Vitamin C – Not Just for Pirates

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Ascorbic acid for bones, joints, and connective tissue

An all macaroni-and-cheese diet? What could possibly go wrong?

When I was in University, two students made a friendly wager to see who could go the longest subsisting on a diet of macaroni-and-cheese. The competition came to a screeching halt when one of the boys (the more sophomoric of the two sophomores) developed fatigue, swollen gums, and leg pain. He went to the hospital, where he was diagnosed with scurvy, an illness caused by vitamin C deficiency. (Yes, this really happened. At a top-ranked university, no less.)

Although most mammals can synthesize vitamin C (ascorbic acid) within their bodies, humans cannot – along with apes, bats, and guinea pigs.[1],[2] This means we must consume vitamin C in our diets (and sometimes in supplement form), as my classmate learned (the hard way).

Vitamin C beyond scurvy

Before the discovery of vitamin C in 1928 made scurvy a disease of the past, vitamin C deficiency disease was a major cause of illness, afflicting some two million sailors, whose diets were lacking in this nutrient.[3] (It was for this reason that the “winner” of the bet earned himself the nickname “Pirate.”)

Although most people associate it with immune support,[4],[5] vitamin C also plays an integral role in connective tissue health. Vitamin C promotes the synthesis of osteoblasts (the cells that produce bone) and stimulates chondrocytes (the cells that make cartilage), thereby supporting the joints and bones. It further enhances bone and joint health by acting as a powerful antioxidant, thereby protecting the tissues. Ascorbic acid is likewise an essential cofactor for the synthesis of collagen and elastin, the substances that make our tissues both strong and flexible (and keep our skin from sagging with age). Vitamin C thus helps fortify the walls of the blood vessels,[6] protect the nerves,[7] and heal the skin.[8]

Vitamin C for bone density and osteoporosis

Several studies have demonstrated vitamin C’s effect in supporting bone mineral density (BMD) and preventing osteoporosis.[9],[10],[11],[12] This news is of particular relevance to Americans above the age of 50, as research suggests that roughly half of all women and one in four men age 50 and older will suffer an osteoporosis-related bone fracture.[13]

On the cellular level, bone density and integrity is greatly influenced by the delicate balance of osteoclasts, the types of cells that resorb (break down) bone, and osteoblasts, the cells that make new bone.

The conventional treatment for osteoporosis often includes bisphosphonate drugs, which have been shown to suppress osteoclast function and thus slow bone degradation, but which have not been shown to stimulate osteoblast formation. Vitamin C, however, supports both sides of the equation. In addition to suppressing osteoclast function, vitamin C has also been shown (in animal studies) to support osteoblastogenesis, the production of more of the cells that create bone.[14] Antioxidant nutrients like resveratrol and maritime pine bark extract have likewise been shown to reduce osteoclast breakdown of bone and improve osteoblast function.[15],[16]

In addition to suppressing osteoclast function, vitamin C has also been shown (in animal studies) to support osteoblastogenesis, the production of more of the cells that create bone.

In a survey of 1,196 postmenopausal women aged 50 years and older, higher dietary vitamin C intake was positively associated with BMD, especially in women with vitamin D deficiency. The researchers also found that the women who had osteoporosis ate diets significantly lower in vitamin C than the women without the disease.[17]

In another cross-sectional study, 189 postmenopausal Korean women were asked to complete a questionnaire regarding their consumption of various food groups and nutrients, and the women’s BMD was then calculated (lumbar spine, femoral neck, and total hip). The women who ate diets rich in vitamin C were more likely to have higher lumbar spine and total hip T-scores (a measurement of bone density). Frequent vegetable consumption was also associated with higher femoral neck and total hip T-scores.[18]

Vitamin C and arthritis

Osteoarthritis (OA) is among the most prevalent joint diseases and a major cause of disability among the elderly.[19]

In addition to vitamin C’s ability to structurally support the bones, it also reduces tissue changes that contribute to OA by acting as an antioxidant.[20] This is because oxidative stress degrades cartilage and causes dysfunction of chondrocytes (the cells that make cartilage).[21]

If oxidative stress can cause OA, and if vitamin C is a powerful antioxidant, could vitamin C then play a role in OA prevent or treatment? Quite likely. Research has shown that vitamin C intake not only reduces the risk of cartilage loss, but also decreases the risk of developing OA.[22],[23],[24]

Research has shown that vitamin C intake not only reduces the risk of cartilage loss, but also decreases the risk of developing osteoarthritis.

In addition to preventing OA, vitamin C may also slow the progression of the disease in those already afflicted. Of the pathological changes seen in OA – changes like inhibited cell growth and cell death, increased oxidative stress, and proteoglycan loss – all were reduced in rats with OA upon taking vitamin C. Surprisingly, however, the 100 mg/kg dosage was more efficient than the 200 or 300 mg/kg dosages, suggesting that high doses aren’t necessarily more effective.[25] In another rat study, vitamin C was found to have a synergistic effect with platelet-derived growth factor injections, preventing OA progression more than the growth factors alone.[26]

Vitamin C for oral health

Vitamin C has also been shown to be of value in preventing periodontitis, a condition in which inflammation of the tissue around the teeth can result in gum shrinkage and loosening (or even loss) of the teeth.

In one study of 10,930 Korean adults age 19 years and older, those with inadequate dietary vitamin C intake were 1.16 times more likely to have periodontitis than those with sufficient intake.[27]

Those with inadequate dietary vitamin C intake were 1.16 times more likely to have periodontitis than those with sufficient intake.

In another study examining periodontal health in smokers, it was found that smokers who ate diets rich in fruits, vegetables, and vitamin C were less likely to develop PD after scaling and root planing (a treatment to manage periodontal disease).[28]

Not just for pirates

Although nowadays most of us aren’t at risk of developing scurvy (barring any ill-contrived bets, that is), even slightly low vitamin C levels can still carry negative implications for our health, and mild to moderate vitamin C deficiencies are still common.

Thankfully, many fruits are rich in vitamin C, such as citrus fruits, strawberries, cantaloupe, and currants. Fresh vegetables, like Brussels sprouts, lettuce, cabbage, peas, collard greens, and asparagus are likewise good sources.[29]

Vitamin C supplements are also readily available and gently priced, with buffered preparations being gentler on the digestive system than the other forms. Vitamin C also combines particularly well with other connective-tissue supportive nutrients like calcium, magnesium, zinc, copper, manganese, selenium, and boron to offer us enhanced healing and bone and joint support.

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