How do people get scurvy now? Understanding modern risk factors

While once a disease synonymous with long sea voyages and a lack of fresh produce, scurvy is still a reality today, even in developed countries. The factors contributing to how people get scurvy now are often rooted in poor nutrition, restrictive diets, and underlying health conditions, far removed from the romanticized tales of pirates and explorers.

Quick Summary

Modern scurvy results from chronic vitamin C deficiency caused by poor diets, restrictive eating disorders, mental health issues, alcohol abuse, or malabsorption issues. Vulnerable populations, including the elderly, institutionalized, and those with specific medical conditions, are most at risk.

Key Points

• Dietary Habits: Modern scurvy is often caused by restrictive or unbalanced diets that exclude fresh fruits and vegetables, not a total absence of food.

• Vulnerable Populations: At-risk groups include the elderly, alcoholics, individuals with eating disorders or autism (ARFID), and those in low socioeconomic brackets.

• Medical Conditions: Malabsorption issues from illnesses like Crohn's disease or bariatric surgery can cause vitamin C deficiency even with adequate intake.

• Lifestyle Factors: Smoking depletes the body's vitamin C stores, and prolonged heavy alcohol use disrupts nutrient absorption, significantly increasing scurvy risk.

• Diagnosis Challenges: Scurvy can present with non-specific symptoms like fatigue and joint pain, leading to delayed diagnosis without a thorough dietary history.

• Easy Treatment and Prevention: The condition is easily reversible with vitamin C supplements and a diet rich in fruits and vegetables once diagnosed.

Scurvy's modern comeback

Scurvy, a disease caused by a severe deficiency of vitamin C (ascorbic acid), has a long history, famously affecting sailors who lacked fresh fruits and vegetables on extended voyages. However, the notion that scurvy is a disease of the past is a misconception. While rare in the general population of developed nations, isolated cases and small outbreaks continue to occur, particularly among vulnerable groups. The modern landscape of scurvy is defined not by a complete lack of food, but by poor, unbalanced dietary choices, altered nutritional needs, and systemic health challenges.

The primary culprits: dietary factors

For most people, the root cause of scurvy remains the same as in centuries past: inadequate dietary intake of vitamin C. The difference lies in why the diet is inadequate.

• Restrictive Diets: Many modern diets, whether driven by fads, allergies, or personal choices, can unintentionally eliminate key sources of vitamin C. For example, individuals with avoidant/restrictive food intake disorder (ARFID), including some on the autism spectrum, might subsist on a very limited number of foods like pasta and bread, completely missing out on vitamin C-rich fruits and vegetables.
• Poor Food Choices: A diet high in processed foods and low in fresh produce is a common cause. Despite widespread food availability, some individuals consume a calorically sufficient but nutritionally empty diet, leading to a severe deficit over time. Cooking methods that involve high heat or boiling can also destroy the water-soluble vitamin C in vegetables.
• Low Socioeconomic Status: People facing economic hardship may not be able to afford fresh fruits and vegetables, which are often more expensive and perishable than shelf-stable processed alternatives.

Medical conditions and lifestyle choices

Beyond simple dietary oversight, several medical conditions and lifestyle factors significantly increase the risk of developing scurvy.

Medical risk factors

1. Malabsorptive Conditions: Diseases that affect the small intestine, where vitamin C is absorbed, can lead to deficiency. Examples include inflammatory bowel diseases like Crohn's disease, celiac disease, and those who have undergone bariatric surgery.
2. Eating Disorders: Anorexia nervosa and other eating disorders severely restrict food intake, almost guaranteeing a lack of essential vitamins and minerals.
3. Chronic Illness: Patients undergoing treatments like chemotherapy may experience chronic nausea and a lack of appetite, leading to poor intake. Certain conditions like type 1 diabetes and iron overload disorders also affect vitamin C metabolism.
4. Hemodialysis: Patients on dialysis lose vitamin C during the process and therefore require increased intake.

Lifestyle risk factors

1. Alcoholism: Chronic heavy alcohol use is a major risk factor for scurvy, as it is often associated with poor dietary habits and can interfere with nutrient absorption. This is a frequent cause seen in clinical reports.
2. Smoking: Nicotine and other compounds in tobacco smoke increase oxidative stress, requiring the body to use up more vitamin C. Smokers require an extra 35 mg of vitamin C per day compared to non-smokers just to maintain the same levels.
3. Older Adults: The elderly, especially those who live alone or are institutionalized, are a high-risk group. They may have limited mobility to shop for fresh food, poor appetite, difficulty chewing, or subsist on simple, unvaried diets. This is sometimes referred to as “widower scurvy”.
4. Mental Health Disorders: Conditions like depression or other mental health issues can lead to neglect of self-care and proper nutrition, putting individuals at risk.

