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DRI DIETARY REFERENCE INTAKES FOR Vitamin C, Vitamin E, Selenium, and Carotenoids
change in urinary oxalate excretion in five of six subjects who consumed 10 g/day of vitamin C over 1 day. Levine et al. (1996a) showed increased urinary oxalate excretion in apparently healthy male volunteers consuming 1 g/day of ascorbic acid; however, mean oxalate concentrations remained within the reference range. None of these studies showed oxalate excretion above normal.
Reports of kidney stone formation associated with excess ascorbic acid intake are limited to individuals with renal disease (see Sauberlich, 1994 for a review). Data from epidemiological studies do not support an association between excess ascorbic acid intake and kidney stone formation in apparently healthy individuals (Curhan et al., 1996, 1999; Fellstrom et al., 1989). A prospective cohort study by Curhan et al. (1996) of 45,000 men aged 40 to 70 years with no history of renal calculi showed that vitamin C intake was not significantly associated with the risk of stone formation. In fact, the age-adjusted relative risk for men consuming 1,500 mg/day or more compared to less than 250 mg/day was 0.78. In addition, vitamin C intake was not associated with kidney stone formation in women (Curhan et al., 1999). The lack of findings on oxalate excretion and kidney stone formation may be explained by the limited absorption of vitamin C at doses greater than 200 mg/day (Levine et al., 1996a). Because of the limited intestinal absorption, limited amounts of vitamin C are metabolized to oxalate in the urine. In addition, the large majority of excess absorbed vitamin C is excreted in the urine as ascorbic acid rather than its degradation products.
Increased Uric Acid Excretion. Similarly, the effect of high ascorbic acid intake on urate excretion has been studied (Berger et al., 1977; Fituri et al., 1983; Hatch et al., 1980; Herbert, 1978; Levine et al., 1996a; Mitch et al., 1981; Schmidt et al., 1981; Stein et al., 1976). Theoretically, increased uric acid excretion could be an important factor in the formation of uric acid stones especially in subjects who normally excrete large amounts of uric acid. The findings are conflicting. Levine et al. (1996a) reported significantly increased uric acid excretion above the normal range following ascorbic acid intakes of 1 g/day or more in 7 apparently healthy male subjects. Another study reported a 70 to 90 percent increase in the fractional clearance of uric acid following a single 4-g dose in nine subjects (Stein et al., 1976). Other studies have shown no significant effect of ascorbic acid intakes up to 12 g/day on uric acid excretion in apparently healthy subjects (Fituri et al., 1983; Hatch et al., 1980; Herbert, 1978; Mitch et al., 1981; Schmidt et al., 1981).