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Vitamins are substances that your body needs to grow and develop normally. Vitamin C is an antioxidant . It is important for your skin, bones, and connective tissue. It promotes healing and helps the body absorb iron.

Vitamin C comes from fruits and vegetables. Good sources include citrus, red and green peppers, tomatoes, broccoli, and greens. Some juices and cereals have added vitamin C.

Some people may need extra vitamin C:

• Pregnant/breastfeeding women
• People recovering from surgery
• Burn victims

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Vitamin c deficiency.

Luke Maxfield ; Sharon F. Daley ; Jonathan S. Crane .

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Last Update: November 12, 2023 .

• Continuing Education Activity

Vitamin C deficiency, commonly called scurvy, is a well-documented nutritional disorder with historical significance that continues to impact global health today. Vitamin C is an essential nutrient for maintaining an individual's good health and well-being. Vitamin C has significant antioxidant properties that protect cells from free radical damage. In addition, vitamin C also nurtures the growth and repair of skin, cartilage, bone, and teeth. Vitamin C deficiency is often linked to low socioeconomic status, food insecurity, and limited access to nutritious foods. Classic signs of vitamin C deficiency include corkscrew hairs, perifollicular hemorrhages, and gingival bleeding. Scurvy is a rare and reversible condition that requires early diagnosis and treatment. This activity reviews the historical background, clinical manifestations, diagnosis, treatment, and preventive measures concerning vitamin C deficiency. This activity also highlights the critical role of the interprofessional team in providing care for affected patients and raising awareness about nutritional deficiencies.

• Identify the clinical signs and symptoms of vitamin C deficiency, such as corkscrew hairs, perifollicular hemorrhages, gingival bleeding, fatigue, and anorexia.
• Assess the effectiveness of treatment by regularly monitoring patients' clinical improvement and resolution of symptoms associated with vitamin C deficiency.
• Select suitable diagnostic tests, such as serum vitamin C levels or leukocyte vitamin C levels, to aid in accurately assessing vitamin C deficiency and treatment response.
• Collaborate with an interprofessional team, including dentists, dietitians, and pharmacists, to provide holistic care and optimize outcomes for patients with vitamin C deficiency.
• Introduction

Scurvy is a clinical syndrome resulting from vitamin C deficiency. Vitamin C is essential for the growth and repair of skin, cartilage, bone, and teeth. In addition, it has significant antioxidant properties that protect cells from free radical damage. This article defines the sources, metabolism, and functions of vitamin C, covering the diagnosis, physical manifestations, evaluation, treatment, prognosis, and prevention of vitamin C deficiency. 

History of Vitamin C Deficiency

Ancient Egyptian medical practitioners first documented the symptoms of this condition in 1550 bc in the Ebers Papyrus  and prescribed the treatment with onions and vegetables. Hippocrates coined  ileos emantis  for the disease and described it as follows: "The mouth feels unpleasant; gums are separated from the teeth; blood flows from the nostrils… ulcerations appear on the legs; skin becomes thin." During the 1700s, James Lind, a British Royal Navy surgeon, made the significant discovery that the consumption of lemons and oranges alleviated the symptoms of vitamin C deficiency. Tales from the pirates and British sailors era have made scurvy infamous across several countries. Scurvy also led to notable morbidity during the European potato famine, [1]  polar expeditions, the United States Civil War, and the California gold rush. [2] In the 1920s, Albert Szent-Györgyi, a Hungarian biochemist, discovered the molecular structure of vitamin C and named it ascorbic acid, meaning anti-scurvy. [3] [4] [5] [6] [7]

Exogenous vitamin C is necessary only for humans and other primates. Most mammals synthesize the vitamin from glucose, as it shares a close chemical resemblance. Humans lack the active form of the enzyme L -gulonolactone oxidase required for synthesizing ascorbic acid, making it essential to acquire vitamin C from dietary sources or supplements. The primary cause of vitamin C deficiency is due to inadequate nutritional intake.

Vitamin C is naturally present in various fruits and vegetables, such as citrus fruits, potatoes, spinach, broccoli, red peppers, strawberries, and tomatoes. [8] Approximately 90% of the vitamin C in typical diets comes from various sources of produce, including fresh, frozen, and canned options. As vitamin C is sensitive to heat, cooking foods at high temperatures can cause the vitamin to decompose. Boiling can also lead to its leaching into the water. [9] Fresh fruits and vegetables possess higher vitamin C content compared to frozen or canned foods. However, the latter can serve as a significant source of vitamin C when fresh produce is not accessible.

Vitamin C is water-soluble and gets absorbed in the distal ileum. The absorption of the vitamin is efficient at dosages up to 100 mg/d. However, when intake exceeds 1500 mg/d, the absorption of the vitamin decreases to 50% or less. [8]  A small amount of vitamin C is found in leukocytes, adrenal glands, and the pituitary gland. Nevertheless, the vitamin C stores in the human body are limited due to its water-soluble nature, and any excess amount is typically excreted from the body. The human body has around 1500 mg of vitamin C in total, and clinical signs of deficiency are exhibited when the level drops below 350 mg. Symptoms of scurvy appear within 4 to 12 weeks of insufficient vitamin C intake. Plasma concentrations primarily indicate recent or current consumption rather than stores and may lack clinical utility. [10] [11] [12] [13]

Risk Factors for Vitamin C Deficiency

Several factors can contribute to an increased risk of vitamin C deficiency, some of which are listed below.

Alcohol use disorder: Individuals with alcohol use disorder consuming more than 80 g/d of ethanol may experience increased renal excretion of vitamin C and poor dietary habits.

Infant feeding practices: Consumption of cow's milk instead of breast milk or fortified formula during infancy can pose a risk for vitamin C deficiency.

Social isolation and dietary habits: Social isolation and a limited diet, often called a "tea and toast" diet, particularly common among older individuals and institutionalized patients, can contribute to a lack of vitamin C intake.

Limited access to fruits and vegetables: Inability to obtain or afford a diverse range of fruits and vegetables can also elevate the risk of vitamin C deficiency.

Smoking: Smoking tobacco can diminish vitamin C levels in the body due to increased oxidative stress.

Eating disorders: Conditions such as anorexia nervosa and selective eating habits, including food faddism, can lead to inadequate vitamin C intake.

Type 1 diabetes: Individuals with type 1 diabetes may experience increased vitamin C requirements, potentially leading to deficiency.

Malabsorptive disorders: Conditions such as inflammatory bowel disease, celiac disease, and cystic fibrosis can hinder vitamin C absorption.

Bariatric surgery: Individuals who have undergone bariatric surgery may be at risk of vitamin C deficiency due to reduced absorption capacity.

Iron-overload conditions: Conditions involving excessive iron accumulation with renal losses of vitamin C can contribute to deficiency.

Restrictive or low carbohydrate diets: Diets significantly restricted in carbohydrates might inadvertently lead to reduced vitamin C intake.

Food allergies: Allergies to specific foods can limit dietary diversity and potentially impact vitamin C intake.

Developmental disabilities and mental illness: Conditions affecting food preferences, often seen in developmental disabilities and mental illness, can result in inadequate vitamin C consumption.

Hemodialysis: Individuals undergoing hemodialysis may experience increased renal losses of vitamin C, potentially leading to its deficiency.

In summary, a range of factors can significantly heighten the risk of vitamin C deficiency. Therefore, recognizing and addressing these risk factors to prevent and mitigate vitamin C deficiency are paramount for maintaining optimal health. [10] [11] [12] [13]  

• Epidemiology

Vitamin C deficiency affects millions of individuals globally. The prevalence of this deficiency varies based on factors such as age, lifestyle, access to nutritious foods, dietary choices, and underlying medical conditions. Individuals who do not include fruits and vegetables in their diet face an elevated risk of vitamin C deficiency, although several high-risk populations have been identified. Scurvy is most commonly found in countries with endemic malnutrition, but its occurrence is global. Prevalence differs across regions, ranging from as low as 7.1% in the United States to as high as 73.9% in northern India. [14]

• Pathophysiology

Scurvy arises due to inadequate vitamin C intake, which is critical in synthesizing collagen. Collagen is a vital structural protein essential for maintaining the integrity and strength of connective tissues throughout the body. Type IV collagen forms the primary building block of blood vessel walls, skin, and the basement membrane that separates the epidermis from the dermis. Collagen constitutes 75% of the dermis. [15] Vitamin C is a cofactor for proline and lysine hydroxylases, which stabilize collagen types I and VI. Furthermore, this vitamin enables crosslinking and facilitates procollagen transcription into collagen. A deficiency in vitamin C levels also results in epigenetic DNA hypermethylation, inhibiting the transcription of collagen in various tissues, including the skin and blood vessels. Insufficient collagen production in the body results in fragile skin and blood vessels, gingival hemorrhages, petechiae, and impaired wound healing. Vitamin C is a potent antioxidant that protects cellular constituents from oxidative stress. Vitamin C deficiency compromises immune function, rendering individuals more susceptible to infections and causing delays in wound healing.

• Histopathology

Vitamin C deficiency exhibits distinctive histopathological features. Microscopic examination of affected tissues reveals evidence of compromised collagen synthesis. In the skin, there is evident dermal disruption and atrophy. The number of collagen fibers is reduced, and they appear fragmented. The affected area displays signs of dilated hair follicles, fibrosis, follicular hyperkeratosis, corkscrew hairs, and perifollicular hemorrhages. [16] [9]  In the oral cavity, the gingival tissues exhibit hemorrhagic changes, which are characterized by capillary dilation and fibrin thrombi, subepithelial hemorrhages, and inflammatory infiltrates. [17] Within the skeletal system, the osteoid matrix is thin and disrupted, accompanied by subperiosteal hemorrhages and indications of osteopenia. [18]  

• History and Physical

Initially, nonspecific symptoms of scurvy emerge after 4 to 12 weeks of insufficient intake of vitamin C. Patients might present with fatigue, malaise, lethargy, and anorexia. [9] Subsequently, patients with scurvy experience oral and skin symptoms such as bleeding gums, easy bruising, skin rashes, fragility, delayed wound healing, and bone and joint aches.

