Thursday, January 24, 2008

Vitamin C Requirements: Optimal Health Benefits vs Overdose

Even many of those who generally do not take Vitamin or Mineral supplements on a regular basis willstill take the odd Vitamin C tablet when feeling a cold coming on, compliments of Linus Pauling's best-seller "Vitamin C and the Common Cold," which rocketed the immune-enhancing effects of ascorbic acid to fame, and thanks to the many articles and books which since followed. While the recommended
daily or dietary allowance (RDA) stands now at 75 - 90 mg per day for adults, a higher dietary referenceintake (DRI) is again in review.

Regardless, many of those who regularly supplement Vitamin C, take inthe vicinity of 250 -1,000+mg per day, and there are those who take up to, and beyond 10,000 mg daily.

Headlines about oxidative damage (DNA mutations) attributed to taking Vitamin C in excess of 500 mg per day had many people step back and reconsider their supplemental routines. In addition, similarstudies had come to light just prior to the Vitamin C revelation about the potential problems of regularly supplementing Beta Carotene. This, however - as it turned out later - only applied to smokers who used higher doses of synthetic, but not natural sources of beta carotene, and which made the use of natural-source, mixed carotenoids the preferred choice and more popular.

Once the headlines on the possible DNA-damaging potential from taking higher doses of Vitamin C faded, most people continued where they left off and resumed their previous regimen again, especially following publications to the contrary which indicated that the original studies on Vitamin C were flawed, and that epidemiological data showed no evidence at all that higher amounts of ascorbic acid caused cancer. (see also Acu-Cell Disorders "Cancer").

However, questions on what daily amounts of Vitamin C could be considered to be an "overdose" stillcome up on a regular basis, to which unfortunately, there is no universal answer applicable to everyone, because overdosing on Vitamin C - just like overdosing on any other nutrient - is RELATIVE to the level of those elements that interact with Vitamin C. In other words, it all depends on their intake and ratio to Vitamin C.

Why do some people maintain good health without supplements?

If one analyzes people living to a ripe old age in reasonable health without the help of any supplements, one finds that they had a lot of odds in their favor. It usually starts with excellent genes, followed by alack of factors that tend to upset the biochemical balance necessary to maintain good health. Anythingupsetting that balance will either shorten someone's life, worsen its quality, or require compensationthrough extra nutritional support or drug intervention. A centenarian who never touched a supplement inhis life has likely maintained such a balance as a result of little "pro-oxidant" activity, which necessitatedlittle "antioxidant" activity -- just to mention one example.

On the other hand, let's assume a very healthy individual with similar longevity odds in his favor ends up with a serious injury early in life. The imbalance introduced to his previously sound chemistry by drugtreatments or organ damage will have him for the rest of his life search for compensatory factors toimprove the quality of life. Unlike before his injury, he is now in the same situation as those born lessfortunate health-wise, and may now have to become more reliant on better nutrition and/or additionalsupplementation. So the reason for supplementation, and the amounts needed change with individualcircumstances.

Even without previous injury, there are enough genetic variations or environmentally introduced factorsthat are responsible for some people to benefit from ingesting several grams of ascorbic acid per day,in contrast to those requiring no additional intake. The most common reason is that they likely exhibitexcessive levels of Vitamin C antagonists, or factors that inhibit Vitamin C activity. Of those, by far themost common one is copper, but there are others, such as excessive levels or intake of zinc, calcium,manganese, Vitamin E..., or very low levels of nickel, which support Vitamin C.

People with very high Copper levels rarely reach optimum levels of Vitamin C (i.e. optimal benefits),unless they take in excess of 1,000 mg / day, or unless they lower copper first through other means, and
I not only see patients supplementing Vitamin C in the 5 -10,000 mg range and just barely reach normal levels, but they start to suffer from medical symptoms as soon as they reduce that amount.

When exhibiting copper overload, or when there is a tendency to retain too much copper (which applies to a majority of the population), and if a multi-vitamin / mineral formulation is used, a brand should bechosen that is copper-free. Iron can be a problem for some people as well, but from personal clinicalexperience, iron overload is not the universal problem it has been made out to be by some sources.

In contrast, there may be those whose copper level is on the low side, and they feel a cold coming on, so they start to take a few grams of Vitamin C. Even after just a few days of doing so, copper levels may drop to a point of provoking an inflammatory response.

