Vitamin C deficiency

Diet lacking in Vitamin C

• Cow’s milk-only diet in infants
• Diets limited to tea and toast, common among the elderly
• Lack of fruits and vegetables
• Restrictive eating habits

Underlying health conditions

• Eating disorders
• Food intolerances
• Type 1 diabetes
• Gastrointestinal diseases like Crohn's, celiac disease, and IBD
• Iron overload
• Cancer
• Psychiatric disorders such as depression

Smoking

• Smokers typically have lower blood levels of Vitamin C

Heavy alcohol consumption

• High alcohol intake (over 80 g/day) can lead to increased Vitamin C loss

Pregnancy

• Expectant mothers have higher nutritional needs and are more susceptible to deficiency

Hemodialysis

• This procedure can significantly reduce Vitamin C levels, with studies showing up to a 50% loss

Low socioeconomic background

• Limited access to fresh produce increases the risk of deficiency in economically disadvantaged groups.

Diagnosing Vitamin C deficiency begins with assessing an individual’s risk factors. A thorough physical examination is essential to identify the signs and determine the extent of the deficiency.

In many instances, the diagnosis is confirmed when symptoms improve following Vitamin C supplementation.

I. Blood Tests

Vitamin C Level

• This test measures the concentration of Vitamin C in the blood. A value below 0.3 mg/dL indicates deficiency. However, the test may not always be reliable since it reflects only recent intake and not overall body stores.

Other Nutrient Levels

• Vitamin C deficiency may occur alongside deficiencies in other nutrients. Therefore, levels of Vitamin B12, folate, calcium, zinc, and iron are often evaluated.

Leukocyte Vitamin C

• Leukocytes (white blood cells) retain higher concentrations of Vitamin C compared to plasma. Measuring Vitamin C in leukocytes provides a better indication of long-term intake. A value below 7 mg/dL suggests a deficiency.

II. Dermoscopy

This technique uses a dermatoscope to closely examine skin lesions. It helps identify features like corkscrew hairs and follicular purpura, which are commonly seen in Vitamin C deficiency.

III. Skeletal X-ray

This imaging is particularly helpful in diagnosing skeletal abnormalities caused by Vitamin C deficiency in children. Changes are typically observed at the ends of long bones, especially around the knee area.

Specialists to Consult

Vitamin C deficiency can present with a wide range of symptoms, from mild to severe. Seek medical attention if you experience:

• Tooth loss
• Dry, damaged skin
• Hair thinning or loss
• Decreased appetite
• Swollen gums

Healthcare professionals who can help diagnose and manage this deficiency include:

• General Physician – First point of contact for symptom evaluation and basic treatment.
• Internal Medicine Specialist – Manages complex adult cases and underlying causes.
• Orthopedist – Handles issues involving bones, joints, and muscles, especially in advanced cases.
• Gastroenterologist – Addresses deficiencies related to nutrient absorption disorders.
• Hematologist – Treats complications like anemia and bleeding disorders caused by the deficiency.
• Pediatrician – Manages symptoms in children.

Regular Consumption of Fruits and Vegetables

• Including fresh produce such as guava, strawberries, papaya, kiwi, spinach, carrots, and bell peppers in your daily diet is the most effective way to prevent deficiency.

Recommended daily intake of Vitamin C:

• 45 mg for children
• 90 mg for adult men
• 75 mg for adult women
• 120 mg for breastfeeding women

Managing Underlying Conditions

• Conditions like celiac disease and cystic fibrosis can interfere with nutrient absorption. Treating these can help maintain adequate Vitamin C levels.

Avoid Restrictive Diets

• Avoiding diets that eliminate key food groups can help prevent vitamin deficiencies, including that of Vitamin C.

I. Supplementation

Vitamin C is usually given in tablet form but can also be administered via injection if necessary.

Common dosage recommendations:

• Children: 300 mg per day
• Adults: 500 mg to 1000 mg daily for one month
• Severe cases: 1–2 g daily for up to 3 days, followed by 500 mg daily for one week, and then 100 mg daily for up to 3 months

II. Management of Related Symptoms

Blood Transfusion

• In cases where ongoing bleeding leads to anemia, a transfusion may be necessary.

Vitrectomy

• For individuals with serious eye complications, this surgical procedure involves replacing the vitreous fluid in the eye to relieve symptoms caused by long-term deficiency.

Orthopedic Surgery

• Children with persistent bone problems not responding to supplements may require surgical intervention.

If left untreated, severe Vitamin C deficiency can result in:

• Unexplained bleeding
• Anemia due to iron deficiency
• Yellowing of the skin and eyes (jaundice)
• Overactivity of the thyroid gland (hyperthyroidism)

Dietary Suggestions

1. Citrus Fruits: Fruits like oranges and lemons are excellent natural sources of Vitamin C.
2. Papaya: Rich in Vitamin C, papaya is a nutrient-dense fruit that can be enjoyed as juice or in salads.
3. Guava: This fruit not only provides a high amount of Vitamin C but also contains antioxidants and fiber. A 100g serving offers approximately 200 mg of Vitamin C.
4. Tomatoes: A versatile ingredient in everyday meals, tomatoes supply both Vitamin C and Vitamin A.
5. Indian Gooseberry (Amla): Amla is recognized for its medicinal benefits and is a potent source of Vitamin C. It can be eaten raw, added to salads, or consumed as juice.
6. Cruciferous Vegetables: Vegetables such as broccoli, cauliflower, and cabbage are all good sources of Vitamin C.

Vitamin C deficiency typically improves within three months with proper nutrition and supplementation. These steps can support quicker recovery:

Include Vitamin C-Rich Foods

• A wide range of fruits and vegetables—such as oranges, strawberries, kiwi, papaya, bell peppers, spinach, cabbage, cauliflower, tomatoes, and broccoli—are rich in Vitamin C and should be part of daily meals.

Minimize Cooking Time

• Vitamin C breaks down when exposed to heat. Therefore, consuming raw or lightly cooked vegetables helps preserve its content.

Avoid Smoking

• Smoking can deplete Vitamin C levels. Reducing or quitting smoking is important, and smokers typically need a higher intake of the vitamin.

Regular Nutritional Screening

• Since poor nutrition often leads to multiple deficiencies, it’s advisable to get screened for other potential nutrient shortfalls.

Consult a Doctor Before Taking Supplements

• Do not self-prescribe Vitamin C supplements. A healthcare provider can determine the appropriate dosage and evaluate for any potential interactions with other medications.

Stay Hydrated

• Since Vitamin C can increase urination, drinking enough fluids is important to prevent dehydration.

Beware of Overconsumption

• Taking Vitamin C in excess can lead to digestive issues like diarrhea, bloating, and stomach discomfort. Always follow the recommended dosage and seek medical advice if side effects occur.