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Vitamin C For Runners

Revision as of 14:01, 30 December 2019 by User:Fellrnr (User talk:Fellrnr | contribs)

Revision as of 14:01, 30 December 2019 by User:Fellrnr (User talk:Fellrnr | contribs)

Vitamin C may be an important supplement for runners. A runner's quads lengthen to slow their body's descent on landing, a type of eccentric exercise. This eccentric stress not only causes Delayed Onset Muscle Soreness (DOMS), but it also causes immediate weakness. If you've ever had problems descending stairs after a marathon, you've had DOMS. The good news is that experiencing DOMS provides a protection from future bouts, something known as the Repeated Bout Effect (RBE), which is where Vitamin C comes in. As well as being an antioxidant, Vitamin C is important in may other ways, including the production of the scaffolding that makes up muscles (collagen.) There is some evidence that Vitamin C may help with the RBE, and without sufficient Vitamin C, the ability to adapt to long runs may be impaired. While Vitamin C has been shown to interfere with the way people adapt to exercise at a biochemical level, that doesn't appear to translate into practical problems. If you take Vitamin C as a supplement, it's best to take it spread evenly through the day rather than a single larger dose.

Contents

1 The Role of Vitamin C

Vitamin C is best known for its role as an antioxidant. However, it's not only an antioxidant, but it's also cofactor for 15 different enzymes[1], including the production of norepinephrine[2], carnitine[3], and collagen[4]. It also enhances non-heme iron absorption[5]. Increased Vitamin C may also boost the amount of Collagen synthesized[6][7]. This is especially valuable for runners, as collagen is a key structural protein, including muscle fibers[8] and tendons[9]. Even within the role as an antioxidant there is the possibility that different antioxidants may fulfill different roles. For instance, there is evidence that Vitamin C depleted plasma is susceptible to fat (lipid) oxidation, even when other anti-oxidants are present[10]. Personally, I suspect that these various roles may result in differing actions of vitamins C in differing circumstances. Vitamin C is concentrated in nearly all cells in the body above plasma levels, such as the brain with 16-18x and muscle with 4-6x, though It's unclear why many tissues concentrate Vitamin C levels well beyond the level needed for the enzymatic actions, sometimes 10-100x higher[11]. There is evidence from animal models that the Vitamin C needs may vary widely, possibly due to genetic differences[12]. This has been seen in humans, where there is wide variation in susceptibility to scurvy amongst sailors[12].

2 Vitamin C Requirements

The recommended intake for vitamins C is focused on preventing deficiency problems, primarily scurvy[13]. Vitamin C deficiency (scurvy) results in lassitude (fatigue), coiled hair, gum problems, anemia, hemorrhages, tooth loss and other problems[11]. Sometimes the only symptom of vitamins C deficiency is lassitude, even when plasma levels are below 8 uM[14]. Most animals can produce their own Vitamin C, except for humans and other primates, Guinea pigs, fruit bats, and some birds and fish[11]. The optimum dose of Vitamin C for runners is unclear based on the available research.

3 Vitamin C Intakes

Vitamin C is absorbed in the small intestine, reaching peak plasma levels in 2-3 hours, and then to extracellular fluids[11]. Over many days, the level of vitamin C in the plasma stabilizes, as shown below[14]]].

The fasting plasma Vitamin C levels of a subject given 60mg/day[14].

/ Varying doses increase the plasma levels with diminishing returns[14], giving a sigmoid (s) shaped curve. Plasma Vitamin C levels are well regulated, with even extreme oral doses (3g every 4 hours) results in peak levels of only 220 mmol/L[15][16] (note that IV Vitamin C produces vastly higher plasma levels.) /

The stable fasting plasma Vitamin C levels reached with varying doses[14]

The graphs above are from a single dose, with the measurement in the fasting state, but it's only at low doses of Vitamin C that peak and fasting levels are the same (i.e. 15 mg twice a day is 8.7 mmol/L) [11]. If you look at the graph below you can see that the time course of Vitamin C and the timing of the doses results in different areas under the curve[16]. Here you can see that while the higher doses of Vitamin C result in similar levels after 20+ hours, the levels following the doses are quite different and much higher for higher doses. Taking Vitamin C regularly though the day would result in higher average levels than a single dose. For instance, 1g/day of Vitamin C is sufficient to saturate fasting plasma levels, but levels may transiently raise higher (250+ mmol/L)[17].

Dose response over the course of a day to different doses of Vitamin C[16]

./ One study found that taking 60mg/day took ~3 weeks to reach stable plateau blood levels, and there were sharp change in blood levels up to 100mg, then far less change from 200mg up to 2,500mg[14].

