|Scurvy Alive and Well? An Investigative Report|
|Written by Roman Bystrianyk|
|Monday, 04 November 2002 00:00|
Vitamin C deficiency is no longer considered a national priority. Especially low intakes of vitamin C can result in scurvy, which is generally considered a disease of the past or possibly found only in specific risk groups such as alcoholics, institutionalized elderly, and others. As a result, health care professionals are not trained to recognize scurvy in a clinical setting. But is scurvy and subclinical scurvy as rare in western society as we believe?
A large number of men in our army were attacked by a certain pestilence, against which the doctors could not find any remedy in their art. A sudden pain seized their feet and legs; immediately afterwards the gums and teeth were attacked by a sort of gangrene, and the patient could not eat any more. Then the bones of the legs became horribly black, and so, after having continued pain, during which they showed the greatest patience, a large number of Christians went to rest on the bosom of our Lord.
-- Jacques de Vitry, the First Crusade
“Overt scurvy is not a common diagnosis in the United States or other industrialized countries. Nevertheless a review of the clinical literature reveals that scurvy may be resurgent, notably among children. Brought on by low intakes of vitamin C, scurvy’s primary symptom is weakened collagenous tissue, which results in petechiae, bruising, and hemorrhaging. Because of the rapid development, children with scurvy also exhibit pathological changes in their bones, including osteoporosis, cortical thinning and epiphysiolysis. … Patients who present with scurvy generally are misdiagnosed with vasculitis, but they also may be diagnosed inappropriately with blood dyscrasias, ulcerative gingivitis, or rheumatic disorders.” 1
In 1746, as full surgeon on the HMS Salisbury, James Lind watched an outbreak of scurvy and then again the following year. During the second outbreak he performed his now famous experiment. He supplied the one group of sailors with oranges and lemons and those receiving the fruit quickly improved. Lind concluded that the oranges and lemons were the most effective method of preventing scurvy.
“In point of fact little note seems to have been taken of Lind’s ‘critical trial’. This was possibly because such a concept was hardly understood at the time, but also because there was already a large body of existing experience to the effect that fresh fruit and vegetables were a protective against the scurvy, at the time well known to affect particularly sailors on long voyages and troops on campaigns. One wonders, in fact, in how many naval engagements the outcome was principally determined by relative degrees of incapacitation of crews by scurvy and other diseases, as opposed to fighting skills.” 2
The determination that vitamin C deficiency is actually the cause of scurvy was later discovered through a series of accidental findings. In 1907, Alex Holst discovered that guinea pigs on a restricted diet developed symptoms similar to scurvy. This provided the first animal model with which vitamin C deficiency could be tested. In 1928, a substance was isolated by a Hungarian biochemist by the name of Albert Szent-Györgyi, and that substance would later be termed ascorbic acid or vitamin C. The function of the substance remained a mystery until in 1932 when simultaneously in Hungary and in the United States experiments were conducted that showed that this substance, ascorbic acid or vitamin C, would cure the guinea pigs of scurvy.
“Our analyses revealed that a considerable number of children had low intakes of vitamin C. Among the seven to twelve-year-olds, 12% of boys and 13% of girls had mean vitamin C intakes that were less than 30 mg/day. Among 13 to 18-year-olds, 14% of boys and 20% of girls consumed less than 30 mg/day vitamin C. An even greater proportion of children had marginal vitamin C intakes. For both age groups, 21% of boys and 27% of girls daily consumed between 30 mg and 60 mg of vitamin C.” 3
And another study in a primary health center in upstate New York found that a large number of children were not consuming an adequate number of servings of fruits and vegetables.
“Forty percent of the 2-year-old children and 50% of the 5-year-old children consumed less than two servings/day of fruits and vegetables. Vitamin C intake was most strongly correlated with consumption of citrus fruits and citrus fruit juices.” 4
Although 95% of the children consuming 2 or more servings per day of fruits and vegetables met the RDA for vitamin C, only 50% of those met that requirement if they consumed less than 2 servings per day. This indicates that 20 to 25 percent of the children are not getting the RDA of vitamin C in their diets.
