Return of scurvy: Cost-of-living crisis driving vitamin C deficiencies

John Elder
Oct 23, 2024, updated Oct 24, 2024

Scurvy was once associated with the poor diet of sailors, but has returned. Photo: AAP

It’s more than 250 years since Captain James Cook fed his sailors watercress, sauerkraut and orange extract to prevent them from developing scurvy, a severe vitamin C deficiency.

In older times it was common for sailors to bleed from their nostrils and teeth with the disease.

Other symptoms of scurvy include loosened teeth that may fall out, a fine rash, bleeding under your skin, easily bruised skin and wounds that don’t heal.

Recently, doctors in a Western Australia hospital were initially stymied by a man aged in his early 50s with slightly subtler symptoms like a red-brown pinprick rash and pain when moving.

Doctors assumed an auto-immune or blood disorder. Not so.

Dietary clues

There were clues. Eight years before, he’d undergone bariatric surgery which is a risk factor for vitamin deficiencies.

It then emerged he’d been skipping meals due to a lack of funds.

The food he did consume was mainly processed.

Fruit and vegetables weren’t a part of his diet, a growing issue in Australia due to the cost-of-living crisis.

The doctors say they were slow to diagnose the man with scurvy because they thought the illness was eradicated.

Writing in the BMJ case reports, they concluded: “Scurvy is a re-emerging diagnosis in the current era of a rising cost of living and increasing number of bariatric surgeries.”

The Perth man, pictured here, had rashes like this one on his body. Photo: Supplied

Is scurvy making a comeback?

In 2016, a hospital in western Sydney reported a number of diabetes patients were suffering from scurvy.

This led to the question: Was the ancient sailor’s disease making a comeback?

An explainer from the University of Wollongong at the time made clear that the average Australian’s very low consumption of vegetables was putting us at risk.

Only seven per cent of adults and five per cent of children eat sufficient serves of vegetables, which means very few Australians were getting sufficient fibre (a key protection against colorectal cancer).

In March, a Monash-led review found that almost three in 10 adult hospital patients in high-income countries may have the deficiency.

Clinical signs of scurvy were present in some of those patients.

Australia under the microscope

A study published in November, the largest study of risk factors for vitamin C deficiency in Australia, examined more than 12,000 vitamin C tests carried out at the Royal Prince Alfred Hospital in Sydney between 2017 and 2021.

The researchers found that:

24.5 per cent of people tested had significant vitamin deficiency, which puts them on or over the scurvy threshold
29.9 per cent of participants had hypovitaminosis C, lower than optimal level
Vitamin C deficiency was more frequent in people living in areas of socio-economic disadvantage. The poorer the postcode, the higher proportion of people with vitamin C deficiency.

Although the study was confined to NSW, the findings are suggestive of vitamin C deficiency Australia wide.

Dr Puja Bhattacharyya, a haematology specialist, and her colleagues, wrote in the Medical Journal of Australia: “The distribution of prosperity and socio‐economic disadvantage in NSW is uneven in both urban and regional areas.”

“Disadvantage influences diet, including the consumption of fresh fruit and vegetables, and thereby the risk of vitamin C deficiency.”