Scurvya disease caused by severe vitamin C deficiency and once considered a disease of the past, has never really gone away in Canada.
More recently, 27 cases were reported in Saskatchewan, highlighting the ongoing risk, particularly among people facing food insecurity or limited access to fresh produce, experts warn.
The disease is both preventable and treatable, but without proper nutrition, a person can develop scurvy, which can lead to symptoms such as bruising, gum disease, tooth loss and even death.
Despite the severity of scurvy, it is very unlikely to develop in people who eat a diet rich in fresh vegetables, fruits and meats, all of which are excellent sources of vitamin C, explained John Neary, associate professor of internal medicine and McMaster University. in Hamilton.
“It’s not exactly a disease of the past, but it can still happen,” he said.
“But the amount of vitamin C that humans need so that their diet does not develop scurvy is quite low. Essentially, it’s impossible to get scurvy if you eat fresh fruits, vegetables, or meat.
Scurvy is a disease caused by a severe deficiency of vitamin C, a vital nutrient that supports collagen production and is essential for maintaining the health of skin, blood vessels, bones and cartilage, according to Health Canada.
Without enough vitamin C, the body cannot heal injuries properly and the structural integrity of blood vessels and connective tissue deteriorates.
Vitamin C also plays a crucial role in the formation of blood vessels, tendons, ligaments, bones, teeth and gums, while helping the body absorb iron and recover from injuries and burns.
“The biological role of vitamin C in the human body is to help stabilize connective tissue,” Neary explained.
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“When the human body lacks vitamin C, connective tissues are weaker than they should be, leading to things like bleeding gums, loose teeth, and easy bruising.”
Other symptoms can also develop, he explained, such as fatigue, weakness, dizziness, fainting and, ultimately, this can lead to cardiovascular collapse and death.
Historically, Neary explains, scurvy was primarily associated with sailors and early explorers who, on long sea voyages, were deprived of fresh food sources. This lack of nutrition often led to severe cases of scurvy, as sailors’ diets consisted primarily of canned foods lacking the essential nutrients needed to prevent illness.
“It’s been rare since the mid-19th century. It was mainly observed during long sailing voyages, when people did not have fresh fruit for months. And the advent of steamships largely did away with that,” he said.
Since then, Neary said episodic cases of scurvy have appeared throughout the 20th and 21st centuries, often linked to socioeconomic factors such as social isolation.
The most recent case in Canada involves a community in northern Saskatchewan. On November 15, it was reported that doctors in La Ronge, Saskatchewan had treated 27 cases of scurvy in the past six months.
In May, the Lac La Ronge Indian Band hired a doctor to investigate a possible vitamin C deficiency in the community. Blood tests on 50 people found that 27 of them had vitamin C deficiency, which indicates scurvy, while 10 had low levels. All participants were over 20 years old and 79 percent were Indigenous.
In October, the Journal of the Canadian Medical Association (CMAJ) has warned doctors to be vigilant for signs of scurvy, following the case of a 65-year-old Toronto woman diagnosed with the disease last year.
The woman, who had difficulty shopping and preparing balanced meals due to various mobility and health issues, had limited social support and relied heavily on canned soup, tuna, white bread and melted cheese.
The study also states that data from the 2017 to 2018 U.S. National Health and Nutrition Examination Survey showed that the prevalence of vitamin C deficiency in the United States was 5.9 percent, while Reports from the United Kingdom suggest that the prevalence of deficiency may be as high. up to 25 percent in some low socioeconomic status groups.
A 2020 study from McMaster University looked at local hospital data between 2009 and 2017 in Hamilton. It found 52 cases of low vitamin C levels, including 13 meeting the criteria for a diagnosis of scurvy. Another 39 cases tested positive for scurvy but were asymptomatic. These conditions were more common among people who were malnourished due to factors such as persistent vomiting, mental illness, social isolation, a restrictive diet or dependence on others for food, adds the study.
“The most commonly documented findings in our scurvy clinical cohort were easy bruising, gingival bleeding, and perifollicular hemorrhage,” the authors said.
Lead author of the CMAJ study, Sally Engelhart, a doctor of general internal medicine at Mount Sinai Hospital in Toronto, said it’s hard not to consider rising food prices as a likely factor in this matter.
“It’s a diagnosis that people associate with 18th-century sailors and is not relevant in 2024 in Canada and Toronto,” she said.
Although taking vitamins daily can help, Engelhart said fresh fruits and vegetables are the best sources.
She said scurvy would take “several weeks to months” of poor diet to appear, but noted that “some people can go several months without consuming fruits, vegetables or other sources of vitamin C in their diet.” .
Pointing to isolated cases of scurvy, like that of this 65-year-old woman in Toronto, Neary noted that social isolation and food insecurity are often significant contributing factors.
“When scurvy appears in large urban areas, it is usually in people who have a completely monotonous diet. It’s the same thing every day, often extremely socially isolated, they don’t eat with other people and what they eat doesn’t contain vitamin C,” he said.
In the case of the 27 people diagnosed with scurvy in northern Saskatchewan, Neary described it as being much more concerning because it suggests the presence of a systemic problem within the community rather than an isolated incident.
“This case in Saskatchewan has other public health implications,” he said.
“This is likely a community where much of the food is shipped and fresh food is likely very expensive, which creates an economic barrier.” »
