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{{DISPLAYTITLE:Vitamin C For Runners}}
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 probably best to take it spread evenly through the day rather than a single larger dose, and the dose should be built up slowly as it can cause stomach upsets and diarrhea. It's unclear to me if the research indicates there is an increased risk of kidney stones from Vitamin C.
=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<ref name="EnglardSeifter1986"/>, including the production of norepinephrine<ref name="LevineDhariwal1991"/>, carnitine<ref name="Rebouche1991b"/>, and collagen<ref name="ProckopKivirikko1995"/>. It also enhances non-heme iron absorption<ref name="HallbergBrune1987"/>. Increased Vitamin C may also boost the amount of Collagen synthesized<ref name="GeesinDarr1988"/><ref name="Sullivan Uschmann Hough Leboy pp. 22500–6"/>. This is especially valuable for runners, as collagen is a key structural protein, including muscle fibers<ref name="KovanenSuominen1984"/> and tendons<ref name="FranchiTrirè2007"/>. 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<ref name="FreiEngland1989"/>. 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<ref name="PadayattyLevine2016"/>. There is evidence from animal models that the Vitamin C needs may vary widely, possibly due to genetic differences<ref name="Yew1975"/>. This has been seen in humans, where there is wide variation in susceptibility to scurvy amongst sailors<ref name="Yew1975"/>.
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<ref name="BryerGoldfarb2006"/>.
=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<ref name="DePhillipoAman2018"/>. 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 months<ref name="BarkerLeonard2009"/>.
=Vitamin C, Running, and the Common Cold=
Controlled studies suggest that Vitamin C may reduce the length of the common cold, but not prevent the colds except in those undergoing severe exercise such as a marathon<ref name="HemiläChalker2013"/>.
=Vitamin C and Diabetes=
A full review of the research is outside the scope of this article, and further reading is encouraged. Recent reviews suggest that Vitamin C may help slow the progression of diabetes complications<ref name="AsmatAbad2016"/> as well as possibly reducing the risk of developing diabetes<ref name="WangZhou2016"/><ref name="RahimiNikfar2005"/>.
=Vitamin C and Kidney Stones=
There is conflicting evidence concerning Vitamin C and kidney stones, possibly because there are many things that change the risk for kidney stones. Personally, I feel that any risk for kidney stones from Vitamin C is offset by my physical activity, low body fat, good hydration, and high intakes of magnesium, potassium, and calcium. As always, read the research yourself and talk to your doctor if you have concerns.
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A metabolite of Vitamin C is oxalate that is excreted in urine<ref name="Hellman-1958 "/>, and calcium oxalate is a common type of kidney stone<ref name=" Scherer-2015"/>. Two studies found that 1,000mg of Vitamin C twice a day increased oxalate in the urine, a risk for kidney stones <ref name="MasseyLiebman2005"/><ref name="TraxerHuet2003"/>. However, two other studies found that 4g/day<ref name="AuerAuer1998"/> or 1, 5, 10g/day<ref name="WandzilakD'andre1994"/> didn't raise oxalate levels. One study found even found that 2g/day of Vitamin C as a supplement didn't change urine oxalate, but the same dose from Orange Juice did raise the urine oxalate<ref name="LiebmanChai1997"/>.
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Likewise, there are conflicting results from large scale prospective studies. A study of 48,850 men found that the risk of kidney stones was more than doubled with those that took more than 7 Vitamin C tablets per week<ref name="ThomasElinder2013"/>. The study doesn't have dosage information as it uses survey data that just ask for number of supplements taken. Another study of 45,619 men found that compared with those who consumed less than 90mg/day, 1+g/day had a 40% greater incidence of kidney stones, and even those that consume 90-249mg/day had 22% greater incidence<ref name="Taylor2004"/>. This relationship between Vitamin C and kidney stones only emerged after adjusting for potassium intake. Potassium intake is associated with Vitamin C intake, and the risk of kidney stones goes down with potassium intake, so the two tend to "even out". This reflects the general complexity of nutrition and kidney stones, where many dietary factors may impact kidney stone formation. The contrasts with a study of 45,251 men<ref name="CurhanWillett1996"/> that found no relationship between Vitamin C intake and the incidence of kidney stones. (A study of 85,557 women<ref name="Curhan1999"/> found no change in risk, but women seem to have a lower incidence of kidney stones.)
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Kidney stone risk may be associated with various nutritional factors, possibly including things that might reduce the risk, such as calcium, potassium, magnesium, fluid intake<ref name="Taylor2004"/>. Obesity may also increase the risk for kidney stones<ref name="CarboneAl Salhi2018"/>, with one estimate suggesting a 20% increase in risk for each 5 BMI and 12% for each 5Kg<ref name=" Aune2018"/>. Diabetes may increase risk of kidney stones, while physical exercise may reduce the risk<ref name=" Aune2018"/>.
