Criteria and recommendations for vitamin C intake
Abstract
Recommendations for vitamin C intake are under revision by the Food and Nutrition Board of the National Academy of Sciences. Since 1989 when the last recommended dietary allowance (RDA) of 60 mg was published, extensive biochemical, molecular, epidemiologic, and clinical data have become available. New recommendations can be based on the following 9 criteria: dietary availability, steady-state concentrations in plasma in relationship to dose, steady-state concentrations in tissues in relationship to dose, bioavailability, urine excretion, adverse effects, biochemical and molecular function in relationship to vitamin concentration, direct beneficial effects and epidemiologic observations in relationship to dose, and prevention of deficiency. We applied these criteria to the Food and Nutrition Board's new guidelines, the Dietary Reference Intakes, which include 4 reference values. The estimated average requirement (EAR) is the amount of nutrient estimated to meet the requirement of half the healthy individuals in a life-stage and gender group. Based on an EAR of 100 mg/d of vitamin C, the RDA is proposed to be 120 mg/d. If the EAR cannot be determined, an adequate intake (AI) amount is recommended instead of an RDA. The AI was estimated to be either 200 mg/d from 5 servings of fruits and vegetables or 100 mg/d of vitamin C to prevent deficiency with a margin of safety. The final classification, the tolerable upper intake level, is the highest daily level of nutrient intake that does not pose risk or adverse health effects to almost all individuals in the population. This amount is proposed to be less than 1 g of vitamin C daily. Physicians can tell patients that 5 servings of fruits and vegetables per day may be beneficial in preventing cancer and providing sufficient vitamin C intake for healthy people, and that 1 g or more of vitamin C may have adverse consequences in some people.
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Deep-freezing is the gentlest way to preserve fruits and vegetables for their vitamin C content for a longer time.
“Summing up, the gentlest way to preserve fruits and vegetables for their content of vitamin C for a longer time is deep-freezing [3,5,11,36,37,38].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Vitamin C reduces ferric ions into ferrous ones.
“The last known function of vitamin C is associated again with its potential to reduce ferric ions into ferrous ones.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Vitamin C increases iron absorption even with a low amount of vitamin C corresponding to its content in a normal diet.
“In this way, vitamin C increases iron absorption even with a low amount of vitamin C corresponding to its content in a normal diet [5,154].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Higher levels of plasma vitamin C are correlated with a lower risk of coronary artery disease and mortality in terms of cardiovascular diseases.
“Higher levels of plasma vitamin C are correlated with a lower risk of coronary artery disease and mortality in terms of cardiovascular diseases.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The relationship between higher plasma vitamin C and lower cardiovascular risk seems to be valid only for inadequate plasma levels.
“However, this relationship seems to be valid only for inadequate plasma levels.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Vitamin C is frequently added to oral preparations containing iron in order to increase iron absorption.
“Vitamin C is frequently added to oral preparations containing iron in order to increase iron absorption [5,154].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Intravenous vitamin C or very high oral vitamin C doses can precipitate hemolysis in glucose-6-phosphate deficiency patients.
“Intravenous vitamin C or very high oral vitamin C doses can precipitate hemolysis in glucose-6-phosphate deficiency patients [5].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Plasma/serum and red blood cell levels of vitamin C are tightly controlled, and vitamin C levels can differ up to 100-fold between plasma and various tissues.
“Several authors recommend using other blood and tissue markers of vitamin C to predict clinical outcomes, as plasma/serum and red blood cell levels of vitamin C are tightly controlled, and vitamin C levels can differ up to 100-fold between plasma and various tissues [16,27,42,43].”
From Enhanced Vitamin C Delivery: A Systematic Literature Review Assessing the Efficacy and Safety of Alternative Supplement Forms in Healthy Adults (2025) · cites this paper as [43]
In pregnant women, an additional 5-10 mg of vitamin C is recommended, and 25 mg in lactating mothers.
“In pregnant women, an additional 5–10 mg is recommended (25 mg in lactating mothers) [3,4,5,6].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Recommendations for vitamin C intake differ substantially from 40 to 120 mg/day in various countries.
“Recommendations differ substantially from 40 to 120 mg/day in various countries.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The maximal steady-state, long-term vitamin C plasma levels achievable by oral administration are 70-85 μM.
“The maximal steady-state, long-term vitamin C plasma levels achievable by oral administration are 70–85 µM [5,64].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The possible reason for the plateau in white blood cells can be the saturable kinetics of active transport by SVCT2 with Km of approximately 60-70 μM, which are the approximate plasma levels associated with 100-mg daily dosing.
“The possible reason can be the saturable kinetics of active transport by SVCT2 with Km of approximately 60–70 µM, which are the approximate plasma levels associated with 100-mg daily dosing [5].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The role of vitamin C as an antioxidant has been clearly and repeatedly demonstrated in vitro, but in vivo the situation is less clear.
“Its role has been clearly and repeatedly demonstrated in vitro, but in vivo, the situation is less clear [5,6,154,155,156].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The involvement of vitamin C as an endogenous antioxidant (e.g., scavenger of ROS) is still a matter of debate.
“The involvement of vitamin C as an endogenous antioxidant, e.g., scavenger of ROS, is still a matter of debate.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
The first symptoms of vitamin C deficiency such as lassitude and tiredness, occurring at plasma levels approximately below 20 μM, can be due to decreased synthesis of carnitine.