4 Factors Influencing Vitamin C Needs

Both smoking and diabetes decrease Vitamin C plasma levels compared with controls, increasing intake needs[11]. Vitamin C can be reversibly or irreversibly oxidized, with irreversible oxidation consuming Vitamin C, resulting in an increased dietary need[11].

5 Distribution of Vitamin C

Vitamin C is regulated by controlling absorption in the intestine, and the balance of excretion/reabsorption in the kidney[18], as well as by recycling Vitamin C after it has functioned as an antioxidant[19]. Typically, humans only have about 1,500mg of Vitamin C in their body[20]. Because vitamin C is an anion at physiologic pH, it cannot simply diffuse across the cell membrane to extracellular fluid and must be actively transported[21], which results in different tissues having different concentrations as shown in the picture below[11]. While the level of vitamin C in skeletal muscle is lower than many other tissues[22], the size of the muscles suggests they main contain 66% of the body's vitamin C[23]. A study of Vitamin C from Kiwi fruit found for intakes between ~50-210mg/day, there was a strong correlation between plasma and muscle Vitamin C levels[24]. /

The distribution of Vitamin C at 100 mg/day[11].

6 Vitamin C, Exercise, and Aerobic Capacity

There is lots of evidence that Vitamin C changes how the human body responds to exercise, but interpreting the evidence is not straightforward. Many of the studies have found changes in enzyme levels after exercise with Vitamin C compared with placebos, but don't measure exercise outcomes such as V̇O2max[25]. I've mostly ignored these studies as they may not reflect real world impacts. In fact, one study of 54 recreationally endurance-trained individuals taking either 100mg Vitamin C plus 235 mg Vitamin E or a placebo found that cellular adaptation to exercise was hampered by the supplements, but no changes in V̇O2max or running performance[26]. I've included the studies I've found where the outcomes are measured in real world terms for aerobic capacity (primarily V̇O2max.)

  • There's strong evidence that Vitamin C deficiency results in impaired exercise ability[27][28][29]. The remainder of the studies in this section will look at Vitamin C supplementation at doses beyond those needed for the prevention of clinical deficiency.
  • Many studies do not have controls with standardized Vitamin C levels, and at low intake levels small changes in intake make a large difference in plasma levels. Interventions should have controls with low intakes of Vitamin C, as some studies have used controls where the plasma levels of Vitamin C are already near saturation[11]. For instance, in one study the Vitamin C treated group had similar plasma levels to the placebo group, rendering the identical results between the groups a bit meaningless[30] (at least they measured.)
  • 15 amateur athletes split between placebo and 90 days of 500mg Vitamin E, 30mg beta-carotene, and then 1,000mg Vitamin C for the last 15 days[31]. There was no measurement of the Vitamin C status in the subjects. The V̇O2max was 57 for the placebo group and 60 for the supplemented. The increase in V̇O2max was not significant for either group, but workload at 4 mmol/L of Lactate was higher in the supplemented group than the placebo (but not at 2 mmol/L). I found this interesting, but inconclusive given the issues of measuring Lactate, and I'd interpret this as showing no impact of Vitamin C on fitness.
  • Of 14 Sedentary men (V̇O2max < 43), 5 were given 1g/day of Vitamin C while 9 acted as controls[32]. All underwent 8 weeks of training, 3 days/week for 40 minutes, ramping up from 65% to 80% of V̇O2max. There were no statistically different changes in V̇O2max, though the average improvement was 22% in the placebo and 10.8% in the supplemented group, mostly due to the lower initial V̇O2max in the placebo group. With such a small group, it's possible that a larger study would reveal differences or that the differences would disappear. Interestingly, they also studied rats and found that Vitamin C dramatically reduced their endurance improvement, though again no significant differences in the rats' V̇O2max. (The levels of Vitamin C in the supplemented group were ~165 mmol/L and in the control group were ~45 mmol/L.)
  • A study that used "antioxidant rich foods" during altitude training found that V̇O2max increased in both treated and control groups equally, but hemoglobin concentration increased more in the treated group[33].
  • A study of 15 recreationally active men were given 1g/day of Vitamin C (n=8) or a placebo for 4 weeks of high intensity interval training, with no difference in improvement for V̇O2max, 10K time trial, or running economy[34].
  • 21 active men underwent cycling training 5 days/week for 12 weeks while 11 of them received 500mg Vitamin C and 400 IU of Vitamin E[30]. There was no statistical difference in improvement in V̇O2max, maximum power, workload at Lactate Threshold, or muscle Glycogen content.

