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When he was a college freshman, Matt Storrs started experiencing some unexplainable symptoms.
“The first thing I noticed was my gums began to bleed really easily,” says Storrs, 37, now a comedian and lawyer in New York City. “Then, I noticed weakness in my day-to-day activities and at the gym. I was getting tired after just a few minutes of exercise and walking from class to class and sore as if I had worked out for hours. I started to nod off in class despite getting more sleep.”
Storrs visited his general practitioner, who — after inquiring about his diet — discovered the unusual cause: scurvy, a rare disease caused by a severe lack of vitamin C.
[READ: Using Food As Medicine]
What Is Scurvy?
Scurvy is a disease characterized by a collection of symptoms when vitamin C deficiency reaches very low levels.
Vitamin C, found in many fruits and vegetables, plays a crucial role in our bodies. Most of us know vitamin C, also called ascorbic acid, may help our immune system fight colds, but it also makes other compounds in our body, such as:
— Collagen, which is important for skin, and cartilage between bones and in the nose
— Nitric oxide, which helps keep blood vessels open for circulation
— Epinephrine and norepinephrine (also called adrenaline and noradrenaline), which aid blood pressure and help the body function when stressed, such as during infection or surgery
[READ: Health Questions to Ask Your Doctor]
Scurvy Symptoms
Common scurvy symptoms include:
— Redness, swelling and bleeding of gums, which can lead to teeth falling out
— Generalized fatigue
— Soreness of the body
— Irritability or depression
— Musculoskeletal complaints and joint pain, especially in legs
— Difficulty walking
— Skin bruising
— Petechiae, a rash caused by tiny spots of bleeding under the skin
— Perifollicular hemorrhage, or bleeding around hair follicles
— Curling or “corkscrew” arm or leg hair
Untreated, scurvy causes longer-term issues, such as:
— Swelling of joints
— Changes in and weakening of bones, to the point of fracture
— Anemia, or low levels of red blood cells to carry oxygen
“When a physician learns about this in medical school or when you hear pirates had scurvy, the things we often think about are bleeding and bruising,” says Dr. Stephanie Gilley, a nutrition physician specialist and pediatrician at Children’s Hospital Colorado who recently published a study on scurvy in children.
Scurvy notoriously ravaged sailors and pirates on long sea voyages from the 1500s to the 1700s, killing more than 2 million seamen.
“What pirates actually died from when they had scurvy was some other infection they wouldn’t be able to fight and would essentially have cardiovascular collapse with no blood pressure,” Gilley adds.
[READ: Best Vitamin C Supplements]
Scurvy Causes
Scurvy isn’t a contagious disease, like a cold or the flu. The only way to get scurvy is by a vitamin C deficiency typically caused by not getting enough vitamin C in your diet.
“We don’t store vitamin C very well in our body, so you need to eat it on a regular basis to have enough,” Gilley says.
As an 18-year-old on his own for the first time, Storrs realized his scurvy was caused by his very poor diet.
“The diner next to my college dorm had low-cost chicken fingers that were even lower in vitamin C,” he says. “I ate there for two or three months with a simple diet otherwise — lots of prepackaged and junk food.”
Less commonly, medical conditions can interfere with the body’s ability to absorb vitamin C, such as inflammatory bowel disease (such as Crohn’s disease), celiac disease or cancer.
Scurvy Risk Factors
These days, it’s no longer mariners who are susceptible to the disease — it’s children with restrictive diets or difficulty eating certain foods, often due to sensory issues.
“That might include a high reliance on processed foods because those always taste the same, whereas each grape even in the same bunch might taste different, each apple tastes different,” Gilley says.
Neurodevelopmental conditions
Children with neurodevelopmental conditions, such as autism spectrum disorder (ASD), are most likely to have such food problems.
In a recent 2024 study on the increase in scurvy cases, autism spectrum disorder was present in 64.2% of scurvy diagnoses among children and adolescents.
“Many ASD patients have a very restrictive diet secondary to sensory issues that often make vitamin C rich foods difficult to eat,” says Dr. Grant Hogue, an orthopedic surgeon at Boston Children’s Hospital who co-authored the study. “Any group that has a restrictive diet can ultimately be affected.” For example, the study found 5.7% of those diagnosed with scurvy had cerebral palsy.
Avoidant restrictive food intake
In addition, children who have avoidant/restrictive food intake disorder (ARFID), a form of disordered eating in which kids are extremely picky to the point of having poor nutrition, are also at risk for scurvy due to vitamin deficiencies.
Aside from children and young adults, at-risk groups include:
— Elderly people who might not be eating a balanced diet
— People who’ve had bariatric surgery with a limited post-surgery diet
— People on a restrictive diet, such as the carnivore diet, that limits or eliminates certain food groups
[READ: What Does Vitamin C Do for the Skin?]
Why Is Scurvy Increasing?
Hogue’s study found that reported inpatient pediatric cases of scurvy more than tripled from 2016 to 2020, from 8.2 to 26.7 cases per 100,000 patients.
