Scurvy

Solved with Vitamin C

Chances are the last time you heard someone mention scurvy, an Errol Flynn type was being forced to walk the plank at swordpoint in a bad old pirate movie: "We'll make shark bait outta ya, ya scurvy dog!"

The name given to a set of symptoms that develop during a severe long-term shortage of vitamin C, scurvy is rare these days. But make no mistake: At one time, scurvy was a plague of epic proportions. In fact, one expert maintains that after famine, scurvy is "probably the nutritional deficiency disease that has caused the most suffering in recorded history."

Source of Sailors' Suffering

Once called the scourge of the navy, scurvy killed or incapacitated countless sailors during the age of naval exploration. Often long sea voyages, even aboard grand sailing ships led by legendary explorers such as Ferdinand Magellan and Vasco da Gama, literally became death trips for the crew. In fact, da Gama lost 100 of 160 men to scurvy during one ten-month voyage.

Soldiers bogged down on long winter campaigns often suffered the same fate: wounds that wouldn't heal, muscle pain, bleeding gums, lost teeth, fatigue, kidney failure, pneumonia and, finally, death.

Between 1556 and 1857, more than 100 scurvy epidemics occurred throughout Europe, including Ireland's infamous Great Potato Famine (potatoes were that country's main source of vitamin C).

Many early medical experts thought that scurvy was contagious, and no one had any idea what caused the disease. Finally, James Lind, a young Scottish physician in the British navy, theorized that sailors' diets, which often consisted of nothing more than biscuits and salted meats such as beef and pork, lacked "acidic principles."

To test his theory, Dr. Lind divided some sick sailors into groups. A few sailors ate oranges in addition to the ship's rations; others ate lemons. Still others were given vinegar. One group even drank seawater!

Within six days, the sailors who ate the oranges and lemons were healthy enough to be reassigned to active duty. And for his part, Dr. Lind had shown that this devastating illness could be cured with the right nutrients. In 1753, Dr. Lind published A Treatise on Scurvy, describing the study and his recommendations for treatment.

Dr. Lind's observations weren't implemented for another 50 years. But they had impact, and not just on health. Soon British sailors were known as limeys, a nickname that poked fun at the lime juice they drank while at sea.

Scurvy Still Exists

Healthier diets featuring lots of vitamin C-containing foods have come close to ending scurvy in America in this century. And yet several factors raise the possibility of a future increase in cases. Among these factors is changing demographics. "Although scurvy is considered uncommon in the United States, the two populations at greatest risk, the institutionalized elderly and alcoholics, are increasing," says Kevin C. Oeffinger, M.D., associate professor of family medicine at the University of Texas Southwestern Medical Center at Dallas.

Dr. Oeffinger had read about scurvy when he was in medical school, but it wasn't until just a few years ago that he came face-to-face with his first case. A 59-year-old man arrived at a Waco, Texas, emergency room accompanied by his sister and complaining of sore, bleeding gums, an outbreak of small purplish red spots on his legs and arms (actually hemorrhaging blood vessels), fatigue and weakness. The man later told Dr. Oeffinger that he had eaten nothing but crackers and eight to ten beers a day for six months.

What's wrong with this dietary picture? Virtually everything. But the man's obvious lack of fruits and vegetables, the best sources of vitamin C, gave him scurvy.

Once a person starts to get scurvy, the disease itself makes it hard to make the kinds of dietary changes needed to overcome it, explains Dr. Oeffinger. That puts people in a real medical emergency.

"It becomes a snowball effect, so to speak," says Dr. Oeffinger. "Because they lose their appetites as a symptom of the disease, their chances of eating something with vitamin C are lowered. In addition, they start getting painful gum changes that make it uncomfortable for them to eat, and that's a further impediment to them eating a normal diet."

Who's at Risk

While few doctors ever see full-blown cases of scurvy, nutrition experts warn that a potentially large number of older folks teeter on the brink of a condition known as sub scurvy. Living alone or in nursing homes, they might eat just enough fruits and vegetables to get the Daily Value of vitamin C, which is 60 milligrams.

But the Daily Value of vitamin C might not be enough for some older people, according to Tapan K. Basu, Ph.D., co-author of Vitamin C in Health and Disease and professor of nutrition at the University of Alberta in Edmonton. Many older folks take aspirin or other analgesics daily to manage arthritis pain, and that can reduce the amount of vitamin C in the body by as much as 50 percent, he explains. "You get a combination effect of aspirin impeding vitamin C absorption in the gastrointestinal tract as well as damaging the vitamin C itself," he says.

People with ulcers are also at risk for sub scurvy. Avoiding acidic foods to help keep pain at bay often means cutting back on solid sources of vitamin C such as oranges and lemons, says Dr. Basu.

Smoking a pack of cigarettes a day has also been found to cut the amount of vitamin C in your body by 50 percent. As a result, the Food and Nutrition Board of the National Research Council recommends that smokers get 100 milligrams of vitamin C daily.

Combine all three--prolonged low vitamin C intake, smoking and daily aspirin use--and you're well on your way to sub scurvy. Symptoms include delayed wound healing, small red spots that show up particularly when pressure is applied to the arms, severe fatigue and bleeding gums.

Treating Deficiency

How much vitamin C does it take to overcome the symptoms of scurvy and sub scurvy? The amount pretty much depends on how severe the deficiency is in the first place, says Dr. Basu.

To begin with, a person with full-blown scurvy should be under a doctor's care. During the first week of treatment, between 500 and 1,000 milligrams of vitamin C a day is usually enough to replenish depleted reserves and help end symptoms such as bleeding gums and those purplish red spots, says Dr. Basu. During the second week, he reduces the daily dose to 100 milligrams and then prescribes that level for the next month. After that, the Daily Value (60 milligrams) is usually enough to avoid a recurrence, he says.

But how much vitamin C should you take if you think you're at risk for sub scurvy? Generally, 200 milligrams a day, says Dr. Basu.

For those who use aspirin frequently, Dr. Basu suggests waiting three hours after taking your aspirin to take vitamin C, giving your body enough time to absorb the aspirin without harming the vitamin C. Taking vitamin C soon after a meal and not on an empty stomach is the answer for people with ulcers. You could also try ester-C, a calcium-based version of vitamin C, to prevent acid-related pain, he advises. This form of vitamin C is available in health food stores, he says.