After I traced the first few cases of acute right-sided conjunctivitis to copper deficiency following a shortcourse of very high ascorbic acid intake by these individuals, subsequent cases were quite amused
when asked about - and confirmed - their recent Vitamin C "overdose" as soon as they walked into myoffice. Chronic conjunctivitis can occur from originally higher copper stores being more graduallydepleted as a result of continuously excessive intake of Vitamin C - or that of other copper antagonists,such as Sulfur (MSM, glucosamine sulfate).

In another chronic copper deficiency / high Vitamin C example, a young boy was brought into my office to investigate the reason why his leg bones were soft and becoming increasingly malformed. It turned out that his father was giving him 2,000 mg of Vitamin C a day, starting shortly after he was born, whichresulted in a severe, long-term copper deficiency. Reducing the Vitamin C to more reasonable levels, and recommending some copper-rich foods for the boy, normalized the problem.

Ascorbic acid lowers Zinc directly, and it lowers it indirectly by supporting iron uptake, so while higherintake of Vitamin C would likely be beneficial for those suffering from some forms of anemia, leukemia,
left-sided ovarian cysts, or from prostatitis, it could compromise benign prostatic hypertrophy, certain liver conditions (hemochromatosis), or more serious kidney disease (renal failure).

Larger amounts of Vitamin C lower Manganese levels and aid greater insulin production in thosecapable of producing insulin, which may be beneficial for Type II diabetics, but it would worsen thosewith hypoglycemic tendencies that exhibit low sodium, since sodium slows insulin response, so high intake of Vitamin C would create larger insulin spikes. (see also Acu-Cell Disorders "Hypoglycemia").

By lowering manganese, Vitamin C affects glycogen stores in the liver, decreasing the liver's ability to store larger amounts. Manganese has some control over the liver's ability to break down estrogen, so too much Vitamin C can affect the length of the menstrual cycle and worsen low estrogenic-types of PMS. On the other hand, congestive liver disease of the right large liver lobe will benefit from agreater intake of Vitamin C by reducing the symptoms of high estrogenic-types of PMS, while at thesame time reducing the risk of developing estrogen-sensitive types of cancers or (fibroid) tumors resulting from a lifelong higher mean average of estrogen.

Calcium metabolism is very much affected by Vitamin C intake. For patients who suffer from calcium overload, larger amounts of Vitamin C are an effective part of the daily regimen to keep calcium soluble
and prevent it from calcifying soft tissue. Frequently, low stomach acid levels are involved with elevated calcium as well, for which higher Vitamin C intake is also beneficial, however acidifying strategies such
as supplementing glutamic acid HCl with betaine HCl and pepsin are additionally required in most of these cases. Some patients also find pineapple juice, or apple cider vinegar helpful for their digestion
under high-calcium circumstances.

Proper amounts of Vitamin C increase bioavailability of average calcium levels, while very high intake of ascorbic acid will eventually put extra demands on calcium stores (bone) to make up calcium loss, which is also reflected in lower cellular levels of calcium. There are a lot of people whose copper and zinc levels are excessively high, so Vitamin C can be used as an ideal remedy because it is capable of lowering both, however the large amounts needed can at the same time significantly reduce calcium levels to the point of seriously accelerating bone loss. One way around that problem is using BufferedVitamin C, such as calcium ascorbate or sodium ascorbate (if kidneys can handle the extra sodium).

With low calcium, there are a number of possible symptoms such as insomnia or light / restless sleep,anxieties, leg cramps (left-sided only, unless magnesium is also low), increasing daytime fatigue, jointpains (more so left-sided), brittle nails with vertical ridges due to low calcium ratios, or increasinglyhorizontal groove-like ridges as a result of prolonged, severe deficiency, or gastrointestinal problems,
and others, depending on what else is affected in the body.

Some of my patients requiring very large doses of Vitamin C are now supplementing a small amount of Nickel, which has helped reduce Vitamin C requirements considerably, and with it the detrimentaleffects of higher dosages of ascorbic acid on the rest of the system (like lowering calcium too much), and also because of different forms of Vitamin C - such as sodium ascorbate for instance - not always being readily available in some areas.

While both - Vitamin C and Vitamin E - exhibit synergistic properties in respect to antioxidant activity, increasing the amounts of one also increases the requirements of the other, otherwise a ratio conflict
or balance problem in regard to nickel takes place, which can change vasodilating or vasoconstrictive properties of the coronary arteries. While this is generally not a big problem for the average, healthyindividual, it can be detrimental for those suffering from angina-related conditions. (see also Acu-Cell Nutrition "Nickel & Cobalt" which discusses the relationship of nickel to Vitamin C and Vitamin E).

