[iko]

Thanks for the article
and discussion VitaminC,

are there simple signs of a
subclinical scurvy, available
in everyday clinical practice?

No. (simple answer)

Why not?  [?]

I think that subclinical scurvy should have specific signs, good enough for a careful observer.
I personally saw in one case only, a 8yr old child, several years ago, a scarlet discolouration of the gengival border corresponding to the superior canine and front teeth.
Just that, no bleeding, no perifollicular petechiae, very mild anemia and fatigue.
Diet history suggested a vitamin C deficiency, plasma AA levels were low: 0.2mg/dL (normal 0.4-1.6mg/dL).  We were lucky to have a routine test running for research on thalassemic patients, so we could play with it.
Now it is much more difficult to obtain such results from a normal lab.
Unfortunately I didn't take a picture...it seemed so obvious!
In those days I was able to find somewhere that this particular sign is sort of typical in subclinical scurvy.  Now this information seems to have vanished.
Maybe someone around here will find it for me.
If confirmed, it could be the 'junk food' sign of the new millennium!

ikod

[iko]

Surfing on GoogleImages I couldn't find anything better than this for you...

 

http://phoenity.com/diseases/images/scurvy_gingival_hemorrhage.jpg
http://home.caregroup.org/clinical/altmed/interactions/Images/Nutrients/VitC.gif

from a short 'disease info':  http://phoenity.com/diseases/scurvy.html

[Bored chemist]

Interesting iea, say we teach all our doctors to look out for this and (at least here in the UK) that can all prescribe free vitamin C to anyone showing this reddening of the gums.
That means that the only observable effect of the disease will be this red colour. Does that mean that the red colour is a clinical sign of vitamin C deficiency and, if so, does it stop being sub- clinical.
My point is that if you can see a sign or symptom then I don't think you have a sub-clinical condition any more. Once you can spot it I think it's clinical. I accept that analysis of the blood might reveal relatively low ascorbate levels well before there were observable symptoms.
Hardlt an important point, just a matter of definition.

Oh, and incidentally,
"What could we expect in a child who had been eating for several weeks only pasta/chips and no fruit and veggies?"
I'd expect them to have overweight parents, but I don't think that's a symptom. :-)

[iko]

That means that the only observable effect of the disease will be this red colour. Does that mean that the red colour is a clinical sign of vitamin C deficiency and, if so, does it stop being sub- clinical.
My point is that if you can see a sign or symptom then I don't think you have a sub-clinical condition any more. Once you can spot it I think it's clinical. I accept that analysis of the blood might reveal relatively low ascorbate levels well before there were observable symptoms.
Hardlt an important point, just a matter of definition.

You are right B.C.
(you don't sound so much bored!)

Subclinical scurvy should be low AAlevels and no signs or symptoms.
Assuming that red gums in a particular area could come much before
and last for long, if the diet is just poor of vitamin C...
Well...there is so much to be studied and confirmed still!
But you are right: it's not subclinical if you see a sign...clinically.  [)]
Take care

ikod

[VitaminC]

Subclinical scurvy should be low AA levels and no signs or symptoms.
Assuming that red gums in a particular area could come much before
and last for long, if the diet is just poor of vitamin C...
Well...there is so much to be studied and confirmed still!

I was simply saying that ascorbic acid deficiency is not routinely tested for (how many physicians actually check for plasma ascorbate status?) and that the symptoms of its deficiency are too non-specific not to be other problems. Even gum problems can occur in those that have 'sufficient' vitamin C in the diet - there is nothing specific to vitamin C.... except actual blood tests.

[iko]

Hi VitaminC,

we should have AAplasma levels in our laboratory routine.
Actually this test is based on a cheap and simple chemical reaction estabilished in 1941.
Its use has been sort of abandoned, due to lack of scorbutic patients...and interest.
In my personal opinion, the area between florid scurvy and mild deficiency in concurrent diseases still needs further investigation.
BTW did you know that Ascorbic acid in cerebral spinal fluid is 3-4 times more concentrated than in peripheral blood (plasma)?
This cofactor should really do something important in our brain, to be 'pumped' so efficiently across the blood brain barrier!  []

ikod

[iko]

I found this article and hypothesis
about human brain evolution quite
interesting, a bit too much ascorbate-
-centered you'll probably think...

