For SURGERY RECOVERY, buffered vitamin C with bioflavonoids is a necessary building block for making collagen, the protein that knits connective tissue together. Studies confirm that vitamin C speeds wound healing, and helps to form stronger scars. As an immune booster, it reduces the risk of post-operative infection. Vitamin C is also a highly effective antioxidant, protecting cells from damage by surgery-induced free radicals. With extra vitamin C, the risk of blood clots is reduced, and blood pressure is stabilized after surgery. Natural bioflavonoids also increase collagen formation, improve circulation to healing wounds, and maximize vitamin C’s effectiveness.
The trauma of surgery increases the need for vitamin C because of greater demands by several systems including cardiovascular activity, collagen production, immune function, cellular energy release, and histamine levels. This water-soluble nutrient is critically important for a host of metabolic processes–especially after surgery, and even more so with age–in addition to its familiar benefit as an immune system booster.
What is Vitamin C with bioflavonoids?
Vitamin C, also known as ascorbic acid, is a vital nutrient that is essential for forming collagen and elastin, the two main structural protein constituents that hold connective tissue and fascia together. As a powerful antioxidant and tissue protector, vitamin C also shields collagen and elastin, and healing organs, from free radical damage. Free radicals are electron-hungry molecules that attack these proteins and “steal” electrons, causing them to lose shape. If collagen or elastin are damaged, then connective tissue becomes fragile, inelastic, and incisions cannot hold together or heal easily. Vitamin C helps to keep blood vessel walls strong, ensuring robust blood flow to healing tissues. Because vitamin C is naturally a very mild acid, it is even better absorbed when it is formulated with minerals such as magnesium or potassium that act as buffers.
Bioflavonoids are biologically active plant pigments that give fruits and flowers their vibrant colors. Bioflavonoids magnify the post-operative benefits of vitamin C: they are a crucial component of the vitamin C complex, usually found together in fruits and vegetables, and they work best in tandem. Bioflavonoids enhance the absorption of vitamin C into the bloodstream. In addition, they improve its utilization, meaning that vitamin C works better within tissues in their presence. Bioflavonoids also improve circulation in their own right.
How does surgery affect the need for Vitamin C and bioflavonoids?
Vitamin C and bioflavonoids aid surgery recovery by several important mechanisms:
- Vitamin C is essential to make collagen, the primary fiber-like protein that provides tensile strength to hold the body structure together. Collagen is crucial for creating fresh, new tissue for wound healing and strong scar formation. For post-operative recovery, collagen maintains skin integrity, bone strength, and keeps tendons, ligaments, and cartilage robust around joints.Bioflavonoids work with vitamin C as crucial building blocks for collagen: They are key nutrients for skin integrity, and for healing incisions and abrasions. Bioflavonoids cross-link collagen strands, thus strengthening the collagen matrix.
- Vitamin C is necessary for making elastin, a spring-like protein that provides resilience and elasticity in new tissue so that it can stretch without tearing. Vitamin C is a critical cofactor in the biochemical step of proline and lysine hydroxylation. This step stabilizes the triple helix structure of collagen with strong hydrogen bonds and crosslinks. Without this stabilization, the structure of connective tissue could rip and disintegrate rapidly.The trauma of surgery increases the need for vitamin C, because of a greater need for the foundational connective tissue proteins, collagen and elastin, that form resilient scar tissue to knit incisions back together.
- Vitamin C and bioflavonoids counteract glycation damage to speed the healing process. Glycation is the uncontrolled reaction of sugars with proteins, where they combine in a way slightly like caramelizing, to form oxidized complexes named Advanced Glycosylation End-products (AGEs). The result is protein damage, which impedes surgery healing and injures tissues and organs. Older people and diabetics are especially at risk of delayed wound healing from glycation.
- Vitamin C is required for robust immune system function, which is especially important for patients with open wounds. Vitamin C nourishes both main aspects of the immune system: It enhances antibody production; and provides essential nutrition for immune cell function. It protects phagocyte white cells that ingest harmful foreign material, bacteria, and dead or dying cells, and reduces post-operative infection rates.
- For the adrenal glands, vitamin C is a cofactor necessary to manufacture stress-managing hormones including cortisol, which is essential for healing after the trauma of surgery. Optimal adrenal function helps maintain blood sugar at levels that deliver fuel for tissue repair, while avoiding excess glucose. Adrenal activity also supports thyroid function, ensuring good energy for recovery, stamina, and a lively metabolic rate.
