Tocopherols, tocotrienols and tocomonoenols: Many similar molecules but only one vitamin E.

The aim of this article is to correct a very general error in scientific articles, in textbooks and in the Internet that has become an accepted fact. In this literature, the term "vitamin E″ is used for several similar molecules (both tocopherols and tocotrienols) that have never been shown to have vitamin property, i.e. a protective effect against the human deficiency disease. In fact, the name "vitamin E″ should only be used to define molecules that prevent the human deficiency disease "Ataxia with Vitamin E Deficiency" (AVED). Only one such molecule is known, α-tocopherol. This error may confuse consumers as well as medical doctors, who prescribe vitamin E without realizing that the current use of the name includes molecules of unknown, if not unwanted functions.

Adding an orange to the banana bag: vitamin C deficiency is common in alcohol use disorders.

BACKGROUND: At least a third of the world's population consumes alcohol regularly. Patients with alcohol use disorders (AUDs) are frequently hospitalized for both alcohol-related and unrelated medical conditions. It is well recognized that patients with an AUD are thiamine deficient with thiamine replacement therapy being considered the standard of care. However, the incidence of vitamin C deficiency in this patient population has been poorly defined. METHODS: In this retrospective, observational study, we recorded the admission vitamin C level in patients with an AUD admitted to our medical intensive care unit (MICU) over a 1-year period. In addition, we recorded relevant clinical and laboratory data including the day 2 and day 3 vitamin C level following empiric treatment with vitamin C. Septic patients were excluded from this study. RESULTS: Sixty-nine patients met the inclusion criteria for this study. The patients' mean age was 53 ± 14 years; 52 patients (75%) were males. Severe alcohol withdrawal syndrome was the commonest admitting diagnosis (46%). Eighteen patients (26%) had cirrhosis as the admitting diagnosis with 18 (13%) patients admitted due to alcohol/drug intoxication. Forty-six patients (67%) had evidence of acute alcoholic hepatitis. The mean admission vitamin C level was 17.0 ± 18.1 µmol/l (normal 40-60 µmol/l). Sixty-one (88%) patients had a level less than 40 µmol/l (subnormal) while 52 patients (75%) had hypovitaminosis C (level < 23 µmol/l). None of the variables recorded predicted the vitamin C level. Various vitamin C replacement dosing strategies were used. A 1.5-g loading dose, followed by 500-mg PO q 6, was effective in restoring blood levels to normal by day 2. CONCLUSION: Our results suggest that hypovitaminosis C is exceedingly common in patients with an AUD admitted to an intensive care unit and that all such patients should receive supplementation with vitamin C in addition to thiamine. Additional studies are required to confirm the findings of our observational study and to determine the optimal vitamin C dosing strategy.

Dietary Vitamin C in Human Health.

Vitamin C is essential to prevent scurvy in humans and is implicated in the primary prevention of common and complex diseases such as coronary heart disease, stroke, and cancer. This chapter reviews the latest knowledge about dietary vitamin C in human health with an emphasis on studies of the molecular mechanisms of vitamin C maintenance as well as gene-nutrient interactions modifying these relationships. Epidemiological evidence indicates 5% prevalence for vitamin C deficiency and 13% prevalence for suboptimal status even in industrialized countries. The daily intake (dose) and the corresponding systemic concentrations (response) are related in a saturable relationship, and low systemic vitamin C concentrations in observational studies are associated with negative health outcomes. However, there is no evidence that vitamin C supplementation impacts the risks for all-cause mortality, impaired cognitive performance, reduced quality of life, the development of eye diseases, infections, cardiovascular disease, and cancers. This might be related to the fact that prevention would not be realized by supplementation in populations already adequately supplied through dietary sources. Recent genetic association studies indicate that the dietary intake might not be the sole determinant of systemic concentrations, since variations in genes participating in redox homeostasis and vitamin C transport had been associated with lowered plasma concentrations. However, impact sizes are generally low and these phenomena might only affect individual of suboptimal dietary supply.

Health research and safeguards: The South African journey.

