Increase in RDA for Vitamin C Could Help Reduce Heart Disease, Stroke, Cancer

The recommended dietary allowance, or RDA, of vitamin C is less than half what it should be, scientists argue in a recent report, because medical experts insist on evaluating this natural, but critical nutrient in the same way they do pharmaceutical drugs and reach faulty conclusions as a result.

The researchers, in Critical Reviews in Food Science and Nutrition, say there’s compelling evidence that the RDA of vitamin C should be raised to 200 milligrams per day for adults, up from its current levels in the United States of 75 milligrams for women and 90 for men.

Rather than just prevent the vitamin C deficiency disease of scurvy, they say, it’s appropriate to seek optimum levels that will saturate cells and tissues, pose no risk, and may have significant effects on public health at almost no expense – about a penny a day if taken as a dietary supplement.

“It’s time to bring some common sense to this issue, look at the totality of the scientific evidence, and go beyond some clinical trials that are inherently flawed,” said Balz Frei, professor and director of the Linus Pauling Institute at Oregon State University, and one of the world’s leading experts on the role of vitamin C in optimum health.

“Significant numbers of people in the U.S. and around the world are deficient in vitamin C, and there’s growing evidence that more of this vitamin could help prevent chronic disease,” Frei said. “The way clinical researchers study micronutrients right now, with the same type of so-called ‘phase three randomized placebo-controlled trials’ used to test pharmaceutical drugs, almost ensures they will find no beneficial effect. We need to get past that.”

Unlike testing the safety or function of a prescription drug, the researchers said, such trials are ill suited to demonstrate the disease prevention capabilities of substances that are already present in the human body and required for normal metabolism. Some benefits of micronutrients in lowering chronic disease risk also show up only after many years or even decades of optimal consumption of vitamin C – a factor often not captured in shorter-term clinical studies.

A wider body of metabolic, pharmacokinetic, laboratory and demographic studies suggests just the opposite, that higher levels of vitamin C could help reduce the chronic diseases that today kill most people in the developed world – heart disease, stroke, cancer, and the underlying issues that lead to them, such as high blood pressure, chronic inflammation, poor immune response and atherosclerosis.

“We believe solid research shows the RDA should be increased,” Frei said. “And the benefit-to-risk ratio is very high. A 200 milligram intake of vitamin C on a daily basis poses absolutely no risk, but there is strong evidence it would provide multiple, substantial health benefits.”

An excellent diet with the recommended five to nine daily servings of fruits and raw or steam-cooked vegetables, together with a six-ounce glass of orange juice, could provide 200 milligrams of vitamin C a day. But most Americans and people around the world do not have an excellent diet.

Even at the current low RDAs, various studies in the U.S. and Canada have found that about a quarter to a third of people are marginally deficient in vitamin C, and up to 20 percent in some populations are severely deficient – including college students, who often have less-than-perfect diets. Smokers and older adults are also at significant risk.

Even marginal deficiency can lead to malaise, fatigue, and lethargy, researchers note. Healthier levels of vitamin C can enhance immune function, reduce inflammatory conditions such as atherosclerosis, and significantly lower blood pressure.

  • A recent analysis of 29 human studies concluded that daily supplements of 500 milligrams of vitamin C significantly reduced blood pressure, both systolic and diastolic. High blood pressure is a major risk factor for heart disease and stroke, and directly attributes to an estimated 400,000 deaths annually in the U.S.
  • A study in Europe of almost 20,000 men and women found that mortality from cardiovascular disease was 60 percent lower when comparing the blood plasma concentration of vitamin C in the highest 20 percent of people to the lowest 20 percent.
  • Another research effort found that men with the lowest serum vitamin C levels had a 62 percent higher risk of cancer-related death after a 12-16 year period, compared to those with the highest vitamin C levels.

Laboratory studies with animals – which may be more accurate than human studies because they can be done in controlled conditions and with animals of identical genetic makeup – can document reasons that could explain all of these findings, Frei said.

Critics have suggested that some of these differences are simply due to better overall diet, not vitamin C levels, but the scientists noted in this report that some health benefits correlate even more strongly to vitamin C plasma levels than fruit and vegetable consumption.