- Vitamin C enhances iron absorption and utilization, reducing the risk of anemia. Ample iron stores, in a storage form called ferritin, are crucial for tissue repair and vitality, for energy to get through surgery healing, and for the demands of resuming an active lifestyle.
- Both vitamin C and bioflavonoids reduce cardiovascular risks after surgery. The chances of blood clots, heart attack, or stroke are lessened by taking extra vitamin C. It stabilizes the linings of blood vessels and cuts the incidence of atherosclerosis.Citrus bioflavonoids including rutin, quercetin, and hesperidin are documented vascular protectors: they optimize capillary permeability, which means that capillaries allow just the right amounts of fluid and electrolytes to cross through their walls. This speeds the clearing of drugs and metabolic waste, and prevents edema. Bioflavonoids also strengthen blood vessel walls and reduce fragility and bruising. They boost capillary integrity by cross-linking collagen strands to strengthen the collagen matrix in capillary walls.
- As a potent antioxidant, vitamin C can protect tissues from damage by free radicals and reactive oxygen species. These increase after the trauma of surgery and anesthetic drugs, and can cause oxidative damage to elastin and collagen, the essential connective tissue proteins. Vitamin C powerfully protects collagen and elastin, as they promote post-operative tissue healing. Bioflavonoids help to raise vitamin C levels in tissues, which further protects against free radical injury, and blocks enzymes that could cleave collagen apart.
Antioxidants are natural substances made in our bodies or from plant or mineral sources that shield all tissues from scavenging free radicals, reduce cell damage, and quench harmful peroxides that damage lipids. Antioxidants boost our own innate protective enzymes, which reduce oxidative damage caused by reactive oxygen species and superoxides. Higher tissue levels of antioxidants are protective against many chronic ailments including heart disease, diabetes, cataracts, macular degeneration, and arthritis.
Free radicals are unstable molecules that form when atoms or molecules gain or lose electrons. They are produced during normal metabolic processes, such as clearing cellular waste, exercise, inflammatory responses; or from exposure to medications, air pollutants, and industrial chemicals. Unstable free radicals have unpaired electrons, and they roam the body seeking other atoms or molecules to bond to. If they attach to tissues, these rogue free radicals cause damage to cells and DNA, called oxidative stress. Ongoing oxidative stress can lead to long-term injury to muscles, organs, and cells.
Vitamin C has a distinct role in each phase of wound healing
Because vitamin C is involved in all phases of wound healing, clinicians need to be aware of the nutritional status of post-operative patients. These people could be at risk for vitamin C deficiency, which may hinder healing.
The three main steps in wound repair are:
- The inflammatory phase which prepares the wound environment for the healing process. Vitamin C is needed for the recruitment of neutrophil white blood cells to the wound and their transformation into macrophages. Without enough vitamin C, the immune response is impaired. Neutrophils form the first line of defense against invading pathogens or tissue injury, and play a prominent role in initiating and perpetuating essential inflammation. They are strong warriors and are also capable of inflicting damage to the surrounding tissue and prolonging inflammation. Once pathogens are cleared, vitamin C ensures that unnecessary neutrophil cells are securely marked for disposal by macrophages.1
- The proliferative phase of wound healing involves rebuilding the wound with new tissue made up of collagen and extracellular matrix. Vitamin C is crucial for the synthesis, maturation, and release of collagen. If vitamin C is deficient, capillary fragility and reduced collagen tensile strength and synthesis can result.2 Without enough vitamin C, collagen laid down during the proliferative phase is disorganized and the wound is abnormally thickened.
- The maturation or remodeling phase aligns collagen fibers along tension lines, so they lay closer together and cross-link. Cross-linking of collagen makes scars stronger without excessive bulkiness. As previously discussed, vitamin C is a crucial cofactor in forming and stabilizing the structure of collagen. After wounds occur, plasma and tissue levels of ascorbic acid diminish, which may hinder the repair process. Deficiencies of vitamin C affect the maturation phase of wound healing by slowing collagen production and scar formation. Further research has shown that vitamin C can also increase collagen gene expression in fibroblasts, the cells which participate in healing by reducing the size of wound. Remodeling begins about 21 days after an injury and can continue for a year or more.3,4
Following surgery, patients require higher intakes of vitamin C to raise their plasma vitamin C levels. Taking antioxidant nutrients, including vitamin C, can accelerate wound closure in patients with delayed healing disorders.