Early oral and dermatologic signs that are visible in physical examination include gingivitis with bleeding, periodontal disease, loss of dentition, mucocutaneous petechiae, ecchymoses, hyperkeratosis, alopecia, corkscrew hairs, and swan neck hairs. [19] Corkscrew strands, characterized by twisted or coiled hair shafts, result from impaired collagen synthesis and are considered pathognomonic for scurvy. Swan neck hairs are hair shafts that bend at multiple points due to weakened hair follicles. Perifollicular hemorrhages are often localized to the lower extremities, as capillary fragility cannot withstand gravity-dependent hydrostatic pressure. This can lead to a condition known as "woody edema." Nail-related observations include koilonychia and splinter hemorrhages.

In addition to mucocutaneous manifestations, physical findings reflect the involvement of various other organ systems. Painful joint swelling, hemarthroses, and subperiosteal hematomas result from vascular fragility caused by impaired collagen formation. [18]  Disrupted endochondral bone formation can result in fragile bones that are prone to fractures. Ocular symptoms include dry eyes, subconjunctival hemorrhages, and scleral icterus.

About 80% of children with scurvy present with musculoskeletal signs and symptoms, including arthralgias, myalgias, hemarthroses, muscle hemorrhages, and subperiosteal hematomas. Children exhibiting bone involvement might display a limp or resist bearing weight. The knee joint is frequently the most affected part of the body. [18] Another notable finding during a physical examination is the "scorbutic rosary," which are tender, angular, and sharp swellings at the costochondral junctions caused by weakened connective tissue. This differs from the "rachitic rosary" in rickets, where the prominences are rounder and non-tender. [20]  

As scurvy progresses, its symptoms become increasingly severe and life-threatening. Advanced ocular manifestations include flame hemorrhages, cotton-wool spots, and retrobulbar bleeding into optic nerves, resulting in atrophy and papilledema. [21]  The immune system becomes compromised and increases susceptibility to infections. If left untreated, severe scurvy can induce profound weakness, dyspnea, anasarca, hemolysis, jaundice, seizures, organ failure, and ultimately, death.

Scurvy is diagnosed clinically through relevant medical history, physical examination observations, and a rapid response to vitamin C supplementation. [21] The evaluation process commences with symptom assessment, dietary history collection, evaluation of risk factors for vitamin deficiencies, and a comprehensive physical examination. Dermoscopy can reveal findings such as follicular purpura and corkscrew hairs, while a 4-mm punch biopsy and histopathology of affected regions typically confirm these observations.

Serum testing for scurvy requires caution due to potentially misleading results from recent vitamin C intake or supplementation. A low plasma vitamin C level of less than 0.2 mg/dL may indicate scurvy, but chronic deficiency could be concealed. [22] The leukocytes provide a more precise measure of vitamin C levels than other methods due to the resistance of white blood cells to dietary changes. A vitamin C level of 0 mg/dL in leukocytes indicates scurvy. A range of 0 to 7 mg/dL indicates a deficiency, whereas levels exceeding 15 mg/dL are considered sufficient. [23] [24]

Patients diagnosed with scurvy might also exhibit inadequate intake of other crucial vitamins and minerals. Therefore, apart from evaluating vitamin C levels, it is also essential to conduct screening for other concomitant vitamin deficiencies. The affected patients often have low vitamin B12, folate, calcium, zinc, and iron levels. As vitamin C contributes to iron absorption, individuals with scurvy should be evaluated for anemia arising from insufficient absorption or blood loss resulting from bleeding.

Imaging studies may reveal the following:

• Fractures and dislocations
• Subperiosteal elevation
• Alveolar bone resorption, osteopenia, or osteoporosis
• Epiphyseal separation of the distal radius
• Treatment / Management

The appropriate dosage of vitamin C for scurvy treatment varies based on the severity of the condition and the individual's particular requirements. Prompt vitamin C supplementation can quickly and efficiently replenish depleted vitamin levels in patients, with dosages up to 300 mg/d for children and 500 to 1000 mg/d for adults. The end point of replacement typically occurs within 1 to 3 months or upon the complete resolution of all clinical signs and symptoms. Alternative treatment regimens for adults include up to 2 g/d for the initial 3 days, 500 mg/d for 1 week, and 100 mg/d for 1 to 3 months. [9]

Treating scurvy involves consuming sufficient fruits and vegetables to prevent recurrences and addressing the underlying causes of malnutrition that lead to vitamin C deficiency. The recommended daily vitamin C intake varies based on age, sex, pregnancy, and lactation. The amount of vitamin C required for children is 15 to 75 mg, men 90 mg, women 75 mg, pregnant women 85 mg, and lactating women 120 mg. Smoking leads to a depletion of vitamin C levels, requiring smokers to consume an additional vitamin C of 35 mg/d. 

Vitamin C is found in a wide range of foods. According to the United States National Institutes of Health, Office of Dietary Supplements, vitamin C can be easily obtained from the following sources:

• 1/2 cup red pepper: 95 mg
• 1 medium orange: 70 mg
• 1/2 cup strawberries: 49 mg
• 1/2 cup Brussels sprouts: 48 mg
• 1 baked potato: 17 mg

Supplements are readily available for individuals unwilling or unable to obtain adequate vitamin C solely from their diet, including standard over-the-counter multivitamin preparations. 

• Differential Diagnosis

The differential diagnosis encompasses a range of pathological conditions that vary based on the presenting signs and symptoms. Some possible considerations are listed below.

Purpura/ecchymoses: Immune thrombocytopenic purpura, Henoch-Schonlein purpura, disseminated intravascular coagulation, Rocky Mountain spotted fever, meningococcemia, and hypersensitivity vasculitis.

Oral and dental disease:  Necrotizing gingivitis, periodontitis, candidiasis, blood dyscrasias, medication-induced gingival overgrowth, and glossitis/cheilitis arising from other nutritional deficiencies.

Rashes and skin changes: Mineral and other vitamin deficiencies.

Bone pain and limp: Osteomyelitis and septic arthritis.

Typically, symptoms of fatigue, body aches, and anorexia improve within 24 hours of treatment. Additional symptoms such as bruising, gingival bleeding, perifollicular hemorrhage, and weakness tend to respond within 1 to 2 weeks following treatment initiation. Corkscrew hairs usually return to their normal appearance within 1 month, and most symptoms tend to resolve completely within 3 months. [9]  Surgical intervention might be necessary to manage severe and advanced bone abnormalities.

• Complications

The complications associated with vitamin C treatment for scurvy are relatively infrequent, generally mild, and often associated with dosage.

Gastrointestinal disturbances:  Elevated doses of vitamin C can lead to diarrhea, nausea, and abdominal cramps. These symptoms are usually self-limiting and resolve spontaneously when the dosage is adjusted or discontinued.

Renal calculi:  Excessive vitamin C consumption has been linked to the development of kidney stones in male patients with a history of calculi or preexisting renal conditions. This complication is believed to be due to increased urinary oxalate excretion. [25] Maintaining proper hydration and moderating vitamin C intake can help mitigate the risk.

Interactions with medications:  The antioxidant properties of vitamin C can reduce the effectiveness of chemotherapy. This property can also interfere with the effectiveness of drugs such as warfarin, statins, and niacin. Careful consideration and monitoring are essential when combining vitamin C supplementation with these medications.

• Deterrence and Patient Education

Patients should be educated about the causes, symptoms, and potential consequences of vitamin C deficiency. They must understand that scurvy primarily develops due to inadequate consumption of vitamin C–rich fruits and vegetables. By providing clear and concise information, healthcare professionals can motivate their patients to make well-informed dietary decisions and integrate vitamin C–rich foods into their daily meals. Excellent sources of vitamin C–rich foods include citrus fruits, juices, berries, melons, red and green peppers, tomatoes, potatoes, and cruciferous vegetables. Individuals should receive counseling to refrain from smoking and, if necessary, limit their alcohol consumption. 

In cases where scurvy stems from a malabsorptive condition, such as inflammatory bowel or celiac disease, patient education should encompass understanding the specific diagnosis to effectively address the underlying disorder and the resulting vitamin C deficiency. When social isolation or food insecurity contributes to inadequate intake of foods rich in vitamin C, it might be essential to consider social services or supplemental food programs to complement standard patient education initiatives. Individuals unable or unwilling to consume fruits and vegetables should be recommended to take a daily multivitamin supplement. 

• Enhancing Healthcare Team Outcomes

A multidisciplinary approach involving physicians, advanced care practitioners, nurses, dieticians, dentists, dental hygienists, and pharmacists is vital for providing patient-centered care, enhancing outcomes, and maintaining patient safety. Each healthcare team member should possess specialized skills in assessing, diagnosing, and managing vitamin C deficiency. Collaboratively, the team should develop comprehensive strategies for identifying patients at risk, implementing evidence-based interventions, and monitoring progress. This approach requires devising strategies for dietary changes and taking supplements.

Healthcare professionals should encourage adequate nutrition for their patients. Although vitamin C deficiency is uncommon in North America, it tends to develop among individuals who have inadequate consumption of vitamin C–rich foods or are affected by malabsorption or other chronic medical conditions. Patients should be educated about the significance of a nutritious diet abundant in fruits and vegetables. Furthermore, it is essential to motivate patients to abstain from smoking and limit alcohol consumption. Upon diagnosing a vitamin deficiency, it becomes imperative to conduct screenings for other potential concurrent deficiencies. As vitamin C deficiency is primarily related to inadequate dietary intake, affected individuals may also exhibit deficiencies in other essential nutrients such as vitamin B12, folate, calcium, zinc, and iron. 

When patients show oral signs and symptoms, dentists may initially diagnose vitamin C deficiency. Collaboration between dentists and primary care physicians through care coordination can improve patient outcomes. In rare cases, where a patient shows limited improvement even after several weeks of treatment, seeking evaluation by a specialist might be necessary to determine the underlying cause of the vitamin C deficiency.

