NUTRITION
Vitamin C, also known as L-ascorbic acid, is no longer just for the common cold. Vitamin C is a water soluble vitamin that is naturally present in common foods, dietary supplements and even intravenous infusions.
The best source of Vitamin C is found naturally in fruit and vegetables. Approximately 70%–90% of vitamin C is absorbed at moderate intakes of 30–180 mg/day. However, at doses above 1 g/day, absorption falls to less than 50% and absorbed, unmetabolized ascorbic acid is excreted in the urine. Vitamin C has low toxicity and is not believed to cause serious adverse effects at high intakes. The most common complaints are diarrhea, nausea, abdominal cramps, and other gastrointestinal disturbances due to the osmotic effect of unabsorbed vitamin C in the gastrointestinal tract.
The recommended dietary allowance is listed above in table 1. It has been found that smokers have up to a TEN time risk of wound healing complications just due to the effects of nicotine alone after surgery. Studies also show that smokers have a lower plasma and leukocyte vitamin C level than nonsmokers. It is recommended that any patients that smoke needs an additional 35mg more of Vitamin C daily than a non-smoker. Vitamin C is the most unstable water soluble vitamin of all the water soluble vitamins. It is not stored in the body and must be replenished daily. Table 2 lists some common foods where vitamin C can be found.
Vitamin C has several functions including anti-inflammatory, anti-oxidant and plays a role in immune function, as well as prevention in several disease processes ie: cardiac disease, age-related macular degeneration and cataracts.
One of the most important functions of Vitamin C is assisting in the formation of collagen. It is considered a co-factor in proline and lysine hydroxylation which is a necessary step in the formation of collagen. It also provides tensile strength to newly built collagen; otherwise, new tissue could not stretch without tearing. This proves to be helpful in patients with pressure ulcers and wounds.
According to a study done by Dr. Oliver Chow and Dr. Adrian Barbul(2014), mice supplemented with vitamin C had improved full thickness wound contraction time after radiation therapy along with increased collagen deposition and fibroblast numbers. In a prospective randomized controlled trial, surgical patients with pressure sores given large doses of ascorbic acid had a significant acceleration in the healing of the pressure sores. Overall, vitamin C supplementation has consistently shown benefit to wound healing.
References
Chow, O., & Barbul, A. (2014). Immunonutrition: Role in Wound Healing and Tissue Regeneration. Advances in Wound Care, 3(1), 46–53. http://doi.org/10.1089/wound.2012.0415
National Institute of Health: Office of Dietary Supplements
https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
Updated March 2, 2017
Collins, N., PhD. (2013). Revisiting Vitamin C and Wound Healing. Ostomy Wound Managment, 12-14. http://www.drnancycollins.com/downloads/owm/VitaminC.pdf
