Study: Increase of Vitamin C Deficiency Associated With Cost of Living and Upsurge of Bariatric Surgery

The vitamin C deficiency, known as scurvy, is resurfacing with the cost of living and the increase in bariatric surgery, according to research published in the journal BMJ Case Reports.¹

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Vitamin C is a crucial nutrient for the body, which plays a role in the development, growth, and healing of the skin, bones, and connective tissue. Study authors noted that the vitamin also helps the body absorb iron, maintains the teeth and gums, and aids the healing process or burns and wounds.²

Scurvy is a nutritional disorder that occurs when an individual is not consuming enough fruits and vegetables which causes a lack of vitamin C in the diet. If left untreated scurvy can result in bleeding gums, loosened teeth, and bleeding under the skin.¹

However, a vitamin C deficiency severe enough to cause scurvy is rare in the US as most individuals receive enough vitamin C through their diet. Study authors noted that 7.1% of individuals in the US may develop scurvy as 73.9% of individuals residing in north India may develop scurvy. The initial symptoms could appear after a few months of inefficient vitamin C intake of less than 10 mg, including general weakness, fatigue, irritability, and joint pain. The disorder can be treated by consuming more vitamin C or taking a vitamin C supplement, according to study authors.²

In the case report, researchers treated a middle-aged man that presented small painful red-brown pinpoints that resembled a rash on his legs. Additionally, the patient reported to have blood in his urine and was anemic. Because scurvy is a rare current disorder, that often is mistaken for other conditions, the researchers tested the patient for inflammatory, autoimmune, and blood disorders. The study authors noted that all tests were negative, and his scans did not reveal any signs of internal bleeding. After being admitted to the hospital the rash spread, allowing researchers to question the patient's diet. Unfortunately, the patient revealed that he currently had limited expenses which resulted in skipping of meals.¹

The patient was diagnosed with scurvy following blood tests to evaluate his nutritional status that found no visible levels of vitamin C and low levels of other important nutrients. The study authors noted that the patient was given 1000 mg of vitamin C, vitamin D3, folic acid, and a multivitamin supplement daily, which cleared the rash and associated symptoms.¹

“Our patient had multiple risk factors, namely, poor dietary habits, obesity, previous bariatric surgery, use of proton pump inhibitors, and low-income status. His history of iron, vitamin D, and folate deficiencies were also clues to his underlying nutritional deficiency,” study authors said in a news release.¹

While lack of vitamin C is the most common cause of scurvy, the case study provided that other factors like alcoholism, smoking, eating disorders, low household income, obesity, kidney dialysis, and steroids that interfere with vitamin C absorption can also initiate the disorder.¹

Additionally, bariatric patients after gastric bypass surgery could follow an insufficient diet, placing them at high risk of vitamin C deficiency.³ The findings highlight the need for health care providers to continue to educate patients on the risk of scurvy, ensuring proper vitamin C intake.

“Scurvy is still seen as a disease of the past, especially in developed countries.” The rising cost of living also makes it harder for families to afford good quality nutritious foods, while there have been numerous reports of scurvy arising from complications following bariatric surgery,” study authors said in a news release.¹

REFERENCES

1. Scurvy may be re-emerging amid cost of living crisis and rise of weight loss surgery. EurekAlert!. News release. October 22, 2024. Accessed October 24, 2024. https://www.eurekalert.org/news-releases/1061881

2. Scurvy. Cleveland Clinic. October 20, 2022. Accessed October 24, 2024. https://my.clevelandclinic.org/health/diseases/24318-scurvy

3. Severe Scurvy After Gastric Bypass Surgery and a Poor Postoperative Diet. National Library of Medicine. March 23, 2012. Accessed October 24, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC3320124/