Vitamin C and Tobacco (SQ-3)

The majority of us believe that taking Vitamin C will help us build a strong immune system. But if you smoke, you are likely to need more of this important vitamin to fight the harmful effects of smoking.

Tobacco smoke contains more than 4,000 chemicals that put almost every organ at risk. More than 50 of these substances have been identified as potent carcinogenic. Is there any surprise that smokers are at increased risk of developing various types of cancer, including cancer of the lung, mouth, pancreas, kidney, larynx, oesophagus and bladder? It is also strongly related to heart and respiratory diseases.

So you don’t smoke. That’s good news. But if you live with a person who does, bad news is that even passive exposure to tobacco smoke is extremely harmful. A latest study published in the journal of Childhood Obesity [1] shows that exposing children to second-hand smoking may increase their risk of becoming obese and hinders their cognitive development. The research also suggests that a high percentage of body fats in smoke-exposed children may even magnify their risk of developing cardiovascular disease and diabetes.

Smoking saps the body of Vitamin C

Did you know just one cigarette can make your body deficient in around 25 mg of Vitamin C? Studies show that smoking drains the levels of Vitamin C in the body and in fact it is broken down much faster in smokers than in people who don’t smoke. In one  study,  Vitamin C  was  shown to be completely  depleted  from (blood) plasma  after  six  puffs  of cigarette smoke [2].

Nicotine and other poisonous substances in tobacco smoke create an abundance of free radicals that cause destruction at the cellular level – initiating inflammatory responses and progression of many chronic, degenerative diseases such as chronic inflammation, cancer and cardiovascular disease. Our body uses up the available pool of Vitamin C to neutralize the effect of this oxidative stress – resulting both from the toxic substances in smoke as well as from the inflammatory responses –  thus causing Vitamin C to deplete faster [3]. In other words, smoking not only exerts overwhelming oxidative stress on the body but also results in increased metabolic turnover of vitamin C and other anti-oxidants, a two-fold setback for smokers who clearly need increased anti-oxidant support.

How Vitamin C is beneficial to smokers?

1. Protection against oxidative damage
   
   Fragile biological molecules such as lipids, lipoproteins and DNA are more susceptible to oxidation in smokers, where lipid oxidation is considered as an early marker in the progression of atherosclerosis. In fact, studies show that smokers have increased amounts of F2-isoprostanes, prostaglandin-like compounds produced by free radicals induced lipid peroxidation [4]. F2-isoprostanes levels are thus considered as a potential indicator of in vivo lipid peroxidation and risk factor for coronary heart disease [5].
   
   A high dose of Vitamin C (2500 mg/day) has been found to be effective in restricting the formation of isoprostane in smokers, suggesting that Vitamin C supplementation can be helpful in protecting plasma lipids against oxidative damage caused by cigarette smoke [6]. As an anti-oxidant, Vitamin C has an enormous potential to reduce the impact of toxic agents like tobacco smoke and also block the destruction to DNA that can otherwise set the stage for cancer development.

2. Improves vasodilation in smokers
   
   Cigarette smoking impairs endothelial functions and plays a big role in the progression of atherosclerosis, hypertension and cardiovascular damage. Nicotine and toxic chemicals along with large amounts of free radicals in tobacco smoke causes coronary arteries to constrict. It is believed that increased oxidative stress induced by cigarette smoke may reduce the bioavailability of endothelium-derived nitric oxide (NO), a molecule that helps to relax the smooth muscles of endothelium (inner lining of blood vessels.) 
   
   Vitamin C improves endothelial function and blood vessel relaxation possibly through a combination of different mechanisms, for example by destroying superoxide radicals, protecting intracellular glutathione or increasing the production of NO synthesis in human endothelial cell [7].
   
   Studies show that Vitamin C improves endothelium-dependent vasodilation in the brachial arteries of smokers [8]. The study concluded that “endothelium-dependent vasodilation in the brachial arteries is impaired in smokers and this impairment is improved by vitamin C administration.” Another study demonstrate that “the antioxidant vitamin C markedly improves endothelium-dependent responses in chronic smokers. This observation supports the concept that endothelial dysfunction in chronic smokers is at least in part mediated by enhanced formation of oxygen-derived free radicals” [9]. Studies also show that smoking increases the adhesion of monocytes to endothelial cells and supplementation with 2,000 mg/day of vitamin C restores the plasma concentrations of Vitamin C and decreases adhesion of monocytes [10].

3. Decreases effects of smoking in pregnancy
   
   Did you know that new-borns whose mothers continued to smoke during pregnancy have the same amount of nicotine in their blood as adults who smoke? And that they struggle with withdrawal symptoms during the initial days? Maternal smoking, both active and passive, has been linked to premature delivery, low birth weight and even miscarriages.
   
   Smoking during pregnancy also adversely affects lung development in an unborn child with a lifelong effect on pulmonary function and increased risk of developing asthma. That’s why such children are more likely to suffer from respiratory disorders, colds, ear aches and other afflictions than offspring born to mothers who don’t smoke. “At birth, new-born infants born to smokers show decreased pulmonary function test (PFT) results, with decreased respiratory flows and respiratory compliance and altered tidal breathing patterns. These changes lead to increased wheezing, hospitalization for respiratory infections, and increased incidence of childhood asthma.” [11].
   
   While the ideal solution is to quit smoking altogether, a study shows that Vitamin C supplementation decreases the effects of smoking on new-borns. “Supplemental vitamin C taken by pregnant smokers improved new-born PFT results and decreased wheezing through 1 year in the offspring. Vitamin C in pregnant smokers may be an inexpensive and simple approach to decrease the effects of smoking in pregnancy on new-born pulmonary function and respiratory morbidities.”

