Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time.
Scurvy is very rare in countries where fresh fruits and vegetables are readily available and where processed foods have vitamin C added. Vitamin C is an important antioxidant vitamin involved in the development of connective tissues, lipid and vitamin metabolism, biosynthesis of neurotransmitters, immune function, and wound healing. It is found in fruits, especially citrus fruits like oranges, lemons, and grapefruit, and in green leafy vegetables like broccoli and spinach. In adults, it may take several months of vitamin C deficiency before symptoms of scurvy develop.
Currently, the recommended daily allowance (RDA) for vitamin C is 50-60 mg/day for adults; 35 mg/day for infants; 40-45 mg/day for children 1-14; 70 mg/day during pregnancy; and 90-95 mg/day during lactation. The body's need for vitamin C increases when a person is under stress, smoking, or taking certain medications.
Causes and symptoms
A lack of vitamin C in the diet is the primary cause of scurvy. This can occur in people on very restricted diets, who are under extreme physiological stress (for example, during an infection or after an injury), and in chronic alcoholics. Infants can develop scurvy if they are weaned from breast milk and switched to cow's milk without an additional supplement of vitamin C. Babies of mothers who took extremely high doses of vitamin C during pregnancy can develop infantile scurvy. In children, the deficiency can cause painful swelling of the legs along with fever, diarrhea, and vomiting. In adults, early signs of scurvy include feeling weak, tired, and achy. The appearance of tiny red blood-blisters to larger purplish blotches on the skin of the legs is a common symptom. Wound healing may be delayed and scars that had healed may start to break down. The gums swell and bleed easily, eventually leading to loosened teeth. Muscle and joint pain may also occur.
Scurvy is often diagnosed based on the symptoms present. A dietary history showing little or no fresh fruits or vegetables are eaten may help to diagnose vitamin C deficiency. A blood test can also be used to check the level of ascorbic acid in the body.
Adult treatment is usually 300-1,000 mg of ascorbic acid per day. Infants should be treated with 50 mg of ascorbic acid up to four times per day.
Treatment with vitamin C is usually successful, if the deficiency is recognized early enough. Left untreated, the condition can cause death.
Eating foods rich in vitamin C every day prevents scurvy. A supplement containing the RDA of vitamin C will also prevent a deficiency. Infants who are being weaned from breast milk to cow's milk need a supplement containing vitamin C.
Another term for vitamin C, a nutrient found in fresh fruits and vegetables. Good sources of vitamin C in the diet are citrus fruits like oranges, lemons, limes, and grapefruits, berries, tomatoes, green peppers, cabbage, broccoli, and spinach.
Recommended daily allowance (RDA)
The daily amount of a vitamin the average person needs to maintain good health.
* "Ascorbic Acid (Vitamin C) Deficiency." In Internal Medicine, ed. Jay H. Stein. St. Louis: Mosby, 1998.
* "Vitamin C (Ascorbic Acid)." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.
* "Vitamin C Deficiency (Scurvy)." In Conn's Current Therapy, 1996, ed. Robert E. Rakel. Philadelphia: W. B. Saunders Co., 1996.
* "Vitamin C Deficiency (Scurvy)." In Professional Guide to Diseases. 5th ed. Springhouse, PA: Springhouse Corporation, 1995.
* "Vitamins and Their Functions." In Cecil Textbook of Medicine. 20th ed. Philadelphia: W. B. Saunders Co., 1996.
* "Major Study Recommends Tripling RDA for Vitamin C." Environmental Nutrition 19 (June 1996): 3.
The Essay Author is Altha Roberts Edgren.
Is Low-Carb Eating Increasing Scurvy?
Eating Low-Carb? Don't Forget Potatoes, Other Foods Rich in Vitamin C
By Jeanie Lerche Davis
June 10, 2004 -- The ancient mariners had scurvy. And apparently, plenty of Americans today have it, too. We're not getting enough vitamin C, the main preventative for scurvy or vitamin C deficiency, researchers say. Could low-carb eating be to blame?
The report appears in the current issue of the American Journal of Public Health.
