An Overview of Scurvy

Scurvy—a potentially fatal medical condition caused by vitamin C deficiency—is not common. However, this nutritional deficit does occur, even in developed countries like the United States. The symptoms of scurvy can be subtle—including fatigue and easy bruising.

Because it is uncommon, scurvy is not typically among the first diagnoses considered when you or your child complain of these effects. And it is not customary to screen for vitamin C levels on a routine blood test. If your symptoms and medical history point to a possibility of scurvy, your vitamin deficiency can be confirmed with a blood test. Treatment of scurvy involves vitamin C replacement with vitamin C-rich foods and/or a vitamin C supplement.

The symptoms of scurvy tend to start out slowly and worsen over time. They tend to be vague, so you might not realize that you or your child is experiencing the effects of this nutritional deficit.

Common symptoms of scurvy include:

• Fatigue and muscle pain
• Loss of appetite
• Stiff and swollen joints
• Spontaneous bleeding and bruising
• Petechiae
• Gingivitis, ulceration of your gums, gum enlargement
• Loss of teeth
• Irritability and/or mood changes

Children who develop scurvy experience the same symptoms that affect adults. Children with scurvy are usually also prone to failure to thrive, which is a condition characterized by a lack of physical growth, and impaired cognitive and social development.

Vitamin C normally enhances the absorption of iron in the gut, so a vitamin C deficiency can result in iron deficiency anemia. Anemia can exacerbate your fatigue. In severe cases, anemia can result in dizziness, pale skin, a rapid heart rate, and shortness of breath.

If left untreated, scurvy can cause serious health issues that manifest with fever, jaundice, open wounds, multi-organ dysfunction, and may eventually lead to death.

Scurvy has historically been considered a disease that affects sailors. This is because fruits, which are rich in vitamin C, are inaccessible on long voyages. The vitamin C stored in your body becomes depleted over the course of one to three months.

Because vitamin supplementation can help to pre-emptively avoid developing this nutritional deficiency on planned trips, scurvy is not typically associated with long stays at sea anymore.

Scurvy is most common in developing countries where malnutrition is an epidemic, but it may occur in developed countries as well. There are several predisposing factors that are associated with an increased risk of scurvy.

Risk factors include:

• Following a restrictive diet that is low in vitamin C
• Having an eating disorder
• Living with dementia or a mental illness that interferes with eating and/or appetite
• Elderly age
• Alcoholism
• Smoking
• Gastric bypass surgery, which can interfere with your ability to absorb nutrients
• Gastrointestinal problems such as Crohn's disease or malabsorptive syndrome
• Poverty

Vitamin C is needed for the formation of collagen—a protein that makes up connective tissues in your body like skin, blood vessels, tendons, ligaments, bones, and cartilage.

With inadequate collagen, these tissues become fragile and weak. For example, with a collagen deficiency, blood vessel walls weaken and leak, causing abnormal bleeding and bruising.

Scurvy can be diagnosed with a combination of diagnostic strategies, including medical history, physical examination, and a blood test. Because the symptoms are vague, other, more common diagnoses may be considered before scurvy is considered. For example, your medical team may consider illnesses such as infections, hemophilia, a blood cancer like leukemia, idiopathic thrombocytopenic purpura, or vasculitis.

Once you are diagnosed with scurvy, your medical team may also search for a cause. Your diet can be the reason for a vitamin C deficiency, but if you are eating enough vitamin C rich foods, a gastrointestinal problem could be causing your condition.

Vitamin C blood levels are not commonly performed unless there is a specific request. However, if there is a concern that your vitamin C level could be the cause of your symptoms, a blood level of vitamin C (also called ascorbic acid) can be checked to confirm the diagnosis of scurvy.

A diet that is lacking in fresh fruits and vegetables (oranges, lemons, potatoes, broccoli, tomatoes, spinach, and red peppers, to name a few) can increase your chances of developing scurvy. 

If your diet seems to include an adequate amount of these foods, then your medical team may look to other causes of low vitamin C, such as gastrointestinal conditions that result in malabsorption.

Your medical team may evaluate issues such as diarrhea, irritable bowel syndrome (IBS), or inflammatory bowel disease (IBD). Tests that help identify these conditions include a stool sample, imaging studies, and/or a colonoscopy.

The treatment of scurvy is often simple, involving daily vitamin C supplementation for about one month or until your symptoms resolve. The usual dietary recommendation for vitamin C is between 25-40 mg/day for children, and between 75-90 m/day for adults.

Women who are breastfeeding need between 115-120 mg/day of vitamin C. And smokers also need a higher vitamin C intake because smoking reduces your vitamin C levels.

To provide a reference, five servings of most fruits and vegetables provide more than 200 mg of vitamin C. 

If you cannot increase your vitamin C level through your diet, then you can take vitamin C supplements. If you are severely deficient in vitamin C, you might increase your intake of vitamin C rich foods and also take a supplement.

Dosing depends on your ascorbic acid blood levels. Typically, children can take approximately 100 to 300 mg of vitamin C daily and adults can take between 300 mg to 1000 mg daily. 

Be aware that excessive vitamin C intake can cause diarrhea, abdominal discomfort, and nausea. A high intake of vitamin C can induce a metabolic reaction that increases the risk of kidney stones.

Your body is unlikely to absorb excess vitamin C, so you should not expect to have a high blood level of this vitamin.

If you are concerned that you or your child's diet is deficient in vitamin C, speak with your doctor. You could have a vitamin C deficiency, as well as other health problems that would need to be corrected.