Introduction

Scurvy is a rare condition that can develop if you don't have enough vitamin C in your diet.

Vitamin C

Vitamin C (also called ascorbic acid) is vital for the body, because it's needed to make collagen. Collagen is a type of protein found in many different types of tissue, such as skin, blood vessels, bones and cartilage.

Without vitamin C, collagen can't be replaced and the different types of tissue break down, leading to the symptoms of scurvy. These include:

  • muscle and joint pain
  • tiredness
  • the appearance of red dots on the skin
  • bleeding and swelling of the gums

Read more about the symptoms of scurvy.

Unlike some other types of vitamins, the human body is unable to make vitamin C.

All of the vitamin C that the body needs has to come from your diet, so the best way to prevent scurvy is to eat a healthy, balanced diet that contains plenty of fruit and vegetables.

Read more about preventing scurvy.

Who's affected by scurvy?

People tend to think that scurvy is a condition of the past, because our diet and standard of living has improved over the years.

However, although rare, vitamin C deficiency can still be a problem for certain groups of people, including:

  • elderly people who are unable to maintain a healthy diet
  • people who smoke or have a dependency on alcohol or drugs
  • people on a low income

Children with autism spectrum disorder (ASD) may also be at risk of getting scurvy if they will only eat certain foods that aren’t good sources of vitamin C.

Read more about the causes of scurvy.

Treating scurvy

A doctor will usually be able to diagnose scurvy by asking about your symptoms and diet. They may also carry out a blood test to measure the level of vitamin C in your blood.

Treatment for scurvy is relatively straightforward. It involves taking vitamin C supplements and eating food that's high in vitamin C. This should quickly reverse the harmful symptoms of scurvy.

The fact that a person has scurvy in the first place is usually a sign that they're vulnerable or living a chaotic lifestyle. Referral to a dietitian, social worker or mental healthcare professional may be required to prevent further episodes of scurvy or other problems linked to malnutrition.

Read more about treating scurvy.

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Symptoms

The symptoms of scurvy usually begin three months after a person stops getting enough vitamin C in their diet.

In adults, the initial symptoms of scurvy include:

  • feeling very tired and weak all the time (fatigue)
  • a general sense of feeling "out of sorts" – such as feeling irritable and miserable all the time
  • pain in your limbs – particularly your legs
  • the appearance of small red-blue spots on your skin

The spots develop where individual hairs grow out of the skin (hair follicles), and they often occur on the shins. Hairs in affected areas usually twist around like corkscrews and break away easily. Without treatment, the spots can grow and merge to create large dark patches on your skin.

Other symptoms then follow, including:

  • swollen gums – which become soft and vulnerable to bleeding (your teeth may feel loose or fall out)
  • severe joint pain, caused by bleeding inside the joints
  • shortness of breath – particularly after periods of physical activity
  • redness and swelling in recently healed wounds (new wounds may also fail to heal)
  • easily bruised skin

Left untreated, scurvy can cause jaundice (yellowing of the skin and whites of the eyes), oedema (swelling caused by a build-up of fluid) and potentially fatal heart problems.

Scurvy in infants

In infants, the initial symptoms of scurvy include:

  • lack of appetite
  • irritability
  • poor weight gain
  • diarrhoea
  • high temperature (fever) of 38C (100.4F) or above

As the condition progresses, additional symptoms include:

  • pain and tenderness in the legs – which is often severe and can make a young child very upset when they're having their nappy changed
  • as with adults, the appearance of reddish-bluish spots on the skin
  • the eyes bulging outwards

Iron deficiency anaemia

As vitamin C helps the body absorb iron, scurvy can lead to a condition called iron deficiency anaemia. Symptoms of iron deficiency anaemia can include tiredness, lethargy (lack of energy) and shortness of breath.

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Causes

Scurvy is caused by a lack of vitamin C in your diet.

If your body doesn't have enough vitamin C, it can't produce new collagen (a protein found in many different types of body tissue, including the skin and bones). Without a new supply of collagen, the body's tissue will begin to break down and deteriorate.