Scientists in France and Denmark collaborated on this report. Research at OSU on these issues has been supported by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health.



Frei B, Birlouez-Aragon I, Lykkesfeldt J. Authors’ Perspective: What is the Optimum Intake of Vitamin C in Humans? Crit Rev Food Sci Nutr 2012; 52 (9): 815-29.


Societal Control of Sugar Essential to Ease Public Health Burden

Robert H. Lustig, MD, and a team of the University of California, San Francisco (UCSF) researchers argue that sugar should be controlled like alcohol and tobacco to protect public health. In a new report, they maintain that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer. 



Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.

Robert Lustig, MD

In the Feb. 2 issue of NatureRobert Lustig, MD, Laura Schmidt, PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at UCSF, argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet, make it a primary culprit of this worldwide health crisis.

This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.

Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver – the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome — the key metabolic changes that lead to diabetes, heart disease and cancer — are not clinically obese.

“As long as the public thinks that sugar is just ‘empty calories,’ we have no chance in solving this,” said Lustig, a professor of pediatrics, in the division of endocrinology at the UCSF Benioff Children’s Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

“There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,” Lustig said. “But sugar is toxic beyond its calories.”

Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. “We recognize that there are cultural and celebratory aspects of sugar,” said Brindis, director of UCSF’s Philip R. Lee Institute for Health Policy Studies (IHPS). “Changing these patterns is very complicated.”

According to Brindis, effective interventions can’t rely solely on individual change, but instead on environmental and community-wide solutions, similar to what has occurred with alcohol and tobacco, that increase the likelihood of success.

Laura Schmidt, PhD, MSW, MPH

The authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar.

“There is an enormous gap between what we know from science and what we practice in reality,” said Schmidt, professor of health policy at UCSF’s IHPS and co-chair of UCSF’s Clinical and Translational Science Institute’s (CTSI) Community Engagement and Health Policy Program, which focuses on bridging academic research, health policy, and community practice to improve public health. In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level,” she said.

The paper was made possible with funding from UCSF’s CTSI, UCSF’s National Institutes of Health-funded program that helps accelerate clinical and translational research through interdisciplinary, interprofessional and transdisciplinary work.

Claire Brindis, DPH

Many of the interventions that have reduced alcohol and tobacco consumption can be models for addressing the sugar problem, such as levying special sales taxes, controlling access, and tightening licensing requirements on vending machines and snack bars that sell high sugar products in schools and workplaces.

“We’re not talking prohibition,” Schmidt said. “We’re not advocating a major imposition of the government into people’s lives. We’re talking about gentle ways to make sugar consumption slightly less convenient, thereby moving people away from the concentrated dose. What we want is to actually increase people’s choices by making foods that aren’t loaded with sugar comparatively easier and cheaper to get.”

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For more information, please visit

Photos by Susan Merrell



Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature 2012; 482 (7383): 27-9.


Is Sugar Toxic?

If you are what you eat, then what does it mean that the average American consumes 130 pounds of sugar a year? Dr. Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. Some physicians go so far as to call sugar a toxin (CBS News, 2012).


$29 Billion Reasons to Lie about Cholesterol

Millions of people around the world are currently taking medications to lower their cholesterol. In England alone, around 7 million people are taking cholesterol-lowering statins in the hope of reducing their risk of a heart attack. But an increasing number of doctors and researchers are questioning the supposed link between cholesterol and heart disease.

At the same time, many people are concerned about the mass prescription of medications. In particular, prescribing medications to people who are, for the most part, perfectly healthy.

A team is now working on a documentary about the cholesterol hypothesis.  The documentary will address several key issues: Have the facts about cholesterol and heart disease been distorted by pharmaceutical companies keen to increase their profits? Have our health authorities done their job to protect us from these commercial interests?

29 billion dollars is a conservative estimate of the current value of the cholesterol-lowering industry.

29 billion pounds is what cardiovascular disease costs the UK economy each year.

If the focus on cholesterol has been a mistake, then the greatest cost is associated with the lost opportunity to tackle heart disease.


