Lack of vitamin C increases the risk of osteoporosis – especially in patients with inflammatory bowel diseases

Vitamin C is important for bone density. A deficiency of the nutrient actually increases the risk of osteoporosis. Patients suffering from Crohn’s disease, ulcerative colitis, and other inflammatory bowel diseases often lack vitamin C and that adds even more to their risk. It is also a problem when normal, healthy people eat a vitamin C-deficient diet, and it becomes even more critical when people with chronic bowel diseases eat a diet with too little vitamin C. Vitamin C has a number of other functions in the body that are of importance to the immune system and the gut flora. Also, our genes for utilizing vitamin C play a role, according to a new study from Poznan University and Human Genetics Polish Academy of Sciences in Poland.

When it comes to bone health, the major focus is concentrated on calcium and vitamin D, but vitamin C – also known as ascorbic acid – should also be included. Vitamin C is a constituent of collagen in connective tissue that is important for the structure of bones, blood vessels, gums, and skin. Vitamin C is also important for macronutrient turnover, the nervous system, iron uptake, the immune defense and wound healing. Vitamin C even functions as an important antioxidant that protects cells and the cardiovascular system against oxidative stress caused by free radicals. Good sources of vitamin C include cabbage, broccoli, red bell pepper, citrus fruits, kiwi, berries, new potatoes, horse radish, spinach, garlic, and herbs. Just for the record, cooking or storing food reduces its vitamin C content.
In Denmark, the so-called daily reference intake level for vitamin C is 80 mg for adults. According to the new Polish study, other recommendations go up as high as 200 mg or more because they take into account the fact that only part of the vitamin C from food or supplements is absorbed in the body.
Most animals have the ability to synthesize their own vitamin C. In the case of infections or stress, their endogenous production can increase manyfold. Correspondingly, it is likely that we humans are able to absorb more vitamin C in situations where have increased need for the nutrient.
The final consequence of vitamin C deficiency is scurvy. It is also known that lack of vitamin C may result in fatigue, bruising, bleeding gums, iron deficiency, impaired immunity, and cardiovascular disease. The Polish scientists have looked at how lack of vitamin C can cause changes in the extracellular matrix of bones and in blood vessels and tendons, all of which contribute to fragile bones. The new study is published in the science journal Nutrients.

The link between vitamin C deficiency, inflammatory bowel disease, and osteoporosis

Scientists, when looking at children and adults with inflammatory bowel diseases, have observed that the diets often contain less fruit and vegetables, which are good sources of vitamin C. In addition, these patients are more likely to become vitamin C-deficient because both their disease and the local inflammation impair the body’s nutrient uptake. It has been shown that patients with inflammatory bowel disease have lower levels of vitamin C in their blood than healthy individuals. This is a problem because vitamin C counteracts oxidative stress and accompanying inflammation.
The lack of vitamin C may also impair bone density and increase the risk of osteoporosis. On the other hand, a meta-analysis has shown that higher intake of vitamin C is associated with increased bone density in the femoral neck and the lumbar vertebrae. Similarly, higher intake of vitamin C may lower the risk of osteoporosis by 33 percent, according to other studies.
As mentioned, the daily reference intake level for vitamin C is 80 mg in Denmark. According to the Food and Nutrition Board (FNB), the safe upper intake level for vitamin C is 2,000 mg. Although most people tolerate vitamin C rather well, excessive intake may cause loose stools, diarrhea, and nausea. A good way to avoid this is by taking a supplement with a vitamin C source that is non-acidic and therefore gentle towards the gastrointestinal mucosa.

Medical therapy for treating inflammatory bowel diseases harm the bones

Various types of medicine are used to treat inflammatory bowel diseases. Corticosteroids are commonly used but they can decrease bone density, damage the bone structure, and thereby increase the risk of osteoporosis and bone fractures. Other types of medicine are also associated with side effects but their direct impact on bone tissue remains unclear.

Genetic background for lacking vitamin C

The body’s vitamin C supply depends on how much of the nutrient you get from the diet. The body’s ability to absorb and utilize the nutrient, however, is also a determining factor. This may hinge on factors like genes, enzyme activities, and chronic diseases. In their new article, the Polish scientists look closer at those proteins that carry vitamin C to different tissues in the body, they look at various antioxidant enzymes, and the metabolic processes of vitamin C that take place in the liver and kidneys. If the ability to utilize vitamin C is poor it may increase a person’s need for the nutrient, but we need more research to fully understand this.

Vitamin C and its effect on gut flora and inflammation in the bowel

The microorganisms keep each other in check in a very delicate balance. This is vital because certain types of microorganisms can cause disease if their number is too high or if they spread to areas where they do not belong. There is increasing awareness of the gut flora and its impact o inflammatory bowel disease. It has been seen that imbalances in the body’s microorganisms can influence the grade of inflammation and the autoimmune processes where the immune system attacks the intestinal mucosa.
On the other hand, it turns out that increased vitamin C intake may reduce the number of E. Coli bacteria at the same time as stimulating the growth of beneficial lactic acid bacteria such as Lactobacillus and Bifidobacterium in the intestines. Vitamin C also has a positive influence on the gut flora in pre-diabetic patients.
Studies show that vitamin C helps limit the production of pro-inflammatory cytokines in the intestines. As mentioned earlier, vitamin C is a structural component of the collagen in connective tissue and that also goes for the connective tissue in the intestines. As an antioxidant, vitamin C helps protect the local tissue against oxidative stress.

Conclusion

The scientists behind the new Polish study conclude that vitamin C has numerous roles in the body. It is directly involved in the structure and function of cells and tissues, while it has an indirect role as an antioxidant and a regulator of genes. Vitamin C is vital for the structure of bone tissue and for preventing osteoporosis.
Vitamin C is of particular importance to patients suffering from inflammatory bowel diseases, as they have an increased need for the nutrient. Still, more research is needed to close in on the vitamin doses that can give the best results.

References:

Alicja Eea Rataczak et al. Vitamin C Deficiency and the Risk of Osteoporosis in Patients with an Inflammatory Bowel Disease. Nutrients 2020

Johns Hopkins Medicine. Calcium supplements may damage the heart. ScienceDaily. 2016

Andrea Rosanoff et al. Essential Nutrient Interactions: Does Low or Suboptimal Magnesium Interact with Vitamin D and/or Calcium status. Advances in Nutrition 2016

Hara Estroff Marano. The Cognitive Benefits of Vitamin C. Psychology Today 2018

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