By Joy Stephenson-Laws, JD, Founder

This blog is probably one of the more difficult ones to write because of the toll Type 2 diabetes has taken on both my parents. I grew up hearing that my dad had passed from diabetes. I was about 3-years-old when he died. Thirty years later, my mom passed away from complications of diabetes. She was hospitalized just prior to her death for a foot ulcer, which just refused to get better. The doctors discussed with her the option of amputating her foot. She went into a coma and died soon after. In my opinion, she simply lost her will to live after being told that her foot would have to be amputated.  

Since the death of my parents, I have taken the time to learn as much as I can about this horrible disease and its complications, that affect well over 285 million people globally and 16 million people in the U.S.  

One complication of diabetes is diabetic foot disorders or ulcers. Over time, diabetes may cause nerve damage (diabetic neuropathy), which may cause you to lose the feeling in your feet. When you lose the feeling in your feet, you "may not feel a blister on your foot or a pebble inside your sock." This can lead to cuts and sores that may become infected and difficult to heal.

Nearly 20% of the estimated 16 million people in the United States with diabetes mellitus will be hospitalized with a foot complication at some point in the disease process. Like my mom, many will require some form of amputation in the area of the foot due to severe infections.

One reason why these wounds may become difficult to heal is poor blood circulation to the feet. Not having enough blood flow to your legs and feet may make it difficult for a sore or infection to heal.   

Another frequently overlooked reason is vitamin C deficiency. It has long been known that vitamin C is necessary for wound healing. According to the National Institutes of Health (NIH), vitamin C is “crucial for the proper function of the enzyme protocollagen hydroxylase which produces collagen, the primary constituent of the granulation tissue that heals a wound.” And wound healing requires more vitamin C than diet alone can easily provide.

People with diabetes are usually told to limit their intake of fruits, due to the potential effect on blood glucose levels. However, a lower intake of fruits may lead to vitamin C deficiency. And even if you eat lots of vegetables, if you overcook them you destroy the vitamin C.

Add to this the fact that recent data shows that the “diets of more than 90% of Americans fall short in providing” the Recommended Dietary Allowances (RDAs) of vitamins and minerals, including vitamin C. And this deficiency has been consistently reported over the years in the National Health and Nutrition Examination Survey (NHANES) analyses.

Not surprisingly, one study published earlier this year found that patients with newly diagnosed Type 2 diabetes had lower vitamin C levels than “matched healthy controls.”

Clinician and researcher Professor Jenny Gunton, (head of the Diabetes Centre at the Westmead Institute for Medical Research in Australia), investigated whether a vitamin C deficiency was the cause of her patient's unhealed wounds.  

According to Professor Gunton, the patient “just did not have a reason not to heal her ulcers and they'd been there for seven months and that's just not right." So she asked the patient some questions about her diet. While the patient “ate veggies quite a few times a week, she cooked them a lot.” So she tested the patient for “vitamin C and zinc levels because they are both needed for normal wound healing and she came back with a vitamin C level of 10, and normal is 40 and up."

Professor Gunton made a decision to test all the patients who attended her clinic and whose wounds were also not healing. And the majority of the group tested had extremely low vitamin C levels.  

"When I asked about their diet, one person was eating little or no fresh fruit and vegetables, but the rest ate fair amounts of vegetables; they were simply over-cooking them, which destroys the vitamin C," she said.

Reportedly, “vitamin C repletion appeared to help these ulcers.”

The study concluded that “ vitamin C deficiency should be considered in people with diabetes who have poor diets, and ulcers with delayed healing, as well as classic factors of easy bruising and bleeding gums. This report indicates that a high index of suspicion is needed, especially in people with non-healing ulcers or bruising without obvious cause.”

“Treatment of vitamin C deficiency is cheap, safe and is likely to improve wound healing.”

Vitamin C deficiency is sometimes referred to as scurvy, and typical symptoms include bleeding gums and depression. These are common symptoms that many people experience but do not connect with vitamin C deficiency.

It is difficult to believe that vitamin C deficiency is still a problem with the abundance of fruits and vegetables in our society. But vitamin C deficiency occurs frequently, with intakes below the Recommended Dietary Allowance (RDA). And the RDA is affected by many factors such as age, sex, pregnancy, lactation, certain medications and diseases. For example, certain medical conditions may reduce our ability to absorb vitamin C. When that is the case, we may have to to identify other ways to get this vitamin in our bodies, such as through liposomal delivery.  

Unlike most animals, humans cannot synthesize vitamin C. So we all need to be especially proactive about our intake, because many plant-based foods are losing nutrient value due to soil aging and erosion.

While we may need further studies in this area, there is certainly enough credible information available to support a finding that vitamin C deficiency is real and plays a critical role in the healing of diabetic wounds. Many doctors do not even consider the role vitamin C plays in our health when we complain of issues and show signs of slow recovery.

One doctor confessed “to not even considering vitamin C (or other micronutrient) deficiency in most of the generally obese diabetic patients” he sees in the hospital and clinic for diabetic ulcers and foot infections. He stated that he “will definitely do so in the future.”

So how can we be proactive about avoiding a vitamin C deficiency?

Know how much vitamin C you need.

• RDA for an adult female over the age of 18 is 75 mg (roughly the equivalent of a medium-sized orange).
• RDA for males is 90 mg.
• RDA for smokers is 35 mg more per day.
• RDA for pregnant women is 85 mg, breastfeeding women 120 mg.

Athletes may need extra vitamin C, because of the increased stress on the body from exercise. And some reports say people with diabetes may need as much as 1000 mg daily. If you are diabetic, talk to your doctor about your vitamin C needs and what foods are appropriate for you to eat, in order to help you get some of your required daily intake.

Foods rich in vitamin C include broccoli, Brussels sprouts, cauliflower, tomatoes, oranges, grapefruit, cantaloupe, spinach, bell peppers, kiwi, strawberries, mango, kale and papaya.

Most importantly, undergo nutritional testing to determine whether you are absorbing the vitamin C from the foods you eat. My mom’s doctors did not consider the possibility that her nutrient levels needed to be assessed. This may have made a world of difference in the healing of her foot and reduced the likelihood of amputation.

If you undergo testing and discover you have a deficiency, talk with your doctor about how you can tweak your diet or take quality supplements.

Enjoy your healthy life!

The pH professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, click here.