Safety of high-level vitamin C ingestion

Procyanidin B1 promotes in vitro maturation of pig oocytes by reducing oxidative stress

Oxidative stress negatively affects the in vitro maturation (IVM) of oocytes. Procyanidin B1 (PB1) is a natural polyphenolic compound that has antioxidant properties. In this study, we investigated the effect of PB1 supplementation during IVM of porcine oocytes. Treatment with 100 μM PB1 significantly increased the MII oocytes rate (p <0.05), the parthenogenetic (PA) blastocyst rate (p <0.01) and the total cell number in the PA blastocyst (p < 0.01) which were cultured in regular in vitro culture (IVC) medium. The PA blastocyst rate of regular MII oocytes activated and cultured in IVC medium supplemented with 100 and 150 μM PB1 significantly increased compared with control (p < 0.01 and p < 0.05). We also evaluated the reactive oxygen species (ROS) levels, mitochondrial membrane potential (Δψm) levels, glutathione (GSH) levels, and apoptotic levels in MII oocytes and cumulus cells following 100 μM PB1 treatment. The results showed that the PB1 supplementation decreased ROS production and apoptotic levels. In addition, PB1 was found to increase Δψm levels and GSH levels. In conclusion, PB1 inhibited apoptosis of oocytes and cumulus cells by reducing oxidative stress. Moreover, PB1 improved the quality of oocytes and promoted PA embryo development. Taken together, our results suggest that PB1 is a promising antioxidant additive for IVM of oocytes.

The Effect of Perioperative Vitamin C on Postoperative Analgesic Consumption: A Meta-Analysis of Randomized Controlled Trials

Because the analgesic effect of vitamin C against acute pain remains poorly addressed, this meta-analysis aimed at investigating its effectiveness against acute postoperative pain. A total of seven randomized controlled trials with placebo/normal controls were identified from PubMed, Cochrane Library, Medline, Google Scholar, and Embase databases. Pooled analysis showed a lower pain score (standardized mean difference (SMD) = -0.68, 95% CI: -1.01 to -0.36, p < 0.0001; I2 = 57%) and a lower morphine consumption (weighted mean difference (WMD) = -2.44 mg, 95% CI: -4.03 to -0.86, p = 0.003; I2 = 52%) in the vitamin group than that in the placebo group within postoperative 1-2 h. At postoperative 24 h, a lower pain score (SMD = -0.65, 95% CI: -1.11 to -0.19, p = 0.005; I2 = 81%) and lower morphine consumption (WMD = -6.74 mg, 95% CI: -9.63 to -3.84, p < 0.00001; I2 = 85%) were also noted in the vitamin group. Subgroup analyses demonstrated significant reductions in pain severity and morphine requirement immediately (1-2 h) and 24 h after surgery for patients receiving intravenous vitamin C but not in the oral subgroup. These findings showed significant reductions in pain score and opioid requirement up to postoperative 24 h, respectively, suggesting the effectiveness of perioperative vitamin C use. Further large-scale trials are warranted to elucidate its optimal intravenous dosage and effectiveness against chronic pain in the postoperative pain control setting.

Mercury disrupts redox status, up-regulates metallothionein and induces genotoxicity in respiratory tree of sea cucumber (Holothuria forskali)

Mercury (Hg) is among the most deleterious contaminant in the aquatic environment and presents a serious risk to humans and ecosystems. This study evaluated the effects of Hg on oxidative stress biomarkers, DNA integrity and histological structure of the respiratory tree of Holothuria forskali exposed to different concentrations of mercury chloride HgCl₂ (0.04, 0.08 and 0.16 mg L^-1) for 96 h. Exposure of H. forskali to Hg led to oxidative stress with an increase in Malondialdehyde (MDA), hydrogen peroxide (H₂O₂), advanced oxidation protein product (AOPP) and protein carbonyls (PCO) levels in the treated groups. Alteration of the antioxidant system was also confirmed by the significant increase in glutathione (GSH), nonprotein thiol (NPSH) and vitamin C contents. Moreover, the enzymatic activity of superoxide dismutase (SOD), Glutathione peroxidase (GPX) and Catalase (CAT) increased significantly. Our research revealed that total Metallothionein (MTs) content enhanced in a dose-dependent manner. Interestingly, the exposure to this metal provoked a decrease in Acetylcholinesterase (AChE) activity. Hg genotoxicity was further evidenced by a random DNA degradation that was observed in the treated groups. The histopathological findings confirmed the biochemical results. Overall, our results indicated that mercury-induced genotoxicity, oxidative damage and histopathological injuries in the respiratory tree of H. forskali.

Nutrition and Lower Extremity Ulcers: Causality and/or Treatment

The association between malnutrition, impaired wound healing, and the presence of chronic wounds has been recognized for a long time. It is widely believed that the lack of adequate nutrition increases the risk of developing wounds which have a great likelihood of progressing to chronicity due to lack of appropriate healing responses. This risk is particularly high in the aging population. For the individual patient, as well as patient populations, the diagnosis of malnutrition has been in dispute; further, there is lack of agreement of when and how to intervene nutritionally in those with wounds or healing deficits. This article examines the relationship of nutritional status with the presence and clinical evolution of leg ulcers in humans, focusing on diabetic and venous leg ulcers; we will further review the effect of nutritional therapy on the outcome of these ulcers.

