Main Research Findings

1) Due to its antioxidative effects, supplementation with vitamin C facilitates a reduction in inflammatory response, myocardial injury, morbidity, and mortality in patients with sepsis.

2) Stimulation therapy with vitamin C has been shown to improve rehabilitation, immune system functioning, and nutritional status in patients who have had a stroke.

 

Selected Data

1) The research team of Jiang et al conducted a randomized controlled trial to investigate the effects of vitamin C supplementation in patients diagnosed with sepsis. The study was conducted over a two-year period and enrolled a total of 83 patients who were admitted to a single hospital. The patients were randomly assigned to one of two groups: the control group, consisting of 41 patients who received standard basic care for sepsis, and the study group, consisting of 42 patients who received vitamin C supplementation in addition to the same basic care. The study followed a randomized controlled design to reduce bias and ensure comparability between groups. All participants provided informed consent prior to enrollment, and the research protocol was reviewed and approved by the hospital’s ethics committee [1].

Patients eligible for the study had to meet several inclusion criteria. First, they were required to fulfill the established diagnostic criteria for sepsis, ensuring the enrolled population was homogenous regarding the primary disease under investigation. Second, participants needed to have completed their treatment entirely at the same hospital, allowing consistent management and follow-up conditions. Third, patients had to present an Acute Physiology and Chronic Health Evaluation II (APACHE II) score of 12 or higher, indicating that the study focused on individuals with moderate to severe disease severity.

To reduce confounding factors and improve the validity of results, patients were excluded based on multiple criteria. Those with preexisting cardiac conditions such as coronary heart disease were excluded to avoid complications related to cardiac comorbidities. Likewise, individuals with renal dysfunction, including chronic kidney disease, were omitted due to the potential impact on drug metabolism and outcome measures. Patients with immune system disorders or malignant hematological diseases like leukemia were also excluded to eliminate variability related to immune dysfunction or malignancy. Additionally, patients using long-term hormones or immunosuppressive drugs were excluded because these medications could alter inflammatory responses. Pregnant or lactating women and those who had taken vitamin C supplements within the month prior to study enrollment were also excluded to avoid influences on vitamin C baseline levels and to protect vulnerable populations [1].

Both study groups received standardized basic care according to current clinical guidelines for managing sepsis, ensuring that all patients were treated with evidence-based interventions. This standard care comprised multiple components including: empirical antibacterial therapy where all patients were initially treated with broad-spectrum antibiotics targeting likely infectious pathogens and adjusted based on microbiological culture results and the patient’s clinical progress; vasoactive drug administration for patients experiencing septic shock and in need of vasoactive medications to maintain adequate blood pressure and organ perfusion; mechanical ventilation for those requiring respiratory support; clinical management based on ICU guidelines on management of pain, agitation, and delirium and promoting optimal patient comfort and recovery; nutritional support providing early enteral nutrition through continuous feeding methods to support metabolic needs and maintain gut integrity; and deep vein thrombosis prophylaxis that was initiated as soon as the patient was stabilized, reducing the risk of thromboembolic complications [1].

The defining intervention in the study group was the administration of supplemental vitamin C. Patients in this group received intravenous infusions of vitamin C prepared as a 3-gram dose dissolved in 250 mL of 0.9% sodium chloride solution, administered once daily for three consecutive days. To maintain blinding and minimize placebo effects, the control group received an intravenous infusion with an equivalent volume of placebo solution, mirroring the vitamin C administration schedule but without the active vitamin component. This design feature strengthens the internal validity of the trial by controlling for the psychological and procedural impacts of receiving an infusion.

Several key clinical and biochemical indicators were measured before and after treatment to assess the effects of vitamin C supplementation including: SOFA Score for Organ Dysfunction used to evaluate organ dysfunction severity across six systems, respiratory, circulatory, coagulation, renal, central nervous system, and hepatic; inflammatory response indicators use to evaluate systemic inflammation, including tumor necrosis factor, high mobility group box 1 protein, and hypersensitive C-reactive protein (hs-CRP); myocardial injury markers including cardiac troponin I, creatine kinase isoenzyme MB, and B-type brain natriuretic peptide. Elevated levels of these markers indicate myocardial cell damage or stress and can predict cardiac complications during sepsis; and morbidity and mortality rates recorded for both groups, providing essential data on the real-world impact of vitamin C supplementation on patient survival and complication rates [1].

