Vitamin C Deficiency

Vitamin C (ascorbic acid) is essential for collagen formation and helps to maintain the integrity of connective tissue, bone and dentin.

• Vitamin C is essential for wound healing and facilitates recovery from burns.
• Vitamin C also facilitates the absorption of iron.
• Severe deficiency results in scurvy, which is characterised by haemorrhages and abnormal bone and dentin formation.
• The adverse effects of more mild degrees of vitamin C deficiency are not known.
• Vitamin C is an anti-oxidant but the benefit of vitamin C supplements is a subject of many claims but with very little evidence.
• Despite claims of benefit, very high doses of vitamin C have not been shown to decrease the incidence or severity of the common cold or protect against malignant disease or atherosclerosis.
• Very high doses of vitamin C do acidify the urine, may cause diarrhoea, predispose to urinary calculi and promote iron overload. Gastrointestinal effects are the most common adverse clinical events associated with acute, high doses of vitamin C given over a short period of time.¹

Vitamin C is found in a wide variety of fruit and vegetables. Good sources include:

• Fruits, especially grapefruits, lemons, blackcurrants, oranges and kiwi fruit
• Vegetables, e.g. broccoli, green peppers, tomatoes, cabbage, sprouts, and sweet potatoes
• Fresh milk

• The incidence of vitamin C deficiency peaks in children aged 6-12 months who are fed a diet deficient in citrus fruits or vegetables.
• Incidence also peaks in the elderly.

Risk factors

• Alcoholism and conforming to food fads
• Elderly
• Low income families tend not to buy foods high in vitamin C
• Vitamin C deficiency has been noted in refugees
• Increased need due to increased utilisation in pregnant and lactating women, thyrotoxicosis, surgery, and burns
• Chronic diarrhoea increases faecal loss

• Early symptoms of scurvy are malaise, lethargy, myalgia and arthralgia.
• Other symptoms include skin changes with easy bruising, gum disease, loosening of teeth and poor wound healing.
• The gums become swollen, purple, spongy, and friable.
• The skin shows papules and haemorrhages around hair follicles, petechiae and multiple bruises.
• Nail splinter haemorrhages may occur.
• In the later stages, jaundice, generalised oedema, oliguria, neuropathy, fever, and convulsions may occur.

• Clotting factor deficiencies
• Leukaemia
• Gingivitis
• Platelet dysfunction
• Senile purpura

• Plasma ascorbic acid levels are reduced.
• Ascorbic acid levels in the white blood cell-platelet layer of centrifuged blood are more significant.
• A positive capillary fragility test is an almost constant finding, and anaemia is common.
• Bleeding, coagulation, and prothrombin times are all normal.

• Ascorbic acid replacement therapy.
• It is rarely necessary to prescribe more than 100 mg daily except early in the treatment of scurvy.²

• Scurvy is fatal if untreated.
• Patients respond quickly to oral therapy.

• The recommended daily intake for vitamin C is 40 mg/day for adults, with an increase in pregnancy to 50 mg/day, and during lactation to 70 mg/day.¹
• The recommended upper limit for vitamin C supplements is 2 g/day.