Reducing Cancer Risk with Vitamins C, E, and Selenium

Current research has provided evidence that nearly 90 percent of all cancers may be related to diet, environment, and lifestyle. Of this number, 30 to 40 percent of cancers in men and up to 60 percent of cancers in women may be related to diet and nutrition. The two-stage process in the formation of many cancers, defined as initiation and promotion, is influenced by many dietary components. Vitamins C, E, and the mineral selenium are nutrients that function as antioxidants, reducing potential cancer-causing chemicals in the body. These natural anticarcinogens are thought to alter the cancer process and are currently under study for their cancer prevention properties. The functions, Recommended Dietary Allowances, food sources, research evidence for cancer prevention, and recommendations for supplementation are presented for these three nutrients. Research suggests that the proper and prudent use of nutrients, along with a healthy diet and lifestyle, may offer protection against this devastating disease.

Potential protective effects of extra virgin olive oil on the hepatotoxicity induced by co-exposure of adult rats to acrylamide and aluminum

Extra virgin olive oil has been shown to be effective against oxidative stress associated diseases.

Review of high-dose intravenous vitamin C as an anticancer agent

In the 1970s, Pauling and Cameron reported increased survival of patients with advanced cancer treated with high-dose intravenous (IV) vitamin C (L-ascorbate, ascorbic acid). These studies were criticized for their retrospective nature and lack of standardization of key prognostic factors including performance status. Subsequently, several well-designed randomized controlled trials failed to demonstrate a significant survival benefit, although these trials used high-dose oral vitamin C. Marked differences are now recognized in the pharmacokinetics of vitamin C with oral and IV administration, opening the issue of therapeutic efficacy to question. In vitro evidence suggests that vitamin C functions at low concentrations as an antioxidant but may have pro-oxidant activity at high concentrations. The mechanism of its pro-oxidant action is not fully understood, and both intra- and extracellular mechanisms that generate hydrogen peroxide have been proposed. It remains to be proven whether vitamin C-induced reactive oxygen species occur in vivo and, if so, whether this will translate to a clinical benefit. Current clinical evidence for a therapeutic effect of high-dose IV vitamin C is ambiguous, being based on case series. The interpretation and validation of these studies is hindered by limited correlation of plasma vitamin C concentrations with response. The methodology exists to determine if there is a role for high-dose IV vitamin C in the treatment of cancer, but the limited understanding of its pharmacodynamic properties makes this challenging. Currently, the use of high-dose IV vitamin C cannot be recommended outside of a clinical trial.

Vitamin C for preventing and treating pneumonia

BACKGROUND

Pneumonia is one of the most common serious infections, causing two million deaths annually among young children in low-income countries. In high-income countries pneumonia is most significantly a problem of the elderly.

OBJECTIVES

To assess the prophylactic and therapeutic effects of vitamin C on pneumonia.

SEARCH METHODS

We searched CENTRAL 2013, Issue 3, MEDLINE (1950 to March week 4, 2013), EMBASE (1974 to April 2013) and Web of Science (1955 to April 2013).

SELECTION CRITERIA

To assess the therapeutic effects of vitamin C, we selected placebo-controlled trials. To assess prophylactic effects, we selected controlled trials with or without a placebo.

DATA COLLECTION AND ANALYSIS

Two review authors independently read the trial reports and extracted data.

MAIN RESULTS

We identified three prophylactic trials which recorded 37 cases of community-acquired pneumonia in 2335 people. Only one was satisfactorily randomised, double-blind and placebo-controlled. Two trials examined military recruits and the third studied boys from "lower wage-earning classes" attending a boarding school in the UK during World War II. Each of these three trials found a statistically significant (80% or greater) reduction in pneumonia incidence in the vitamin C group. We identified two therapeutic trials involving 197 community-acquired pneumonia patients. Only one was satisfactorily randomised, double-blind and placebo-controlled. That trial studied elderly patients in the UK and found lower mortality and reduced severity in the vitamin C group; however, the benefit was restricted to the most ill patients. The other therapeutic trial studied adults with a wide age range in the former Soviet Union and found a dose-dependent reduction in the duration of pneumonia with two vitamin C doses. We identified one prophylactic trial recording 13 cases of hospital-acquired pneumonia in 37 severely burned patients; one-day administration of vitamin C had no effect on pneumonia incidence. The identified studies are clinically heterogeneous which limits their comparability. The included studies did not find adverse effects of vitamin C.

AUTHORS' CONCLUSIONS

The prophylactic use of vitamin C to prevent pneumonia should be further investigated in populations who have a high incidence of pneumonia, especially if dietary vitamin C intake is low. Similarly, the therapeutic effects of vitamin C should be studied, especially in patients with low plasma vitamin C levels. The current evidence is too weak to advocate prophylactic use of vitamin C to prevent pneumonia in the general population. Nevertheless, therapeutic vitamin C supplementation may be reasonable for pneumonia patients who have low vitamin C plasma levels because its cost and risks are low.