2) This study conducted by the research team of Wang et al aimed to evaluate the effectiveness of vitamin C stimulation in improving swallowing function, nutritional status, and immune function in stroke patients with dysphagia. The study involved 120 stroke patients diagnosed with dysphagia; these patients were randomly divided into two equal groups: a control group and a vitamin C stimulation group, with 60 patients in each. All participants completed the designated training regimen, and no statistically significant differences were found in the general baseline characteristics between the two groups, indicating successful randomization [2].

Patients were included in the study if they met the following criteria: they were diagnosed with stroke using imaging tools such as CT or MRI in accordance with the diagnostic criteria established by the national cerebrovascular disease academic conference; were confirmed to have swallowing dysfunction via the water swallow test or swallowing imaging studies; had experienced their first cerebral hemisphere stroke with disease duration under three months; had normal cognitive function and no history of mental illness; had stable vital signs and no severe organ dysfunction or pacemaker implantation; had water swallow test levels rated between 3 and 5; and had provided informed consent. Exclusion criteria included unstable vital signs, severe cognitive, visual, or auditory impairments, history of psychiatric illness, severe complications such as lung infection, myocardial infarction, gastrointestinal ulcers, or non-stroke-related dysphagia.

The control group received standard swallowing rehabilitation therapy. This therapy included a variety of approaches aimed at enhancing the strength and coordination of the oral and facial muscles responsible for swallowing. Training involved sensory and muscle strength stimulation targeting the lips, tongue, jaw, and soft palate. Indirect swallowing therapy involved using frozen wet cotton swabs to stimulate the soft palate and posterior pharyngeal wall, thus promoting the pharyngeal reflex. Additional techniques, such as glottal closure training through vocalization exercises, and ingestion practice using different swallowing postures including but not limited to empty swallowing, turning head swallowing, and nodding swallowing, were also employed. Patients were guided to chew and swallow carefully, ensuring the previous bite had been fully swallowed before the next. Foods of uniform density and appropriate viscosity were selected to minimize residue. This rehabilitation was performed once daily for 30 minutes over a two-week period by trained therapists who were blinded to group allocation [2].

The Vitamin C group received the same standard rehabilitation training, augmented with vitamin C stimulation. In this group, vitamin C delivered via 0.1 g tablet was applied to both sides of the tongue using a cotton swab twice daily. Patients were guided to perform a variety of swallowing actions including but not limited to empty, sideways, alternating, and nodding swallowing. Additional exercises included tongue massage and chewing muscle stimulation using the patients’ cleaned fingers dipped in vitamin C powder. These sessions were conducted five to six times per training period, lasting about 15 minutes each, over a two-week period. The added vitamin C was intended to stimulate the oral and orofacial muscles and enhance sensory feedback, thereby improving swallowing function.

To assess clinical efficacy, several evaluations were used. The water swallow test was conducted with patients consuming warm water at a temperature of 37–40°C under standardized conditions. Water swallow test results were categorized into five levels, from level I: normal swallowing without interruption or coughing; to level V: inability to drink due to frequent coughing. Treatment outcomes were rated as follows: “recovery” defined as reaching level I and resolving dysphagia, “effectual” defined as improving by at least two water swallow test levels but not reaching level I, “effective” defined as improvement by one water swallow test level, and “ineffective” defined as no change in water swallow test score [2].

Another major assessment tool used was the Video Fluoroscopic Swallowing Study Under X-ray fluoroscopy, patients were asked to consume foods of different consistencies and quantities including: 2 ml nectar-like, 5 ml honey-like, and 10 ml pudding-like. Their swallowing was observed from frontal and lateral views. Video Fluoroscopic Swallowing Study scores ranged up to 10 points and were calculated based on three components: the oral stage, the pharyngeal stage, and aspiration. The oral stage was scored from 0 to 3, depending on the patient’s ability to form and move a food bolus. The pharyngeal stage was scored from 0 to 3, evaluating reflexes and residue after swallowing. The aspiration score ranged from 0 to 4, with higher scores reflecting better control and absence of aspiration [2].

In addition to swallowing assessments, the study also evaluated the patients’ nutritional status using several markers such as body mass index, serum albumin, total serum protein, and hemoglobin. Body mass index was calculated by dividing weight by height squared, with a normal range defined as 18.5–23.9. Blood samples were collected under fasting conditions before and after the intervention to measure the biochemical indicators using standard laboratory procedures [2].

