Marta Canfield, MD

Marta Canfield, MD Dr. Marta Canfield is a board certified family physician who practices women's hormonal health using an integrative medicine lens. She is licensed in 12 states.

Dr. Marta Canfield does not accept any insurances. Her office is located in NC but she is available for telemedicine in NY, PA, DE, NJ, VT, MI, VA, DC, MD, FL, TN.

Vitamin C…
04/11/2026

Vitamin C…

Most people who take vitamin C take 1,000mg in a single pill. Most people who criticize that dose say absorption drops above 200mg so you're wasting your money. Both groups are missing the more interesting part of the data.

Levine et al. (1996, PNAS) conducted one of the most rigorous vitamin C pharmacokinetic studies ever done. Seven healthy men were hospitalized for 4 to 6 months on a diet containing less than 5mg of vitamin C per day. They were then repleted at seven sequential doses from 30 to 2,500mg, with steady-state plasma concentrations measured at each level.

The absorption curve is sigmoidal. Bioavailability is complete (100%) for a single 200mg dose. At 500mg it drops to roughly 73%. At 1,000mg it drops to roughly 50%. At 1,250mg it is approximately 33%. The intestinal transporter SVCT1 saturates, renal excretion increases, and the fraction you absorb declines with every step above 200mg. Levine et al. (2001, PNAS) confirmed the same pattern in 15 women.
This is the part most people stop at. It's also where the analysis gets lazy.

The fraction drops, but the total milligrams absorbed still increases. At 200mg you absorb about 200mg. At 500mg you absorb about 365mg. At 1,000mg you absorb about 500mg. You are absorbing more vitamin C at every dose increase. You are just doing it less efficiently per milligram. Less efficient is not the same as useless.
This matters because of what happens on the demand side. Immune cells, particularly neutrophils, monocytes, and lymphocytes, actively concentrate vitamin C to levels 50 to 100 times higher than plasma through SVCT2 transporters. In healthy people consuming at least 100mg per day, intracellular concentrations reach roughly 1.5 mM in neutrophils and 3.5 mM in lymphocytes. These cells saturate at about 100mg daily intake under normal conditions.

But conditions are not always normal. During infection, inflammation, surgery, or critical illness, plasma vitamin C can drop below 30 micromol/L within days. Activated neutrophils burn through vitamin C during the oxidative burst, taking up oxidized dehydroascorbic acid via glucose transporters and reaching intracellular concentrations as high as 10 mM. The body pool, roughly 1.5 to 2 grams total, can be substantially depleted during severe illness. At that point, the rate of consumption exceeds what a 200mg dose can replace.

This is the argument for higher doses during illness. Not that absorption is efficient. It is not. But that the absolute amount reaching your bloodstream is still higher at 500 or 1,000mg than at 200, and during periods of high demand, that additional supply maintains the plasma floor your immune cells draw from. The Cochrane review on vitamin C and the common cold (Hemila & Chalker, 2013) found that regular supplementation (200mg to 2g daily) reduced cold duration by 8% in adults and 14% in children, with larger effects in those under physical stress.

The practical insight is not about whether to take more. It is about how to take it.

200mg taken five times per day delivers approximately 1,000mg absorbed, because each individual dose falls within the range of complete bioavailability. 1,000mg taken once per day delivers approximately 500mg absorbed, because the single large dose exceeds SVCT1 saturation.

Same total dose. Roughly double the absorption. If you are going to take a gram of vitamin C per day, splitting it into smaller doses across the day is a straightforward way to get more of it into your body.
For most healthy people eating a reasonable diet, 200 to 400mg per day is sufficient to saturate plasma and immune cells. Supplementation beyond that has diminishing returns under normal conditions. But during acute illness or high physical stress, the math changes because the demand side changes, and split dosing becomes the most efficient way to meet it.
J

Levine et al., PNAS, 1996
Levine et al., PNAS, 2001
Hemila & Chalker, Cochrane Database Syst Rev, 2013

04/10/2026

Most people who take CoQ10 think of it as an antioxidant. It is one. But that is not the most important thing it does.

CoQ10 is the only mobile electron carrier in the inner mitochondrial membrane. The electron transport chain has four protein complexes fixed in the membrane. Complex I accepts electrons from NADH. Complex II accepts them from FADH2. But neither can pass those electrons directly to Complex III. They hand them to CoQ10, which physically shuttles across the lipid bilayer to deliver them. Complex III passes them to Complex IV, which reduces oxygen to water and drives the proton gradient that ATP synthase uses to produce ATP.

Without CoQ10, the chain breaks between Complex I/II and Complex III. Electrons have nowhere to go. The proton gradient collapses. ATP production stalls. This is not an antioxidant function. This is the core mechanism of aerobic energy production.

CoQ10 is predominantly synthesized endogenously through the mevalonate pathway, the same pathway that produces cholesterol. HMG-CoA reductase is the rate-limiting enzyme. Statins inhibit HMG-CoA reductase. That is how they lower cholesterol. It is also how they lower CoQ10.

