Scurvy

Scurvy, or scorbutus, is a form of malnutrition caused by a severe lack of vitamin C, also known as ascorbic acid. Early signs include weakness, fatigue, and aching arms and legs. If left untreated, it can lead to anemia, gum disease, hair changes, and skin bleeding. As the condition worsens, wounds heal poorly, personality shifts occur, and death can result from infection or bleeding. Symptoms typically appear after at least a month of very little vitamin C in the diet.

Today, scurvy is most common among neglected children, people with mental disorders, those with restrictive eating habits like ARFID, alcoholics, and elderly individuals living alone. Other risk factors include intestinal malabsorption and dialysis. Unlike most animals and plants, humans cannot produce their own vitamin C. This vitamin acts as an antioxidant and is essential for making collagen, carnitine, and catecholamines, and it helps the intestines absorb iron from food. Diagnosis is usually based on physical signs, X-rays, and a positive response to treatment.

Treatment involves vitamin C supplements taken by mouth or intravenously for faster results. Improvement often begins within days, with full recovery in a few weeks. Good dietary sources of vitamin C include raw citrus fruit and raw vegetables like red peppers, broccoli, and tomatoes, though cooking reduces the vitamin content. Scurvy is rare compared to other nutritional deficiencies but is more common in the developing world, especially where malnutrition is widespread. Among refugees, rates range from 5 to 45 percent.

Historically, scurvy was a major problem on long sea voyages, where crews were isolated from land for months and relied on a limited diet lacking fresh fruit and vegetables. It was estimated that half of all sailors on major voyages of exploration would die from it. The condition was known as far back as ancient Egypt.

Signs and symptoms begin with malaise and lethargy. After one to three months, shortness of breath and bone pain appear. Muscle pain may occur due to reduced carnitine production. Other symptoms include rough skin, easy bruising, tiny red spots (petechiae), gum disease, loose teeth, poor wound healing, and emotional changes that can appear before physical signs. Dry mouth and dry eyes, similar to Sjögren’s syndrome, may also develop. In late stages, jaundice, widespread swelling, reduced urine output, nerve damage, fever, seizures, and death are common. Other signs include low blood pressure, high blood pressure in the lungs, and an enlarged heart.

The cause is a dietary lack of vitamin C, since the human liver cannot make it due to a non-working enzyme called L-gulonolactone oxidase. If the diet has enough vitamin C, this missing enzyme doesn’t matter. In modern Western societies, scurvy is rare in average adults but can affect underfed people such as drug users, the homeless, neglected children, and the elderly. Most commercial baby formulas contain added vitamin C, preventing infant scurvy, and breast milk has enough if the mother’s intake is adequate. Pasteurization destroys the natural vitamin C in commercial milk.

Scurvy is one of several diseases linked to malnutrition, along with beriberi and pellagra, and remains widespread in areas dependent on food aid. Even in industrialized nations, rare cases occur due to poor dietary choices.

Vitamin C is essential for many bodily processes, including the production of enzymes. It speeds up hydroxylation and amidation reactions, which are needed for making peptide hormones, nitric oxide, norepinephrine, carnitine, and collagen. It also helps regulate gene expression through epigenetic mechanisms affecting over a thousand genes. Early symptoms like malaise and lethargy may stem from impaired fat or energy metabolism due to low carnitine or catecholamines, which reduces ATP production. In collagen synthesis, vitamin C is a cofactor for enzymes that modify proline and lysine, stabilizing collagen through cross-linking. Collagen is a key structural protein for blood vessels, muscle, skin, bone, cartilage, and connective tissue. Defective collagen leads to fragile capillaries, abnormal bleeding, bruising, and internal hemorrhaging. Bone formation suffers, teeth loosen, bones break more easily, and old fractures may reopen.