The adrenal-vitamin C axis: from fish to guinea pigs and primates

Critical Care Journal ^ | Jan 28, 2019 | Michael H. Hooper, Anitra Carr & Paul E. Marik

[ConservativeMind]

Primates and guinea pigs are unable to synthesize vitamin C. In contrast, almost all other mammals produce vitamin C in their livers with production increasing during stress. Furthermore, largely to metabolic consumption, a high percentage of critically ill patients are deficient in vitamin C.

In an observational study, Carr et al. found that 75% of critically ill patients had plasma levels of vitamin C that were abnormally low [1]. The degree and incidence of deficiency were most pronounced in those patients with sepsis. Several trials have shown that administration of vitamin C to patients with sepsis is associated with better patient outcomes, suggesting a causal relationship between vitamin C deficiency and outcome. The mechanism(s) by which vitamin C administration may improve outcomes is unclear.

Observations of very high vitamin C levels in the adrenal gland as well as its release in response to ACTH suggest that vitamin C plays a role in the stress response [2]. Release of cortisol in response to stress is well documented in humans and throughout the animal kingdom. However, there is marked inter-species variation in the amount of cortisol released in response to a stressor.

Interestingly, there is a strong inverse correlation between the ability of an animal to endogenously produce vitamin C and the cortisol response when stressed. Barton et al. reported the baseline cortisol and response of numerous fish species to handling [3]. Those fish species which synthesized vitamin C had a 1.6-fold increase in cortisol levels after stress as compared to a 20.2-fold increase in those fish species that were unable to produce vitamin C, with the non-producers having a significantly higher baseline cortisol level. Additional evidence supports the concept of an inverse correlation between vitamin C and cortisol levels. Guinea pigs that are made deficient in vitamin C hyper-secrete cortisol [4].

Supplementation of ascorbic acid in humans and animal models is associated with a decreased cortisol response after a psychological or physical stressor [5]. High serum levels of cortisol in patients with sepsis are associated with a poor prognosis. Traditionally, this association has been explained on the assumption that higher cortisol responses are due to a more intense physiological stress and a higher severity of illness. However, the inverse relationship of cortisol levels with vitamin C status would suggest an alternative hypothesis, namely, that high levels of cortisol and the associated poorer outcomes of patients are a function of vitamin C deficiency.

[ConservativeMind]

High cortisol levels can be greatly attenuated with Vitamin C.

The vast majority of critical-level patients have very high cortisol and very low Vitamin C levels.

Perhaps supplementing those patients with Vitamin C could help them.

[NativeSon]

I like to take enough vitamin C supplements to make my urine sample appear radioactively vibrating.

[LadyDoc]

In the past, we routinely added vitamins to the iv fluid of the who were on ivs more tan a day or 2...

They stopped doing that but started to give iv hyperalimentation to the critically ill.

And the sick and injured have a high cortisol level because they need it...we often give it for sepsis because a weak body doesn't produce enough.

[meatloaf]

Does this tie into adrenal fatigue where a lack of cortisol results?

[RandallFlagg]

So, I shouldn’t eat my niece’s guinea pigs.
Got it.

[chrisser]

Im too lazy this morning to Google...is cortisol bad?

[ConservativeMind]

Too much cortisol is.

Sadly, this is a common issue.

[MarMema]

Thank you for posting this. I had no idea.

[gnarledmaw]

I think that the point of the article is that you can as long as you make them with a citrus glaze.

[bert]

So, when you get sepsis as a result of a catheter while in a hospital bed, you should eat orangesto prevent death

[Right Wing Assault]

Thanks for the concise summary of that article.

[P.O.E.]

Which is why we evolved to make vodka to help us drink orange juice. Oh, and with cranberry juice on holidays.

[Openurmind]

From what I understand a proper balance of vitamin C with supplemental Calcium is also important?

[logi_cal869]

Well, yes...for critically-ill patients.

Otherwise we’re still talking about painting over dry-rot for everyone else, as cortisol is also produced as a response to general inflammation.

“Screwdriver” aficionados take note: You now have another arrow in your quiver to validate stress-response alcohol consumption. /s

[Pete from Shawnee Mission]

Thank you!

Ascorbic acid is part of a Sepsis protocol developed by a hospital in NJ. Share it.

https://pulmccm.org/critical-care-review/hydrocortisone-ascorbic-acid-and-thiamine-hat-therapy-in-sepsis-a-question-answer-with-dr-paul-marik/

Snip...”So I thought I had an obligation to try this again on our next patient with septic shock. This time we added intravenous thiamine to the mix … and the response was exactly the same as the first case. As all three agents are widely available and approved drugs which are devoid of side effects and extremely cheap - I felt I had an ethical obligation to continue to treat our patients with severe sepsis and septic shock with this cocktail. And indeed, the response was reproducible time over time over time. This led to us reporting our initial experience with this cocktail in a retrospective, before-after propensity adjusted study reported in Chest in June of 2017. We have to date treated over 850 patients with the same reproducible findings. In addition, hundreds of patients have been treated world-wide and this combination has become the standard of care in a number of hospital in the US and abroad.”

https://www.ncbi.nlm.nih.gov/pubmed/30441816

“Sepsis is a devastating disease that carries an enormous toll in terms of human suffering and lives lost. Over 100 novel pharmacologic agents that targeted specific molecules or pathways have failed to improve the outcome of sepsis. Preliminary data suggests that the combination of Hydrocortisone, Ascorbic Acid and Thiamine (HAT therapy) may reduce organ failure and mortality in patients with sepsis and septic shock. HAT therapy is based on the concept that a combination of readily available, safe and cheap agents, which target multiple components of the host’s response to an infectious agent, will synergistically restore the dysregulated immune response and thereby prevent organ failure and death. This paper reviews the rationale for HAT therapy with a focus on vitamin C.”

[spacejunkie2001]

that’s b vitamins that does that