Effectively addressing vitamin C deficiency demands the coordinated efforts of an interprofessional team. Healthcare professionals can collectively enhance patient outcomes, safety, and overall team performance by harnessing their skills, adopting a patient-centered approach, delineating clear responsibilities, fostering open communication, and ensuring streamlined care coordination.

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Disclosure: Luke Maxfield declares no relevant financial relationships with ineligible companies.

Disclosure: Sharon Daley declares no relevant financial relationships with ineligible companies.

Disclosure: Jonathan Crane declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Maxfield L, Daley SF, Crane JS. Vitamin C Deficiency. [Updated 2023 Nov 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Vitamin C Deficiency

(scurvy; ascorbic acid deficiency).

• Pathophysiology |
• Symptoms and Signs |
• Diagnosis |
• Treatment |
• Prevention |
• Key Points |

In countries with low rates of food insecurity, vitamin C deficiency can occur as part of general undernutrition, but severe deficiency (causing scurvy) is uncommon. Symptoms include fatigue, depression, and connective tissue defects (eg, gingivitis, petechiae, rash, internal bleeding, impaired wound healing). In infants and children, bone growth may be impaired. Diagnosis is usually clinical. Treatment consists of oral vitamin C.

Vitamin C plays a role in collagen, carnitine, hormone, and amino acid formation. It is essential for bone and blood vessel health and wound healing and facilitates recovery from burns. Vitamin C is also an antioxidant, supports immune function, and facilitates the absorption of iron (see table Sources, Functions, and Effects of Vitamins ).

Dietary sources of vitamin C include citrus fruits, tomatoes, potatoes, broccoli, strawberries, and sweet peppers. (See also Overview of Vitamins .)

Severe vitamin C deficiency results in scurvy, a disorder characterized by hemorrhagic manifestations and abnormal osteoid and dentin formation.

Etiology of Vitamin C Deficiency

In adults, primary vitamin C deficiency is usually due to

Inadequate diet

The need for dietary vitamin C is increased by febrile illnesses, inflammatory disorders (particularly diarrheal disorders), achlorhydria, smoking , hyperthyroidism , iron deficiency , cold or heat stress, surgery, burns , and protein deficiency. Heat (eg, sterilization of formulas, cooking) can destroy some of the vitamin C in food.

Pathophysiology of Vitamin C Deficiency

When vitamin C is deficient, formation of intercellular cement substances in connective tissues, bones, and dentin is defective, resulting in weakened capillaries with subsequent hemorrhage and defects in bone and related structures.

Bone tissue formation becomes impaired, which, in children, causes bone lesions and poor bone growth. Fibrous tissue forms between the diaphysis and the epiphysis, and costochondral junctions enlarge. Densely calcified fragments of cartilage are embedded in the fibrous tissue. Subperiosteal hemorrhages, sometimes due to small fractures, may occur in children or adults.

Symptoms and Signs of Vitamin C Deficiency

In adults, symptoms of vitamin C deficiency develop after weeks to months of vitamin C depletion. Lassitude, weakness, irritability, weight loss, and vague myalgias and arthralgias may develop early.

Symptoms of scurvy (related to defects in connective tissues) develop after a few months of deficiency. Follicular hyperkeratosis, coiled hair, and perifollicular hemorrhages may develop. Gums may become swollen, purple, spongy, and friable; they bleed easily in severe deficiency. Eventually, teeth become loose and avulsed. Secondary infections may develop. Wounds heal poorly and tear easily, and spontaneous hemorrhages may occur, especially as ecchymoses in the skin of the lower limbs or as bulbar conjunctival hemorrhage.

Other symptoms and signs include femoral neuropathy due to hemorrhage into femoral sheaths (which may mimic deep venous thrombosis), lower extremity edema, and painful bleeding or effusions within joints.

In infants, symptoms include irritability, pain during movement, anorexia, and slowed growth. In infants and children, bone growth is impaired, and bleeding and anemia may occur.

Diagnosis of Vitamin C Deficiency

Usually clinical (based on skin or gingival findings and risk factors)

Diagnosis of vitamin C deficiency is usually made clinically in a patient who has skin or gingival signs and is at risk of vitamin C deficiency. Laboratory confirmation may be available. Complete blood count is done, often detecting anemia. Bleeding, coagulation, and prothrombin times are normal.

Skeletal x-rays can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. Early changes resemble atrophy. Loss of trabeculae results in a ground-glass appearance. The cortex thins. A line of calcified, irregular cartilage (white line of Fraenkel) may be visible at the metaphysis. A zone of rarefaction or a linear fracture proximal and parallel to the white line may be visible as only a triangular defect at the bone’s lateral margin but is specific. The epiphysis may be compressed. Healing subperiosteal hemorrhages may elevate and calcify the periosteum.

< 0.6 mg/dL ( < 34 mcmol/L) are considered marginal; levels of < 0.2 mg/dL ( <

In adults, scurvy must be differentiated from arthritis, hemorrhagic disorders, gingivitis, and protein-energy undernutrition. Hyperkeratotic hair follicles with surrounding hyperemia or hemorrhage are almost pathognomonic. Bleeding gums, conjunctival hemorrhages, most petechiae, and ecchymoses are nonspecific.

Treatment of Vitamin C Deficiency

Prevention of vitamin c deficiency.

Vitamin C 75 mg orally once a day for women and 90 mg orally once a day for men prevents deficiency. People who smoke should consume an additional 35 mg/day. Five servings of most fruits and vegetables (recommended daily) provide > 200 mg of vitamin C.

The need for vitamin C is increased by fever, inflammation, diarrhea, smoking, hyperthyroidism, iron deficiency, cold or heat stress, surgery, burns, and protein deficiency.

After weeks or months, the deficiency causes nonspecific symptoms (eg, weakness, lassitude, irritability, arthralgias, myalgias); later, connective tissue is affected, causing follicular hyperkeratosis, coiled hair, swollen and bleeding gums, loose teeth, poor wound healing, and spontaneous hemorrhages.

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If you want to avoid arthritis, improve tissue reparation or strengthen your immune system, we recommend you take a trip to the beautiful orange fields in Valencia, they’re full of Vitamin C! This vitamin is heavily present in oranges, but you can also find it in cantaloupes, broccoli, peppers and kiwis. And you can also find it in this beautiful template!

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• Published: 24 May 2024

Efficacy and safety of vitamin C supplementation in the treatment of community-acquired pneumonia: a systematic review and meta-analysis with trial sequential analysis

• Yogesh Sharma 1 , 2 ,
• Subodha Sumanadasa 3 ,
• Rashmi Shahi 4 ,
• Richard Woodman 5 ,
• Arduino A. Mangoni 6 ,
• Shailesh Bihari 7 &
• Campbell Thompson 8  

Scientific Reports volume  14 , Article number:  11846 ( 2024 ) Cite this article

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• Respiratory tract diseases

Community-acquired pneumonia (CAP) poses a significant global health challenge, prompting exploration of innovative treatments. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of vitamin C supplementation in adults undergoing treatment for CAP. A comprehensive search of the MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and Clinical Trials.gov databases from inception to 17 November 2023 identified six randomized-controlled-trials (RCTs) meeting inclusion criteria. The primary outcome analysis revealed a non-significant trend towards reduced overall mortality in the vitamin C group compared to controls (RR 0.51; 95% CI 0.24 to 1.09; p = 0.052; I 2  =  0 ; p = 0.65). Sensitivity analysis, excluding corona-virus-disease 2019 (COVID-19) studies and considering the route of vitamin C administration, confirmed this trend. Secondary outcomes, including hospital length-of-stay (LOS), intensive-care-unit (ICU) LOS, and mechanical ventilation, exhibited mixed results. Notably, heterogeneity and publication bias were observed in hospital LOS analysis, necessitating cautious interpretation. Adverse effects were minimal, with isolated incidents of nausea, vomiting, hypotension, and tachycardia reported. This meta-analysis suggests potential benefits of vitamin C supplementation in CAP treatment. However, inconclusive findings and methodological limitations warrants cautious interpretation, emphasising the urgency for high-quality trials to elucidate the true impact of vitamin C supplementation in CAP management.

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Introduction.

Community acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma acquired outside hospital and is a leading cause of morbidity and mortality worldwide. Globally, CAP is the second most common cause of hospitalisation and is the most common infectious cause of death 1 . According to the World Health Organisation (WHO) 2 , lower respiratory tract infections remain the primary infective cause of death globally accounting for 6.1% of deaths.

Inpatient mortality from CAP ranges between 4.2 and 5.5% while mortality at 6 months can be as high as 23% 3 . Recent evidence 4 suggest that despite advancements in clinical care, mortality rates from pneumonia have not any shown any substantial change over time. An excess inflammatory response seems to be partly responsible for treatment failure in some patients with CAP and has been associated with poor clinical response to antibiotics 5 . Therefore, there is a need to explore adjunctive therapies that have immunomodulatory and barrier-enhancing functions augmenting treatment of CAP.

Vitamin C is a water-soluble vitamin with powerful antioxidant properties that can scavenge free radicals 6 . This vitamin has immune mediating properties as it has been found to support neutrophil migration to the site of infection and is responsible for production of hormones such as noradrenaline and vasopressin 6 . These properties have led to an investigation of its potential role as an additional therapeutic agent in the treatment of pneumonia.

Clinical studies of vitamin C supplementation in pneumonia have yielded varied results. While some studies 7 , 8 have suggested that vitamin C supplementation may reduce severity of pneumonia 7 , the impact on mortality remains unclear with one study 9 suggesting a significant reduction in mortality while the other 10 showing no difference in mortality but a trend towards reduction of hospital length of stay (LOS). In addition, the safety of vitamin C in CAP remains unclear. Therefore, we conducted a systematic review to assess the efficacy and safety of parenteral and or oral vitamin C alone or in combination with other therapies in adults being treated for CAP.

Materials and methods

This systematic review and meta-analysis adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) 2020 standards. The research protocol was registered with the International Prospective Registry of Systematic Reviews (PROSPERO) number CRD42023483860.