Results of another new study on scurvy in pediatric hospital patients from 2006 to 2021 led by Dr. Kathleen Murphy, a pediatric hospitalist at Children’s Hospital of Philadelphia (CHOP), found similar results, with the steepest uptick in cases after 2017.
Gilley has seen cases since she started practicing nutrition medicine in 2019.
“In our hospital we see about two or three cases a year, possibly more,” Gilley says. “Personally, I think I’ve seen six or seven cases in the last four years, most of those children who had autism or ARFID.”
While it’s unclear why scurvy rates are increasing among kids, certain factors include:
Lack of awareness and medical recognition
Scurvy might not be on people’s radar as something to be concerned about.
“To some extent it is likely a lack of public awareness and the belief that this is a ‘historical’ disease that only happened to sailors in old books,” Hogue says.
Doctors might also have difficulty recognizing scurvy because it’s a relatively rare disease compared to others it might be confused with, especially if the child is growing normally. Plus, doctors aren’t taught as much about nutrition in medical school as they used to be, Gilley says.
In addition, many insurance companies don’t cover dietitian support, Gilley says, so parents might not be getting enough guidance on their child’s nutrition from any medical provider.
More kids with restrictive diets
An increase in children who have restrictive or selective diets may also be contributing, Murphy says. Autism diagnosis rates have concurrently been rising over the past two decades, which could be linked.
Also, this group’s intake of vitamin C might have been affected by the American Academy of Pediatrics’s recommendation to limit juice. National survey data shows a general decrease in juice intake between 1999 and 2018, and this group may not have replaced the vitamin C in children’s diets from other sources, Murphy says.
Premature babies
Another reason for the increase in restrictive diets could be more premature babies.
“Children are having greater and greater survival at younger and younger gestations,” Gilley says. “In the study we did, we saw a fair number of children who had neurodevelopmental consequences of their prematurity, like having cerebral palsy.”
Fewer feeding tubes
In the past, doctors more often used feed tubes to provide full nutrition to children who have very poor growth, extreme food aversions or a condition that makes eating difficult, such as cerebral palsy. However, Gilley says many doctors have children eat by mouth now, which may make it more difficult for them to get the vitamin C they need.
Changes in farming practices
Others have proposed that farming practices might be decreasing the amount of vitamin C in food, Gilley says. This might include using certain fertilizers.
Scurvy Treatments
The good news is treating scurvy early is exceedingly easy and inexpensive with vitamin C supplements. Pediatric patients are often treated with 100 to 300 milligrams daily and adults with 500 to 1,000 milligrams daily for one month or until symptoms resolve.
Pediatric patients can experience relief from scurvy very quickly once treated. Most patients show improvement within 48 hours, according to Gilley.
“One patient … who hadn’t been walking for a month was running within 48 hours,” she says. “It’s like magic.”
Storrs found this to be the case as well.
“My doctor prescribed me orange juice. He wrote out a prescription and everything as a joke because I had been so thick-headed,” he says. “But I took it to heart and got some along with fresh broccoli and other vegetables. Within a matter of days my symptoms began resolving.”
Once scurvy has resolved, it’s important to maintain a healthy, vitamin C-rich diet to prevent it from returning.
Scurvy Prevention
For most people in developed countries, scurvy continues to be rare if you eat vitamin C-rich foods, such as:
— Citrus fruits, such as oranges, lemons and limes
— Broccoli
— Leafy greens
— Bell peppers
— Tomatoes
— Potatoes
— Strawberries
— Kiwi
— Brussel sprouts
It doesn’t take much to meet the required amounts to prevent scurvy.
For a 1 to 3 year old, the recommended intake of vitamin C is 15 milligrams and goes up to 75 milligrams at age 18. One orange gives you 70 milligrams of vitamin C, half a cup of red bell pepper gets almost 100. So, if your child is eating one clementine, half a cup of sliced strawberries or a kiwi, that’s enough.
One caution with fruits and veggies: Cooking decreases the amount of vitamin C in food. For example, bell peppers are a great source of vitamin C, but cooking them reduces the amount by more than half.
You can also discuss with your pediatrician whether your child should incorporate a vitamin C supplement or drink a nutritionally complete beverage like PediaSure.
Talk to Your Doctor
Scurvy could be back for good, so parents and doctors need to keep it in mind. If a patient has symptoms, pediatricians should be sure to collect a detailed dietary history, especially in children with autism or other neurodevelopmental disorders.
“Identifying an increased risk for scurvy from a diet history can prevent a prolonged workup, or even hospitalization,” Murphy says.
If you have any concerns about your child’s diet, bring it up with your pediatrician.
“If your child is missing an entire food group, they’re at risk for deficiencies,” Gilley says. “Talk to your primary care provider and ask for help. If they’re not taking you seriously, don’t be afraid to advocate for your child and speak up.”
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Scurvy: Symptoms and Causes originally appeared on usnews.com