It provides results from a large nationwide survey, showing that seniors and children get the most vitamin C in their diet. However, men and women aged 25 to 44 get the least -- and are most at risk for developing scurvy.
"A considerable number of U.S. residents are vitamin C deficient," writes researcher Carol Johnston, a professor of nutrition at Arizona State University.
Other studies have shown similar results, she writes. One U.S. study shows that 18% of adults get fewer than 30 milligrams daily of vitamin C. Another study shows that up to 20% of the 13- to 18-year-old group gets fewer than 30 milligrams daily.
Because scurvy is rarely suspected, people with the symptoms -- fatigue, limping, bleeding gums, or swollen extremities -- may not be tested for vitamin C deficiency, she explains. Very often, these patients are misdiagnosed and medicated for other disorders -- not for their vitamin deficiency.
The recommended daily allowance for vitamin C is 75 milligrams for women and 90 milligrams for men. While some people get too much vitamin C in their diets, many others get too little, she says. The body excretes excess vitamin C in the urine.
With the low-carb craze, the vitamin C-rich potato -- once the centerpiece of a healthy diet -- has been pushed aside, notes Althea Zanecosky, MS, RD, a spokeswoman for the American Dietetic Association and professor of sports and nutrition at Drexel University in Philadelphia. She agreed to comment on Johnston's study.
"Potatoes are a great source of vitamin C and other nutrients," Zanecosky tells WebMD. Other vitamin C-rich fruits are also taboo for some people adopting a low-carb diet.
The Study Details
In her study, Johnston used data from health and diet surveys completed by 15,769 Americans aged 12 to 74. Each person surveyed also had his or her blood tested for vitamin C levels.
Among her findings:
* 14% of males and 10% of females were vitamin C deficient.
* Only 6% of 12- to 17-year-olds were deficient.
* The adults aged 25 to 44 had the worst vitamin C levels.
Nearly one-quarter -- 23% -- of males aged 25 to 44 were vitamin C deficient, compared with 15% of 65- to 74-year-olds.
Among females, 20% of those aged 25 to 44 were deficient, whereas 13% of 65- to 74-year-olds were also vitamin C deficient.
* Smokers were nearly four times as likely to be vitamin C deficient as nonsmokers.
* Those who didn't take a vitamin supplement were three times as likely to be deficient in vitamin C.
Seniors are most likely to purchase and use vitamin supplements, notes Johnston. "Vitamin C consistently ranks as one of the most frequently purchased supplements," she writes.
"We showed that individuals who did not use supplements in the previous month had a greatly increased risk of vitamin C deficiency," she notes. "For many years, physicians, dietitians, and other health professionals have hesitated to discuss vitamin supplements with patients."
Seniors are also more likely to take their medicine with orange juice," says Zanecosky. "A lot of seniors buy fortified orange juice, which has vitamins C, E, D, and calcium added. Children are getting juices fortified with vitamin C."
How often does she have to say it? "Eat fruits and vegetables! We always encourage people to eat a variety. If all you eat is an apple, you won't get vitamin C."
Potatoes are low in fat and calories. "The problem is what people put on top of the potato," Zanecosky tells WebMD. "Salsa adds vitamin C, and is a low-fat, low-cal alternative to sour cream, margarine, or butter. Salsa even counts as an extra vegetable! Broccoli also has vitamin C. Broccoli with cheddar cheese over a potato -- you get calcium, vitamin C -- a lunchtime meal."
Also, ample amounts of vitamin C are found in:
* Orange juice
Zanecosky advises eating foods rather than relying on supplements. "The foods have many more other vitamins and minerals that you don't get in a pill," she notes. "They're low in calories, low in fat, and fill you up. Don't tell me you can't find food on this list that's good."
Info From: Johnston, C. American Journal of Public Health, May 2004. Althea Zanecosky, MS, RD, spokeswoman, American Dietetic Association; and professor, sports and nutrition, Drexel University, Philadelphia.
WebMD Medical News
You may also find Chronic Scurvy a very useful article as well.
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