“The Recommended Daily Allowance (RDA) for vitamin C is 60 mg/day, an amount associated with plasma vitamin C concentrations ranging from 28 to 34 μmol/L. Plasma vitamin C concentrations ranging from 11 μmol/L to less than 28 μmol/L represent marginal vitamin C status, which Jacob defines as a moderate risk of developing vitamin C deficiency due to low tissue stores. Plasma vitamin C concentrations less than 11 μmol/L are indicative of vitamin C deficiency. The average daily intake of vitamin C in men in the United States is about twice the RDA, yet the prevalence of vitamin C deficiency and marginal vitamin C status in men is 13% and 24% respectively. Women consume an average of 90 mg vitamin C daily, and the prevalence of vitamin C deficiency and marginal vitamin C status in women is 9% and 18%, respectively. These data indicate that although the average vitamin C intake in adult men and women is adequate, vitamin C deficiency and marginal vitamin C status are strikingly prevalent in these populations.
Again it is important to note that the authors state “vitamin C deficiency and marginal vitamin C status are strikingly prevalent in these populations”.
“Modern societies with year-round access to fresh fruits and vegetables, most of which are rich sources of vitamin C, seldom develop scurvy, and the disease is usually considered in a historical context. However, examination of the recent medical literature suggests that scurvy continues to be observed in developed nations. … The number of these recent case reports is surprising, and little research has been conducted to determine the prevalence of vitamin C deficiency in the US population. This study showed that vitamin C deficiency was present at surprisingly high rates among generally healthy patients visiting a health care facility for routine health exams, gynecological exams, and pregnancy exams. … the present study demonstrated that vitamin C depletion and vitamin C deficiency was evident in an outpatient population (prevalence rates, 30.4% and 6.3%, respectively). Symptoms associated with vitamin C deficiency are subtle but physiologically relevant.” 6
Another study of random adults in Alameda County, California also showed a significant portion of that population was in danger of vitamin C deficiency.
“Fourteen per cent of respondents appeared to have no regular source of vitamin C. This group includes persons who reported that they did not have at least two servings of fruit or vegetables almost every day, had none of the specified juices on an average day, and did not take vitamin C pills each day. Because of possible underreporting, 14 per cent is probably too high an estimate of persons who had inadequate vitamin C. However, there is cause for concern if any segment of the population lacks a regular source of vitamin C sufficient to meet nutritional needs.” 7
So we can see that a significant portion of the general population has either a vitamin C deficiency or marginal vitamin C status. In addition, people who have a marginal vitamin C status can more rapidly develop a vitamin C deficiency than people who have adequate vitamin C levels.
“Subjects who began the study with marginal vitamin C status appeared to be at a high risk of rapidly developing a biochemical vitamin C deficiency on diets lacking vitamin C-rich fruits and vegetables. Because the prevalence of marginal vitamin C status may be as high as 20% to 30% in certain US populations, these data stress the importance of consuming vitamin C-rich fruits and vegetables daily. Subjects who began the study with adequate vitamin C status did not tend to develop biochemical deficiency with dietary fruits and vegetables were restricted for 1 to 2 weeks.” 8
So it is apparent from the medical literature that using the RDA as a standard there are a large percentage of the United States population that are not receiving a good supply of vitamin C and even a significant percentage that can be classified as deficient.
“It [Vitamin C] is an enzyme cofactor in the metabolism of tyrosine and the synthesis of carnitine, norephinephrine, and peptide hormones. It increases absorption of iron from the small intestine, and it functions as an antioxidant, reducing harmful free radicals and thereby decreasing damage to lips, lipoprotiens, DNA, protein, and vessel walls.” 9
Vitamin C in fact does have quite a wide variety of function in the body impacting the immune system, cardiovascular health, and because of it’s antioxidant capabilities it plays a role in protecting us from cellular damage that may result in cancer.
