Literature Review

Antioxidants are known to be one of the most important substances a human being can

consume due to their ability to fight off damaging free radicals in the body. Free radicals are

damaging molecules that create oxidative stress within the body; this stress contributes to a

greater likelihood for the risk of disease. Antioxidants such as vitamin C, vitamin E, and

carotenoids help protect cells from damage caused by free radicals (Antioxidants, 2014).

Since it is important to keep the body healthy, it is beneficial to know there are vast sources of

antioxidants, some of which can be found naturally in the body, in food, as well as in the form of

supplementation.

Vitamin C is a water soluble vitamin that helps produce collagen, assists in maintaining

connective tissue, as well as aids in the absorption of iron and folate. Vitamin C can be found in

food sources such as citrus fruits, strawberries, tomatoes and potatoes (Antioxidants, 2014).

The appropriate amount of vitamin C per day is dependent on the individuals age and sex. Men

over the age of eighteen should receive 90 mg per day, whereas woman over the age of eighteen

should receive 75 mg per day. The upper limit of this vitamin is 2,000 mg, this means that if this

number exceeded, an individual may experience diarrhea, nausea, vomiting, etc.

On the other hand, vitamin E is a fat soluble vitamin thats function is to protect tissue

from oxidative stress that can lead to cancer, heart disease, and cataracts as we age

(Antioxidants, 2014). This vitamin can be found in substances such as vegetable oil, salad

dressing, and wheat germ. Like vitamin C, an adequate amount of vitamin E is also mostly

dependent upon age and sex. The recommended amount for men and women over the age of
fourteen is 15 mg. The upper limit for this vitamin is 1000 mg, and if exceeded, an individual

may experience an inability to clot blood after a cut.

Today, strokes are the leading cause of adult disability and the second most common

cause of death (Jena et al., 2017). A stroke is defined as rapidly developed clinical signs of

focal and at times global disturbances of cerebral function lasting more than twenty four hours or

leading to death, with no apparent cause other than vascular origin (Jena et al., 2017). Although

there are numerous types of stokes, this review aims to focus one specific type, an acute ischemic

stroke. An acute ischemic stroke results from blockage of a cerebral artery or impaired cerebral

blood flow due to cervical or intracranial arterial stenosis (Heit & Wintermark, 2017), which is

a buildup of plaque inside the arterial wall. In the elderly population, an ischemic stroke accounts

for over eighty percent of all stroke cases (Jena et al., 2017). The goal of ischemic recovery is to

preserve tissue and restore blood flow to the compromised area of the brain. This is often

achieved by tissue plasminogen activator, which dissolves the clot. Although this treatment has

been proven effective, patients still often suffer from neurological damage.

Although antioxidants play a major role in the body, they have been known to play a

larger role in protecting against disease. Neurological damage caused by an ischemic stroke has

an undisputed relationship to oxidative stress, due to the brains cellular membrane lipids, which

are rich in polyunsaturated fatty acid side chains (Jena et al., 2017). This is important because

these side chains are extremely sensitive to attacks from free radicals. In one study, within

twenty four hours of the attack, fifty acute stroke patients were examined and compared to fifty

healthy age and sex matched controls. The examination showed that the patients and an increase

in free radicals in the brain and decreased antioxidants in the body, as compared to the controls

(Jena et al., 2017). This study demonstrates the protective nature of antioxidants against disease.
 Furthermore, a study of the Mediterranean diet concluded that adherence to the diet

resulted in reduced risk of stroke, especially among males. The Mediterranean diet is known for

its high abundance of antioxidant foods and can therefore be concluded that antioxidants played

a noteworthy role in protecting against this disease (Psaltopoulou et al., 2013).

Along with many other studies, antioxidants have been proven to increase disease

protection in the body, there is little evidence to support that antioxidants have the ability to

increase neurological recovery time in ischemic stroke patients. The journal article

Antioxidants- Protecting healthy Cells (2014), claims that antioxidant supplementation has not

shown to be beneficial in preventing disease or; however this does not mean that they would not

be helpful in the recovery process.

