One of the oldest known nutritional disorders, Vitamin C deficiency presently affects close to 17 percent of low-income population groups. The lack of dietary vitamin C causes the disease that was initially associated with only pirates of a bygone era. Popularly known as scurvy, the disease is attributed to insufficient intake of ascorbic acid, or a lack of ascorbic acid, typically found in fruits and vegetables especially fruits belonging to the citrus family. It is essential to know what causes scurvy and more about the condition, so as to modify diets accordingly and prevent the onset of conditions that have plagued populations. Here is a detailed look at vitamin C deficiency and its effects.

Overview of Vitamin C deficiency and what causes scurvy?

Individuals with scurvy are at risk of developing anaemia, and experiencing various other symptoms with acute discomfort and manifestation. For instance, individuals may experience pain in the lower limbs, bleeding for no particular reason, extreme exhaustion without indulging in physical activity, and debilitation. In certain cases, patients with scurvy are also known to lose teeth alongwith the formation of ulcers in the gums.

Typically, scurvy had been associated with certain conditions that prevented entire populations or sections of society from having access to fruits and vegetables. One of the reasons why seafarers were linked to the condition was the inability to maintain adequate stocks of perishable vegetables and fruits during long voyages. However, despite the significant changes in diet, and the availability of fresh produce, certain populations ned up with scurvy outbreak. Low income groups without access to fresh produce or products that are fortified/enriched with vitamin C are at higher risk of contracting scurvy.

Individuals/sections of society at higher risk of contracting scurvy

• As we learn more about what causes scurvy it is essential to identify individuals or sections of society that are higher risk of contracting the condition. Some of the more common and high risk groups include the following :

• Individuals with known alcoholic conditions

• Patients with chronic malnutrition issues

• Individuals with a history of consuming food without adequate portions of fruits/vegetables daily

• Individuals who reside alone – relying on easily available food that may not have the desired nutritional balance (known as bachelor scurvy or widower scurvy)

• Individuals with food habits that are distinctly unusual with a clear dislike for certain food products

• Patients suffering from certain psychiatric conditions that cause irrational fear of food, dietary intake disorders and intentional self-starvation

• Patients with certain conditions that impact the ability of the body to absorb vitamin C. For instance patients on routine dialysis are known to have lesser ability to intake vitamin C. Similarly, patients with severe dyspepsia and Crohns disease are also at risk of developing scurvy.

• Entire populations in certain geographical locations that are known for higher malnutrition cases. In such populations, the dietary intake may often be restricted to cereal grains and may typically not include fresh fruit and vegetables due to a lack of access.

Commonly discernible symptoms of the deficiency and what causes scurvy?

Among the discernible symptoms of vitamin C deficiency, the most serious is the prolongation of the healing cycle. In other words, individuals with injuries will find that it takes a longer time for the injuries to heal when afflicted with the condition. While understanding what causes scurvy it is also necessary to know that in rare cases, the manifestations or outcomes of scurvy could be fatal. As the condition is attributed to a lack of adequate intake of dietary vitamin C, the best preventive method is to ensure that individuals with the condition receive supplements. This could be in the form of oral supplements or intravenous supplements.

Scurvy is also known by skin conditions which are typically the first to be seen/experienced. For instance, individuals end up with the development of perifollicular hyperkeratotic papules. The formation of the papules are most often on the shins – the region between the knee and the ankles. The formation is typically reddish or bluish in color with spots that form around the hair follicles. The hair follicles end up being twisted and are susceptible to breaking easily. In certain cases, the papules may actually link with adjoining papules to form larger areas of bruising.

How does vitamin C deficiency cause problems?

Now that we have taken a good look at what causes scurvy it is necessary to understand why its deficiency causes problems. For instance, vitamin C is essential in the production of collagen, and a lack of vitamin C ends up reducing the ability of the body to create collagen. As a result, the first visible symptoms are often on the skin. Similarly, collagen is pivotal in nature when it comes to the constitution of connective tissues and blood vessels, offering vital support for the structure of blood tissues and connective tissues. When there is inadequate supply of vitamin C, this impacts the structure of blood vessels and connective tissues. Additionally, vitamin C also has a role in the body’s immune system, while helping in the absorption of iron. It also has a vital role in the metabolism of cholesterol, apart from various other functions.

Impact of vitamin deficiency on teeth

One of the most noticeable symptoms of scurvy is the impact on teeth. This makes it extremely important to understand all about what causes scurvy. The teeth is often the first feature that individuals see in a person’s face, during a conversation, and inadequate vitamin C can result in loss of teeth and visible damage. Other oral damage resulting from scurvy includes swelling of the gums that often turn red and spongy in nature. As the gums end up being softened due to scurvy, the slightest force, or friction is all that is needed for the gums to bleed. Consequently, individuals with the condition may practice poor oral hygiene to prevent bleeding during brushing of the teeth and flossing. This could result in aggravation of the conditions due to scurvy, resulting in various dental issues.

Various manifestations of scurvy

Now that we have fully understood what causes scurvy, it is time to look at other manifestations of the deficiency. For instance, vitamin C is vital for carnitine to be synthesized. This is similar to amino acid and helps the body turn fat into energy. When there is inadequate absorption of vitamin C, the ability of the body to synthesize carnitine is compromised. Consequently, individuals feel exhausted due to insufficient energy levels. It is necessary to understand that part of the energy produced in the body is from fat, and when this is reduced, individuals are likely to feel weak/tired. The individual may lose weight, or show disinterest in eating properly, and could end up losing weight.

Similarly, vitamin C is required for dopamine to be synthesized. As a result of inadequate vitamin C, the levels of dopamine, norepinephrine, and epinephrine drop and this triggers various effects. These neurotransmitters have important functions and a drop in the levels of the neurotransmitters has effects that could be mild or moderate in nature. The impact of the deficiency on neurotransmitters could cause irritability among patients, apart from a clear lethargic attitude, with a marked lack of interest in activities.

Possible aggravated conditions due to scurvy in a patient over a longer period
While understanding what causes scurvy it is essential to learn how the conditions affects individuals over a long term. For instance, patients with the condition for a long term may begin to exhibit conditions such as edema. This condition refers to the swelling of the limb extremities due to excessive fluid trapped in the tissues. While the condition may have an effect on any part of the body, it is more likely to be easily visible in the legs, arms, ankles and feet. When left untreated or when there is prolonged deficiency of vitamin C, individuals will end up with edema. Additionally, the conditions is also known to cause jaundice, and the destruction of red blood cells. Known as hemolysis, this condition causes a release of hemoglobin from the red blood cells into the blood plasma. Anemia with hemolysis is a rare condition from scurvy and it is therefore important to prevent the condition from affecting individuals on a long-term basis.

Effective measures for preventing scurvy

With the above sections clearly highlighting what causes scurvy it is time to look at effective measures for preventing the onset of scurvy. Vitamin C cannot be synthesized by humans – this essentially means that the only way to deliver vitamin C to the body is through dietary intake. Fresh fruit and vegetables are the best source of vitamin C, and need to be included in daily diet. In the event that individuals do not have access to fresh fruit or vegetables, the next best option is to take supplements or foods that are fortified with vitamin C. There are various options for administration of vitamin C in patients with scurvy – injections and oral formulations – that may be required to be given anywhere between 3 days or 3 months, depending on the condition. The results of such oral/injection administration is swift, with improvements reported within a day. Most of the other conditions resolve in a fortnight, with the possible exception of irreversible oral damage.

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