Effect of vitamin C on neutrophil function after high-intensity exercise

Exploring the Relationship between Micronutrients and Athletic Performance: A Comprehensive Scientific Systematic Review of the Literature in Sports Medicine

The aim of this systematic review is twofold: (i) to examine the effects of micronutrient intake on athletic performance and (ii) to determine the specific micronutrients, such as vitamins, minerals, and antioxidants, that offer the most significant enhancements in terms of athletic performance, with the goal of providing guidance to athletes and coaches in optimizing their nutritional strategies. The study conducted a systematic search of electronic databases (i.e., PubMed, Web of Science, Scopus) using keywords pertaining to micronutrients, athletic performance, and exercise. The search involved particular criteria of studies published in English between 1950 and 2023. The findings suggest that vitamins and minerals are crucial for an athlete's health and physical performance, and no single micronutrient is more important than others. Micronutrients are necessary for optimal metabolic body's functions such as energy production, muscle growth, and recovery, which are all important for sport performance. Meeting the daily intake requirement of micronutrients is essential for athletes, and while a balanced diet that includes healthy lean protein sources, whole grains, fruits, and vegetables is generally sufficient, athletes who are unable to meet their micronutrient needs due to malabsorption or specific deficiencies may benefit from taking multivitamin supplements. However, athletes should only take micronutrient supplements with the consultation of a specialized physician or nutritionist and avoid taking them without confirming a deficiency.

Vitamin C and Neutrophil Function: Findings from Randomized Controlled Trials

Vitamin C is known to support immune function and is accumulated by neutrophils to millimolar intracellular concentrations suggesting an important role for the vitamin in these cells. In this review, the effects of vitamin C, as a mono- or multi-supplement therapy, on neutrophil function were assessed by conducting a systematic review of randomized controlled trials (RCTs). Specifically, trials which assessed neutrophil migration (chemotaxis), phagocytosis, oxidative burst, enzyme activity, or cell death (apoptosis) as primary or secondary outcomes were assessed. A systematic literature search was conducted using the Cochrane Central Register of Controlled Trials, EMBASE, Embase Classic, Joanna Briggs Institute EBP, Ovid MEDLINE^®, Ovid MEDLINE^® In-Process & Other Non-Indexed Citations, Ovid Nursing Database, CINAHL and PubMed database, which identified 16 eligible RCTs. Quality appraisal of the included studies was carried out using the Cochrane Risk of Bias tool. Three of the studies assessed neutrophil chemotaxis in hospitalised patients or outpatients, two of which showed improved neutrophil function following intravenous vitamin C administration. Ten RCTs assessed neutrophil phagocytosis and/or oxidative burst activity; five were exercise studies, one in smokers, one in myocardial infarction patients and three in healthy volunteers. Two of the multi-supplement studies showed a difference between the intervention and control groups: increased oxidative burst activity in athletes post-exercise and decreased oxidant generation in myocardial infarction patients. Two studies assessed neutrophil enzyme activity; one showed deceased antioxidant enzyme activity in divers and the other showed increased antioxidant enzyme activity in athletes. One final study showed decreased neutrophil apoptosis in septic surgical patients following intravenous vitamin C administration. Overall, 44% of the RCTs assessed in this review showed effects of vitamin C supplementation on neutrophil functions. However, the studies were very heterogeneous, comprising different participant cohorts and different dosing regimens. There were also a number of limitations inherent in the design of many of these RCTs. Future RCTs should incorporate prescreening of potential participants for low vitamin C status or utilize cohorts known to have low vitamin status, such as hospitalized patients, and should also comprise appropriate vitamin C dosing for the cohort under investigation.

Glycolaldehyde impairs neutrophil biochemical parameters by an oxidative and calcium-dependent mechanism--protective role of antioxidants astaxanthin and vitamin C

AIM

The present study examined the effects of glycolaldehyde (GC) on biochemical parameters of human neutrophils and whether the antioxidant astaxanthin associated with vitamin C can modulate these parameters.