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$29 Billion Reasons to Lie About Cholesterol29 Billion Reasons to Lie about Cholesterol provides the facts; enabling readers to make informed choices about the prevention of heart disease and diabetes.

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Two Vitamin C Tablets Every Day Could Save 200,000 American Lives Every Year

Ascorbate Supplementation Reduces Heart Failure

New research has reported that risk of heart failure decreases with increasing blood levels of vitamin C [1]. Persons with the lowest plasma levels of ascorbate had the highest risk of heart failure, and persons with the highest levels of vitamin C had the lowest risk of heart failure.

According to the US Centers for Disease Control (CDC) there are about 600,000 deaths from heart disease each year. [2] This is an enormous number. The definition of heart failure used by the study authors was on the basis of drugs prescribed, which would include all forms of heart disease that cause death. This agrees well with the CDC definition.

Specifically, the study found that each 20 micromole/liter (μmol/L) increase in plasma vitamin C was associated with a 9% reduction in death from heart failure. That works out to 54,000 fewer deaths from heart failure for each increase in 20 μmol/L plasma vitamin C. If everyone took high enough doses of vitamin C to reach the highest quartile (80 μmol/L), that would work out to approximately 216,000 fewer deaths per year. Just from taking vitamin C.

What is Heart Failure?

The heart muscle fails for many reasons. As we get older, it weakens and may not get enough nutrients to keep it healthy. A severe heart attack, that does not kill the patient but has caused significant damage to the heart muscle, may leave the heart in a very weakened state. Long standing or acute high blood pressure can put a massive strain on the heart and cause it to fail. An abnormal beating of the heart such as a very fast heart rate, an irregular beat or a lot of missed beats will result in a less effective pumping and eventual failure. Anemia will make the heart pump harder and faster in an attempt to deliver enough oxygen to the organs. The valves in the heart which direct blood flow are made up of an important fibrous strengthening tissue called collagen. Weakness or tearing of these valves can cause the blood to flow backwards, making the heart pump very inefficiently and eventually causing it to fail. When the heart muscle begins to fail, there is a buildup of carbon dioxide and waste products, resulting in weakening of the kidneys and liver. Eventually, fluid builds up in all the organs and the person presents with severe fatigue, shortness of breath (from fluid in the lungs) and swelling of the ankles.

Viruses and other microorganisms can attack the heart and weaken the heart muscle cells permanently by causing viral myocarditis. As the heart muscle cells get older they may require more energy to work and a greater level of protection from free radical damage. Nutrients such as magnesium, orotic acid, coenzyme Q10, acetyl L-Carnitine, and others may be required. Toxins, chemotherapeutic drugs, alcohol and deficiencies of some nutrients such as selenium may cause the heart to increase the size of its cells to compensate for the weakness. An enlargement of the heart muscle is called cardiomyopathy. These hearts are much more likely to fail.

Medical treatment of cardiac failure uses drugs that open the arteries, reduce blood pressure, and force the excessive fluid out of the body (diuretics). Drugs known as ACE Inhibitors improve quality of life and survival. Diet, fluid and salt restriction, and tolerable exercise are essential. For the most severe cases, a heart transplant may be required. However, many of these treatments have significant side effects. For example, treatment with diuretics to remove excess fluid will tend to lower the plasma vitamin C level and exacerbate the causes of cardiac failure.

How Much Vitamin C is Needed?

It takes less vitamin C than you may have thought. To achieve a plasma level of 80 μmol/L, and thereby reduce deaths by 216,000 per year, requires a daily dosage of about 500 mg of vitamin C. This is only one or two tablets per day, costing less than ten cents.

3,000 to 8,000 mg/day, in continued divided doses, can achieve a plasma level twice as high (160 μmol/L). This much C could save an additional 216,000 lives as it is an additional 80 μmol/L, assuming the relationship holds.

We can go still higher, and without intravenous administration. 1,000 mg of oral vitamin C per hour for 12 hours (12,000 mg/day) will result in a plasma level of about 240 μmol/L. A single 5,000 milligram dose might take you to a peak of 240 μmol/L, but only for about 2-4 hours after the intake. That is why the dosage needs to be spread out: better absorption, gradual excretion, higher plasma levels . . . and better results.


