0:00

What? Do you get when you mix

0:02

Spanish missionaries? The. British Navy mosquitoes,

0:04

happy hour and pregnant women.

0:07

All in one big fun package. Well

0:09

it turns out. It's called Water

0:11

Soluble Vitamins Park to. That's right,

0:13

this week we're gonna be talking about how

0:15

all these various things come together and we're

0:17

gonna be continuing our series. On various

0:19

water soluble vitamins and the nutritional deficiencies

0:21

that can occur in your patients when

0:23

they come see you in the office.

0:26

I'm doctrine a cats on point. You're

0:28

friendly neighbors, internist and gastroenterologist. Let's. Kick

0:30

off that music and discuss. Vitamin

0:32

C. Know

0:45

our first vitamins going to be vitamin C

0:47

or Ascorbic Acid. Know all of you know

0:49

that vitamin C is something our parents have

0:52

told us to consume when we have colds

0:54

or of prevent the common cold. It turns

0:56

out it never actually worked out for that.

0:58

But. Why didn't see plays? A role in a

1:01

lot of parts than the human body. Besides.

1:03

Being an important part of every

1:05

single person's breakfast in the morning,

1:07

we need it for a lot

1:09

of different actions and biological processes

1:11

including nitric oxide synthesis, prostaglandin metabolism,

1:13

and most importantly for all the

1:15

dermatologist that you listen to on

1:17

Tic Toc. It's. Also necessary for

1:19

the formation of college in and

1:22

of course that enzymatic hydroxyl Asian.

1:24

A protein and lysine. However,

1:26

In history, it really wasn't known that

1:28

Vitamin C would play such a big

1:31

role. It actually has a deficiency state

1:33

known as scurvy, and you know this

1:35

because of it's prominent different findings on

1:37

the skin. Like. Critique He I

1:39

perry follicular hemorrhaging, bruising and even

1:41

bleeding from the gums and change

1:43

vitesse. And if you work in

1:45

impatient medicine, if you have with

1:47

severe nutrient deficiencies like Vitamin C,

1:49

they may even have impaired wound

1:51

healing. And. Scrub he's played a

1:53

role in a huge part of history. It's

1:55

been around since Ancient Egyptian, Greek, and Roman

1:58

literature. It. Turns out that the

2:00

first ever randomized controlled trial that we

2:02

accept new quote unquote as randomized controlled

2:04

trials was actually done on Scurvy. and

2:06

it has to do with the British

2:09

Navy. You see, scurvy has

2:11

been bothering people since the Crusades, and

2:13

in fact that Adama even realize that

2:15

citrus fruits or important for the people

2:18

boarding his ship. But it wasn't until

2:20

seventeen Forty seven, when a physician name's

2:22

England figured it out in that Eighteenth

2:24

century. Turned out that scurvy killed more

2:27

British sailors during wartime than enemy action

2:29

at means that they were dying from

2:31

scurvy more than anything else. And in

2:33

that time period, hundred eighty five thousand

2:36

sailors were actually enlisted in about one

2:38

hundred and thirty Four thousand. Of them

2:40

went missing or died and the assumption was

2:42

that scurvy was the leading cause. So.

2:44

James Linda physician and I'm able surgeon

2:47

the it's a metal a sound to

2:49

censor do some actual investigating. In fact,

2:51

he himself had observed about fourteen hundred

2:54

British soldiers lose their lives simply because

2:56

of scurvy. So. He went ahead

2:58

and descend to do little experiment testing

3:00

different types of foods. This. Includes

3:02

things like hard cider, vinegar, oranges, lemons

3:04

and even a mix of garlic mustard

3:06

and radish. And he wrote a book

3:09

or paper really on the treaties on

3:11

the scurvy and figured out that basically

3:13

oranges and lemons were the most of

3:15

sexual remedies for this problem at sea

3:17

time. Now he did this by taking

3:19

twelve men from the Royal Navy to

3:21

test the theory by giving them different

3:24

acidic foods like we just mentioned and

3:26

gave them to six different sets of

3:28

volunteers. After a few days he long

3:30

the outcomes is gentle saying the result.

3:32

The my experiments with an armed them lemons

3:34

were the most effective remedies. And. there

3:36

you have it the first clinical trial and

3:38

seventeen forty seven and that's how the actual

3:41

cure for scurvy began they may be wondering

3:43

is that why the british name is called

3:45

la nice exactly right you see other parts

3:47

of the world called the british me being

3:49

line juicers and as time went on it

3:51

just became line me as or the mean

3:53

he began issuing lines used to the sailors

3:55

the late seventies hundred after the paper and

3:57

this was purely to prevent scurvy So

4:00

how are your patients going to present?