4. Reactivates Vitamin E
   
   Oxidative stress induced by poisonous substances in tobacco smoke highlights the importance of anti-oxidants in smokers. While Vitamin C is a strong anti-oxidant itself, it also helps the body to recycle Vitamin E, another powerful antioxidant. Vitamin C plays an important role in preventing heart attacks and also protects the respiratory system from oxidative damage. In addition to its anti-oxidant property, Vitamin E also displays other anti-inflammatory activities such as lowering monocyte-endothelial adhesion and release of inflammatory cytokines. The body also needs Vitamin E to maintain a strong immune system, and is another strong requirement for people who smoke.

5. Reduces CRP levels
   
   Smoking increases the levels of C-reactive (CRP) protein, an inflammatory biomarker that indicates an increased risk of cardiovascular disease. Vitamin C helps in lowering these excessive CRP levels [12].

6. Better recovery form surgery and illness
   
   Vitamin C concentrations in the body decrease with in any injury, trauma or surgery; possibly due to increased oxidative stress placed on the body [13]. As such, the requirement for Vitamin C increases greatly in such situations - and for smokers the increased need is emphasised even more. Without sufficient Vitamin C in the body, smokers require longer recovery times and are at increased risk of complications associated with injuries (such as infections) than are non-smokers. In addition, nicotine is known to constrict the blood vessels thus impairing their oxygen carrying capacity to the healing tissue.
   
   Vitamin C plays an important role in helping the body with managing fast recovery from surgery, wound healing and other illnesses by stimulating the formation of collagen in healing wounds and scars, and boosting the immune system to offer increased resistance against infections. It also helps blood vessels to relax and thereby to carry more oxygen and nutrients at the site of injury for faster healing.

7. Helps quit smoking
   
   Supplementing with Vitamin C for short periods can reduce nicotine cravings and even help flush nicotine along with other toxins, such as cadmium and lead, from the liver and the kidneys. Vitamin C also supports the adrenal glands. This helps in coping with additional stress your body goes through when you are trying to quit smoking. In fact, our adrenal glands contain the highest concentration of vitamin C in the body, almost 100 times more than that in the blood plasma levels.
   
   The best solution to avoid all these health risks would be to quit smoking altogether. But considering the addictive nature of the nicotine, it may take some time to kick the habit and some may even find it impossible. Taking Vitamin C supplements may downplay several risk factors and thus may offer health benefits to smokers.

References:

1. Second-hand smoke increases fatness, hinders cognition in children. EurekAlert, The Global Source for Science News.  Medical College of Georgia at Augusta University. PUBLIC RELEASE: 28-JAN-2016.
2. Eiserich JP, tan der Vliet A, Handelman GJ, Halliwell B, Cross CE: Dietary antioxidants and  cigarette  smoke induced  biomolecular  damage:  a  complex  interaction.  The American  Journal of Clinical Nutrition 1995, 62(6):1490S-1500S.
3. Lykkesfeldt J, Christen S, Wallock LM, Chang HH, Jacob RA, Ames BN. Ascorbate is depleted by smoking and repleted by moderate supplementation: a study in male smokers and nonsmokers with matched dietary antioxidant intakes. The American  Journal of Clinical Nutrition. 2000;71(2):530-536.
4. Morrow JD et al. Increase in circulating products of lipid peroxidation (F2-isoprostanes) in smokers. Smoking as a cause of oxidative damage. The new England Journal of medicine. 1995;332:1198–1203.
5. Bożena Piłacik et al. F2-Isoprostanes Biomarkers Of Lipid Peroxidation: Their Utility In Evaluation Of Oxidative Stress Induced By Toxic Agents. International Journal of Occupational Medicine and Environmental Health, Vol. 15, No. 1, 19—27, 2002.
6. Dietrich et.al.  Antioxidant supplementation decreases lipid peroxidation biomarker F2-isoprostanes in plasma of smokers. Cancer Epidemiology Biomarkers and Preventions :  a publication of the American association for Cancer Reasearch, cosponsored by the American Society of Preventive Onconology 2002 Jan;11(1):7-13.
7. LV d Uscio et. Al. Long-Term Vitamin C Treatment Increases Vascular Tetrahydrobiopterin Levels and Nitric Oxide Synthase Activity. Circulation Research. 2003
8. Motoyama et al. Endothelium-dependent vasodilation in the brachial artery is impaired in smokers: effect of vitamin C. American Journal of Physiology - Heart and Circulatory Physiology Published 1 October 1997 Vol. 273 no. 4, H1644-H1650 DOI:
9. Heitzer T et al.  Antioxidant vitamin C improves endothelial dysfunction in chronic smokers. Circulation. 1996 Jul 1;94(1):6-9.
10. Weber et al. Increased Adhesiveness of Isolated Monocytes to Endothelium Is Prevented by Vitamin C Intake in Smokers. Circulation.1996; 93: 1488-1492 doi: 10.1161/01.CIR.93.8.1488.
11. Cindy et al. Vitamin C Supplementation for Pregnant Smoking Women and Pulmonary Function in Their Newborn Infants. JAMA The Journal of the American Medical Association. 2014;311(20):2074-2082. doi:10.1001/jama.2014.5217.
12. Block G et al. Vitamin C treatment reduces elevated C-reactive protein. Free Radical Biology and Medicine. 2009 Jan 1;46(1):70-7. doi: 10.1016/j.freeradbiomed.2008.09.030. Epub 2008 Oct 10.
13. Fukushima R, Yamazaki E. Vitamin C requirement in surgical patients. Current Opinion in Clinical Nutrition and Metabolic Care. 2010 Nov;13(6):669-76. doi: 10.1097/MCO.0b013e32833e05bc.

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