=Vitamin C, Depression, and Anxiety=
There is some evidence that Vitamin C may be related to depression and anxiety. More details to follow.
=References=
<references>
<ref name=" Aune2018"> Aune, Dagfinn, et al. "Body fatness, diabetes, physical activity and risk of kidney stones: a systematic review and meta-analysis of cohort studies." (2018): 1033-1047.</ref>
<ref name="CarboneAl Salhi2018">Antonio Carbone, Yazan Al Salhi, Andrea Tasca, Giovanni Palleschi, Andrea Fuschi, Cosimo De Nunzio, Giorgio Bozzini, Sandro Mazzaferro, Antonio L. Pastore, Obesity and kidney stone disease: a systematic review, Minerva Urologica e Nefrologica, volume 70, issue 4, 2018, ISSN [http://www.worldcat.org/issn/03932249 03932249], doi [http://dx.doi.org/10.23736/S0393-2249.18.03113-2 10.23736/S0393-2249.18.03113-2]</ref>
<ref name="ThomasElinder2013">Laura D. K. Thomas, Carl-Gustaf Elinder, Hans-Göran Tiselius, Alicja Wolk, Agneta Åkesson, Ascorbic Acid Supplements and Kidney Stone Incidence Among Men: A Prospective Study, JAMA Internal Medicine, volume 173, issue 5, 2013, pages 386, ISSN [http://www.worldcat.org/issn/2168-6106 2168-6106], doi [http://dx.doi.org/10.1001/jamainternmed.2013.2296 10.1001/jamainternmed.2013.2296]</ref>
<ref name="Taylor2004">E. N. Taylor, Dietary Factors and the Risk of Incident Kidney Stones in Men: New Insights after 14 Years of Follow-up, Journal of the American Society of Nephrology, volume 15, issue 12, 2004, pages 3225–3232, ISSN [http://www.worldcat.org/issn/1046-6673 1046-6673], doi [http://dx.doi.org/10.1097/01.ASN.0000146012.44570.20 10.1097/01.ASN.0000146012.44570.20]</ref>
<ref name="Curhan1999">GC Curhan, WC Willett, FE Speizer, MJ Stampfer, Intake of vitamins B6 and C and the risk of kidney stones in women., Journal of the American Society of Nephrology : JASN, volume 10, issue 4, 1999, ISSN [http://www.worldcat.org/issn/1046-6673 1046-6673], PMID [http://www.ncbi.nlm.nih.gov/pubmed/10203369 10203369], pages 840–5</ref>
<ref name="CurhanWillett1996">Gary C. Curhan, Walter C. Willett, Eric B. Rimm, Meir J. Stampfer, A Prospective Study of the Intake of Vitamins C and B6, and the Risk of Kidney Stones in Men, Journal of Urology, volume 155, issue 6, 1996, pages 1847–1851, ISSN [http://www.worldcat.org/issn/0022-5347 0022-5347], doi [http://dx.doi.org/10.1016/S0022-5347(01)66027-0 10.1016/S0022-5347(01)66027-0]</ref>
<ref name="WandzilakD'andre1994">Theodore R. Wandzilak, Stacy D. D'andre, Paul A. Davis, Hibbard E. Williams, Effect of High Dose Vitamin C on Urinary Oxalate Levels, Journal of Urology, volume 151, issue 4, 1994, pages 834–837, ISSN [http://www.worldcat.org/issn/0022-5347 0022-5347], doi [http://dx.doi.org/10.1016/S0022-5347(17)35100-5 10.1016/S0022-5347(17)35100-5]</ref>
<ref name="AuerAuer1998">Bronwyn Leigh Auer, Derek Auer, Allen Lawrence Rodgers, The Effect of Ascorbic Acid Ingestion on the Biochemical and Physicochemical Risk Factors Associated with Calcium Oxalate Kidney Stone Formation, Clinical Chemistry and Laboratory Medicine, volume 36, issue 3, 1998, ISSN [http://www.worldcat.org/issn/1434-6621 1434-6621], doi [http://dx.doi.org/10.1515/CCLM.1998.027 10.1515/CCLM.1998.027]</ref>
<ref name="LiebmanChai1997">Michael Liebman, Weiwen Chai, Ellen Harvey, Laura Boenisch, Effect of supplemental ascorbate and orange juice on urinary oxalate, Nutrition Research, volume 17, issue 3, 1997, pages 415–425, ISSN [http://www.worldcat.org/issn/02715317 02715317], doi [http://dx.doi.org/10.1016/S0271-5317(97)00012-2 10.1016/S0271-5317(97)00012-2]</ref>
