Canadian doctors warned to be on the lookout for scurvy

Scurvy is a disease that probably conjures up images of sick sailors from hundreds of years ago, but doctors in Canada are now being warned to look out for the condition, due to growing food insecurity.

A report published On Monday, the Canadian Medical Association Journal (CMAJ) detailed the case study of a 65-year-old woman who was diagnosed with scurvy at a Toronto hospital last year.

The authors say the case highlights the need for doctors to consider the possibility of scurvy, especially in patients at higher risk of nutrient deficiencies, including people of low socioeconomic status and isolated older adults.

“This is not the first case of scurvy that I have seen so far in my career,” said Dr. Sally Engelhart, lead author of the study and an internal medicine specialist at Mount Sinai Hospital in Toronto.

Scurvy results from a severe deficiency of vitamin C. Natural sources of vitamin C – also known as ascorbic acid – include citrus fruits, such as oranges and lemons, and vegetables such as broccoli and spinach.

The CMAJ report draws links between scurvy and food insecurity – when low income forces a person to skip meals or reduce the nutritional value of the food they eat.

While there are no clear statistics showing whether the incidence of scurvy is increasing in Canada, recent research suggests it is a growing problem in the US.

A study A July publication that examined hospital records of about 19 million children in the US found that the incidence of scurvy tripled over a four-year period. The rate went from 8.2 cases per 100,000 children in 2016 to 26.7 cases per 100,000 children in 2020.

Engelhart says she thinks most doctors in Canada don’t expect cases of scurvy.

“Really, if you don’t think about scurvy, there’s no way you can diagnose it,” Engelhart said in an interview.

Her report says the case is “a complex example of food insecurity manifesting as an unusual diagnosis.”

The woman – socially isolated, with little family support and limited mobility – lived almost entirely on canned soup, canned tuna, white bread and processed cheese, without fresh produce.

Symptoms Scurvy can be seen within eight to 12 weeks of inadequate vitamin C intake and may include fatigue, large areas of bruising, bleeding gums, and bleeding that makes the hair follicles appear bright red.

If left untreated, it can lead to spontaneous internal bleeding, the destruction of red blood cells and ultimately death.

No ‘archaic diagnosis’

The authors of the CMAJ report say that scurvy “should not be regarded solely as an archaic diagnosis of 18th-century seafarers.”

Researchers at McMaster University in Hamilton, Ontario, found Between 2009 and 2017, 52 patients were hospitalized whose vitamin C levels were low enough to cause scurvy. The disease was actually diagnosed in 13 of them.

Healthcare advocates in Britain have warned for years about the risk of scurvy in poorer communities.

A 2008 study published in the Journal of Public Health among 1,300 people from low-income households in the United Kingdom, found that 25 percent of men and 16 percent of women were deficient in vitamin C.

“Health professionals should be aware that poor vitamin C status is relatively common among adults living on low incomes,” the authors of the British study said.

Dr. Andrew Boozary, a family physician at the University of Toronto’s Dalla Lana School of Public Health, says people with higher levels of food insecurity are at much greater risk for many chronic diseases, including cardiovascular disease and mental illness.

“There is a real continuum of serious health problems that really exacerbates food insecurity,” Boozary said in an interview.

Boozary, who was not involved in the CMAJ study, said it “speaks to some of the really disturbing statistics that families and households face. [lack of] food security.”

According to research According to Statistics Canada published in May, 16.9 per cent of Canadians faced moderate or severe food insecurity in 2022, compared to 12.9 per cent in 2021.

A 2015 study CMAJ found higher health care system use – everything from emergency room visits to physician services and prescription medications – among Ontario households with higher rates of food insecurity.