Vitamin C deficiency

Causes Of Vitamin C deficiency

Vitamin C also known as ascorbic acid performs the following functions in the body:

• Helps in synthesizing collagen. Collagen is the primary building block of skin, muscles, bones, and connective tissues. 

• Supports blood vessels through managing structure of collagen

• Serves as an antioxidant which helps prevent the deposition of cholesterol in the blood vessels

• Aids in absorption of iron in the small intestine

Humans are unable to produce Vitamin C. The deficiency occurs as a result of sustained dietary deficiency for several months. Symptoms start to develop when the total body stores are reduced from 1500 mg to 300 mg. 

Symptoms Of Vitamin C deficiency

The signs and symptoms of Vitamin C deficiency start to develop 8 to 12 weeks after inadequate intake of Vitamin C.

The major characteristic signs of Vitamin C deficiency are:

• Corkscrew hair (dry, brittle, and coiled hair)

• Perifollicular hemorrhage (bleeding around hair follicles)

• Gingival bleeding (gum bleeding)
  
  

The other signs and symptoms include:

• Weakness

• Fatigue

• Poor wound healing

• Shortness of breath

• Poor appetite

• Fever

• Anemia

• Swelling of gum

• Loss of teeth

• Mucocutaneous petechiae (pinpoint-sized spots of bleeding under the skin or mucous membranes)

• Ecchymosis (discoloration of the skin resulting from bleeding underneath)

• Hyperkeratosis (increased thickness of the skin)

• Swan-neck hair (bending of hair)

• Edema (swelling caused by too much fluid trapped in the body's tissues)

• Koilonychia (depression of the central portion of the nails)

• Painful hemarthrosis (bleeding into the joint cavity)

• Dry eyes

• Hair loss

Risk Factors For Vitamin C deficiency

1. Diet deficient in Vitamin C

• Exclusive cow’s milk diet (in children)

• Exclusive tea and toast diet (mostly seen in elderly)

• Absence of fruits and vegetables in the diet

• Restrictive diets
  
  

2. Medical conditions

• Eating disorders

• Food allergies

• Type 1 diabetes

• Gi disorders such as inflammatory bowel disease, celiac disease, and Crohn disease

• Iron overload

• Cancer 

• Psychiatric illnesses such as depression

3. Smoking

Smokers have been found to have least concentration of Vitamin C in the blood.

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4. Excessive alcohol intake 

Alcohol increases the excretion of Vitamin C. The excessive consumption of alcohol (>80 g/day) is associated with an increased risk of Vitamin C deficiency.
 

5. Pregnancy 

Pregnant women are more prone to the deficiency of Vitamin C due to the increase in requirement.

6. Hemodialysis

Hemodialysis increases the risk of Vitamin C deficiency due to its loss during the procedure. Studies have shown a 50% decrease in Vitamin C after dialysis treatment.

7. Low socioeconomic status

Fresh fruit and vegetables are the major dietary source of vitamin C. Individuals with low socioeconomic status are more likely to develop Vitamin C deficiency due to limited access to these sources.

Did you know? Children who skip breakfast may have poor nutritional profiles.
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Diagnosis Of Vitamin C deficiency

The diagnosis of Vitamin C deficiency is made primarily by the evaluation of risk factors. Physical examination is also required in order to evaluate the symptoms and their severity. 

In most of the cases, the disease is confirmed with the recovery of supplementation. 

I. Blood tests

1. Vitamin C 

It includes testing the blood concentration of Vitamin C. A blood concentration below 0.3 mg/dl indicates deficiency. However, this test is not much reliable as it reflects the recent intake rather than body stores. 

2. Other nutrients

The other nutritional deficiency can be concomitantly associated with Vitamin C deficiency. The level of other nutrients such as Vitamin B12, folate, calcium, zinc, and iron are also assessed during Vitamin C deficiency. 

3. Leukocyte test

Leukocyte is a type of blood cell which is able to maintain vitamin C concentrations several times higher than blood.  It indicates the long-term dietary intakes of Vitamin C. 

A leukocyte vitamin C level of  less than 7 mg/dL indicates deficiency. 

II. Dermoscopy

This procedure involves examination of the skin lesions using an instrument called dermatoscope. It helps in evaluating the follicular purpura and corkscrew hairs which are the characteristic feature of Vitamin C deficiency. 

III. Skeletal X-ray

This is used to confirm the skeletal changes in children as a result of Vitamin C deficiency. Most of the changes are seen at the end of long bones specifically at the knee.

Specialist To Visit 

The symptoms of Vitamin C deficiency can range from mild to severe. Consult the doctor in case of the following symptoms:

• Loss of teeth

• Dry and damaged skin

• Hair loss

• Loss of appetite

• Swelling of gum

Doctors who can help you diagnose and treat Vitamin C deficiency include: 

• General physician

• Internal medicine specialist

• Orthopedics

• Gastroenterologist

• Hematologist

• Pediatrician (in case of children)
  
  

A general physician will examine your symptoms and initiate treatment.

In case of severe cases, they may refer you to an Internal Medicine specialist who provides comprehensive care for adult patients, managing complex cases and addressing underlying health conditions.