Effect of selenium on methimazole-induced liver damage and oxidative stress in adult rats and their offspring

This study aimed to investigate the protective effect of selenium (Se) on methimazole (MMI; an antithyroid drug)-induced hepatotoxicity in adult rats and their progeny. Female Wistar rats were randomly divided into four groups of six rats in each group: group I served as controls that received standard diet; group II received MMI in drinking water as 250 mg L−1 and standard diet; group III received both MMI (250 mg L−1, orally) and Se (0.5 mg kg−1 of diet); group IV received Se (0.5 mg kg−1 of diet) as sodium selenite. Treatments were started from the 14th day of pregnancy until day 14 after delivery. Exposure of rats to MMI promoted oxidative stress with an increase in liver malondialdehyde levels, advanced oxidation protein products and protein carbonyl contents and a decrease in the levels of glutathione, nonprotein thiols and vitamin C. A decrease in the activities of liver glutathione peroxidase, superoxide dismutase, catalase and lactate dehydrogenase and in the levels of plasma total protein and albumin was also observed. Plasma transaminase activities and total, direct and indirect bilirubin levels increased. Coadministration of Se through diet improved all biochemical parameters. The histopathological changes confirmed the biochemical results. Therefore, our investigation revealed that Se, a trace element with antioxidant properties, was effective in preventing MMI-induced liver damage.

Dimethoate-induced oxidative damage in erythrocytes of female adult rats

Pesticide hazards have been accentuated by the sharp rise in their agricultural, industrial and domestic use. Acute exposure to pesticides can cause oxidative damage. Our study investigated the potential ability of selenium (Se) and/or vitamin E, used as nutritional supplements, to alleviate erythrocyte oxidative damage induced by dimethoate (DM), an organophosphate pesticide. Female Wistar rats were exposed to DM (0.2g/L−1 of drinking water), DM + Se (0.5 mg/kg of diet), DM + vitamin E (100 mg/kg of diet), or DM + Se + vitamin E. Rats exposed to DM for 30 days showed an increase in malondialdehyde levels, superoxide dismutase and glutathione peroxidase activities in their erythocytes, while Na+,K+-ATPase and catalase activities, glutathione, non-protein thiol, vitamin E and vitamin C levels decreased. We also noted an increase in lactate dehydrogenase activity, marker of haemolysis and a decrease in acetylcholinesterase, the principal mode of organophosphorus action. Co-administration of Se or vitamin E to the diet of DM-treated rats ameliorated the biochemical parameters cited above. But the combined effect of Se and vitamin E was more powerful in antagonizing DM-induced oxidative stress. Therefore, our investigation revealed that both Se and vitamin E were useful elements in preventing DM-induced erythrocytes damage.

Cardioprotective effects of selenium on chromium (VI)-induced toxicity in female rats

Acute exposure to hexavalent chromium compounds can cause cardiotoxicity. Our study pertains to the protective effect of selenium against K(2)Cr(2)O(7)-induced cardiotoxicity. Female Wistar rats were divided into four groups of six each: group I served as controls which received standard diet; group II received in drinking water K(2)Cr(2)O(7) alone (700 ppm); group III received both K(2)Cr(2)O(7) and Se (0.5 Na(2)SeO(3) mg/kg of diet); group IV received Se (0.5 mg/kg of diet) for 3 weeks. The exposure of rats to chromium promoted oxidative stress with an increase in malondialdehyde levels and a decrease in antioxidant non-enzymatic levels such as glutathione, non-protein thiol and vitamin C, while, an increase in glutathione peroxidase, superoxide dismutase and catalase activities was observed. However, plasma transaminases, lactate dehydrogenase activities, cholesterol, triglycerides and low density lipoprotein-cholesterol levels increased, and high density lipoprotein-cholesterol decreased. Coadministration of Se restored the parameters cited above to near-normal values. The histopathological findings confirmed the biochemical results.

WITHDRAWN: The role of ascorbic acid transporter in the lens of streptozotocin-induced diabetic rat

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.bionut.2010.09.008. The duplicate article has therefore been withdrawn.

Vitamin C: update on physiology and pharmacology

Although ascorbic acid is an important water-soluble antioxidant and enzyme cofactor in plants and animals, humans and some other species do not synthesize ascorbate due to the lack of the enzyme catalyzing the final step of the biosynthetic pathway, and for them it has become a vitamin. This review focuses on the role of ascorbate in various hydroxylation reactions and in the redox homeostasis of subcellular compartments including mitochondria and endoplasmic reticulum. Recently discovered functions of ascorbate in nucleic acid and histone dealkylation and proteoglycan deglycanation are also summarized. These new findings might delineate a role for ascorbate in the modulation of both pro- and anti-carcinogenic mechanisms. Recent advances and perspectives in therapeutic applications are also reviewed. On the basis of new and earlier observations, the advantages of the lost ability to synthesize ascorbate are pondered. The increasing knowledge of the functions of ascorbate and of its molecular sites of action can mechanistically substantiate a place for ascorbate in the treatment of various diseases.