METHODS

Neutrophils from healthy subjects were treated with GC (1mM) followed or not by the antioxidants astaxanthin (2 μM) and vitamin C (100 μM). We examined the phagocytic capacity, hypochlorous acid, myeloperoxidase (MPO) and glucose-6-phosphate dehydrogenase (G6PDH) activities, cytokines and [Ca(2+)](i). Also, superoxide anion, hydrogen peroxide, nitric oxide production, antioxidant enzyme activities and glutathione-recycling system were evaluated.

RESULTS

GC promoted a marked reduction on the phagocytic capacity, maximal G6PDH and MPO activities, hypochlorous acid production and release of IL-1β, IL-6 and TNF-α cytokines. Some impairment in the neutrophils biochemical parameters appears to be mediated by oxidative stress through ROS/RNS production and calcium reduction. Oxidative stress was evidenced by reduction in the activities of the main antioxidant enzymes, GSH/GSSG ratio and in the increment of O(2)(-) and H(2)O(2) and NO.

CONCLUSIONS

Treatment of cells with the combination of the antioxidants astaxanthin and vitamin C was able to restore some neutrophils function mainly by decreasing ROS/RNS production and improving the redox state. Overall, our findings demonstrate that GC modulates several neutrophils biochemical parameters in vitro.

Update: effects of antioxidant and non-antioxidant vitamin supplementation on immune function

The purpose of this manuscript is to review the impact of supplementation with vitamins E and C, carotenoids, and the B vitamins on parameters of innate and adaptive immune function as reported from clinical trials in humans. There is evidence to support causal effects of supplementation with vitamins E and C and the carotenoids singly and in combination on selected aspects of immunity, including the functional capacity of innate immune cells, lymphocyte proliferation, and the delayed-type hypersensitivity (DTH) response. Controlled intervention trials of B vitamin-containing multivitamin supplements suggest beneficial effects on immune parameters and clinical outcomes in HIV-positive individuals.

Nutritional modulation of exercise-induced immunodepression in athletes: a systematic review and meta-analysis

BACKGROUND

Heavy exercise induces marked immunodepression that is multifactorial in origin. Nutrition can modulate normal immune function.

OBJECTIVE

To assess the efficacy of nutritional supplements in exercise-induced immunodepression in athletes.

DESIGN

Systematic review.

REVIEW METHODS

Randomised and/or controlled trials of athletes undertaking nutritional supplements to minimise the immunodepression after exercise were retrieved. The primary outcome measure was incidence of upper respiratory tract (URT) illness symptoms after exercise, and secondary outcomes included cortisol, cell counts, plasma cytokine concentration, cell proliferative response, oxidative burst, natural killer cell activity and immunoglobulins. When data were available for a pooled estimate of the effect of intervention, meta-analyses were conducted for direct comparisons.

RESULTS

Forty-five studies were included (1603 subjects). The studies were heterogeneous in terms of exercise interventions, selection of athletes, settings and outcomes. The overall methodological quality of most of the trials was poor. Twenty studies addressed carbohydrate supplementation, eight glutamine, 13 vitamin C and four others interventions. Three trials assessed the effect of intervention on prevention of URT infections. The pooled rate ratio for URT infections after vitamin C supplementation against placebo was 0.49 (0.34-0.71). Carbohydrate supplementation attenuated the increase in cortisol and neutrophils after exercise; vitamin C attenuated the decrease in lymphocytes after exercise. No other interventions had significant or consistent effect on any of the studied outcomes.

CONCLUSIONS

Although the prevention of URT infections by vitamin C was supported by two trials, further studies are needed. The available evidence failed to support a role for other nutritional supplements in preventing exercise-induced immune suppression. Larger trials with clinically relevant and uniform end points are necessary to clarify the role of these nutritional interventions.

Response of blood cell antioxidant enzyme defences to antioxidant diet supplementation and to intense exercise

BACKGROUND

Exhaustive exercise induces oxidative stress. The cellular antioxidant defence systems have demonstrated great adaptation to chronic exercise.

AIM

To establish the influence of the antioxidant diet supplementation on the erythrocyte and lymphocyte antioxidant enzyme activities in athletes at basal and post-exercise levels.

