Scurvy is a disease known since the days of long sea voyages when sailors suffered from the lack of fresh food. The disease manifested itself in fatigue, anemia, bleeding gums, bruising, and swollen joints. The link between the disease and a deficiency of something found in “acidic fruits” was established by Scottish doctor James Lind in 1747. His research showed that including citrus fruits in the diet effectively prevented and treated this condition, saving the lives of many sailors.
What is Vitamin C?
Vitamin C, or ascorbic acid, is an important antioxidant found in “acidic fruits.” It supports cell health, strengthens the immune system, and aids in collagen synthesis — a protein necessary for the normal function of the skin, teeth, bones, and blood vessels. Vitamin C also helps with iron absorption, promotes wound healing, and reduces inflammation.
The History of the Discovery of Vitamin C
In the early 20th century, scientists began investigating the causes of scurvy and discovered that the disease is linked to a deficiency of vitamin C in the body. In 1937, Albert Szent-Györgyi was awarded the Nobel Prize in Physiology or Medicine for the discovery of vitamin C and its role in preventing scurvy. He isolated vitamin C from peppers and other plants, proving that its deficiency can lead to scurvy, while its presence in food protects against the disease.
The discovery of vitamin C was a crucial step in understanding the role of vitamins in the human body. However, despite the significance of this discovery, modern medicine sometimes overlooks the importance of maintaining adequate vitamin levels. Vitamin deficiencies can be the cause of numerous serious diseases, many of which are difficult to diagnose and pose significant health risks.
Symptoms of Scurvy
Scurvy occurs due to a prolonged deficiency of vitamin C, which disrupts collagen synthesis and leads to a range of characteristic symptoms. The main signs of scurvy include:
- Fatigue and weakness: Reduced energy levels, chronic fatigue, and general weakness are the first signs of vitamin C deficiency.
- Anemia: Vitamin C deficiency hinders iron absorption, which can lead to a decrease in hemoglobin levels and the development of anemia.
- Bleeding gums: Inflammation and bleeding of the gums are characteristic symptoms associated with collagen deficiency.
- Bruising and poor wound healing: Impaired collagen synthesis weakens blood vessels, causing them to become fragile, leading to bruising and slow wound healing.
Scurvy in Canada, 2024
Even today, scurvy still poses a threat. In La Ronge, a small community in Saskatchewan, Canada, doctors identified 27 cases of scurvy among adults. This is part of a broader issue related to food insecurity, where many people face difficulties accessing fresh fruits and vegetables. The cases were discovered in May 2024 after blood tests revealed that a significant portion of the local population had low vitamin C levels.
The problem is likely even more widespread, as testing for vitamin C levels is not currently considered necessary. Vitamin C is found in many fresh foods, and most people typically receive the minimal dose needed to prevent scurvy simply through their diet.
Problems Associated with Vitamin C Deficiency
In addition to scurvy, a low level of vitamin C can lead to various other conditions and symptoms:
- Weakened immune system: Vitamin C plays a key role in maintaining immune function. Its deficiency can increase susceptibility to infections, such as colds and flu.
- Chronic fatigue: Vitamin C deficiency can cause feelings of fatigue due to its role in energy metabolism and its ability to help normalize iron levels in the blood.
- Skin problems: A lack of vitamin C can lead to skin issues such as dryness, wrinkles, and a dull complexion. This is related to its essential role in collagen synthesis, which supports skin firmness and health.
- Arthritis: Vitamin C aids in collagen synthesis, which is necessary for joint health, as it helps reduce inflammation and supports cartilage structure. This is particularly important in osteoarthritis and other inflammatory joint diseases.
- Diabetes: Vitamin C may play a role in improving blood sugar control and supporting antioxidant activity. Diabetics may have lower levels of vitamin C, making it an important element in supporting health in this condition. Vitamin C also helps reduce oxidative stress, which is characteristic of diabetes.
- Reduced iron absorption: Vitamin C enhances iron absorption from food. Its deficiency can lead to iron deficiency anemia, even if the diet contains sufficient iron.
- Psychological symptoms: Recent studies have shown that vitamin C deficiency may be linked to depression, anxiety, and mood swings, possibly due to its role in regulating neurotransmitters and protecting cells from oxidative stress.
- Weak teeth and gum problems: In addition to bleeding gums, vitamin C deficiency can lead to the destruction of tooth enamel and other dental issues, such as periodontitis.
- Cardiovascular diseases: Recent research has shown that vitamin C deficiency may be associated with an increased risk of cardiovascular diseases, such as hypertension and atherosclerosis. Vitamin C helps lower cholesterol levels and inflammation, which can reduce the risk of cardiovascular diseases.
