Vitamin C is probably the most well-known and studied vitamin. I’ve come to believe that it may also be one of the most important ones for people suffering from chronic bladder problems, which I’d like to explain in today’s post.

If you have interstitial cystitis (IC), you may have been told to stay clear of vitamin C supplements – a.k.a Ascorbic Acid. Why? Because as the name suggests, it is rather acidic and could therefore be rather uncomfortable when getting in contact with inflamed tissue. But fear not, I will explain how you can take it without the burn!

I have only recently started supplementing high doses of vitamin C and have to say it is one of the very few supplements that’s ever made a (positive) difference to my health.

I have experienced a reduction in some of my lingering digestive issues, I have not been ill once since starting supplementation, my tendency to get nose-bleeds when blowing my nose has decreased a lot, as well as bleeding gums and so far my hayfever symptoms have been very mild. I found I can even stop a hayfever attack by taking some vitamin C!

I even got my dad to take high-dose vitamin C and, although he claims he is fine anyways, my mom is convinced that it got him through flu-season unscathed!

The Roles of Vitamin C

Vitamin C has many roles in the body, which is why it may be so beneficial.

• Antioxidant: Vitamin C is a water-soluble antioxidant and has the ability to scavenge many reactive oxygen species (oxidants or free radicals). It can help reduce oxidation of various compounds, which is why ascorbic acid is used as a preservative in the food industry (think of using lemon juice to prevent apple slices from browning). It also helps activate detoxification enzymes in the liver.
• Collagen formation: collagen provides structural strength to tissues and joints. Vitamin C is needed for the production of strong, mature collagen. Therefore, it supports wound healing and integrity of tissues (including skin, blood vessels, gums, bladder and gut lining etc.).
• Immunity: Immune cells accumulate vitamin C 100-fold compared to blood levels. It is used up rapidly during infections. Vitamin C increases the activity of immune cells and increases the production of antiviral proteins. It may help protect tissue from damage during an immune response to infection.
• Anti-inflammatory activity: Vitamin C helps control inflammation by reducing histamine (a pro-inflammatory chemical released by mast cells) and decreasing the production on pro-inflammatory messengers.
• Stress adaptation: The adrenal glands produce the ‘stress hormones’ and they also accumulate the highest level of vitamin C in the body, where it plays a role in the production of ‘stress-hormones’. Therefore, Vitamin C is used in high amounts during stressful periods.
• Protein and neurotransmitter metabolism.
• May help protect DNA from damage.
• Supports circulation and cholesterol levels.
• Iron metabolism: it helps the absorption of iron, helps take iron where it needs to go and away from where it shouldn’t be.
• Folate metabolism.

Signs of Inadequate Vitamin C levels

Please note that these symptoms also could be caused by other things.

• Increased susceptibility to infections
• Easy bruising
• Nose bleeds, bleeding gums, swollen gums, gum infections, loss of teeth
• Circulatory disorders, weak blood vessels
• Poor wound healing
• Dry, wrinkled skin
• Low resistance to stress
• Iron-deficiency or overload
• Back, joint or muscle pain, disorders of spinal disks
• Depression, irritability, lack of appetite
• Scurvy: Scurvy is the severe form of vitamin C deficiency. It is characterized by gum disease, decreased red blood cells, bleeding from the skin, poor wound healing, bone pain, malaise, lethargy, shortness of breath, loosening of teeth, changes to hair and emotional changes. Dry mouth and eyes may also occur, which is why it has been associated with Sjoergen’s syndrome.

Why Vitamin C could be beneficial for Bladder Problems

Chronic cystitis is a chronic infection and as I’ve mentioned above, Vitamin C plays an important role in supporting the immune system during chronic infections. It is used up rapidly during infections, so topping up may be a good idea. Many cases of IC may also be cases of missed chronic infections, because of unreliable testing methods (also see Kimberly’s IC Story).

One characteristic of interstitial cystitis can be raised mast cells. Mast cells secrete histamine, which is a pro-inflammatory chemical that plays a role in painful symptoms. Vitamin C helps to break down histamine [1] and may therefore help reduce inflammation and pain.

In a study from the 60s, 4 patients with Hunner’s lesions were treated with a vitamin cocktail of vitamin C, B12 and B6. One patient could not complete the treatment but the other three were free of pain and frequency after 3 months [2]. I know that this study is too small to be representative but I don’t think it should be disregarded.

Vitamin C is important for tissue regeneration and wound healing and could therefore support the integrity of the bladder wall.

Additionally, vitamin C is important for resistance to stress and stress can play a role in triggering bladder flares.

Moreover, vitamin C plays a role in getting iron where it needs to go and away from where it shouldn’t be. While iron is important, too much of it or in the wrong places is not a good thing: it can become a free-radical, contributing to inflammation and tissue damage and it can also feed pathogenic microbes.

I see signs of poor iron metabolism (too high or too low) and lowered vitamin C status in all my chronic bladder clients!

