Vitamin C

Vitamin C, also known as ascorbic acid, is one of thirteen essential vitamins. This nutrient is considered an essential vitamin because of its numerous physiological health benefits. Vitamin C's two major functions are as an antioxidant and enzyme cofactor. We need to consume essential vitamins through diet because our body cannot produce these nutrients on its own, or make enough of it to sustain healthy body functions.

Vitamin C is a water-soluble vitamin, meaning it dissolves in water and isn't stored in our fatty tissue or liver like fat-soluble vitamins, such as Vitamin D. It is rare to develop harmful side effects with these water-soluble vitamins because they are easily flushed out of the body. Thus, high dose supplementation might be a reasonable complement to a healthy lifestyle

4 Musculoskeletal Benefits of Vitamin C

 

1. Vitamin C Supports Joint Health

Vitamin C is a key participant in the production of glycosaminoglycans(GAGs).

An example of a glycosaminoglycans is hyaluronic acid. These molecules provide the high negative charge that attracts water molecules into the cartilage extracellular matrix. This water cushion allows cartilage to act as a shock absorber. Additionally, vitamin C is a vital ingredient in the production of collagen. Collagen makes up to 20% of cartilage mass and is an all important contributor to cartilage strength.

 

Unhealthy joints have been associated with low vitamin C intake. Researchers in Boston found a threefold reduction of unhealthy joints when study participants consumed 75 mg or more of vitamin C per day. (McAlindon et al. ARTHRITIS & RHEUMATISM Vol. 39, No. 4, April 19%, pp 648-6656.)

 

To test the hypothesis that more vitamin C in the diet can reduce pain and improve function, Danish scientists performed a multicenter, double-blind, randomized, placebo-controlled trial in patients with unhealthy hips and knees. Subjects were treated with 1000 mg/day of vitamin C for 14 days. The vitamin C treatment group experienced significant pain reduction and function improvement compared to the placebo group. (Jensen et al. Ugeskr Laeger. 2003 Jun 16;165(25):25636.)

 

2.  Vitamin C Supports Bone Health

Free radical damage leads to increased activity of bone resorbing cells called osteoclasts. Vitamin C helps combat free radical injury and potentially osteoclast activation. Moreover, scientists have demonstrated that vitamin C helps provide a favorable environment for the growth of new bone producing cells called osteoblasts.

Also, 90% of organic  bone is composed of collagen. As previously noted, vitamin C is required for  properly functioning collagen . Vitamin C helps cross link collagen and helps give bone tensile strength. In the absence of sufficient vitamin C, bones would be brittle and break easily.

 

American investigators looked at the relationship between vitamin C intake and bone mineral density. The author’s concluded higher vitamin C intake was associated with high bone mineral density. (Hall SL, Greendale GA. The relation of dietary vitamin C intake to bone mineral density: results from the PEPI study. Calcified tissue international. 1998; 63(3):183–189. [PubMed: 9701620])

 

 

3. Vitamin C Support Muscle Health

Healthy, vibrant muscle cells are important for sustaining strength, endurance, and function. Muscle cells possess large amounts of mitochondria. As the primary energy generator of the cell, mitochondria generate many free radicals. Excessive exposure to free radicals causes premature aging of muscle. Vitamin C’s powerful anti-oxidant properties helps protect the vulnerable muscle cells.

Additionally, vitamin c is a required cofactor for the synthesis of L-carnitine. L-carnitine facilitates the transport of fatty acids into the mitochondria.The mitochondria is the power generator of the cell and its favorite fuel is fat. 

The mitochondria turns fatty acids into packets of energy called ATP. The more ATP your mitochondria produces the more energy you have. The cell uses this energy to repair damaged internal machinery, support normal cellular function, and grow new muscle.