This thread deserves such a link:

http://www4.dr-rath-foundation.org/THE_FOUNDATION/About_Dr_Matthias_Rath/publications/pub12.htm

http://www4.dr-rath-foundation.org/images/sc_pub/pub12_evofig2%5B1%5D.gif

" The discoveries presented in this publication open the opportunity to greatly improve human health in this generation and future generations of mankind"

...talking about modesty! []

ikod   [^]

[GBSB (OP)]

By any discussion about diagnosis and treatment of the scurvy it need to bear in mind that, “The main criteria for diagnosing scurvy are:

• A history of dietary inadequacy of vitamin C.

• Clinical manifestations characteristic of a scorbutic state (Tables 3 and 4).

• Biochemical indices, i.e. low levels of vitamin C in the blood (serum, white blood cells and whole blood) and a low urinary excretion rate.

The clinical picture of scurvy in children is quite different from that seen in adults” http://whqlibdoc.who.int/hq/1999/WHO_NHD_99.11.pdf

The clinical picture of scurvy in guinea pigs is quite different from that seen in humans.

For example if someone is affected by any negative health condition it is enough to detect low level of vitamin C and to be diagnosed with scurvy it shows how ridiculous is wisdom about vitamin C and illnesses because any known negative health condition can be named as scurvy.

Another example “Babies of mothers who took extremely high doses of vitamin C during pregnancy can develop infantile scurvy.” http://www.becomenatural.com/blog/2006/12/scurvy-former-terror-of-the-seas/

Again in this case the scurvy is diagnosed by detection of low level of vitamin C in the body.

In reality the intake of extremely high dose of vitamin C is damaging mother’s health and negative health condition by baby is caused and in same time is reflection of negative health condition by mother that is caused by intace of high dose of vitamin C.

Question is it any dose of vitamin C necessary or is just snake oil that doesn’t have any beneficiary effect but in most case damaging peoples health.

It needs to bear in mind that vitamin C is just one millions other molecules that human’s body contain.


I start this topic with intention to explain that events that lead to establish the role between vitamin C and scurvy is “The Scurvy, the Vitamin C and the blasphemy” are littered with quackery and need to be re-examined.

If scurvy didn’t have disappeared from sea thanks to lime juice than plenty of present wisdom about causes and treatment of illnesses will be re-examined.

On this point the discussion about current wisdom about diagnosis and treatment doesn’t make productive discussion but flooding the tread.


Back to the subject (The scurvy, The vitamin C and the blasphemy)

In 1867 it was made mandatory for all ships in both the Royal Navy and British Merchant Navy to include lime juice in the sailors' daily rations to prevent scurvy.

In everyone’s mind is that is what saves sailors from the scurvy. But on the other side there isn’t reported any outbreak of the scurvy.
Only the British sailors where obligate to drink lime juice but in the other navy sailors wasn’t.

If drinking the lime juice has protected the British sailors from the scurvy, than question is why sailors from other navies didn’t experience any outbreak of the scurvy?

It means that drinking the lime juice to ward scurvy was meaningless, because scurvy already disappeared long time ago from the sailor’s life.
Claim that drinking the lime juice will prevent scurvy sounds unfounded.

Anyway it will be constructive if anyone can point on the evidence that show any outbreak of the scurvy on the sea after year 1850. 

   

Luka Tunjic

http://www1.biomechanicsandhealth.com/

[Bored chemist]

"It needs to bear in mind that vitamin C is just one millions other molecules that human’s body contain. "
Yes, it happens to be the molecule that cures scurvy. Also, it's the molecule known to be responsible for the production of hydroxyproline which is needed to make connective tissue; this is lacking in scurvy.