- Aging: Vitamin C plays a crucial role in collagen synthesis, which provides skin firmness and elasticity. It protects the skin from damage caused by UV rays and pollution, thanks to its antioxidant properties, slowing down the aging process. Additionally, vitamin C reduces wrinkles and hyperpigmentation and helps maintain healthy skin tone and texture.
Can We Produce Vitamin C?
Humans cannot produce vitamin C, unlike most animals that synthesize it in their liver or kidneys. This is due to the absence of the enzyme glucose-6-phosphate dehydrogenase in the human body, which is essential for the synthesis of ascorbic acid. As a result, we must obtain vitamin C from food or supplements to avoid deficiency.
Furthermore, vitamin C does not accumulate in the body. It is a water-soluble vitamin that cannot be stored in tissues for long. Excess vitamin C that the body does not use is excreted through the kidneys in urine. This is why regular intake of vitamin C through food is important for maintaining optimal levels in the body.
What Causes Vitamin C Deficiency?
We already know that a lack of vitamin C in the diet will always result in a deficiency because we cannot produce it. However, there are also other causes of vitamin C deficiency in the body, even if it is present in your diet:
- Absorption issues: Gastrointestinal diseases, such as Crohn’s disease, celiac disease, and ulcers, can impair the absorption of vitamins, including vitamin C.
- Increased needs: Pregnancy, breastfeeding, intense physical activity, or stressful situations increase the need for vitamin C.
- Smoking: Smokers have higher vitamin C requirements due to increased excretion and reduced absorption.
- Chronic inflammatory diseases: Conditions like arthritis, autoimmune gastritis, and other chronic inflammations increase oxidative stress in the body, which raises the need for vitamin C.
- Liver and kidney diseases: Liver diseases (e.g., cirrhosis) and kidney diseases (especially in dialysis patients) can lower vitamin C levels in the body.
- Infections and fever: During acute infections, especially with a fever, the body uses more vitamin C to maintain immune function, which can lead to deficiency.
- Genetic disorders: Rare genetic diseases, such as Ehlers-Danlos syndrome (EDS), can affect vitamin C metabolism.
- Medications: Long-term use of medications like aspirin or anticonvulsants can reduce vitamin C absorption.
Prevention of Vitamin C Deficiency
Dietary Recommendations:
- Daily Intake: Include foods rich in vitamin C in your diet. These include citrus fruits (oranges, lemons, grapefruits), berries (blueberries, strawberries), and vegetables (bell peppers, broccoli, greens).
- Vitamin C Stability: Try to avoid prolonged storage of food products to retain the maximum amount of vitamin C.
- Reducing Vitamin C Losses: Steam vegetables or eat them raw, as high temperatures destroy the vitamin. Vitamin C begins to break down at temperatures above 60°C, and its losses significantly increase when boiling (100°C), especially with prolonged cooking.
Supplement Intake:
- Recommended Dosage: For the prevention of deficiency, adults typically need 75–90 mg of vitamin C per day, while smokers may require up to 125 mg. It is important to note that these doses are based on 100% absorption of the supplement, similar to doses received through injections.
- Individual Needs: A personalized approach is recommended for most people, considering the above-mentioned factors. However, when using higher doses of supplements, it is important to avoid excessive intake to prevent potential side effects like diarrhea.
Diagnosis of Vitamin C Deficiency
Vitamin C deficiency is often diagnosed based on clinical symptoms. However, to confirm the diagnosis, blood tests are performed to verify vitamin C deficiency. It is important to note that the symptoms may resemble other conditions, so confirming vitamin C deficiency through laboratory tests is a key step.
Treatment of Vitamin C Deficiency
The treatment for vitamin C deficiency and scurvy includes taking vitamin supplements and adjusting the diet. Patients are advised to increase their intake of vitamin C-rich foods and take supplements/injections of vitamin C in doses recommended by a doctor. It is also important to check for conditions that may interfere with the normal absorption of vitamin C, such as gastrointestinal diseases, diabetes, or smoking, which can reduce its absorption. Usually, improvement begins within a few days of starting treatment, and symptoms start to subside. The prognosis for scurvy with timely treatment is very favourable. With proper therapy, patients usually recover fully and can return to a normal lifestyle.
Conclusion
While scurvy has become a rare condition in the modern world, it continues to occur in some countries, such as Canada, where vitamin C deficiencies are observed. This disease, closely tied to historical sea voyages, serves as a reminder of the importance of balanced nutrition and timely diagnosis of deficiencies. The diagnosis of scurvy typically involves a combination of clinical symptoms and laboratory tests, such as blood tests for vitamin C levels. If you have symptoms that could indicate scurvy, your doctor may conduct a test to confirm or rule out your suspicion.
Scurvy in Canada: Is the vitamin C deficiency disease making a comeback?