Vitamin C and Bone Health: Are You Getting Enough?
Some of the symptoms of the vitamin C deficiency disease, scurvy – sore limbs, bleeding gums, and poor wound healing – are related to one of the roles of vitamin C in the body, namely the production of collagen. Collagen is a structural protein in the body and forms the matrix upon which bone minerals are deposited. Finck and co-workers recently looked at whether vitamin C intake or serum levels in EPIC study participants are associated with measures of bone health in elderly people for this reason.
Although scurvy brings to mind sailors in centuries past who suffered terribly from a lack of fresh fruit and vegetables on long sea journeys, recent studies show that vitamin C levels low enough for scurvy to be a concern are still an issue. For example, Schleicher and colleagues found an overall prevalence of vitamin C deficiency of 7.1% in the US population. A Finnish-Russian group headed by Paalanen showed that over three quarters of study participants in Pitkäranta, Russia were deficient. Szczuko and associates found 8% of Polish students had sub-clinical vitamin C deficiency and 1% had frank deficiency. Chiplonkar et al. found that three quarters of Western Indian adults had deficient vitamin C. Vitamin C deficiency is not an 18th- century problem, but also a modern problem. Aside from frank deficiency, inadequate intakes or levels may also affect long term bone health.
In the study from Finck and co-workers, the authors used data from 2327 EPIC participants from Norfolk in England. Subjects completed a 7-day diary to measure nutrient intakes, and plasma vitamin C levels were determined. They had access to ultrasound measurements of bone, which provide information about the structural organization of bone, with more resistance to ultra sound indicating better resistance to fractures. History of bone fractures was also determined.
The authors found that higher vitamin C intakes were associated with improved bone structure as assessed by heel ultrasound measurements. In addition, higher plasma vitamin C was related to reduced risk of bone fractures in men. This may be important: as men have a higher lean mass, they need greater intakes of vitamin C and are be at greater risk of deficiency (see study by Jungert and Neuhäuser-Berthold).
In light of the non-negligible risk of vitamin C deficiency even in well-nourished populations, and possible importance of vitamin C in bone health, we advise health care and nutrition professionals to continue to stress the importance of consuming sufficient vitamin C.
Henriette Finck, Andrew R Hart, Marleen AH Lentjes, Amy Jennings, Robert N Luben, Kay-Tee Khaw, and Ailsa A Welch. Cross-sectional and prospective associations between dietary and plasma vitamin C, heel bone ultrasound, and fracture risk in men and women in the European Prospective Investigation into Cancer in Norfolk cohort. First published November 4, 2015, doi: 10.3945/ajcn.115.111971
Chiplonkar SA, Agte VV, Mengale SS, Tarwadi KV. Are lifestyle factors good predictors of retinol and vitamin C deficiency in apparently healthy adults? Eur J Clin Nutr. 2002 Feb;56(2):96-104. http://www.ncbi.nlm.nih.gov/pubmed/11857042
Jungert A, Neuhäuser-Berthold M. The lower vitamin C plasma concentrations in elderly men compared with elderly women can partly be attributed to a volumetric dilution effect due to differences in fat-free mass. Br J Nutr. 2015 Mar 14;113(5):859-64. doi: 10.1017/S0007114515000240. Epub 2015 Mar 4. http://www.ncbi.nlm.nih.gov/pubmed/25735881
Levavasseur M, Becquart C, Pape E, Pigeyre M, Rousseaux J, Staumont-Sallé D, Delaporte E. Severe scurvy: an underestimated disease. Eur J Clin Nutr. 2015 Sep;69(9):1076-7. doi: 10.1038/ejcn.2015.99. Epub 2015 Jun 17. http://www.ncbi.nlm.nih.gov/pubmed/26081492
Paalanen L, Prättälä R, Alfthan G, Salminen I, Laatikainen T. Vegetable and fruit consumption, education and plasma vitamin C concentration in Russian and Finnish Karelia, 1992-2002. Public Health Nutr. 2014 Oct;17(10):2278-86. doi: 10.1017/S1368980013002243. Epub 2013 Aug 30. http://www.ncbi.nlm.nih.gov/pubmed/23987990
Schleicher RL, Carroll MD, Ford ES, Lacher DA. Serum vitamin C and the prevalence of vitamin C deficiency in the United States: 2003-2004 National Health and Nutrition Examination Survey (NHANES). Am J Clin Nutr. 2009 Nov;90(5):1252-63. doi: 10.3945/ajcn.2008.27016. Epub 2009 Aug 12. http://www.ncbi.nlm.nih.gov/pubmed/19675106
Szczuko M, Seidler T, Stachowska E, Safranow K, Olszewska M, Jakubowska K, Gutowska I, Chlubek D. Influence of daily diet on ascorbic acid supply to students. Rocz Panstw Zakl Hig. 2014;65(3):213-20. http://www.ncbi.nlm.nih.gov/pubmed/25247801