"If scurvy didn't have disappeared from sea thanks to lime juice than plenty of present wisdom about causes and treatment of illnesses will be re-examined. "
True but irrelevant. Scurvy did disappear when better food,not least citrus juices, were introduced.
It took a little longer to realise that the stuff had to be kept properly.


"If drinking the lime juice has protected the British sailors from the scurvy, than question is why sailors from other navies didn't experience any outbreak of the scurvy?"
They did get scurvy, and if they hadn't we might not have one some of our more famous naval battles.


"Only the British sailors where obligate to drink lime juice but in the other navy sailors wasn't."

Bastards that we were, we wanted to keep winning so we didn't give away the secret.

"Claim that drinking the lime juice will prevent scurvy sounds unfounded."
I don't agree; it seems perfectly well founded to me both empirically (it worked) and on the basis of the well documented biochemistry.

"Anyway it will be constructive if anyone can point on the evidence that show any outbreak of the scurvy on the sea after year 1850.  "
True, because it will destroy your idea that it was some physical effect of being at sea. The sea hasn't changed since 1850.

[iko]

Hi VitaminC,

we should have AAplasma levels in our laboratory routine.
Actually this test is based on a cheap and simple chemical reaction estabilished in 1941.
Its use has been sort of abandoned, due to lack of scorbutic patients...and interest.
In my personal opinion, the area between florid scurvy and mild deficiency in concurrent diseases still needs further investigation.
BTW did you know that Ascorbic acid in cerebral spinal fluid is 3-4 times more concentrated than in peripheral blood (plasma)?
This cofactor should really do something important in our brain, to be 'pumped' so efficiently across the blood brain barrier!  []

ikod

Now let's be serious for a while again...
Does anybody know what is concentrated ascorbic acid doing in our brains?
Even more concentrated in preterm babies and newborns?
It is an old finding, still a mystery to me!

ikod   []

[iko]

Hi VitaminC,

we should have AAplasma levels in our laboratory routine.
Actually this test is based on a cheap and simple chemical reaction estabilished in 1941.
Its use has been sort of abandoned, due to lack of scorbutic patients...and interest.
In my personal opinion, the area between florid scurvy and mild deficiency in concurrent diseases still needs further investigation.
BTW did you know that Ascorbic acid in cerebral spinal fluid is 3-4 times more concentrated than in peripheral blood (plasma)?
This cofactor should really do something important in our brain, to be 'pumped' so efficiently across the blood brain barrier!  []

ikod

Now let's be serious for a while again...
Does anybody know what is concentrated ascorbic acid doing in our brains?
Even more concentrated in preterm babies and newborns?
It is an old finding, still a mystery to me!

ikod   []

...and even in various 'ocular compartments'
ascorbic acid is concentrated 20 folds in respect to plasma!

http://www.iovs.org/cgi/reprint/32/8/2266.pdf

To protect from ultraviolet rays oxidizing effects?
Isn't this just fascinating...

http://www.bmchan.com/retail/spa/pic.jpg

[GBSB (OP)]

Linus Pauling and vitamin C

(The physical damage to people he (Linus Pauling) led astray cannot be measured.)

A flyer distributed in 1991 by the Linus Pauling Institute recommended daily doses of 6,000 to 18,000 mg of vitamin C, 400 to 1,600 IU of vitamin E, and 25,000 IU of vitamin A, plus various other vitamins and minerals. These dosages have no proven benefit and can cause troublesome side effects.

Although Pauling's megavitamin claims lacked the evidence needed for acceptance by the scientific community, they have been accepted by large numbers of people who lack the scientific expertise to evaluate them.
 
Thanks largely to Pauling's prestige, annual vitamin C sales in the United States have been in the hundreds of millions of dollars for many years.
The physical damage to people he led astray cannot be measured. http://www.quackwatch.com/01QuackeryRelatedTopics/pauling.html

The fear from illnesses, diseases and premature death make humans highly vulnerable to quackery. Before any discussion about miracle healing property of vitamin C it is useful to confront with some fact about recently claims about healing property of vitamin C.
 

