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.
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.
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 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.
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.
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.
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