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Thursday 20 June 2019
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Letters to the Editor

Lack of vitamin C and diabetic patients

THE EDITOR: There are over 500 amputations each year in TT, according to information from the Ministry of Health. This is a most alarming situation for a country of only 1.4 million people. It is one of the unpleasant outcomes of the failure of wounds to heal in diabetic patients.

The main approach to addressing this situation is the launch by the ministry of an awareness campaign on non-communicable diseases and the need for healthy lifestyles. This of course is commendable since, as is often said, we are what we eat.

However, as I have pointed out in the past, a more fundamental issue remains unaddressed. This is the observation that there tends to be a deficiency in older people of the trace element chromium that is essential for the metabolism of glucose and the prevention of diabetes.

Robert Crayhon’s Nutrition Made Simple indeed argues, “Chromium in adequate amounts may completely prevent adult-onset diabetes.”

But there is another factor that can directly address this horrendous situation. Collagen, a substance manufactured by the body, is critical for the healing of wounds as it provides mechanical strength in the rebuilding of tissue.

Vitamin C is necessary for the manufacture of collagen and in the absence of this nutrient, the resulting collagen fibres are structurally weak and hence the healing process is severely impaired.

Also, glucose competes with vitamin C for uptake into body cells and in the presence of high glucose levels, as occurs in diabetic patients, very little vitamin C gets into cells, resulting in weak collagen fibres and the failure of wounds to heal. This problem can be reduced by simply increasing the intake of vitamin C through supplementation.

In a report in the journal Diabetic Medicine published in November 2016, researchers studied 11 diabetic patients. Seven of them had non-healing foot ulcers, six of whom had vitamin C deficiency. Of the four diabetic patients without foot ulcers, three had low vitamin C levels. Thus vitamin C deficiency appeared common among diabetics. The researchers treated the patients with 500-1000mg vitamin C daily and five of the seven healed their ulcers.

Dr Dean Winslow, Professor of Medicine at Stanford University School of Medicine, said in a commentary that he found the results intriguing. He stated:

“Although this small study does not describe well the presence or absence of traditional risk factors for lower extremity ulcers in these 11 patients with diabetes (vascular disease and neuropathy), the prevalence of vitamin C deficiency in this small cohort of patients is striking.

“I confess to not even considering vitamin C (or other micronutrient) deficiency in most of the generally obese diabetic patients I see in the hospital and clinic for diabetic ulcers and foot infections, but I will definitely do so in the future.”

Perhaps our local healthcare providers should follow the science and do the same.

PROF STEPHAN GIFT

Pro-Vice Chancellor

Graduate Studies & Research, UWI

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