Vitamin C deficiency

Symptoms: fatigue, depression, and connective tissue defects (eg, gingivitis, petechiae, rash, internal bleeding, impaired wound healing)

Causes: The primary cause of vitamin C deficiency is due to inadequate nutritional intake. 

Risk Factors: A lack of vitamin C is frequently associated with food insecurity, low socioeconomic status, and restricted access to nutrient-dense foods. 

Prevalence: VCD was present in 27.7% of cases overall. Poor nutritional status and severe acute illness were associated with a high prevalence of VCD in the patients. In 48% to 62% of VCD patients, scurvy was present.

Severity: Mild to severe 

Which doctor to consult: Nutritionist, Primary care provider, Paediatrician 

Overview: 

Scurvy, or a lack of vitamin C, is a well-known nutritional illness with historical significance that still affects people's health today. Maintaining one's health and wellbeing requires consuming adequate amounts of vitamin C. A powerful antioxidant, vitamin C, shields cells from the damaging effects of free radicals. Further supporting the development and maintenance of skin, cartilage, bone, and teeth is vitamin C. Food insecurity, low socioeconomic status, and restricted access to nutrient-dense foods are frequently associated with vitamin C deficiency. Corkscrew hairs, perifollicular haemorrhages, and gingival bleeding are classic indicators of vitamin C deficiency. Early detection and treatment are necessary for scurvy, an uncommon but treatable condition.

Symptoms: 

Here are some common signs and indications of vitamin C deficiency:

1.  Rough, Bumpy Skin: Vitamin C plays a crucial role in collagen production, which is essential for healthy skin, hair, joints, bones, and blood vessels. When vitamin C levels are low, a skin condition called keratosis pilaris can develop. This condition results in bumpy “chicken skin” on the back of the upper arms, thighs, or buttocks due to a buildup of keratin protein inside the pores.

2. Corkscrew-Shaped Body Hair: Abnormally bent, coiled, or corkscrew-shaped body hairs are another hallmark sign of vitamin C deficiency. These damaged hairs are more likely to break off or fall out.

3. Bright Red Hair Follicles: Hair follicles contain tiny blood vessels that supply blood and nutrients. When the body lacks vitamin C, these blood vessels become fragile and break easily, leading to small, bright red spots around the hair follicles. This condition is known as perifollicular hemorrhage and is a well-documented sign of severe vitamin C deficiency.

Remember that vitamin C deficiency can cause other symptoms as well, including easy bruising, easy bleeding, and joint and muscle pains. If you suspect a deficiency, consider incorporating vitamin C-rich foods into your diet or taking vitamin C supplements. Always consult with a healthcare provider for proper evaluation and guidance.

Increased Susceptibility to Infections: Frequent illnesses or infections indicating a weakened immune system.

If you are experiencing any of these symptoms, it’s important to consult with a healthcare provider. They can perform a blood test to confirm vitamin D levels and recommend appropriate treatment options, such as supplementation or dietary changes. Remember, it’s essential not to self-diagnose or self-treat without professional guidance. 

Causes: 

Vitamin C deficiency can occur due to several factors, primarily related to inadequate intake of vitamin C-rich foods. Here are some common causes:

Insufficient Intake: Not consuming enough foods high in vitamin C, such as fruits and vegetables, can lead to deficiency.

Dietary Restrictions: People with allergies, food intolerances, or those on restrictive diets may not get enough vitamin C.

Age: Older adults may have a poor diet, leading to insufficient vitamin C intake.

Alcoholism: Excessive alcohol consumption can lead to appetite loss and, consequently, a lack of adequate vitamin C intake.

Smoking: Smokers have lower levels of vitamin C and require more than non-smokers to prevent deficiency.

Malnutrition: Conditions that cause malnutrition, including anorexia nervosa and severe mental illness, can result in vitamin C deficiency.

Chronic Illnesses: Certain chronic illnesses and conditions like dialysis can increase the need for vitamin C.

Pregnancy: During pregnancy, the body requires more vitamin C. If not enough is consumed, it can lead to deficiency.

To prevent vitamin C deficiency, it’s important to consume a balanced diet with plenty of fresh fruits and vegetables.

Risk Factors: 

Risk factors for vitamin C deficiency, which can lead to conditions like scurvy, include: 

Poor Diet: A diet lacking in fruits and vegetables is the most common cause of vitamin C deficiency.

Alcoholism: Excessive alcohol intake can lead to poor dietary choices and nutrient deficiencies.

Anorexia and Other Eating Disorders: These conditions can result in inadequate intake of vitamin C-rich foods.

Severe Mental Illness: Mental health issues can affect eating habits and lead to nutrient deficiencies.

Smoking: Smokers have increased oxidative stress and require more vitamin C to counteract it.

Dialysis: Patients undergoing dialysis may have increased requirements for vitamin C.

Age: Elderly individuals may consume a limited diet, leading to deficiencies.

Financial Constraints: Limited access to fresh produce can result in inadequate vitamin C intake.

Chronic Diseases: Certain chronic conditions, such as gastrointestinal disorders or type 1 diabetes, can increase the need for vitamin C.

