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Diagnosing vitamin C deficiency
As an aid to deter excessive intake
Ascorbic acid (vitamin C) is essential for the enzymatic amidation of neuropeptides, production of adrenal cortical steroid hormones, promotion of the conversion of tropocollagen to collagen, and metabolism of tyrosine and folate. It also plays a role in lipid and vitamin metabolism and is a powerful reducing agent or antioxidant. Specific actions include: activation of detoxifying enzymes in the liver, antioxidation, interception and destruction of free radicals, preservation and restoration of the antioxidant potential of vitamin E, and blockage of the formation of carcinogenic nitrosamines. In addition, vitamin C appears to function in a variety of other metabolic processes in which its role has not been well characterized.
Prolonged deficiency of vitamin C leads to the development of scurvy, a disease characterized by an inability to form adequate intercellular substance in connective tissues. This results in the formation of swollen, ulcerative lesions in the gums, mouth, and other tissues that are structurally weakened. Early symptoms may include weakness, easy fatigue and listlessness, as well as shortness of breath and aching joints, bones, and muscles.
The need for vitamin C can be increased by the use of aspirin, oral contraceptives, tetracycline, and a variety of other medications. Psychological stress and advancing age also tend to increase the need for vitamin C. Among the elderly, lack of fresh fruit and vegetables often adds vitamin C depletion to the inherently increased need, with development of near-scurvy status.
Values <0.3 mg/dL indicate significant deficiency.
Values >0.6 mg/dL indicate adequate supply.
The actual level at which vitamin C is excessive has not been defined. Values >3.0 mg/dL are suggestive of excess intake. Whether vitamin C in excess is indeed toxic continues to be uncertain. However, limited observations suggest that this condition may induce uricosuria and, in individuals with glucose-6-phosphate dehydrogenase deficiency, may induce increased red blood cell fragility.
Testing of nonfasting specimens or the use of vitamin supplementation can result in elevated plasma vitamin concentrations. Reference values were established in patients who were fasting.
After consuming vitamin C, plasma values rapidly rise within 1 to 2 hours and reach peak concentration within 3 to 6 hours after ingestion.
1. Anonymous: Vitamin C toxicity. Nutr Rev 1976;34:236-237
2. Moser U, Bendich A: Vitamin C. In Handbook of Vitamins. Second edition. Edited by LJ Machlin. New York, Marcel Dekker, 1991, pp 195-232
3. Ball GFM: Vitamins: Their Role in the Human Body. London, Blackwell Publishing LTD, 2004, pp 393-420