Prevalence: Is a 'Sailor's Disease' Possible in Modern College Life?
Scurvy, a disease historically associated with sailors on long sea voyages, results from a severe, long-term deficiency of vitamin C (ascorbic acid). While fresh fruits and vegetables are widely available in developed countries today, certain demographic groups—including college students—can still be at risk due to specific lifestyle and dietary factors. The critical question is not whether scurvy is rampant on campus, but rather how common the underlying vitamin C deficiency is, and what factors contribute to it.
Several studies highlight that marginal vitamin C status is more prevalent among young adults than full-blown scurvy. A 1998 study examining a campus population found that while only 1-2% of non-smoking students had serum vitamin C levels low enough to be considered clinical deficiency, a much larger proportion—12% of the fall sample and 16% of the winter sample—had marginal vitamin C status. More recently, national health data from the NHANES 2017-2018 indicated that 5.9% of the overall US population had vitamin C deficiency, a figure that includes young adults. These figures show that while severe, symptom-producing scurvy is rare and typically limited to extreme cases, the nutritional insufficiency that precedes it is far more widespread.
Documented Cases and High-Risk Groups
Despite its overall rarity, case reports of scurvy in young adults do surface in medical literature. These cases are often tied to significant dietary restrictions or underlying health issues, rather than typical college eating. For example, a case of scurvy was reported in a 15-year-old with a history of anorexia nervosa and an extremely restrictive diet. Similarly, another report detailed a 25-year-old male with scurvy linked to an inadequate diet during the COVID-19 pandemic, exacerbated by an isolated lifestyle. These instances reinforce that while the risk is low for the average student, specific dietary patterns or medical conditions can push individuals into a high-risk category.
Why College Students Are Prone to Deficiency
The transition to university often involves a significant shift in dietary habits, moving away from home-cooked meals to a reliance on convenience foods, dining hall fare, or budget-friendly options that may lack fresh produce. This can be compounded by academic stress, irregular schedules, and social factors. Key risk factors for vitamin C deficiency in the college student population include:
- Low Fruit and Vegetable Intake: Studies frequently show that college students fail to meet the recommended daily intake of fruits and vegetables. For instance, a 2025 study in Chile found only 11% of university students met the daily fruit and vegetable goal, and a 2022 study in the UAE found just 28.7% of students consumed fruit daily. Since vitamin C is not stored long-term in the body, consistent intake of these foods is crucial.
- Reliance on Ultra-Processed Foods: The staple college diet often includes fast food, packaged snacks, and sugary drinks, which are poor sources of essential vitamins.
- Skipping Meals: Irregular eating patterns, especially skipping meals like breakfast, are common among students, leading to potential nutrient gaps.
- Stress and Mental Health: Academic pressure and emotional challenges can influence eating habits, sometimes leading to poor dietary choices or a restricted intake. Eating disorders like anorexia nervosa are also a known risk factor.
- Smoking: Tobacco use significantly lowers the body’s vitamin C absorption, increasing the risk of deficiency. Studies have shown current smoking status to be a strong predictor of vitamin C deficiency in young adults.
Recognizing the Symptoms
Recognizing the signs of severe vitamin C deficiency is critical for early intervention. The symptoms can develop after just one to three months of insufficient intake. Early symptoms are often non-specific and easily mistaken for other issues, but they escalate over time.
Early signs:
- Fatigue and weakness
- Irritability and mood changes
- Joint and muscle pain
- Slow wound healing
Advanced signs (Scurvy):
- Swollen, spongy, and bleeding gums
- Easy bruising and small red or blue spots under the skin (petechiae)
- Corkscrew-shaped hairs and dry, rough skin
- Swelling in the legs
- Anemia
Deficiency vs. Scurvy: A Comparison
To understand the spectrum of risk, it's helpful to distinguish between a mild vitamin C deficiency and full-blown scurvy.
| Feature | Marginal Vitamin C Deficiency | Clinical Scurvy (Severe Deficiency) |
|---|---|---|
| Prevalence in College Students | More common; reported in 12-16% of a campus population in one study. | Very rare; typically found only in those with extreme dietary restrictions or other risk factors. |
| Symptom Onset | Gradual and often subtle, with non-specific signs like fatigue. | Manifests after several months of critically low intake, with more severe and specific symptoms. |
| Key Symptoms | Fatigue, weakness, and potentially increased susceptibility to illness. | Bleeding gums, petechiae, corkscrew hairs, severe joint pain, and slow wound healing. |
| Diagnosis | Blood tests showing low but not critically low plasma vitamin C levels. | Diagnosis based on classic clinical signs, confirmed by very low serum vitamin C levels. |
| Treatment | Increasing dietary intake of fruits and vegetables; possibly supplements. | High-dose oral or intravenous vitamin C supplementation and dietary changes. |
Prevention Strategies for College Students
Given the potential risks, college students can take proactive steps to prevent vitamin C deficiency. These include simple dietary adjustments and lifestyle changes.