Health research, as a social good, needs to be conducted in the interests of the common good. Because of the unfortunate exploitation of research participants globally, safeguards for protections are necessary. Most international codes and guidelines originated as responses to the abuse and mistreatment of research subjects. By the 1890s, antivivisectionists were already calling for laws to protect children, as a result of the increasing numbers of institutionalised children being subjected to vaccine experiments in Europe and the USA. Just after the turn of the century, the first attempt to test a polio vaccine was thwarted after the American Public Health Association condemned the programme. In South Africa, medical scientists were busy with discoveries and innovations as far back as the 1800s. In December 1967, the historic first human heart transplant was undertaken in Cape Town. Although it is unclear how much research preceded this procedure, there is no doubt that the operation was done in a research setting, and it had a far-reaching impact.

Ascorbic acid prevents protein oxidation in livers of senescence marker protein-30/gluconolactonase knockout mice.

AIM: Senescence marker protein-30 (SMP30)/gluconolactonase (GNL) knockout (KO) mice are incapable of synthesizing L-ascorbic acid (AA) in vivo. As AA is known to be a water-soluble anti-oxidant, we assessed protein oxidation levels in livers from SMP30/GNL KO mice maintained in an AA-insufficient condition. METHODS: Livers were collected from male SMP30/GNL KO mice at the ages of 3, 6 and 12 months, and wild-type (WT) mice at the ages of 3, 6, 12 and 24 months. To assess protein oxidation, we measured the content of protein carbonyl, which is a major protein oxidation marker. AA levels were measured by 2,4-dinitrophenylhydrazine method using high-performance liquid chromatography. RESULTS: Livers of SMP30/GNL KO mice had just ∼5% as much AA as those of WT mice from 3 to 12 months-of-age. Protein carbonyl levels in livers from SMP30/GNL KO mice were a significant 1.8- to 2.3-fold higher than those from age-atched WT mice. To establish that the AA-insufficiency caused this difference, we added AA to some drinking water, and examined the effect on AA and protein carbonyl levels in livers from SMP30/GNL KO and WT mice. Livers from SMP30/GNL KO mice given extra AA had a significantly higher content than those from their deprived counterparts. Furthermore, protein carbonyl levels in livers from AA-supplemented SMP30/GNL KO mice were significantly lower than those from the SMP30/GNL KO mice without AA supplementation. However, added AA did not affect the protein carbonyl levels in WT mice. CONCLUSIONS: These results strongly suggest that AA plays an important role in preventing protein oxidation in vivo, thus enhancing overall health.

Earthsickness: circumnavigation and the terrestrial human body, 1520-1800.

From their distinctive experience of going around the world, maritime circumnavigators concluded that their characteristic disease, sea scurvy, must result from their being away from land too long, much longer than any other sailors. They offered their scorbutic bodies as proof that humans were terrestrial creatures, physically suited to the earthly parts of a terraqueous globe. That arresting claim is at odds with the current literature on the cultural implications of European expansion, which has emphasized early modern colonists' and travelers' fear of alien places, and has concluded that they had a small and restricted geographic imagination that fell short of the planetary consciousness associated with the nineteenth and twentieth centuries. But circumnavigators did conceive of themselves as actors on a planetary scale, as creatures adapted to all of the land on Earth, not just their places of origin.

Scurvy and cloudberries: a chapter in the history of nutritional sciences.

We translated two Latin texts about scurvy. One is by Ambrosius Rhodius, who in 1635 published his doctoral thesis on scurvy. This contains aspects of 16th- and 17th-century folklore medicine. The other is a 1593 letter by Henrik Høyer (Hoierus), a German physician in Bergen, Norway. The letter states that in Norway grew a plant, Chamaemorus Norvegicus, whose berries had curative abilities against scurvy. Rhodius lists symptoms of scurvy and suggests ingestion of fatty and smoked foods as etiological agents. He thought that a malfunction of the spleen was involved in this disease, so that the undigested parts of the chylus perturbed liver function. Plants with curative abilities were "those that abound in volatile salts." He listed seven facilitating causes of scurvy and its therapies. These included blood-letting after laxatives and root extracts. The star of the show was the cloudberry, which had miraculous effects on scurvy patients. Palliative care included a bath containing decoction of brooklime, water cress, mallow, hogweed, roman chamomile, and similar plants. Before bathing, the person was to drink an extract of wormwood, scurvy grass, or elder. As medication for gums and teeth, Rhodius recommended rosemary, hyssop, bistort, sage, nasturtium, waterweed, creeping Jenny, and scurvy grass. He referred to medications described by Albertus, Sennertus, and in antiquity by Hippocrates and Galenus. We discuss the manuscripts by Høyer and Rhodius in light of earlier treatments and opinions about scurvy.

