SCURVY

Scurvy

Scurvy is the name for a vitamin C deficiency. It can lead to anemia, debility, exhaustion, spontaneous bleeding, pain in the limbs, and especially the legs, swelling in some parts of the body, and sometimes ulceration of the gums and loss of teeth.

Scurvy has been known since ancient Greek and Egyptian times. It is often associated with sailors in the 15th to 18th centuries, when long sea voyages made it hard to get a steady supply of fresh produce. Many died from the effects.

It also occurred during the Irish potato famine in 1845 and the American Civil War. The most recent documented outbreak was in Afghanistan in 2002, following war and a drought.

Modern cases of scurvy are rare, especially in places where enriched breads and cereals are available, but it can still affect people who do not consume enough vitamin C.

Scurvy is a state of dietary deficiency of vitamin C (ascorbic acid). The human body lacks the ability to synthesize and make vitamin C and therefore depends on exogenous dietary sources to meet vitamin C needs.The body's pool of vitamin C can be depleted in 1-3 months. Ascorbic acid is prone to oxidation in vivo, and body stores are affected by environmental and lifestyle factors (eg, smoking), biological conditions (eg, inflammation, iron excess), and pathologic conditions (eg, malabsorption) that may alter its oxidation. Consumption of fruits and vegetables or diets fortified with vitamin C is essential to avoid ascorbic acid deficiency.

Fast facts about scurvy:

Here are some key points about scurvy. More detail is in the main article.

·     Symptoms of scurvy result from severe vitamin C deficiency.

·     They include bleeding sores, tooth loss, anemia, and a reduced rate of healing for injuries.

·     It can be fatal if left untreated.

·     Scurvy is treatable with oral or intravenous vitamin C supplements.

What is scurvy?

Scurvy happens when there is a lack of vitamin C, or ascorbic acid. The deficiency leads to symptoms of weakness, anemia, gum disease, and skin problems.

This is because vitamin C is needed for making collagen, an important component in connective tissues. Connective tissues are essential for structure and support in the body, including the structure of blood vessels.

A lack of vitamin C will also affect the immune system, absorption of iron, metabolism of cholesterol and other functions.

Symptoms

One of the more notable symptoms of scurvy is the loss of and damage to teeth

Vitamin C is a necessary nutrient that helps the body absorb iron and produce collagen.

If the body does not produce enough collagen, tissues will start to break down.

It is also needed for synthesizing dopamine, norepinephrine, epinephrine, and carnitine, needed for energy production.

Symptoms of vitamin C deficiency can start to appear after 8 to 12 weeks. Early signs include a loss of appetite, weight loss, fatigue, irritability, and lethargy.

Within 1 to 3 months, there may be signs of:

·         anemia

·         myalgia, or pain, including bone pain

·         swelling, or edema

·         petechiae, or small red spots resulting from bleeding under the skin

·         corkscrew hairs

·         gum disease and loss of teeth

·         poor wound healing

·         shortness of breath

·         mood changes, and depression

In time, the person will show signs of generalized edema, severe jaundice, destruction of red blood cells, known as hemolysis, sudden and spontaneous bleeding, neuropathy, fever, and convulsions. It can be fatal.

What are the symptoms of scurvy?

Vitamin C plays many different roles in the body. A deficiency in the vitamin causes widespread symptoms.

Typically signs of scurvy begin after at least four weeks of severe, continual vitamin C deficiency. Generally, however, it takes three months or more for symptoms to develop.

Early warning signs

Early warning signs and symptoms of scurvy include:

·         weakness

·         unexplained exhaustion

·         reduced appetite

·         irritability

·         aching legs

·         low-grade fever

Symptoms after one to three months

Common symptoms of untreated scurvy after one to three months include:

·         anemia, when the blood lacks enough red blood cells or hemoglobin

·         gingivitis, or red, soft, and tender gums that bleed easily

·         skin hemorrhages, or bleeding under the skin

·         bruise-like raised bumps at hair follicles, often on the shins, with central hairs that appear corkscrewed, or twisted, and break easily

·         large areas of reddish-blue to black bruising, often on the legs and feet

·         tooth decay

·         tender, swollen joints

·         shortness of breath

·         chest pain

·         eye dryness, irritation, and hemorrhaging in the whites of the eyes (conjunctiva) or optic nerve

·         reduced wound healing and immune health

·         light sensitivity

·         blurred vision

·         mood swings, often irritability and depression

·         gastrointestinal bleeding

·         headache

Left untreated, scurvy can cause life-threatening conditions.

Severe complications

Symptoms and complications associated with long-term, untreated scurvy include:

·         severe jaundice, which is yellowing of the skin and eyes

·         generalized pain, tenderness, and swelling

·         hemolysis, a type of anemia where red blood cells break down

·         fever

·         tooth loss

·         internal haemorrhaging

·         neuropathy, or numbness and pain usually in the lower limbs and hands

·         convulsions

·         organ failure

·         delirium

·         coma

·         death

Infants with scurvy will become anxious and irritable. They may experience pain that causes them to assume a frog-leg posture for comfort.

Scurvy in infants

Infants with scurvy will be irritable, anxious, and difficult to soothe. They may also appear to be paralyzed, lying with their arms and legs extended halfway out. Infants with scurvy may also develop weak, brittle, bones prone to fractures and hemorrhaging, or bleeding.

Risk factors for scurvy in infants include:

·         malnourished mothers

·         being fed evaporated or boiled milk

·         difficulty nursing

·         restrictive or special dietary needs

·         Digestive or absorption disorders.

