Vitamin C and alcohol: a call to action

Vitamin C, an essential water-soluble nutrient that cannot be synthesised by humans, has a role in numerous biological reactions.1 It is necessary for enzymatic reactions and biosynthesis of hormones,2 and protects biomolecules through its antioxidant properties.1 Critical in the biosynthesis of collagen, it is crucial in preserving essential tissue structure and function, without which capillary fragility develops.1 2 While its biological function has been well proven, its therapeutic utility has been well contested over the years. The initial hope of a positive association between vitamin C status and health from several large cohort trials3–5 was quashed by results from large randomised controlled trials (RCTs) that did not find significant positive effects of vitamin C supplementation, when mortality or morbidity were set as endpoints.6–8 A review by Lykkesfeldt and Poulsen9 remarked this to be a result of a non-specific approach to examining the isolated effect of vitamin C, and lamented a lack of subpopulation definition in the trials. However, the subsequent shift in the public’s and health authorities’ interests has left a gaping hole in evidence regarding vitamin C replacement. Chronic alcoholism, on the other hand, remains a significant and widespread public health issue, whereby a recent global study found alcohol to be the seventh leading risk factor for death and disability-adjusted life-years.10 There has been no lack of case reports documenting florid scurvy in chronic alcoholics,11–17 yet the mechanistic links between hypovitaminosis C and chronic alcoholism remain postulations based on research from the early 1980s. Furthermore, replacement regimens and routes remain far from standardised, as evidenced by the varied treatment approaches in these reports (table 1). View this table: Table 1 Case reports on vitamin C deficiency and chronic alcohol intake As such, the present review examines the current and past knowledge on vitamin C …