Vitamin C, also known as ascorbic acid, is an essential vitamin best know for its antioxidant and strong anti-inflammatory action, immune system enhancing effects and especially wound healing benefits. A generous intake, whether from dietary sources or dietary supplements, can visibly accelerate the wound healing process. This is achieved by boosting collagen synthesis for proper skin regeneration and regulating inflammatory processes and white blood cell activities in view of tissue repair. As a result of its immune system modulating action, vitamin C further reduces susceptibility to wound infection with subsequent benefits for skin tissue repair.
How does vitamin C affect the body to help with faster wound healing? Vitamin C supports and optimizes wound healing processes via its antioxidant, anti-inflammatory and immune system modulating activities as well as through the fundamental role it plays in synthesizing collagen, the principal structure-giving protein in the body that imparts strength and elasticity to connective tissues, skin included. The vitamin is taken up by white blood cells (examples: mast cells, macrophages) and is present in tissues, organs and systems throughout the body, including skin cells, tendons, ligaments, cartilage, blood plasma and bone tissue.
Studies show one of the main factors negatively affecting wound healing is vitamin C deficiency. The average adult on a 2000 kcal diet was required to get at least 60 mg of vitamin C a day to prevent a deficiency and associated side effects. The recommended daily intake has recently been risen to 75 mg of vitamin C a day for women and 90 mg for men. Despite the increase in recommended intake, research shows that visible health effects of vitamin C may only be observed starting from 500 mg of a day and upwards, with the upper tolerable intake being 2 g of vitamin C a day.
A vitamin C deficiency is easily attainable, especially if there is no or poor access to fresh fruits and vegetables or supplementation. All of the below factors, either alone or combined, create the perfect setting for vitamin C deficiency:
1) Stress: Chronic, long-term stress, brought on by physical or mental illness or stressful life events.
2) Physical illness: Anything from the common cold or flu to cardiovascular disease or cancer can use up the body’s entire vitamin C reserves and increase requirements.
3) Mental illness: The stress associated with mental illness is believed to increase requirements of the vitamin and encourage a deficiency.
4) Medical events: surgery increases requirements and predisposes to deficiencies.
5) Insufficient intake, either from dietary sources (not eating enough fresh fruits and vegetables) or dietary supplements (not supplementing when needed).
6) Increased physical or mental effort. For example, taking up a physically demanding sport causes perspiration and dehydration, which require an increased water intake and cause a higher urine output (vitamin C is then eliminated through urine in higher amounts than usual). Studying for exams raises nutritional requirements for the vitamin.
7) Sleep deprivation: Not sleeping enough is a source of multiple vitamin and mineral deficiencies. The lack of sleep puts the body in overdrive and increase requirements of essential nutrients in order to maintain metabolic activities at optimal levels. This, in turn, causes a susceptibility to nutritional deficiencies.
8) Oxidative stress caused by pollution, smoking, sun radiation and other factors.
The stages of the wound healing process are:
1) Hemostasis: Stopping of bleeding by binding platelets or thrombocytes to form blood clots.
2) Inflammation: Caused by white blood cells infiltrating the site of the wound to clear out pathogens and prevent infection. Neutrophils eat bacteria or other pathogens. Monocytes turn into macrophages which also digest any existing pathogens. Lymphocytes provide NK cells, T cells and B cells.
3) Proliferation of cells in view of tissue regeneration: New skin cells form and differentiate as they rise to the surface to take the place of old, damaged skin cells. New blood vessels form. Collagen is synthesized to give strength and elasticity to the new skin tissue. This is done with the help of human growth factors.
4) In the remodeling phase, capillary growth finishes and the newly formed blood vessels regress to the point normal vascular density is achieved. Collagen is remodeled and realigned to provide structure to the new skin tissue.
What does vitamin C do to your skin to help it heal? There are several functions of the vitamin that contribute to a faster wound healing time and other skin benefits:
1) Collagen synthesis. One of the most important functions of vitamin C is its ability to stimulate the production of collagen, a protein that provides structure to connective tissues all over the body, including to skin. Its role in collagen synthesis and maturation makes it vital for proper wound healing, both in terms of physical structure and time. Studies suggest supplementing with the vitamin well above the recommended daily intake (old RDI: 60 mg, new RDI: 75 mg women, 90 mg men), meaning up to 3-4 g of vitamin C a day, accelerates wound healing, boosts collagen synthesis and improves collagen quality.
