Scurvy – Encountering An Old Health Problem In A Modern World
Where it was once a common plight for sailors on long ocean journeys, scurvy hasn’t been a mainstream health problem for many decades, if not a century or more. For that reason it’s dropped off the medical radar somewhat and is no longer included in general health surveys. However, it recently reappeared in a group of patients with diabetes at a hospital in western Sydney in Australia.
Scurvy is caused by a severe and long lasting lack of vitamin C in the diet. Vitamin C is a vitally important nutrient that is required by the body for a number of functions, including tissue repair. Scurvy can also be fatal if not diagnosed and treated. The fact that nearly 2 million sailors died of the condition between 1500 and 1800, before it was discovered that sucking on a lime daily prevented it, is proof of scurvy’s deadliness.
One of the primary sources of dietary vitamin C is fruit, particularly citrus fruit. However, fruit also contains fructose, a natural sugar that is converted to glucose by the body. Because of this, many diabetes patients cut back their fruit intake in an effort to keep their blood glucose levels under control. Unfortunately as it turns out this has brought on other serious health consequences. Such as scurvy
And it’s thought that the problem may not just be restricted to diabetic sufferers either. Australia, like so many other developed countries, suffers from its fair share of modern dietary issues. Until now though scurvy was not considered one of them but that belief may have to be rethought in the light of these findings.
Discovering Modern Scurvy
The recent re-occurrence of this disorder first came to the attention of Professor Jenny Gunton, who heads up the Westmead Institute for Medical Research Diabetes Centre in Sydney. She noticed that one particular patient had an ulcer that was not healing, despite regular topical treatments. So she started wondering and, following up on a hunch, quizzed the patient about her diet.
It turns out that the patient was inadvertently over cooking her vegetables whilst at the same time not eating very much fruit due to her diabetes. So the Professor ordered a blood test for vitamin C and zinc, two essential nutrients required for efficient wound healing. Sure enough, the patient returned a vitamin C score of just 10. Given that forty plus is normal, this patient had only one quarter of the quantity of vitamin C required for normal healthy function.
Professor Gunton then arranged to test other patients who attended her clinic with wounds that were slow to heal. Two thirds of those tested, or about a dozen people, subsequently returned the same very low vitamin C levels as the original patient. They were all prescribed a daily vitamin C tablet and, not surprisingly, their sores rapidly started healing.
Upon further investigation, most of those tested were found to be consuming enough vegetables in their diet to supply them with adequate amounts of vitamin C. However, they were overcooking them, which was destroying the vitamin C content. So Professor Gunton arranged for them to visit a dietitian in order to learn about effective ways to incorporate enough vitamin C and other important nutrients into their diet without affecting their blood glucose levels. She also wanted them to learn how to prepare food correctly in order to preserve as much of their nutrient value as possible.
One of the take home lessons to be learned from all this, according to Professor Gunton, is that even when someone is eating a seemingly normal, healthy diet, or appears outwardly healthy, they can still have serious nutritional deficiencies. Depending upon how the food is prepared, what else is eaten and so on. As this group of patients showed, something as simple as over cooking vegetables whilst not consuming enough fresh fruit was enough to drop their vitamin C levels to detrimental levels.
Scurvy – The Ins And Outs Of This Olde Tyme Disease
As previously mentioned, scurvy develops when the body doesn’t have enough vitamin C. Vitamin C is required for a whole host of functions.
- It’s used to create collagen. Collagen is a primary strengthening component in our skin, our bones and our blood vessels. Collagen is also used to help with wound healing.
- It is a powerful antioxidant. This is the role most of us typically associate with vitamin C. Antioxidants help to destroy and remove dangerous free radicals. Free radicals are molecular compounds that are created as a by-product of cellular oxygen metabolism. Amongst other things, free radicals do a lot of damage to cell membranes and are implicated in a whole range of serious health conditions, including cancer.
- It is required for efficient absorption of iron. Without vitamin C, our uptake of iron, especially non-haem iron, is nowhere near as efficient. Non-haem iron by the way is the type of iron we get from plant sources like lentils and beans.
- It is needed by our immune system, especially the lymphocytes. Lymphocytes control the type of response our immune system gives to any infection, disease or foreign substance that enters our body.
- It is also used in the production of various other chemicals in our body, like neurotransmitters or brain chemicals.
