In 2010, I read that some guy named Paul Jaminet claimed to have contracted scurvy a few years prior. My first reaction: the man is clearly on drugs. No wonder he’s causing a stir in the paleo community. Or maybe he’s watching too many episodes of House? Either way, poor Shou-Ching 🙁
Well, it turns out that Paul’s scurvy experience is not so uncommon in low-to-zero carb dieters who might otherwise appear to have adequate vitamin C intake. Vitamin C deficiency is a big deal — aside from some well-known roles (e.g. immune system, growth), it’s one of a variety of micronutrients that can be helpful when recovering from injury.
Orthopedic surgery and pain
One of the biggest injuries of them all is an intentional injury known as “surgery”. Studying chronic pain as part of a PhD thesis, I had run across instances of vitamin C being used to prevent a terrible pain condition sometimes caused by surgeries called RSD (Reflex Sympathetic Dystrophy, alternately called Complex Regional Pain Syndrome or CRPS). Being in the middle of a series of orthopedic surgeries at the time, I wanted to avoid RSD like the plague.
So what is RSD? It’s an experience that’s tough to capture with words. Like how do you explain being in love to someone who hasn’t experienced it? RSD often brings burning, constant pain, coupled with swelling and immobility. In some cases, a light gust of wind across your skin can feel like a hot poker; laying a blanket on a patient can feel like barbed wire to them. Pain levels of different conditions are compared using the McGill Pain Index, on a scale of 0 to 50. A bone fracture is 18, childbirth is in the 30s, RSD (formerly known as causalgia) is at 42 — making it one of the, if not the most, painful of chronic conditions.
What if I told you that taking 500 mg/day of vitamin C starting immediately after surgery can nearly eliminate the occurrence of RSD? The same timing and dose may apply in cases of injury (bad ankle sprain, suspected ACL tear, etc).
Aside from antioxidant mechanisms (stabilizing free radicals that would normally damage lipid membranes and microcirculation), vitamin C can help normalize pain-inhibiting pathways involving dopamine, NMDA, and other neurotransmitters, and has shown promise for a variety of pain conditions in animal models. A higher vitamin C dose of 2 grams was shown to reduce morphine use after surgery. Reducing opioid intake post-surgically should be approached with caution, and always listen to your doctor. That being said, some people can’t tolerate opioids, are at risk of addiction, or just want to avoid the constipation that often accompanies painkiller use. In the above trial, patients took it orally just before surgery, as vitamin C peaks four hours after administration which coincides with waking from surgery.
I’m no actuary, but the numbers seem to favor taking a dose of vitamin C insurance for orthopedic surgery and injury. But is this also true for other surgery-related cases? The answer is not so straight forward.
Hospital food isn’t optimally nutritious? Whaaa?
The reputation of hospital food is a tier below airline food — bland, unsatisfying, and noted for having gelatinous blobs. Aside from taste, the other thing about hospital food (along with tube feeds, and intravenous nutrition) is that it will likely deplete your micronutrient stores, including vitamin C. Not only is the food not incredibly nutritious, but hospital patients often don’t eat much. Is it because of the taste or because of being sick in the hospital? Who knows.
One of the most important times to optimize your nutrition is when in the hospital. In surgical patients, supplementing with 200 mg of vitamin C is not enough to attain adequate vitamin C levels or reduce oxidative stress.
If you can get enough vitamin C perioperatively (how much is “enough” will be explored in part 2), it may prove therapeutic to a variety of conditions. In GI surgery, 500 mg of vitamin C by IV reduced post-surgical oxidative stress. Several trials have shown that taking 1-2 grams of vitamin C before and after heart surgery prevents atrial fibrillation and reduces hospital stay.
The benefits of vitamin C extend to less critical conditions as well. After laser surgery for skin, topical vitamin C reduced skin injury and restored acidic skin pH. Acidic skin provides defense against microbes, and inflamed skin can have a higher than normal pH. Vitamin C also has anti-acne effects (possibly by lowering sebum secretion and preventing water loss from skin) and reduces pigmentation (e.g. for freckle reduction or to help remove skin marks).
Vitamin C for other serious conditions
High doses of vitamin C show promise for critical care patients such as those with major burns. Surgical patients with major infection or critical illness require tissue to be replaced at a high rate, and hence use up vitamin C quickly — 300 mg isn’t enough for repletion but 1000 mg is. If you have borderline vitamin C stores before a hospital stay, there’s a chance that vitamin C dipping further will lead to fragile capillaries, poor wound healing, and possible hemorrhage. Luckily, bleeding ceases in under 24 hours with vitamin C supplementation, and adverse skin changes are reversed in 2-3 weeks.
Even if you’re as healthy as an ox, there’s a good chance that you’re the (welcome or unwelcome) nutrition adviser among friends and family with health conditions. If grandma or grandpa is hospitalized with a respiratory infection, remember that vitamin C significantly improves respiratory function in these patients. Vitamin C combined with vitamin E also reduces oxidative damage caused by sleep apnea, which has been called an “oxidative stress disorder”.
Finally, if you fracture your wrist, that is one instance where taking vitamin C (500 mg/d for 50 days) is unequivocally and officially recommended by evidence-based guidelines.
Conclusion
In part 2, we’ll check out some reasons to be cautious when considering vitamin C intake before and after surgery.
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