Vitamin C for preventing and treating tetanus

BACKGROUND

Tetanus is a severe infection that can be prevented by vaccination. In developing countries vaccination coverage is not always high and in developed countries cases may still occur, particularly in elderly people owing to their reduced immunoprotection. It has been estimated that there are about one million cases of tetanus per year globally. In animal studies, vitamin C protected against various infections. In a study with rats, vitamin C protected against tetanus toxin.

OBJECTIVES

To assess the prophylactic and therapeutic effect of vitamin C in tetanus.

SEARCH STRATEGY

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, issue 4), MEDLINE (1950 to January 2008), EMBASE (1980 to 2008 Week 03), the Cochrane Wounds Group Specialised Register (January 2008), the Cochrane Infectious Diseases Group Specialised Register (June 2007), and the reference lists of relevant reviews and monographs.

SELECTION CRITERIA

We included controlled trials of vitamin C as a prevention or treatment for tetanus, whether or not placebo controlled, in any language, published or unpublished. Two authors independently made inclusion decisions.

DATA COLLECTION AND ANALYSIS

Both review authors independently extracted data from trial reports.

MAIN RESULTS

One single trial was eligible for inclusion. This non randomised, controlled, unblinded treatment trial involved 117 tetanus patients and was undertaken in Bangladesh. Vitamin C at a dosage of 1 g/day was administered intravenously alongside conventional treatment. At recruitment, the participants were stratified into two age groups and the results were reported by age. In the children aged 1 to 12 years (n = 62), vitamin C treatment was associated with a 100% reduction in tetanus mortality (95% confidence interval from -100% to -94%). In people aged 13 to 30 years (n = 55), vitamin C treatment was associated with a 45% reduction in tetanus mortality (95% confidence interval from -69% to -5%).

AUTHORS' CONCLUSIONS

A single, non randomised, poorly reported trial of vitamin C as a treatment for tetanus suggests a considerable reduction in mortality. However, concerns about trial quality mean that this result must be interpreted with caution and vitamin C cannot be recommended as a treatment for tetanus on the basis of this evidence. New trials should be carried out to examine the effect of vitamin C on tetanus treatment.

Changes of terminal cancer patients' health-related quality of life after high dose vitamin C administration

Over the years there has been a great deal of controversy on the effect of vitamin C on cancer. To investigate the effects of vitamin C on cancer patients' health-related quality of life, we prospectively studied 39 terminal cancer patients. All patients were given an intravenous administration of 10 g vitamin C twice with a 3-day interval and an oral intake of 4 g vitamin C daily for a week. And then we investigated demographic data and assessed changes in patients' quality of life after administration of vitamin C. Quality of life was assessed with EORTC QLQ-C30. In the global health/quality of life scale, health score improved from 36+/-18 to 55+/-16 after administration of vitamin C (p=0.001). In functional scale, the patients reported significantly higher scores for physical, role, emotional, and cognitive function after administration of vitamin C (p<0.05). In symptom scale, the patients reported significantly lower scores for fatigue, nausea/vomiting, pain, and appetite loss after administration of vitamin C (p<0.005). The other function and symptom scales were not significantly changed after administration of vitamin C. In terminal cancer patients, the quality of life is as important as cure. Although there is still controversy regarding anticancer effects of vitamin C, the use of vitamin C is considered a safe and effective therapy to improve the quality of life of terminal cancer patients.

Nutrition and Wound Healing

The relationship between nutrition and wound healing--after injury or surgical intervention--has been recognized for centuries. There is no doubt that adequate carbohydrate, fat, and protein intake is required for healing to take place, but research in the laboratory has suggested that other specific nutritional interventions can have significant beneficial effects on wound healing. Successful translation into the clinical arena, however, has been rare. A review of normal metabolism as it relates to wound healing in normoglycemic and diabetic individuals is presented. This is followed by an assessment of the current literature and the data that support and refute the use of specialized nutritional support in postoperative and wounded patients. The experimental evidence for the use of arginine, glutamine, vitamins, and micronutrient supplementation is described. Most of the experimental evidence in the field supporting the use of specialized nutritional support has not been borne out by clinical investigation. A summary of the clinical implications of the data is presented, with the acknowledgment that each patient's plan of care must be individualized to optimize the relationship between nutrition and wound healing.

Intravenously administered vitamin C as cancer therapy: three cases

Early clinical studies showed that high-dose vitamin C, given by intravenous and oral routes, may improve symptoms and prolong life in patients with terminal cancer. Double-blind placebo-controlled studies of oral vitamin C therapy showed no benefit. Recent evidence shows that oral administration of the maximum tolerated dose of vitamin C (18 g/d) produces peak plasma concentrations of only 220 micromol/L, whereas intravenous administration of the same dose produces plasma concentrations about 25-fold higher. Larger doses (50-100 g) given intravenously may result in plasma concentrations of about 14,000 micromol/L. At concentrations above 1000 micromol/L, vitamin C is toxic to some cancer cells but not to normal cells in vitro. We found 3 well-documented cases of advanced cancers, confirmed by histopathologic review, where patients had unexpectedly long survival times after receiving high-dose intravenous vitamin C therapy. We examined clinical details of each case in accordance with National Cancer Institute (NCI) Best Case Series guidelines. Tumour pathology was verified by pathologists at the NCI who were unaware of diagnosis or treatment. In light of recent clinical pharmacokinetic findings and in vitro evidence of anti-tumour mechanisms, these case reports indicate that the role of high-dose intravenous vitamin C therapy in cancer treatment should be reassessed.