Research confirms that Vitamin C with bioflavonoids helps surgery recovery
A 2009 study of 392 patients looked at vitamin C use as a preventative for connective tissue pain. The focus was specifically on complex regional pain syndrome type I (CRPS1) that can result from foot and ankle surgery. The results demonstrated the effectiveness of vitamin C in preventing CRPS I of the foot and ankle; a frequent complication. Vitamin C reduced inflammation and sped the healing process. The study authors recommended preventive management by using extra vitamin C to enhance tissue repair and reduce chronic pain.5
The president of the American Society of Plastic Surgeons noted that a supplement with antioxidant nutrients can speed wound healing by 20%, shaving off three days from the recovery time following a facelift or similar plastic surgery procedures. “That really is dramatic, and frankly, I didn’t expect it,” says researcher Rod J. Rohrich, MD.6
Research confirms that vitamin C deficiency results in decreased collagen synthesis, delayed healing, and worsened capillary fragility. Wounds may fail to heal because scar tissue does not form. Ascorbic acid deficiency is also associated with impaired immune function, which can decrease the ability to fight foreign microbes and increase post-op infection rate.7
Surgical case studies in 2016 were presented to show how deficiency of vitamin C impairs wound healing in post-op patients. Noting that scurvy due to vitamin deficiency is regarded as “something from the past,” researchers were concerned that patients with borderline low or subclinical levels of ascorbic acid were frequently undergoing surgery in their hospital. Although a subclinical deficiency may not lead to the hallmark symptoms of scurvy, altered collagen synthesis will have major detriments for adequate wound healing. Treating deficient patients with vitamin C “leads to swift improvement of the wound healing process post-surgery, thereby reducing the costs of extensive wound treatment and extended stays in hospital.”8
Our patients’ experience with Vitamin C with bioflavonoids
In our clinic, we prefer water-soluble vitamin C in a buffered, low-acidity potassium-magnesium blend that is gentle on the stomach, with a pH of ideally around 4.2. It is highly absorbable, and far more rarely causes loose stools than other vitamin C formulas. We like to include bioflavonoids with vitamin C, knowing that these plant pigments bring surgery healing benefits of their own and also enhance the actions of vitamin C.
Our patients undergoing surgery or healing from wounds tell us that ample doses of 1,000 to 2,000mg daily buffered vitamin C and 200-600 mg of bioflavonoids speed up their tissue healing and reduce swelling and bruising. These patients report fewer post-operative infections and shorter hospital stays, and say that they were more comfortable during the post-operative weeks.
Recommendation: Buffered vitamin C 1,000mg, buffered with magnesium and/or potassium, and including citrus Bioflavonoids 200mg, taken with any meals, one to three doses daily; or as directed by your healthcare provider.
- El Kebir, Driss, and János G. Filep. “Modulation of neutrophil apoptosis and the resolution of inflammation through β2 integrins.” Frontiers in immunology 4 (2013): 60.
- Quain, Angela M., and Nancy M. Khardori. “Nutrition in Wound Care Management: A Comprehensive Overview.” Wounds: a compendium of clinical research and practice 27.12 (2015): 327-335.
- Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients. 2017;9(11):1211. Published 2017 Nov 3.
- Moores, Jane. “Vitamin C: a wound healing perspective.” British journal of community nursing 18.Sup12 (2013): S6-S11.
- Besse, Jean-Luc, et al. “Effect of vitamin C on prevention of complex regional pain syndrome type I in foot and ankle surgery.” Foot and Ankle Surgery 15.4 (2009): 179-182.
- George Broughton, I. I., et al. “Use of herbal supplements and vitamins in plastic surgery: a practical review.” Plastic and reconstructive surgery 119.3 (2007): 48e-66e.
- Molnar JA. Overview of Nutrition and Wound Healing. In: Molnar J, editor. Nutrition and Wound Healing. First Edition ed. Boca Raton, FL: CRC Press; 2007. p. 1-14.
- Bikker, A., et al. “Ascorbic acid deficiency impairs wound healing in surgical patients: Four case reports.” International Journal of Surgery Open 2 (2016): 15-18.
- Guo, S. al, and Luisa A. DiPietro. “Factors affecting wound healing.” Journal of dental research 89.3 (2010): 219-229.