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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.
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.
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.
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.
Infants with scurvy will become anxious and irritable. They may experience pain that causes them to assume a frog-leg posture for comfort.
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.
The main cause is an insufficient intake of vitamin C, or ascorbic acid.
Risk factors
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 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.
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.
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 papaya
- 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.