Vitamin C, also known as ascorbic acid, is a water-soluble vitamin essential for many bodily functions, including collagen synthesis, immune support, and antioxidant activity. Since the human body cannot produce it, regular dietary intake of vitamin C-rich foods is crucial. While scurvy, the disease caused by severe deficiency, is largely a historical curiosity, suboptimal levels are still a concern for many. Identifying the groups most at risk is the first step toward prevention and healthy nutrition.
Lifestyle Factors that Increase Risk
Several common lifestyle habits can significantly deplete the body's vitamin C stores, making individuals more susceptible to deficiency.
Smokers and Those Exposed to Secondhand Smoke
This is one of the most consistently cited groups at high risk. Smoking and exposure to secondhand smoke increase oxidative stress in the body, which consumes a higher amount of vitamin C to counteract cellular damage. The body’s increased use of the vitamin means smokers require an additional 35 mg per day on top of the standard recommended dietary allowance (RDA). Without this increased intake, their vitamin C levels can plummet.
Individuals with Alcohol or Drug Dependency
Chronic and excessive consumption of alcohol or reliance on drugs often leads to poor dietary habits. Individuals in this category may neglect to eat fresh fruits and vegetables, which are the primary sources of vitamin C. Alcohol can also interfere with the absorption and metabolism of many nutrients, exacerbating the risk of deficiency.
Individuals on Restrictive or Limited Diets
People who avoid certain food groups due to allergies, personal preferences, or financial constraints may not get enough vitamin C. This risk applies to those with severe food allergies, those following faddish diets, or individuals experiencing food insecurity. In impoverished or refugee communities, limited access to fresh produce is a major contributing factor to widespread vitamin C inadequacy.
Medical Conditions and Physiological States
Beyond lifestyle, certain medical and physiological conditions can increase the body's requirement for vitamin C or hinder its absorption.
People with Malabsorption and Chronic Diseases
Conditions that affect nutrient absorption in the gut can lead to deficiency despite adequate dietary intake. These include:
- Crohn's disease: Chronic inflammation of the digestive tract.
- Ulcerative colitis: A form of inflammatory bowel disease.
- Celiac disease: An autoimmune disorder causing damage to the small intestine.
- End-stage renal disease and hemodialysis: Patients on dialysis often lose significant amounts of water-soluble vitamins, including vitamin C.
- Cancer: Some cancer patients, particularly those with cachexia or undergoing certain treatments like chemotherapy, may have higher nutritional needs and poor intake.
The Elderly and Malnourished Individuals
Older adults, particularly those who live alone or are institutionalized, are at higher risk. Factors include reduced appetite, difficulty preparing fresh food (the “tea-and-toast” diet), and lower overall calorie and nutrient intake. The multiple pathologies associated with old age can also increase vitamin C turnover.
Pregnant and Breastfeeding Women
These individuals have increased physiological requirements for vitamin C to support both their own and their child's health. While a balanced diet can meet these needs, inadequate nutrition during these critical periods increases the risk of deficiency.
Infants on Unfortified Formulas
While modern infant formulas are fortified with vitamin C, infants fed evaporated or boiled cow's milk are at risk. Cow's milk naturally contains very little vitamin C, and heat from boiling destroys what little is present. Breast milk provides adequate vitamin C if the mother's diet is sufficient.
People with Psychiatric Conditions and Eating Disorders
Mental health issues or unusual eating habits, like those seen in conditions such as anorexia nervosa or Avoidant/Restrictive Food Intake Disorder (ARFID) in children with autism, can severely limit dietary variety. The resulting lack of fresh fruits and vegetables is a direct cause of vitamin C deficiency.
Comparison of Risk Factors for Vitamin C Deficiency
| Risk Factor Type | At-Risk Group | Primary Mechanism | Prevention Strategy |
|---|---|---|---|
| Lifestyle | Smokers / Secondhand Smoke | Increased oxidative stress and vitamin turnover | Quit smoking, avoid secondhand smoke, increase intake |
| Lifestyle | Alcohol / Drug Dependency | Poor dietary habits, reduced intake, malabsorption | Address underlying dependency, improve diet with fresh produce |
| Dietary | Limited Food Variety / Poverty | Insufficient intake of fruits and vegetables | Diversify diet, seek assistance for food insecurity |
| Medical | Malabsorption Disorders (e.g., Crohn's) | Impaired intestinal absorption | Medical management, targeted dietary changes, supplementation |
| Medical | Chronic Kidney Disease / Dialysis | Increased loss of water-soluble vitamins | Regular supplementation under medical supervision |
| Medical | Cancer Patients | Increased needs, poor appetite (cachexia) | Nutritional support, address side effects of treatment |
| Physiological | Pregnant / Breastfeeding Women | Increased physiological demand | Nutrient-dense diet, potentially with supplements after consulting a doctor |
| Demographic | Elderly Individuals | Poor diet, reduced intake, living alone | Improve food access, nutritional counseling, consider supplementation |
Foods to Help Prevent Deficiency
Preventing vitamin C deficiency relies heavily on a diet rich in fruits and vegetables. Here is a list of some of the best dietary sources:
- Red and green bell peppers: Excellent sources, with red peppers providing even more vitamin C.
- Citrus fruits: Oranges, grapefruits, lemons, and kiwis are classic sources.
- Strawberries: A single cup offers more than a day's worth of vitamin C for adults.
- Broccoli and Brussels sprouts: These cruciferous vegetables are packed with the vitamin.
- Papaya and guava: Tropical fruits that are exceptionally high in vitamin C.
- Kale and spinach: Leafy greens that contribute significantly to daily intake.
Scurvy in Modern Times
While rare, severe vitamin C deficiency, known as scurvy, still occurs in vulnerable populations, particularly those who are severely malnourished for extended periods. Symptoms include widespread connective tissue weakness, easy bruising, bleeding gums, joint pain, and fatigue. Early recognition and treatment with vitamin C supplementation typically lead to a rapid reversal of symptoms, often within weeks.
Conclusion
Vitamin C deficiency, while not a widespread issue in the form of overt scurvy in the developed world, continues to affect specific populations. A combination of dietary, lifestyle, medical, and demographic factors can put individuals at higher risk. Recognizing who is most at risk for vitamin C deficiency is the first step toward proactive health management. By promoting a balanced diet rich in fresh fruits and vegetables and providing targeted nutritional support to vulnerable groups, public health can significantly mitigate the risk of insufficiency and the potential health complications that follow.
For more comprehensive nutritional information, consult the National Institutes of Health Office of Dietary Supplements(https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/).