“Plants and most animals can synthesize ascorbate from glucose but primates, guinea pigs, and fruit bats lost one of the necessary enzymes (L-gulono-γ-lactone oxidase) during their evolution and so require ascorbate in their diet. In fact, the gene that should encode this enzyme is still present in the human genome, but in a highly mutated inactive form.” 12
This is important because while most animals manufacture their own vitamin C and obtain the health benefits, humans must continuously consume this vital nutrient.
“The current leading causes of death in the United States are cardiovascular disease and cancer; both of these have been linked to dietary intake and may have their origin in childhood. Because food preferences and eating habits may be established during childhood, parents should emphasize high-vitamin C vegetables and fruits when planning their children’s meals and snacks.” 13
And unfortunately often times any fruit and vegetable selections that made are not good sources of vitamin C.
“Lettuce, onions, apples, and bananas – some of the most frequently consumed vegetables and fruits reported here – are not rich in vitamin C.” 14
It is important that people consume certain foods on a daily basis to ensure that they have a good supply of vitamin C.
“Important sources of vitamin C include fruits and vegetables such as lemons, oranges, broccoli, brussel sprouts, cauliflower, strawberries, and cabbage. Milk, meats, fish, and fowl have negligible amounts of vitamin C” 15
Who is at risk for scurvy?
“One group comprises adults living alone, most commonly (“bachelor” or “widower” scurvy), but sometimes women, who have a deficient intake because of such factors as poverty, poor access to groceries, reclusiveness, dementia, or nutritional ignorance. They mostly prepare their own meals, but those who dine in restaurants do not order fresh fruits and vegetables. Other patients with scurvy avoid these “acid” foods because of purported allergies to them, or because they produce or exacerbate gastrointestinal symptoms, such as dyspepsia, dysphagia, diarrhea, and heartburn. Some of these patients have underlying alimentary disorders such as ulcerative colitis, Whipple’s disease, peptic ulcers, and gastroesophogeal reflux, and occasionally advice from clinicians to avoid fruits and vegetables because of abdominal complaints has led to “iatrogenic scurvy.” Vitamin C deficiency has also occurred when poor or absent dentition has been made consumption of fruits and vegetables difficult. Sometimes people shun these foods just because they don’t like the taste, and others because of bizarre dietary beliefs, including food fads.” 16
“It is well established that the elderly individuals, whether institutionalized or not, have lower vitamin C blood levels than younger adults. Plasma and leukocyte vitamin C levels decrease with aging and elderly people require higher vitamin C intakes to reach the same vitamin C blood levels found in young adults.” 17
So we can see there are wide ranges of groups including the elderly, alcoholics, hospitalized patients, pregnant or breast-feeding women, and others groups that are risk for vitamin C deficiency.
“We report a case of scurvy occurring in a 5-year-old boy who had regular access to medical care. His presentation with rheumatic complaints and skin lesions resulted in confusion with possible immunologic or neoplastic disease. … A previously healthy 5-year-old white boy with and unremarkable medical history developed a limp. … On the day before his referral he developed gingival bleeding. … in the most recent 5 months, his diet consisted of biscuits, Pop-Tarts® (Kellogg’s C, Battle Creek, Mich), cheese pizza, and water. He refused fruits, vegetables, and juices, and his mother had been unsuccessful in administering chewable vitamin supplements. … These laboratory findings were diagnostic of scurvy. After administration of ascorbic acid, his pain improved rapidly, and he again began to walk.” 19
So we can see through actual case histories that there are cases of scurvy that still occur in the present day. And as stated by one researcher, which despite advances in medicine, living conditions, and nutrition that scurvy can still occur and that we need to pay attention to this serious condition. And since this condition can easily be mistaken for other conditions, and the general belief that scurvy no longer exists, we have to ask just how many misdiagnoses occur.
“Compared to overt scurvy, subclinical scurvy may be diagnosed even less readily because its symptoms are non-specific. For example, marginal vitamin C status results in vague symptoms such as fatigue, irritability, and impaired lung function.” 23
Also, again an emphasis has to be made on eating plenty of fruits and vegetables instead of consuming vitamin deficient foods that are convenient and cleverly marketed in today’s society. Adequate vitamin C intake on a daily basis can easily reverse problems of scurvy and subclinical scurvy.
