ABSTRACT Evidence is presented to support your decision about vitamin C (AA) supplementation. The Recommended Daily Allowance for men of AA has been raised from 60 to 90 mg. Because higher doses may be more beneficial, the Food and Nutrition Board has established an Upper Limit for safety of 2,000 mg per day. Studies of AA dosage for humans demonstrated that 500 mg twice a day is the lowest oral dosage that provides significant saturation of blood plasma. One study endorsed 200 mg from dietary sources for the RDA. Recently several studies have indicated the benefit of high levels of AA to maintain the brain and heart, reduce damage from stroke, brain trauma, and cataracts, and lower the risk of cancer metastasis and colds. Evidence is presented consistent with the hypothesis that people, especially older people and soldiers in combat environments at risk for brain trauma, will benefit if they maintain the saturating level of AA that can be obtained with supplements. INTRODUCTION In 1956, Denham Harman, founder of AGE, proposed the free radical (ROS) theory of aging (Beckman and Ames 1998b). Linus Pauling proposed megadoses of the water-soluble antioxidant vitamin C (ascorbic acid, AA) to trap free radicals, recommending dosages up to 16 g per day (Pauling 1970). In 1994, King et al (1994) discovered that 500 mg of AA taken orally every 12 hr were sufficient to provide continuous excretion of excess AA into the urine. In 1996, a similar study by Levine M et al (1996) confirmed those results, showing that that dosage provides the highest statistically significant concentration in plasma for protection from free radical damage. But they recommended only 200 mg AA consumed from dietary sources as the RDA, based on the plasma AA level necessary to saturate certain white blood cells. The Food and Nutrition Board of the Institute of Medicine raised the RDA for AA for men and women to 90 and 75 mg resp., with an Upper Limit for safety established at 2 g per day. This review describes recent studies relevant to the selection of a daily intake of AA for health maintenance. EVIDENCE HOW CONCENTRATIONS IN DIFFERENT TISSUES AFFECT FUNCTION In addition to serum and white blood cell concentrations of vitamin C, there are many other tissues in which high AA concentrations are important to maintain. Some studies below reflect the metabolic and antioxidant functions of AA in controlling cell differentiation through nutrition signaling. In a process called nutrient signaling, described only in the past decade, nutrients can transform metabolic processes as hormones do (Bhalla and Iyengar 1999; Ordman 2008). AA signals cell differentiation of brain and heart stem cells described below. BRAIN: Taking 500 mg of vitamin C twice daily may lessen Alzheimer's, stroke, and head trauma damage. Stroke is the leading cause of disability worldwide (Zweifler 2003), and head trauma is common in war veterans. Several studies reveal the value of elevated levels of AA for protecting brain function. First, in humans with Alzheimer's and mild cognitive impairment, tissues and biofluids show evidence of oxidative stress (Su et al 2008). Cognitive decline in aging dogs is lessened simply by adding antioxidants to the diet. The deposition of amyloid-beta is decreased (Araujo et al 2005). AA is a water-soluble antioxidant that crosses the blood-brain barrier. AA is produced in the liver of most mammals. Hibernating animals naturally store high concentrations of AA in the brain for protection from the metabolic stress that accompanies arousal (Ten et al. 2001). In humans, brain stroke damage continues when blood flow resumes. AA substantially prevented this reperfusion injury (Rozell 1998). Polidori et al (2001) show that AA is much lower in plasma for those with head trauma or intracranial hemorrhage compared to healthy subjects, while other antioxidants such as vitamin E are unaffected. Even at a dose of 200 mg AA/day, ischemic stroke-related lipid peroxidation decreased significantly in humans (Polidori et al 2005). Via nutrient signaling, AA may exert effects on brain maintenance and recovery. How neural progenitor cells (NPCs) differentiate is determined by the redox state of the brain (Adler 2008). In the reducing environment produced by AA, NPCs become neurons. Under oxidizing conditions, astrocytes are formed. Prozorovski et al (2008) conclude that nontoxic manipulation of redox conditions in the brain influences NPC fate to produce neurons. People are able to generate new neurons throughout their entire lives (Song et al. 2005). High AA concentrations in the brain maintain the potential to generate new neurons. HEART: The benefits of AA for the circulatory system include improved circulation and heart health. AA reverses the endothelial dysfunction caused by oxidative stress (Levine GN et al 1996). As with brain stem cells mentioned above, sufficient AA causes embryonic stem cells to differentiate into cardiac myocytes (Takahashi et al 2003). DISCUSSION Review of Evidence for Determining Your Vitamin C DosageAlfred “Roc” OrdmanBiochemistry Program, Beloit College, Beloit, WI 53511 Physicians accept the role of AA as a vitamin for immediate health benefits such as prevention of scurvy. Ever since Harman's free radical theory of aging and anti-nuclear activist Linus Pauling's proposal to take megadoses of AA as an ROS scavenger to maintain long-term health, people have found higher doses controversial. Periodically, the media report erroneous findings, like those of Podmore et al (1998) that AA may cause DNA mutations. The press has failed to report their erroneous technique and the ULs established in 2000 defining the safety of antioxidant nutrients. The dosages still advocated actively in the literature are three. They are: 90 mg, found in most diets, providing the Daily Value, sufficient to prevent scurvy; 200 mg, the highest intake likely through a conscientious diet, sufficient to saturate certain WBCs; and 500 mg twice a day, which can be obtained only through oral supplements, and is the highest dosage necessary and sufficient for oral dosage saturation of plasma in vivo. Given the likely benefits of higher plasma levels reflected in Table 1, along with the safety of those levels, greater education should be provided to people to help alleviate the expense and suffering that may be caused by inadequate AA intake. TABLE 1: SUMMARY OF POTENTIAL DAMAGE BY OXIDATIVE STRESS AND BENEFITS OF AA INTAKES OF 500 MG TWICE A DAY TO HUMANS CONCLUSION As documented above, 500 mg of vitamin C taken every 12 hrs may reduce many major causes of chronic disease and aging decline, not to mention colds. The safety and benefit of vitamin C supplements is of critical importance, especially those in war zones or of advancing years. People ought to be informed of the safety and benefit of vitamin C supplements. REFERENCES Abbreviations: AA- ascorbic acid (Vitamin C) ROS-Reactive oxygen species (free radicals) • Adler EM (2008) Science signaling: Sirtuin to become astrocytes. Science 320: 291 • Araujo JA, Studzinski CM, Head E, Cotman CW, Milgram NW (2005) Assessment of nutritional interventions for modification of age-associated cognitive decline using a canine model of human aging. AGE 27: 27-37 • Beckman KB, Ames BN (1998a) Mitochondrial aging: open questions. 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Alaska Science Forum Article 1378 Sasazuki S, Sasaki S, Tsubono Y, Okubo S, Hayashi M, Tsugane S (2006) Effect of vitamin C on common cold: randomized controlled trial. Eur J Clin Nutr 60: 9-17 • Song H, Kempermann G, Wadiche LO, Zhao C, Schinder AF, Bischofberger J (2005) New neurons in the adult mammalian brain: Synaptogenesis and functional integration. J Neurosci 25: 10366-10368 • Su H, Gornitsky M, Geng G, Velly AM, Chertkow H,Schipper HM (2008) Diurnal variations in salivary protein carbonyl levels in normal and cognitively impaired human subjects. AGE 30: 1-9 • Takahashi T, Lord B, Schulze PC, Fryer RM, Sarang SS, Gullans SR, Lee RT (2003) Ascorbic acid enhances differentiation of embryonic stem cells into cardiac myocytes. Circulation 107: 1912-1916. • Toein O, Drew KL, Chao ML, Rice ME (2001) Ascorbate dynamics and oxygen consumption during arousal from hibernation in Arctic ground squirrels. Am J Physiol