METHODS

Fifteen amateur trained male athletes were randomly distributed in two groups: control and antioxidant supplemented (90 days' diet supplementation with 500 mg/day vitamin E and 30 mg/day beta-carotene, and the last 15 days also with 1 g/day vitamin C). The study was double blind. Maximal and submaximal exercise tests were performed after three months of diet supplementation. The study was developed during the training and competition season.

RESULTS

The sportsmen of the supplemented group presented significantly higher plasmatic final levels of vitamin C, vitamin E and beta-carotene. Erythrocyte glutathione reductase activity significantly decreased in the placebo group but was maintained in the supplemented group after the three months studied. The erythrocyte superoxide dismutase activity increased after the training/competition period in the placebo group. Lymphocyte catalase and glutathione peroxidase activities increased significantly in the supplemented group after the supplementation period but were maintained in the placebo group. No effects of the antioxidant supplementation were observed in the erythrocyte antioxidant enzyme response to the exercise tests. The antioxidant supplementation induced a better adaptation of lymphocyte catalase after submaximal test.

CONCLUSIONS

Lymphocytes showed higher sensibility to antioxidant supplementation, improving the response of antioxidant enzymes to training and to acute exercise. In erythrocytes the training adaptations were more important than the antioxidant supplementation effects.

Does prolonged cycling of moderate intensity affect immune cell function?

BACKGROUND

Prolonged exercise may induce temporary immunosuppression with a presumed increased susceptibility for infection. However, there are only few data on immune cell function after prolonged cycling at moderate intensities typical for road cycling training sessions.

METHODS

The present study examined the influence on immune cell function of 4 h of cycling at a constant intensity of 70% of the individual anaerobic threshold. Interleukin-6 (IL-6) and C-reactive protein (CRP), leukocyte and lymphocyte populations, activities of natural killer (NK), neutrophils, and monocytes were examined before and after exercise, and also on a control day without exercise.

RESULTS

Cycling for 4 h induced a moderate acute phase response with increases in IL-6 from 1.0 (SD 0.5) before to 9.6 (5.6) pg/ml 1 h after exercise and CRP from 0.5 (SD 0.4) before to 1.8 (1.3) mg/l 1 day after exercise. Although absolute numbers of circulating NK cells, monocytes, and neutrophils increased during exercise, on a per cell basis NK cell activity, neutrophil and monocyte phagocytosis, and monocyte oxidative burst did not significantly change after exercise. However, a minor effect over time for neutrophil oxidative burst was noted, tending to decrease after exercise.

CONCLUSIONS

Prolonged cycling at moderate intensities does not seem to seriously alter the function of cells of the first line of defence. Therefore, the influence of a single typical road cycling training session on the immune system is only moderate and appears to be safe from an immunological point of view.

Norepinephrine as mediator in the stimulation of phagocytosis induced by moderate exercise

During intensive exercise the stimulation of phagocytosis is mediated by "stress hormones". During moderate exercise, however, such mediation is less clear. The influence of moderate exercise (45 min at 55% maximal oxygen uptake) on the phagocytic capacity of neutrophils was evaluated in sedentary men. The exercise stimulated phagocytosis of Candida albicans, and the stimulation was maintained for at least 24 h. The possible neuroendocrine mediators were then investigated. Stimulation of phagocytosis was found after incubating neutrophils from sedentary individuals, who were in a basal state, with plasma from exercised individuals. Immediately after exercise, there was a significant increase in the concentration of norepinephrine, but not of epinephrine or cortisol. Incubation of neutrophils with this post-exercise physiological concentration of norepinephrine also stimulated phagocytosis, and the effect was blocked by both propranolol and phentolamine. The norepinephrine-augmented phagocytosis was accompanied by an increase in intracellular levels of cAMP, but not of cGMP or calcium. In conclusion, moderate exercise performed by sedentary people stimulates the phagocytic capacity of neutrophils, and the stimulation lasts for at least 24 h. Norepinephrine mediates the stimulation, although other mechanisms could be involved during the recovery period.

