Scurvy in Modern America: Not Just for Pirates Anymore
Quantum Nutrition, Episode 2
Imagine having your teeth fall out, your joints fall apart, your vision deteriorate (or disappear altogether), or spontaneously bleeding from your gums, your gut, or your major blood vessels. That is what you get with scurvy, also known as vitamin C deficiency.
What Is Scurvy?
This disease was discovered in the early 1900’s by the physician-scientist Albert Szent-Gyorgi. It had already been banished by modern chemistry and food preservation, and the empirical observation that sailors who ate nothing but preserved, dried foods ended up with scurvy. The addition of fresh food to their diet reversed the disease, or, better yet, prevented it. Today, you need only eat the occasional piece of raw fruit or vegetable, or even processed food preserved with vitamin C, to prevent scurvy. Most multi-vitamins contain vitamin C. Deficiency is (thought) to be exceedingly rare.
Not Just for Pirates Anymore
Few physicians will tell you that they have ever diagnosed this disease, or even seen someone with a history of it. I have seen it three different times. I believe that scurvy is making a comeback and that modern physicians are blind to its re-emergence because it masquerades as other illnesses. I test for it infrequently and each time I have found it, I have been surprised. In fact, I have rarely tested a vitamin C level and found a normal level.
A surgeon I trained with used to say, “as soon as you start patting yourself on the back, that’s when someone’ll stick a knife in it.” I find myself saying this to myself constantly in the hospital. As a hospitalist, my job is in some way an endless stream of catastrophes that frequently get worse before they get better. Keeping my feet on the ground is important. Stopping to think and often to re-think a case is vital to good patient care. I question my assumptions (I like to think I question them enough and logically). Physicians are still human and if history is any indication, we too often ignore the signs of illness until it is far advanced. I believe that modern clinicians are off their game when it comes to nutritional deficiency, as I intend to outline in this series of blog posts.
I have diagnosed vitamin B1, B6, B12, C, and D deficiency, plus L-carnitine deficiency, in the past five years. As a hospitalist, I rarely test for these things because most of them are chronic conditions that are better handled by a primary care doctor. When I do test for them, it is because something is dramatically wrong and the clinical picture simply does not fit. That, or the patient has serious risk factors for the disease.
My First Sight of Scurvy
The first case of scurvy I saw was on the wards at Maine Medical Center, during the first week of my internal medicine residency. Every resident was told to go and see the patient, so rare was the disease. The main symptoms in his case were corkscrew hairs, follicular petechiae (bleeding in the skin beneath the hair follicle), easy bruising, and joint and muscle pain.
His story was one that has since become familiar to me. He was in his 20’s or 30’s, a busy young professional working a typical office job. He developed chronic diarrhea that did not respond to treatment. He lost weight. He severely restricted his diet, which helped somewhat, but did not alleviate his symptoms entirely. He saw a gastroenterologist, who performed a colonoscopy that revealed nothing. He had months of medical tests and images that revealed nothing. Finally, he became so ill that he presented to our hospital with acute dehydration.
While hospitalized, one of the residents had the idea to test his vitamin C levels. They were undetectable. This is only logical for someone who had been eating a restricted diet and, even then, passing it too quickly to absorb its nutrients.
The patient was angered by the fact that the diagnosis had been missed. We did not cure his chronic diarrhea and I never looked into the case again. The point was made to me, however, that nutritional deficiencies were going undiagnosed. Our patients are frustrated by a system that keeps them waiting months to see specialists who make the same money no matter the quality of their work, and who then miss diseases that are well understood and easily diagnosed. Before you throw stones at people who put their faith in acupuncture or herbalism, ask yourself why they should trust doctors who can miss a disease that we defeated more than a hundred years ago. The modern medical profession is derelict in its duty to provide timely and thorough care, largely because we are paid based on how many patients we see, rather than how well those patients do. Doctors and practitioners have too little skin in the game, and the patients are the ones who suffer for it.
The case piqued my curiosity. I began reading the nutritional literature and found many such case reports, often in which the admonition was given to physicians not to forget about this diagnosis. While still far from common, my experience (I have been practicing just 5 years) indicates that if you are not diagnosing scurvy here and there, you are probably missing it. What the clinical importance is to your patients (or yourself, if you are not a practitioner) is a topic for a future blog post in this series.
I have since diagnosed scurvy twice more. I have diagnosed it in people who have been to places like The Mayo Clinic — and they missed it. American clinicians rarely bother to test for nutritional deficiencies. We have no idea the magnitude of the problem. I believe this is probably because there is little interest in nutrition compared to pharmaceutical research. How can we provide good care when we do not make the right diagnosis? Why should the public put their trust in us when we forget how to diagnose simple nutritional deficiencies? For one clinician to have missed it in the case above would have been hardly worth remarking on, but multiple providers missed this diagnosis while the patient suffered for months.
We might not be able to cure everything that ails our patients, but we have a lot to learn from the patients who suffer from our delays to diagnosis. Sadly, it seems that our major medical journals are more interested in publishing big-pharma clinical trials than in focusing on the problems within the profession. This, I believe, is the source of much of the decay within modern medicine.
This series of blog posts explores the cases of nutritional deficiency I have seen and how they have changed my practice. Up next, we will discuss the second case of scurvy I have seen. Hopefully, these stories will help you understand what tests to ask your doctor for, how to act on the results, and, if you are a clinician, give you some food for thought.
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