Beriberi. Pellagra. Scurvy. These nutritional deficiency diseases have such short, pithy names, it should be difficult to forget them. But forget them we have, since in the developed world they are relatively uncommon nowadays. On the other hand, they are still common in the developing world.
Scurvy, which is caused by lack of vitamin C, used to be much more common in the west. Sailors at sea seemed to be particularly prone to getting scurvy, some even dying from it, for reasons not well understood centuries ago. Scurvy is characterized by bleeding gums, spots on the skin, fever, weakness, and depression. These symptoms result from the body’s inability to produce collagen, which requires vitamin C(ascorbic acid) to be synthesized. Collagen is an important protein that is the main building block of the body’s connective tissues.
It was sometimes mistakenly thought that scurvy was a contagious disease, until it became clear that there was something missing from the sailor’s standard diet of dried meat, dried fish, and grain. Simply adding fresh fruits and vegetables to their diet, in particular citrus fruits, seemed to cure scurvy, though they didn’t know why.
The Royal Navy’s solution in the early 19th century was to add lemon or lime juice to their sailor’s daily ration of watered down rum(grog). This is how the word “limey“, the derogatory word for people from Britain originated. Many other countries soon followed the British example(though some used sauerkraut instead of citrus juice), thereby reducing scurvy cases among seamen.
It wasn’t until the 1930s that scientists isolated and identified the mysterious “anti-scorbotic” factor(the factor that prevents scurvy), vitamin C. Studying the history of nutrition and nutritional deficiency diseases in particular is a great way to see how science works.
Nowadays scurvy is pretty rare in the U.S, but it is more common among certain subgroups like the elderly and homeless drug addicts. According to the Mayo Clinic, Scottsdale, Arizona, in Scurvy: a disease almost forgotten(2006):
In addition to our patient, seven of 11 patients whose records in the institutional database mentioned vitamin C deficiency were women. The age ranged from a neonate to 77 years (mean, 48 years). The most common associated causes were concomitant gastrointestinal disease, poor dentition, food faddism, and alcoholism. Vitamin or mineral deficiencies other than vitamin C deficiency were also found in our patients who had scurvy. The most common symptoms were bruising, arthralgias, or joint swelling. The most common signs were pedal edema, bruising, or mucosal changes. Four patients had vague symptoms of myalgias and fatigue without classic findings, and five had concomitant nutritional deficiencies. Follow-up available for six of 12 patients treated by vitamin C supplementation showed complete resolution of symptoms in five.
Patients with scurvy may present with classic symptoms and signs or with nonspecific clinical symptoms and an absence of diagnostically suggestive physical findings. Concomitant deficiency states occur not uncommonly. Taking a thorough dietary history and measuring serum ascorbic acid levels should be considered for patients with classic signs and symptoms, nonspecific musculoskeletal complaints, or other vitamin or mineral deficiencies.
In other words, scurvy hasn’t been completely eradicated, and we should be on the lookout for symptoms of it in the elderly who are eating poorly. This doesn’t mean that the elderly or you should be taking vitamin C supplements, though taking the occasional multivitamin for insurance probably won’t hurt.
Drinking orange juice or eating enough fruits and vegetables will give you well beyond the 60 mg of vitamin C we need to prevent scurvy. However, there’s no good reason to mega-dose with vitamin C, or any other nutrient for that matter.