Ascorbate-mediated enhancement of reactive oxygen species generation from polymorphonuclear leukocytes: modulatory effect of nitric oxide

Recent studies from our laboratory have demonstrated that ascorbate potentiated enzymatic synthesis of nitric oxide (NO) from polymorphonuclear leukocytes (PMNs). NO is known to modulate various function of PMNs such as chemotaxis, adherence, aggregation, and generation of reactive oxygen species (ROS). The role of ascorbate in the PMN phagocytosis, ROS generation, and apoptosis was thus evaluated in the present study. Ascorbate and its oxidized and cell-permeable analog, dehydroascorbate (DHA), did not affect the phagocytosis but enhanced ROS generation and apoptosis following treatment with Escherichia coli or arachidonic acid. A detailed investigation on the DHA-mediated response indicated that inhibitors of DHA uptake, reduced nicotinamide adenine dinucleotide phosphate oxidase, NO synthase, or ROS scavengers attenuated ROS generation. In DHA-treated cells, enhanced generation of peroxynitrite was also observed; thus, ascorbate-mediated ROS and reactive nitrogen species generation might mediate cytotoxicity toward the ingested microbes and subsequently, augmented PMN apoptosis. Results of the present study have helped in delineating the role of ascorbate in the modulation of NO-mediated ROS generation from PMNs.

Role of ascorbate in the regulation of nitric oxide generation by polymorphonuclear leukocytes

We have recently demonstrated that NO-mediated polymorphonuclear (PMN)-dependent inhibition of rat platelet aggregation is significantly enhanced in the presence of ascorbate. Consequently, the present study was undertaken to elucidate the underlying mechanisms involved in ascorbate-mediated potentiation of NO synthesis in PMNs. We observed that ascorbate or its oxidized product, dehydroascorbate (DHA), enhanced NOS activity, as measured by nitrite content, diaminofluorescein fluorescence or conversion of L-[3H]arginine to L-[3H]citrulline in rat, monkey, and human PMNs. The increase in NO generation following ascorbate treatment was due to the intracellular ascorbate as iodoacetamide-mediated inhibition of DHA to ascorbate conversion attenuated the DHA-mediated increase in NO synthesis. The augmentation of NOS activity in the PMN homogenate by tetrahydrobiopterin was significantly enhanced by ascorbate, while ascorbate alone did not influence the NOS activity. Ascorbate-mediated enhancement of NOS activity in the cultured PMNs was significantly reduced in the presence of biopterin synthesis inhibitors. Ascorbate, thus, seems to regulate the NOS activity in the PMNs through tetrahydrobiopterin.

Oxidative stress, exercise, and antioxidant supplementation

Cells continuously produce free radicals and reactive oxygen species (ROS) as part of metabolic processes. These free radicals are neutralized by an elaborate antioxidant defense system consisting of enzymes such as catalase, superoxide dismutase, glutathione peroxidase, and numerous non-enzymatic antioxidants, including vitamins A, E and C, glutathione, ubiquinone, and flavonoids. Exercise can produce an imbalance between ROS and antioxidants, which is referred to as oxidative stress. Dietary antioxidant supplements are marketed to and used by athletes as a means to counteract the oxidative stress of exercise. Whether strenuous exercise does, in fact, increase the need for additional antioxidants in the diet is not clear. This review examines the markers used to determine oxidative stress in blood and muscle samples (e.g. lipid peroxidation, expired pentane, malondialdehyde (MDA), F2-isoprostanes, congugated dienes, and 8-hydroxy-2'-deoxyguanosine (8-OhdG)), the changes in oxidative stress markers induced by exercise, and whether athletes require antioxidant supplements.