In fact, one study demonstrates how an antioxidant chemical may be useful in the

recovery process. During this study, 142 adult rats were used to test the effects of alpha-lipoic

acid, an antioxidant chemical, on ischemic stroke recovery. All of the rats were deprived of

blood flow to the brain for two straight hours, causing ischemia. After the two hours, seventy one

rats were allowed blood flow to the brain, this was known as the control group. The other

seventy one rats were allowed blood flow to the brain as well as a shot of alpha-lipoic acid; this

was the experimental group. Short term results found that the experimental group seemed to have

a decreased mortality rate, a decreased neuron damage rate, and a decreased deficit score when

compared to the control group (Kang-Ho at al., 2015). This study seemed to be successful in rats,

and it would be beneficial to try a similar evaluation abiding by ethical standards for human

participants.
 Antioxidants have the potential to increase the neurological recovery time in ischemic

stroke victims. Due to the fact that this theory has not been tested on members of the human

species, it would benefit human kind to know if antioxidants do, in fact, speed up recovery time.

This study would help the patient because it would potentially increase quality of life. Since this

study is the beginning of such research, it would be irresponsible to pick a random antioxidant

supplement, therefore, this study should be tested using one of the most powerful antioxidants;

vitamin C.

Introduction

Strokes are among the leading causes of elderly death in the world. This study strives to learn the

significance of a 1,000 mg vitamin C supplement in relation to recovery time after an acute

ischemic stroke. This is important information because if the hypothesis of the study suggests

accuracy, patients and their families can significantly benefit in knowing that the supplement can

improve recovery outcome time. However, if the hypothesis is proven to be insignificant, we will

have gained the knowledge that this antioxidant has no effect on recovery time and can therefore

take another approach while researching this topic.

Research Question

What is the relationship between a 1,000 mg vitamin C supplement and neurological recovery

time in male acute ischemic stroke patients between the ages of fifty five and sixty five in

northeastern Pennsylvania?

Sub questions
-What will be the recovery time in the variable group consuming a 1,000 mg vitamin C

supplement?

- What will be the recovery time in the control group who will receive a placebo?

-What is the relationship between a 1,000 mg vitamin C supplement and recovery time?

Independent Variable

-The amount of vitamin C the participants will receive

Dependent Variable

-The neurological recovery time outcome in the participants

Hypothesis

Taking a 1,000 mg supplement of vitamin C will decrease recovery time in male ischemic stroke

patients.

Null Hypothesis

There will be no difference in the neurological recovery time in male acute ischemic stroke

patients due to taking a 1,000 mg vitamin C supplement compared to the placebo.

Definition of Terms

Acute ischemic stroke is a cerebrovascular disorder caused by deprivation of blood flow to an

area of the brain. In this study it will be defined as a blockage or impairment of blood flow to the

brain due to a buildup of plaque inside the cerebral artery wall

Recovery is the process of combating a disorder or a real or perceived problem. In this study

recovery means the regaining of speech abilities, physical sensation, physical movement, and

memory loss

Supplement provides sufficient quantities of a specific nutrient through a pill like capsule. In this

study the supplement is 1,000mg of vitamin C

Delimitations

-This study is limited to males between the ages of fifty five and sixty five in northeastern

Pennsylvania

-This study is limited to 200 patients who have suffered an acute ischemic stroke in the past three

weeks

-This study is limited to a time frame of one year

Limitations

-Willingness of patients to participate

-Generalization of sample size may not represent the whole population well

-Improvements in recovery may be due to factors other than the vitamin C supplement

Assumptions

-Participants will answer all questions honestly

-Participants will not receive help during testing

-Participants will have prior knowledge of the tasks they will be asked to perform
Research Sample

This study will use a convenience non-probability sampling. The sample will consist of males in

northeastern Pennsylvania between the ages of fifty five and sixty five who have suffered an

acute ischemic stroke within the past three weeks. Participants will be recruited via notices in

hospital settings and posters. The maximum amount of participants will be 200 and informed

consent will be active. Exclusion criteria include participants who may move out of the area.

Instrumentation

The European Stroke Scale measures the functions of individuals after they have suffered

a stroke involving the middle cerebral artery. Some of the function categories include speech,

facial movement, arm rising, and strength in fingers. This scale has a minimum scale of zero and

a maximum scale of 100. I will use it to measure stoke patients function during the initial

meeting and I will use it periodically for one year after the stroke to see if the scores significantly

change.