“Smoking dramatically lowers blood ascorbate levels, as does aspirin consumption, oral contraceptives, acute and chronic diseases, and a variety of other stresses.” 24
As such smokers require an increased amount of vitamin C to attain the status of non-smokers. It’s also interesting to note that use of aspirin and oral contraceptives also have a negative impact on vitamin C levels. Considering that much of the population uses oral contraceptives and still more use aspirin not only for pain relief, but also for the supposed benefits in prevention of heart disease.
“It is clear that the vitamin C status of smokers needs to be improved. Individuals who smoke required over 200 mg vitamin C daily to maintain serum vitamin C concentrations at a level equivalent to nonsmokers consuming the RDA for vitamin C.” 25
Unfortunately adults are not the only group to engage in this high-risk activity. Many children are directly exposed to the toxic affects of smoking which also adversely affects their vitamin C levels.
“Approximately 3,000 children begin smoking every day in the United States, imposing exogenous oxidative stress on their bodies. Every puff of cigarette smoke contains 1014 low-molecular-weight free radicals. Antioxidants such as vitamin C may have a protective effect against oxidative damage by scavenging oxidants in blood plasma and in tissues. Serum concentrations of vitamin C among smokers are about 25% lower than those of non-smokers, and Kallner et al. reported that metabolic turnover of vitamin C was 40% higher among smokers than non-smokers. Children and adolescents who use tobacco products place themselves at risk for vitamin C hypovitaminosis and have the greatest need for dietary intervention.” 26
And not only does direct smoking affect vitamin C levels, the more parents smoke, the less of the vitamin youngsters have in their bloodstreams, says Richard Strauss of the University of Medicine and Dentistry of New Jersey. His research published in Pediatrics is the first major scientific study on how passive smoke affects vitamin metabolism in children and adolescents. Passive smoke already has been linked to lower levels of vitamin C in adults.
“Exposure of children to ETS (Environmental Tobacco Smoke) leads to significant alterations in serum ascorbic acid levels in addition to the previously described respiratory ailments associated with ETS. This report is the first large study to document direct metabolic consequences of ETS in children. This study is, therefore, in direct contrast to continued assertions by the tobacco industry that ETS causes no damage. Because ascorbic acid protects against plasma lipid and low-density lipoprotein oxidation, and also appears to be important in protecting DNA from oxidative damage, this report further highlights the potential dangers of ETS to children.” 27
Vitamin C Deficiency and Diseases
“The recent scientific literature indicates that beyond merely protecting against scurvy vitamin C contributes to many aspects of human health. The main areas of research reviewed include: 1. Vitamin C requirements of smokers. The data indicate that the vitamin C requirements of smokers is higher by at least 60 mg per day (up to 140 mg per day) than that of nonsmokers. 2. Important functions of the body such as immune response, pulmonary function, and iron absorption are related to vitamin C in takes. Daily vitamin C intake of at least 150-200 mg per day enhance these functions. 3. Vitamin C may play critical roles in the prevention of CHD [Coronary Heart Disease], cancer and cataract. Based on the available data, vitamin C intakes of at least 80-120 mg per day are associated with lowering the risk of these chronic diseases. The literature documents that these and much higher intake levels of vitamin C are safe.” 28
“A multitude of epidemiologic studies have shown that increased consumption of fresh fruit and vegetables is associated with a reduced risk of most types of cancer. Fruit and vegetables contain many constituents that may contribute to protection against cancer, including antioxidant vitamins. … Kromhout et al reported a significant 64% risk reduction of lung cancer with vitamin C intakes > 83 mg/d. … Pandley et al observed a significant 39% lower risk of all cancers in men consuming > 113 mg of vitamin C/d than those consuming, 82 mg/d. A vitamin C intake > 50 mg/d from the diet plus regular supplements, totaling approximately 300 mg/d, was found to be associated with a moderate 21% risk reduction of all cancers in men compared with a dietary intake of < 49 mg/d, although no significant effect was observed in women.” 29
In many studies analyzing vitamin C and cancers of the stomach, esophagus, oral cavity, and pharynx there were major reductions in disease of these areas in patients that had higher levels of vitamin C as compared to those who did not. Studies indicate an enormous 69% and 79% reduction in risk of these types of cancers.
