T A B L E 3 8 -2
Metabolic Functions o f Ascorbate
A: As specific electron donor for enzymes and their
Three collagen hydroxylases
Two enzymes in carnitine
Carnitine is essential for
Necessary for the
Participates in tyrosine
Required for amidation
of peptide hormones
B: As potential chemical reductant and/or
antioxidant in nonenzymatic reactions.
Reaction or Function
Gastrointestinal iron absorption.
Oxidative DNA and/or protein damage.
Low-density lipoprotein oxidation.
Oxidants and nitrosamines in gastric juice.
Extracellular oxidants from neutrophils.
levels at values found in wild animals suggest that the
RDA is low by as much as an order of magnitude. This
discrepancy may arise from the use of a single criterion for
ascorbate repletion—prevention of scurvy—which may
not accurately reflect all the functions of ascorbate. For
example, it is not known whether enzymes that require
or are activated by ascorbate (see below) are fully active
in persons maintained on the RDA. The biological func-
tions requiring the greatest amount of ascorbate have to
be defined. The RDA for ascorbate intake of 60 mg/d is
currently under revision. Studies have suggested that an
ascorbate intake of
1 0 0 - 2 0 0
mg/d may be needed to pre-
vent adverse health effects due to vitamin C deficiency.
To maintain optimal health, the dietary guidelines encour-
age consumption of five servings of fruits and vegetables
Claims that consumption of massive doses of ascorbate
1 - 2
g/d or even higher quantities) can prevent or cure
common cold, cancer, or other ailments have no basis in
fact. Although ascorbate has low toxic effects, adverse
effects at high dose, such as hyperoxalemia (oxalate is a
catabolite of ascorbate) in patients undergoing dialysis, or
hemolysis in subjects with glucose-
genase deficiency, have been reported.
Major dietary sources of vitamin C are fresh, frozen, and
canned citrus fruits. Other fruits, leafygreen vegetables,
and tomatoes are important contributors to ascorbate
intake. Human milk contains 30-55 mg/L, depending on
maternal intake of vitamin C. Exposure to copper, iron,
and oxygen can destroy vitamin C by oxidation. The vita-
min is heat-labile, so excessive cooking will degrade it.
quently used as a food preservative, has one-twentieth the
biological activity of L-ascorbate.
Absorption of vitamin C from the small intestine is a
carrier-mediated process that requires sodium at the lu-
minal surface. Transport is most rapid in the ileum and
resembles the sodium-dependent transport of sugars and
amino acids, but the carrier is distinct for each class of
compound. Some ascorbate may also enter by simple dif-
fusion. With dietary intake less than 100 mg/d, efficiency
of absorption is 80-90%. With intake equal to the RDA,
plasma ascorbate is 0.7-1.2 mg/dL, and the ascorbate pool
size is 1500 mg. Scurvy becomes evident when the pool is
less than 300 mg, at which point plasma ascorbate is 0.13-
0.24 mg/dL. Highest tissue concentrations of ascorbate are
in the adrenal gland (cortex > medulla).
Most signs of scurvy can be related to inadequate or ab-
normal collagen synthesis. Ascorbate enhances prolyl and
lysyl hydroxylase activities (Chapter 25). Collagen formed
in scorbutic patents is low in hydroxyproline and poorly
cross-linked, resulting in skin lesions, bone fractures, and
rupture of capillaries and other blood vessels. The abso-
lute amount of collagen made in scorbutic animals may
also decrease independently of the hydroxylation defect.
The anemia of scurvy may result from a defect in iron
absorption or folate metabolism.
needed for the conversion of p-hydroxyphenylpyruvate to
homogentisate (Chapter 17), synthesis of norepinephrine
from dopamine (Chapter 32), and two reactions in
carnitine synthesis (Chapter 18). It is not known whether
decreased activity of these enzymes contributes to the
clinical characteristics of scurvy. Although ascorbic acid
is needed for maximal activity of these enzymes
, most show some activity when other reducing
agents are used.
38.3 Vitamin-Responsive Inherited
The vitamin requirements indicated by the RDA
resent the amounts needed for normal health by most
in the population.
'(See Table 38-1.)