The Nutrition in Medicine Research Group carries out translational nutrient-based clinical studies with the aim of having a positive impact on patient health outcomes and quality of life.
Critical illness and septic shock
We have shown that critically ill patients, particularly those with septic shock, have severely depleted vitamin C status, despite recommended intakes. This indicates enhanced requirement for the vitamin during inflammatory and infectious conditions.
We have recently carried out a study administering intravenous vitamin C to patients with septic shock to assess the effects on patient health outcomes and quality of life as vitamin C has been shown to support the cardiovascular system and other organ systems.
Current research
Published research
- Hypovitaminosis C and vitamin C deficiency in critically ill patients despite recommended enteral and parenteral intakes
- Stability of intravenous vitamin C solutions: a technical report
- Circulating myeloperoxidase is elevated in septic shock and is associated with systemic organ failure and mortality in critically ill patients
- The effect of conservative oxygen therapy on systemic biomarkers of oxidative stress in critically ill patients
- Neutrophils isolated from septic patients exhibit elevated uptake of vitamin C and normal intracellular concentrations despite a low vitamin C milieu
- Circulating protein carbonyls are specifically elevated in critically ill patients with pneumonia relative to other sources of sepsis
- Intravenous vitamin C administration to patients with septic shock: a pilot randomised controlled trial
- Critically ill septic patients have elevated oxidative stress biomarkers: lack of attenuation by parenteral vitamin C
- Effect of intravenous vitamin C on arterial blood gas analyser and Accu-Chek point-of-care glucose monitoring in critically ill patients.
Review articles and commentaries
- Ascorbate-dependent vasopressor synthesis: a rationale for vitamin C administration in severe sepsis and septic shock?
- Vitamin C in pneumonia and sepsis
- Can a simple chemical help to both prevent and treat sepsis?
- Duration of intravenous vitamin C therapy is a critical consideration
- Vitamin C administration in the critically ill: a summary of recent meta-analyses
- Is the VITAMINS RCT indicating potential redundancy between corticosteroids and vitamin C?
- Is "mega-dose" IV vitamin C required for septic and critical coronavirus disease 2019 patients?
Infection and immune function
Vitamin C supports the immune system and has important roles to play in immune cell function. We carry out observational and interventional studies in immune-compromised patients and patients with severe infections, such as pneumonia, which is one of the major causes of sepsis. If we are able to attenuate the symptoms of severe infection, this may decrease the likelihood of sepsis developing and improve patient outcomes and quality of life.
Pneumonia and sepsis are major complications of severe COVID-19. For more information about the role of vitamin C in COVID-19 see the Vitamin C and COVID-19 Research Resource.
Published research
- The role of physiological vitamin C concentrations on key functions of neutrophils isolated from healthy individuals
- Patients with community acquired pneumonia exhibit depleted vitamin C status and elevated oxidative stress
- Patients undergoing myeloablative chemotherapy and hematopoietic stem cell transplantation exhibit depleted vitamin C status in association with febrile neutropenia
- Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C
Review articles and commentaries
- Vitamin C and immune function
- Vitamin C in pneumonia and sepsis
- Vitamin C and neutrophil function: findings from randomized controlled trials
- Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections
- A new clinical trial to test high-dose vitamin C patients with COVID-19
- Micronutrient status of COVID-19 patients: a critical consideration
- The Emerging Role of Vitamin C in the Prevention and Treatment of COVID-19
- Vitamin C-An Adjunctive Therapy for Respiratory Infection, Sepsis and COVID-19
- Micronutrients and respiratory infections: the biological rationale and current state of clinical evaluation
- Vitamin C and COVID-19: should clinical trials be prioritized for low-income settings and vitamin C deficient populations?
- Vitamin C intervention for critical COVID-19: A pragmatic review of the current level of evidence
- Vitamin C and COVID-19: should clinical trials be prioritised for low income settings and vitamin C-deficient populations?
