Who is most likely to develop vitamin C deficiency?

December 25, 2025 •

4 min read

While severe vitamin C deficiency, known as scurvy, is rare in developed countries, certain populations remain at high risk. Understanding the common risk factors is crucial for prevention, especially for individuals whose diets, lifestyle, or health conditions compromise their nutritional intake. This article explores who is most likely to develop vitamin C deficiency and why these groups are particularly vulnerable.

Quick Summary

This guide covers individuals with high risk for vitamin C inadequacy, such as smokers, alcoholics, the elderly, and those with certain medical conditions. It details how lifestyle and health affect vitamin C levels and highlights common deficiency symptoms.

Key Points

Smokers are at high risk: Increased oxidative stress from cigarette smoke rapidly depletes the body's vitamin C, necessitating a higher daily intake.
Alcoholics often have poor nutrition: Individuals with alcohol use disorder frequently have inadequate diets, and alcohol can also impair vitamin C absorption and increase its urinary excretion.
The elderly are vulnerable: Factors like poor appetite, limited food access, social isolation, and chronic illness can lead to low vitamin C intake in older adults.
Malabsorption issues increase risk: Medical conditions such as inflammatory bowel disease, celiac disease, and gastric bypass surgery can all interfere with the body's ability to absorb vitamin C.
Poor and restrictive diets are a primary cause: A lack of fresh fruits and vegetables is the most common reason for deficiency, affecting individuals on food fads, with mental illness, or those with limited food variety.
Certain illnesses and procedures increase demand: Surgery, burns, and other critical illnesses can heighten the body's vitamin C requirements, leading to depletion.

Understanding Vitamin C Deficiency

Vitamin C, or ascorbic acid, is an essential water-soluble vitamin that the human body cannot produce on its own. It plays a critical role in collagen synthesis, wound healing, immune function, and iron absorption. A consistent lack of vitamin C from the diet can lead to a deficiency, with severe cases resulting in scurvy. While the average person in developed nations rarely experiences this, certain groups face significantly higher risks due to various factors.

People with Poor or Restrictive Dietary Habits

The most common cause of vitamin C deficiency is an inadequate intake of fresh fruits and vegetables. The following groups are especially susceptible:

Individuals on limited diets: People who have restricted access to fresh produce, whether due to poverty, isolation, or personal preference, are at risk. Examples include some older, impoverished individuals or those who adhere to food fads.
Infants fed evaporated or boiled milk: Unprocessed cow's milk contains very little vitamin C, and heating can destroy it. While modern infant formulas are fortified, this historical practice is a known cause of deficiency.
Picky eaters, particularly children with autism: Some developmental disabilities or mental illnesses, such as Avoidant/Restrictive Food Intake Disorder (ARFID) often seen in autism, can lead to extremely limited diets that lack vitamin C-rich foods.

Lifestyle Factors that Increase Risk

Certain lifestyle choices can deplete the body's vitamin C stores or increase its requirements, making deficiency more likely even with a moderately healthy diet.

Smokers and those exposed to secondhand smoke: Studies consistently show that smokers have lower plasma and leukocyte vitamin C levels than non-smokers. The oxidative stress caused by cigarette smoke rapidly depletes the body's vitamin C, and smokers need an additional 35 mg per day to compensate.
Individuals with alcohol use disorder: Alcohol abuse can lead to malnutrition by reducing appetite and interfering with nutrient absorption. Many alcoholics subsist on nutritionally poor diets, and alcohol can also increase the urinary excretion of vitamin C.
People with higher body weight: Obesity is associated with enhanced inflammation and oxidative stress, which can deplete vitamin C levels. Some research indicates that heavier individuals may require a higher intake of vitamin C to achieve adequate serum concentrations.

Medical Conditions Affecting Vitamin C Status

Several health conditions can reduce vitamin C absorption, increase its loss, or raise the body's demand for the nutrient.

Gastrointestinal malabsorption disorders: Conditions like Crohn's disease, inflammatory bowel disease, or celiac disease can impair the absorption of vitamin C from the small intestine.
End-stage renal disease (ESRD) and dialysis: Patients on chronic hemodialysis experience increased renal loss of water-soluble vitamins, including vitamin C.
Post-surgery and critical illness: Following surgery, burns, or during severe illness like sepsis, the body's requirement for vitamin C increases significantly to support tissue repair and immune function, leading to potential depletion.
Iron overload: Conditions involving excessive iron can accelerate the breakdown of ascorbic acid in the body.

