Vitamin C Improves the Mood of Acutely Hospitalized Patients

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According to new research, supplementation with vitamin C could improve the emotional state of hospitalized patients [1]. The study, published in the journal Nutrition, demonstrates that increasing vitamin C levels in acutely hospitalized patients results in a rapid, statistically and clinically significant improvement in mood state.

Sixty percent of patients in hospitals have extremely low levels of vitamin C. Their plasma levels are less than half that of normal levels; one in five patients have levels so low that they have scurvy, a condition characterized by general weakness, anemia, gum disease and skin hemorrhages as a result of vitamin C deficiency. But rather than giving them sauerkraut, like eighteenth century sailors received to combat scurvy on long voyages, Dr. John Hoffer at the Jewish General Hospital in Montreal gave them vitamin C supplements. He found that their moods improved significantly.

Dr. Hoffer is interested in analyzing the benefits and risks associated with using high-dose intravenous vitamin C to combat cancer. In order to determine why patient’s vitamin C levels are so low, he did a study investigating responses to vitamin C supplements [2]. Since low vitamin C levels are known to negatively impact state of mind, he assessed mood as part of the study. This study revealed that vitamin C improved the mood of acutely hospitalized patients, but since all of the study participants got vitamin C this could have been due to a placebo effect. So he designed a second, double blind controlled clinical trial to test if vitamin C had a stronger effect on mood than a placebo.

Vitamin D was chosen as the placebo because vitamin D deficiency, like vitamin C deficiency, is common among acutely hospitalized patients. And again like vitamin C deficiency, vitamin D deficiency has been associated with psychologic abnormalities. Thirty-two patients completed the study with highly varied clinical diagnoses: cardiovascular disease, infectious disease, diabetes, gastrointestinal disease, cancer and renal failure. None were in the intensive care unit or being considered for transfer there. Trial participants received either 500mg vitamin C or 1000 IU vitamin D twice daily for five to ten days. Although vitamin D administration increased plasma vitamin D levels, it had no effect on mood. In contrast, vitamin C administration precipitated a rapid and statistically significant elevation in mood. All of the patients were mentally competent, so these results may not apply to those with psychiatric disorders.

A short version of the Profile of Mood States (POMS) questionnaire was administered to study participants to assess their mood. In it, patients rate statements describing moods or feelings on a 5 point scale, ranging from zero (none at all) to four (extremely). The questionnaire measures six mood states: tension, depression, anger, vigor, confusion and fatigue. The shortened version was specifically designed to accommodate the limited reserve of physically ill individuals and has been extensively used and validated.

Dr. Hoffer noted that “the treatment is safe, simple, and cheap, and could have major clinical practice implications” [3]. Indeed, not many therapies come with qualifications like that.

Vitamin C or ascorbic acid performs many functions in the body. It is an antioxidant, so it protects DNA from being damaged by the oxidative free radicals that occur as a byproduct of normal metabolic functions. It is required for the enzymatic reactions that make collagen, which is why lacking it causes scurvy. It is also involved in neurotransmitter metabolism, acting as a cofactor for the enzyme that makes norepinephrine from dopamine.

Vitamin C levels are generally three times higher in cerebrospinal fluid than in plasma. Diminished vitamin C levels in the cerebrospinal fluid may adversely affect brain function and may be the reason why increasing the level of vitamin C enhances mood.

Vitamin C is most commonly associated with citrus fruits but it is found in many other plants as well. Perhaps surprisingly, broccoli and kiwi have three times as much vitamin C per unit weight as limes, tangerines and grapefruits. Red peppers are also a good source of vitamin C.

References

Zhang et al. Vitamin C provision improves mood in acutely hospitalized patients. Nutrition. 2010 Aug 4. [Epub ahead of print]
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Evans-Olders et al. Metabolic origin of hypovitaminosis C in acutely hospitalized patients. Nutrition. 2010 Nov-Dec;26(11-12):1070-4. Epub 2009 Dec 16.
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Vitamin C rapidly improves emotional state of acutely hospitalized patients, say LDI researchers. Jewish General Hospital. 2010 Sep 23.