Luka Tunjic
http://www1.biomechanicsandhealth.com/

[Bored chemist]

Linus Pauling was just plain wrong about vitamin C. Those repeating his claims abouyt it curing cancer are also wrong; if they are doing it to make a fast buck then they are frauds and should be prosecuted as such.
It is true that people's fear of illness can lead to all sorts of odd behaviour (personally I think prayer is one of the oddest things it can produce but that's another topic). Taking big vitamin C pills when you have a cold is relatively harmless and the placebo effect may well make the overall effect on humanity beneficial.

The oposite of this quackery is science; for example the science shows that adequate levels of vitamin C are required to prevent scurvy (science really shows this whether you like it or not).
It also shows that excessive consumption is at best a waste of money, and in extreme cases harmful.

That's a really good reason for singing the praises of science; not for talking nonsense about established biochemistry.

[iko]

http://www.minerva.unito.it/Theatrum%20Chemicum/R1/paulingOld.jpg

Linus Pauling was just plain wrong about vitamin C. Those repeating his claims abouyt it curing cancer are also wrong; if they are doing it to make a fast buck then they are frauds and should be prosecuted as such.
It is true that people's fear of illness can lead to all sorts of odd behaviour (personally I think prayer is one of the oddest things it can produce but that's another topic). Taking big vitamin C pills when you have a cold is relatively harmless and the placebo effect may well make the overall effect on humanity beneficial.

The oposite of this quackery is science; for example the science shows that adequate levels of vitamin C are required to prevent scurvy (science really shows this whether you like it or not).
It also shows that excessive consumption is at best a waste of money, and in extreme cases harmful.

That's a really good reason for singing the praises of science; not for talking nonsense about established biochemistry.

I feel too ignorant to agree with you about Linus Pauling.
I respect and admire scientists who studied their beloved biochemistry in the past century, especially those who managed to get 2 (two) Nobel prizes in a row.
There is something missing about vitamin C and cancer.
Obviously there is no cure in taking lots of ascorbic acid just like that.
If you study carefully what has been done in the past, well, Cameron et al. claimed  positive results in a few patients with lymphosarcoma. Nobody published negative results later on, then -I think in '85- a negative report was published, concerning colon cancer patients...
I mean, to disprove those theories they chose just one disease, the most resistant to any drug treatment, one that is practically cured by early surgery only.  Is that so scientific?  I must say that the editorial commenting on those results was making this point clear.

I see a sort of attitude to disrespect this type of scientific issues.
Then we are ready to miss a diagnosis of scurvy in a malnourished child.
We can also diagnose 'multiorganfailure' a shoshin beriberi starving for weeks in ICU.
Neglected has been even a study showing that one third of leukemic children had low AA values compared to 3% in the normal population.  This may sound nothing to the most, certainly not to me.
After ages of ignorance, now we know that properly nourished leukemic kids do better through chemotherapy.  How clever we are.

There are ups and downs even for extremely smart scientists.
Maybe Pauling went too high in the recent past...he will rise again.


ikod   [^]

 

[iko]

...Some ICU operators started giving i.v. vitamin C to severely burned patients.
This recent experimental (poor sheep!) report actually supports previous clinical 'evidence':

High-dose vitamin C infusion reduces fluid requirements in the resuscitation of burn-injured sheep.

Shock. 2005 Aug;24(2):139-44.
Dubick MA, Williams C, Elgjo GI, Kramer GC.
U.S. Army Institute of Surgical Research, San Antonio, Texas 78234-6315, USA. Michael.Dubick@amedd.army.mil