4:02

Well, because we know that it's primarily

4:04

vitamin C that's a large component of

4:06

collagen synthesis, the most common symptoms that

4:08

are going to occur usually after three

4:10

months of low intake is going to

4:13

be perifolicular hemorrhaging and petechiae. So they're

4:15

going to get some easy bruising. Now

4:17

in the United States, it's actually really hard to

4:19

get a vitamin C deficiency because it's almost in

4:22

everything. We primarily see it in people who are

4:24

on TPN if their dosages aren't

4:26

right, for example, those with drug and

4:28

alcohol use disorder, or those who have

4:30

bariatric surgery, or those who have socioeconomic

4:32

issues and are unable to get fruits

4:34

and vegetables. I've actually seen

4:36

scurvy when in residency in very elderly populations,

4:39

in patients who are quote unquote shut-ins. These

4:41

are older adults who actually don't want to

4:43

go outside because they're either afraid of going

4:45

outside and not being able to get home,

4:48

or they don't want to spend money on things because they're

4:50

on a fixed income. It's very sad

4:52

to say they do develop scurvy simply because

4:54

of their tea and toast diet. That's

4:56

also going to be something you're going to see on

4:58

the boards. But if you see the words tea and

5:00

toast, start thinking scurvy. How do

5:02

you treat this? Well, it's pretty straightforward. No, no,

5:05

we're not going to tell your patients to put

5:07

on red jackets and start acting like the British

5:09

Navy and suck on limes. Basically, we're going to

5:11

give them vitamin C tablets with 300

5:13

to 1,000 milligrams a day for about a month.

5:16

Most symptoms get better within 24 hours, and

5:18

the gingival bleeding and the bruising use you within a

5:21

few weeks. Now you might

5:23

be wondering, wow, vitamin C, it's become a big part of

5:25

everything that we drink. Well, it turns out for a long

5:27

period of time it wasn't. And

5:29

this whole vitamin C boom also created the

5:31

entire idea of happy hour. Now you

5:34

might be wondering how that is. Well, it turns out back

5:36

in the day, Spanish missionaries went down to South America and

5:39

found that people were super, super sick, and they

5:41

realized that the bark of the cinchona tree, that's

5:44

right, cinchona, cinchinism, the

5:46

whole thing that happens when you have too much quinine

5:48

in your system actually protected people from malaria. So

5:51

they went ahead and started to get a whole bunch of

5:53

these tree barks and started distilling quinine. Now you

5:55

know malaria is still a big problem And

5:58

we use quinine. Nickname for the

6:00

tree back Monday was Fever Tree. If any

6:02

of you have ever been to a bar

6:04

of ever order drink there's a brand of

6:07

mixers call Fever Tree and I know where

6:09

they got the name from now on. That

6:11

time a watchmaker by the name of Johan

6:13

Jacob swept That's right you heard of said

6:15

before like they're ginger ale another beverages. He

6:17

discovered some carbonated water deposits in the foothills

6:19

of Germany and area known as Seltzer or

6:21

is you know it now as Sensor and

6:23

he decided to market this to the British

6:25

economy and it grew so now at the

6:27

exact same time you got people using quinine.

6:30

You've got brand new seltzer water and

6:32

Sin is becoming super popular in the

6:34

area and the British navy still getting

6:36

a lot of limes for their scurvy.

6:38

So as a British naval mean you've

6:40

gotta take this cinchona fever tree bark

6:42

extract which tastes like pure evil. It's

6:44

like sore on in a capsule. it's

6:46

awful and thus upon the slime and

6:48

you know there's gin and stuff seltzer

6:50

water because it's clean water. We know

6:52

you're not going to get diarrhea from

6:54

it. So what ends up happening? The

6:56

red Coat come together and decide. let's

6:58

mix it all together Now. The best way

7:00

to use quinine is the ticket. prophylactically knew that

7:02

a build up blood levels before the mosquitoes come

7:05

out at night. The best time to do that.

7:07

Mix all your drinks and things yet. The tix

7:09

together was part of being a British naval month

7:11

or and five or six pm so the quinine

7:13

levels in your bloodstream would go up. They'd get

7:15

that vitamin C from the lines is used a

7:17

ginger for the tasted good and they have it

7:20

folks. That is how whole bunch of different things

7:22

came together to create two or three of the

7:24

most common things we see today. First of all

7:26

why this gin and tonic com about While turns

7:28

out slap who them figured out. that create this

7:30

water he bought a back to britain and turn

7:32

it into on a quarter of that was bottled

7:35

they would do seem on a client and with

7:37

of people got used to drinking it the british

7:39

naval and came back started teaching their friends about

7:41

happy hour five o'clock and drinking gin and tonics

7:43

and the line or that to stuck around for

7:46

the tasted good isn't history wonderful isn't science history

7:48

even better than the united states recommend the amount

7:50

of vitamin c for an adult to be about

7:52

one hundred and twenty milligrams per day he has

7:54

ever been inside of a costco you know that

7:57

the tablet stories about thousand families and was ten

7:59

times higher Well, 120 milligrams a

8:01

day is the minimum requirement to prevent scurvy.

8:04

1,000 milligrams is to sell tablets. It turns

8:06

out that all that excess isn't really going

8:08

to be helpful. And if you're still out

8:10

there thinking about vitamin C to prevent and

8:13

cure the common cold, it turns out as

8:15

we discussed previously in many podcasts, and at

8:17

the start of this one, large meta-analyses found

8:19

that high doses of vitamin C doesn't really

8:21

prevent the common cold, doesn't treat the common

8:23

cold, and possibly maybe sort of kind of

8:25

might reduce how long the cold lasts, but

8:28

that's still not completely definite either. And with

8:30

that, ladies and gentlemen, brings us to the end

8:32

of this podcast and a very popular water-soluble vitamin,

8:34

vitamin C. I hope you learned a lot this

8:36

week, and I'll see you next week where we go

8:38

into the last two, B12 and Foley. We'll see you

8:40

then.