 

Discussion

1) The study conducted by Jiang et al compared the effects of vitamin C supplementation with standard care in patients suffering from sepsis. The analysis focuses on several important clinical and biochemical outcomes, including demographic factors, organ dysfunction severity, inflammatory response indicators, myocardial injury markers, and morbidity and mortality rates.

The study initially examined the baseline demographic characteristics of both patient groups to ensure comparability. Age and gender, two critical demographic factors, were carefully analyzed. Statistical analysis revealed no significant differences between the vitamin C supplemented group and the control group in terms of these factors, indicating that the groups were well matched at baseline. This balance is essential for reducing confounding influences on the study outcomes and supports the validity of subsequent comparisons between the groups [1].

Organ dysfunction is a hallmark of sepsis severity, and it was assessed using the Sequential Organ Failure Assessment score, a well-established clinical tool. Both groups showed a reduction in scores following treatment, indicating an improvement in organ function. However, the reduction was significantly greater in the vitamin C supplemented group compared to the control group. This difference was observed across all six organ systems assessed by the SOFA score: respiratory, circulatory, coagulation, renal, central nervous system, and hepatic function. Importantly, no significant differences in SOFA scores were noted between groups before treatment, reinforcing that the observed improvements post-treatment were attributable to the intervention rather than baseline discrepancies [1].

The inflammatory response plays a central role in the pathophysiology of sepsis, and the study assessed three key inflammatory markers: hypersensitive C-reactive protein, tumor necrosis factor-α, and high mobility group box 1 protein. Before treatment, levels of these markers did not significantly differ between groups, confirming baseline equivalency. After treatment, both groups experienced decreases in inflammatory markers, but the reductions were significantly more pronounced in the vitamin C group.

This suggests that vitamin C supplementation can effectively attenuate the excessive inflammatory response characteristic of sepsis. The pathogenesis of sepsis involves a dysregulated inflammatory cascade that can escalate into a cytokine storm. This storm increases vascular endothelial permeability, promotes coagulation abnormalities, destabilizes hemodynamics, and elevates mortality risk. The anti-inflammatory effects of vitamin C may be attributed to its inhibition of nuclear factor-kappa B activation, a transcription factor integral to cytokine storm propagation. Vitamin C achieves this by preventing phosphorylation events that activates nuclear factor-kappa B, thereby reducing the production of pro-inflammatory cytokines such as Tumor necrosis factor-α. Additionally, vitamin C has inhibitory effects on late-stage inflammatory mediators, including HMGB1 and hs-CRP, further mitigating the inflammatory burden [1].

The study’s findings emphasize the multifaceted role of vitamin C in the management of sepsis, particularly through its anti-inflammatory and antioxidative properties. The ability of vitamin C to mitigate the severity of the inflammatory response is critical because an uncontrolled inflammatory cascade underlies much of the organ dysfunction and hemodynamic instability seen in sepsis. By inhibiting nuclear factor-kappa B activation and reducing pro-inflammatory cytokines, vitamin C helps prevent the cytokine storm that exacerbates tissue damage [1].

Moreover, the antioxidant capacity of vitamin C directly counters the oxidative stress responsible for myocardial injury and potentially other organ damage. By neutralizing oxygen free radicals, vitamin C protects cell membranes and organelles, limits apoptosis, and preserves cardiac function, as evidenced by the lower levels of myocardial injury biomarkers in the supplemented group. The reduction in SOFA scores in the vitamin C group also reflects improved overall organ function, further supporting the concept that vitamin C contributes to preventing or attenuating multi-organ failure in sepsis. This improvement translates into better clinical outcomes, including lower morbidity and mortality [1].

2) The research team of Wang et al conducted a study investigating the effects of vitamin C stimulation on stroke patients suffering from dysphagia. The study involved 120 participants, evenly split into a control group and a vitamin C stimulation group, and compared several key health parameters before and after a two-week intervention period.

At the beginning of the experiment, the researchers evaluated the baseline characteristics of participants, including gender, age, educational level, smoking status, presence of diabetes, and initial Water Swallow Test grade. These characteristics were comparable between the two groups, ensuring the validity of subsequent comparisons. The primary goal was to assess whether vitamin C stimulation, when added to conventional swallowing rehabilitation training, would yield additional benefits in the recovery of swallowing function, nutritional status, and immune health [2].