So should one supplement or not?
The difference between healthy people who supplement Vitamin C and other basic nutrients, andhealthy ones who do not, can perhaps be compared to younger versus older people facing the same medical condition. Younger people simply tend to handle medical situations better, or recover fasterthan older ones. Supplementing may perhaps be compared to lowering someone's biological age.

The above graph illustrates what percentage of the population will enjoy optimal benefits from extra Vitamin C supplementation - not counting dietary sources of Vitamin C. These amounts are based onaverage, cellular requirements of Vitamin C, which go beyond the recommended deficiency-preventiveminimum intake (RDA / DRI). Instead, they consider the synergistic and antagonistic effect of all othernutrients that interact with Vitamin C as well, to encompass a much wider scope of disease prevention.

However even optimal requirements tend to fluctuate under specific medical circumstances and mayneed to be adjusted upwards to meet extra cellular demands (i.e. with injuries, viral / bacterial infections,
high stress situations, and other factors such as food binges [ chocolate ] resulting in copper overload).

If uncertain what one's actual requirements are, 500 mg of Vitamin C / day is universally considered to be safe and covers basic requirements, even though that amount will not be an optimal intake for agood portion of the population. In addition, it is better to use a basic multi-vitamin / mineral formulation with as many essential ingredients as possible, but not much higher than the RDA / DRI, despite the fact that this will also not provide optimal amounts of nutrients.

The reason is simply that no multi-formulation will ever provide all essential nutrients in their optimal configuration for everyone. Requirements not only vary from one person to another, but they even vary for the same person over a lifetime. In addition, the nutrients not provided will increasingly become deficient ratio-wise if a high-potency supplement is used. Unfortunately, optimal intake of Vitamin C
- or any other nutrient - can usually only be achieved by those who have the resources to measure theiractual individual requirements. "Bowel Tolerance" supplementation of Vitamin C only measures one'stolerance to the type of Vitamin C and the amounts used, but it does not reflect optimal intake.

Randomly megadosing on single nutrients (which includes Vitamin C) creates a risk of significantlyimbalancing one's system, and it makes little difference whether water-soluble vitamins like Vitamin C and B-vitamins are used or not. While excessive intake of fat-soluble vitamins as well as overdosing on a number of trace minerals can be toxic, even water-soluble nutrients can do an amazing amount of damage when regularly overdosed on during their sometimes short journey through the body.
Any time a single nutrient is supplemented at excessive amounts, one is really dealing with a much more powerful drug-like effect. And although this has a greater potential to help a medical situation, it equally has the potential of making a particular medical condition worse, or even create new ones if inappropriately used. Supplementing above-RDA / DRI amounts of Vitamin C will most certainly have a positive effect on most people's general health, however the decision to megadose on Vit C
(> 5,000 mg) - or any other nutrient - should at least be supported with some valid clinical reasons orevidence.

In most cases, it is the synergistic effect of several similar nutritional compounds that yield the best results because of their more food-like attributes, and their lesser chance of provoking side effects.
Rutin and Hesperidin are the main flavonoids / bioflavonoids - or accessory nutrients - that form an ascorbic acid or Vitamin C complex. Both function synergistically with Vitamin C in regard to
numerous health issues which are addressed further below. (see also Acu-Cell "Bioflavonoids").

Being educated about nutrition and trying to take control of one's health is highly commendable, but sometimes it certainly helps to have a medical professional check out what all that supplementation
is actually doing to one's system.
* * *
Ascorbic Acid / Vitamin C is an essential nutrient that Humans, as well as Apes and Guinea pigs must obtain from dietary sources. Most other animals produce ascorbic acid in the liver from glucose, and in much higher amounts than we get from our diets today.

Vitamin C is found mostly in fruits and vegetables, where the highest concentrations are in fresh, rawfoods, while whole grains, seeds, or beans contain very little Vitamin C, except when they are sprouted, which raises the ascorbic acid content. Similarly, animal foods contain almost no Vitamin C, although raw fish has enough to prevent deficiency symptoms.
Vitamin C is water-soluble and one of the leaststable vitamins. Cooking can destroy much of the Vitamin C content in food, and it is easily oxidized inair and sensitive to light. Being mostly contained in the watery part of fruits and vegetables, Vitamin Cis easily lost during cooking in water, so the steaming of vegetables minimizes its loss.

Ascorbic acid was isolated from lemons in 1932, following the discovery of its link to scurvy. It was first written about circa 1500 B.C. and described by Aristotle in 450 B.C. as a syndrome characterized by
lack of energy, tooth decay, gum inflammation, and bleeding problems. A high percentages of sailors with the British navy and other fleets used to die from scurvy until James Lind discovered that the juice of lemons could cure and also prevent the disease. The ships then routinely carried limes for the sailors to consume daily, and thus these sailors became known as "limeys." Only about 10 mg of Vitamin C is necessary to prevent scurvy.

