Canadian doctors urged to stay vigilant for signs of scurvy.

Commonwealth_ Scurvy, a disease that often evokes images of sailors from centuries past, has reemerged as a health concern in Canada. Due to rising food insecurity, Canadian doctors are being advised to remain vigilant for this condition. A recent report in the Canadian Medical Association Journal (CMAJ) highlighted the case of a 65-year-old woman diagnosed with scurvy at a Toronto hospital last year, underscoring the need for increased awareness among healthcare professionals. The study’s lead author, Dr. Sally Engelhart, an internal medicine specialist at Mount Sinai Hospital in Toronto, emphasized that this is not an isolated case. “This isn’t the first case of scurvy I’ve encountered in my career so far,” said Engelhart, pointing out that the condition, though rare, is still present in modern medical practice. The report serves as a reminder that scurvy, a disease caused by severe vitamin C deficiency, should not be overlooked, especially among vulnerable populations.

Vitamin C, also known as ascorbic acid, is essential for the body’s ability to produce collagen, repair tissues, and maintain healthy blood vessels. It’s naturally found in citrus fruits like oranges and lemons, as well as in vegetables like broccoli, spinach, and bell peppers. However, individuals with limited access to fresh produce are at risk of developing a deficiency. While scurvy is generally associated with history books, recent cases in both Canada and the U.S. suggest that it may be resurfacing, particularly among those who face economic challenges or have restricted diets.

The 65-year-old patient, who had been living in social isolation with minimal family support and limited mobility, subsisted primarily on canned soup, canned tuna, white bread, and processed cheese foods that lack sufficient vitamin C. As a result, she developed classic symptoms of scurvy. These symptoms can manifest within eight to 12 weeks of inadequate vitamin C intake and include fatigue, bruising, bleeding gums, and even hemorrhages around the hair follicles that cause them to appear bright red. If left untreated, scurvy can progress to more serious complications such as spontaneous internal bleeding, destruction of red blood cells, and eventually death.

Although no concrete data currently exists to show whether scurvy is on the rise in Canada, evidence from other countries suggests that it is becoming more prevalent. A study published in the U.S. in July found that the incidence of scurvy tripled over a four-year period. Researchers reviewed hospital records of around 19 million children and found that the number of cases increased from 8.2 per 100,000 children in 2016 to 26.7 per 100,000 children in 2020. While the study focused on pediatric patients, it highlights the possibility that scurvy could be an underrecognized issue across various demographics.

Engelhart believes that many Canadian doctors may not anticipate encountering scurvy in their patients, as it is not commonly taught or discussed as part of routine diagnosis. “Really, if you’re not thinking about scurvy, then there’s no way you’re going to diagnose it,” she noted in an interview. This case, she says, “presents a complex example of food insecurity manifesting as an uncommon diagnosis.”

Food insecurity is becoming an increasingly critical public health concern in Canada. For many people living in poverty or with limited mobility, obtaining fresh produce is challenging. Without access to essential nutrients, individuals are at risk of developing various diet-related conditions, scurvy being one of the more severe examples. The CMAJ report calls on healthcare providers to be aware of the potential for scurvy, particularly among older adults, low-income individuals, and people living in social isolation who may struggle to maintain a balanced diet.

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