The Essentials of Vitamin C

Everyone needs this vitamin and some people, especially the sick, may need more of it

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Vitamin C gets a lot of love from nutritionists. PubMed lists some 70,000-plus studies into this essential vitamin, looking at everything from its effect on sepsis to how it affects nanoparticle additives in food.

When it comes to its potential as a disease fighter, those who study these things are pretty enthusiastic about it.

“Vitamin C is the world’s best natural antibiotic, antiviral, antitoxin and antihistamine,” writes Andrew W. Saul, author of “Doctor Yourself: Natural Healing That Works” and editor-in-chief of Orthomolecular Medicine News Service.

“As English literature concentrates on Shakespeare, so orthomolecular (megavitamin) therapy concentrates on vitamin C. Let the greats be given their due. The importance of vitamin C cannot be overemphasized.”

But just because vitamin C is well-regarded, doesn’t mean it is simply a matter of taking more. There are different kinds of vitamin C and different ways that people need it or can better use it. Some people absorb all the nutrients they need from eating fruits and vegetables high in vitamin C. Others with health challenges process vitamin C more efficiently with high-dose infusions or daily supplementation.

Dr. Henry Ealy, founder and Executive Community director of the Energetic Health Institute says that for more than 20 years, he has been teaching his students one inescapable truth of disease: “When a person comes to you for help, you know exactly one thing ... you know that that person is nutrient deficient.”

He said he tells his students who are studying the pathology of chronic and infectious disease that the most common symptom to look for is fatigue.

A well-nourished and nutrient-dense body produces higher amounts of energy and therefore has more energy to optimize cellular function, Ealy said. In the case of well-nourished immune cells, the body’s susceptibility to infection plummets dramatically.

“If they are nutrient-dense, then they are less susceptible to an exposure turning into an infection. It’s that simple,” he said. It sounds easy enough, but most doctors aren’t sure how to dose supplements such as vitamin C. Some doctors rarely even mention nutrition.

“There is a strategy for effective dosing of nutraceuticals that often eludes medical professionals that lack training in clinical nutrition. According to the National Academy of Sciences, the average M.D. only receives about 19.6 hours of nutritional training, or what amounts to a weekend workshop … if they receive any nutritional education at all.”

“Sadly, most M.D.s simply aren’t qualified to use nutrition as a clinical therapy and that’s not their fault. It’s a major failing of modern allopathic medical education,” Ealy said.

How Does Vitamin C Work?

Vitamin C, also known as ascorbic acid or ascorbate, is naturally present in some whole foods, added to others, and available as a dietary supplement or intravenous infusion.

Unlike animals and plants that can create their own vitamin C, humans cannot synthesize the vitamin through internal metabolism as we do with vitamin D. Therefore, we need to ingest it and hence, its “essential” status.

Vitamin C is absorbed by a group of different proteins in the small intestine, where an active transport system can move it through the gut and into the bloodstream. Unlike fat-soluble vitamins such as D, E, A, and K, which are absorbed and stored in tissue, vitamin C is water-soluble and therefore can’t be stored in your body for later use. Whatever your body can handle, it uses to boost your cells and support the rest of the body, while what isn’t used is eliminated through urine.

According to Alexander Michels, a research associate for the Linus Pauling Institute at Oregon State University, vitamin C can stay in the body for weeks.

“Levels of vitamin C in the blood are controlled by the kidneys through a process known as ‘renal reabsorption,’ which prevents vitamin C from being lost in the urine. Taking large doses of it can overwhelm this system, so the extra amount is lost in the urine in a matter of hours,” he writes on the institute’s blog.

“When someone who doesn’t have high blood levels of vitamin C takes it, the vitamin stays in the system longer.”

Getting adequate C every day is like having your own personal mechanic checking your car before you drive it. He clocks out at the end of the day, but is available for work tomorrow if you need him.

Vitamin C, Health, and Immunity

Medical researchers, nutritionists, and holistic healers agree on many of the benefits of vitamin C, including its importance in immune function.

Vitamin C is a confirmed antioxidant, which means it can counter free radicals. Free radicals are molecules that are missing an electron, which leaves them hunting for one to balance themselves. This hunt means they are reactive and damaging to cells. This makes them significant contributors to disease. Antioxidants neutralize free radicals.

Ongoing research is examining whether vitamin C may prevent or delay certain cancers, heart disease, and other diseases by limiting the damaging effects of free radicals.