Vitamin C may also be helpful for those with infections in the vagina (and if the genital microflora is disrupted, we may become more prone to bladder infections) – vitamin C suppositories have been shown to be helpful in some cases of bacterial vaginosis (BV) [3].

How to Take Vitamin C (so it doesn’t hurt)

Vitamin C has been identified as a common trigger ‘food’ for IC sufferers [4]. Therefore, sufferers are likely to avoid supplementing vitamin C.

Vitamin C is ascorbic acid, which is quite acidic (as the name suggests). This is the form of vitamin C usually used in supplements. When the strong acid comes in touch with inflamed tissue, logically it burns.

Luckily, we can take vitamin C in a buffered form. Mineral ascorbates consist of ascorbic acid combined with a (alkaline) mineral. In this form, vitamin C is much less acidic and probably better tolerated. Common forms are sodium-, calcium- and magnesium ascorbate. I personally have found many people to be high in calcium (including myself – that’s a topic for another day), which is why I don’t like using calcium ascorbate. That leaves sodium and magnesium ascorbates. Of the two, I find sodium ascorbate the best tolerated one in higher dosages, although I use some magnesium ascorbate as well.

Blood tests for vitamin C status are not very useful, as they only reflect recent dietary intake. A more reliable test would be leukocyte concentration.

However, we can gauge our own needs by using the bowel tolerance method. This refers to the amount of vitamin C that can be tolerated orally, without overloading the body’s capacity to absorb it. Going over the tolerance results in diarrhoea, as unabsorbed vitamin C enters the colon and water is then drawn to dilute it, plus a bowel movement is stimulated to excrete it.

The bowel tolerance increases with infections and severity of disease.

The therapeutic dose is the one just before exceeding bowel tolerance, this is also known as ‘Near Bowel Tolerance’ (NBT).

How to dose to NBT:

• This is easiest to do with powders rather than capsules.
• Start with 500 mg. We can spread the dosage throughout the day or take it at once. Most people tolerate vitamin C better in the evening and not on an empty stomach, but it’s a good idea to experiment with dosage and timing.
• The dosage can then be raised gradually by 500 mg, until stools become loose.
• Then, the dosage should be lowered to the amount just before geting loose stools. This is the therapeutic dose.
• Please note that NBT may change over time (e.g. more during times of illness, less during times of health). A normal dosage would be around 3 -10 gram.
• Abdominal grumbling and flatulence can be a sign that NBT has been reached and the dosage can be reduced if this causes issues.
• It is not recommended to stop a large dose suddenly as this can cause ‘rebound scurvy’ i.e. sudden withdrawal can lead to symptoms of deficiency. It is better to reduce gradually.

I personally find high-dose vitamin C one of the most useful supplements and am using it for most of my clients.

Update: I have found that people with oxalate issues (potentially due to high yeast levels) can have issues with high-dose vitamin C. Apparently, supplemental vitamin C above 4 gram daily can be metabolized into oxalates. Excess oxalates can cause pain in the bladder. Therefore, I don’t recommend anyone with oxalate issues (or suspected issues) take more than 4 gram vitamin C daily.

What is your experience with vitamin C? Have you tried it? Let me know in the comments.




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Sources

• Paxton, Fay Foundations of Naturopathic Nutrition (Crows Nest: Allen & Unwin, 2015)
• Wikipedia Scurvy accessed June 2018 https://en.wikipedia.org/wiki/Scurvy
• Patak, P. et al Vitamin C is an important cofactor for both adrenal cortex and adrenal medulla. Endocr Res. 2004 Nov;30(4):871-5. https://www.ncbi.nlm.nih.gov/pubmed/15666839
• Shaik-Dasthagirisaheb, YB et al Role of vitamins D, E and C in immunity and inflammation. Journal of Biological Regulators and Homeostatic Agents [01 Apr 2013, 27(2):291-295] http://europepmc.org/abstract/med/23830380

1. Johnston C.S. (1996) The Antihistamine Action of Ascorbic Acid. In: Harris J.R. (eds) Subcellular Biochemistry. Subcellular Biochemistry (Ascorbic Acid: Biochemistry and Biochemical Cell Biology), vol 25. Springer, Boston, MA https://link.springer.com/chapter/10.1007/978-1-4613-0325-1_10
2. Shipton, E. HUNNER’S ULCER (Chronic Interstitial Cystitis): A Manifestation of Collagen Disease 1965 BJU [37 (4): 443-449] https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1464-410X.1965.tb09624.x
3. Petersen, EE et al Efficacy of vitamin C vaginal tablets in the treatment of bacterial vaginosis: a randomised, double blind, placebo controlled clinical trial. Arzneimittelforschung 2011; 61: 260–5. https://www.researchgate.net/publication/51199407_Efficacy_of_vitamin_C_vaginal_tablets_in_the_treatment_of_bacterial_vaginosis_A_randomised_double_blind_placebo_controlled_clinical_trial
4. Friedlander, Justin et al Diet and its role in interstitial cystitis/bladder pain syndrome (IC/BPS) and comorbid conditions 2012 BJU [109 (11): 1584-1591] https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-410X.2011.10860.x