Fluid resuscitation to maintain adequate tissue perfusion while reducing edema in the severely burned patient remains a challenge. Recent studies suggest that reactive oxygen species generated by thermal injury are involved in edema formation associated with burn. The present study tested the hypothesis that adding a free radical scavenger to the resuscitation fluid would reduce total fluid requirements in the treatment of severe thermal injury. Anesthetized chronically instrumented sheep received a 40% total body surface area full-thickness flame burn. At 1 h after injury, animals were resuscitated with lactated Ringer's (LR, n = 14) as control, LR containing high doses of vitamin C (VC, n = 6), 1000 mOsM hypertonic saline (HS, n = 7), or 1000 HS containing VC (HS/VC, n = 7) in coded bags so that investigators were blinded to the treatment. Fluids were infused at an initial Parkland rate of 10 mL/kg/h, adjusted hourly to restore and maintain urine output at 1 to 2 mL/kg/h. Sheep in the VC or HS/VC group received 250 mg/kg VC in the first 500 mL of LR or HS, and then 15 mg/kg/h thereafter. Hemodynamic variables and indices of antioxidant status were measured. At 48 h postburn, sheep were euthanized, and heart, liver, lung, skeletal muscle, and ileum were evaluated for antioxidant status. All fluid resuscitation regimens were equally effective in restoring cardiac output to near baseline levels; no treatment effects were apparent on arterial pressure or heart rate. VC infusion significantly reduced fluid requirements and, therefore, net fluid balance (fluid in, urine out) by about 30% at 6 h and about 50% at 48 h in comparison with the LR group (P < 0.05). HS and HS/VC reduced fluid requirements by 30% and 65%, respectively, at 6 h, but the volume-sparing effect of HS was not observed after 36 h and that of HS/VC was lost after 12 h. Plasma total antioxidant potential increased about 25-fold (P < 0.05) at 2 and 3 h in response to VC infusion compared with the LR and HS groups, and remained about 5- to 10-fold higher throughout the rest of the study. VC infusion also prevented the 4-fold increase in plasma thiobarbituric acid reactive substances seen in the LR group early after burn (P < 0.05). Tissue antioxidant status was similar between groups. In this sheep burn model, continuous high-dose VC infusion reduced net fluid balance, reduced indices of plasma lipid peroxidation, and maintained overall antioxidant status in comparison with standard-of-care LR treatment.

[VitaminC]

Oops. I guess I took too long of a break from this forum. So much to reply to!

BTW did you know that Ascorbic acid in cerebral spinal fluid is 3-4 times more concentrated than in peripheral blood (plasma)?
This cofactor should really do something important in our brain, to be 'pumped' so efficiently across the blood brain barrier!  []

Certainly. If you read the work by Mark Levine and others with the knockout mice model of the vitamin C transporter SVCT2, you'll see the absolute importance of vitamin C in the brain and the CSF.... especially in newborns. SVCT2 is the only route by which vitamin C can enter the placenta.

http://www.nature.com/nm/journal/v8/n5/full/nm0502-514.html [nofollow]

I start this topic with intention to explain that events that lead to establish the role between vitamin C and scurvy is “The Scurvy, the Vitamin C and the blasphemy” are littered with quackery and need to be re-examined.

You need to understand what Scurvy is before you can really understand why vitamin C is liked to it. Scurvy is deficiency in several biosynthetic processes within the cell by which reduction/oxidation reactions in a metal-containing enzyme is necessary for full activity. Does this mean that vitamin C is absolutely necessary for enzymatic activity of these processes? No -- vitamin C is not an absolute requirement, but the enzymes cannot work at full capacity without vitamin C. The deficiency (in strict biochemical terms) is not in vitamin C itself, but in the enzymatic activities that vitamin C participates in. That is the true nature of scurvy.

But does this difference really matter? If you don't eat vitamin C, you will die. It's an absolute requirement for life. How we differentiate the disease versus the molecule that treats the disease is a question of semantics.

Also, I should point out in all your examples about vitamin C and lime juice -- lime juice did NOT cure scurvy in the British Navy, because the limes did not have as much vitamin C in them as lemons. Some sailors still developed the disease, just fewer than before.

Other navies had other methods for dealing with vitamin C loss. Tomatoes, potatoes, cabbage -- why do you think pickled cabbage was necessary for German Navy?! Scurvy prevention. It's been going on since the time of the vikings. All you need is fresh fruit and/or vegetables - citrus is NOT a requirement.

