Vitamin C,

Are You Really Good For Covid-19?

The number of positive COVID-19 cases is still on the high side. If we are not careful, this phenomenon will cause Malaysia's healthcare system on the verge of reaching its breaking point and the hospitals treating the COVID-19 patients including ICU will reach nearly 100% capacity. The symptoms of COVID-19 can range from mild symptoms (fever, tiredness, cough and body aches) to more serious ones that can be life-threatening (sepsis and shortness of breath). It is caused by a strain of coronavirus known as SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). It has been identified as one of the most pathogenic coronaviruses in human beings. Because there are limited proven treatments for COVID-19, it is wise to tighten our immunity while observing the necessary SOPs.

Vitamin C is an essential vitamin for immunity, which means our body is not able to produce it internally. We need to get it from our diet or supplements. A sick person will have a significant drop in their level of vitamin C. Vitamin C level declines rapidly when the body is under conditions of physiological stress such as infections, trauma, surgery and burns (MacLennan et al 1977). A few studies across the globe revealed that most hospitalized COVID-19 patients have very low vitamin C levels (Fain et al 2003, Gan et al 2008, Ravindran et al 2018).

The Link Between Vitamin C Deficiency And Pneumonia

The preventive effect of healthy levels of vitamin C on respiratory infections has been proven in the 1940’s (Hemila et al 2007). There are also multiple studies that reported on the significant reductions in respiratory infections with vitamin C supplementations. In the local settings, a retrospective analysis conducted in two different hospitals have shown that there was a 57% lower death rate in the vitamin C group. These subjects were reported to have 9 days shorter hospitalisation stay and reduced usage of ventilator. A 2019 review found that vitamin C shortens the duration of mechanical ventilation usage by 18.2% in patients affected by COVID-19 (CK Wong et al). This has shown that not only Vitamin C helps to prevent ourselves from falling sick easily, but also helps us recover sooner.

When the vitamin C level is very low, the inflammatory marker shoots up. This proves the value of vitamin C as an anti-inflammatory. Once the coronavirus enters the body, it triggers a cascade of inflammatory reactions. These reactions release the pro-inflammatory cytokines and form a cytokine storm (Cytokine storm is a condition due to a ‘deranged’ immune system whereby the body attacks itself rather than the virus. All of these will exert an overwhelming oxidative stress onto our normal body cells, which results in severe tissue damage (Sanchez-Moreno et al 2003, de Melo et al 2020).

Preventing Sepsis In COVID-19 With Vitamin C

Our immune cells use ROS (reactive oxygen species) to support their functions. However, excessive production of ROS can lead to sepsis, a life-threatening condition. Vitamin C is a potent antioxidant that has the potential to neutralize unstable compounds in our body called free radicals. This helps to prevent lung injury and other organ failures (Bosmann et al 2013) 


With more scientific data made available on COVID-19, it is more definitive to state that COVID-19 does cause sepsis. Sepsis is a condition when the bacteria or virus has excessively entered into the blood while the immune system is trying to remove these pathogens. This can lead to an excessive inflammation and subsequently causes multiple organs damage(Bosmann et al 2013). It is one of the most common causes of death in people who are ill with COVID-19. Vitamin C is known to

avoid infections and improves immune responses. It reduces excessive inflammation and protects the lungs from oxidative injury. Furthermore, it has an essential role in stimulating tissue healing and improves immune responses against infections.

According to an article published in the Chinese Journal of Infection Diseases, the Shanghai Medical Association endorsed the use of high doses of vitamin C as a treatment in hospitalized COVID-19 patients. High doses of vitamin C given through IV are recommended to correct disease-induced deficiency, reduce oxidative stress and support the anti-inflammatory action. It has shown promising results, certainly when the patients are in ICU and are on ventilators to support their life. Researchers suggest that consuming 2g of vitamin C daily reduces the incidence and duration of respiratory infections (Hammond et al 2017).

Generally, Vitamin C has low toxicity and is not believed to cause serious adverse effects. Being a water-soluble vitamin, the excessive amounts will be eliminated through urine, and thus it is not stored in the body. With that being said, there are some common complaints reported when taking vitamin C, such as diarrhoea, nausea and gastrointestinal disturbances due to the osmotic effect of unabsorbed Vitamin C in the gastrointestinal tract.

