Interview with Alexander Michels
Patrick has interviewed Alexander Michels (AM), from the Linus Pauling Institute at the Oregon State University and find out what he had to say below:
PH: We really wanted to understand why the RDA/RNI that is this sufficient for older people in care homes?
AM: Unfortunately, we have no idea if the RDA/RNI is sufficient for older people regardless of their living situation. The studies that were done to establish the most recent recommendations were performed in young, healthy adults. Until someone does these studies with older adults and older adults with underlying conditions, we’ll never know what amount of vitamin C is adequate in older adults.
AM: Dietary recommendations (RDA/RNI) are not set in hopes of achieving optimum status. They are set in such fashion as to minimize risk of micronutrient deficiencies. This is completely different than promoting health outcomes. There are several nutrients, including vitamin C, that should be consumed in excess of current government recommendations, to promote better health and optimize nutrition status.
PH: How does one establish an older person’s vitamin C need?
AM: In order to establish vitamin C needs in older adults, you have to first define what you mean by “need”. Very little vitamin C is needed to prevent scurvy, but much more is required to lower risk of chronic disease. Even more is required to maximize the antioxidant protection of vitamin C in the body.
Circulating levels of vitamin C are reduced by the presence of oxidants. Older adults are under heightened oxidative stress even in the absence of any co-morbidities. Chronic diseases and the use of pharmaceuticals, both increasingly more common as we age, can increase the amount of oxidative stress in the body and lead to a depletion of vitamin C levels in the body.
There are also indications that vitamin C absorption changes with age. We do not know the full extent of how this happens because rigorous testing of vitamin C absorption in different age groups has not been done.
Because we don’t have any perfect markers of vitamin C status within the body, we usually rely on surrogates like plasma vitamin C concentrations or excretion of urinary ascorbate.
Ideally, we would all be consuming enough vitamin C that our plasma concentrations are above 50 micromoles per litre.
PH: How do we know what an older person needs to have optimal vitamin C status?
AM: Since researchers haven’t found a good biomarker of optimal vitamin C status, the only way to determine optimal vitamin C status in older persons is by systematic testing at different dose levels of supplemental vitamin C. The goal is to determine what amounts of oral vitamin C shift plasma concentrations effectively. An optimal dose in any person can be defined as the minimum amount of oral vitamin C that ensures plasma vitamin C concentrations at saturation.
PH: Should vitamin C, for these people, be taken in once, twice or three times a day?
AM: Vitamin C is probably best consumed throughout the day rather than in a single dose. The mechanisms for vitamin C absorption in the gut can become overwhelmed with too much vitamin C at once. It is possible that this is accentuated in older adults, as vitamin C transport mechanisms in the intestines could change with age.
What we are going to do first is to test older people in care homes using a urine vitamin C strip. It is normal to excrete vitamin C in the urine. An absence of urinary vitamin C is an indicator of likely deficiency. Then, we are going to give them varying amounts of vitamin C to find out what’s needed to achieve sufficiency.
We will also measure dietary intake but we hope and expect that the care homes will be feeding the required intake according to the government’s nutritional standards, eg the Reference Nutrient Intake. In that sense, the care homes may be following instructions. We suspect those instructions are wrong because they are based on younger people, over 65, not in care homes and not with the same comorbidities that increase need.
We have a leading university who are able to run with this study and we currently have the study design, background and scope to present for ethical approval.
This study is going to cost in the region of £15,000, which we need to fund. Thanks to your generous donations we have a little over £4,000 raised towards this project, once we have covered other costs. We need £11,000 more. If you can help, in any small way, here’s the link to donate. I know lots of us are frustrated with pharmaceuticals dominating this conversation but they are able to fund and run studies quickly, which is part of the problem with vitamins and food studies. Who pays, and without funds they don’t happen. Don’t let that happen with this vitamin C study that we are so close with and do donate now. We have 8,000 people signed and if 110 people gave £100 then we will have raised the funds to make this happen. Equally if you can’t afford that whatever you can give will help us achieve this goal.