Optimizing vitamin C intake optimizes the health of a person taking it. This includes persons with potentially life-threatening disorders. It is a simple, cheap, effective, and safe therapy. Vitamin C is no longer a “controversial” therapy. It is an ignored therapy. It is time for the medical profession to fully awaken to what this recent study confirms: higher vitamin C intakes mean less heart failure. That means that higher vitamin C intakes mean fewer deaths. 200,000 per year fewer.

With just two vitamin C tablets per day.

(Orthomolecular Medicine News Service, November 22, 2011)


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Low Vitamin C Levels May Raise Heart Failure Patients’ Risk



1. Pfister R, Sharp SJ, Luben R, Wareham NJ, Khaw KT. Plasma vitamin C predicts incident heart failure in men and women in European Prospective Investigation into Cancer and Nutrition-Norfolk prospective study. Am Heart J 2011; 162: 246-253.



Low Vitamin C Levels May Raise Heart Failure Patients’ Risk

Low levels of vitamin C were associated with higher levels of high sensitivity C-Reactive protein (hsCRP) and shorter intervals without major cardiac issues or death for heart failure patients, in research presented at the American Heart Association’s Scientific Sessions 2011.

Compared to those with high vitamin C intake from food, heart failure patients in the study who had low vitamin C intake were 2.4 times more likely to have higher levels of hsCRP, a marker for inflammation and a risk factor for heart disease.

The study is the first to demonstrate that low vitamin C intake is associated with worse outcomes for heart failure patients.

Study participants with low vitamin C intake and hsCRP over 3 milligrams per liter (mg/L) were also nearly twice as likely to die from cardiovascular disease within one year of follow-up.

“We found that adequate intake of vitamin C was associated with longer survival in patients with heart failure,” said Eun Kyeung Song, Ph.D., R.N., lead author of the study and assistant professor at the Department of Nursing, College of Medicine, in the University of Ulsan in Korea.

The average age among the 212 patients in the study was 61, and about one-third were women. Approximately 45 percent of the participants had moderate to severe heart failure.

Participants completed a four-day food diary verified by a registered dietitian and a software program calculated their vitamin C intake. Bloods tests measured hsCRP.

Researchers divided participants into one group with levels over 3 mg/L of hsCRP and another with lower levels. Patients were followed for one year to determine the length of time to their first visit to the emergency department due to cardiac problems or death.

Researchers found that 82 patients (39 percent) had inadequate vitamin C intake, according to criteria set by the Institute of Medicine. These criteria allowed the researchers to estimate the likelihood that the patient’s diet was habitually deficient in vitamin C based on a four day food diary. After a year follow-up, 61 patients (29 percent) had cardiac events, which included an emergency department visit or hospitalization due to cardiac problems, or cardiac death.

The researchers found that 98 patients (46 percent) had hsCRP over 3 mg/L, according to Song.

Inflammatory pathways in heart failure patients may be why vitamin C deficiency contributed to poor health outcomes, the data suggests.

“Increased levels of high-sensitivity C-reactive protein means a worsening of heart failure,” Song said. “An adequate level of vitamin C is associated with lower levels of high-sensitivity C-reactive protein. This results in a longer cardiac event-free survival in patients.”

The use of diuretics may also play a role because vitamin C is water soluble and diuretics increase the amount of water excreted from the kidneys, said Terry Lennie, Ph.D., R.N., study author and associate dean of Ph.D. studies in the College of Nursing at the University of Kentucky in Lexington, Kentucky.

“Diet is the best source of vitamin C,” Lennie said. “Eating the recommended five servings of fruits and vegetables a day provides an adequate amount.”

More randomized controlled trials and longitudinal prospective studies are needed to determine the impact of other micronutrients on survival or rehospitalization, Song said.


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Two Vitamin C Tablets Every Day Could Save 200,000 American Lives Every Year


Your Heart Loves Vitamin C 

Dr. Benjamin Weeks explains in this video from 2008 how vitamin C impacts the heath of the cardiovascular system.


It’s Official — Chocolate Linked To Heart Health

Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis.