Choosing The Right Vitamin C

There is a large variant of Vitamin C in the market. We should choose wisely based on our needs and its functionality. For those with compromised kidney function, Kordel’s Ester C® is recommended. It is an acid free formulation which causes less discomfort to the gastrointestinal tract and has the ability to reduce oxalate levels to prevent kidney stones formation. It uses a unique form of vitamin combining with its metabolite, threonates, that helps higher vitamin C absorption from the digestive tract to the circulation. Thus, resulting in 4 times better bioavailability and absorption than ascorbic acid. It retains longer in the body and is proven to stay as long as 24 hours in the white blood cells to provide a 24 hours immune protection. 

Consuming zinc along with vitamin C enhances the benefits in promoting a healthy immune system. Vitamin C and zinc complement each other in enhancing the immune function. They modulate the body’s resistance to reduce the risk, severity and duration of infections.  While vitamin C enhances the efficacy and efficiency of white blood cells, especially neutrophils;  Zinc is able to block the adhesion of viruses on mucosa and prevent virus replication. Vitamin C and zinc are better and more quickly absorbed in an effervescent formulation, especially for those who require immediate protection.  This fast dissolve formulation leads to better efficacy, as compared to capsules or tablets. Some ingredients in an effervescent formulation are able to buffer the acidity of vitamin C, which makes it less irritating to the stomach. Vitamin C and zinc in effervescent form is convenient and tasty.   It is easy for people who do not prefer swallowing tablets. Kordel’s Effervescent C is made in Germany using a well-known and advanced effervescent technology. It is sugar-free with no artificial colouring. It is also Halal certified. 

The Downside

Despite their reputation for boosting the powers of your immune system, a new study reports that vitamin C and zinc supplements don't help COVID-19 patients recover from their illness.The findings were published February 12 in the journal JAMA Open Network.

The study conducted at the Cleveland Clinic, 214 patients with COVID were randomized to receive either 10 days of zinc gluconate (50mg), ascorbic acid (8000 mg), both agents, or standard care. The results showed no significant difference in the duration of symptoms among the 4 groups.

These results may tell us that we should  take precautionary steps to improve our immunity as soon as possible. After all, prevention is better than treatment. The immediate response by the immune system is critical in determining infectivity and the severity in Covd-19 cases. 

Find out what Kordel's Scientist cum Senior Pharmacist, Dr. Lum, has to say on this.

The Conclusion

In the absence of a widely available treatment for Covid-19, supplementation of Vitamin C emerges as an important measure to support the immune system and to prevent the development of severe symptoms. Its beneficial effects in management of severe respiratory infections and critically ill patients were reported in all the clinical trials. Given the fact that Vitamin C is cheap, readily-available and safe, it is sensible to add it into Covid-19 management protocol as an adjunctive measure. 

References:

1. Maclennan et al. The effect of acute illness on leucocyte and plasma ascorbic acid levels. Br. J. Nutr. 1977, 38, 217-223. DOI:10.1079/bjn1977081/

2. Fain, et al. Hypovitaminosis C in hospitalized patients. Eur. J. Intern. Med. 2003, 14, 49-225. DOI:10.1016/jejm2003.08.006

3. Gan et al. Vitamin C deficiency in a teaching hospital. J. Am. Coll. Nutr. 2008, 27, 428-433. DOI:10.1080/0721575724.2008.10710721

4.Ravindren et al. Vitamin C deficiency in an Australian cohort of metropolitan surgical patients. Pathology 2018, 50, 654-658. DOI:10.1016/j pathol.2018.07.004

5.Hemila et al. Vitamin C may affect lung infections. J R Soc Med. 2007 Nov; 100(11):495-498. DOI: 10.128/jrsm.100.11.49

6. CK Wong et al. Effects of high dose of vitamin C supplementation on severe COVID-19 patients in the ICU: A retrospective analysis

7. Sanchez-Moreno et al. Decreased levels of plasma vitamin C and increased concentrations of inflammatory and oxidative stress markers after stroke. American Heart Association. Volume 35, Issue 1, 2004.

8. de Melo et al. High-dose intravenous vitamin C may help in cytokine storm in severe SARS-CoV-2 infection . Critical Care (2020)24:500. https://doi/10.1186/s13054-020-03228-3

9. Bosmann et al. The inflammatory response in sepsis. Trends in immunology 2013. DOI:10.1016/j.it.2012.09.004\

10. Hammond et al. Identifying an oxygenation index threshold for increased mortality in acute respiratory failure. Respiratory Care. 2017 Oct;62 (10):1249-1254.

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