<ref name="TraxerHuet2003">Olivier Traxer, Beverley Huet, John Poindexter, Charles Y.C. Pak, Margaret S. Pearle, Effect of Ascorbic Acid Consumption On Urinary Stone Risk Factors, Journal of Urology, volume 170, issue 2, 2003, pages 397–401, ISSN [http://www.worldcat.org/issn/0022-5347 0022-5347], doi [http://dx.doi.org/10.1097/01.ju.0000076001.21606.53 10.1097/01.ju.0000076001.21606.53]</ref>
<ref name="MasseyLiebman2005">Linda K. Massey, Michael Liebman, Susan A. Kynast-Gales, Ascorbate Increases Human Oxaluria and Kidney Stone Risk, The Journal of Nutrition, volume 135, issue 7, 2005, pages 1673–1677, ISSN [http://www.worldcat.org/issn/0022-3166 0022-3166], doi [http://dx.doi.org/10.1093/jn/135.7.1673 10.1093/jn/135.7.1673]</ref>
<ref name="YfantiÅkerström2010">Christina Yfanti, Thorbjörn Åkerström, Søren Nielsen, Anders R. Nielsen, Remi Mounier, Ole H. Mortensen, Jens Lykkesfeldt, Adam J. Rose, Christian P. Fischer, Bente K. Pedersen, Antioxidant Supplementation Does Not Alter Endurance Training Adaptation, Medicine & Science in Sports & Exercise, volume 42, issue 7, 2010, pages 1388–1395, ISSN [http://www.worldcat.org/issn/0195-9131 0195-9131], doi [http://dx.doi.org/10.1249/MSS.0b013e3181cd76be 10.1249/MSS.0b013e3181cd76be]</ref>
<ref name="RobertsBeattie2011">Llion A. Roberts, Kris Beattie, Graeme L. Close, James P. Morton, Vitamin C Consumption Does Not Impair Training-Induced Improvements in Exercise Performance, International Journal of Sports Physiology and Performance, volume 6, issue 1, 2011, pages 58–69, ISSN [http://www.worldcat.org/issn/1555-0265 1555-0265], doi [http://dx.doi.org/10.1123/ijspp.6.1.58 10.1123/ijspp.6.1.58]</ref>
<ref name="DePhillipoAman2018">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 [http://www.worldcat.org/issn/2325-9671 2325-9671], doi [http://dx.doi.org/10.1177/2325967118804544 10.1177/2325967118804544]</ref>
<ref name="BarkerLeonard2009">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 [http://www.worldcat.org/issn/08915849 08915849], doi [http://dx.doi.org/10.1016/j.freeradbiomed.2009.09.010 10.1016/j.freeradbiomed.2009.09.010]</ref>
<ref name="AsmatAbad2016">Ullah Asmat, Khan Abad, Khan Ismail, Diabetes mellitus and oxidative stress—A concise review, Saudi Pharmaceutical Journal, volume 24, issue 5, 2016, pages 547–553, ISSN [http://www.worldcat.org/issn/13190164 13190164], doi [http://dx.doi.org/10.1016/j.jsps.2015.03.013 10.1016/j.jsps.2015.03.013]</ref>
<ref name="WangZhou2016">Guoying Wang, Chunling Zhou, Lixin Na, Ruiqi Shan, Yu Cheng, Ying Li, Xiaoyan Wu, Changhao Sun, Dietary Vitamin C Intake Reduces the Risk of Type 2 Diabetes in Chinese Adults: HOMA-IR and T-AOC as Potential Mediators, PLOS ONE, volume 11, issue 9, 2016, pages e0163571, ISSN [http://www.worldcat.org/issn/1932-6203 1932-6203], doi [http://dx.doi.org/10.1371/journal.pone.0163571 10.1371/journal.pone.0163571]</ref>
<ref name="RahimiNikfar2005">Roja Rahimi, Shekoufeh Nikfar, Bagher Larijani, Mohammad Abdollahi, A review on the role of antioxidants in the management of diabetes and its complications, Biomedicine & Pharmacotherapy, volume 59, issue 7, 2005, pages 365–373, ISSN [http://www.worldcat.org/issn/07533322 07533322], doi [http://dx.doi.org/10.1016/j.biopha.2005.07.002 10.1016/j.biopha.2005.07.002]</ref>
<ref name="Hellman-1958 ">Metabolism of L-ascorbic acid-1-C14 in man., The Journal of biological chemistry, volume 230, issue 2, 1958, ISSN [http://www.worldcat.org/issn/0021-9258 0021-9258], PMID [http://www.ncbi.nlm.nih.gov/pubmed/13525409 13525409], pages 923–30</ref>
<ref name=" Scherer-2015">Scherer, Kai, et al. "Non-invasive differentiation of kidney stone types using X-ray dark-field radiography." Scientific reports 5 (2015): 9527.</ref>
</references>