An updated meta-analysis by Qu et al. (2018) pooled 12 RCTs with 1,776 participants and found statins significantly reduced circulating CoQ10. The reduction was independent of statin type, intensity, or treatment duration. Both lipophilic and hydrophilic statins produced the same effect. This is consistent with what the biochemistry predicts: the pathway is shared.

On top of statin-induced depletion, CoQ10 in human heart tissue declines naturally with age. Kalén et al. (1989) measured CoQ10 concentrations in myocardial tissue and found levels peak around age 20, decline by more than 30% by age 40, and drop approximately 50% by age 80. The organ with the highest energy demand loses half its electron carrier over a lifetime.

A 2025 meta-analysis by Kovacic et al. (Journal of Nutritional Science, 7 RCTs, 389 patients) found CoQ10 supplementation significantly reduced statin-associated muscle symptoms measured by pain intensity. This is the most current pooled data on clinical outcomes.

One important nuance: while plasma CoQ10 depletion from statins is well established, whether intramuscular CoQ10 drops proportionally is inconsistent. Some studies found no change or even increases in muscle tissue CoQ10 during statin treatment. The plasma reduction may partly reflect reduced LDL particles, which are the primary carriers of CoQ10 in blood. The clinical significance of depletion beyond muscle symptoms remains debated.

Roughly 200 million people worldwide take statins. The mevalonate pathway that produces their target also produces the electron carrier their mitochondria depend on. The mechanism is not controversial. The clinical implications are still being defined.

Kalén et al., Lipids, 1989.

Qu et al., Eur J Med Res, 2018.

Kovacic et al., J Nutr Sci, 2025.

Say it louder for those in the back….So many patients tell me they are told a progestin is progesterone. It is not. It i...
04/06/2026

Say it louder for those in the back….

So many patients tell me they are told a progestin is progesterone. It is not. It is a Progestogen - umbrella ☂️ term for the class and then progestins (birth control) and progesterone (Bioidentical) are very, very different in what they do in the body.

A patient told me that her midwife told her the micronized progesterone she was taking would work as birth control! 😱 Um, no!

Please understand what you are taking because your provider doesn’t always know. 🥴🥴🥴

If you want help please let me know! My goal is to educate women so you can be your own health advocate.

05/14/2025
My Free Weight Optimization Webinar:
05/10/2025

My Free Weight Optimization Webinar:

How I think about Weight Loss...

Are you tired, have brain fog, feel anxious and stressed out?Have you tried to lose weight with exercise and diet but no...
03/16/2025

Are you tired, have brain fog, feel anxious and stressed out?

Have you tried to lose weight with exercise and diet but nothing changes?

Do you feel like no matter how much sleep you are always tired?

You could have thyroid and/or adrenal gland dysfunction.

Let me help you get to the root cause of your symptoms with quizzes, education, lab work and steps to take to feel better!

This is a 2 part group visit - 60 min zoom, 4 weeks apart. It costs $250 per person paid in full ($300 if paid in two payments). Total value $850.

Dates: April 2nd and April 30th from 12-1pm via Zoom.
Who is this for? Any woman who has felt this way but maybe can't afford to see me 1-on-1.

https://SchedulewithDrCanfield.as.me/Thyroid-Adrenal-Group-Visit

Or Visit my Website and click on Schedule an Appointment.
Licensed States: NY, NJ, PA, DE, MI, VA, MD, DC, FL, TN, NC, NH, VT.

06/28/2024
Next Up: April 18th at 12:15pm via Zoom - stay tuned for the link to sign up for free. A Free Webinar Weight Optimizatio...
03/26/2024

Next Up: April 18th at 12:15pm via Zoom - stay tuned for the link to sign up for free.

A Free Webinar Weight Optimization Introduction for Women
Join me to learn how weight loss should really be weight optimization and ultimately that equals hormone balancing.

Especially for women who suffer from PCOS, insulin resistance, prediabetes and diabetes type 2 or are in perimenopause and menopause.




Today! Sign up here - it's FREE! This is the number one topic I am asked about...don't worry if you can't make it live, ...
03/21/2024

Today! Sign up here - it's FREE! This is the number one topic I am asked about...don't worry if you can't make it live, sign up and you'll get the recording right in your secure account.

https://lets-talk-hormones.teachery.co/let-s-talk-hormones-free-webinar

TODAY! Join me LIVE at 12:15pm today for a FREE webinar on women's hormones.

Let's Talk Hormones! A Guide to Understanding Your Menstrual Cycle (from first through second puberty - hello, menopause!)

https://lets-talk-hormones.teachery.co/let-s-talk-hormones-free-webinar

Address

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Mooresville, NC
28117

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Monday 9am - 5pm
Tuesday 9am - 5pm
Wednesday 9am - 5pm
Thursday 9am - 5pm

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+16072282945

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