A Surprising Resurgence in the Modern Era
Scurvy, a nutritional disease caused by a severe lack of vitamin C, has long been relegated to history books, primarily associated with 15th- to 19th-century sailors on long sea voyages. However, recent data reveals a troubling resurgence in high-income countries like the United States. A 2024 study analyzing data from 19.5 million pediatric patients from 2016 to 2020 found that the incidence of scurvy in children increased from 8.2 to 26.7 cases per 100,000, suggesting a significant, though still rare, rise in documented cases.
Unpacking the Risk Factors and Causes
Today's scurvy cases are not the result of months without any fresh produce but rather chronic, inadequate intake in specific at-risk populations. Several contributing factors highlight a shift in how nutritional deficiencies manifest in a modern society with ostensibly abundant food. These risk factors include:
- Children with Autism Spectrum Disorder (ASD): The pediatric study found that a majority (nearly 65%) of scurvy patients had an ASD diagnosis. This is thought to be linked to extreme food selectivity or a limited food repertoire often associated with the disorder.
- Food Insecurity and Low-Income Groups: Economic hardship and rising food costs can limit access to fresh, vitamin C-rich produce, forcing reliance on cheaper, processed foods. Research shows that patients with scurvy were more likely to be in the lowest income quartile.
- Obesity: Counterintuitively, obesity is a risk factor. The same pediatric study found that obese males were at a higher risk of developing scurvy, possibly due to poor dietary choices, low intake of micronutrients, or altered nutrient metabolism.
- Restrictive Diets and Medical Conditions: Restrictive diets due to allergies, mental health issues like anorexia, or conditions like inflammatory bowel disease and celiac disease can limit vitamin C intake. Malabsorptive conditions post-bariatric surgery also increase risk.
- Substance Abuse and Elderly Individuals: Chronic alcohol and drug dependency can significantly impair nutrient absorption and lead to poor dietary habits. Similarly, elderly individuals, particularly those living alone, may subsist on limited, nutrient-poor diets, increasing their risk.
- Smoking: Tobacco use reduces the amount of vitamin C the body absorbs from food. Smokers and those exposed to secondhand smoke require a higher daily intake to combat the increased oxidative stress.
The Subtle Signs and Symptoms of a Hidden Deficiency
Scurvy is often underdiagnosed today because its early symptoms are vague and non-specific, making it easy to mistake for other conditions. Fatigue, lethargy, and joint pain can mimic countless other ailments. Doctors, unaccustomed to seeing scurvy, may overlook the less common but more specific signs that point toward a diagnosis. As the deficiency progresses, more distinct symptoms appear:
- Swollen, bleeding, and spongy gums, with potential tooth loss.
- Perifollicular hemorrhages, appearing as tiny red or blue spots around hair follicles, particularly on the lower legs.
- Corkscrew hairs, where body hairs become dry, brittle, and coiled.
- Easy bruising and bleeding under the skin, known as ecchymosis.
- Impaired wound healing and anemia.
- Bone and joint pain, sometimes causing a refusal to walk in children.
Comparison: Historical vs. Modern Scurvy Risk Factors
| Risk Factor | Historical Scurvy (e.g., 15th-19th century sailors) | Modern Scurvy (Today) |
|---|---|---|
| Primary Cause | Lack of fresh produce on long sea voyages | Chronic inadequate intake from restrictive diets or food insecurity |
| Key Population | Adult male sailors on voyages | Vulnerable children (ASD), elderly, low-income adults |
| Dietary Pattern | Total absence of fresh fruits and vegetables | Unbalanced, restrictive diets high in processed food; low in fresh produce |
| Socioeconomic Status | Factor of occupation/confinement | Key determinant; disproportionately affects lowest income quartile |
| Medical Context | Lack of understanding of vitamin C | Co-morbidities like ASD, malabsorption post-bariatric surgery, alcoholism |
Preventing Scurvy with a Nutritious Diet
Preventing scurvy relies on a consistent and adequate intake of vitamin C through diet or supplementation. While severe deficiency is rare, depletion is more common, so ensuring a varied diet is crucial.
Excellent food sources of vitamin C include:
- Citrus fruits (oranges, grapefruit, kiwi)
- Red and green peppers
- Strawberries, cantaloupe, and papaya
- Broccoli, Brussels sprouts, and cauliflower
- Potatoes, tomatoes, and spinach
It's important to note that cooking can reduce vitamin C content in foods, so incorporating raw produce is beneficial. For at-risk individuals, medical professionals often recommend targeted vitamin C supplements.
Diagnosis and Treatment
Due to its subtle presentation, diagnosing scurvy often requires a high index of clinical suspicion. While blood tests can confirm low vitamin C levels, the rapid and dramatic response to supplementation is often a diagnostic clue. Treatment involves providing adequate amounts of vitamin C, typically through oral supplementation, until symptoms resolve. The fatigue and pain can improve within days, while other signs like bruising and gum issues resolve over a few weeks. A long-term plan for a balanced diet or continued supplementation is necessary to prevent recurrence, especially for patients with underlying risk factors like extreme food selectivity or food insecurity.
Conclusion
While a severe lack of vitamin C is still uncommon in the general U.S. population, the evidence confirms a modern resurgence of scurvy among specific vulnerable groups. The tripling of pediatric cases between 2016 and 2020, particularly among children with ASD and those facing economic hardship, serves as a stark reminder that even in developed nations, nutritional deficiencies persist. By increasing awareness among clinicians and targeting support for at-risk populations, this easily treatable disease can be identified and addressed before causing significant health complications. Understanding the modern risk factors—from restrictive diets to food insecurity—is the first step in ensuring that scurvy once again becomes a relic of the past.