Search strategy

We searched the following electronic databases: MEDLINE, Embase, CINAHL, the Cochrane Central Register of Controlled Trials, and Clinical Trials.gov from inception to 17 November 2023 with the help of a medical librarian. The search strategy for this systematic review is provided in Supplementary File 2 . We used a combination of keywords and medical subject headings (MeSH) as follows: adults, community acquired pneumonia, bronchopneumonia, lower respiratory tract infections, hospitalisation, inpatients, critical care, vitamin C, ascorbic acid, ascorbate, mortality, randomised controlled trials (RCTs), placebo, intravenous administration and oral vitamin C. No language restrictions were applied.

Eligibility criteria

Design and population.

We included parallel-arm RCTs of adults aged ≥ 18 years with CAP. Pneumonia was defined as symptoms of fever, dyspnoea, cough, and sputum production along with imaging evidence of a pulmonary infiltrate requiring hospitalisation and possibly intensive care unit (ICU) admission. We included publications in which authors did not clearly define pneumonia but instead used terms such as 'pneumonia' or ‘consolidation on imaging studies' to identify their target population.

Intervention

Clinical trials with at least one arm involving the administration of parenteral and or oral vitamin C alone or in combination with other micronutrients and therapies were included.

Comparator arm

We included studies which had at least one control arm which included patients who were not prescribed parenteral and or oral vitamin C. The control arm may have received placebo or any other active treatment.

Types of outcome measures

Data extraction.

Two reviewers (YS and SS) screened identified citations at the title and abstract screening level using predefined eligibility criteria electronically by use of reference manager. Potentially eligible citations were then reviewed at the level of full-text screening by the paired reviewers. The screening was completely independent and in duplicate and any disagreements were resolved by involvement of a third reviewer (RS). We included studies based upon the eligibility criteria and reporting at least one primary or secondary outcome of interest.

Study quality assessment

The quality of studies was independently assessed by two reviewers (YS and RS) who evaluated the risk of bias using the modified version of the RoB tool (Rob 2.0) 11 and the modified Jadad scale 12 . Risk of bias were classified as low risk, high risk or unclear risk after assessment of the following key domains: generation of random sequence, use of allocation concealment method, blinding of participants, data collectors, and outcome assessors, and incomplete or missing outcome data and other biases. In addition, the quality of studies was independently assessed by the two reviewers by using the modified Jadad scale. Studies with a modified Jadad scale score of 1–3 are considered low-quality studies and those with a score of 4- 7 were considered as high quality studies 12 .

Outcome measures

Primary outcomes.

The primary outcome was overall mortality from date of admission including in-hospital deaths. Different studies have used in-hospital mortality or 30-day mortality. We included mortality data closest to the time points of interest.

Secondary outcomes

The secondary outcomes included length of hospital stay (LOS), intensive care unit (ICU) LOS, 30-day readmission risk, use of vasopressor support, use of non-invasive and invasive ventilation, time to clinical stabilisation (defined previously 13 as patients achieving all the following criteria: (1) temperature ≤ 37.8 °C; (2) heart rate ≤ 100 beats/minute; (3) respiratory rate ≤ 24 breaths/minute; (4) systolic blood pressure ≥ 90 mmHg; and (5) arterial oxygen saturation ≥ 90% or partial pressure of oxygen ≥ 60 mmHg on room air), and adverse events relating to the use of vitamin C.

Effect measures

Binary outcomes were reported as relative risks (RR), while continuous outcomes as standardised mean differences (SMD) with their corresponding 95% confidence intervals (CI).

Statistical analyses

For data processing we converted medians and interquartile ranges (IQR) to means and standard deviations (SD) as suggested by the Cochrane Collaboration Group 14 . The interventions were compared by use of the random effects modelling and Forest plots were generated. The statistical heterogeneity among studies was assessed by use of the chi-squared test and the I 2 statistics. If significant heterogeneity was detected, then a leave-one-out sensitivity analysis 15 was performed in STATA to evaluate the influence of individual studies on the pooled estimate. Publication bias was assessed by visual inspection of the funnel plots and use of the Egger’s test for small-study effects 16 . In case of fewer than 10 studies, Egger’s test reliability is compromised. In such instances, a fail-safe calculation following the Rosenthal approach 17 estimated additional studies needed to assess and mitigate potential publication bias. All statistical analyses were performed by use of Stata software version 18.0 and all estimates were reported with a 95% CI.

Sensitivity analyses

We performed sensitivity analysis after excluding: (1) studies which included only COVID-19 positive patients (as diagnosed by a positive viral reverse transcription polymerase chain reaction (RT-PCR) test results), and (2) studies which used only oral preparations of vitamin C, to determine the differential impact of vitamin C on mortality among CAP patients according to their COVID status and route of vitamin C administration, respectively. In addition, if significant heterogeneity was observed in the included studies, then further exploration was done by use of a leave-one-out sensitivity analysis using STATA.

Trial sequential analysis (TSA)

We conducted a TSA for overall mortality to control for both type-1 and type-2 errors and to further validate the findings of our meta-analysis 18 . The chosen parameters for this analysis were alpha = 5% and beta = 20%. The DerSimonian–Laird random effects model was employed, with between-trial heterogeneity adjusted by the diversity-estimate ( D 2 ) 19 . We used the control group mortality of 15.2%, as determined by this meta-analysis, and the effect size (relative risk reduction (RRR)) of 40% as observed in a previous meta-analysis 20 . Sensitivity analyses were also performed for RRRs of 30% and 20%, respectively.

Additionally, a sensitivity analysis using the Biggerstaff-Tweedie random effects model 21 was conducted, attributing more weight to larger trials than smaller trials. The TSA data analysis was carried out using TSA software (0.9.5.10 Beta, The Copenhagen Trial Unit, Denmark).

Study identification and selection

Our initial search identified 276 studies from Scopus, Cochrane CENTRAL, ClinicalTrials.gov, MEDLINE and CINHAL (Fig.  1 ) and 2 studies were identified by manual citation searching. Finally, six eligible studies enrolling a total of 366 patients were included in the meta-analysis 7 , 10 , 22 , 23 , 24 , 25 . It is noteworthy that two additional studies 26 , 27 discovered through manual searches of references were excluded from our review. For detailed information, please refer to Supplementary File 3 .

PRISMA flow diagram showing four phases of the study.

Study characteristics

The characteristics of six studies are shown in Table 1 . Two studies included only COVID-19 patients 23 , 25 while two studies used only oral preparations of vitamin C 7 , 24 . Four studies 7 , 10 , 22 , 24 compared vitamin C with a matching placebo and one study 22 included CAP patients who were admitted in the ICU. Five studies 22 , 23 , 24 , 25 were published in 2021 or later.

Assessment of the quality of the included studies based on the Cochrane Collaboration’s Tool is shown in Fig.  2 and the scores of the modified Jadad scale are presented in Table 1 . Apart from two studies 10 , 22 , all studies were graded low quality according to the assessment tools.

Risk of bias assessment.

Primary outcome

Overall mortality.

Five of the six studies 7 , 10 , 22 , 23 , 25 were included in the analysis for overall mortality, consisting of 314 patients, which included 150 patients in the vitamin C supplemented group and 164 patients in the control group. The overall mortality was lower in the vitamin C supplemented group when compared to the control group, however, this difference was not statistically significant (RR 0.51; 95% CI 0.24 to 1.09; p = 0.052; I 2  =  0 ; p = 0.65) (Fig.  3 ). The Funnel plot (Fig.  4 ) and the regression-based Egger’s test for small-study effects, did not reveal apparent publication bias (p = 0.206). To assess the robustness of the findings and potential publication bias, we conducted a Fail-Safe calculation using the Rosenthal approach. This analysis suggested that an additional 5 studies with a similar effect size (RR = 0.51) would be needed to confirm the absence of publication bias.

Forest plot showing comparison of overall mortality between vitamin C supplemented group and control group. CI confidence interval.

Funnel plot for overall mortality.

Trial sequential analysis

The TSA graphs are presented in Supplementary Figs. S1 , S2 and S3 . Although a relatively large sample size of 908 would be required for a treatment effect of 40%, there was a trend towards significant mortality reduction in the vitamin C supplemented group when compared to control group (RR 0.57; 95% CI 0.28 to 1.17, p = 0.127, I 2  = 0, p = 0.655). Sensitivity analysis using the Biggerstaff-Tweedie random effects model confirmed these findings (RR 0.57; 95% CI 0.44 to 0.74, p = 0.157, I 2  = 0, p = 0.655). Similar trends were also observed for treatment effects of 30% and 20%, although much larger sample sizes, 1699 and 4012, respectively, would be needed to demonstrate a mortality reduction with vitamin C supplementation of patients being treated for pneumonia (Supplementary Figs. S2 and S3 ).

Subgroup analysis

Exclusion of covid19 studies.

After exclusion of COVID-19 studies 23 , 25 , the overall mortality remained lower in patients who were in the vitamin C supplemented group compared to the control group, but the difference remained statistically non-significant (RR 0.46; 95% CI 0.13 to 1.62; p = 0.131 I 2  = 0; p = 0.593) (Supplementary Fig. S4 ). The funnel plot (Supplementary Fig. S5 ) and the Egger’s test did not reveal any apparent publication bias (p = 0.339). The fail-safe calculation using the Rosenthal approach suggested that additional 3 studies, each with a similar effect size (RR = 0.46) would be needed to confirm absence of publication bias.

Route of vitamin C administration

After exclusion of a study which used oral vitamin C 7 , the mortality remained lower among patients in the vitamin C supplemented group compared to those in the control group but was not statistically significant (RR 0.57; 95% CI 0.24 to 1.36; p = 0.122; I 2  = 0, p = 0.64) Supplementary Fig. S6 ). The funnel plot (Supplementary Fig. S7 ) and the Egger’s test did not reveal any publication bias (p = 0.421). The fail-safe calculation using the Rosenthal approach suggested that 1 additional study with a similar effect size (RR = 0.57) would be needed to confirm absence of publication bias.