Influence of vitamin C supplementation on oxidative and salivary IgA changes following an ultramarathon

This randomized study measured the influence of vitamin C ( N=15) compared to placebo ( N=13) supplementation on oxidative and salivary immunoglobulin A (sIgA) changes in runners competing in an ultramarathon race. Seven days prior to the race, subjects ingested in randomized, double-blind fashion three 500-mg tablets of vitamin C or placebo each day. On race day, blood and saliva samples were collected 1 h pre-race, after 32 km of running, and then again immediately post-race. During the race, runners received 1 l/h carbohydrate beverages (60 g/l) with vitamin C (150 mg/l) or without in a double-blinded fashion. The runners also ingested two to three carbohydrate gel packs per hour (25 g each). Subjects in both groups ran a mean of 69 km (range 48-80 km) in 9.8 h (range 5-12 h) and maintained an intensity of approximately 75% maximal heart rate (HR(max)) throughout the ultramarathon race. Plasma ascorbic acid was higher in the vitamin C compared to placebo group pre-race, and increased significantly in the vitamin C group during the race [post-race, 3.21 (0.29) and 1.28 (0.12) microg/100 microl, respectively, P<0.001]. No significant group or interaction effects were measured for lipid hydroperoxide and F(2)-isoprostane, but both oxidative measures rose significantly during the ultramarathon race. Saliva volume, sIgA concentration, sIgA secretion and sIgA:saliva protein ratio all decreased significantly (P<0.001) during the race, but the pattern of change in all saliva measures did not differ significantly between groups. No significant correlations were found between post-race plasma vitamin C, oxidative, and saliva measures, except for a positive correlation between post-race serum cortisol and serum vitamin C (r=0.50, P=0.006). These data indicate that vitamin C supplementation in carbohydrate-fed runners does not serve as a countermeasure to oxidative and sIgA changes during or following a competitive ultramarathon race.

Influence of vitamin C supplementation on oxidative and immune changes after an ultramarathon

The purpose of this randomized study was to measure the influence of vitamin C (n = 15 runners) compared with placebo (n = 13 runners) supplementation on oxidative and immune changes in runners competing in an ultramarathon race. During the 7-day period before the race and on race day, subjects ingested in randomized, double-blind fashion 1,500 mg/day vitamin C or placebo. On race day, blood samples were collected 1 h before race, after 32 km of running, and then again immediately after race. Subjects in both groups maintained an intensity of approximately 75% maximal heart rate throughout the ultramarathon race and ran a mean of 69 km (range: 48-80 km) in 9.8 h (range: 5-12 h). Plasma ascorbic acid was markedly higher in the vitamin C compared with placebo group prerace and rose more strongly in the vitamin C group during the race (postrace: 3.21 +/- 0.29 and 1.28 +/- 0.12 microg/100 microl, respectively, P < 0.001). No significant group or interaction effects were measured for lipid hydroperoxide, F2-isoprostane, immune cell counts, plasma interleukin (IL)-6, IL-10, IL-1-receptor antagonist, or IL-8 concentrations, or mitogen-stimulated lymphocyte proliferation and IL-2 and IFN-gamma production. These data indicate that vitamin C supplementation in carbohydrate-fed runners does not serve as a countermeasure to oxidative and immune changes during or after a competitive ultramarathon race.

Exercise immunology: nutritional countermeasures

In contrast to moderate physical activity, prolonged and intensive exertion causes numerous changes in immunity that reflect physiologic stress and suppression, and an increased risk of upper respiratory tract infection. Enzymes in immune cells require the presence of micronutrients, leading to attempts by investigators to alter changes in immunity following heavy exertion through use of nutritional supplements, primarily zinc, dietary fat, vitamin C and other antioxidants, glutamine, and carbohydrate. Except for carbohydrate supplementation, none of these nutrients has emerged as an effective countermeasure to exercise-induced immunosuppression. Data from several studies of endurance athletes suggest that carbohydrate compared to placebo ingestion is associated with an attenuated cortisol, growth hormone, and epinephrine response to heavy exertion, fewer perturbations in blood immune cell counts, lower granulocyte and monocyte phagocytosis and oxidative burst activity, and a diminished pro- and anti-inflammatory cytokine response. Overall, the hormonal and immune responses to carbohydrate compared to placebo ingestion during intensive exercise suggest that physiologic stress and inflammation are diminished, although clinical significance awaits further research.