Symptoms and diagnosis

Scurvy symptoms typically appear after one to three months of severe vitamin C deficiency. Early signs are often non-specific and can include fatigue, irritability, and joint pain. As the condition progresses, more specific signs emerge, which can easily be misdiagnosed as other illnesses if a dietary history is not taken.

Common symptoms include:

• Gums: Swollen, spongy, purple, and bleeding gums.
• Skin: Petechiae (small red or blue spots), perifollicular hemorrhages (bleeding around hair follicles), corkscrew hairs, and easy bruising.
• Musculoskeletal: Bone and muscle pain, especially in the legs, and poor wound healing.
• Systemic: Anemia, malaise, and general weakness.

Diagnosis typically involves a dietary history, physical examination, and blood tests to measure vitamin C levels.

Comparison: Historical vs. modern scurvy

Feature	Historical Scurvy	Modern Scurvy
Primary Cause	Lack of fresh produce on long sea voyages or during famine.	Restrictive diets, alcoholism, mental illness, malabsorption disorders.
At-Risk Populations	Sailors, explorers, besieged populations.	The elderly, institutionalized, individuals with mental health or eating disorders, alcoholics, smokers, those with malabsorptive conditions.
Context of Deficiency	Lack of access to vitamin C-rich food.	Often due to choice, habit, or underlying medical issues, despite wide food availability.
Diagnosis	Based on observable, advanced symptoms.	Often delayed due to misdiagnosis, requiring dietary history and blood tests.
Treatment Availability	Delayed and often based on anecdotal evidence (like lemons).	Readily available vitamin C supplements and dietary counseling.

Treatment and prevention

Fortunately, scurvy is easily treated once diagnosed. The treatment involves replenishing the body's vitamin C stores through supplements and dietary changes.

Treatment

• Vitamin C Supplements: Oral supplements are highly effective. Adults may be prescribed 500–1000 mg per day for a month or until symptoms resolve. Intravenous administration is used in severe cases or for those with absorption issues.
• Dietary Adjustments: Patients are advised to incorporate fresh fruits and vegetables into their daily meals to maintain vitamin C levels after supplementation.

Prevention

Prevention is straightforward and centers on maintaining a balanced diet rich in vitamin C. Foods particularly high in vitamin C include:

• Citrus fruits (oranges, lemons, grapefruit)
• Strawberries
• Broccoli
• Sweet peppers
• Tomatoes
• Potatoes

Regular consumption of these items, along with addressing underlying risk factors, can prevent the development of scurvy. Healthcare professionals, especially in populations at risk, should be vigilant in taking a complete dietary history.

Conclusion

Scurvy in the modern era is no longer the widespread scourge of seafaring crews but a hidden threat that disproportionately affects marginalized and vulnerable populations. The disease persists not due to a global lack of produce, but because of complex factors like poor dietary habits, economic constraints, mental health issues, and chronic illnesses that interfere with proper nutrition. A high index of suspicion, combined with effective dietary counseling and targeted nutritional support, is necessary to combat this preventable and treatable condition. Recognizing that poor diet in developed countries is a primary cause is the first step toward effective prevention and treatment in the 21st century.

• Disclaimer: This article is for informational purposes only and does not constitute medical advice. For diagnosis and treatment, consult a healthcare professional. For more nutritional information, visit the National Institutes of Health website at https://www.ncbi.nlm.nih.gov/.

Frequently Asked Questions

Can scurvy happen in developed countries today?

Yes, scurvy can and does happen in developed countries, particularly among vulnerable populations such as the elderly, alcoholics, individuals with restrictive diets, and those with certain medical conditions that affect vitamin C absorption.

What are the early signs of modern scurvy?

Early signs can be non-specific, including general weakness, fatigue, joint and muscle pain, and irritability. These can appear after a few months of severe vitamin C deficiency.

How does alcoholism lead to scurvy?

Chronic alcoholism is a major risk factor because heavy drinkers often neglect their diet and substitute fresh food with alcohol. This leads to a consistent and severe lack of dietary vitamin C and impairs nutrient absorption.

Does smoking increase my risk of getting scurvy?

Yes, smoking significantly increases the risk of scurvy. Smoking increases the body's oxidative stress, which depletes vitamin C levels. Smokers need a higher daily intake of vitamin C to counteract this effect.

How is scurvy treated in the modern era?

Modern scurvy is treated with vitamin C supplements, often in high doses initially, followed by a maintenance dose. Patients are also given dietary counseling to ensure long-term intake of vitamin C-rich foods.

Which specific foods help treat and prevent scurvy?

Foods rich in vitamin C include citrus fruits, strawberries, kiwis, broccoli, bell peppers, tomatoes, and potatoes. A balanced diet with these items is key for prevention.

Can children get scurvy in modern times?

Yes, children are still at risk, especially those with restrictive eating habits, autism (ARFID), or who are experiencing malnutrition due to neglect or poverty.