A nutritional illness once synonymous with ancient sailors is rearing its ugly head in the modern day. Researchers in the U.S. and elsewhere are warning that cases of scurvy might be climbing, particularly among vulnerable populations like children with sensory issues, elderly people, and others struggling to eat or afford healthy fruits and vegetables.
Scurvy is the disease caused by a severe and chronic deficiency of vitamin C. Our bodies need vitamin C for many different functions, such as supporting our immune system and repairing damaged tissue, so those with scurvy will commonly experience symptoms like skin lesions, loose teeth, internal bleeding, and eventually death if left untreated. Though Scottish physician James Lind famously demonstrated in the mid-1700s that citrus fruits high in the vitamin could treat and prevent scurvy, it would take until the 20th century for the connection to be proven and widely accepted. Thanks to that knowledge, scurvy is now rarely seen in most pockets of the world. But recent research and case reports suggest it’s becoming a more relevant issue again.
This July, for instance, a study analyzing nationwide pediatric hospital admissions in the U.S. found that the reported rate of scurvy cases in children had increased more than threefold between 2016 to 2020. In early October, doctors in Canada reported on a specific case of scurvy involving a 65-year-old woman; they further cautioned that the condition “should not be considered only an archaic diagnosis of 18th-century seafarers.” And just today, a separate team of researchers in Australia documented their own scurvy case in a middle-aged man following bariatric surgery.
“The incidence of scurvy diagnosis is increasing among children in the U.S.,” Grant Hogue, senior author of the July study and a pediatric spine surgeon at Boston Children’s Hospital and Harvard Medical School, told Gizmodo in an email.
To be clear, scurvy will continue to be a rare condition for the foreseeable future. A 2021 study did find that up to 41% of American adults have insufficient levels of vitamin C, including about 6% who met the criteria for deficiency. But while many of us may have lower vitamin C levels than we should, it takes two to three months of sustained deficiency for any symptoms to appear. And even in Hogue and his team’s research, they only identified 265 cases during the study period (out of nearly 20 million patients overall). Compared to the sailors of the past, it’s simply a lot easier for the average person to get vitamin C in their diet without much thought. But doctors like Ebubekir Daglilar, who co-authored a review on scurvy in 2023, do argue that cases of scurvy today are being missed by doctors, and that we could be doing more to help people unfortunate enough to develop it.
“It’s not going to be some huge thing. It still takes very limited intake of vitamin C for someone to get scurvy. But I think it’s definitely underdiagnosed. I’m testing for it more and more as I train my fellows and they’re testing more, too. You would be surprised at how we are not diagnosing these patients,” Daglilar, a gastrologist at West Virginia University, told Gizmodo.
There are some groups more vulnerable to scurvy, Daglilar says, such as people struggling with alcohol use, people with morbid obesity, the elderly, and those in poverty. The authors of the Canadian case report argued that food insecurity in particular can be a major risk factor for scurvy; their patient had mobility issues and was living on a low income, which limited her access to fresh produce. The Australian researchers noted that their patient’s weight loss surgery may have predisposed him to scurvy, since these surgeries tend to affect how well the body absorbs certain nutrients, along with the rising cost of living and healthier foods. Their patient reported that he had little money, which led to him often skipping meals and dropping the use of nutritional supplements that are prescribed to patients post-surgery. And Hogue points out that about two-thirds of the children in his team’s study were concurrently diagnosed with autism spectrum disorder. Many people with ASD experience sensory issues that make them adverse to a variety of foods, which can then result in extremely selective diets and increase their risk of malnutrition.
As debilitating as scurvy can be, it’s even more treatable today than it was during James Lind’s day. Daglilar has seen patients’ poor blood coagulation and other symptoms clear up quickly after they start getting high doses of vitamin C. And the blood testing needed to confirm that someone has low vitamin C is also inexpensive, according to Hogue. The bigger problem for doctors is knowing when these tests and treatments are needed for their patients. Daglilar says doctors should remember that scurvy still exists and be willing to look for it, particularly in people at higher risk.
“I think just increasing the awareness of it would help. I often tell my fellows that if they have a suspicion, especially in these vulnerable patient populations—if they see something like bleeding—then to throw in a vitamin C test. And many times, it’ll come back with very low or undetectable levels. And once you look back, you can see that there was other signs there. Maybe they had skin lesions, dental problems—it all just makes sense all of a sudden,” he said. People can also proactively reach out to their doctors for testing, he adds, especially if they know that they haven’t been getting enough fruits and vegetables in their diet.
Scurvy may never again be the danger that it was during the olden days of sea travel, but it’s definitely something that doctors and some people should be on the lookout for.
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