Swallowing function was assessed using two key measures: the water swallow test and the Video Fluoroscopic Swallowing Study. Both assessment tools demonstrated significant improvements in swallowing ability in both groups following the two-week intervention. However, improvements were more pronounced in the vitamin C group. In terms of water swallow test levels, both groups showed reductions, indicating better swallowing performance, but the decrease in water swall test level was greater in the vitamin C group. This suggests that vitamin C stimulation led to more significant restoration of swallowing function [2].

Similarly, the Video Fluoroscopic Swallowing Study scores, which reflect the physiological effectiveness and safety of swallowing as observed through X-ray imaging, also improved in both groups. The baseline Video Fluoroscopic Swallowing Study scores were similar for both groups. After the intervention, the control group’s average Video Fluoroscopic Swallowing Study score rose to 7.17 ± 1.59, while the vitamin C group improved more significantly, reaching an average of 8.08 ± 1.52. These data indicate that vitamin C stimulation enhanced the motor coordination and muscle function involved in swallowing to a greater extent than routine therapy alone.

Further analysis categorized the clinical efficacy of treatments into four outcomes based on water swallow test improvements: recovery defined as complete resolution of dysphagia, effectual defined as improvement by two water swallow test levels, effective defined as by improvement by one level, and ineffective defined as by no improvement. Results showed that the vitamin C group had a higher percentage of patients classified as recovered or effectual, while the proportions of effective and ineffective outcomes were lower compared to the control group [2].

Specifically, the recovery rate in the vitamin C group increased from 8.3% to 16.7%, and the rate of effectual improvement increased from 10% to 28.3%. Conversely, the rates for effective and ineffective outcomes decreased from 48.4% to 33.3% and from 33.3% to 21.7%, respectively. These findings confirm that while both interventions were beneficial, vitamin C stimulation led to a more substantial improvement in swallowing function. Importantly, the study found there was no significant difference in treatment efficacy between patients with ischemic and hemorrhagic strokes, suggesting that vitamin C stimulation could be effective across different types of stroke pathology [2].

Beyond swallowing function, the researchers examined the Nourishment State Index, which included several nutritional markers such as body mass index, serum hemoglobin, serum albumin, and serum total protein. Improvements in all these parameters were observed in both groups after treatment, reflecting general improvements in patients’ nutritional health. However, the vitamin C group demonstrated greater gains in each measure. For instance, body mass index increased more substantially in the vitamin C group, indicating better weight and nutritional restoration. Hemoglobin levels, which reflect oxygen-carrying capacity and overall nutritional status, also rose more significantly in this group. Similarly, improvements in serum albumin and total protein levels suggest enhanced protein synthesis and metabolic recovery, which are essential for tissue repair and immune function.

The researchers then turned their attention to immune function indices, including serum immunoglobulin levels, IgA, IgM, and IgG. These immunoglobulins are key components of the body’s immune defense system. Following the intervention, both groups showed elevated levels of all three immunoglobulins, indicating improved immune responses. Yet again, the improvements were more significant in the vitamin C group, implying that vitamin C stimulation not only facilitated physical rehabilitation but also enhanced systemic immunity. These results are consistent with the known antioxidant and immunomodulatory effects of vitamin C, which can support immune cell activity and reduce oxidative stress after a stroke [2].

 

Disclaimer

**LAB USE ONLY**
*This information is for educational purposes only and does not constitute medical advice. THE PRODUCTS DESCRIBED HEREIN ARE FOR RESEARCH USE ONLY. All clinical research must be conducted with oversight from the appropriate Institutional Review Board (IRB). All preclinical research must be conducted with oversight from the appropriate Institutional Animal Care and Use Committee (IACUC) following the guidelines of the Animal Welfare Act (AWA).

Citations

[1] Jiang N, Li N, Huang J, et al. Impact of Vitamin C on Inflammatory Response and Myocardial Injury in Sepsis Patients. Altern Ther Health Med. 2024;30(10):427-431.

[2] Wang J, Chang E, Jiang Y. Effects of vitamin C stimulation on rehabilitation of dysphagia after stroke: a randomized trial. Eur J Phys Rehabil Med. 2022;58(4):558-564. doi:10.23736/S1973-9087.22.07337-3

 

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