Scurvy is largely a historical disease, but there are signs it is making a comeback

Scurvy is often considered a historical disease, evoking images of sailors on long sea voyages suffering from a lack of fresh fruits and vegetables.

However, doctors in developed countries, including Australian doctors, have recently reported treating cases of scurvy reported their findings today in the diary BMJ Case Reports.

What is scurvy?

Scurvy is a disease caused by a severe deficiency of vitamin C (ascorbic acid), which is necessary for the production of collagen. This protein helps maintain the health of skin, blood vessels, bones and connective tissue.

Without enough vitamin C, the body cannot properly regenerate tissues, heal wounds or fight infections. This can lead to a row symptoms including:

• fatigue and weakness
• swollen, bleeding gums or loose teeth
• pain and tenderness in joints and muscles
• bruises easily
• dehydrated, rugged or discolored skin (reddish or purple spots caused by bleeding under the skin)
• cuts and wounds take longer to heal
• anemia (lack of red blood cells leading to further fatigue and weakness)
• increased susceptibility to infections.

This has affected sailors in the past

There was scurvy common from the 15th to 18th centuries, when naval sailors and other explorers lived on rations or went for long periods without fresh food. You may have heard about some of the milestones in the history of this disease:

• in the years 1497-1499Vasco da Gama’s crew he suffered seriously from scurvy during an expedition to India, as a result of which a huge part of the crew died

• from the 16th to the 18th centuryscurvy spread among European navies and explorers, affecting notable figures such as Ferdinand Magellan and Sir Francis Drake. It was considered one of the greatest threats to the health of sailors during long voyages

• in 1747British naval surgeon James Lind He is believed to have conducted one of the first clinical trials to show that citrus fruits could prevent and treat scurvy. However, it took several decades before his discoveries were widely implemented

• in 1795the British Royal Navy officially adopted the practice of giving sailors lemon or lime juicedramatically reducing the number of cases of scurvy.

Evidence of re-emergence of scurvy

In a up-to-date case report, doctors from Western Australia reported treatment of a middle-aged man with this disease. In a separate case report, doctors in Canada reported treats a 65-year-old woman.

Both patients had leg weakness and broken skin, although doctors did not initially consider scurvy. This was based on premise that there is a lot of vitamin C in our state-of-the-art food, so deficiencies should not occur.

In both cases, treatment with high doses of vitamin C (1,000 mg daily for at least seven days) resulted in symptom relief and eventual complete recovery.

The authors of both case reports fear that untreated scurvy may lead to inflammation of blood vessels (vasculitis) and potentially cause fatal bleeding.

Last year, a huge hospital in Fresh South Wales undertook: chart reviewin which patient records are reviewed to answer research questions.

Vitamin C deficiency has been found to be common. More than 50% of patients whose vitamin C levels were tested were either moderately deficient (29.9%) or severely deficient (24.5%). Deficiencies were more common in patients from rural areas and lower socioeconomic status.

Now they are doctors he insisted consider vitamin C deficiency and scurvy as a potential diagnosis and seek support from a dietitian.

Why might scurvy come back?

Obtaining and consuming nutritious foods that contain enough vitamin C is unfortunately a problem is still a problem for some people. Factors that boost the risk of vitamin C deficiency include:

• bad diet. People on restricted diets – due to poverty, food insecurity or dietary choices – may not be enough vitamin C. This also applies to people who rely heavily on processed, nutrient-poor foods rather than fresh produce

• food deserts. In areas where access to fresh, inexpensive fruits and vegetables is restricted (often called food deserts), people can inadvertently suffer from vitamin C deficiency. In some parts of developing countries, such as India, lack of access to fresh food is a problem considered a risk for scurvy

• cost of living crisis. With more people is unable to pay for fresh producePeople who limit their fruit and vegetable intake may experience nutrient deficiencies, including scurvy

• Weight loss procedures and medications. Restricted food intake due to weight loss surgery or weight loss medications may lead to nutrient deficienciesas in this one case report of scurvy from Denmark

• mental illnesses and eating disorders. Conditions such as depression and anorexia nervosa can lead to severely restrictive diets, increasing the risk of scurvy, e.g. case report as of 2020 in Canada

• insulation. Older people, especially those living alone or in nursing homes, may have this difficulty preparing balanced meals with the right amount of vitamin C

• specific diseases. People with digestive disorders, malabsorption disorders, or on restrictive medical diets (due to severe allergies or intolerances) may develop scurvy if: is unable to absorb or consume enough vitamin C.

How much vitamin C do we need?

Australian Dietary Guidelines recommend adults consume 45 mg of vitamin C (more if pregnant or breastfeeding) each day. This is about as much as you would find in half an orange or half a cup of strawberries.

When there is more vitamin C digested than necessary, the excess is excreted from the body in the urine.

Symptoms of scurvy may appear within a month of consuming less than 10 mg of vitamin C daily.

Eating foods opulent in vitamin C – such as oranges, strawberries, kiwi, plums, pineapple, mango, peppers, broccoli and Brussels sprouts – may improve symptoms within a few weeks.

Vitamin C is also readily available as a supplement if there are reasons why your dietary intake may be at risk. Typically, supplements contain 1000 mg per tablet, a recommended upper limit daily intake of vitamin C is 2000 mg.