People still get scurvy today. Infants, children, adults, elderly. It just is more prevalent in children and the elderly. Adults, especially alcoholics - as was mentioned by Ikod - also suffer from vitamin C deficiency. Have you seen the vitamin C levels in dialysis patients? The wound healing is terrible for these people, and they still won't give them a glass of orange juice.

Does anybody know what is concentrated ascorbic acid doing in our brains?
Even more concentrated in preterm babies and newborns?
It is an old finding, still a mystery to me!

Protection, for the most part. But also don't forget vitamin C's role in neurotransmitter production.

Again, this is due to the role of SVCT2, which is also present in the eye.

Linus Pauling and vitamin C

(The physical damage to people he (Linus Pauling) led astray cannot be measured.)

Linus Pauling was not a quack - he dealt with the information that he had at the time. He was a very brilliant chemist... but he was NOT a biologist. He knew vitamin C was important, but he did not know everything about the vitamin. This is mainly because most of the important vitamin C research as been done in the last two decades. Pauling died in 1993, if I recall correctly, just as the field was getting some much deserved attention.

A flyer distributed in 1991 by the Linus Pauling Institute recommended daily doses of 6,000 to 18,000 mg of vitamin C, 400 to 1,600 IU of vitamin E, and 25,000 IU of vitamin A, plus various other vitamins and minerals. These dosages have no proven benefit and can cause troublesome side effects.

Vitamin C levels in these doses can have some side effects, but in most people they do no harm. However, if you bothered to notice, the vitamin C levels recommended by the Linus Pauling Institute are no longer this high:

http://lpi.oregonstate.edu [nofollow]

They have learned from the evidence that is around them, but that doesn't say that vitamin C levels of this level do nothing... read on, and I'll explain.

The fear from illnesses, diseases and premature death make humans highly vulnerable to quackery. Before any discussion about miracle healing property of vitamin C it is useful to confront with some fact about recently claims about healing property of vitamin C.

Certainly. Vitamin C cannot do everything. However, vitamin C can do a lot more than people are willing to give it credit for. I don't want to go into too much detail right now (this is already getting long) but vitamin C is gaining more and more roles as we learn more about it - and what regulated its level in the body! Pauling's hypotheses about vitamin C and cancer are finally getting some rigorous evidence to back it up:

http://www.cmaj.ca/cgi/content/abstract/174/7/937 [nofollow]

http://www.pnas.org/cgi/content/abstract/104/21/8749 [nofollow]

...Some ICU operators started giving i.v. vitamin C to severely burned patients.
This recent experimental (poor sheep!) report actually supports previous clinical 'evidence':

Yes, burn injury in sheep is a good model for humans. Vitamin E also seems to be very protective against systemic reactions to major burns. Many oxygen radicals being produced during these insults.

[iko]

Wow

Thank you so much whoever is hiding under VitaminC!
I had been drowning in nice cod liver oil in the last few years.
I must say I neglected ascorbic acid literature a bit:
this short update of yours is quite refreshing indeed.

ikod [^]

[iko]

 

http://lpi.oregonstate.edu/f-w03/images/Triplehelix.jpg
http://www.minerva.unito.it/Theatrum%20Chemicum/R1/paulingOld.jpg

There are ups and downs even for extremely smart scientists.
Maybe Pauling went too high in the recent past...he will rise again.


ikod   [^]

 

I couldn't really imagine his return happening right NOW!

Thanks again for your citations VitaminC:
I'll cross AA&ca on PubMed again...after long years of skepticism.

ikod   []

[daveshorts]

I know someone who gave himself scurvey by only eating packet food for about 6 months while sailing to Australia in an open boat. He got the classic symptoms, bleeding gums not repairing injuries. Luckily a doctor in the bush in NE Austrailia worked out the problem and put him on Vitamin C and it clear up in a week or two...

[Bored chemist]

Was he trying for a Darwin award? It's not as if a packet of multivitamins would have taken up a lot of space in the boat.