– Vitamin C and human wound healing. By Ringsdorf WM Jr, Cheraskin E.. Published in oooojournal.net. 1982 Mar; 53(3):231-6.
2) Anti-inflammatory effects. Although inflammation is needed during the first phases of the wound healing process, at a certain point during this process it has to subside in order to allow proper skin tissue regeneration and vascularization. Studies show the higher the blood plasma concentration of vitamin C, the lower the levels of C-reactive protein and other inflammatory markers.
3) Enhances the activity of immune system cells. The onset of inflammation is a sign of a healthy wound healing process. The very presence of vitamin C in white blood cells, the fact that it supports the production of antibodies, supports and enhances the activities of several different types of white blood cells (NK cells, B cells, T cells, neutrophils, macrophages) all contribute to the inflammatory phase of wound healing, an essential and fundamental stage of the process.
4) Counteracts oxidative stress and stimulates skin regeneration. Thanks to its strong antioxidant action, vitamin C counteracts oxidative stress and helps repair potentially mutagenic DNA. The vitamin stimulates skin tissue regeneration by supporting inactive skin cells divide and differentiate, contributing to the renewal of damaged skin tissue.
5) Antimicrobial action. Wounds can get infected at any stage during the healing process. A sufficient intake of vitamin C not only enhances the immune system response by supporting the activity and increasing the responsiveness of various white blood cells and antibodies, but also weakens bacterial cell membranes, making them more susceptible to the action of antibiotics. Mega-doses of the vitamin, 2 g a day for 2 weeks, significantly increased the bactericidal activity of white blood cells. Effects persisted for 4 weeks after discontinuing supplementation.
– Effect of mega doses of vitamin C on bactericidal activity of leukocytes. By Shilotri PG, Bhat KS. Published in the American Journal of Clinical Nutrition. 1977, Jul; 30(7): 1077-81.
6) Strengthens capillaries. A capillary is one of the smallest, finest types of blood vessel, an extension of larger blood vessels, one that vascularizes tissues and achieves exchanges of nutrients and waste material between blood and tissue fluids. An sufficiently generous intake of vitamin C strengthens capillary walls and prevents easy bruising and bleeding, with benefits for wound healing.
The vitamin C dose for wound healing starts at 500 mg a day, with the average upper tolerable intake currently being set at 2,000 mg a day. Some researchers believe the intake must be maintained for a minimum of 10 days consecutively, while others cite visible benefits from 6 months onward. Regular dietary supplements are extremely effective for most wound healing requirements, but topical vitamin C can further add to the benefits as it acts directly on the skin, providing extensive photoprotective benefits.
Some experts recommend dividing your intake over the course of the entire day to ensure a constant level of circulating blood plasma vitamin C. They propose a minimum of 200 mg of the vitamin per dose to maximize absorption for better wound healing potential and other benefits. Studies reveal that at a daily intake of 500 mg of vitamin C a day, blood plasma concentration reach an estimated 80 micromoles per liter, which is a desirable value for speeding the wound healing process. Side effects are not expected in healthy adults who do not exceed 2,000 mg a day.
Other vitamin recommendations for wound healing: Ascorbic acid is essential for wound healing, but not the only required nutrient. Vitamins A, D, E, zinc and varied phytochemicals with antioxidant activity all play a part in the process.
Since the nutrient cannot be produced by the human body and is required from diet, here the some of the best vitamin C sources:
1) Kakadu plum, camu camu, acerola cherry (extreme sources, between 1,500 mg-5,300 mg of the vitamin/100 g of fruit).
2) Sea buckthorn, rose hip, guava, blackcurrant, redcurrant, kiwifruit, papaya, strawberries, pineapple, cantaloupe, citrus fruit, mango, passion fruit.
3) Bell peppers, kale, broccoli, cauliflower, Brussels sprouts, spinach, cabbage.