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Vitamin C
Why Is It So Important For Heart Health?

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Quick Summary tl;dr

Atherosclerotic plaques develop when damage to artery walls cannot be repaired and an internal clot develops instead to prevent excess bleeding.

Vitamin C is needed to repair damaged artery walls by promoting the formation of collagen, the main structural component of blood vessels.

Lp(a) is presumed to be an evolutionary surrogate for Vitamin C. This hypothesis was first put forth by Linus Pauling. Pauling is the only person in history to ever be awarded two Nobel Prizes ( 2).

Human experiments to see if high-dose vitamin C supplementation can lower Lp(a) and heart risk in humans with high Lp(a) are currently ongoing ( 6).

A car is driving along the highway when… SMASH… car crash! It’s a 10-car pileup and the road is wrecked. Of course, the first priority is to cordon off the space to prevent further damage. This necessarily congests traffic.

But, because nobody was hurt, once the cars are removed and the highway is repaired with new asphalt, the blockade is removed, and traffic continues as normal; it is as if nothing had happened.

But what if there wasn’t enough new asphalt to repair the road? The blockade would have to stay up and traffic would remain congested. Furthermore, as more and more car accidents occurred overtime, the highway would become more damaged, the number and size of blockades would grow, and the highway would eventually need to be shutdown.

This, of course, is an analogy. In this analogy, the highway is your arteries, the blockade is a clot (a.k.a. an atherosclerotic plaque) and the new asphalt is collagen, the substance used to build artery walls.

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The Role of Vitamin C in Collagen Formation and the Accumulation of Lp(a) Deposits

I also want to introduce two more metabolic players: Vitamin C and Lp(a). Vitamin C you know as the antioxidant present in oranges, but it is also an essential player in collagen formation ( 1).

Procollagen, the precursor to collagen, requires “lysine and proline hydroxylation” to become the mature collagen that is needed to repair the artery highway. Therefore, if you don’t have enough vitamin C, you can’t make collagen (new asphalt) and the artery highway remains broken.

Vitamin C is needed to repair damaged artery walls by promoting the formation of collagen, the main structural component of blood vessels.

Lp(a) is a lipoprotein (it is similar to LDL cholesterol particles, but with a tail) that acts like the physical barriers blocking off traffic (or orange cones) in our analogy. In arteries, Lp(a) binds to the damaged area and promotes clotting. In the short term, this is good as it prevents excess bleeding. However, in the absence of vitamin C, Lp(a) blockades accumulate, leading to eventual complete highway closure ( 2,  3).

So, let’s review. The highway is your arteries, the blockade is a clot (atherosclerotic plaque), the new asphalt is collagen, which requires vitamin C to be produced, and Lp(a) is the physical barrier blocking off traffic. If you don’t have vitamin C, Lp(a) deposits — the atherosclerotic plaque — grows, and eventually you end up with serious heart disease.

When it comes to heart health, we need vitamin C to prevent Lp(a) deposits from accumulating. Atherosclerotic plaques develop when damage to artery walls cannot be repaired and an internal clot develops instead to prevent excess bleeding.

How Much Vitamin C Do Humans Need?

So, now that you know all about why vitamin C is important in heart health, I want to share two animal fun facts with you that might make you think twice about how much vitamin C you might want to get through your diet and supplements each day.

First, animals that can produce their own vitamin C from glucose ( 4), which includes most animals, don’t tend to get heart disease. By contrast, those who can’t produce vitamin C, specifically primates and guinea pigs ( 5), are prone to heart disease.

You can give a guinea pig heart disease by simply removing vitamin C from its diet, even if its diet lacks cholesterol. Second, goats make more vitamin C in their bodies than any other animal. The average 70 kg goat (which is the same weight as your typical fully grown woman) makes 13,300 mg of vitamin C per day.

By contrast, the human recommended daily allowance (RDA) of vitamin C is a measly 75 mg for women and 90 mg for men, the amount required to just barely avoid getting scurvy. What’s more, when goats are stressed or becoming sick, they bump their vitamin C production by 10-100-fold! That means a stressed goat is producing 15,000-times more vitamin C per day than is currently clinically recommended for the averaged stressed human (and most of us are stressed most of the time).

Broccoli, cauliflower, Brussels sprouts and red bell peppers are all great low-carb, keto-friendly sources of vitamin C.

If you’re a visual learner, Martina and I helped Thomas DeLauer produce a video on this topic that you can find here.

For more science-backed articles related to this topic, read the posts below:

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Dr. Nicholas Norwitz
PhD in Ketogenics and Metabolism, Oxford University

Nicholas Notwitz

Dr. Nicholas Norwitz is a new shining star in nutrition science. This 25-year-old Ivy League Valedictorian obtained his PhD at Oxford University in just two years and is now pursing his MD at Harvard Medical School. His research expertise is ketosis and brain aging; however, he has published scientific papers on topics ranging from neuroscience to heart disease to gastrointestinal health to genetics to bone health to diabetes.

You can find Nick on Twitter at @nicknorwitz.

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Comments (5)

How did our ancestors get sufficient Vitamin-C without any supplements? Isn't 300mg Vitamin-C per day enough for most?

You know how real estate is all about "location, location, location"? Well, nutrition is all about "context, context, context."
You're 100% correct that our ancestors were not doing to be getting probably even the RDA of vitamin C (which is 90 mg), but they also lived and ate very differently such that they ran a lower risk of heart disease and had lower vitamin C needs.
I could go on forever about context, evolution and nutrition, but can answer your question most quickly by sharing data from a self experiment I did in which I ate only animal products, including organ meats, for two months. I had no vegetables of any kind and my vitamin C intake was, on average, only about 20 mg per day. You'd think I would be deficient after that time period, right? I might even have scurvy? Nope, in fact, my vitamin C levels were optimal / high!
It get's complicated... NADPH... vitamin C recycling... redundancy with other antioxidant systems... possible endogenous synthesis upon intestinal colonization (that one is speculative)... etc. But the point is this: most people in the developed world would benefit from more vitamin C because most people are at evaluated risk of cardiovascular disease due to pathologies than harm blood vessels like oxidative stress and inflammation.
If you live like our evolutionary ancestors, then I probably wouldn't recommend higher doses of vitamin C. I hope that makes sense and thank you for the great question!

I love eating low carb, every day I learn something new! Nick, I was wondering what your thoughts are on carnivore keto. Is it true that if you go carnivore you won't need as much vitamin C as others that are not carnivore? There isn't much vitamin C in animals and we can't make it...

At the risk of offending the carnivores, I am going to say yes with three caveats: (i) there is a lot we don't know about the microbiome and it's feasible (although unlikely) that the carnivore microbiome adapts and produces some vitamin C [] (ii) if you eat nose to nail, e.g. organ meat like liver, you get some vitamin C that, in the absence of glucose, doesn't have to compete for absorption (glucose and vitamin C use the same transporters) (iii) sometimes people need to choose between the lesser of two evils. While I do not think carnivore is optimal for most people (and we are evolutionarily an omnivorous species), there may be a select few who do better on a plant-free diet (perhaps the Petersons are such a case). Hope that helps.

Thank you so much!