Scurvy, caused by a lack of vitamin C, once ravaged sailors on long voyages, causing weakness, bleeding gums, and even death. Thanks to better nutrition and the availability of fresh food, scurvy has been all but forgotten in developed countries. However, recent reports have shown that this condition is occurring again.
The significance of the recurrence of scurvy is that it is more than just an isolated health problem. This highlights the ongoing challenges posed by nutritional and economic inequalities. You may not think about scurvy today, but the rise in scurvy cases highlights the importance of awareness of the disease today.
If not diagnosed in time, scurvy will lead to serious health complications and higher healthcare costs. Recognizing the signs of this condition and understanding risk factors can help save lives and reduce unnecessary hospitalizations.
Recent cases of scurvy have brought the condition back into the spotlight.
In Western Australia, a 51-year-old man developed scurvy, a painful rash and anemia, after he stopped taking supplements following sleeve gastrectomy due to financial strain.1 Similarly, Canadian doctors treated a 65-year-old woman whose poor mobility and skin lesions were diagnosed as scurvy after other conditions had been ruled out. Her limited mobility and lack of social support left her dependent on a limited diet consisting mostly of non-perishable foods.2,3
A common trend in these cases is insufficient vitamin C intake. One important factor contributing to this deficiency is economic pressures, such as rising costs of living, forcing patients to prioritize cheaper processed foods. However, these foods lack fresh fruits and vegetables, which provide nutrients needed for optimal health, such as vitamin C.
The link between low socioeconomic status and scurvy is supported by a July 2024 study published in The Journal of the AAOS Global Research and Reviews. The study found that 36.5% of scurvy cases occurred in the lowest income quartile.4
Adding to the problem, scurvy symptoms are often similar to other medical conditions, leading to misdiagnosis. Patients often complain of musculoskeletal pain, bruising, and fatigue, which are often mistaken for vasculitis, autoimmune disease, or other nutritional deficiencies.5 This confusion delays appropriate diagnosis and treatment, increases length of stay and health care costs.
Scurvy is on the rise among children, especially those on the spectrum.
According to a feature study in The Journal of the AAOS Global Research and Reviews:6 Pediatric scurvy cases increased from 8.2 to 26.7 per 100,000 between 2016 and 2020. This significant increase over a relatively short period of time highlights the vulnerability of certain groups.
A notable majority (64.2%) of pediatric scurvy cases were found in children diagnosed with autism spectrum disorder (ASD). This high prevalence highlights the link between neurodevelopmental disorders and nutritional health. Children with ASD often exhibit selective eating behavior, which leads to restricted diets that are deficient in essential nutrients, including vitamin C.
The association between ASD and scurvy highlights the need for increased awareness among caregivers and educators of the importance of balanced nutrition and targeted nutritional interventions. The authors emphasize the need for health care providers to prioritize regular dietary assessment and vitamin supplementation in children with ASD to reduce the risk of scurvy and other related deficiencies.
The paradox of obesity and scurvy
The featured study also found that obesity was present in 7.6% of scurvy cases and that some patients were classified as morbidly obese.7 The coexistence of obesity and scurvy is paradoxical. This is because although obesity is often associated with excessive calorie intake, individuals may still suffer from micronutrient deficiencies such as vitamin C.
In morbid obesity, especially in people who have had gastric bypass or other obesity surgery, nutrient absorption is often impaired due to changes in the digestive process. These increasingly common procedures promote weight loss by reducing stomach size or bypassing part of the digestive system, but limit the body’s ability to absorb essential nutrients.8,9
Patients are usually advised to take vitamin supplements to avoid deficiencies. If patients stop taking these supplements due to financial constraints or lack of awareness, their risk of developing scurvy increases significantly.10,11
How much vitamin C do you need?
Vitamin C is a water-soluble vitamin that dissolves in water and is quickly distributed to cells, making it ready for immediate use. Unused vitamin C is excreted through urine because the body does not store it for future needs like fat-soluble vitamins.
Because the body cannot produce vitamin C on its own, it is important to get this nutrient from a variety of fruits and vegetables. Not only do you get easily absorbed natural vitamin C, but you also get dozens of other nutrients, such as antioxidants and phytochemicals that help fight chronic disease, reduce inflammation, and boost immune function. Fruits and vegetables that are particularly rich in vitamin C include:
red bell pepper | Acerola or Barbados Cherry | orange |
sweet potato | grapefruit | tomato |
cauliflower | Kale | pepper |
papaya | melon | Brussels Sprouts |
cabbage | kiwi | artichoke |
strawberry | broccoli | blackcurrant |
Additional Strategies to Combat Scurvy
In addition to adding vitamin C-rich foods to your diet, other practical steps you and your community can take to maintain optimal vitamin C levels and prevent scurvy include:12,13
1. Choose organic, locally grown fruits and vegetables — If possible, choose produce from local farms that practice regenerative agriculture. This not only enriches the land, but also produces produce with higher nutritional content, including vitamin C. Farmers’ markets, community supported agriculture (CSA) programs, and local cooperatives are great sources of sustainably grown food.
2. Grow your own vitamin C-rich foods — Growing your own food at home or in a community garden promotes self-sufficiency while providing direct access to a reliable and cost-effective source of vitamin C-rich produce. Even setting up a small garden or container can provide you with nutrient-dense foods like tomatoes, strawberries, and greens.
3. Supplement as needed for targeted support — If you are at higher risk for vitamin C deficiency or are having difficulty meeting your needs through diet alone, targeted supplements provide additional support. I recommend liposomal vitamin C as it has improved bioavailability compared to other oral formulations.
The current recommended daily intake of vitamin C is 75 mg for adult women and 90 mg for adult men.14 Although taking a few hundred mg per day is beneficial for many people, research suggests that taking more than 1,000 mg per day may be more effective in preventing disease and supporting overall health.
4. If you are at higher risk, monitor your nutritional intake — Regular screening for nutritional deficiencies is especially important for people at high risk, such as children with autism, low-income families, and people who have had bariatric surgery. Regular evaluations help identify deficiencies early, allowing timely intervention through supplements or dietary adjustments.
5. Support community initiatives for access to nutritious food — We support community efforts to increase access to fresh, vitamin-rich food, especially in low-income areas. Initiatives such as community gardens, mobile markets, and produce subsidy programs provide affordable access to fresh food and help address food insecurity and improve nutrition.
When communities prioritize access to nutritious produce, it benefits the health and well-being of everyone and helps curb the rise in nutrition-related health problems.