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.

Methods of human islet culture for transplantation

The ability to maintain isolated human islet preparations in tissue culture has recently been adopted by most islet transplant centers, and improves the safety as well as the practicality of islet transplantation. Maintaining islet viability and recovery, however, remains challenging in a clinical setting, due to stringent conditions required for culture. Islet culture is further complicated by the fact that islets do not form a monolayer. This review aims to clarify media, supplementation, and conditions that have been shown to be relevant to human islets, as well as to offer avenues of future research. Factors examined that may influence islet survival include base medium, glucose concentration, vitamin, inorganic ion, lipid, hormone, growth factor, amino acid, and binding protein composition and concentration, as well as culture temperature and seeding density. In addition, this article reviews novel techniques, such as coculture and matrices, that have been employed in an attempt to improve islet survival and functional viability.

Antioxidant activity of selected foodstuffs

The growing interest in the substitution of synthetic food antioxidants by natural antioxidants and in the health implications of antioxidants as nutraceuticals has fostered research on vegetable sources and the screening of raw materials for identifying antioxidants. Plant and plant products have been used as a source of medicine for a long time. Among the more important constituents of edible plant products, low molecular weight antioxidants are the most important species. It is known that consumption of fruits and vegetables is essential for normal health of human beings. The aim of the present work was to evaluate the total antioxidant activity of selected natural food materials by an in vitro method involving the measurement of oxidation of linoleic acid by fluorimetry. Among the food materials chosen for the present study, pomegranate peel gave the maximum antioxidant activity due to the presence of its high polyphenolic content. At a concentration of 60 ppm, pomegranate peel powder reduced lipid peroxidation by 65% in an in vitro assay.

Current concepts in the use of antioxidants for the treatment of preeclampsia

Preeclampsia is a leading cause of maternal and neonatal mortality and morbidity. It is a complex syndrome of undetermined etiologic origin, usually diagnosed during the second half of pregnancy, with clinical features of hypertension, proteinuria, and edema. No cure for preeclampsia exists, except premature delivery. There is increasing evidence that oxidative stress is an important contributing factor to the pathogenesis of preeclampsia. Oxidative stress is defined as an imbalance between reactive oxygen species (ROS), such as nitric oxide (NO*), superoxide anion (O2*-), and hydrogen peroxide (H2O2), and antioxidants, favouring an overabundance of ROS. The consequence of an overproduction of ROS can be observed as increased levels of markers of oxidative stress, such as lipid peroxides. Pregnant women affected by preeclampsia may have abnormal ROS production, particularly NO* and O2*-, abnormal levels of antioxidant defences, and increased placental lipid peroxidation. Several observations suggest that decreased bioavailability of endothelium-derived NO*, due to oxidative destruction of NO* by ROS, might contribute to the impaired endothelium-dependent vasodilatory responses and multisystemic pathology of preeclampsia, a phenomenon in which antioxidant vitamins may play a beneficial role. This review focuses on the rationale for vitamins C and E supplementation toward prevention of preeclampsia, with an emphasis on the limit of our scientific knowledge concerning the deleterious oxidative events taking place in this pathology.

Influence of vitamin C diet supplementation on endogenous antioxidant defences during exhaustive exercise

We determined the effects of dietary vitamin C supplementation on erythrocyte antioxidant enzymes and on plasma antioxidants during athletic competition and short-term recovery. Blood samples were taken from 16 volunteer endurance athletes, participating in a duathlon competition, under basal conditions and both immediately and 1 h after the competition. The results were analysed taking into account the individual vitamin C intake and the plasma levels. Athletes were assigned to either the vitamin C-supplemented or control groups ( n=8 each). The control group had normal plasma ascorbate levels, the supplemented group high levels as a result of the higher vitamin C intake. Uric acid and lactate dehydrogenase increased after the competition only in the control group. Plasma ascorbate decreased after short-term recovery in the supplemented group. Erythrocyte catalase activity increased after the competition in the supplemented group. Glutathione peroxidase activity (determined with cumene hydroperoxide as substrate) increased only in the control group after short-term recovery. This pattern may suggest an important role for plasma ascorbate, and dietary vitamin C supplementation, in the defence against oxidative stress induced by exercise and in avoiding negative effects on erythrocyte integrity.

Effect of ascorbic acid consumption on urinary stone risk factors

PURPOSE

Ascorbic acid (AA) has been implicated as a risk factor for calcium oxalate stones due to its conversion to oxalate and potential acidifying properties. We evaluated the effect of AA consumption on urinary saturation of calcium oxalate (CaOx) and urinary pH.

MATERIALS AND METHODS

A total of 12 normal subjects (NS) and 12 CaOx stone formers (SF) underwent 2, 6-day phases of study while maintained on a controlled metabolic diet. In each phase subjects ingested 1 gm AA or an identical appearing placebo twice daily. On the last 2 days of each phase 2, 24-hour urine collections were analyzed for pH and stone risk factors, and blood specimens were submitted for serum chemistry studies.