High levels of chocolate consumption might be associated with a one third reduction in the risk of developing heart disease, finds a study published on

The findings confirm results of existing studies that generally agree on a potential beneficial link between chocolate consumption and heart health. However, the authors stress that further studies are now needed to test whether chocolate actually causes this reduction or if it can be explained by some other unmeasured (confounding) factor.

The World Health Organisation predicts that by 2030, nearly 23.6 million people will die from heart disease. However, lifestyle and diet are key factors in preventing heart disease, says the paper.

A number of recent studies have shown that eating chocolate has a positive influence on human health due to its antioxidant and anti-inflammatory properties. This includes reducing blood pressure and improving insulin sensitivity (a stage in the development of diabetes).

However, the evidence about how eating chocolate affects your heart still remains unclear. So, Dr Oscar Franco and colleagues from the University of Cambridge carried out a large scale review of the existing evidence to evaluate the effects of eating chocolate on cardiovascular events like heart attack and stroke.

They analysed the results of seven studies, involving over 100,000 participants with and without existing heart disease. For each study, they compared the group with the highest chocolate consumption against the group with the lowest consumption. Differences in study design and quality were also taken into account to minimise bias.

Five studies reported a beneficial link between higher levels of chocolate consumption and the risk of cardiovascular events and they found that the “highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with lowest levels.” No significant reduction was found in relation to heart failure.

The studies did not differentiate between dark or milk chocolate and included consumption of chocolate bars, drinks, biscuits and desserts.

The authors say the findings need to be interpreted with caution, in particular because commercially available chocolate is very calorific (around 500 calories for every 100 grams) and eating too much of it could in itself lead to weight gain, risk of diabetes and heart disease.

However, they conclude that, given the health benefits of eating chocolate, initiatives to reduce the current fat and sugar content in most chocolate products should be explored.



Buitrago-Lopez A, Sanderson J, Johnson L, Warnakula S, Wood A, Di Angelantonio E, Franco OH. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; 343: d4488.


Fructose Consumption Increases Risk Factors for Heart Disease

Study suggests U.S. Dietary Guideline for Upper Limit of Sugar Consumption is too High:

A recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM) found that adults who consumed high fructose corn syrup for two weeks as 25 percent of their daily calorie requirement had increased blood levels of cholesterol and triglycerides, which have been shown to be indicators of increased risk for heart disease.

The American Heart Association recommends that people consume only five percent of calories as added sugar. The Dietary Guidelines for Americans 2010 suggest an upper limit of 25 percent or less of daily calories consumed as added sugar. To address this discrepancy in recommended consumption levels, researchers examined what happened when young overweight and normal weight adults consumed fructose, high fructose corn syrup or glucose at the 25 percent upper limit.

“While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting,” said the study’s senior author, Kimber Stanhope, PhD, of the University of California, Davis. “Our findings demonstrate that several factors associated with an elevated risk for cardiovascular disease were increased in individuals consuming 25 percent of their calories as fructose or high fructose corn syrup, but consumption of glucose did not have this effect.”

In this study, researchers examined 48 adults between the ages of 18 and 40 years and compared the effects of consuming 25 percent of one’s daily calorie requirement as glucose, fructose or high fructose corn syrup on risk factors for cardiovascular disease. They found that within two weeks, study participants consuming fructose or high fructose corn syrup, but not glucose, exhibited increased concentrations of LDL cholesterol, triglycerides and apolipoprotein-B (a protein which can lead to plaques that cause vascular disease).

“These results suggest that consumption of sugar may promote heart disease,” said Stanhope. “Additionally our findings provide evidence that the upper limit of 25 percent of daily calories consumed as added sugar as suggested by The Dietary Guidelines for American 2010 may need to be re-evaluated.”

Also working on the study were: Andrew Bremer, Guoxia Chen, Tak Hou Fong, Vivien Lee, Roseanne Menorca, Valentia Medici, Peter Havel and Nancy Keim of the University of California, Davis; Katsuyuki Nakajima and Takamitsu Nakano of Otsuka Pharmaceutical Co. in Tokyo, Japan; and Yasuki Ito of Denka Seiken Co. in Tokyo, Japan.

The article, “Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women,” appears in the October 2011 issue of JCEM.