Research Design

This descriptive quantitative study will examine the correlation between males between the ages

of fifty five and sixty five, who have recently suffered an acute ischemic stroke, and a 1,000 mg

vitamin C supplement. This study aims to demonstrate whether or not the antioxidant will

improve neurological recovery time in the participants when compared to males who have not

taken the supplement.

Procedure
Permission to conduct this study will be obtained through the Marywood IRB. The researcher

will email hospitals throughout northeastern Pennsylvania, telling them about the study the

researcher would like to conduct and asking if they would be willing to distribute posters with

information of my study throughout the building. If they say no, the researcher will discontinue

contact. If they say yes, the researcher will email them fifty copies of my poster to hang

throughout their hospital. This poster will state what the research is for and the aims. It will also

state that the research requires male participants between the ages of fifty five and sixty five,

who have suffered an acute ischemic stroke within the past three weeks. The poster will have

information about the exclusion criteria, the duration of the study, an explanation of what the

participant can expect, the reward for participating, the date in which participants will no longer

be accepted, and my contact information. After the date that participants will no longer be

accepted, two weeks, the researcher will go to the hospitals and visit with the participants who

have agreed to do the study. The researcher will tell them more about the study, their

expectations, and ask if they have any questions. The researcher will then hand them a consent

form in which the researcher will read to them and have them sign. The researcher will then file

it alphabetically in a folder. After the researcher has done this with the participant, the researcher

will then use the European Stroke Scale to determine their function ability and save their scores.

After doing this with all the participants, the researcher will then write down everyones names

on separate sheets of paper and mix them up. The researcher will then divide evenly, one group

will receive the 1,000mg supplement of vitamin C that the researcher purchased and the other

half will receive a placebo. The researcher will then contact the hospitals and send the

substances; they will make sure that the participants receive their substance every day. Every

month for a year, the researcher will go to each participant and conduct the same European
Stroke Scale test with them to test their function. The researcher will then input the results

monthly into the spss system analyzation to explore themes and subthemes.

Analysis

Sub problem One- what will be the recovery time in the variable group consuming a 1,000 mg

vitamin C supplement, will be analyzed using frequency distribution and other descriptive

statistics.

Sub problem two- what will be the recovery time in the control group who will receive a

placebo, will be analyzed using frequency distribution and other descriptive statistics.

Sub problem three- what is the relationship between a 1,000 mg vitamin C supplement and

recovery time in male acute ischemic stroke patients between the ages of fifty five and sixty five

in northeastern PA, will be analyzed using independent samples t test.

 References

Antioxidants - Protecting Healthy Cells. (2014, December 22). Academy of Nutrition and

Dietetics. Retrieved from http://www.eatright.org/resource/food/vitamins-and-

supplements/types-of-vitamins-and-nutrients/antioxidants.

Heit, J. J., & Wintermark, M. (2017). New developments in clinical ischemic stroke prevention

and treatment and their imaging implications. Journal of Cerebral Blood Flow &

Metabolism. doi:10.1177/0271678x17694046

Jena, I, Nayak, S.R., Behera, S., Singh, B., Ray, S., Jena, P., & Sahoo, S.K. (2017). Evaluation of

ischemia-modified albumin, oxidative stress, and antioxidant status in acute ischemic

stroke patients. Journal of Natural Science, Biology, and Medicine, 8(1), 110-113.

doi:10.4103/0976-9668.198346

Kang-Ho, C., Man-Seok, P., Hyung-Seok, K., Kyung-Tae, K., Hyeon-Sik, K., Joon-Tae, K., & ...

Ki-Hyun, C. (2015). Alpha-lipoic acid treatment is neurorestorative and promotes

functional recovery after stroke in rats. Molecular Brain, 8(1), 1-16. doi:10.1186/s13041-

015-0101-6

Psaltopoulou, T., Sergentanis, T. N., Panagiotakos, D. B., Sergentanis, I. N., Kosti, R., &

Scarmeas, N. (2013). Mediterranean diet, stroke, cognitive impairment, and depression:

A meta-analysis. Annals of Neurology, 74(4). doi:10.1002/ana.23944