporosis.
Further reading from Nutrigold:
Addressing Allergies: A Functional Nutrition Approach to Hayfever
Is a Vegan Diet Healthy?
Do Alkaline Diets Really Work?
Antioxidants work at different speeds
Nutritional Support For Joint and Bone Health
How Healthy Are Your Joints & Bones?
References
[1] Carpenter KJ. The discovery of vitamin C. Ann Nutr Metab. 2012;61(3):259-64.[2] Linster CL, Van Schaftingen E. Vitamin C biosynthesis, recycling and degradation in mammals. FEBS J. 2007 Jan; 274(1):1-22.
[3] Yang H. Conserved or lost: molecular evolution of the key gene GULO in vertebrate vitamin C biosynthesis. Biochem Genet. 2013 Jun;51(5-6):413-25.[4] Block G. Epidemiologic evidence regarding vitamin C and cancer. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1310S-4S.
[5] Carr AC, Maggini S. Vitamin C and immune function. Nutrients. 2017 Nov 3;9(11). pii: E1211. [6] May JM, et al. How does ascorbic acid prevent endothelial dysfunction? Free Radic Biol Med. 2000 May 1;28(9):1421-9. [7] Noto Y. [Ascorbic Acid and Charcot-Marie-Tooth Disease]. Brain Nerve. 2015 Oct;67(10):1241-6. [8] Ringsdorf WM Jr, et al. Vitamin C and human wound healing. Oral Surg Oral Med Oral Pathol. Mar 1982;53(3):231-6. [9] Morton DJ, et al. Vitamin C supplement use and bone mineral density in postmenopausal women. J Bone Miner Res. Jan2001;16(1):135-40. [10] Hall SL, Greendale GA. The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study. Calcif Tissue Int. Sep1998;63(3):183-9. [11] Wang MC, Luz Villa M, Marcus R, Kelsey JL. Associations of vitamin C, calcium and protein with bone mass in postmenopausal Mexican American women. Osteoporos Int. 1997;7(6):533-8. [12] Leveille SG, et al. Dietary vitamin C and bone mineral density in postmenopausal women in Washington State, USA. J Epidemiol Community Health. Oct1997;51(5):479-85.What is osteoporosis and what causes it? [Internet]. National Osteoporosis Foundation. [Cited 30 November 2018]. Available from: https://www.nof.org/patients/what-is-osteoporosis/
[14] Gabbay KH, et al. Ascorbate synthesis pathway: the dual role of ascorbate in bone homeostasis. Journ Biol Chem. 18 June 2010;285:19510-20. [15] Mizutani K, et al. Resveratrol stimulates the proliferation and differentiation of osteoblastic MC3T3-E1 cells. Biochem Biophys Res Commun. 1998 Dec 30;253(3):859-63. [16] Hasegawa N, Mei L, Mochizuki M. Pycnogenol® enhances proliferation and mineralization in osteoblast-like MC3T3-E1 cells. Phytopharmacology. 2013;4(3):569-74. [17] Kim YA, et al. Favorable effect of dietary vitamin C on bone mineral density in postmenopausal women (KNHANES IV, 2009): discrepancies regarding skeletal sites, age, and vitamin D status. Osteoporos Int. 2015 Sep;26(9):2329-37. [18] Kim DE, et al. Relationship between bone mineral density and dietary intake of β-carotene, vitamin C, zinc and vegetables in postmenopausal Korean women: a cross-sectional study. J Int Med Res. 2016 Oct;44(5):1103-14. [19] Rahmati M, et al. Inflammatory mediators in osteoarthritis: a critical review of the state-of-the-art, current prospects, and future challenges. Bone. 2016 Apr; 85:81-90. [20] Padayatty SJ, et al. Vitamin C as an antioxidant: evaluation of its role in disease prevention. J Am Coll Nutr. 2003 Feb; 22(1):18-35. [21] Chang Z, et al. Ascorbic acid provides protection for human chondrocytes against oxidative stress. Mol Med Rep. 2015 Nov;12(5):7086-92. [22] Li H, et al. Associations between dietary antioxidants intake and radiographic knee osteoarthritis. Clin Rheumatol. 2016 Jun; 35(6):1585-92.McAlindon TE, et al. Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum. 1996 Apr; 39(4):648-56.
[24] Chang Z, et al. Ascorbic acid provides protection for human chondrocytes against oxidative stress. Mol Med Rep. 2015 Nov; 12(5):7086-92. [25] Chiu PR, et al. Vitamin C protects chondrocytes against monosodium iodoacetate-induced osteoarthritis by multiple pathways. Int J Mol Sci. 2016 Dec 27;18(1).pii: E38. [26] Azizi S, et al. Intra-articular effects of combined xenogenous serum rich in growth factors (SRGF) and vitamin C on histopathology grading and staging of osteoarthritis in the rat model. Transfus Clin Biol. 2018 Aug 25;pii: S1246-7820(18)30245-3. [27] Lee JH, et al. The association of dietary vitamin C intake with periodontitis among Korean adults: Results from KNHANES IV. PLoS One. 2017 May 10;12(5):e0177074. [28] Dodington DW, et al. Higher intakes of fruits and vegetables, β-Carotene, vitamin C, α-tocopherol, EPA, and DHA are positively associated with periodontal healing after nonsurgical periodontal therapy in nonsmokers but not in smokers. J Nutr. 2015 Nov;145(11):2512-9. [29] Marz R. Vitamin C. In: Medical Nutrition from Marz. 2nd ed. Portland, OR: Omni-Press; 2002.