Hospital LOS

Only three of the six studies 10 , 23 , 25 involving 179 patients determined the efficacy of vitamin C supplementation on hospital LOS. Patients who were in the vitamin C supplemented group had a shorter hospital LOS but this difference was not statistically significant and there was marked heterogeneity between studies (SMD – 0.23; 95% CI – 1.68 to 1.21; p = 0.558; I 2  = 81.1%, p = 0.005) (Supplementary Fig. S8 ). The funnel plot (Supplementary Fig. S9 ) did show some evidence of publication bias, however, the Egger’s test was not significant (p = 0.810).

Exploration of heterogeneity by use of the leave-one-out sensitivity analysis identified one outlier 23 , an open-label randomized controlled trial (RCT). Upon exclusion of this study from the meta-analysis, a statistically significant reduction in hospital LOS was observed in patients receiving vitamin C supplementation compared to the control group, accompanied by a decrease in heterogeneity (SMD – 0.59; 95% CI – 0.96 to – 0.22; p = 0.001 I 2  = 0, p = 0.36) (Supplementary Fig. S10 ). The funnel plot (Supplementary Fig. S11 ) revealed evidence of publication bias and the Egger’s test remained non-significant. To assess the robustness of findings regarding publication bias, a fail-safe calculation using the Rosenthal approach was performed. This calculation suggested that an additional 5 studies, each with a similar effect size (SMD = – 0.23), would be needed to confirm the absence of publication bias.

Analysis of ICU LOS included data from only two of the six studies (Jamali Moghadam Siahkali et al. 23 ; Mahmoodpoor et al. 22 ), comprising a total of 140 patients. The comparison between patients in the vitamin C supplemented group and the control group did not reveal a statistically significant difference in ICU LOS, and the studies exhibited heterogeneity (standardized mean difference [SMD] – 0.13; 95% Confidence Interval [CI] – 3.77 to 3.52; p = 0.737; I 2  = 64.2%, p = 0.09) (see Supplementary Fig. S12 ).

Given the limited number of studies, we refrained from exploring the sources of heterogeneity. Although the funnel plot (Supplementary Fig. S13 ) may not provide statistically informative insights due to the small sample size, it did not exhibit any apparent asymmetry.

Mechanical ventilation

Two studies 22 , 23 involving 140 CAP patients determined the risk of intubation. There was no significant difference in intubation rates in the vitamin C supplemented group when compared to the control group (RR 0.77; 95% CI 0.00 to 122.06, p = 0.634, I 2  = 2%, p = 0.312) (Supplementary Fig. S14 ). The funnel plot (Supplementary Fig. S15 ) did not show any publication bias and the Egger’s test could not be performed due to insufficient number of studies. The fail-safe calculation using the Rosenthal approach suggested that no additional study with a similar effect size (RR = 0.77) would be needed to confirm absence of publication bias.

Vasopressor use

Vasopressor use was reported by only one study 22 which found that the duration of vasopressor use was significantly reduced among patients being treated for CAP who were in the vitamin C supplemented group when compared to placebo (2.28 ± 1.24 days vs. 3.39 ± 1.23 days, p = 0.003). There was no significant difference in the dose of vasopressor used between the two groups (6.8 ± 3.18 mcg/min vs. 8.26 ± 3.58 mcg/min, p = 0.14) in vitamin C and control groups, respectively.

Readmission risk

Only one study 10 reported risk of 30-day readmissions which was not significantly different among treated CAP patients who received vitamin C compared to the control group (3% vs. 11% respectively, p = 0.22).

Time to clinical stabilisation

Time to clinical stability was reported by only one study 10 which found a trend towards early stability among patients with CAP with the administration of vitamin C compared to the control group (median 22 h (IQR 40, 90) vs. 49 h (IQR 18, 137), p = 0.083).

Adverse effects of vitamin C

Only two studies 10 , 22 reported data on adverse effects of supplementation of vitamin C. Chambers et al. 10 reported 2 adverse events which could be possibly related to vitamin C administration including nausea and vomiting, while Mahmoodpoor et al. 22 reported 3 episodes of hypotension and tachycardia during IV administration of vitamin C which were self-limited and resolved after reduction in dose of vitamin C. No study attributed AKI to administration of vitamin C. One study 10 also reported minor adverse effects associated with the use of placebo, including nausea, vomiting and distaste for the medication.

This systematic review and meta-analyses evaluated the efficacy and safety of vitamin C in the treatment of patients with CAP. By including recent RCTs with a substantial number of CAP patients, our primary outcome analysis indicated a noteworthy trend towards a reduction in overall mortality in the vitamin C treatment group when compared to the control group. However, this observed reduction in mortality did not reach statistical significance, warranting careful interpretation of the findings. The TSA confirmed the trend towards reduced mortality in the vitamin C supplemented group but suggested that a sample size of 908 would be required to achieve statistical significance for a 40% reduction in relative risk.

After excluding studies 23 , 25 which included only COVID-19 patients and an older study incorporating oral vitamin C supplementation, the non-significant reduction in mortality persisted between the two groups. The absence of statistical significance in our primary outcome may be attributed to the limited number of studies included in the meta-analysis. This highlights the critical need for future well-designed and adequately powered trials to offer more robust evidence regarding the role of vitamin C in CAP treatment. It is notable that a previous meta-analysis 28 did not identify any studies investigating the mortality benefits of vitamin C in CAP.

Our systematic review contradicts a recent harmonised study 27 combining data from two RCTs 26 , 29 on vitamin C use in COVID-19 patients. This study suggests futility with vitamin C supplementation, but acknowledges limitations, including study design variations, post-randomisation care discrepancies, and lack of COVID-19 vaccination data. These limitations stress the need for cautious interpretation and highlight the importance of additional research to understand the relationship between vitamin C supplementation and outcomes in COVID-19 patients.

Our findings, although non-significant, align with a recent systematic review 30 which included 24 RCTs and suggested that intravenous vitamin C might improve short-term mortality (RR 0.82; 95% CI 0.65 to 1.02; p = 0.07) and overall mortality (RR 0.86; 95% CI 0.74 to 1.01; p = 0.06) in septic patients; their review was not just limited to those with CAP. Despite these promising trends, it is essential to consider the limitations of the studies included in the above meta-analysis, such as high heterogeneity and publication bias. Thus, current evidence on the mortality benefits of vitamin C supplementation during treatment for severe infections, including CAP, remains inconclusive.

Our meta-analysis indicates a potential trend towards a reduction in hospital LOS in the vitamin C supplemented group compared to the control group. However, the studies included in our review exhibited significant heterogeneity. Following sensitivity analysis and the exclusion of an outlier study, our review revealed a statistically significant decrease in hospital LOS in the vitamin C supplemented group compared to the control group. It is crucial to approach this finding with caution due to the inclusion of a limited number of studies with smaller sample sizes in this review, raising the potential for inflated effect sizes as has been highlighted by Zhang et al. 31 .

In contrast, our analysis of ICU length of stay did not reveal a statistically significant difference between the vitamin C and control groups. While this non-significant finding could be influenced by the limited number of studies available for analysis and the observed heterogeneity in study designs, it remains possible that the beneficial effects of vitamin C supplementation are more visible in those less critically unwell. These results are, however, similar to a recent systematic review in septic patients which found that vitamin C did not reduce ICU LOS when compared to the control group (RR – 0.05; 95% CI – 0.19 to 0.09; p = 0.50).

This study suggests that the duration of vasopressor use was significantly shorter among critically ill CAP patients who received vitamin C. However, only one study was available for review, preventing a meta-analysis. Nonetheless, a prior meta-analysis by Muhammad et al. 32 , that included twelve studies on septic patients also reported a statistically significant reduction in vasopressor support time for those treated with vitamin C compared to placebo (SMD = – 1.03; 95% CI – 1.62 to – 0.44; p = 0.001; I 2  = 88.96%). The substantial heterogeneity observed in the studies included in this meta-analysis limits the certainty of the evidence. Therefore, further research is needed to explore the role of vitamin C in reducing vasopressor support among septic patients.

A critical consideration in our analysis is the overall poor quality of the included studies, with the exception of two studies 10 , 22 . The methodological limitations and potential biases in the majority of studies underscore the need for rigorously conducted trials to enhance the reliability of our findings.

Recent research 26 , 32 has primarily focused on the efficacy of vitamin C in critically ill septic patients, who are inherently at a heightened risk for adverse clinical outcomes. There has also been an ongoing debate about the choice of vitamin C preparation used in these studies, with concerns raised that using ascorbic acid instead of sodium ascorbate may exacerbate metabolic acidosis and lead to poorer outcomes 33 . Furthermore, the abrupt discontinuation of vitamin C supplementation could potentially cause a further decline in plasma vitamin C levels, resulting in a rebound increase in oxidant stress 34 . This has contributed to lingering clinical equipoise regarding the benefits of vitamin C in patients with sepsis.

Urgent future research is needed to elucidate the differential effects of vitamin C supplementation in pneumonia and sepsis, considering factors such as dosage, route of administration (intravenous vs. oral), and type of preparation used (sodium ascorbate vs. ascorbic acid). Additionally, exploring a slow tapering regimen instead of abrupt discontinuation could help maintain stable serum vitamin C levels. In addition, more studies are needed to ascertain benefits of vitamin C among non-critically ill patients to determine whether it can prevent further clinical deterioration.

Moreover, future studies should incorporate the vaccination status of participants to better understand the impact of vitamin C on patient outcomes. Considering the potentially protective role of pneumococcal vaccination in patients with CAP 35 , this could be a crucial variable to consider in future research.

Conclusions

In conclusion, our study offers insights into potential benefits of vitamin C supplementation in CAP treatment. While an apparent reduction in overall mortality and hospital LOS was observed, the lack of statistical significance and poor study quality, necessitates cautious interpretation. Our findings emphasise the need for rigorous trials to clarify vitamin C’s true impact on CAP outcomes.

Data availability

Data used for this study are available from the corresponding author on request.