When the body is depleted of vitamin C, the immune system can be compromised, and the body can be vulnerable to illness and disease. An epidemiological study published in the Nutrition Journal, July 2021, found 82 percent of critically ill COVID-19 adult patients had low vitamin C values.

“Given the potential role of vitamin C in sepsis and ARDS [Acute respiratory distress syndrome], there is gathering interest of whether supplementation could be beneficial in COVID-19,” wrote the researchers.

Others have found intravenous vitamin C to be effective in the early treatment of COVID-19, particularly in hospitalized cases, as evidenced in Ealy’s peer-reviewed position paper: “COVID-19: Restoring Public Trust During A Global Health Crisis,” which references an effective vitamin C protocol used in Shanghai, China, from early 2020 [page 55].

Among vitamin C’s other roles, it aids in the absorption of nonheme iron (the form of iron present in plant-based foods that carries oxygen throughout the body so cells can produce energy).

How Much is Enough?

Most university medical schools recommend using the Recommended Dietary Allowance (RDA) as a guide on just how much C we need. For instance, healthy women are supposed to shoot for 75 mg of C per day (120 mg per day for women who are pregnant or breastfeeding).

Looking at the RDA, the average person thinks adding black currants (1-cup=203 mg) to their lunch box yogurt, or eating a sliced-up kiwi (1 cup=164 mg) first thing in the morning is really all they need.

Unfortunately, most nutritionists and naturopaths say we need to need to raise our vitamin C intake beyond that.

The RDA for vitamin C provided by the Food and Nutrition Board, is low and outdated, according to Ealy.

“Deficiency of even one essential nutrient and the cascade of negative events [that follow] for a cell can be truly devastating long-term,” he said, adding that certain nutrients and botanical medicines can help amplify the intended healing effect.

Processed foods containing synthetic vitamin C can have less vitamin C than their fresh counterparts no matter how hard technologies try to preserve the fragile vitamin. Fruit-flavored snacks, juices, and cereals need to be fortified with ascorbic acid to help replenish vitamin C content lost in processing.

If you are sick or looking for a therapeutic effect from vitamin C, you may need to take more.

Using Vitamin C Therapeutically

The RDA for vitamin C is far too low for patients experiencing chronic infection or recovering from chronic disease. While the RDA suggests that 75 to 120 mg of vitamin C for adults is the goal, Ealy said, in actuality, that amount is the bare minimum to stave off nutrition preventable disease.

“In clinical practice, given the amount of elevated levels of stress most Americans feel daily and the high rate of exposure to chemical pollution in most foods, water, and homes, the daily requirements for vitamin C as an antioxidant, antiviral, detoxifier and essential nutrient for adrenal health are much, much higher.”

“Yet, even though the requirements for vitamin C are much, much higher on a daily basis, even the CDC [Centers for Disease Control and Prevention] knows that 37-46 percent of Americans aren’t getting even the minimal RDA amounts,” Ealy said.

Typically, naturopathic doctors, functional medicine practitioners, and certified holistic nutritionists with the highest success rates employ a strategy known as therapeutic range, which answers the important clinical question, “How much of a particular nutrition do I need to get into the body in order to produce a healing response at the cellular level?”

Ealy said vitamin C requires approximately 3,000 to 5,000 mg per day to fall within the therapeutic range, “and sometimes even this range may be too low.”

Best Sources of Vitamin C

There are many ways to get vitamin C, so which is the best? A berry acai smoothie? Sauteed kale or spinach? A 1,000-milligram capsule, a tasty, sugar-coated gummy vitamin, or a trip to the hydration bar for an infusion?

People’s techniques for “C-loading” vary widely, and unless you are a professionally trained nutritionist, you may be unsure what is best for you.

Let’s get into some details on which is the best way for you:

Raw Food: Best for Conscientious Eaters

If you are a health food superstar and watch what you eat, getting your recommended intake through raw foods high in vitamin C is your yellow brick road. Raw fruits and vegetables have the highest amounts of vitamin C. If you cook those foods, it will affect how much vitamin C they retain.

“It’s best to consume foods high in vitamin C raw whenever possible, instead of cooked, because cooking methods like boiling, simmering, sautéing, stir-frying and poaching can cause significant losses of vitamin C and other ‘delicate’ nutrients,” Jillian Levy, CHHC, said in Ancient Nutrition.