Restrictive Diets: Those with food allergies or intolerances may avoid vitamin C-rich foods.

It’s important to address these risk factors by ensuring a balanced diet rich in vitamin C, considering supplements if necessary, and consulting healthcare providers for personalized advice.

Possible Complications: 

Vitamin C deficiency, if left untreated, can lead to several serious health complications. Here are some potential complications associated with prolonged vitamin C deficiency:

Iron Deficiency: Vitamin C is crucial for the absorption of iron. A deficiency can lead to iron-deficiency anemia.

Anemia: Apart from iron deficiency, anemia can also occur due to the reduced ability to absorb and utilize iron.

Bleeding: Vitamin C is essential for maintaining the health of blood vessels. Deficiency can cause easy bleeding and bruising.

Poor Wound Healing: Vitamin C is needed for collagen formation, which is vital for wound healing. Without it, wounds heal poorly.

Gum Diseases: Scurvy can lead to gum disease, with symptoms like bleeding gums and loosening of teeth.

Personality Changes: Severe deficiency can affect mental health, leading to changes in personality and mood.

Skin Hemorrhages: Small blood vessels can become fragile, leading to petechiae or small red spots from bleeding under the skin.

Myalgia: Due to carnitine production issues, muscle pain can occur.

Scurvy: This is the most severe form of vitamin C deficiency, characterized by general weakness, anaemia, and skin haemorrhages. If untreated, it can be fatal.

To prevent these complications, it’s important to maintain an adequate vitamin C intake through diet or supplements, especially if you’re at risk of deficiency.

Prevention: 

Vitamin C deficiency can be prevented by consuming the recommended amounts of fresh fruits and vegetables or by taking the recommended amount of vitamin C in daily supplements. People who smoke require more.

When to see a doctor? 

If you have symptoms of vitamin C deficiency or you suspect you might have a vitamin C deficiency it’s essential to consult a healthcare provider.

Diagnosis: 

In most cases, vitamin C deficiency is diagnosed clinically based on the presence of specific signs and symptoms.

A healthcare provider will assess the patient’s history, perform a physical examination, and look for characteristic features associated with scurvy.

Laboratory Confirmation:

Blood tests can measure the levels of ascorbic acid (vitamin C) in the blood.

A complete blood count (CBC) may detect anemia.

Coagulation and prothrombin times are usually normal. 

Treatment: 

The treatment for vitamin C deficiency primarily involves replenishing the body’s supply of vitamin C. Here’s how it can be addressed:

Supplementation:

Oral vitamin C supplements, typically ascorbic acid, are used to quickly restore vitamin C levels.

In severe cases, intravenous therapy with fluids containing vitamin C supplements may be necessary.

Dietary Changes:

Increasing the intake of foods rich in vitamin C is crucial. This includes:

Fruits like oranges, kiwi, grapes, papaya, and citrus fruits.

Vegetables such as broccoli, sprouts, cabbage, and spinach.

Self-Care:

It’s important to eat a balanced diet with plenty of fresh fruits and vegetables.

Avoid smoking and excessive alcohol consumption, as these can affect vitamin C absorption and increase the body’s requirements.

Medical Advice:

Always consult with a healthcare provider before starting any new treatment or supplement, especially if you have underlying health conditions or are taking other medications.

Monitoring:

Follow-up with a healthcare provider is essential to ensure that the treatment is effective and to adjust dosages if necessary.

Patients with vitamin C deficiency typically see improvement within 24 hours after starting treatment, and the condition usually resolves within 1-2 weeks with proper management. 

Additional information:

Can children also develop scurvy?

Children can develop scurvy, just like adults. Scurvy in children is typically caused by a severe deficiency of vitamin C, which is essential for the development and repair of all body tissues. Here are some key points regarding scurvy in children:

Symptoms in Children:
They may experience symptoms similar to adults, such as weakness, fatigue, sore arms or legs, and gum diseases.
Children with scurvy might also show signs of failure to thrive, which includes a lack of physical growth and impaired cognitive and social development.
Risk Factors:
Not having access to fresh fruits or vegetables.
Eating very little due to medical treatments or an eating disorder.
Smoking (secondhand smoke exposure for children), which reduces the amount of vitamin C the body absorbs.
Having a drug or alcohol dependency in the household affects the child’s diet.
Having a restrictive diet or food allergies.
Diagnosis:
Physical examination and patient history.
Blood tests to evaluate vitamin C levels and check for anemia.
X-rays to detect any possible internal damage.
Treatment:
Vitamin C supplements and increasing the intake of foods rich in vitamin C, such as citrus fruits, kiwi, grapes, oranges, papaya, and vegetables like broccoli, sprouts, cabbage, and spinach.
Prevention:
Ensuring a balanced diet with sufficient vitamin C.
Providing plenty of fresh fruits and vegetables.
Avoiding smoking and consumption of alcohol around children.
Taking multivitamins if necessary.
It’s important for parents and caregivers to be aware of the risk factors and symptoms of scurvy in children and to seek medical advice if they suspect a deficiency.