The Vulnerability of Older Adults

Older adults are a key at-risk demographic for vitamin C deficiency due to a combination of factors. These can include poor appetite, dental issues that affect their ability to eat fruits and vegetables, social isolation leading to limited food variety, and chronic illnesses. They may subsist on a limited diet, sometimes referred to as a "tea-and-toast" diet, that lacks essential nutrients.

Comparison of Vulnerable Groups


Risk Group	Primary Cause of Deficiency	Other Contributing Factors	Common Symptoms	Prevention Strategy
Smokers	Increased oxidative stress depletes vitamin C rapidly.	Poor dietary habits, reduced appetite.	Bleeding gums, easy bruising, poor wound healing.	Consume 35mg+ more vitamin C daily than non-smokers; cessation is best.
Alcoholics	Poor diet and malabsorption of nutrients.	Liver damage, increased urinary loss of vitamin C.	Fatigue, myalgia, bleeding gums, easy bruising.	Improve nutrition with fruits/vegetables; consider supplements.
Elderly	Poor dietary intake due to various factors.	Social isolation, limited food access, dental issues, chronic illness.	Fatigue, weak bones, poor wound healing, gum problems.	Focus on varied diet, multivitamins, and meal support if needed.
Malabsorption	Conditions like Crohn's or celiac disease impair uptake.	Surgical procedures like bariatric surgery impact absorption.	Joint pain, diarrhea, anemia, poor wound healing.	Address underlying condition; supplements often required.

Preventing Vitamin C Deficiency

Preventing vitamin C deficiency is largely a matter of maintaining a balanced diet rich in fruits and vegetables. Some of the best sources include bell peppers, oranges, kiwi, broccoli, and strawberries. Cooking methods also matter, as heat and prolonged storage can destroy vitamin C. Opting for raw fruits and vegetables, or steaming/microwaving, can help preserve the nutrient content. In cases where a deficiency is suspected or diagnosed, a healthcare provider may recommend dietary adjustments or oral supplementation.

Conclusion

While a severe vitamin C deficiency is uncommon for many, several populations face significant risks due to their dietary limitations, lifestyle, or underlying health issues. Smokers, alcoholics, the elderly, and individuals with malabsorption disorders are particularly vulnerable and should be mindful of their vitamin C intake. Ensuring a consistent and adequate dietary intake of fresh fruits and vegetables is the most effective preventative measure. For those at high risk, or where dietary intake is compromised, supplementation can be a crucial part of maintaining optimal health. If you fall into one of the high-risk categories and experience symptoms like fatigue, easy bruising, or bleeding gums, consult a healthcare provider to assess your vitamin C status.

Frequently Asked Questions

Early symptoms of vitamin C deficiency include fatigue, weakness, irritability, muscle and joint aches, and easy bruising. As the deficiency progresses, more severe signs appear.

Yes. Studies show that smokers have significantly lower levels of vitamin C due to increased oxidative stress from cigarette smoke. It is recommended that smokers consume an additional 35 mg of vitamin C per day compared to non-smokers.

Yes, one of the classic symptoms of vitamin C deficiency and severe scurvy is swollen, spongy, and bleeding gums. This is due to vitamin C's role in maintaining healthy connective tissues.

The elderly are more susceptible due to poor diet, possibly from dental problems or social isolation, and chronic diseases that can affect nutrient absorption. Their diets may lack sufficient fruits and vegetables.

The best prevention is a balanced diet rich in fresh fruits and vegetables. Eating them raw or lightly cooked is ideal, as heat and prolonged storage can reduce vitamin C content.

Alcohol use disorders can cause vitamin C deficiency through multiple mechanisms. Alcohol can reduce appetite, leading to poor dietary intake, and can impair nutrient absorption and increase vitamin C excretion.

Yes, conditions such as inflammatory bowel disease, celiac disease, and end-stage renal disease can reduce vitamin C absorption or increase the body's requirements, putting individuals at higher risk.