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Sep 06, 2012

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VITAMIN C. THREE GIRLS Anthony, Veronica &amp; Bernice, &amp; A GUY Donna. OUTLINE. OUR SUBJECT IS VITAMIN C DIETARY SOURCES HOW THE BODY USES VITAMIN C CHEMICAL PROCESSES DISEASE. CHEMICAL STRUCTURE OF VITAMIN C.

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VITAMINC THREE GIRLS Anthony, Veronica & Bernice, & A GUY Donna

OUTLINE OUR SUBJECT IS VITAMIN C • DIETARY SOURCES • HOW THE BODY USES VITAMIN C • CHEMICAL PROCESSES • DISEASE

CHEMICAL STRUCTUREOF VITAMIN C Vitamin C is also known as ascorbic acid

Vitamin C structure • -OH groups allow solubility in water • makes it easier to excrete when consumed in excess. • -High affinity for binding to many minerals and compounds, i.e., iron and phytates.

Good source of vitamin C

Broccoli, Brussels sprouts, Cauliflower, Cabbage, Mangetout, Green leafy vegetables, Red peppers, Chilies, Watercress, Parsley, Blackcurrants Strawberries, Kiwi fruit, Guavas, Citrus fruit. Vitamin C sources

What is Mangetout?

poor intake of dietary sources cooking or canning of fruit absence of fresh fruit in the diet Dietary Vitamin C Insufficiency

Loss of Vitamin C • COOKING PROCESS DESTROYS VITAMIN C DUE TO OXIDATION. • IN WATER, VITAMIN C REACTS WITH OXYGEN OR OTHER OXIDIZING SUBSTANCES

Seeking vitamin C sources • Consume natural food sources of vitamin C dietary supplements may be used It is better to consume some form of vitamin C, than none at all.

What is the difference between natural food sources of vitamin C and synthetically made vitamin C?

Naturally, vitamin C is derived from glucose SYNTHESIZING ASCORBIC ACID • The Sonoyama method uses enzymes Michael Blaber at FSU

How the Body Uses Vitamin C • Collagen • Anti-oxidant • Hormones • Cardiovascular • Nervous System • Other Functions

Vitamin C & Collagen • Collagen is the most abundant connective tissue in the body. • Vitamin C is vital to the formation of collagen in the body. • Without vitamin C, collagen synthesis is disrupted in the body, and the joints suffer. COLLAGEN

Clinical symptoms of Vitamin C deficiency in scurvy

Free radicals are caused by: smoking bad fats in the diet exhaust fumes in the air Antioxidants consume the free radicals that damage cells, especially T-cells. As a water soluble vitamin, Vitamin C can help neutralize harmful reactions in the watery parts of the body (i.e., blood, intercellular fluid). As an antioxidant, Vitamin C protects LDL, low density lipoprotein cholesterol from the free radical damage. Only when LDL is damaged, can cholesterol lead to heart disease. ANTIOXIDANT PROPERTIES

Hormones • Vitamin C aids in the function of the adrenal gland. • The adrenal gland plays a primary in the endocrine system.

Cardiovascular System By protecting LDL cholesterol, Vitamin C aids in the HDL production • HDL cholesterol helps to promote good circulation and blood pressure • Vitamin C helps prevent heart disease by reducing artery stiffness and the tendency of platelets to clump together

Vitamin C & Nervous System • plays a role in converting tryptophan to serotonin, a vital neurotransmitter • aids in norepinephrine synthesis • enhances conversion of dopamine to epinephrine in the brain

Other functions of Vitamin C • Aids in iron absorption • Activates folic acid • Aids in drug metabolism and detoxification • Facilitates bile formation • Aids in synthesis of amino acid carnitine from dietary amino acids

BENEFITS OF VITAMIN C • wound healing • blood formation • healthy teeth and gums

RDA • CHILDREN 15-25 MG/D • MEN (19-30YRS.) 90 MG/D • WOMEN (19-30YRS.) 75MG/D • PREGNANCY (19-30 YRS.) 85 MG/D • LACTATION (19-30YRS.) 120MG/D Coulston et al., p. 754

-according to Loria et al, Low serum vitamin C is linked to increased mortality rate in men from cancer, but not in women.

Since the human body does not make Vitamin C for itself, people have to consume vitamin C either from food sources or dietary supplements or both. -Vitamin C is a powerful anti-oxidant, which explains its relation to lowering cancer risk

PATHOLOGY OF DISEASE • Deficiency • BARLOW’S DISEASE • SCURVY • AT RISK: • ALCOHOLICS • ISOLATED ELDERLY • MALABSORPTION SYNDROMES • FAD DIETING • INFANTS • SMOKERS

SIGNS & SYMPTOMS of deficiency of Vitamin C

Frequency • In the US & Internationally: Scurvyis rare • Young children (0-6 months usually protected from Vitamin C deficiency, unless mother is deficient). • Those most commonly affected ages are aged 6-18 months; however, adults can also be affected. • The elderly are predisposed to scurvy because of poor diet • Food over preparation (cooking process destroys vitamin C). Vitamin C

Smoking • Tribble et al. studies • Passive smokers have lower levels of ascorbic acid in their bodies. • Smokers have a 40% increase in use of ascorbic acid turnover Packer & Fuchs, p.399

VITAMIN C EXCESS Above2000 milligrams a day MIGHT lead to • diarrhea • kidney stones • joint pains • rash • iron overload • false positive glucose test

Clinical Details of Vitamin C • Normal, total body pool = 1500 mg. Normal plasma level should range from 0.7-1.2 mg/dL.If total levels decrease below 350 mg Scurvy manifests itself within 2-3 months. At least 10 mg/d maintains the total body pool above 350 mg and will prevent scurvy.

Clinical Symptoms include: • Mental confusion, malaise, and fatigue • Hair follicle enlargement • Dry, rough skin • Swollen gums and possible tooth loss • Ecchymoses, small hemorrhages • Costochondral junction problems • Slow skeletal development • Impaired wound healing and ulcer degeneration WHY?

Malabsorption • tobacco use • chronic oxidative stress • hemodialysis • Drug- aminopterin • reduces the vitamin C level in the body.

SOURCES • www.heart-disease-bypass-surgery.com/data/molecular/m9.htm(The 3-Dstructure of Vitamin C) • www.suburbanchicagonews.com/opinions/columnists/gott/c04gott.htm(Suburban Chicago Newspapers) • www.emedicine.com/radio/topic628.htm • http://www.sustaintech.org/pub11.pdf(Sustain- Results Report on Vitamin C program) http://home.caregroup.org/clinical/altmed/interactions/nutrients/vitamin_C.htm(IBIS medical group) http://www.thebody.com/bp/may99/nutrients.htm ( (AIDS and HIV resource site) http://home.howstuffworks.com/vitamin-C.htm(How Vitamin C works) http://www.symmcorp.com/info/vitamin-C.htm(Vitamin C products)

sources • http://www.microscopy.fsu.edu/vitamins/pages/vitaminc.html(ascorbic acid gallery picture) • http://www.acclaimimages.com/_gallery/_pages/0015-0309-1519-3837.html(Stock photography - orange picture) • http://www.tastingarizona.com/pages/foodnews/fj18.html(On-line publication for the food service industry) • http://www.serrins.com/ymotm.html • http://www.wesley.edu/Chemistry/chemistry227/bindprotns/nanoimages/collagen.gif • http://wine1.sb.fsu.edu/research/dkr.html(Dr. Blaber’s web-site) • http://www.vitamincfoundation.org(vitamin C foundation picture)

Paper Media: The Lancet, vol. 357, March 3, 2001 Vitamin C in Health and Disease; Packer, Lester, and Jurgen Fuchs; Marcel Dekker, Inc., New York, c. 1997 Nutrition in the Prevention and Treatment of Disease; Coulston, Ann; Chery Rock, and Elaine Monsen;Academic Press, San Diego, c. 2001 Web: www.nlm.nih.gov/medlineplus/ency/article/000355.htm 2003 Sep;17(9):641-54. PMID: 13679954 [PubMed - in process Scurvy: historical review and current diagnostic approach.Am J Emerg Med. 2003 Jul;21(4):328-32. PMID: 12898492 [PubMed - indexed for MEDLINE http://www.ncbi.nlm.nih.gov/entrez/query.fcgi http://www.perio.org/ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd http://merck.com/mrkshared/mmanual/section1/chapter3/3q.jsp

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Vitamin C . Core Practical. Background. Vitamin C is an antioxidant Which type of fruit juice provides the most vitamin C? Is drinking fruit juice as good as eating fruit (for antioxidants)? Fruit juice in cartons is long life (heat treated). Testing for Vitamin C.

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Vitamin C. Objectives. After reading Chapter 6, completing a concept map and class discussion, you will be able to: Describe characteristics of Vitamin C Identify food sources of Vitamin C Discuss roles of Vitamin C Antioxidant Collagen formation cofactor Stress reaction

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Vitamin C. What is Vitamin C?. Vitamin C is a water soluble vitamin that is commonly found in fruits and vegetables. Where Does It Come From?. Kiwi Oranges Sweet potatoes Lemons Tomatoes Strawberries Turnip Greens Broccoli Red peppers Cantaloupe White potatoes Papaya Blueberries

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Vitamin C. By Tyler Paterson. Why We Need It. Humans cannot produce their own source of vitamin C so we have to obtain it through our own diet.

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Vitamin C. Basis for the oldest Nutrient deficiency disease. Scurvy – became prominent during colonialism – 16 th century Ships – high protein diets Symptoms – inflamed bleeding gums, hemorrhaging, impaired wound healing, joint pain, infections, weakness, fatigue, anemia, anorexia, diarrhea.

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Vitamin C. Organic compound Ascorbic Acid Dehydroascorbic acid (DHA ) Water-soluble vitamin In food we eat, but our body can not make it. Function of Vitamin C. Vitamin C is required for the growth and repair of tissue. Is necessary to form collagen. Prevents scurvy.

