Molly Crenshaw

Dr. Pucciarelli

NUTR 346

Vitamin C Paper Review

16 February 2018

In this research paper, a case study is given. This is different than an experiment in the

way that an experiment is more generalized. An experiment can be applied as a general theory

while a case study is formed around only one specific patient. This provides both benefits and

limitations. Another doctor can see these findings and apply it to other patients he/she sees, thus

eliminating unnecessary tests and diagnoses. However, each patient is different and a common

symptom in multiple patients might not lead to the same diagnosis in all of them.

This particular patient has cerebral palsy and was administered to the hospital for what

was thought to be osteomyelitis. Osteomyelitis was the original concern, but no bacterial cultures

were found. Abnormalities of the collagen matrix were observed, suggesting that the patient

developed scurvy. Since there was no data on vitamin C intake, questions were asked about

dietary habits in which they discovered that “the patient was fed by his mother only with milk

products” (Bouaziz, 1317). Vitamin C was administered, the mother was educated on how to

modify the diet, and the patient’s condition improved in a time frame of three weeks.

Vitamin C cannot be synthesized by the human body because we lack the enzyme

gulonolactone oxidase, which is why consumption must be continuous. Glunololactone oxidase

converts L-Gulonolactone to ascorbic acid, or vitamin C. As pertaining to this case study,

vitamin C is a component of collagen synthesis. It is essential for collagen cross-linking.

Collagen is a major component in keeping blood vessel walls closed. Without vitamin C to help
with collagen cross-linking, the arterial walls will then become loose, causing blood to leak out.

This is why one of the signs of vitamin C deficiency is hemorrhaging. As well as hemorrhaging,

musculoskeletal abnormalities are also prevalent most of the time. In children, it is more difficult

to determine it by a radiograph. However, there are still indicators of scurvy: “osteoporosis of the

epiphysis which is surrounded by a white line of calcification…; epiphyseal separations;

transvers line of increased density…and a transverse metaphyseal bands of decreased density…”

(Bouaziz 1318). These discoveries were found in the patient.

An important fact mentioned in this case study is that the patient’s diet consisted of only

milk products. Milk is not a major source of vitamin C to begin with, but through the

pasteurization process, the vitamin is degraded and even less is available for consumption.

Because vitamin C is a water soluble vitamin, it is easily degraded by heat.

Vitamin C has many functions including collagen synthesis and the production of

neurotransmitters. This helps explain why the patient is affected by cerebral palsy. Ascorbate is

required for multiple steps in the production of neurotransmitters. If there is not a proper balance

of signals to a developing brain from neurotransmitters, musculoskeletal issues can arise. And

this is shown in the development of cerebral palsy in this patient.

Vitamin C is metabolized through oxidation reactions as well as hydrolysis and

decarboxylation reactions, vitamin C, or ascorbic acid, can be converted to multiple types of

metabolites. In this study, it cannot be metabolized because the patient is deficient. Because there

is a deficiency, collagen is degraded. In this process, vitamin C is needed for the activation of

prolyl hydroxylase. Prolyl hydroxylase is needed for the extensive hydroxylation of proline (an

amino acid) residues in collagen. Without enough vitamin C, there is not enough proline

hydroxylation occurring, thus interfering with procollagen assembly. Without procollagen

assembly, collagen is then degraded and this degradation causes blood to leak out from the

arterial walls.

This paper relates to the class because we have learned that one of the main functions of

vitamin C is to be a component in collagen synthesis. This gives a real-life example of how

important vitamin C is in the diet. It allows us to see first-hand the effects of a vitamin C

deficiency. It also helps us to see that even though deficiencies are rare, they still occur even in

developed countries. It gives us an example of potential scenarios we might encounter as

practicing dietitians. By looking at the symptoms of this patient in the case study, we are able to

look back at the science behind the metabolism and synthesis of vitamin C and determine why

certain symptoms were shown.