What is Vitamin C Deficiency?
Scurvy is a health problem caused by a lack of vitamin C in your diet. Vitamin C is needed for the growth and healing of our skin, cartilage, bones, and teeth. It is also an important antioxidant, which helps to protect our cells from damage. This description provides an overview of vitamin C – where we get it from, how our bodies use it, and what it does in our bodies. It explains how to tell if a person has a vitamin C deficiency, how it affects the body, and how to treat and prevent it.
The symptoms of scurvy were first recorded by Ancient Egyptian doctors in 1550 BC, who treated it with onions and vegetables. The Greek doctor Hippocrates gave it a name and described some of its symptoms, such as an unappealing taste in the mouth, gums moving away from the teeth, nosebleeds, leg ulcers, and thin skin. In the 1700s, James Lind, a surgeon in the British Royal Navy, found out that eating lemons and oranges could ease the symptoms of vitamin C deficiency. Stories about pirates and British sailors suffering from scurvy have made it well-known in many countries. Scurvy also caused a lot of illness during significant historical times, like the European potato famine, polar expeditions, the American Civil War, and the California gold rush.
In the 1920s, a Hungarian biochemist named Albert Szent-Györgyi found out what vitamin C looks like at the molecular level and called it ascorbic acid, which means anti-scurvy.
What Causes Vitamin C Deficiency?
Humans and some primates need to get vitamin C from outside sources, rather than producing it themselves like most other animals. The reason for this is that we don’t have the necessary enzyme (called L-gulonolactone oxidase) to make it. This means we have to get our vitamin C from our diet or from taking supplements, and if we don’t get enough, we can develop a vitamin C deficiency.
Many different fruits and vegetables are rich in vitamin C, such as citrus fruits, potatoes, spinach, broccoli, peppers, strawberries, and tomatoes. Around 90% of the vitamin C in most people’s diets comes from these types of produce, whether they’re fresh, frozen, or canned. However, vitamin C can be damaged by heat, so cooking these foods at high temperatures or boiling them can reduce their vitamin C content. Fresh fruit and vegetables typically have more vitamin C than the frozen or canned versions, but these can still be good sources of vitamin C if fresh produce isn’t available.
Vitamin C is a water-soluble vitamin that our bodies can absorb well up to about 100 mg per day. But if your daily intake is more than 1500 mg, your body will absorb less than half of the vitamin C you consume. There are small amounts of vitamin C found in certain parts of the body such as white blood cells and some glands, but because it’s water-soluble, our bodies don’t store much of it. The average person has about 1500 mg of vitamin C in their body in total. If their vitamin C level drops below 350 mg, they’ll start showing signs of deficiency. After 4 to 12 weeks of low levels of vitamin C, they’ll start to develop symptoms of scurvy. Blood tests for vitamin C levels reflect recent or current intake, not the amount stored in the body, so they don’t give a good indication of your vitamin C status.
There are many factors that can increase your risk of vitamin C deficiency. These include alcohol addiction, infant feeding practices such as giving cow’s milk instead of breast milk or fortified formula, social isolation and limited diet, lack of access to fruit and vegetables, smoking, eating disorders, type 1 diabetes, digestive disorders affecting nutrient absorption, bariatric surgery which decreases nutrient absorption, disorders leading to unusually high iron levels, restrictive or low-carb diets, food allergies, developmental disabilities and mental illness affecting dietary choices, and kidney dialysis. It’s really important to be aware of these risk factors and do everything you can to prevent vitamin C deficiency for your overall health.
Risk Factors and Frequency for Vitamin C Deficiency
Vitamin C deficiency is a global problem, affecting millions of people. Its occurrence varies depending on several factors like age, lifestyle, access to nutritious foods, dietary choices, and existing health conditions. For instance, people who don’t regularly eat fruits and vegetables are more likely to lack Vitamin C. It’s a common issue in places where malnutrition is widespread, but it can happen anywhere. However, the prevalence of this deficiency varies significantly from one region to another. In the United States, it’s as low as 7.1%, while in northern India, it can go as high as 73.9%.
- Vitamin C deficiency impacts millions worldwide.
- Several factors can influence the prevalence of this deficiency, like age, lifestyle, access to nutritious foods, diet, and other health conditions.
- Those who don’t eat enough fruits and vegetables are at a higher risk.
- Countries with high rates of malnutrition tend to see more cases.
- The deficiency can occur anywhere in the world.
- The number of people affected varies by region, with a prevalence as low as 7.1% in the U.S. and as high as 73.9% in northern India.
