Scurvy Cases May Rise in Canada, Experts Warn

Sailors suffered from scurvy in the 18th century because of the unavailability of fresh fruit and vegetables. logoboom/Shutterstock

A 65-year-old Toronto woman who got scurvy while living on canned soup and processed food highlights the risk of health issues resulting from food insecurity, a new study warns.

Doctors at a Toronto hospital who examined the woman last year found she lived with little social and family support, said the Canadian Medical Association Journal (CMAJ) report. She had swollen gums, skin discolouration on both thighs, weakness in her legs, and poor mobility.

Her inability to move made it difficult for her to shop and cook, and she relied on nonperishable foods—mainly canned soup, tuna, white bread and processed cheese.

Scurvy was dreaded by sailors centuries ago who had limited access to fresh fruits and vegetables while at sea. The disease is caused by severe vitamin C deficiency, and is marked by symptoms like easy bruising, fatigue, bleeding gums, and tooth loss. Now Canada may see an uptick due to food insecurity, said the CMAJ report. “This case presents a complex example of food insecurity manifesting as an uncommon diagnosis,” wrote the authors referring to the woman’s case, adding they arrived at the diagnosis only after evaluating her social and dietary history.

“There are numerous risk factors for [scurvy], but clinicians should have a higher index of suspicion in patients with low socioeconomic status or who are experiencing food insecurity.”

A Diet Devoid of Fresh Produce

The 65-year-old woman had a history of hypertension, dyslipidemia, hypothyroidism, anxiety, and depression. Her social isolation and physical constraints resulted in a diet devoid of fresh produce, and she did not take vitamins, according to the report. She also smoked half a pack of cigarettes per day.

Based on the woman’s medical records, which showed undetectable vitamin C levels many years earlier, the doctors gave her a course of vitamin C, first by intravenous infusions and then orally. With the treatment, the woman’s leg weakness subsided, the report said, “confirming a diagnosis of hypovitaminosis C”–or vitamin C deficiency.

The authors noted that while the woman’s diet already predisposed her to low vitamin C levels, her smoking increased the risk, as smoking is known to deplete vitamin C.

Vitamin C helps the body heal wounds, promotes iron absorption, and acts as an antioxidant. It is usually found in vegetables such as peppers, broccoli, and leafy greens, and in fruits like oranges, strawberries, and kiwi.

Given the broad role vitamin C plays in the body, initial symptoms of deficiency are often nonspecific and include fatigue, weakness, irritability, and low mood, according to the report. Patients with prolonged deficiencies may suffer from gum disease, corkscrew hair, and anemia.

Food Insecurity

Approximately one in four Canadians is experiencing food insecurity, according to Food Banks Canada’s 2024 Poverty Report Cards. The agency said thousands of food banks across the country have seen a 50 percent increase in services since 2021, and that 44 percent of Canadians say they feel worse off financially compared to last year.

In 2022, the proportion of Canadians who were food insecure was 16.9 percent, up 5.3 percentage points from 2018, according to Statistics Canada. Over that time period, food insecurity increased more among those not living in poverty (by 5.8 percentage points), than among those living in poverty (up 3.6 percent).

“The rise in food prices could be contributing to more Canadians experiencing food insecurity,” reads the agency’s report, noting that food prices have gone up by 19.1 percent from 2018 to 2022.

The authors of the CMAJ report advise doctors to assess food insecurity when screening patients for conditions such as vitamin C deficiency.

“Particular attention should also be paid to assessing for food insecurity, which is an equally important and ubiquitous risk factor for hypovitaminosis C, affecting about 1 in 5 Canadian households,” they wrote.