Ascorbic acid is used up more rapidly with alcohol use, smoking, and under stressful conditions. Otherfactors that increase Vitamin C requirements include viral illness and fever, ASA and other medications
(sulfa antibiotics, cortisone), environmental toxins (DDT), and exposure to heavy metals such as lead,mercury, or cadmium. Vitamin C is involved in the formation and maintenance of collagen, which is the
basis of connective tissue found in capillary walls, skin, ligaments, cartilage, vertebral discs, joint linings, bones and teeth. Collagen, and thus Vitamin C, is needed for wound healing and to maintain healthy
blood vessels.

Vitamin C helps thyroid hormone production and the metabolism of folic acid, tyrosine, and tryptophan,and it stimulates adrenal function and the release of norepinephrine and epinephrine, which are stresshormones. However, prolonged stress depletes Vitamin C in the adrenals and decreases blood levels.

Ascorbic acid is further important in cellular immune functions, where it may be helpful against bacterial,viral, and fungal diseases. At higher amounts, Vitamin C may decrease the production of histamine,
thereby reducing allergy potential.

A combination of very high doses of Vitamin C + Vit E + Vit B12 has been found effective in lesseningthe symptoms of shingles (herpes zoster), provided they are all taken at the earliest onset of the attack.

Vitamin C helps the absorption of iron (particularly the vegetable, or non-heme form), so it is helpful for iron-deficiency anemia. Other conditions that benefit from ascorbic acid metabolism include diabetes (for insulin production), certain cases of male infertility, as well as arteriosclerosis, atherosclerosis, cataracts, glaucoma and musculoskeletal degeneration (mostly by Vitamin C keeping calcium soluble and preventing it from going to high).

When no other test methods are available, most doctors recommend the

"Bowel Tolerance Challenge"
for determining the optimal intake of Vitamin C - by ingesting increasing amounts of ascorbic acid until diarrhea sets in, then reducing Vitamin C to a tolerated dose, which - as mentioned above - only reflectssomeone's tolerance to the type of Vitamin C used, but it does not indicate actual requirements. ¤
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Dietary Reference Intake (DRI) is the latest term replacing daily dietary reference values such as Adequate Intake (AI *), Tolerable Upper Intake Level (UL), Estimated Average Requirements (EAR), Nutrient Reference Value (NRV), and Recommended Dietary Allowance / Intake (RDA / RDI).


Cellular / Intracellular Attributes and Interactions:
Vitamin C Synergists:Vitamin C Antagonists:

Nickel, Iron, phosphorus, germanium, selenium,Manganese, zinc, calcium, Vitamin E, tin, Vitamin A, adrenals, [cobalt, Vitamin B15], copper, [cobalt, Vitamin B12], estrogen, Low Levels / Deficiency - Symptoms and/or Risk Factors:

Scurvy, slow wound healing, anemia, easy bruising, shortness of breath, fatigue, nosebleeds, frequent infections, gastrointestinal problems, depression, chronic gingivitis, increased risk for various cancers,
impaired formation and maintenance of collagen, impaired multiple hormonal functions, dermatitis, arthritis, reduced insulin production, some types of male infertility, vascular degeneration, gallstones,

High levels / Overdose / Toxicity / Negative Side Effects - Symptoms and/or Risk Factors:

Diarrhea, abdominal cramps, high stomach acid, increased urination, insomnia, irritability, joint pains,osteoporosis, headaches, hypoglycemia, weakness, anemia, PMS, may increase infections by causing
copper deficiency, reduced estrogen, reduced progesterone, reduced prolactin,
______________________________________________________________________________
Vitamin C Sources:
Citrus fruit, green peppers, sweet and hot peppers, potatoes, spinach, parsley, cabbage, broccoli, Brussels sprouts, rose hips, black currants and other berries, tomatoes, horseradish, watercress. ¤
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General recommendations for nutritional supplementation: To avoid stomach problems and promote better tolerance, supplements should always be taken earlier, or in the middle of a larger meal. When taken on an empty stomach or after a meal, there is a greater risk of some tablets causing irritation, oreventually erosion of the esophageal sphincter, resulting in Gastroesophageal Reflux Disease (GERD).


It is also advisable not to lie down immediately after taking any pills.
When taking a very large daily amount of a single nutrient, it is better to split it up into smaller doses to not interfere with the absorption of other nutrients in food, or nutrients supplemented at lower amounts.



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