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Vitamin C. Lily Chin Nikita Gupta Shirley He Brenda Wong. Vitamin C. Ascorbic Acid water soluble helps to synthesize collagen, norepinephrine, and carnitine Antioxidant. Vitamin C. Function in the Body. Collagen –important part of blood vessels, ligaments, tendons and bone

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Vitamin C Adventure. Jobs of Vitamin C. It is important in forming collagen, which is a protein that gives structure to bones, cartilage, muscles, and blood vessels It is important for healthy blood. it helps maintain small blood vessels, bones, and teeth. Vitamin C Food Sources. Guavas

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Vitamin C. Matt Meinnert. Original Use.

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vitamin c. L-ascorbic acid, ascorbate Synthesized from glucose by most animals Vitamin C is an electron donor. Functions of Vitamin C. Enhances absorption of iron reduces iron to more absorbable ferrous form chelates with ferrous ion to make it more soluble. Functions of Vitamin C.

349 views • 12 slides

Vitamin C. The Facts, The Fiction, And the Law. In the Words of Mark Twain. “Be careful in reading health books. You may die of a misprint.”. Reference Checking. Go to: http://www.ncbi.nlm.nih.gov/pubmed/ In the PubMed search box, enter:

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Vitamin C Cream

We aim to meet customer satisfaction by providing elite customer care. Oval Earth’s outlook is to continue supplying quality products that will benefit customers and satisfy needs. http://ovalearth.com/

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Liposomal vitamin c

So today Quicksilver Scientific will dedicate a brief review of "The history" of this great vitamin, because, as Quicksilver Scientific will see, not only covers the treatment of the common cold as many thinks, but the evidence takes far beyond.

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Vitamin C IV

Vitamin therapy is a wonderful way for you to stay healthy while you live your life and beat the common cold and flu.

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Vitamin C serum

Nowadays, if you are in the beauty/anti-aging scene, or the skincare game in general, then you would have most likely heard of Vitamin C serum. It is the new king of beauty products as it is touted to be by popular dermatologists and beauty bloggers. Vitamin C is a very potent antioxidant that help in the production of collagen which in turn repair damages done by free radicals and the sun, thus, reducing the signs of aging. Although it canu2019t replace a sunscreen, it has been known to also protect the body against future damage. The usage of vitamin C always result in great results like firmer and brighter skins, fewer wrinkles, and even skin tone.

63 views • 5 slides

The Vital Vitamin- Vitamin C

In the era where nothing is pure, it has become difficult to have a pure source of vitamins, but you people need not worry, immune system booster vitamins USA company manufactures these vitamins you can buy immune defence vitamin C online anywhere anytime.

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Vitamin C face mask

And, before you try to select a vitamin C cream for your nose, take a peek at these professional tips to make the most of your vitamin C face mask or serum.

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vitamin c serums

Vitamin C serums have been helping thousands of real customers who have reported that this has helped them clear up their age or sunspots. These vitamin C serums are best to go for.

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Thematic Issue: Rare Endocrine Diseases 2024

Read our special collection of journal articles, published in 2023-2024, focused on rare endocrine diseases! Curation of the collection was guided by  Altmetric Attention Scores , article downloads, and designation as a featured article.

In Journal of the Endocrine Society , Richter and Bechmann report that ancestral origins and biological sex are strong influences on the driver genes identified in a retrospective analysis of over 2000 Asian and European patients with pheochromocytoma and paraganglioma. Charoenngam and coauthors report favorable results from a small study testing the feasibility of using a pump to infuse recombinant parathyroid hormone moieties in adult patients with hypoparathyroidism. Else and colleagues find that a novel radiotracer is effective for staging paragangliomas using positron emission tomography.

In JCEM Case Reports , Rosenberg and coauthors describe a rare case of adrenal cortical carcinoma with hyperaldosteronism and cortisol excess. Shu et al. describe the case of a woman diagnosed with Fahr syndrome secondary to pseudohypoparathyroidism. Park and associates describe a case of pseudo-Cushing syndrome with atypically high cortisol burden.

In Endocrine Reviews , Mullen and colleagues discuss how new technologies have advanced the treatment of primary aldosteronism-induced hypertension. Mulders and associates analyze the literature on carcinoid syndrome, a debilitating complication of neuroendocrine neoplasms. Timmers and coauthors review advances in the imaging of pheochromocytomas and paragangliomas.

In Endocrinology , Birgersson et al. review the significance of estrogen receptor beta in granulosa cell tumors and evaluate its clinical potential. Yamagata and associates describe results suggesting that corticotropin releasing factor neurons in the paraventricular nucleus of the hypothalamus are responsible for the pathogenesis of impaired water excretion in secondary adrenal insufficiency. Costa-Guda and coauthors report evidence from a mouse study suggesting that suboptimal vitamin D status may not initiate parathyroid tumors but may accelerate the growth of an existing tumor.

In JCEM , Ceccato et al.  provide a systematic review and meta-analysis of the effectiveness of dynamic tests in the differential diagnosis of Cushing syndrome and ectopic adrenocorticotropic hormone secretion. Magnotto and colleagues find that, in a cohort of patients with central precocious puberty, novel mutations in different domains of the gene MKRN3 give rise to proteins with different patterns of ubiquitination, suggesting distinct mechanisms by which the loss of MRKN3 results in the early onset of puberty. Zhang et al. report evidence of gut microbial dysbiosis in patients with Cushing syndrome, and identify a group of bacteria whose abundance was positively correlated with patients’ cortisol levels.

JOURNAL OF THE ENDOCRINE SOCIETY

Patient sex and origin influence distribution of driver genes and clinical presentation of paraganglioma.

Continuous Subcutaneous Delivery of rhPTH(1-84) and rhPTH(1-34) by Pump in Adults With Hypoparathyroidism

3-[18F]Fluoro-para-hydroxyphenethylguanidine (3-[18F]pHPG) PET—A Novel Imaging Modality for Paraganglioma

JCEM CASE REPORTS

Dual aldosterone- and cortisol-secreting adrenal cortical carcinoma: pre- and perioperative evaluation and management.

Fahr Syndrome Secondary to Pseudohypoparathyroidism

Pseudo-Cushing Syndrome With an Atypically High Cortisol Burden and Clinical Improvement With Adrenal Enzyme Inhibitor

ENDOCRINE REVIEWS

Treating primary aldosteronism-induced hypertension: novel approaches and future outlooks.

What Is Carcinoid Syndrome? A Critical Appraisal of Its Proposed Mediators

Imaging of Pheochromocytomas and Paragangliomas

ENDOCRINOLOGY

Erß in granulosa cell tumors and its clinical potential.

Vasopressin Expressed in Hypothalamic CRF Neurons Causes Impaired Water Diuresis in Secondary Adrenal Insufficiency

Influence of Vitamin D Deficiency on Cyclin D1-Induced Parathyroid Tumorigenesis

THE JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM

Dynamic testing for differential diagnosis of acth-dependent cushing syndrome: a systematic review and meta-analysis.

Novel MKRN3 Missense Mutations Associated With Central Precocious Puberty Reveal Distinct Effects on Ubiquitination

Cushing Syndrome Is Associated With Gut Microbial Dysbiosis and Cortisol-Degrading Bacteria

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¿Qué es la vitamina C? ¿Para qué sirve?

La vitamina C, conocida como ácido ascórbico, es un nutriente hidrosoluble que se encuentra en ciertos alimentos. En el cuerpo, actúa como antioxidante, al ayudar a proteger las células contra los daños causados por los radicales libres. Los radicales libres son compuestos que se forman cuando el cuerpo convierte los alimentos que consumimos en energía. Las personas también están expuestas a los radicales libres presentes en el ambiente por el humo del cigarrillo, la contaminación del aire y la radiación solar ultravioleta.

Además, el cuerpo necesita vitamina C para producir colágeno, una proteína necesaria para la cicatrización de las heridas. La vitamina C también mejora la absorción del hierro presente en los alimentos de origen vegetal y contribuye al buen funcionamiento del sistema inmunitario para proteger al cuerpo contra las enfermedades.

¿Cuánta vitamina C necesito?

La cantidad de vitamina C que necesita por día depende de su edad. Las cantidades promedio diarias de vitamina C, expresadas en miligramos (mg), que se recomiendan para las personas de diferentes edades son las siguientes:

Si usted fuma, debe añadir 35 mg a los valores arriba indicados para calcular la cantidad total recomendada de vitamina C que necesita cada día.

¿Qué alimentos son fuente de vitamina C?

Las frutas y verduras son las mejores fuentes de vitamina C. Para ingerir las cantidades recomendadas de vitamina C, consuma alimentos variados como:

• frutas cítricas (por ejemplo: naranjas y pomelos/toronjas) y sus jugos, así como pimientos rojos y verdes y kiwi, ricos en vitamina C.
• otras frutas y verduras, como brócoli, fresas, melón, papas horneadas y tomates, que también contienen vitamina C.
• algunos alimentos y bebidas fortificadas con vitamina C. Lea la etiqueta del producto para saber si un alimento contiene vitamina C agregada.

El contenido de vitamina C de un alimento podría disminuir al cocinarse o almacenarse por tiempo prolongado. Es posible que al cocinar los alimentos al vapor o en hornos de microondas la pérdida de vitamina C sea menor. Afortunadamente, muchas de las mejores fuentes de vitamina C, como las frutas y verduras, se comen crudas.

¿Qué tipos de suplementos dietéticos de vitamina C existen?

La mayoría de los suplementos multivitamínicos contienen vitamina C. Además, esta vitamina se consigue sola, como suplemento dietético, o combinada con otros nutrientes. En general, la vitamina C presente en los suplementos dietéticos se encuentra en forma de ácido ascórbico, pero algunos suplementos contienen otras formas, como ascorbato de sodio, ascorbato de calcio, otros ascorbatos minerales y ácido ascórbico con bioflavonoides. Los estudios científicos no han demostrado que ninguna forma de vitamina C sea más eficaz que otras.

¿Consumo suficiente vitamina C?