Mood and cognitive health
The brain and neuroendocrine glands contain the highest levels of vitamin C in the body indicating an important role for the vitamin in the nervous system. We carry out studies investigating the vitamin C status and biomarkers of inflammation and oxidative stress in patients with mood disorders.
Published research
- Positive Association of Ascorbate and Inverse Association of Urate with Cognitive Function in People with Parkinson's Disease
- Inflammation and Vitamin C in Women with Prenatal Depression and Anxiety: Effect of Multinutrient Supplementation
Metabolic health
Individuals with diabetes mellitus are under enhanced inflammatory and oxidative stress. Our research shows that they have lower vitamin C status. We carry out observational and interventional studies to determine vitamin C status in severe diabetes and the effect of vitamin C and micronutrient supplementation on inflammation in people with obesity and metabolic dysregulation (metabolic syndrome).
We have found that people with obesity and diabetes have enhanced requirements for vitamin C.
Published research
- Inadequate vitamin C status in prediabetes and type 2 diabetes mellitus: associations with glycaemic control, obesity, and smoking
- SunGold kiwifruit supplementation of individuals with prediabetes alters gut microbiota and improves vitamin C status, anthropometric and clinical markers
- Vitamin C status in people with types 1 and 2 diabetes mellitus and varying degrees of renal dysfunction: relationship to body weight
- Estimation of vitamin C intake requirements based on body weight: Implications for obesity
- People with diabetes and hypovitaminosis C fail to conserve urinary vitamin C
- Estimating Vitamin C Intake Requirements in Diabetes Mellitus: Analysis of NHANES 2017-2018 and EPIC-Norfolk Cohorts.
Patient quality of life
Acute and chronic illnesses can dramatically impact on patients' quality of life. Furthermore, various drugs, such as those used during cancer chemotherapy, can also impact negatively on quality of life.
We have carried out a number of case studies showing dramatic improvement in quality of life of oncology patients administered intravenous vitamin C. We recently carried out a randomised controlled trial to improve the vitamin C status and quality of life of myeloma patients undergoing conditioning chemotherapy and stem cell transplantation.
Published research
- Relief from cancer chemotherapy side effects with pharmacologic vitamin C
- Parenteral vitamin C for palliative care of terminal cancer patients
- Parenteral vitamin C relieves chronic fatigue and pain in a patient with rheumatoid arthritis and mononeuritis multiplex secondary to CNS vasculitis
- Supplementation with oral vitamin C prior to and during myeloablative chemotherapy and autologous haematopoietic stem cell transplantation
Review articles
- The role of vitamin C in the treatment of pain: new insights
- Intravenous vitamin C for cancer therapy - identifying the current gaps in our knowledge
- The effect of intravenous vitamin C on cancer- and chemotherapy-related fatigue and quality of life
Global health and nutrition
People in low-middle income countries (LMIC) tend to have depleted nutrient status due to inadequate dietary intakes of essential nutrients and related comorbidities which increase requirements for specific nutrients, such as vitamin C. These factors may increase their risk and morbidity from COVID-19. Elderly are particularly at risk of severe COVID-19, therefore, we plan to assess the vitamin C requirements of elderly people. People with obesity (itself considered a global pandemic) are also at higher risk of severe COVID-19, and have higher requirements for vitamin C. This is currently not taken into account in the setting of global dietary intake recommendations for vitamin C.
We have recently contributed to the updating of the dietary intake recommendations for vitamin C for the Nordic Nutrition Recommendations 2023
Published research
- Does aging affect vitamin C status relative to intake? Findings from NHANES 2017–2018
- Factors affecting the vitamin C dose-concentration relationship: Implications for global vitamin C dietary recommendations
Review articles
- Discrepancies in global vitamin C recommendations: a review of RDA criteria and underlying health perspectives
- Factors affecting vitamin C status and prevalence of deficiency: a global health perspective
- Global vitamin C status and prevalence of deficiency: A cause for concern?
- Does aging have an impact on vitamin C status and requirements? A scoping review of comparative studies of aging and institutionalisation
- Vitamin C
- Vitamin C – a scoping review for Nordic Nutrition Recommendations 2023