Historic, rare condition among diabetes patients resurfaces

A resurgence of the rare condition of scurvy among a group of diabetes patients, has been reported at a major western Sydney hospital and has raised questions about the health state of the rest of Australians. Clinician-researcher Professor Jenny Gunton heads the Diabetes Centre at Westmead Hospital and investigated whether a vitamin C deficiency was behind one of her patient’s unhealed wounds. “She just did not have a reason not to heal her ulcers and they’d been there for seven months and that’s just not right,” Professor Gunton said, as quoted by ABC News.

“When something doesn’t add up you go and look for the unusual causes … so it all started with that.

“I asked her a few questions about her diet and while she ate veggies quite a few times a week, she cooked them a lot. So [I] tested her for vitamin C and zinc levels because they are both needed for normal wound healing and she came back with a vitamin C level of 10, and normal is 40 and up.”

Professor Gunton diagnosed her with scurvy on the basis of the blood test and her symptoms, and decided to then test everyone who came to the clinic whose wounds were also not healing.

Around a dozen of them — two thirds of the group tested — had extremely low vitamin C levels and were given the same diagnosis.

“When I asked about their diet, one person was eating little or no fresh fruit and vegetables, but the rest ate fair amounts of vegetables; they were simply over-cooking them, which destroys the vitamin C,” she said.
“The irony is that it is possible for patients to have scurvy, even when they are overweight or obese. It highlights a danger that you can consume plenty of calories yet not receive enough nutrients.”

Everyone was told to take one tablet of vitamin C a day and their wounds quickly began to heal.

They were also sent to a dietician to learn about more about how to consume adequate amounts of vitamin C in their daily diets.

Professor Gunton said health authorities did not tend to test for scurvy these days and generally did not keep population data on the incidence of it.

“This is thought of as an historical disease, with the English sailors needing to eat the dried limes on their way out to Australia so they didn’t get scurvy,” she said.

“I think the resurgence in my patients with diabetes might be in part because people with diabetes tend to avoid eating fresh fruit because it raises your blood glucose levels. They should still eat fresh fruit but they worry about their blood glucose levels.

“But then if they are also overcooking their vegetables, then you have a problem.”

She said it could be a more widespread issue than is generally known.

“That’s what I’m worried about. Many people do eat vegetables but cook them quite a lot so if you add that to the picture of people not eating much fruit, I think you can wind up in trouble very easily,” she said.

“Scurvy can be fatal, so in the olden days of course the sailors on the long-haul ships died. There’s a fascinating study in the New England journal from 50 years ago about this mad surgeon who decided to give himself scurvy by not eating vitamin C and a few months into the study his old appendix scar came open even though the scar was a couple of decades old.

“So you can’t heal anything without vitamin C, you also bruise easily all over, you bleed, you break bones and your teeth fall out, so if it goes far enough it can be very severe.

“And yet it’s so easily treated with one vitamin C tablet a day and a good diet.”

What is scurvy?

Scurvy is a disease resulting from a lack of vitamin C
Patients develop anaemia, debility, exhaustion and swelling in some parts of the body
People with, or at risk of type 2 diabetes are often recommended a low-carbohydrate high-fat diet (LCHFD)
These diets often limit the amount of fruit or Vitamin C consumed

Have you heard of scurvy before? Do you know anyone who is living with this condition?