En los Estados Unidos, la mayoría de las personas obtienen suficiente vitamina C de los alimentos y bebidas que consumen. Sin embargo, ciertos grupos de personas son más propensos que otros a tener dificultades para obtener suficiente vitamina C:

• Los fumadores y las personas expuestas al humo del cigarrillo, en parte porque el humo aumenta la cantidad de vitamina C que el cuerpo necesita para reparar el daño causado por los radicales libres. Los fumadores necesitan 35 mg más de vitamina C por día que quienes no fuman.
• Los bebés alimentados con leche de vaca, evaporada o hervida, porque la leche de vaca contiene una cantidad muy escasa de vitamina C y el calor puede destruir esta vitamina. No se recomienda la leche de vaca para bebés menores de 1 año de edad. La leche materna y la fórmula para bebés contienen cantidades suficientes de vitamina C.
• Las personas que consumen una variedad muy limitada de alimentos.
• Las personas con ciertos trastornos de salud, como hipoabsorción (absorción insuficiente) grave, ciertos tipos de cáncer, y enfermedad renal que requiere hemodiálisis.

¿Qué ocurre si no consumo suficiente vitamina C?

La deficiencia de vitamina C es poco común en los Estados Unidos y Canadá. Quienes ingieren escasa o ninguna cantidad de vitamina C (menos de 10 mg por día) durante varias semanas pueden contraer escorbuto. El escorbuto causa cansancio, inflamación de las encías, pequeñas manchas en la piel de color rojo o violeta, dolor en las articulaciones, mala cicatrización de las heridas, y vello ensortijado o en forma de "sacacorchos". Otros síntomas de esta enfermedad incluyen depresión, inflamación y sangrado de las encías y aflojamiento o pérdida de dientes. Las personas que padecen escorbuto también pueden sufrir anemia. Sin tratamiento, el escorbuto es mortal.

¿Cuáles son algunos de los efectos de la vitamina C en la salud?

Los científicos estudian la vitamina C para determinar cómo afecta a la salud. A continuación, algunos ejemplos de los resultados de estas investigaciones:

Prevención y tratamiento del cáncer

Es posible que quienes consumen gran cantidad de vitamina C al comer frutas y verduras corran menos riesgo de tener varios tipos de cáncer, como cáncer de pulmón, seno y colon. Sin embargo, al parecer, tomar suplementos dietéticos de vitamina C, con o sin otros antioxidantes, no ayuda a prevenir el cáncer.

No se sabe con certeza si el consumo elevado de vitamina C es beneficioso para el tratamiento del cáncer. Los efectos de la vitamina C parecen depender de la forma en que ésta se administra al paciente. Las dosis orales de vitamina C no pueden elevar los niveles de vitamina C en la sangre casi a los niveles de las dosis administradas mediante inyecciones intravenosas. Algunos estudios en animales y tubos de ensayo indican que los niveles muy elevados de vitamina C en la sangre podrían reducir los tumores. Sin embargo, se requieren estudios adicionales para determinar si altas dosis de vitamina C por vía intravenosa contribuyen al tratamiento del cáncer.

Los suplementos dietéticos de vitamina C y otros antioxidantes podrían interactuar con la quimioterapia y la radioterapia para el cáncer. Las personas que reciben tratamiento contra el cáncer deben consultar con el oncólogo antes de tomar suplementos de vitamina C u otros suplementos dietéticos, en especial en concentraciones elevadas.

Enfermedad cardiovascular

Al parecer, quienes comen frutas y verduras en abundancia corren menos riesgo de sufrir una enfermedad cardiovascular. Los investigadores creen que el contenido de antioxidante de estos alimentos podría ser en parte responsable de esta asociación porque el daño oxidativo es una de las principales causas de la enfermedad cardiovascular. Sin embargo, los científicos aún no pueden afirmar con certeza si la propia vitamina C, presente en alimentos o suplementos, ayuda a proteger a las personas contra la enfermedad cardiovascular. Tampoco se sabe con certeza si la vitamina C contribuye a evitar el agravamiento de la enfermedad cardiovascular en quienes la padecen.

Degeneración macular relacionada con la edad y cataratas

La degeneración macular relacionada con la edad y las cataratas son dos de las principales causas de pérdida de la visión en personas de edad avanzada. Los investigadores no consideran que la vitamina C y otros antioxidantes influyan en el riesgo de padecer degeneración macular relacionada con la edad. Sin embargo, los estudios de investigación indican que la vitamina C, combinada con otros nutrientes, podría retrasar la progresión de la degeneración macular relacionada con la edad.

En un estudio científico amplio de personas de edad avanzada con degeneración macular relacionada con la edad que corrían un alto riesgo de que empeore a una fase avanzada, aquellas que tomaron un suplemento dietético diario con 500 mg de vitamina C, 80 mg de zinc, 400 UI de vitamina E, 15 mg de betacaroteno y 2 mg de cobre durante unos 6 años presentaron menos probabilidades de progresar a la fase avanzada de este trastorno de la visión. Además, presentaron una pérdida de la visión menor que aquéllos que no tomaron el suplemento dietético. Sin embargo, es aconsejable que las personas que tienen o comienzan a tener esta enfermedad hablen con su médico acerca de la posibilidad de tomar suplementos dietéticos.

No queda claro cuál es la relación existente entre la vitamina C y la formación de cataratas. Algunos estudios indican que las personas que consumen más vitamina C presente en los alimentos corren menos riesgo de padecer cataratas. Sin embargo, se requieren más estudios para esclarecer esta asociación y determinar si los suplementos de vitamina C influyen en el riesgo de tener cataratas.

Resfriado común

Si bien la vitamina C ha sido durante mucho tiempo un remedio popular para el resfriado común, los estudios de investigación demuestran que en la mayoría de las personas los suplementos de vitamina C no reducen el riesgo de resfriarse. Sin embargo, quienes toman suplementos de vitamina C con regularidad podrían sufrir resfriados de duración levemente menor o síntomas algo más leves al resfriarse. El consumo de suplementos de vitamina C tampoco parece ser de utilidad una vez que comienzan los síntomas del resfriado.

¿Puede la vitamina C ser perjudicial?

El consumo de vitamina C en concentraciones demasiado elevadas puede causar diarrea, náuseas y cólicos estomacales. En las personas que padecen hemocromatosis, un trastorno que provoca una acumulación excesiva de hierro en el organismo, la vitamina C en dosis elevadas podría empeorar el exceso de hierro y dañar los tejidos del cuerpo.

A continuación aparecen lo límites superiores darios para la vitamina C:

¿Existen interacciones con la vitamina C que debo conocer?

Los suplementos dietéticos de vitamina C pueden interactuar o interferir con los medicamentos que toma. Por ejemplo:

• Los suplementos dietéticos de vitamina C podrían interactuar con los tratamientos contra el cáncer, como la quimioterapia y la radioterapia. No se sabe con certeza si la vitamina C podría tener el efecto no deseado de proteger a las células tumorales de los tratamientos contra el cáncer, o si podría proteger a los tejidos normales contra los daños. Si usted recibe tratamiento contra el cáncer, hable con el profesional de la salud que lo atiende antes de tomar suplementos de vitamina C u otros antioxidantes, en especial en concentraciones elevadas.
• En un estudio, la vitamina C combinada con otros antioxidantes (como la vitamina E, el selenio y el betacaroteno) redujo los efectos de protección cardíaca de dos medicamentos ingeridos en forma combinada (una estatina y una niacina) para controlar los niveles de colesterol. No se sabe si esta interacción también ocurre con otras estatinas. Los profesionales de la salud deben vigilar los niveles de lípidos en las personas que toman estatinas y suplementos de antioxidantes.

Hable con el médico, farmacéutico y otros profesionales de la salud sobre los suplementos dietéticos y medicamentos que toma. Ellos le indicarán si estos suplementos dietéticos podrían interactuar o interferir con sus medicamentos recetados o no recetados o si los medicamentos podrían interferir con la forma en que su cuerpo absorbe, utiliza o descompone los nutrientes.

La vitamina C y la alimentación saludable

¿Dónde puedo consultar más información sobre nutrición y suplementos dietéticos?

Si desea más información en español y en inglés , sírvase visitar la página de la Oficina de Suplementos Dietéticos (NIH).

Aviso de renuncia de responsabilidad

La información presentada en esta hoja informativa de la Oficina de Suplementos Dietéticos (ODS) de los Institutos Nacionales de Salud (NIH) de ninguna manera sustituye el asesoramiento de un médico. Le recomendamos que consulte a los profesionales de la salud que lo atienden (médico, dietista registrado, farmacéutico, etc.) si tiene interés o preguntas acerca del uso de los suplementos dietéticos, y que podría ser mejor para su salud en general. Cualquier mención en esta publicación de un producto o servicio específico, o recomendación de una organización o sociedad profesional, no representa el respaldo de ODS a ese producto, servicio, o asesoramiento de expertos.

Última revisión: 18 de diciembre de 2019 Historia de las revisiones de esta hoja informativa

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A Destructive Midfacial Mass in a Middle-Aged Man

• 1 Department of Dermatology and Venereology, Peking University First Hospital, Beijing, China
• 2 National Clinical Research Center for Skin and Immune Diseases, Beijing, China
• 3 Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China

A 43-year-old man with a progressive midfacial mass for 6 months presented at our department. Just prior to presentation, he developed epistaxis, high fever, and weight loss of 10 kg. He did not have any medical disease and denied cocaine abuse. On physical examination, an egg-sized soft mass with erythema at the edge could be observed on his nose, and the mass was covered with multiple erosions, ulcers, and exudate ( Figure 1 A). Laboratory examination revealed moderate anemia and elevated C-reactive protein levels. Fungal microscopic examination and culture revealed negative results, while metagenomic next-generation sequencing of the lesion showed significant positivity for Pseudomonas aeruginosa and Epstein-Barr virus (EBV). Findings of computed tomography of the paranasal sinus were basically normal except for mucosal thickening. Skin biopsies were taken for histopathological examination ( Figure 1 B).

Read More About

Deng R , Li R , Wang X. A Destructive Midfacial Mass in a Middle-Aged Man. JAMA Dermatol. Published online May 29, 2024. doi:10.1001/jamadermatol.2024.0969

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