Medicina tropical / Tropical medicine

Faz uma abordagem sobre a descoberta da cura do escorbuto através do tratamento com ervas e frutas nativas do Brasil. Da natureza brasileira vieram as práticas médicas utilizadas desde o período colonial. A literatura médica credita ao cirurgião inglês James Lind a descoberta da cura do escorbuto. Em serviço no Hospital Real da Marinha inglesa, em 1747, começou a empregar frutas cítricas para combater o mal muito recorrente entre os marinheiros, tratamento que, mais tarde, foi divulgado em seu livro 'A Treatise of the Scurvy (1753)'. No entanto, foi o português João Cardoso de Miranda quem realizou primeiramente a descoberta. (AU)

Sailors' scurvy before and after James Lind--a reassessment.

Scurvy is a thousand-year-old stereotypical disease characterized by apathy, weakness, easy bruising with tiny or large skin hemorrhages, friable bleeding gums, and swollen legs. Untreated patients may die. In the last five centuries sailors and some ships' doctors used oranges and lemons to cure and prevent scurvy, yet university-trained European physicians with no experience of either the disease or its cure by citrus fruits persisted in reviews of the extensive but conflicting literature. In the 20(th) century scurvy was shown to be due to a deficiency of the essential food factor ascorbic acid. This vitamin C was synthesized, and in adequate quantities it completely prevents and completely cures the disease, which is now rare. The protagonist of this medical history was James Lind. His report of a prospective controlled therapeutic trial in 1747 preceded by a half-century the British Navy's prevention and cure of scurvy by citrus fruits. After lime-juice was unwittingly substituted for lemon juice in about 1860, the disease returned, especially among sailors on polar explorations. In recent decades revisionist historians have challenged normative accounts, including that of scurvy, and the historicity of Lind's trial. It is therefore timely to reassess systematically the strengths and weaknesses of the canonical saga.

British naval health, 1700-1800: improvement over time?

Did British naval health improve over the course of the eighteenth century? The Sick and Hurt Board sought cures for common ailments such as scurvy by encouraging experimentation, and the development of cheap universal treatments. It also strove to provide a healthful environment and diet. Overall, prevention rather than the development of cures was very much the focus. This chapter also argues that too much emphasis has been placed on the authoritarian nature of the British Navy in the eighteenth century.

Ascorbic acid increases the severity of spontaneous knee osteoarthritis in a guinea pig model.

OBJECTIVE: To determine whether ascorbic acid might be of benefit for the treatment of spontaneous osteoarthritis (OA) when administered over a long period of time. METHODS: We investigated the effects of 8 months' exposure to low, medium, and high doses of ascorbic acid on the in vivo development of histologic knee OA in the male Hartley guinea pig. The low dose represented the minimum amount needed to prevent scurvy. The medium dose was the amount present in standard laboratory guinea pig chow and resulted in plasma levels comparable with those achieved in a person consuming 200 mg/day (5 fruits and vegetables daily). The high dose was the amount shown in a previous study of the guinea pig to slow the progression of surgically induced OA. RESULTS: We found an association between ascorbic acid supplementation and increased cartilage collagen content but, in contrast to findings in a previous study of surgically induced OA in the guinea pig, ascorbic acid worsened the severity of spontaneous OA. Active transforming growth factor beta (TGF beta) was expressed in marginal osteophytes, whose size and number were significantly increased with increasing intake of ascorbic acid. Synovial fluid levels of cartilage oligomeric matrix protein, a biomarker of cartilage turnover, corroborated the histologic findings. CONCLUSION: Ascorbic acid has been shown to activate latent TGF beta. Prolonged intraarticular exposure to TGF beta has been shown to cause OA-like changes. We found expression of active TGF beta in osteophytes, a prominent feature of the joint histology seen in association with ascorbic acid treatment. Thus, the deleterious effects of prolonged ascorbic acid exposure may be mediated in part by TGF beta. This worsening of OA with ascorbic acid supplementation suggests that ascorbic acid intake should not be supplemented above the currently recommended dietary allowance (90 mg/day for men and 75 mg/day for women).