Signs and Symptoms of Vitamin C Deficiency
Scurvy is a condition that happens when there is not enough Vitamin C in the diet. It takes between 4 to 12 weeks of Vitamin C deficiency for the early signs of scurvy to show up. These symptoms include tiredness or a feeling of discomfort, lack of energy, decreased appetite. Within some time, more evident symptoms concerning skin and mouth like bleeding gums, widespread blue-black blotches on the skin, skin rashes, frail skin, slow healing of wounds, and bone and joint pains start appearing.
- Tiredness or a feeling of discomfort
- Lack of energy
- Decreased appetite
- Bleeding gums
- Blue-black blotches on the skin
- Skin rashes
- Frail skin
- Slow wound healing
- Bone and joint pain
In a physical check-up, doctors might see signs of gum disease with bleeding, loss of teeth, blood spots on the skin, rough skin, hair loss, twisted hair, and bent hair due to feeble hair roots. There might be blood spots around hair follicles, especially in the lower part of the body, due to fragile blood vessels that cannot bear the pressure of standing up. This may result in a firm, stiff, and swollen condition known as “woody edema”. The nails may have signs like the spoon shape nails and tiny lines of blood under the nails.
Apart from symptoms related to skin and mouth, other body systems may also be affected. Painful joint swelling, bleeding in joints, and bleeding under the outer layer of bone could be due to fragile blood vessels caused by impaired collagen formation. This can affect bone formation making the bones prone to breaking. The eyes may feel dry, there may be blood spots in the eyes, and yellowing of the part of the eye.
Almost 80% of kids with scurvy show signs related to the bones and muscles, for example, joint and muscle pain, bleeding in joints and muscles, and bleeding under the outer layer of bone. Children with bone-related issues might display a limp or resist putting weight on their legs. The knee joint is most often affected. During a physical check-up, doctors might notice a “scorbutic rosary” which are painful, angular, and sharp swellings at the joint of the ribs and breastbone caused by weakened connective tissue. This specifically is a key symptom of scurvy.
As scurvy worsens, its symptoms become more and more serious and can become life-threatening. Advanced signs in the eyes include flame-like hemorrhages, cotton-wool spots, and bleeding behind the eyes into optic nerves, resulting in nervous damage and swollen optic disc. The immune system starts becoming weak making the body prone to infections. If not treated, severe scurvy can cause intense weakness, shortness of breath, swelling of the whole body, breakdown of red blood cells, yellowing of the skin, seizures, organ failure, and in the end, death.
Testing for Vitamin C Deficiency
Scurvy is diagnosed by examining the patient’s medical history, physical signs, and their response to vitamin C treatment. The doctor starts by checking the patient’s symptoms, what they eat, their chances of having vitamin deficiencies, and carrying out a thorough physical check-up. Tools like dermoscopy can show change in hair and skin, such as corkscrew hairs and purpura (small purple spots due to bleeding under the skin), and a small skin sample (or biopsy) can confirm these findings.
However, testing for vitamin C in the blood must be done carefully because eating vitamin C-rich foods or supplements recently can affect the results. If the vitamin C in the blood is less than 0.2 mg/dL, it could mean scurvy, but a long-term deficiency might not show up. Therefore, some doctors prefer to check the vitamin C in white blood cells, because this measure is less affected by changes in diet. If the vitamin C is at 0 mg/dL in these cells, it means scurvy. Between 0 and 7 mg/dL shows a deficiency, while more than 15 mg/dL is enough.
People with scurvy often don’t get enough of other vitamins and minerals too. So, along with checking for vitamin C, the doctor should also look for deficiencies in other key vitamins like B12 and folate, and in minerals like calcium, zinc, and iron. This is important due to the role vitamin C plays in helping the body absorb iron. So, those with scurvy should also be checked for anemia, a condition that can arise from not being able to absorb enough iron, or from losing blood through bleeding.
Some imaging tests might show the following findings linked to scurvy:
* Fractures and dislocations (bones coming out of joints)
* A lift in the layer of connective tissue that lines the outer surface of the bones (subperiosteal elevation)
* Loss of bone in the jaw (alveolar bone resorption), or less bone mass or bone density overall (osteopenia or osteoporosis)
* Separation of the end part of the bone in the lower arm near the wrist (epiphyseal separation of the distal radius)
Treatment Options for Vitamin C Deficiency
The right amount of vitamin C needed to treat scurvy depends on how serious the person’s condition is and their individual needs. Quick supplementation of vitamin C can effectively restore the vitamin levels in patients. Dosages can be up to 300 mg per day for kids and 500 to 1000 mg per day for adults. This supplementing usually lasts between 1 to 3 months or until all signs and symptoms have completely disappeared. Another option for adults is to take up to 2g per day for the initial 3 days, followed by 500 mg per day for a week, and then 100 mg per day for 1 to 3 months.
