Researchers at McGill University and Jewish Medical Hospital in Montreal report on August 6, 2010 in the journal Nutrition the finding of an improvement in mood among acutely hospitalized patients supplemented with vitamin C.
In their introduction to the article, Michelle Zhang and her coauthors remark that a recent survey uncovered reduced levels of vitamin C in 60 percent of acute medical ward patients in a Montreal teaching hospital, compared to 16 percent of those tested in the hospital's outpatient department. A response to systemic inflammation that often occurs in hospitalized patients could redistribute vitamin C or increase breakdown of the vitamin, resulting in deficiency.
Previous research involving supplementation of vitamin C in hospitalized patients revealed an improvement in mood; however, the trial lacked a placebo group. For the current study, 32 men and women hospitalized on medical and surgical wards were provided with 500 milligrams vitamin C or 1000 international units (IU) vitamin D (as a placebo) twice per day for up to 10 days. Mood assessment questionnaires were completed and blood levels of the vitamin were measured before and after at least 5 days of treatment.
Plasma vitamin C concentrations more than tripled in those who received the vitamin and the group experienced a 34 percent average reduction in mood disturbance. While vitamin D levels rose among patients who received it, no improvement in mood was noted; however, the authors note that the short duration of the trial and low dose of vitamin D administered in this study would be insufficient to draw any conclusions concerning its effect.
Dr Zhang and her colleagues observe that acutely hospitalized patients experience emotional distress for a number of reasons, and that psychologic abnormalities are a feature of vitamin C deficiency. The vitamin is involved in nerve transmission and neurotransmitter metabolism, and is found in high concentrations in cerebrospinal fluid. "This and other recent studies document a high prevalence of hypovitaminosis C in acutely hospitalized patients," they conclude. "Whether the explanation is tissue redistribution, insufficient vitamin C provision in a setting of increased catabolism, or both, a consequence of in-hospital hypovitaminosis C could be cerebral hypovitaminosis C with a resulting mood disorder that could be easily ameliorated or prevented by adequate vitamin C provision."
In general, surgery can be divided into three main phases: the preoperative period; the period during the surgery; and the postoperative, or recovery, period. At each of these stages, patients can take an active role in their own well-being by following documented steps to support their body’s antioxidant stores, reduce inflammation, and modulate the immune responses that accompany surgery. By paying careful attention to nutritional status, patients can speed their recovery and experience more successful results (Asher ME 2004; Schmiesing CA et al 2005).
Each of the three phases of a surgical procedure poses different threats to the patient’s well-being, although there may be considerable overlap. The most variable phase is the preoperative, or preparatory, phase. In the case of emergency surgery, this period may be limited to a very few hours (and in the case of trauma even to a few minutes). In most cases, however, both the patient and the surgical team have longer to prepare, and it is during this period that many nutritional interventions can be made. One overlooked statistic is that up to 50 percent of patients admitted to hospitals are malnourished (Patel GK 2005). This startling statistic underscores the critical importance to the surgical patient of proper nutritional intervention.
Virtually all disease processes that require surgery, including traumatic injury, impose substantial oxidative threats to tissue (DeWeese TL et al 2001). For instance, initial oxidative (free radical) damage can be caused by impaired blood supply as a tumor presses on major vessels or diverts blood from healthy tissues. Toxins may be released from infected or malignant tissue or by release of intracellular contents, including protein-damaging enzymes, from dying cells (Michalik L et al 2006).
Blood released from normal circulation into various body compartments, such as the abdomen, can itself produce oxidative damage (Potts MB et al 2006). An early response to oxidative damage is inflammation, which is aimed at destroying unhealthy tissue or invading infectious agents.
It is widely recognized that psychological and emotional stress reduces the body’s immune function and renders people more vulnerable to disease; scientists today understand that much of this effect is mediated by brain structures that influence the production of stress-induced hormones such as corticosteroids (Leonard BE 2005; Straub RH et al 2005).
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