There may also be subperiosteal hemorrhage, a type of bleeding that occurs at the ends of the long bones.

Animal studies have shown that vitamin C deficiency in a woman during pregnancy can lead to problems with fetal brain development.

Causes

The main cause is an insufficient intake of vitamin C, or ascorbic acid.

Risk factors

Not getting enough vitamin C is a cause of scurvy. To prevent this, get a healthy amount of vitamin C from sources such as oranges and fresh fruit.

Humans cannot synthesize vitamin C. It needs to come from external sources, especially fruits and vegetables, or fortified foods.

A deficiency may result from:

·         a poor diet lacking in fresh fruits and vegetables, possibly due to low income or famine

·         illnesses such as anorexia and other mental health issues

·         restrictive diets, due to allergies, difficulty orally ingesting foods, or other reasons

·         older age

·         excessive consumption of alcohol or use of illegal drugs

Late or unsuccessful weaning of infants can also lead to scurvy.

Conditions, treatments, or habits that reduce the body's ability to absorb nutrients, such as Crohn's disease, ulcerative colitis, chemotherapy, and smoking, increase the risk.

Treatment

Treatment involves administering vitamin C supplements by mouth or by injection.

The recommended dosage is:

·         1 to 2 grams (g) per day for 2 to 3 days

·         500 milligrams (mg) for the next 7 days

·         100 mg for 1 to 3 months

Within 24 hours, patients can expect to see an improvement in fatigue, lethargy, pain, anorexia, and confusion. Bruising, bleeding, and weakness start to resolve within 1 to 2 weeks.

After 3 months, a complete recovery is possible. Long-term effects are unlikely, except in the case of severe dental damage.

Diagnosis

A physician will conduct a physical exam, and request lab tests to assess vitamin C levels in the blood.

Imaging tests can reveal internal damage resulting from scurvy.

Prevention

Scurvy can be prevented by consuming enough vitamin C, preferably in the diet, but sometimes as a supplement.

The United States (U.S.) Office of Dietary Supplements (ODS) advise the following intake of vitamin C:

·         Up to 6 months: 40 mg, as normally supplied though breastfeeding

·         7 to 12 months: 50 mg

·         1 to 3 years: 15 mg

·         4 to 8 years: 25 mg

·         9 to 13 years: 45 mg

·         14 to 18 years: 75 mg for men and 65 mg for women

·         19 years and above: 90 mg for men, 75 mg and women

During pregnancy, women should consume 85 mg of vitamin C, rising to 120 mg while breastfeeding.

Smokers need 35 mg more than nonsmokers every day.

Food sources

Foods that contain vitamin C include:

·         fruits, such as oranges, lemons, strawberries, blackberries, guava, kiwi fruit, and amla

·         vegetables, especially tomatoes, carrots, bell peppers, broccoli, potatoes, cabbage, and spinach

Other good sources are paprika, liver, and oysters

One medium orange contains 70 mg of vitamin C, and a green bell pepper contains 60 mg.

Ascorbic acid can be destroyed by heat and during storage, so fresh, raw fruit and vegetables offer the best supply.

Vitamin C supplements are also available to purchase in health food stores or online. Do consult your physician for better results.

Recovery

Most people begin to recover from scurvy fairly quickly after starting treatment. You should see an improvement in some symptoms within a day or two of treatment, including:

·         pain

·         exhaustion

·         confusion

·         headache

·         mood swings

Other symptoms may take a few weeks to improve following treatment, including:

·         weakness

·         bleeding

·         bruising

·         jaundice

Daily recommended vitamin C

Daily vitamin C recommendations depend on age, gender, and other health conditions.

Age	Male	Female	During pregnancy	During lactation
0–6 months	40 mg	40 mg
7–12 months	50 mg	50 mg
1–3 years	15 mg	15 mg
4–8 years	25 mg	25 mg
9–13 years	45 mg	45 mg
14–18 years	75 mg	65 mg	80 mg	115 mg
19 + years	90 mg	75 mg	85 mg	120 mg

People who smoke or have digestive conditions typically require at least 35 mg a day more than nonsmokers.

Sources of vitamin C

Citrus fruits like oranges, limes, and lemons have traditionally been used to prevent and treat scurvy. Several other fruits and vegetables contain higher doses of vitamin C than citrus fruits. Many prepared foods, like juices and cereals, also contain added vitamin C.

Foods with high levels of vitamin C include:

·         sweet peppers

·         guavas and papayas

·         dark, leafy greens, especially kale, spinach, and Swiss chard

·         broccoli

·         Brussels sprouts

·         kiwifruits

·         berries, especially raspberries, strawberries, and blackberries

·         pineapples and mango

·         tomatoes, especially tomato pastes or juices

·         cantaloupes and most melons

·         green peas

·         potatoes

·         cauliflower

Vitamin C dissolves in water. Cooking, canning, and prolonged storage can greatly reduce the vitamin content in foods. It’s best to eat vitamin C rich foods raw, or as close to it as possible.

Outlook

Scurvy is caused by a chronic vitamin C deficiency. Most cases:

·         are mild

·         develop in people with unbalanced diets

·         are easily treatable with dietary changes or supplement use

Left untreated, chronic scurvy can cause serious health complications.

There’s no specific therapeutic dose set for vitamin C. The recommended daily allowance for most people ranges between 75 and 120 mg daily.