Vitamin C deficiency in COVID-19 sufferers is still too rarely investigated

The consequences of this for patients were investigated at the Universities of Tübingen and Hohenheim, Germany.

Acute infectious diseases lead to a pronounced drop in vitamin C levels in blood plasma and leucocytes [1]. This can result in a vitamin C deficiency, which has now also been detected in COVID-19 patients in many studies [2]. This is not without consequences, as a lack of vitamin C can impair many reactions of the defense against infection, in particular chemotaxis, complement activation, and interferon production [1]. The latter triggers a whole cascade of antiviral reactions. 

Vitamin C deficiency increases hospitalization and the risk of death

Scientists from the Universities of Tübingen and Hohenheim, Germany, have investigated just how fatal an undersupply of vitamin C can be [3]. They determined the concentrations of vitamins A, C, E, and D in blood samples from COVID-19 patients with varying degrees of severity. SARS-Cov-2 infected people were significantly more likely to have a vitamin C deficiency compared to healthy people. There was a correlation between the severity of the deficiency and the severity of the COVID-19 disease [3]. The survival analysis showed that vitamin C plasma levels below 11.4 μM (0.19 mg/dL) were associated with a significantly longer hospital stay and a higher risk of death. There were no differences between infected and non-infected patients for the other immune-relevant vitamins [3]. The scientists discuss the study situation on the supportive intravenous administration of vitamin C in COVID-19 and emphasize the importance of early administration and a sufficiently high vitamin C dose of at least 100 mg/kg body weight per day.

Intravenous vitamin C quickly remedies deficiencies

At the beginning of the coronavirus pandemic, numerous studies were immediately initiated on the effectiveness of supportive vitamin C therapy to remedy a deficiency. One of the plausible reasons for this is the rapid consumption of vitamin C at the beginning of an infection. In most clinical studies, vitamin C was administered intravenously due to its significantly better bioavailability. The study design of these clinical trials focussed on common parameters for intensive care medicine and not on the determination of vitamin C blood levels. Meta-analyses of these studies emphasize the importance of vitamin C for the immune system. Patients who received vitamin C to compensate for the suspected deficiency had lower inflammation levels, shorter stays in the intensive care unit, and a lower risk of severe courses and mortality [4, 5]. 

It is not enough to treat viruses and bacteria - effective immune modulation is important. 

It is not viruses and bacteria, but the excessive inflammatory reaction to the pathogen that damages the immune system the most and thus increases the risk of severe courses. Vitamin C plays an important role in immunomodulation by being involved in many processes of defense against infection and at the same time in reactions that curb excessive inflammation [6, 7]. Vitamin C is important so that the immune system can develop and maintain an adequate response to pathogens without the organism being excessively damaged by the oxidative burst of the immune defense system[7]. A vitamin C deficiency can result in the body no longer being able to fully fulfill all the functions of the immune system. 

Pascorbin® 7.5 g: Highest-dose vitamin C infusion

Pascorbin 7.5 g can be used to compensate for an existing deficiency. Pascorbin® is the only vitamin C infusion authorized by the authorities and has the highest approved single dose of up to 7.5 g as an additive to an infusion. It has been used for over 40 years in medical practices and clinics for vitamin C deficiency. Pascorbin® is stable at room temperature (up to 25°C) and therefore easy to store. It can be used directly in a suitable carrier solution without warming. 

1. Pascoe pharmazeutische Präparate GmbH, Information for healthcare professionals Pascorbin. 2020, Pascoe pharmazeutische Präparate GmbH,: Gießen.

2. Holford, P., et al, Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence. Life 2021, 11, 1166, 2021. 11: p. 1166.

3. Sinnberg, T., et al, Vitamin C Deficiency in Blood Samples of COVID-19 Patients. Antioxidants (Basel), 2022. 11(8).

4. Sun, L., et al, Therapeutic effects of high-dose vitamin C supplementation in patients with COVID-19: a meta-analysis. Nutr Rev, 2023.

5. Bhowmik, K.K., et al, Impact of high-dose vitamin C on the mortality, severity, and duration of hospital stay in COVID-19 patients: A meta-analysis. Health Sci Rep, 2022. 5(5): p. e762.

6. Mousavi, S., S. Bereswill, and M.M. Heimesaat, Immunomodulatory and Antimicrobial Effects of Vitamin C. Eur J Microbiol Immunol (Bp), 2019. 9(3): p. 73-79.

7. Carr, A.C. and S. Maggini, Vitamin C, and Immune Function. Nutrients, 2017. 9(11).