Smart dietary choices:
- Incorporate vitamin C-rich foods like oranges, strawberries, bell peppers, broccoli, and kiwi into your diet.
- Opt for whole fruits and vegetables as snacks instead of processed alternatives.
- Choose fresh or minimally cooked produce, as cooking can reduce vitamin C content. Microwaving or steaming can help preserve nutrients.
- Look for vitamin C-fortified foods and drinks, though relying on whole foods is preferable.
Lifestyle modifications:
- Prioritize regular meals and avoid frequent meal-skipping.
- For students who smoke, addressing tobacco use is a critical step in reducing deficiency risk.
- Seek support from campus health services or counseling if dealing with stress or eating disorders that impact nutritional intake.
Conclusion
While the sight of a college student with clinical scurvy is exceptionally rare, the risk of marginal vitamin C deficiency is a genuine concern due to prevalent poor dietary habits on campuses. This deficiency can lead to common and often overlooked symptoms like fatigue and reduced immune function. By understanding the risk factors—primarily poor diets and smoking—students can implement simple, effective strategies to ensure adequate vitamin C intake. Addressing student nutritional health requires a combined approach of personal awareness and accessible, health-promoting campus resources to prevent deficiency from ever reaching the level of severe illness.
The Role of University Health Programs
As recognized by research, university health promotion programs have a key role to play in addressing nutritional concerns among students. Providing accessible information on balanced diets, healthy meal planning, and the importance of fresh produce can help mitigate risk factors. Some campuses have already taken steps to improve dining options, offer nutrition counseling, or raise awareness through health campaigns. Fostering a supportive campus environment can help students not only meet their academic goals but also maintain their physical health for the long term. For more information on scurvy and vitamin C, you can visit the Cleveland Clinic's article on scurvy.
Correction and Awareness In a 2024 review, it was highlighted that scurvy may not be a rare disease but a rare diagnosis. This emphasizes that clinicians and students alike may overlook the symptoms, leading to delayed or missed diagnoses. Greater awareness of the subtle, non-specific symptoms is necessary to catch cases early.
Student Responsibility and Long-Term Health Making healthy dietary choices during college has a lasting impact on future health, reducing the risk of chronic diseases later in life. Adopting good nutritional habits now can establish a foundation for a healthier adulthood, extending beyond simply preventing deficiencies like scurvy.
Summary of Key Takeaways
While clinical scurvy is a very rare diagnosis, marginal vitamin C deficiency is not uncommon among college students, fueled by poor dietary habits.
- Clinical Scurvy is Rare: Actual cases of clinical scurvy are very rare among college students in developed countries, often linked to extreme dietary restrictions or other medical issues.
- Marginal Deficiency is More Common: A more significant portion of the student population may have suboptimal vitamin C levels, which can lead to fatigue and weakened immunity.
- Dietary Habits are the Primary Culprit: Low consumption of fruits and vegetables and heavy reliance on processed foods are major drivers of vitamin C insufficiency.
- Smoking Significantly Increases Risk: Tobacco use decreases the body’s ability to absorb vitamin C, making smokers particularly vulnerable to deficiency.
- Symptoms Can Be Subtly Missed: Early symptoms like fatigue, joint pain, and slow wound healing are often ignored or attributed to other factors, delaying diagnosis.
- Prevention is Simple and Accessible: Consuming a balanced diet rich in vitamin C and addressing lifestyle factors like smoking is highly effective in preventing deficiency.
A Call to Action
Understanding that vitamin C deficiency can occur even in a food-abundant environment is the first step towards prevention. College students can protect their health by making conscious food choices and being aware of the subtle signs of inadequacy. Universities can support this by promoting healthy eating and providing accessible nutritional education. By raising awareness, we can ensure that scurvy remains a rare historical footnote, not a hidden risk on campus.
The Student-Athlete Exception
While not specifically noted for vitamin C deficiency in the searches, student-athletes who train rigorously may have higher nutritional needs and could potentially be at risk if their dietary intake does not match their energy expenditure. This is a topic that could be explored in more depth in future research.