Scurvy in the British Mercantile Marine in the 19th century, and the contribution of the Seamen's Hospital Society.

When long voyages in sailing vessels were commonplace, scurvy was a major health hazard in mariners of all nations. The observations of James Lind (1716-94) and others indicated that citrus fruits had both a preventive and curative role in this disease. In the light of this work, by 1800 the disease had been virtually eliminated from Britain's Royal Navy. However, it continued in the merchant navies of all nations until the latter half of the 19th century. In 1867, the Merchant Shipping Amendment Act was passed by the British Parliament largely as a result of a concerted effort by the Seamen's Hospital Society (SHS), one of whose physicians, Harry Leach (1836-79) was the major proselytiser for improved conditions in the merchant service. Examination of the SHS records before and after this event demonstrate a marked reduction in the prevalence of scurvy in the Port of London. Although other factors-such as the introduction of steam ships, which resulted in faster voyages-were clearly important, the compulsory administration of genuine lime juice under supervision in the merchant service seems to have exerted a significant effect.

An epidemic of scurvy in Afghanistan: assessment and response.

In March 2002, there were reports of a hemorrhagic fever outbreak in western Afghanistan. It was later confirmed that the hemorrhagic symptoms and increased mortality were actually due to scurvy. Most aid workers did not include scurvy in the initial differential diagnosis because it is uncommon throughout the world and has mainly been reported in refugee populations in recent times. A rapid assessment confirmed the cases clinically, estimated a prevalence rate of 6.3% (a severe public health problem), and determined that the attack rates peaked each year in January and February (the end of the winter). Many Afghans have limited dietary diversity due to isolated locations, lengthy winters, the continuing drought of the last four years, asset depletion, and loss of livelihood. After numerous food and fortification options to prevent future outbreaks had been considered, vitamin C tablet supplementation was selected because of the relatively rapid response time as compared with other prevention methods. A three-month course of vitamin C tablets was distributed to 827 villages in at-risk areas. The tablets were acceptable and compliance was good. No cases of scurvy were reported for the winter of 2002-03. The case study from Afghanistan demonstrates that scurvy can occur in nonrefugee or nondisplaced populations; vitamin C supplementation can be an effective prevention strategy; there is an urgent need to develop field-friendly techniques to diagnose micronutrient-deficiency diseases; food-security tools should be used to assess and predict risks of nutritional deficiencies; and the humanitarian community should address prevention of scurvy in outbreak-prone areas.

Captain Cook's beer: the antiscorbutic use of malt and beer in late 18th century sea voyages.

The custom of allowing British seamen the regular use of fermented liquor is an old one. Ale was a standard article of the sea ration as early as the fourteenth century. By the late eighteenth century, beer was considered to be at once a food (a staple beverage and essential part of the sea diet), a luxury (helping to ameliorate the hardship and irregularity of sea life) and a medicine (conducive to health at sea). In particular, beer and its precursors, wort and malt, were administered with the aim of preventing and curing scurvy. This paper examines the use of malt and beer during late eighteenth century British sea voyages, particularly their use as antiscorbutic agents, focusing on James Cook's three voyages during the period 1768-1780. Cook administered sweet wort (an infusion of malt), beer (prepared from an experimental, concentrated malt extract), and spruce beer (prepared mainly from molasses), among many other items, in his attempts to prevent and to cure scurvy. Despite the inconclusive nature of his own experiments, he reported favourably after his second voyage (1772-1775) on the use of wort as an antiscorbutic sea medicine (for which purpose it is now known to be useless). Cook thereby lent credibility to erroneous medical theories about scurvy, helping to perpetuate the use of ineffective treatments and to delay the discovery of a cure for the disorder.

Corrupt captains and convicts.

Australia is unique in that so many of its wine companies were founded by members of the medical profession. The First Fleet, which brought the first convicts and settlers to Australia in 1787, was delayed until wine was provided as a medicine for the long voyage from England. Australia's wine doctors were advocating the use of wine as a medicine 200 years before the French Paradox.