Orthopedics can be consulted to manage the symptoms related to the musculoskeletal system (bones, muscles, joints, and soft tissues). 

Gastroenterologist can also be consulted to treat the cases where Vitamin C deficiency is developed as a result of malabsorption. 

Hematologist can be consulted to treat symptoms that developed as a result of excessive bleeding. 

You can consult a pediatrician if you notice any signs and symptoms of Vitamin C deficiency in children.

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Prevention Of Vitamin C deficiency

1. Consume fruits and vegetables regularly

Fresh fruits and vegetables such as guava, strawberry, papaya, kiwi, spinach, carrots, and bell peppers are a very good source of Vitamin C. The best way to prevent Vitamin C deficiency is to have a balanced diet. 

The daily requirement of Vitamin C is 

• 45 mg per day for children

• 90 mg per day for men

• 75 mg per day for women

• 120 mg per day for lactating women.

Five servings of most fruits and vegetables (recommended daily) provide > 200 mg of vitamin C. 

People who smoke should consume an additional 35 mg/day.

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2. Treat underlying medical conditions 

People with underlying health conditions such as celiac disease and cystic fibrosis affect the absorption of nutrients. Therefore treating the underlying condition may help in maintaining the optimum level of Vitamin C. 

3. Avoid restrictive diets

Fad diets generally lead to vitamin deprivation. Avoiding restrictive diets may help prevent the deficiency. 

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Treatment Of Vitamin C deficiency

I. Vitamin C supplementation

They are mostly available in tablet form. However, it can also be given intravenously or intramuscularly as per the need of the individual. 

It can be either one of the two recommended patterns:

• 300 mg daily for children

• 500 mg to 1000 mg daily for adults for 1 month

• 1 to 2 g for up to 3 days followed by 500 mg daily for a week followed by 100 mg daily for up to 3 months.
  
  

The time period can be extended if symptoms persist.

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II. Treatment of associated symptoms

1. Transfusion 

The severe deficiency of Vitamin C can also cause anemia as a result of persistent bleeding in some individuals. Such people may require blood transfusion.

2. Vitrectomy

It is performed in individuals having severe eye problems such as dry eyes as a result of prolonged Vitamin C deficiency.  During the surgery,  vitreous  fluid (a gel-like substance that fills the space within the eye) is replaced with another solution. 

3. Bone surgery

Children with bone disease may require surgery if symptoms do not resolve with supplements.

Home care For Vitamin C deficiency

Dietary recommendations

1. Citrus fruits: Citrus fruits such as lemon and orange are a very good source of Vitamin C. 

2. Papaya: It is an excellent source of Vitamin C. It is known as a powerhouse of nutrients. It can be consumed either in the form of salad or juice.

3. Guava: It is a good source of Vitamin C also along with fiber and antioxidants. A single guava fruit (100g) contains around 200 mg of Vitamin C.

4. Tomato: They should be added in daily cooking as they are also a very good source of Vitamin C along with Vitamin A. 

5. Indian gooseberry (amla): It is known from years for its medicinal properties. It is a very rich source of Vitamin C. Amla can be either eaten raw, as salads or in the form of juice. 

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6. Cruciferous vegetables: Broccoli, cabbage, cauliflower are all examples of cruciferous vegetables. They are also rich sources of vitamin C. 

Complications Of Vitamin C deficiency

The severe Vitamin C deficiency can cause:

• Bleeding

• Iron deficiency anemia

• Jaundice

• Hyperthyroidism

Living With Vitamin C deficiency

Vitamin C deficiency mostly resolves within 3 months with conscious eating and dietary supplements. The following measures might help in faster recovery:

1. Eat Vitamin C rich foods

Vitamin C is abundantly found in fresh fruits and vegetables. The common sources include oranges, green peppers, watermelon, papaya, grapefruit, strawberries, kiwi, mango, broccoli, tomatoes, cauliflower, and cabbage.

Green leafy vegetables such as turnip and spinach), red and green peppers are also rich sources of vitamin C. These foods are easily accessible and should be included in the daily diet.

2. Avoid overcooking

It is advised to eat fruits and vegetables raw or very lightly cooked for the maximum effect. It is because Vitamin C is sensitive to heat and overcooking can degrade it.

3. Abstain from smoking

Smoking serves as a trigger for Vitamin C deficiency. It is advised to completely avoid smoking or to limit it. Individuals who smoke require higher amounts of supplements. 

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4. Go for screening

In most cases, the deficiency of Vitamin C is developed as a result of poor dietary intake. This may lead to other deficiencies also. So, it is important to screen for other nutritional deficiencies.

5. Do not self-medicate

It is advised to consult health care professionals before starting supplements. The doctor prescribes the right dose as per your need. Vitamin C also interacts with other medications which a doctor may help you to find and fix. 

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6. Keep yourself hydrated

Vitamin C supplements increase urination. Make sure to keep yourself hydrated to compensate the water loss. 

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7. Be aware of overdosage

The higher doses of Vitamin C can cause diarrhea, gas, or stomach upset. It is always advised to take the recommended amount of Vitamin C. Seek immediate medical consultation if you're experiencing any such signs.