Researchers in West Virginia evaluated the effect of vitamin C on chronically overused leg muscles of rats. The researchers demonstrated that vitamin c was associated with a reduction in markers of oxidative stress and boosted of the rats anti-oxidant enzymes.(Ryan et al. Vitamin E and C supplementation reduces oxidative stress, improves antioxidant enzymes and positive muscle work in chronically loaded muscles of aged rats. Exp Gerontol. 2010 Nov; 45(11): 882–895.)

 

 

4. Vitamin Supports Tendon Health

Healthy tendons need collagen to function properly. In fact, tendons are  90% collagen by dry weight. As noted before, collagen confers on tendons the proper amount of strength that is needed to transfer the force generated by muscle to bones.

 

Turkish researchers investigated the effect of Vitamin C on unhealthy rat Achilles tendons. The treatment group demonstrated significantly greater new tendon cells synthesis compared to non treatment group.(Omeroglu et al. High ­dose vitamin C supplementation accelerates the Achilles tendon healing in healthy rats. Arch Orthop Trauma Surg. 2009 Feb;129(2):281­6. doi: 10.1007/s00402­008­0603­0. Epub 2008 Feb 29.)

Other Health Benefits

There are other conditions that vitamin C may assist, although more research is needed and for some conditions results to date have been mixed. Those include:

  • Supports heart health
  • Boosts brain health
  • Promotes eye health
  • Enhances blood sugar health
  • Supports lung health

 

Rich Sources of Vitamin C

Fruits and vegetables are rich sources of vitamin C.

 

Recommended Dietary Allowance (RDA)

The Food and Nutrition Board has developed a table of recommended dietary allowances (RDAs) of vitamin C, based on age and gender. 

For adults over age 19:

  • Men, 90 mg daily
  • Women, 75 mg daily
  • Pregnant women, 85 mg daily
  • Breastfeeding mother, 120 mg daily

Adequate Intakes (AIs) for children:

  • Infants 0 to 6 months, 40 gm daily
  • Infants 7 to 12 months, 50 gm daily

For teens and children the RDAs are:

  • Toddlers 1 to 3 years, 15 mg daily
  • Children 4 to 8 years, 25 mg daily
  • Children 9 to 13 years, 45 mg daily
  • Male teens 14 to 18 years, 75 mg daily
  • Female teens 14 to 18 years, 65 mg daily

 

Precautions

Vitamin C from natural foods is generally well tolerated. RDA amounts can be obtained from a balanced, healthful diet. 

The FNB has published an upper limit value of 2000 mg /day. 

Excessive intake of supplemental vitamin C may cause nausea, diarrhea, and kidney stones. 

Any consideration a supplementation should be discussed with a qualified health professional familiar with your unique medical history.

References

(2016). Vitamin C fact sheet for health professionals. National Institutes of Health. Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/

(2017). Vitamin C. Micronutrient Information Center. Retrieved from http://lpi.oregonstate.edu/mic/vitamins/vitamin-C

(2017). Vitamin C. The World’s Healthiest Foods. Retrieved from http://www.whfoods.com/genpage.php?tname=nutrient&dbid=109

Beren, J., Hill, S., Diener-West, M., & Rose, N. R. (2001). Effect of pre-loading oral glucosamine HCl/chondroitin sulfate/manganese ascorbate combination on experimental arthritis in rats. Exp Biol Med, 226(2), 144-51.

Canter, P. H., Wider, B., & Ernst, E. (2007). The antioxidant vitamins A, C, E and selenium in the treatment of arthritis: a systematic review of randomized clinical trials. Rheumatology, 46, 1223–1233 doi:10.1093/rheumatology/kem116

Das, A. & Hammad, T. A. (2000). Efficacy of a combination of FCHG49Y glucosamine hydrochloride, TRH122Y low molecular weight sodium chondroitin sulfate and manganese ascorbate* in the management of knee osteoarthritis. Osteoarthritis and Cartilage, 8, 343–350. doi:10.1053/joca.1999.0308

Jensen, N. H. (2003). Reduced pain from osteoarthritis in hip joint or knee joint during treatment with calcium ascorbate. A randomized, placebo-controlled cross-over trial in general practice. Ugeskr Laeger, 165(25), 2563-6.