In the developed world, even if someone has a relatively unhealthy and imbalanced diet, it should provide an adequate supply of vitamin C. Therefore, for scurvy to develop, there are usually other contributing factors, such as:

  • alcohol misuse or drug dependency
  • homelessness
  • complex mental health conditions – such as severe depression or schizophrenia
  • being elderly and unable to maintain a healthy diet – for example, elderly men who've recently been widowed and have little experience of cooking for themselves can sometimes develop scurvy
  • treatments that cause nausea as a side effect, such as chemotherapy, can sometimes result in a person losing their appetite
  • conditions that affect a person's ability to digest food – such as Crohn's disease or ulcerative colitis
  • anorexia nervosa – an eating disorder where a person becomes very concerned about gaining weight and tries to control it by eating as little as possible
  • fad diets
  • smoking – which can reduce the amount of vitamin C absorbed by the body
  • pregnancy or breastfeeding – as the body needs more vitamin C at these times

In the UK, scurvy in children is relatively rare. It usually occurs through a combination of parents being on a low income and knowing little about nutrition. For example, in 2009, a case of scurvy was reported in a child whose diet only consisted of bread and jam.

However, delayed or unsuccessful weaning of babies and toddlers to solid food can also lead to scurvy, if these children aren't given the recommended supplementation of vitamins A, C and D from six months of age, or if they're drinking less than 500ml of formula milk.

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Treatment

Scurvy is treated with vitamin C supplements, which can quickly improve your symptoms.

Some symptoms, such as joint pain, will usually resolve within 48 hours. Most people will make a full recovery within two weeks.

Once your symptoms improve, you should be able to get enough vitamin C by eating a healthy, balanced diet and you'll no longer have to take supplements.

Read more about preventing scurvy.

Referral to a specialist

You may also be referred to a health or social care specialist to address the underlying reasons for developing scurvy in the first place. The type of specialist will depend on the underlying cause. For example, you may be referred to a:

  • dietitian – if your scurvy is caused by a very unhealthy diet and there are no underlying factors
  • social worker or occupational therapist – if your scurvy is caused by an inability to cook for yourself due to disability or poor health
  • gastroenterologist – a doctor who specialises in treating digestive conditions, such as Crohn's disease, if your scurvy is caused by this type of condition
  • psychologist – if your scurvy is associated with a mental health or behavioural condition, such as depressionschizophrenia or anorexia nervosa
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Prevention

The best way to prevent scurvy is to eat a healthy, balanced diet that contains plenty of fresh fruit and vegetables. This will ensure that you have enough vitamin C in your body at all times.

Recommendations

It's recommended that:

  • babies (0-12 months old) get around 25mg of vitamin C a day
  • children 1-10 years old get around 30mg of vitamin C a day
  • children 11-14 years old get around 35 mg of vitamin C a day
  • older children and adults get around 40mg of vitamin C a day (smokers and heavy drinkers of alcohol may require slightly more)
  • pregnant women get 50mg of vitamin C a day
  • breastfeeding mothers get around 70-75mg of vitamin C a day

It's very easy for most people to get the recommended daily amount (RDA) of vitamin C from their diet. For example, eating one large orange, a bowl of strawberries or a single kiwi fruit would provide you with more than enough vitamin C to meet your body's needs.

Consuming more than the amounts of vitamin C outlined above isn't overly harmful. The only adverse effects you would experience if you were to regularly eat more than 1000mg of vitamin C a day (the equivalent of eating about 15 oranges) would be stomach pain, diarrhoea and flatulence.

Sources of vitamin C

Good sources of vitamin C include:

  • oranges
  • lemons
  • limes
  • grapefruits
  • blackcurrants
  • kiwi fruits
  • tomatoes
  • broccoli
  • asparagus
  • cabbage
  • green peppers
  • sprouts
  • sweet potatoes

It's better to eat raw fruit and vegetables as vitamin C is easily destroyed during cooking. If you cook vegetables, it is a good idea to steam rather than boil them as vitamin C dissolves in water.

Levels of vitamin C also gradually reduce during storage, so frozen vegetables can have a higher vitamin C content than fresh vegetables that are not eaten soon after purchase.

Read more about healthy eatingdiet and the eatwell plate.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 30/03/2015 15:15:03