Scurvy is often thought of as a historical ailment, famously affecting sailors and explorers on long sea voyages centuries ago. Yet, in recent years, doctors in developed countries have begun diagnosing and treating cases of scurvy, signaling that this old disease might be re-emerging. On October 23, 2024, Australian doctors published new findings in the BMJ Case Reports, indicating scurvy is no longer confined to history. This article explores the disease, its symptoms, historical significance, recent resurgence, and why it's making a comeback.
What is Scurvy?
Scurvy is caused by a severe deficiency of vitamin C, also known as ascorbic acid, which plays a critical role in the production of collagen. Collagen is a protein necessary for the health of skin, blood vessels, bones, and connective tissue. Without enough vitamin C, the body struggles to repair tissues, heal wounds, and fight infections, leading to a variety of symptoms.
Common symptoms of scurvy include:
Fatigue and weakness
Swollen, bleeding gums or loose teeth
Joint and muscle pain or tenderness
Bruising easily
Dry, rough, or discolored skin, often showing reddish or purple spots due to bleeding under the skin
Delayed healing of cuts and sores
Anemia, leading to further fatigue and weakness
Increased susceptibility to infections
If left untreated, scurvy can lead to severe health complications, including inflamed blood vessels (vasculitis) and potentially fatal bleeding.
A Historical Disease
Scurvy was a widespread problem from the 15th to 18th centuries, particularly among sailors and explorers who spent long periods at sea without access to fresh produce. Here are some key moments in the history of the disease;
1497-1499 - Vasco da Gama's crew was devastated by scurvy during their expedition to India, resulting in many deaths.
16th to 18th centuries - Scurvy affected European navies and explorers, including figures like Ferdinand Magellan and Sir Francis Drake. It was considered one of the greatest threats to sailors’ health during long voyages.
1747 - British naval surgeon James Lind conducted one of the first clinical trials, discovering that citrus fruits could prevent and cure scurvy. However, it took decades for his findings to be widely implemented.
1795 - The British Royal Navy officially began providing lemon or lime juice to sailors, significantly reducing scurvy cases.
While scurvy became rare after the introduction of fresh fruits and vegetables into diets, the disease has not disappeared entirely.
Evidence of Scurvy’s Re-emergence
Recent case reports from developed nations suggest scurvy is still a health risk. In one case from Western Australia, doctors treated a middle-aged man for scurvy, while in Canada, a 65-year-old woman also presented with the condition. Both patients had leg weakness and compromised skin, symptoms that were initially misdiagnosed because vitamin C deficiency is rarely considered in modern clinical settings.
In both cases, patients recovered after receiving high doses of vitamin C (1,000 mg per day for at least seven days), illustrating how quickly the condition can be reversed with appropriate treatment.
A hospital in New South Wales also conducted a chart review that revealed a surprising number of patients with vitamin C deficiency. Over 50% of those tested showed some level of deficiency, with higher rates among patients from rural or lower socioeconomic areas. These findings prompted doctors to encourage greater consideration of scurvy as a potential diagnosis and to involve dietitians in patient care.
Why is Scurvy Re-emerging?
Even in today’s developed world, there are several reasons why people might be at risk for vitamin C deficiency:
Poor Diet: A diet lacking in fresh fruits and vegetables, often due to poverty, food insecurity, or dietary choices, can lead to scurvy. Those who rely heavily on processed, nutrient-poor foods rather than fresh produce are particularly at risk.
Food Deserts: In areas where access to affordable fresh produce is limited (commonly referred to as food deserts), residents may unintentionally suffer from vitamin C deficiency. In parts of developing countries like India, where fresh food is scarce, scurvy remains a health concern.
Cost-of-living Crisis: As the cost of living rises, more people are finding it difficult to afford fresh fruits and vegetables, which may lead to scurvy. Economic hardship can force individuals to make dietary compromises, reducing their intake of essential nutrients.
Weight Loss Procedures and Medications: Restrictive diets due to weight loss surgeries or certain medications can lead to nutrient deficiencies, including scurvy. A recent case report from Denmark highlighted scurvy in a patient following weight loss surgery.
Mental Health Conditions and Eating Disorders: Disorders such as depression and anorexia nervosa can severely restrict food intake, increasing the risk of vitamin C deficiency. For example, a 2020 case report from Canada described scurvy in a patient with anorexia nervosa.
Isolation: Older adults, particularly those who live alone or in nursing homes, may struggle to prepare balanced meals that include enough vitamin C. This can result in unintentional vitamin C deficiency.
Medical Conditions: People with digestive disorders, malabsorption issues, or restrictive medical diets (due to severe allergies or intolerances) may not be able to absorb or consume enough vitamin C, putting them at risk of scurvy.
How Much Vitamin C Do We Need?
In Australia, the dietary guidelines recommend that adults consume 45 mg of vitamin C per day, with higher amounts recommended for pregnant or breastfeeding women. This is the equivalent of roughly half an orange or half a cup of strawberries. Signs of scurvy can appear within a month if daily intake drops below 10 mg.
Fortunately, vitamin C is easily accessible through diet. Consuming fruits and vegetables such as oranges, strawberries, kiwifruit, plums, pineapple, mango, capsicum, broccoli, and Brussels sprouts can resolve symptoms of scurvy within weeks. For those unable to meet their needs through food, vitamin C supplements are also available, typically containing 1,000 mg per tablet. However, it is important not to exceed the recommended upper limit of 2,000 mg per day.
A Preventable Disease Making a Comeback
While scurvy may seem like a relic of the past, recent reports show that it is re-emerging even in developed nations. Poor diets, limited access to fresh food, economic hardship, and certain medical or psychological conditions all contribute to the risk of vitamin C deficiency. Fortunately, scurvy is both preventable and easily treatable with an adequate intake of vitamin C. Raising awareness among both the public and healthcare professionals is essential to ensuring this historical disease remains rare in modern times.
Scurvy's resurgence serves as a reminder that nutritional deficiencies, even in modern times, can lead to serious health conditions if left unaddressed. While the disease is entirely preventable through proper diet or supplementation, it highlights larger issues of food access, economic inequality, and dietary awareness. Ensuring individuals, especially those in vulnerable populations, have access to vitamin C-rich foods is crucial in combating this preventable condition. Healthcare professionals must remain vigilant, and public health initiatives should focus on improving nutrition and food security to keep scurvy from becoming a more widespread problem again.