Kurz, B., Jost, B., & Schunke, M. (2002). Dietary vitamins and selenium diminish the development of mechanically induced osteoarthritis and increase the expression of antioxidative enzymes in the knee joint of STR/1N mice. Osteoarthritis and Cartilage, 10, 119- 126. doi:10.1053/joca.2001.0489

McAlindon, T. E., Jacques, P., Zhang, Y., Hannan, M. T., Aliabadi, P., Weissman, B., & … Felson, D. T. (1996). Do antioxidant micronutrients protect against the development and progression of knee osteoarthritis? Arthritis Rheum, 39(4), 648-56.

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Peregoy, J. & Wilder, F. V. The effects of vitamin C supplementation on incident and progressive knee osteoarthritis: a longitudinal study. Public Health Nutrition, 14(4), 709–715 doi:10.1017/S1368980010001783

Schwartz, E. R., Leveille, C., & Oh, W. H. (1981). Experimentally-induced osteoarthritis in guinea pigs: Effect of surgical procedure and dietary intake of vitamin C. Lab Anim Sci, 31(6), 683-7.

Schwartz, E., & Adamy, L. (1977). Effect of ascorbic acid on arylsulfatase activities and sulfated proteoglycan metabolism in chondrocyte cultures. The Journal of Clinical Investigation, 60, 96- 106.

 

New SA, Bolton-Smith C, Grubb DA, Reid DM. Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. The American journal of clinical nutrition. 1997; 65(6):1831–1839. [PubMed: 9174480]

Simon JA, Hudes ES. Relation of ascorbic acid to bone mineral density and self-reported fractures among US adults. American journal of epidemiology. 2001; 154(5):427–433. [PubMed: 11532784]

Franceschi RT, Iyer BS, Cui Y. Effects of ascorbic acid on collagen matrix formation and osteoblast differentiation in murine MC3T3-E1 cells. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1994; 9(6):843–854.

Temu TM, Wu KY, Gruppuso PA, Phornphutkul C. The mechanism of ascorbic acid-induced differentiation of ATDC5 chondrogenic cells. American journal of physiology Endocrinology and metabolism. 2010; 299(2):E325–E334. [PubMed: 20530736]

Franceschi RT, Iyer BS. Relationship between collagen synthesis and expression of the osteoblast phenotype in MC3T3-E1 cells. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1992; 7(2):235–246.

Franceschi RT, Young J. Regulation of alkaline phosphatase by 1,25-dihydroxyvitamin D3 and ascorbic acid in bone-derived cells. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 1990; 5(11):1157–1167.

Xiao G, Cui Y, Ducy P, Karsenty G, Franceschi RT. Ascorbic acid-dependent activation of the osteocalcin promoter in MC3T3-E1 preosteoblasts: requirement for collagen matrix synthesis and the presence of an intact OSE2 sequence. Molecular endocrinology. 1997; 11(8):1103–1113. [PubMed: 9212058]

Ilich JZ, Brownbill RA, Tamborini L. Bone and nutrition in elderly women: protein, energy, and calcium as main determinants of bone mineral density. European journal of clinical nutrition. 2003; 57(4):554–565. [PubMed: 12700617]

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 Bergholm R, Makimattila S, Valkonen M. et al. Intense physical training decreases circulating antioxidants and endothelium­ dependent vasodilatation in vivo. Atherosclerosis. 1999;145:341–349. [PubMed: 10488962]

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Lawler et al. Living in a Box or Call of the Wild? Revisiting Lifetime Inactivity and Sarcopenia ANTIOXIDANTS & REDOX SIGNALING Volume 15, Number 9, 2011 DOI: 10.1089/ars.2011.3974

 Lucas J. Bader MD

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