The Resurgence of an Ancient Disease
Historically associated with sailors on long voyages, scurvy, a disease caused by a severe deficiency of vitamin C (ascorbic acid), is surprisingly still relevant today. While the average person in a developed country is at very low risk due to widespread access to vitamin C-rich foods, health experts note its re-emergence among vulnerable populations. Instead of a total lack of food, modern scurvy stems from chronic poor diet, malabsorption, or other lifestyle factors. Understanding if you fall into one of these high-risk groups is the first step in assessing your personal likelihood of developing this preventable condition.
Who Is at Risk for Scurvy?
The probability of developing scurvy is not evenly distributed across the population. Instead, it is concentrated within specific groups who struggle to maintain an adequate intake of fresh fruits and vegetables over several months. These at-risk populations include:
- The elderly and isolated: Older adults, particularly those living alone, may have poor diets often referred to as 'tea-and-toast' diets, which lack essential nutrients. Poor appetite, difficulty shopping, or mental illness can also contribute.
- People with alcoholism or drug dependency: Alcohol and drug abuse often disrupt dietary habits, leading to severely malnourished states. Alcohol can also interfere with vitamin C metabolism.
- Individuals with restrictive or 'fad' diets: People who severely limit or eliminate food groups, for reasons such as allergies, weight loss, or avoidant/restrictive food intake disorder (ARFID), are at risk. This includes some children and young people with autism spectrum disorder who may only eat a small range of foods.
- Those with mental health conditions or eating disorders: Conditions like anorexia nervosa, depression, and other psychiatric illnesses can cause individuals to limit their food intake drastically, leading to malnutrition.
- People with malabsorption or chronic illness: Conditions like Crohn's disease, ulcerative colitis, and end-stage renal disease (ESRD) on hemodialysis can impair the body's ability to absorb or retain vitamin C effectively.
- Infants on specific diets: Babies fed exclusively with evaporated or boiled milk, rather than breast milk or fortified formula, are at risk because heat destroys vitamin C.
- Smokers: The body's requirement for vitamin C is higher in smokers due to increased oxidative stress. They need an additional 35 mg per day.
Symptoms of Scurvy: A Progression of Deficiency
It takes approximately 3 months of minimal or no vitamin C intake for symptoms of scurvy to appear. Early symptoms are often vague and nonspecific, making diagnosis challenging, but they progress to more noticeable signs if left untreated. Symptoms include:
- Early stage: Fatigue, weakness, malaise, loss of appetite, and irritability.
- Intermediate stage: Aching joints and limbs, especially the legs. Anemia and easy bruising begin to appear.
- Classic late stage:
- Swollen, spongy, and bleeding gums.
- Perifollicular hemorrhages (tiny red or blue spots around hair follicles, especially on the legs).
- Corkscrew hairs, where hair becomes dry, brittle, and coiled.
- Poor wound healing or reopening of old scars.
Is Your Diet Putting You at Risk? A Comparison
To better understand how your eating habits contribute to your scurvy likelihood, consider this comparison between two typical diets.
| Feature | Typical 'Western' Diet (Risk-Increasing) | Scurvy-Preventing Diet (Low-Risk) |
|---|---|---|
| Fruit & Vegetables | Inconsistent or very low intake; relies on cooked, processed, or stored versions where vitamin C is lost. | At least 5 servings daily, including plenty of fresh, raw fruits and vegetables. |
| Processed Foods | Frequent consumption of ultra-processed foods, ready meals, and sugary snacks, which lack vitamin C. | Minimal reliance on processed foods, prioritizing whole, nutrient-dense options. |
| Cooking Methods | Boiling vegetables for long periods, which can destroy vitamin C. | Light steaming or microwaving vegetables, and eating fruits and salads raw to preserve nutrients. |
| Dietary Variety | Limited food variety, relying on a few staples without considering vitamin C content. | A wide variety of food sources, ensuring intake of vitamin C-rich foods like citrus, berries, peppers, and broccoli. |
The Role of Diagnosis and Treatment
If a healthcare provider suspects scurvy based on symptoms and dietary history, the diagnosis can be confirmed through a blood test to check vitamin C levels. In many cases, a rapid and dramatic clinical response to vitamin C supplementation is also diagnostic. Treatment is straightforward and effective, involving:
- High-dose vitamin C supplements: Initially, patients receive high doses (e.g., 500-1000 mg daily) for several weeks to quickly restore the body's vitamin C stores.
- Dietary changes: Following the initial phase, a sustainable, vitamin C-rich diet is crucial to prevent recurrence.
With treatment, symptoms like fatigue often improve within days, and more severe signs resolve over a few weeks or months. Complete recovery is the expected outcome, reinforcing that scurvy is entirely manageable when identified promptly. For a detailed list of vitamin C sources and recommendations, consult the Health Professional Fact Sheet from the NIH.
Conclusion: Assessing Your Personal Likelihood
For most people with a varied and reasonably healthy diet, the likelihood of developing scurvy is extremely low. However, modern lifestyles, specific medical conditions, and socioeconomic factors can create hidden risks. The key to prevention is not an obsession with health fads but rather a simple commitment to including enough fresh fruits and vegetables in your daily diet. If you belong to any of the at-risk groups, or if you've noticed persistent, unexplained fatigue, bruising, or dental issues, it's wise to speak with a doctor. While rare, modern scurvy is not extinct, and awareness is the best defense against this preventable disease.