Preventing scurvy from returning involves eating enough fruits and vegetables and addressing any other nutrition issues that may cause a vitamin C deficiency. The daily recommended vitamin C intake changes based on factors such as age, sex, pregnancy, and breastfeeding. Kids need 15 to 75 mg, men 90 mg, women 75 mg, pregnant women 85 mg, and breastfeeding women 120 mg. Because smoking can reduce vitamin C levels, smokers should consume an extra 35 mg per day.
Vitamin C is found in many foods. According to the United States National Institutes of Health, Office of Dietary Supplements, these are some examples:
- 1/2 cup red pepper: 95 mg
- 1 medium orange: 70 mg
- 1/2 cup strawberries: 49 mg
- 1/2 cup Brussels sprouts: 48 mg
- 1 baked potato: 17 mg
If someone can’t or doesn’t want to get their vitamin C just from their diet, they can take supplements. These are widely available, including in standard multivitamin products you can buy over the counter.
What else can Vitamin C Deficiency be?
When trying to diagnose a medical condition, doctors consider a variety of diseases and conditions that could be the true cause of the symptoms. This process is called a differential diagnosis. Here are some possibilities:
- If someone has unexplained bruises or purple spots (purpura/ecchymoses), the cause could be Immune Thrombocytopenic Purpura, Henoch-Schonlein purpura, a condition causing abnormal blood clots and bleeding, Rocky Mountain Spotted Fever, a bacterial infection causing rash and fever, meningococcemia, which is another serious infection, or vasculitis caused by an allergic reaction.
- For oral and dental problems like very severe gum disease (necrotizing gingivitis), gum inflammation (periodontitis), a yeast infection in the mouth (candidiasis), abnormal levels of blood cells (blood dyscrasias), unusually large gums due to medication, or inflammation of the tongue or lips due to nutritional deficiencies could be potential causes.
- Rashes and changes to the skin could be caused by a lack of certain minerals or vitamins.
- And if someone has bone pain or is limping, that might be caused by osteomyelitis, a type of bone infection, or septic arthritis, which is an infection in a joint.
These are just some examples of what doctors might consider when diagnosing a medical issue. The aim is to figure out the most likely cause, so that the patient can receive the most effective treatment.
What to expect with Vitamin C Deficiency
Usually, signs like fatigue, body aches, and loss of appetite get better within 24 hours of starting treatment. Other symptoms such as bruising, bleeding gums, bleeding around hair follicles, and weakness typically improve within one to two weeks after beginning treatment. Hair that has twisted like a corkscrew usually goes back to normal within a month, and most symptoms are completely gone within three months. However, serious and advanced bone problems might need to be treated with surgery.
Possible Complications When Diagnosed with Vitamin C Deficiency
Vitamin C treatment is commonly used to treat scurvy and rarely results in complications. Any adverse effects that do occur are typically minor and often related to the dose level. The few potential complications include:
- Gastrointestinal disturbances: High doses of vitamin C might cause unwanted side effects such as diarrhea, nausea, and stomach cramps. However, these signs usually go away without needing treatment if you reduce your vitamin C dosage or stop taking it.
- Renal calculi/kidney stones: Consuming too much vitamin C has been linked with the development of kidney stones, especially in men with a history of kidney stones or existing kidney diseases. This issue is believed to arise from an increase in the amount of a substance called oxalate in the urine. To minimize this risk, it’s important to drink plenty of water and avoid taking excessive amounts of vitamin C.
- Interactions with medications: Vitamin C, due to its antioxidant properties, may decrease the effectiveness of some medications, including chemotherapy drugs, warfarin, statins, and niacin. It’s crucial to monitor these interactions and consider them carefully when supplementing your diet with vitamin C.
Preventing Vitamin C Deficiency
People should be informed about what causes vitamin C deficiency, the signs to watch out for, and the possible health issues that can arise if it’s not treated. The main cause is not eating enough fruits and vegetables that are high in vitamin C – like citrus fruits, juices, berries, melons, red and green peppers, tomatoes, potatoes, and certain green vegetables. Health experts can use this information to help patients make better food choices and incorporate more vitamin C into their daily meals. They should also advise people not to smoke and to limit their alcohol consumption if necessary.
If it turns out that a patient’s vitamin C deficiency is due to a problem absorbing nutrients, like inflammatory bowel disease or celiac disease, doctors should explain this condition to the patient so they can deal with the root of the problem and make up for their lack of vitamin C. If someone’s not getting enough food high in vitamin C because they’re socially isolated or don’t have enough access to food, health professionals might need to work with social services or food assistance programs, on top of their usual patient education efforts. Finally, for those who can’t or won’t eat fruits and vegetables, doctors should suggest taking a daily multivitamin supplement to get their vitamin C.
