Vitamin C is a nutrient that is found in food, such as oranges, grapefruit, papaya, peppers, and kale, or in dietary supplements. Vitamin C is an antioxidant and helps prevent damage to cells caused by free radicals. It also works with enzymes to play a key role in making collagen. Vitamin C is also called L-ascorbic acid or ascorbate.

Indications:  wound healing, collagen stimulation/ skin wellness, immunity, iron absorption, improved mood, complementary treatment in cancer patients, reduction in hypertension.

Side effects/ Contraindications: In general, high-dose vitamin C given by IV has caused very few side effects in clinical trials. However, IV vitamin C may cause serious side effects in patients with kidney disease, G6PD deficiency, or hemochromatosis.

Studies:

• Some studies of IV high-dose vitamin C in patients with cancer have shown improved quality of life, as well as fewer side effects 

• Laboratory and animal studies have tested the effects of high-dose vitamin C. Laboratory studies suggest that high levels of vitamin C may kill cancer cells.

• In another small study of 9 patients with advanced pancreatic cancer, patients were given chemotherapy once a week for 3 weeks along with IV vitamin C twice a week for 4 weeks during each treatment cycle. The disease did not progress over an average of 6 months in these patients. No serious side effects were reported with the combined treatment.

• In a 2014 study of 27 patients with advanced ovarian cancer, chemotherapy alone was compared with chemotherapy and IV vitamin C. IV vitamin C was given during chemotherapy and for 6 months after chemotherapy ended. Patients who received IV vitamin C had fewer side effects from the chemotherapy.

• Patients with non-small cell lung cancer or glioblastoma multiforme in two pilot trials were given standard therapy plus IV vitamin C. Patients had better overall survival and fewer side effects compared to the control groups.

Vitamin C and Immune Function

Conclusions: Overall, vitamin C appears to exert a multitude of beneficial effects on cellular functions of both the innate and adaptive immune system. Although vitamin C is a potent antioxidant protecting the body against endogenous and exogenous oxidative challenges, it is likely that its action as a cofactor for numerous biosynthetic and gene regulatory enzymes plays a key role in its immune-modulating effects. Vitamin C stimulates neutrophil migration to the site of infection, enhances phagocytosis and oxidant generation, and microbial killing. At the same time, it protects host tissue from excessive damage by enhancing neutrophil apoptosis and clearance by macrophages, and decreasing neutrophil necrosis and NETosis. Thus, it is apparent that vitamin C is necessary for the immune system to mount and sustain an adequate response against pathogens, whilst avoiding excessive damage to the host. Vitamin C appears to be able to both prevent and treat respiratory and systemic infections by enhancing various immune cell functions. Prophylactic prevention of infection requires dietary vitamin C intakes that provide at least adequate, if not saturating plasma levels (i.e., 100–200 mg/day), which optimize cell and tissue levels. In contrast, treatment of established infections requires significantly higher (gram) doses of the vitamin to compensate for the increased metabolic demand. Epidemiological studies indicate that hypovitaminosis C is still relatively common in Western populations, and vitamin C deficiency is the fourth leading nutrient deficiency in the United States. Reasons include reduced intake combined with limited body stores. Increased needs occur due to pollution and smoking, fighting infections, and diseases with oxidative and inflammatory components, e.g., type 2 diabetes, etc. Ensuring adequate intake of vitamin C through the diet or via supplementation, especially in groups such as the elderly or in individuals exposed to risk factors for vitamin C insufficiency, is required for proper immune function and resistance to infections.

Reference:Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017 Nov 3;9(11):1211. doi: 10.3390/nu9111211. PMID: 29099763; PMCID: PMC5707683.

Critical Care Medicine: IV Vitamin C in Critically Ill Patients: A Systematic Review and Meta-Analysis

Conclusions: IV vitamin C administration appears safe and may be associated with a trend toward reduction in overall mortality. High-dose IV vitamin C monotherapy may be associated with improved overall mortality, and further randomized controlled trials are warranted.

Reference:

Patel, Jayshil J. MD1; Ortiz-Reyes, Alfonso MSc2; Dhaliwal, Rupinder RD2; Clarke, John MSc, RKin2; Hill, Aileen MD3; Stoppe, Christian MD4; Lee, Zheng-Yii MSc5; Heyland, Daren K. MD2 IV Vitamin C in Critically Ill Patients: A Systematic Review and Meta-Analysis, Critical Care Medicine: March 2022 - Volume 50 - Issue 3 - p e304-e312

doi: 10.1097/CCM.0000000000005320

Critical Care Medicine: Reversal of the Pathophysiological Responses to Gram-Negative Sepsis by Megadose Vitamin C

Conclusions: IV megadose sodium ascorbate reversed the pathophysiological and behavioral responses to Gram-negative sepsis without adverse side effects. Clinical studies are required to determine if such a dose has similar benefits in septic patients.

Reference:

Lankadeva, Yugeesh R. PhD1,2; Peiris, Rachel M. BSc (Hons)1; Okazaki, Nobuki MD1,3; Birchall, Ian E. PhD4; Trask-Marino, Anton BSc1; Dornom, Anthony1; Vale, Tom A. M. BA1; Evans, Roger G. PhD5; Yanase, Fumitaka MD6,7; Bellomo, Rinaldo MD, PhD2,6,7; May, Clive N. PhD1,2 Reversal of the Pathophysiological Responses to Gram-Negative Sepsis by Megadose Vitamin C, Critical Care Medicine: February 2021 - Volume 49 - Issue 2 - p e179-e190doi: 10.1097/CCM.0000000000004770

*Nervana Medical does NOT endorse CAM (complementary alternative medicine) alone but rather in conjunction with conventional treatments.