“Cooking nutrient-dense foods tends to destabilize some of their valuable enzymes and destroy certain antioxidants and vitamins,” Levy said.

A Korean study published in Food Science and Biotechnology found boiling vegetables destroyed vitamin C in almost all their samples (0-73.86 percent), due to the vitamin leaching into the water, with the greatest loss found in boiled chard. Blanching reduced vitamin C in the samples (57.85 to 88.86 percent), with the greatest loss found in blanched spinach. Steaming significantly reduced the retention of C in all vegetables except broccoli (0-89.24 percent). The authors found:

“Steaming and microwaving retained higher concentrations of vitamin C than boiling because of the reduced contact with water at relatively low temperatures. Using minimal cooking water and cooking for shorter time periods should result in higher vitamin C retention.”

A study from Zhejiang University in China discovered cooking broccoli with the high heat saute method also caused 16 percent losses of vitamin C. No formal studies have been done to measure vitamin C loss in grilling or baking vegetables, however, perhaps keep in mind a rule University of Central Florida nutritionists follow:

“There are three main things that deplete veggies of their nutrients when cooking: temperature, time, and water. So the lower the temperature, less time exposed to heat and less water used, the better.”

Also important to note, Michels, the research associate for the Linus Pauling Institute,  wrote that vitamin C levels in many foods are retained during freezing and canning.

“The freezing process destroys some of the enzymes that would otherwise degrade vitamin C in fresh fruit and vegetables. Also, the cold temperatures tend to preserve ascorbic acid. Canned fruit has also been shown to be a good source of vitamin C—likely because the products are canned shortly after harvest with minimal additional processing, and the use of brief amounts of heat in the canning process can destroy enzymes that would otherwise degrade it.”

Supplements: Necessary for the Majority

“Never underestimate the power of a potent multivitamin to really amplify the effectiveness of any individual nutrient or botanical,” Ealy said. “There is a simplicity to the art of healing when we select the right synergistic nutrients and botanicals and then dose them in amounts high enough to produce the intended therapeutic effect.”

What form of Vitamin C is best depends on what problems you are having. Dr. Brian Lum of the Functional Healthcare Institute recommends ester C for immune boosting, allergy symptoms, and helping your body reduce histamine levels. This form is generally better absorbed than ascorbic acid but not as well absorbed as liposomal vitamin C.

Lum recommends liposomal vitamin C supplementation for methylation (detoxification) issues, such as those who carry the MTHFR gene, a gene studied for its association with autism spectrum disorders. “This form is the best and is great for those with digestive problems because it can be absorbed without fully going through the digestive system,” he writes in a recent blog post.

Lum’s page provides “loose guidelines” for people, but recommends putting a plan together with your doctor. For instance, he might recommend a combination of remedies for a sore throat, depending on his patient, such as “rose hip tea with Ester C and zinc picolinate.”

Yet depending on which medical consultant you ask, the answer may be different. What supplement is best for you depends on needs, varying from allergies, light or chronic deficiencies, and specific health problems. It’s personal.

And then there’s the problem of supplement ‘impostors.’

Autumn Smith, a holistic nutritionist and founder of Paleo Valley writes on the website for her supplement company that we need to be careful when researching our vitamin C supplements. Like most nutritionists, she recommends eating a plethora of whole foods for vitamin C, but if you need to supplement, she said it’s vital to find a natural product that doesn’t contain sugar, GMOs, harsh processing ingredients, or synthetic ascorbic acid.

She said it’s imperative to read the labels before you buy.

When finding the right supplement for you, make sure you find a natural, clean, and potent product, she said. For those who have reactions to the many variations of supplements, they may want to look into intravenous vitamin C (IVC).

Infusion: Best for Immediate Need

Intravenous vitamin C drip supplementation is a little more complicated than swallowing a capsule or juicing a bag of grapefruits, but some find it’s the most effective way of getting high doses of vitamin C into your system. Some people use this method to attack cancer cells with high-dose vitamin C.

The way the IVC process works is by inserting the vitamin C right through a needle in your arm, bypassing the digestive system by taking the shortcut straight to your bloodstream. Proponents say skipping the gastrointestinal tract this way makes the vitamin C more bioavailable.

“IVC is an excellent way to deliver high doses of vitamin C at or beyond the upper limits of therapeutic range directly into the bloodstream,” Ealy said.

