- What specific nutritional deficiency is suggested by these findings?
The findings are indicative of vitamin C (ascorbic acid) deficiency with scurvy.
- How could this situation have been prevented?
As the voyages of exploration became longer, ships' crews went without fresh food, including fruits and vegetables, for much longer times. Portuguese, Dutch, and Arab traders were the first to recognize the importance of diet, particularly citrus fruits, in preventing illness on long voyages. Captain James Cook knew that ships of the Dutch East India Company included plenty of sauerkraut (pickled cabbage) in their stores, and their crews did not suffer from scurvy. He included this item in his stores for his voyages of discovery to the Pacific, and his men did not develop scurvy. Scurvy remained prevalent in the English Navy, however, until 1795 when Dr. James Lind, a Scottish physician, recommended that lime juice be issued to all British naval vessels (the sailors subsequently were called "limeys"). Dr. Lind knew that the Dutch sailors had employed use of citrus fruits for several hundred years. Why did the British Navy take so long? A popular refrain from the Gilbert & Sullivan opera "Pirates of Penzance" in spoofing career advancement in the British Admiralty goes, "Stick close to your desks, and never go to sea, and you all may be rulers of the Queen's Navy."
- What is the mechanism by which the pathologic findings are produced?
Vitamin C activates enzymes that hydroxylate procollagen to form collagen. Collagen a principle building block of connective tissues. Poor formation of collagen leads to increased capillary fragility and bleeding into soft tissues. The connective tissues of the gums in the mouth and the joints are also affected. Collagen forms the matrix of bone, so that growing bones in children have weakened matrix that produces deformities (widened epiphysis). Wound healing is dependent upon collagen formation.
- What laboratory findings may be present?
A CBC will show a moderate degree of anemia with red blood cells of normal size, or reduced size if iron absorbtion is affected by the vitamin C deficiency. Tests of the coagulation mechanism are normal (PT, PTT, platelet count). Vitamin C is not ordinarily measured, as levels of water soluble vitamins are subject to dietary intake and can be variable.
- In the modern world, who is at risk for these problems?
A full blown case of scurvy is rare since diets contain vitamin supplementation in many products. However, any form of stress increases the requirement for vitamin C, particularly any form of inflammation. Pregnancy also increases the requirement for vitamin C, as does surgery. Vitamin C absorbtion is decreased with achlorhydria and diarrhea.
- What are good dietary sources?
In a typical American diet, over 90% of vitamin C comes from fruits and vegetables. The heat from cooking diminishes the amount of vitamin C available in foods, so foods prepared by steaming, simmering, or microwaving with minimal water (vitamin C is water soluble) are preferred, as are fruits and veggies served raw. Veggies that are good sources include broccoli, cabbage, peas, potatos (with skins), and tomatos.