7 Vitamin C, Exercise, and Muscular Resiliency

Unlike cycling or swimming, running involves eccentric muscular stress, with the muscles extending under load to absorb the body weight on landing[35][36], something that's exacerbated by downhill running[37]. This eccentric stress is one of the causes of muscle soreness after a marathon[38]. This damage causes Delayed Onset Muscle Soreness (DOMS), and it's particularly important to runners because while the soreness is delayed, there is muscular weakness that occurs during the damaging exercise[39]. This means the soreness you experience after a marathon involves muscular weakness during the race. There are various ways of reducing the muscle damage and treating the soreness from DOMS, but the most important is called "the repeated bout effect" (RBE). The principle of RBE is that performing exercise that causes DOMS and recovering then gives protection from similar exercise in the future[40]. There are a number of possible mechanisms behind RBE[41], including neural adaptations, changes in muscle fiber structure, changes in inflammatory response, and extracellular matrix structural remodeling. It's the extracellular matrix structural remodeling that's of interest here, as that remodeling involves collagen formation[42], and as noted above, Vitamin C is an important part in collagen formation[6][7]. There's one study that suggests that Vitamin C might be important for the Repeated Bout Effect[43] . This study used 1,000mg of Vitamin C and 400 IU Vitamin E per day on 22 moderately trained men and subjected them to two bouts of downhill running (40 min, -10%, 65-70% V̇O2max.) They found that the supplementation not only reduced DOMS after the first bout, but enhanced the RBE. Obviously, this is only one study, it used Vitamin E in addition to Vitamin C, and didn't measure strength deficits, but it's highly suggestive.

7.1 My Vitamin C Experiment

The research above mirrors my personal anecdotal experience. I've been taking Vitamin C in doses around 1g/day for many years as it seems to help my skin condition. I stopped taking Vitamin C for some months in 2018 due to the research suggesting it interferes with enzyme response to exercise. During that time without Vitamin C supplementation, I was also trying to ramp back up my Downhill Running via Treadmill Descents. I believe downhill running was a key component in my training for ultras, allowing me to race 100 miles with little muscle soreness the next day. Unfortunately, I found that 60-90 minutes of downhill running produced severe DOMS, and I couldn't get past that mark. I seemed to be stuck at that level and unable to make progress, where in previous years I'd been able to build up to marathon+ distance downhill runs. After a particularly disappointing all-day, self-supported run on Mount Mitchell in August I revisited the research on Vitamin C more comprehensively and found the study on Vitamin C and the Repeated Bout Effect. Having restarted my Vitamin C intake, and upped it to 500mg 3-5x per day, I found my ability to run downhill returned rapidly. I was able to built up to running marathon distance downhill runs at -10% within a few months, and only #1 on the DOMS scale. So for me at least, Vitamin C may be a critical component to endurance running.

7.2 Addition Eccentric Exercise Research

Sadly, most research on eccentric exercise has focused on preventing or treating causes Delayed Onset Muscle Soreness (DOMS), rather than maximizing the Repeated Bout Effect, or even limiting the immediate reduction on strength. For instance, a study showed that 3g/day of Vitamin C reduced DOMS, but not reduce muscular power[44].

8 Vitamin C and Tendons

A 2018 review of the research found that Vitamin C studies on animals improved tendon and bone healing, but that the human research at that point was limited[45]. One study found that 200 IU Vitamin E with 500 mg Vitamin C improved ACL healing (1-6 weeks) after ACL surgery, but the differences disappeared by 3 monthsCite error: Closing </ref> missing for <ref> tag [34] A. E. Koivisto, G. Paulsen, I. Paur, I. Garthe, E. Tønnessen, T. Raastad, N. E. Bastani, J. Hallén, R. Blomhoff, S. K. Bøhn, Antioxidant-rich foods and response to altitude training: A randomized controlled trial in elite endurance athletes, Scandinavian Journal of Medicine & Science in Sports, volume 28, issue 9, 2018, pages 1982–1995, ISSN 09057188, doi 10.1111/sms.13212</ref> [26][25][32][31][14][11][20][14][1][2][3][4][5][6][7][19][18][22][23][24][46][12][17][10][15][16][47][14][8][9][13][21][27][28][29][30][43][35][36][37][38][39][40][41][42][44][33][45][48]