IVC patients can take their time in a chair with custom blends of ‘vitamin cocktails’ at hydration bars and integrative clinics. Others go for straight, pure vitamin C.

People are using IVC as an adjunct therapy in between chemotherapy, for Lyme disease, intractable epilepsy, and many other conditions, especially where the person can’t digest food properly or absorb oral supplements due to severe health conditions.

A study published in Frontiers in Physiology 2018, found IVC can decrease toxicity and side effects of chemotherapeutic agents in cancer patients with low levels depleted by chemotherapy. The IV administration provided significantly higher peak plasma concentrations because it bypasses the regulated intestinal uptake of oral vitamin C. The study examined a number of anti-cancer mechanisms proposed, such as indirect generation of hydrogen peroxide and antioxidant and anti-inflammatory functions.

Yet, outside of oncology and other chronic conditions, people are faced with deciding if a short-term boost of IV vitamin C is worth it. Since vitamin C is known to have a relatively short half-life, some IV vitamin C critics have called the infusions “expensive urine.” IVs mean time and money. The process takes up to 45 minutes to an hour to complete and depending on where you go, the cost varies from $35 to $155 for one infusion, depending on the venue.

The average person participating in IV vitamin C treatments will go 1 to 2 times per month, according to a PLoS One survey of complementary and alternative medicine practitioners. Those with more serious conditions showed a frequency of approximately twice a week and about 19 treatments per patient.

Ealy believes IV vitamin C is worth it for a long list of chronic conditions:

“In the cases of cancer and severe infections,” he added, “severe nutrient deficiency must be assumed during the initial assessment and confirmed by laboratory testing whenever possible.”

“Vitamin C will most surely be deficient and because vitamin C is a master nutrient that plays essential roles in a multitude of key cellular functions across multiple tissues and organs, delivering it directly into the bloodstream, in high doses, is often incredibly effective at achieving the desired therapeutic effect.”

Vitamin C Deficiency

Whether you are sick or not, you will want to avoid vitamin C deficiency.

“Cells have many, many diverse nutritional needs,” Ealy said. “Cells don’t ask for much, but what they need...they need.”

The concept of bioavailability, or the percentage of an administered substance that is absorbed in the intestines (and ultimately available for use in your cells and tissues), comes to play when considering how to best receive your vitamin C.

Though some health professionals say about half the vitamin C you eat in food is bioavailable (at best), some people cannot (or will not) eat the foods that give them the right amount of daily vitamin C, and therefore benefit from supplementation.

Vitamin C deficiency can result in a long list of symptoms, simply because vitamin C is an essential vitamin that synergistically affects every function in the human body. Typical initial symptoms include irritability and loss of appetite.

Certain groups are at risk for vitamin C inadequacy. This includes smokers, infants fed evaporated or boiled milk, individuals with limited food variety, and people with malabsorption and certain chronic diseases such as cancer, gastrointestinal conditions, cardiovascular disease, age-related macular degeneration, and eye disease.

If you are getting sick every cold and flu season, you may not be getting vitamin C in your diet for one reason or another and need to take vitamin C supplements.

If COVID-19 caught up to you, you are likely on the risk list.

Testing for Vitamin C Deficiency

That said, you have two options: You can get a blood test for vitamin C deficiency, or you can take the recommended supplement dose and hope for the best.

If you choose the second route, the challenge is deciding which version of the vitamin is best. This process takes research, as one size doesn’t fit all.

The products on the market are endless—from liposomal, esterified, time-release, to mineral forms. When you take them and how often play a role, and whatever else you are taking as far as drugs, other supplements, and your lifestyle, complicates that process. If you have health conditions or concerns, you should consult a professional.

Conclusion and Caution

No matter how you get it, you need vitamin C because your body cannot produce it, and that is the reason it is called an essential vitamin. The best way to get your vitamin C is through whole foods (preferably raw, and organic) but if you need to supplement, that’s an equally viable route, as long as you have real data (either labs, personal information, or professional nutritional advice) that advises the right amount and protocol you need.

A word of caution: In some people, high vitamin C doses can cause symptoms such as diarrhea, nausea, heartburn, gastritis, fatigue, flushing, headache, and insomnia. People with chronic liver or kidney conditions, gout, or a history of calcium–oxalate kidney stones may have issues with supplements, according to standard medical literature.