“The first mentioned symptoms of vitamin C deficiency such as lassitude and tiredness, occurring at plasma levels approximately below 20 µM, can be due to decreased synthesis of carnitine since a deficiency in carnitine leads to decreased oxidation of fatty acids in muscles and other tissues.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
A single oral dose of vitamin C of 5-10 g produces transient osmotic diarrhea and/or abdominal bloating with pain but, otherwise, even such a high dose is considered to be safe.
“A single oral dose of vitamin C of 5–10 g produces transient osmotic diarrhea and/or abdominal bloating with pain but, otherwise, even such a high dose is considered to be safe.”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
In adequate vitamin C plasma levels, supplementation with vitamin C has a little effect.
“In adequate vitamin C plasma levels, supplementation with vitamin C has a little effect [2,5,189].”
From Vitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination (2021) · cites this paper as [5]
Vitamin C cannot be synthesized by the human body and must be introduced by diet.
“Vitamin C (ascorbic acid) is an essential cofactor in several enzymatic reactions but, since it cannot be synthesized by the human body, it has to be introduced in the organism by diet [98].”
From Antioxidants from Plants Protect against Skin Photoaging (2018) · cites this paper as [98]
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“Vitamin C transport will achieve Vmax in tissues,(61) LDL oxidation might be decreased compared with lower doses,(6,7) ascorbate recycling as a protective mechanism in neutrophils might be optimized,(64) and decreased nitrosation in the gastrointestinal tract might result from this dose.(67) Also, intake of 5 servings…”
BackgroundAntioxidants and cancer prevention
Huang, M., Ho, C., & Lee, C. Y. (1992) · American Chemical Society eBooks · Cited by 42 · see citing works
The RDA Concept: Time for a Change?
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Effect of large doses of ascorbic acid in man on some nitrogenous components of urine.
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Does vitamin C have a pro-oxidant effect?
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Self-citationRapid enzymatic determination of urinary oxalate.
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In situ kinetics and ascorbic acid requirements
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Self-citationRole of Ascorbic Acid in Modulation of Gene Expression
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Dietary Vitamin C and Serum Lipids in Black and White Girls
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Contribution of epidemiology to understanding relations of diet to age-related cataract
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Changes in plasma and buffy layer vitamin C following surgery
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Self-citationThe vitamin C content of foods.
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Vitamin C and Gastric Cancer Prevention
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Enhancement of Urinary Oxalate Excretion by Vitamin C: Fact or Artifact ?
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Free radicals, antioxidants and functional foods: impact on human health
Lobo, V, Patil, A., Phatak, A., & Chandra, N. (2010) · Pharmacognosy Reviews · doi:10.4103/0973-7847.70902 · Cited by 5,435 · see citing works
Vitamin C as an Antioxidant: Evaluation of Its Role in Disease Prevention
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Self-citationVitamin C: The known and the unknown and Goldilocks
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Self-citationVitamin C-Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination
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A new recommended dietary allowance of vitamin C for healthy young women
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Vitamin C: Update on physiology and pharmacology
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Phase I clinical trial of i.v. ascorbic acid in advanced malignancy
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Self-citationVitamin C: A concentration-function approach yields pharmacology and therapeutic discoveries
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Antioxidants from Plants Protect against Skin Photoaging
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Effect of vitamin C supplements on urinary oxalate and pH in calcium stone-forming patients
Baxmann, A. C., de O.G. Mendonça, C., & Heilberg, I. P. (2003) · Kidney International · doi:10.1046/j.1523-1755.2003.00815.x · Cited by 176 · see citing works
Scientific Opinion on Dietary Reference Values for vitamin C
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Gazdik, Z., Zitka, O., Petrlova, J., Adam, V., Zehnalek, J., Horna, A., Reznicek, V., Beklova, M., & Kizek, R. (2008) · Sensors · doi:10.3390/s8117097 · Cited by 170 · see citing works
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Regulation of vitamin C homeostasis during deficiency
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Vitamin C requirement in surgical patients
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Self-citationVitamin C supplementation and respiratory infections: a systematic review
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Oxalic acid excretion after intravenous ascorbic acid administration
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Vitamin C and myocardial infarction: the heart of the matter3
Padayatty, S. J., & Levine, M. (2000) · The American Journal of Clinical Nutrition · doi:10.1093/ajcn/71.5.1027 · Cited by 18 · see citing works
Moyad, M. A., Combs, M. A., Vrablic, A. S., Velasquez, J., Turner, B., & Bernal, S. (2008) · Advances in Therapy · doi:10.1007/s12325-008-0106-y · Cited by 15 · see citing works
Calder, P. C., Kreider, R. B., & McKay, D. L. (2025) · Nutrients · doi:10.3390/nu17020279 · Cited by 12 · see citing works
- Authors
- Levine, M.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Levine, Mark
- ORCID
- Levine, Mark
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 1999-04-21
- Volume
- 281
- Issue
- 15
- Pages
- 1415
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2062837765
- Cited by
- 559
- References
- 99
- Citations by year
- 2026: 8 · 2025: 11 · 2024: 18 · 2023: 19 · 2022: 28 · 2021: 27 · 2020: 33 · 2019: 23 · 2018: 22 · 2017: 24 · 2016: 17 · 2015: 23 · 2014: 23 · 2013: 19 · 2012: 27
- FWCI
- 19.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
- Health Sciences › Medicine › Biochemistry › Antioxidant Activity and Oxidative Stress
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
- Keywords
- vitamin C, Dietary Reference Intakes, RDA, estimated average requirement, adequate intake, tolerable upper intake level, bioavailability, dietary recommendations, cancer prevention
- MeSH terms
- Antioxidants, Ascorbic Acid, Biological Availability, Fruit, Humans, Vegetables, Free Radical Scavengers, Nutrition Policy
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