With the exception of calcium deficiency rickets in Nigeria, no satisfactory explanation has been found for the apparently low prevalence of osteoporosis in countries on low calcium intakes. On international comparisons on a larger scale, it is very difficult to separate genetic from environmental factors. Osteoporosis was largely a disease of affluent industrialized cultures. Hip fracture prevalence (and by implication osteoporosis) is consequently related to animal protein intake, but also, paradoxically, to calcium intake because of the strong correlation between calcium and protein intakes within and between societies. This could be explained if protein actually increased calcium requirement.
Fracture risk has recently been shown to be a function of protein intake in North American women. There is also suggestive evidence that hip fracture rates depend on protein intake, national income, and latitude. Vitamin D deficiency in hip fracture patients in the developed world was established. Such fractures can be successfully prevented with small doses of vitamin D and calcium. It is therefore possible that hip fracture rates may be related to protein intake, vitamin D status, or both.
Vitamin C, or L-ascorbic acid, or ascorbate, is an essential nutrient for humans, a water-soluble vitamin. Humans, unlike most animals, are unable to synthesize vitamin C, so it is an essential dietary component.
- Vitamin C is required for the biosynthesis of collagen (an essential component of connective tissue), L-carnitine, and certain neurotransmitters, it is also involved in protein metabolism.
- Vitamin C is also an important physiological antioxidant and has been shown to regenerate other antioxidants within the body, including alpha-tocopherol (vitamin E). Vitamin C regenerates vitamin E by reducing vitamin E radicals formed when vitamin E scavenges the oxygen radicals.
- Vitamin C plays an important role in immune function and improves the absorption of nonheme iron, the form of iron present in plant-based foods.
Approximately 70%–90% of vitamin C is absorbed at moderate intakes of 30–180 mg a day. At doses above 1 g a day, absorption falls to less than 50% and absorbed, unmetabolized ascorbic acid is excreted in the urine.
Insufficient vitamin C intake causes scurvy, which is characterized by fatigue or lassitude, connective tissue weakness, and capillary fragility.
Cells accumulate vitamin C. The total body content of vitamin C ranges from 300 mg (at near scurvy) to about 2 g.
- High levels of vitamin C are maintained in cells and tissues, and are highest in leukocytes (white blood cells), eyes, adrenal glands, pituitary gland, and brain.
- Relatively low levels of vitamin C are found in extracellular fluids, such as plasma, red blood cells, and saliva.