Regul Integr Comp Physiol 281: R572-R583 • Valero MP, Fletcher AE, De Stavola BL, Vioque J, Alepuz VC (2002) Vitamin C is associated with reduced risk of cataract in a Mediterranean population. J. Nutr. 132: 1299-1306 • Zweiﬂer RM (2003) Management of acute stroke. South Med J 96: 380–385 PLASMA: Heinz bodies reflect ROS damage to red blood cells (RBCs). Johnston and Cox (2001) measured Heinz bodies in RBCs (Beutler et al. 1995) in college students. They concluded that the antioxidant protection afforded by short-term vitamin C supplementation is maximal at the 500–1000 mg dosage. When taken in conjunction with 400 IU of vitamin E, a fat-soluble antioxidant, Moser et al (2006) concluded that 500 mg of AA taken twice daily was superior to 200 mg in reducing Heinz bodies, while vitamin E with minimal AA prevented protein carbonyl and TBARS damage. CATARACTS: A major study in Europe shows that blood levels of AA above 49 mol/L were associated with a 64% reduced odds for cataract (Valero et al 2002). US daily value for AA provides only about 20 mol/L, while 500 mg twice daily provides about 75 mol/L. COLDS: Evidence for any benefit of AA for preventing or treating colds remains controversial. A meta-analysis by Douglas and Hemila (2005) evaluated 55 comparative studies treating colds with oral doses of 200 mg of AA per day, and found at most limited evidence for any benefit in prevention or treatment of colds. Although twice-a-day dosing is necessary to maintain elevated serum AA, I have not been able to locate any studies conducted with this requirement. Recently Saszuki et al (2006) reported that the risk of getting a cold decreased in response to single doses of AA. In a study over the range from 50 to 500 mg AA daily, the risk of contracting three or more colds during a 5 yr period was decreased 66% by daily intake of 500 mg. CANCER: Research has demonstrated that mutations of mitochondria accumulate with age (Beckman and Ames 1998a). Each mitochondrion generates about 4,000 free radicals per second (Gredilla et al 2001; Myers and Bosmann 1974). In human tumors, mitochondrial DNA mutations occur at high frequency. Ishikawa et al (2008) demonstrated that pretreatment of tumor cells in mice with free radical scavengers prevents those cells from metastasizing. By prevention of mitochondrial DNA mutations, a mechanism to maintain a high concentration of antioxidants in mitochondria could reduce the risk of metastatic tumors. A review by Frei and Lawson (2008) also shows many recent studies demonstrating that millimolar vitamin C by i.v. infusion will kill cancer cells but not normal cells. TELOMERES : People who take vitamin C and E supplements have longer telomeres than people who do not, while people taking iron supplements, or with oxidative stress or inflammation, have shorter telomeres. (Am J Clin Nutr 2009 89: 1721-1722) SAFETY: There are periodic reports that taking large amounts of AA over long periods of time may be harmful. But even doses of 10 g/day in adults have not been reported to cause harm in reliable scientific studies. Doses above 2,000 mg daily may cause diarrhea and gastric disturbance in some people. In addition, too much AA distorts results of tests commonly used to measure the amount of glucose in urine and blood. Combining oral anticoagulant drugs and excessive amounts of AA can produce abnormal results in blood-clotting tests (e.g., lowering prothrombin time). However, while media reports periodically raise concern about taking AA and vitamin E supplements, those reports are based on misinterpretations of peer-reviewed studies. In response, a major review by numerous authorities, John N Hathcock, Angelo Azzi, Jeffrey Blumberg, Tammy Bray, Annette Dickinson, Balz Frei, Ishwarlal Jialal, Carol S Johnston, Frank J Kelly, Klaus Kraemer, Lester Packer, Sampath Parthasarathy, Helmut Sies and Maret G Traber (2005), was titled "Vitamins E and C are safe across a broad range of intakes". They provided numerous human studies justifying the tolerable Upper Limit (UL) established by the Food and Nutrition Board, which is 1,000 mg daily for vitamin E and 2,000 mg daily for AA.