RESULTS

No difference in urinary pH was found between placebo and AA phases in NS (6.02 versus 6.02) and SF (6.0 versus 6.0). However, urinary oxalate was statistically significantly higher in the AA versus placebo phase for NS (34.7 versus 28.5 mg, p = 0.008) and SF (41.0 versus 30.5 mg, p <0.001). Likewise, the CaOx relative saturation ratio was significantly higher in the AA versus placebo phase for both groups.

CONCLUSIONS

Ingestion of 2 gm AA daily results in no change in urinary pH but a moderate though statistically significant increase in urinary oxalate in NS (20%) and SF (33%). Stone formers respond no differently to AA than normal subjects. We recommend limiting AA use to less than 2 gm daily in CaOx stone formers.

Nutrition and wound healing

The relationship between host nutrition and wound healing has been the subject of study and experimentation for centuries. Despite the many years of study and a substantial knowledge base of the specific processes and factors involved, wound healing remains enigmatic. There is still much to learn about the wound-specific nutritional interventions that are available to improve wound healing. Nutrition profoundly influences the process of wound healing. Nutritional depletion exerts an inhibitory effect, and nutritional supplementation with such positive effectors as arginine can stimulate wound healing. Within this paradigm, the physician should be able to recognize patients who may be expected to have wound healing difficulties and offer early intervention to avoid wound failure.

Nutrient requirements for preterm infant formulas

Achieving appropriate growth and nutrient accretion of preterm and low birth weight (LBW) infants is often difficult during hospitalization because of metabolic and gastrointestinal immaturity and other complicating medical conditions. Advances in the care of preterm-LBW infants, including improved nutrition, have reduced mortality rates for these infants from 9.6 to 6.2% from 1983 to 1997. The Food and Drug Administration (FDA) has responsibility for ensuring the safety and nutritional quality of infant formulas based on current scientific knowledge. Consequently, under FDA contract, an ad hoc Expert Panel was convened by the Life Sciences Research Office of the American Society for Nutritional Sciences to make recommendations for the nutrient content of formulas for preterm-LBW infants based on current scientific knowledge and expert opinion. Recommendations were developed from different criteria than that used for recommendations for term infant formula. To ensure nutrient adequacy, the Panel considered intrauterine accretion rate, organ development, factorial estimates of requirements, nutrient interactions and supplemental feeding studies. Consideration was also given to long-term developmental outcome. Some recommendations were based on current use in domestic preterm formula. Included were recommendations for nutrients not required in formula for term infants such as lactose and arginine. Recommendations, examples, and sample calculations were based on a 1000 g preterm infant consuming 120 kcal/kg and 150 mL/d of an 810 kcal/L formula. A summary of recommendations for energy and 45 nutrient components of enteral formulas for preterm-LBW infants are presented. Recommendations for five nutrient:nutrient ratios are also presented. In addition, critical areas for future research on the nutritional requirements specific for preterm-LBW infants are identified.

Vitamin C supplementation and common cold symptoms: problems with inaccurate reviews

In 1971, Linus Pauling carried out a meta-analysis of four placebo-controlled trials and concluded that it was highly unlikely that the decrease in the "integrated morbidity of the common cold" in vitamin C groups was caused by chance alone (P < 0.00003). Studies carried out since then have consistently found that vitamin C (> or = 1 g/d) alleviates common cold symptoms, indicating that the vitamin does indeed have physiologic effects on colds. However, widespread conviction that the vitamin has no proven effects on the common cold still remains. Three of the most influential reviews drawing this conclusion are considered in the present article. Two of them are cited in the current edition of the RDA nutritional recommendations as evidence that vitamin C is ineffective against colds. In this article, these three reviews are shown to contain serious inaccuracies and shortcomings, making them unreliable sources on the topic. The second purpose is to suggest possible conceptual reasons for the persistent resistance to the notion that vitamin C might have effects on colds. Although placebo-controlled trials have shown that vitamin C does alleviate common cold symptoms, important questions still remain.

Vitamin C, the placebo effect, and the common cold: a case study of how preconceptions influence the analysis of results

A large number of placebo-controlled studies have shown that vitamin C supplementation alleviates the symptoms of the common cold, but widespread skepticism that vitamin C could have any significant effect remains. One of the most influential common cold studies, published in 1975, was carried out by Thomas Karlowski et al, at the National Institutes of Health. Their placebo consisted of lactose, which can easily be distinguished from ascorbic acid by taste. Karlowski et al, found a 17% decrease in the duration of cold episodes in the group administered vitamin C (6 g/day); however, they suggested that the decrease was entirely due to the placebo effect. In this article it will be shown that the placebo effect is not a valid explanation for the results of the Karlowski study, as it is inconsistent with their results. This is an important conclusion for two reasons. First, the placebo explanation becomes even more unreasonable as regards the reported benefits found in several other studies with valid placebo tablets. Second, as the results from the Karlowski study are not due to the placebo effect, their results can be used to assess the quantitative effects of vitamin C supplementation. The most important conclusions from Karlowski's study are that therapeutic vitamin C supplementation during a common cold episode appears to be as effective as regular supplementation, and that there appears to be linear dose dependency at least up to 6 g/day. These findings suggest that large therapeutic vitamin C doses might alleviate the symptoms of the common cold substantially.