Vitamin C is also an essential nutrient, meaning the body can’t manufacture it so it has to come from our diet. Foods rich in vitamin C include
- Citrus fruit (oranges, mandarins, grapefruit, lemons, limes etc) and other fruits like mangos, tomatoes, strawberries, black currants and kiwi fruit.
- Green vegetables – broccoli, spinach, capsicum (particularly the yellow one) and cabbage.
- Liver and kidney
Symptoms Of Scurvy
Assuming a normally adequate intake, our body can store a limited amount of vitamin C for short periods. Therefore, we can survive without adequate daily vitamin C intake for a brief time. However, it’s when that couple of days becomes a couple of weeks then a couple of months that problems arise.
If a diet is completely lacking in vitamin C for any appreciable length of time, then how long the vitamin C reserve lasts will determine how long it takes scurvy symptoms to start to appear. On average though symptoms will begin to show up around a month after vitamin C intake completely ceases.
Unfortunately, a lot of the early signs of a possible vitamin C deficiency can also be attributed to other health issues. They include a general feeling of unwellness, inappetence, nausea, fatigue, fever, sore muscles and joints, diarrhea and tiny visible spots of bleeding around hair follicles. As you can see, with the possible exception of the bleeding, these could indicate any one of a number of illnesses.
If not detected and left untreated, these mild symptoms develop into some of the more known signs of full-blown scurvy. For example:
- Loose teeth as well as purple coloured gums that are spongy and swollen
- Proptosis (where the eyes bulge)
- Constant and severe bruising in the skin, caused by bleeding
- Brownish skin that is very dry and scaly to the touch
- Curly, dry hair that has a tendency to break off near the skin
- Wounds that are very slow to heal and old scars that reopen
- Swelling over bones in the limbs caused by bleeding into muscles and joints
- In babies and children lack of vitamin C causes the soft growth plates at the ends of the bones to harden prematurely, stalling bone growth and stunting overall development.
Ultimately, scurvy can also lead to an increased risk of heart attack and/or anaemia, or even death.
Some groups of people are more at risk of developing scurvy than others but ultimately; scurvy is a disease that comes about as a result of certain lifestyle choices. Those who have an unhealthy diet are prime candidates; especially those who have made other choices in life that affect their ability to make informed decisions about their diet. Alcoholics and drug addicts are a typical example of this as many of these people neglect their diets completely. Mentally ill people and the elderly are another high-risk group prone to suffering dietary neglect, generally through circumstances beyond their control.
People who crash diet, go on extreme diets that exclude complete food groups, are on allergy diets, have eating disorders ie anorexia nervosa or bulimia or are simply fussy eaters who don’t like eating foods high in vitamin C are other at-risk groups for developing scurvy. Note however that these types of diets are only problematic with respect to vitamin C if they specifically exclude foods high in vitamin C and don’t allow for alternative supplementation ie vitamin C tablets.
Smokers are also a group at risk of developing a vitamin C deficiency because smokers have higher vitamin C requirements than normal due to the damage smoking does to their body. Damage that requires a lot of vitamin C to fix.
Scurvy – Diagnosis And Treatment
A diagnosis for scurvy may involve a blood test for vitamin C and iron as well as a physical exam, information about the patient’s medical history and diet and x-rays of knee, rib and wrist joints.
Treatment options for scurvy are generally fairly simple. Just increasing daily vitamin C will, in most cases, completely cure the patient. In more severe cases higher than normal volumes of vitamin C intake may be prescribed to help speed up recovery. Gums and bleeding problems should start to dissipate within a day or two of beginning vitamin C therapy. Joints and muscles may take longer to recover but in most cases patients can expect to be on the road to full recovery within a very short space of time after beginning treatment.
Patients suffering from scurvy may also have other issues that also require treatment, as a vitamin C deficiency is not likely to have occurred on its own. There will invariably have been a contributing cause, such as health conditions causing dietary issues, an eating disorder or alcohol or drug use. Long term recovery and prevention of a relapse ultimately depends on the successful treatment of these contributing causes.
When dealing with scurvy it’s important to bear in mind that excessive intake of vitamin C is also detrimental and should never be done unless under medical supervision. Excessive vitamin C use can also affect some other types of medications, notably some blood-thinning drugs. People who have kidney stones or kidney disease should also be careful taking too much vitamin C.