Scurvy, a disease once the scourge of 18th century sailors, has resurfaced in Australia.

Several cases of scurvy were recently diagnosed in a diabetes clinic in Western Sydney following testing of vitamin C levels, prompted by investigation of a patient with a wound that just wouldn’t heal – one of the signs of scurvy. The patient turned out to have vitamin C levels well below the recommended levels.

Causes of scurvy

Scurvy is caused by a lack of vitamin C – not something normally found in people who eat a balanced diet, but potentially a problem in anyone malnourished, such as some elderly people, smokers or people with a drug or alcohol problem.

Overcooking vegetables will deactivate vitamin C – so it’s also possible to eat enough vegetables, but still have a vitamin C deficiency.

Risk factors

Vitamin C deficiency is more common among older people, smokers, people living alone and those with a low income.

Vitamin C deficiency may also be associated with:

  • certain conditions such as chronic kidney disease or pancreatitis;
  • eating disorders such as anorexia nervosa; and
  • some fad diets that are extremely restrictive.

People with dementia and certain mental health conditions may also be at risk.

Symptoms

Vitamin C is needed for the body to make collagen – a protein required for healthy bones, skin and blood vessels. Without regular replacement of collagen, tissues start breaking down, leading to symptoms such as swollen bleeding gums, joint pain and swelling, wounds that won’t heal and skin that bruises easily.

Vitamin C is also an antioxidant and is involved in helping the immune system function properly. It’s important in helping your body absorb iron, and a lack of vitamin C can lead to anaemia.

If left untreated, vitamin C deficiency can lead to breathlessness, red-blue spots on the skin, and hairs that grow like corkscrews and break easily. It can eventually cause fluid retention and heart problems that could result in death.

Tests and diagnosis

The diagnosis is frequently delayed in cases of scurvy because the signs and symptoms are often non-specific, particularly in the early stages of the illness. Also, scurvy is still rarely seen in Australia.

If you are concerned about your vitamin C levels, see your GP (general practitioner), who will ask about your symptoms and diet. Your doctor will perform a physical examination, including looking in your mouth and checking your gums, to look for any signs of vitamin C deficiency.

A simple blood test can be done to diagnose a lack of vitamin C. Other tests (such as a full blood count or X-rays of your joints) may also be recommended to check for complications.

Treatment for scurvy

Taking vitamin C supplements and changing diet usually quickly improves the situation and reverses symptoms – joint pain is one symptom that usually improves within days.

Within a couple of weeks of the vitamin C-deficient patients in Western Sydney starting to take vitamin C supplements, foot ulcers that had been present for many months healed.

Diet and vitamin C

Australians get 40% of their vitamin C from vegetables, 19% from fruit and 27% from fruit and vegetable juices. Good sources of vitamin C are blackcurrants, citrus fruits (e.g. oranges, lemons and limes), sprouts, broccoli and kiwi fruit.

The recommended daily intake (RDI) of vitamin C is 45 mg/day for adults but more for pregnant and breastfeeding women.

Your body cannot make vitamin C and can only store it for about a month. So, make sure you get enough vitamin C in your diet by regularly eating plenty of fresh fruits and vegetables.

Last Reviewed: 21/08/2019

myDr



References

1. Christie-David DJ, Gunton JE. Vitamin C deficiency and diabetes mellitus - easily missed? Diabetic Medicine 2016; online. https://doi.org/10.1111/dme.13287

2. Water-soluble vitamin deficiencies (published March 2016). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2019 Jun. https://www.tg.org.au/ (accessed Aug 2019).

3. Australian Government. National Health and Medical Research Council. Nutrient reference values for Australia and New Zealand. Vitamin C (updated 23 Jan 2017). https://www.nrv.gov.au/nutrients/vitamin-c (accessed Aug 2019).

4. BMJ Best Practice. Vitamin C deficiency (reviewed July 2019; updated Dec 2017). https://newbp.bmj.com (accessed Aug 2019).