Lipid peroxidation: a review of causes, consequences, measurement and dietary influences

In this review the process of lipid peroxidation and the atherogenicity of peroxidied lipids are discussed. Recent findings with regard to the effect of selected dietary factors on susceptibility of lipids to oxidative stress and on antioxidant defences are analysed with particular reference to their potential use in the prevention and treatment of atherogenesis and, by extension, coronary heart disease. Laboratory methods of assessing antioxidant defences, lipid peroxidation and the effects of lipid peroxidation are also reviewed and discussed with particular reference to their ability to assess in vivo oxidative stress and lipid peroxidation status. A range of oxidative stress indices are presented and their limitations discussed, but the main focus is on the most commonly used laboratory test for lipid peroxidation, the thiobarbituric acid reacting substances (TBARS) test. Finally, the influence of selected dietary factors on measured peroxidation status is discussed, with particular reference to the antioxidant vitamins C (ascorbic acid) and E (alpha tocopherol) and the type of fatty acids (mono- and poly-unsaturated) in the diet.

Idiopathic calcium oxalate urolithiasis and endogenous oxalate production

Despite the great effort that has gone into investigating urolithiasis, this condition still persists as one of the major ailments of the urinary tract. Calcium oxalate urolithiasis is the most common form, accounting for some 60 to 80% of total stones. This review examines the elements (i.e., urine volume and pH and urinary excretion of calcium, oxalate, citrate, urate, magnesium, pyrophosphate, and glycosaminoglycans) that give rise to idiopathic calcium oxalate urolithiasis. Treatment strategies for idiopathic calcium oxalate urolithiasis, including lithotripsy, also are discussed. Urinary oxalate excretion is a major risk factor for calcium oxalate urolithiasis, with 85 to 95% of the urinary load derived endogenously. The factors controlling endogenous oxalate production are reviewed, including pathways for the diversion of glyoxylate from oxalate production. The use of beta-aminothiols and other substances to reduce endogenous oxalate production in subjects with idiopathic calcium oxalate urolithiasis is also discussed. A review of current methodologies for the determination of urinary oxalate is also included.

Natural antioxidants for the prevention of atherosclerosis

Hypercholesterolemia, cigarette smoking, hypertension, and obesity are known contributing risk factors for the development of atherosclerotic coronary artery disease (CAD). However, they account for only half of all cases of CAD, and the complete pathologic process underlying atherosclerosis remains unknown. Growing evidence suggests that oxidative modification of low-density lipoprotein (LDL) may be of particular importance in the pathogenesis. Oxidized LDL exhibits proatherogenic effects. Therefore, current research has focused on inhibiting the oxidation of LDL as a means of inhibiting the atherosclerotic process. One such approach is to enhance the endogenous antioxidant defense systems within the LDL particle with lipophilic antioxidants such as alpha-tocopherol and beta-carotene, or by supplementing the aqueous-phase antioxidant capacity with ascorbic acid. Observational data suggest a protective effect of antioxidant supplementation on the incidence of CAD; however, specific doses cannot be recommended since the data are inconclusive.

Vitamin C and the common cold: a retrospective analysis of Chalmers' review

In 1975 Thomas Chalmers analyzed the possible effect of vitamin C on the common cold by calculating the average difference in the duration of cold episodes in vitamin C and control groups in seven placebo-controlled studies. He found that episodes were 0.11 +/- 0.24 (SE) days shorter in the vitamin C groups and concluded that there was no valid evidence to indicate that vitamin C is beneficial in the treatment of the common cold. Chalmers' review has been extensively cited in scientific articles and monographs. However, other reviewers have concluded that vitamin C significantly alleviates the symptoms of the common cold. A careful analysis of Chalmers' review reveals serious shortcomings. For example, Chalmers did not consider the amount of vitamin C used in the studies and included in his meta-analysis was a study in which only 0.025-0.05 g/day of vitamin C was administered to the test subjects. For some studies Chalmers used values that are inconsistent with the original published results. Using data from the same studies, we calculated that vitamin C (1-6 g/day) decreased the duration of the cold episodes by 0.93 +/- 0.22 (SE) days; the relative decrease in the episode duration was 21%. The current notion that vitamin C has no effect on the common cold seems to be based in large part on a faulty review written two decades ago.

The health effects of vitamin C supplementation: a review

A comprehensive review of the literature indicates that populations with long-term consumption of higher than RDA levels of vitamin C (> or = 60 mg/day) from foods and/or supplements have reduced risks of cancer at several sites, cardiovascular disease, and cataracts. The safety of higher than RDA intakes of vitamin C is confirmed in eight placebo-controlled, double-blind studies and six non-placebo clinical trials in which up to 10,000 mg of vitamin C was consumed daily for up to 3 years. There are no clinical data which suggest that vitamin C's enhancement of non-heme iron absorption in individuals with low iron status could be a critical factor in the possible increased risk of heterozygous hemochromatosis-related cardiovascular disease. In fact, the cumulative data do not confirm that iron status is related to risk of cardiovascular disease. Moreover, higher than RDA intakes of vitamin C have been associated with several indices of lowered cardiovascular disease risk including increases in HDL, and decreases in LDL oxidation, blood pressure and cardiovascular mortality.