“In a comprehensive review of vitamin C and cancer risk, Block found “extremely strong and consistent” evidence of a protective effect against cancers of the stomach, esophagus, oral cavity, and pharynx: 17 of 19 studies showed statistically significant associations between low intake of dietary vitamin C and increased risk of cancer at these sites. … A recent study by Kune et al compared 41 men from Melbourne, Australia with oral or pharyngeal cancer to 398 male controls. This study found a significant risk reduction of oral/pharyngeal cancer of 79% in the patients having a vitamin C intake of > 106 mg/day with no further risk reduction in the patients with vitamin C intake of > 201 mg/day. In an area of China with a high rate of stomach cancer, serum levels of vitamin C were assayed out of a population of 3,433 subjects. Histological diagnosis was made employing a gastric mucosa tissue sample as collected by gatroscopy. Subjects with low vitamin C serum levels had a 50% higher risk for gastric metaplasia, which is considered to be a pre-cancerous lesion. … A recently published study on gastric cancer and micronutrients conducted during 1988 and 1989 in Barcelona, Spain found that subjects in the uppermost quartile of dietary vitamin C intake showed a statistically significant gastric cancer risk reduction of 69%. Finally, a Swedish study pointed out that vitamin C intake in the highest quartile vs. the lowest quartile 20 years prior to cancer manifestations was significantly associated with reduction in the risk of gastric cancer.” 30
In a large study of 136,000 males in the United States there was an increased risk of 1.7 times for those who consumed fruit less than 3 times a week as compared to those who consumed fruit 5-7 times a week.
“Long-de and Hammond examined data from a prospective study in which 136,000 white males in the United States provided information on their frequency of consumption of fruit and green salad; 671 lung cancer deaths were seen over the subsequent 11-y follow-up. Men who consumed fruit less than three times per week had 1.7 times the lung cancer risk of those who ate it 5-7 times per week, a statistically significant increase. … Pancreatic cancer is the fifth most common cause of cancer mortality in the United States and is a disease with extremely poor prognosis. In the current state of our ability to treat this disease prevention is of primary importance. All five pancreas cancer studies have found statistically significant protective effects of fruit, and in some instances for vegetables as well. The one study that calculated a vitamin C index found a significant twofold reduction in risk associated with high intake. … seven investigators have reported on vitamin C dietary intake and stomach cancer risk. All seven have found statistically significant protective effects of approximately two-fold … Verreault et al examined 189 women with invasive cervical cancer and population controls. Low intake of vitamin C was associated with a statistically significant twofold increased risk. The effect of fruit juices was even stronger. The effect of carotene and dark green vegetables was in the same direction, although weaker.” 31
Here we see that daily consumption of vitamin C can play a key role in prevention of pancreatic cancer, which is a form of cancer that is not very treatable. One study showed a two times reduction in risk of getting pancreatic cancer when taking in high amounts of vitamin C. Vitamin C also has a major impact on stomach and cervical cancer.
“In terms of attributable risk, the authors conclude that “if all postmenopausal women in the population modify their saturated fat intake to (that of the lower one-fifth of the population), the current rate of breast cancer would be reduced by 10% in postmenopausal women … were to increase fruit and vegetable intake to reach an average daily consumption of vitamin C (equivalent to that of the highest one-fifth of the population), risk of breast cancer … would be reduced by 16%.” The effects were approximately additive, and simultaneously make both changes would reduce the risk by 24%” 32
Even in a disease like breast cancer if there was an increased consumption of vitamin C and reduction in consumption of saturated fat there would be a large 25% decrease in breast cancer.