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  33. ↑ 33.0 33.1 A. E. Koivisto, G. Paulsen, I. Paur, I. Garthe, E. Tønnessen, T. Raastad, N. E. Bastani, J. Hallén, R. Blomhoff, S. K. Bøhn, Antioxidant-rich foods and response to altitude training: A randomized controlled trial in elite endurance athletes, Scandinavian Journal of Medicine & Science in Sports, volume 28, issue 9, 2018, pages 1982–1995, ISSN 09057188, doi 10.1111/sms.13212
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  37. ↑ 37.0 37.1 R G Eston, J Mickleborough, V Baltzopoulos, Eccentric activation and muscle damage: biomechanical and physiological considerations during downhill running., British Journal of Sports Medicine, volume 29, issue 2, 1995, pages 89–94, ISSN 0306-3674, doi 10.1136/bjsm.29.2.89
  38. ↑ 38.0 38.1 H. Kyröläinen, T. Pullinen, R. Candau, J. Avela, P. Huttunen, P. V. Komi, Effects of marathon running on running economy and kinematics, European Journal of Applied Physiology, volume 82, issue 4, 2000, pages 297–304, ISSN 1439-6319, doi 10.1007/s004210000219
  39. ↑ 39.0 39.1 Vicky Marginson, Ann V. Rowlands, Nigel P. Gleeson, Roger G. Eston, Comparison of the symptoms of exercise-induced muscle damage after an initial and repeated bout of plyometric exercise in men and boys, Journal of Applied Physiology, volume 99, issue 3, 2005, pages 1174–1181, ISSN 8750-7587, doi 10.1152/japplphysiol.01193.2004
  40. ↑ 40.0 40.1 G. Howatson, K. Van Someren, T. Hortobágyi, Repeated Bout Effect after Maximal Eccentric Exercise, International Journal of Sports Medicine, volume 28, issue 7, 2007, pages 557–563, ISSN 0172-4622, doi 10.1055/s-2007-964866
  41. ↑ 41.0 41.1 Robert D. Hyldahl, Trevor C. Chen, Kazunori Nosaka, Mechanisms and Mediators of the Skeletal Muscle Repeated Bout Effect, Exercise and Sport Sciences Reviews, volume 45, issue 1, 2017, pages 24–33, ISSN 0091-6331, doi 10.1249/JES.0000000000000095
  42. ↑ 42.0 42.1 Ryo Takagi, Riki Ogasawara, Arata Tsutaki, Koichi Nakazato, Naokata Ishii, Regional adaptation of collagen in skeletal muscle to repeated bouts of strenuous eccentric exercise, Pflügers Archiv - European Journal of Physiology, volume 468, issue 9, 2016, pages 1565–1572, ISSN 0031-6768, doi 10.1007/s00424-016-1860-3
  43. ↑ 43.0 43.1 F. He, J. Hockemeyer, D. Sedlock, Does Combined Antioxidant Vitamin Supplementation Blunt Repeated Bout Effect?, International Journal of Sports Medicine, volume 36, issue 05, 2015, pages 407–413, ISSN 0172-4622, doi 10.1055/s-0034-1395630
  44. ↑ 44.0 44.1 S.C. Bryer, A.H. Goldfarb, Effect of High Dose Vitamin C Supplementation on Muscle Soreness, Damage, Function, and Oxidative Stress to Eccentric Exercise, International Journal of Sport Nutrition and Exercise Metabolism, volume 16, issue 3, 2006, pages 270–280, ISSN 1526-484X, doi 10.1123/ijsnem.16.3.270
  45. ↑ 45.0 45.1 Nicholas N. DePhillipo, Zachary S. Aman, Mitchell I. Kennedy, J.P. Begley, Gilbert Moatshe, Robert F. LaPrade, Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review, Orthopaedic Journal of Sports Medicine, volume 6, issue 10, 2018, pages 232596711880454, ISSN 2325-9671, doi 10.1177/2325967118804544
  46. ↑ Robert A. Jacob, Assessment of Human Vitamin C Status, The Journal of Nutrition, volume 120, issue suppl_11, 1990, pages 1480–1485, ISSN 0022-3166, doi 10.1093/jn/120.suppl_11.1480
  47. ↑ Harri Hemilä, Elizabeth Chalker, Vitamin C for preventing and treating the common cold, Cochrane Database of Systematic Reviews, 2013, ISSN 14651858, doi 10.1002/14651858.CD000980.pub4
  48. ↑ Tyler Barker, Scott W. Leonard, Janet Hansen, Roy H. Trawick, Ronda Ingram, Graham Burdett, Katherine M. Lebold, James A. Walker, Maret G. Traber, Vitamin E and C supplementation does not ameliorate muscle dysfunction after anterior cruciate ligament surgery, Free Radical Biology and Medicine, volume 47, issue 11, 2009, pages 1611–1618, ISSN 08915849, doi 10.1016/j.freeradbiomed.2009.09.010
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