Dietary vitamin C decreases endogenous protein oxidative damage, malondialdehyde, and lipid peroxidation and maintains fatty acid unsaturation in the guinea pig liver

Guinea pigs were fed during 5 weeks with three different levels of vitamin C in the diet: 33 (marginal deficiency), 660, or 13,200 mg of vitamin C per kg of diet. The group fed 660 mg of vitamin C/kg of diet showed strongly reduced levels of protein carbonyls (46% decrease), malondialdehyde (HPLC; 72% decrease), and in vitro production of TBARS (both stimulated with ascorbate-Fe2+ and with NADPH-ADP-Fe2+; 68% and 71% decrease), increased glutathione reductase activity, and increased vitamin C content (48 times higher) in the liver in relation to the group fed 33 mg/kg. The treatment with 660 mg of vitamin C/kg did not decrease any of the antioxidant defenses studied: superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, GSH, vitamin E, or uric acid. Further supplementation with 13,200 mg vitamin C/kg also reduced protein and lipid peroxidation, but decreased hepatic glutathione reductase and uric acid and resulted in a lower body weight of the animals. Both low (33 mg/kg) and very high (13,200 mg/kg) levels of vitamin C decreased body weight, glutathione reductase, and unsaturation of fatty acids in membrane lipids. The results show that a diet supplying an amount of vitamin C 40 times higher than the minimum daily requirement to avoid scurvy increases the global antioxidant capacity and is of protective value against endogenous lipid and protein oxidation in the liver under normal nonstressful conditions.

Elevated concentrations of ascorbate and normoxia suppress testosterone production in cultured guinea pig Leydig cells

In recent years, several metabolic roles have been proposed for vitamin C. Recent information suggests a strong causal relationship between high endogenous levels of ascorbic acid and changes in normal reproductive biology. Using highly enriched populations of guinea pig Leydig cells, we have found that elevated levels (50 to 500 microM) of ascorbate significantly (P < 0.01) depressed testosterone production in a dose-dependent manner while low levels (0 to 10 microM) were without effect. Leydig cells incubated under hypoxic (3% oxygen) culture conditions produced significantly (P < 0.01) more testosterone than similar cells cultured under normoxic (19% oxygen) conditions. The results of this study suggest that high concentrations of ascorbate and normoxic culture conditions suppress testosterone production in isolated Leydig cells. Thus, it would seem that there exists a delicate balance between normal metabolic requirements for vitamin C and excessive ascorbate levels that might alter normal gonadal reproductive events.

Impact of higher doses of vitamin C in modulating pesticide genotoxicity

The modulatory effect of higher doses of vitamin C (ascorbic acid) on the genotoxicity of the three pesticides (endosulfan, phosphamidon, and mancozeb) was assessed in the in vivo micronucleus test in Swiss albino mice. Concurrent administration of the vitamin in a dose (20 mg/kg bwt/day) equivalent to double the human therapeutic one, along with each of the three pesticides, was most effective as an antimutagen. The therapeutic dose (10 mg/kg bwt/day) was comparatively less so, and the quadruple (40 mg/kg bwt/day) of it did not show any further amelioration.

Does vitamin C alleviate the symptoms of the common cold?--a review of current evidence

Since 1971, 21 placebo-controlled studies have been made to establish whether vitamin C at a dosage of > or = 1 g/day affects the common cold. These studies have not found any consistent evidence that vitamin C supplementation reduces the incidence of the common cold in the general population. Nevertheless, in each of the 21 studies, vitamin C reduced the duration of episodes and the severity of the symptoms of the common cold by an average of 23%. However, there have been large variations in the benefits observed, and clinical significance cannot be clearly inferred from the results. Still, the consistency of the results indicates that the role of vitamin C in the treatment of the common cold should be reconsidered.

Vitamin C (ascorbic acid): new roles, new requirements?

There is an enormous amount of literature on vitamin C intake and health in animals, cell cultures, and humans. Beyond its function in collagen formation, ascorbic acid is known to increase absorption of inorganic iron, to have essential roles in the metabolism of folic acid and of some amino acids and hormones, and to act as an antioxidant. In recent years, research has increasingly focused on this latter function, stimulated by suggestions that "oxidative stress" may be a causal factor in the etiology of such diverse and important disorders of aging as cancer, cardiovascular disease, and cataract formation. The present evidence is strong enough to have convinced nutritionists that daily vitamin C intake should be many times higher than the amount needed to protect against scurvy, and this is reflected in the present Recommended Dietary Allowances. Suggestions that the recommended levels should be higher still are largely based on extrapolations from results of animal and tissue culture studies. How much ascorbic acid is necessary to achieve in humans the effects seen in animal studies is not clear. In general, the limited human studies have not been persuasive. The data are incomplete, and many of the studies have serious flaws. There are no toxicity studies of the type done for new compounds being considered for approval as therapy for major disease conditions. Intervention studies will be difficult, but are essential, and methods for tissue saturation measurement must be defined before new recommendations for the public are designed.