“Thomas Sinks and John R Wilkins III interviewed parents of 100 children with brain tumors and 200 matched control subjects, regarding the mothers’ diets during pregnancy. A statistically significant threefold increased risk of delivering a child who later developed a brain tumor was associated with a low maternal intake of vitamin C during pregnancy, an effect that remained after adjustment for other factors.” 33
“In an analysis of data from the U.S. First National Health and Nutrition Examination Survey (NHANES I) and its 10-year follow-up study, Enstrom et al found strong inverse relationships between vitamin C intake and all-cause mortality and cardiovascular mortality especially in men. This study included more than 11,000 people and assessed vitamin C intake form both diet and supplementation. At the highest level of vitamin C consumption (> 50 mg/day from diet plus regular use of supplements), men had an almost 50% lower rate of death from cardiovascular disease and women had a 35% lower rate.” 34
This large and lengthy study shows that vitamin C can have a significant impact on this major disease reducing the death rate by 50% in men and 35% in women.
“In another recently published study of a 20 year follow-up cohort of randomly selected 730 male and female elderly people living in different areas of Britian, those in the highest tertile of vitamin C intake, which was > 44.9 mg per day, had a 50% lower risk of experiencing a stroke.” 35
“Several epidemiological studies have investigated the association of vitamin C intake with the incidence of cataract. Two case-controlled studies indicated a strong inverse association between high intakes of vitamin C and cataract. Robertson et al found that intakes of >300 mg vitamin C/d were associated with a 70% reduced risk of cataract. Similarly, Jacques and Chlack found that daily intakes of >490 mg were associated with a 75% lower risk of cataract than intakes <125 mg/d. … Two studies, one of them involving > 50,000 women, indicated that vitamin C has a positive effect on cataract risk when supplements were taken for > 10 y; risk reductions of 45% and 77-83% were reported.” 36
In these studies vitamin C had a major impact on cataract. Reducing the incidence of this disease in one study by an enormous 70 percent.
“Vitamin C supplementation has been shown to reduce the severity of symptoms associated with the common cold. In people who experience extreme physical stress, vitamin C may be of benefit in preventing respiratory infections. A double-blind trial conducted in South Africa showed that marathon runner consuming 1 g vitamin C per day had a significantly lower rate of post-race respiratory infection as compared to those consuming 500 mg/day. … In HANES II serum vitamin C levels were negatively associated with chronic bronchitis indicating that vitamin C intake might be of value in subjects with chronic respiratory problems.” 37
Shown here vitamin C has an affect on our immune system that helps protect us again infection.
“A recently published review concluded that vitamin C appears to improve human fertility by various mechanisms. The result of controlled human studies also support a possible role of vitamin C in human fertility. Fraga et al have demonstrated that dietary vitamin C protects human sperm against endogenous oxidative DNA damage. A placebo-controlled study in 75 smokers found a significant dose-dependent improvement of six sperm qualities after 4 weeks of daily supplementation with vitamin C. Sperm quality increased in the 200-mg group by 15% and in the 1,000 group by 40%.” 38
With large amount of vitamin C there is a significant 40% increase in the quality of sperm. This provides a simple low-tech method of helping a significant percentage of the population with fertility problems.
“Several reviews have concluded that vitamin C is safe even when consumed at high levels of intake for long periods of time. There are also no clinical data, which suggests that the enhancement of non-heme iron absorption by vitamin C in individuals with low iron status could be a critical factor in the possible increased risk of heterozygous hemochromatosis-related cardiovascular disease. The committee that prepared the 1989 RDAs pointed out that many people habitually take vitamin C supplements at dosages of 1 g/day without apparent adverse effects.” 39
There are literally tens of thousands of articles in the medical literature, many of which are human studies, reporting numerous health benefits for vitamin C. People have been taking megadoses of vitamin C for decades. Dr. Linus Pauling who won two Nobel Prizes reportedly took more than 15 grams (15,000 mg) of vitamin C daily and lived well into his nineties.
1. Hampl J., PhD, RD, Taylor C., and Johnston C., PhD, RN, FACN, “Intakes of Vitamin C, Vegetables and Fruits: Which Schoolchildren Are at Risk?” Journal of the American College of Nutrition, 1999, Vol. 18, No. 6, pp. 582-590
|Last Updated on Sunday, 21 February 2010 21:22|