intakes (Hoffer, 1973; Ludvigsson et al., 1979). Evidence that rebound scurvy may appear in infants whose mothers ingested large doses of vitamin C during pregnancy is limited to one anecdotal report of 2 infants (Cochrane, 1965). Overall, the evidence is inconsistent and does not suggest that systemic conditioning occurs to any significant extent in infants and adults.
Pro-oxidant Effects. Under certain conditions, ascorbate can act as a pro-oxidant by reducing iron and copper ions, which catalyze production of the hydroxyl radical via Fenton chemistry (Buettner and Jurkiewicz, 1996). The combination of ascorbic acid and redoxactive (non-protein-bound) iron can promote lipid peroxidation in vitro (Laudicina and Marnett, 1990). In vivo however, iron is bound to proteins such as transferrin and ferritin and therefore is not normally available for such catalytic functions. Nevertheless, the strong pro-oxidant nature of the iron-ascorbate complex in vitro raises concern that consumption of vitamin C supplements by individuals with high iron stores may contribute to oxidative damage in vivo. In addition, dietary ascorbic acid can enhance the intestinal absorption of nonheme iron (Hallberg, 1985).
Concerns for a possible in vivo pro-oxidant effect of the iron-ascorbate couple were heightened by the report of a fatal cardiomyopathy in a patient with hemochromatosis who ingested excessive vitamin C (McLaran et al., 1982). Also, an association between myocardial infarctions and serum ferritin levels has been reported in a Finnish population (Salonen et al., 1992). Other studies have not supported the latter finding that high iron stores were associated with increased risk of heart disease (Baer et al., 1994) and have not indicated that excess vitamin C intakes have contributed significantly to iron overload or oxidant damage in normal healthy people. Controlled human studies in which supplemental vitamin C was added to the meals of apparently healthy adults for periods of up to 2 years showed little or no change in iron status measures including serum ferritin (Cook et al., 1984; Hunt et al., 1994). Data on iron-ascorbate combinations in the plasma of normal healthy adults and preterm infants with high plasma ascorbate levels showed that high plasma ascorbate concentrations in the presence of redox-active iron did not cause either lipid or protein oxidation. In addition, the endogenous ascorbate prevented rather than promoted lipid peroxidation in iron-overloaded plasma (Berger et al., 1997).
Similarly, concern for an in vivo pro-oxidant action of vitamin C in concert with copper has been suggested but not substantiated. Possible increased oxidant damage in premature infants had been