SCURVY - CONNECTIVE TISSUE NUTRITIONAL DEFICIENCY DISORDER

                                                                                                               

Scurvy (Vitamin C deficiency) is a nutritional disorder characterized by initially as symptoms of malaise and lethargy, followed by formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. Spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. As scurvy advances, there can be open, suppurating wounds, loss of teeth, jaundice, fever, neuropathy and death.

Vitamin C (ascorbic acid) is essential for the formation of the tissue that holds the body's structures together (connective tissue). It also helps the body absorb the essential mineral iron, and it helps the body recover from burns and wounds. Vitamin C is also a member of the class of chemicals called antioxidants. Antioxidants help protect the body's cells from damage.

Vitamin C does not only invigorate the immune system, it is an essential vitamin that aids the repair of collagen cells. Scurvy was once a common disease among sailors in the 15th, 16th, 17th, and 18th centuries because they were stuck at sea without food for a long period of time without fresh fruits rich in vitamin C. Scurvy affects the dense connective tissue by breaking down the tendons. Dense connective tissue is a type of connective tissue that is characterized by its densely woven fibers of collagen that fit together to form rows called fibroblasts. Dense connective tissue is affected by connective tissue diseases that stem from severe vitamin C deficiency. This disease is commonly known as scurvy.

Causes of Scurvy:

Scurvy is caused by a prolonged dietary deficiency of vitamin C. Humans obtain 90% of their intake of vitamin C from fruits and vegetables, and cooking these sources decreases vitamin C content 20-40%. The body's pool of vitamin C can be depleted in 1-3 months. Ascorbic acid is prone to oxidation in vivo, and body stores are affected by environmental and lifestyle factors (eg, smoking), biological conditions (eg, inflammation, iron excess), and pathologic conditions (eg, malabsorption) that may alter its oxidation.

Risk factors for vitamin C deficiency include

·        Babies who are fed only cow's milk during the first year of life.

·        Alcoholic individuals and those who conform to food fads

·        Economically disadvantaged persons, who tend to not purchase foods high in vitamin C (eg, green vegetables, citrus fruits)

·        Cigarette smokers: These individuals require an increased intake of vitamin C because of lower vitamin C absorption and increased catabolism

·        Pregnant and lactating women and those with thyrotoxicosis: These individuals require an increased intake of vitamin C because of increased utilization

·        People with anorexia nervosa or anorexia from other diseases such as acquired immunodeficiency syndrome (AIDS) or cancer

·        People with type 1 diabetes have increased vitamin C requirements, as do those on hemodialysis and peritoneal dialysis.

·        People with disease of the small intestine such as Crohn, Whipple, and celiac disease, because vitamin C is absorbed in the small intestine

·        Individuals with iron overload disorders - These may lead to renal vitamin C wasting

Pathology of vitamin C Deficiency:

Vitamin C (Ascorbic Acid) deficiency may lead to Defective formation of collagen in connective tissue,Defective intercellular cement,Defective dentine in teeth ,Defective osteoid tissue in bone., Capillary haemorrhages, delayed healing of wounds and defective formation of teeth bones occur during growth, In adults the teeth may become loose, Anaemia may be a prominent feature of scurvy.

Symptoms and signs:

Symptoms of scurvy may begin with Loss of appetite, Poor gain in weight, Fever , Irritability , Shortness of breath (Increased respiratory rate), Disconmfort and tenderness in legs, Pain and swelling over weight bearing bone, Feelings of paralysis.

As the disease advances a scurvy patient may come with Bleeding gums, Loosening of teeth, Bruising and petetial haemorrhage of mucous membrane and skin, Hoemorragic eyes, Poor wound healing , Bulging of eye balls (Proctosis) , Follicular keratosis sometimes associated with vitamin A deficiency ,Costochondral beading (Cartilage between joints) leads to enlargement of costochondral junction, Curly hairs (Corkscrew hair), Sicca syndrome (Autoimmune disease of connective tissue), By the time the disease is fully developed the patient is often anaemic.

Examination of an adult patient with scurvy usually reveals no abnormal physical signs of disease except gingivitis and subcutaneous haemorrhages and so gravity of his condition may not be appreciated, Patient may die suddenly from cardiac failure without warning, In the late stages of disease, general anasarca (generalised oedema), jaundice, oligurea, neuropathy, fever and convulsions and if continue leads to death.
In infants the main clincal features of scurvy are Lassitude (Weakness with lack of energy), Anaemia, Painful limbs, Enlargement of the costochondral junctions. Before the teeth eruption, scorbutic infants do not develop gingivitis & when it occurs the gums have typical 'scurvy buds', a feature of considerable diagnostic importance.

Diagnosis of Scurvy :

The health care providers will perform a thorough physical examination for signs and symptoms of scurvy mentioned above. Exact vitamin C levels can be measured by laboratory tests that analise ascorbic acid levels in the serum (or WBC ascorbic acid concentration). Radiological measures can be performed to diagnose and to see the damage done by the disease.

Skeletal x-rays can help diagnose childhood (but not adult) scurvy. Changes are most evident at the ends of long bones, particularly at the knee. Early changes resemble atrophy. Loss of trabeculae results in a ground-glass appearance. The cortex thins. A line of calcified, irregular cartilage (white line of Fraenkel) may be visible at the metaphysis. A zone of rarefaction or a linear fracture proximal and parallel to the white line may be visible as only a triangular defect at the bone's lateral margin but is specific. The epiphysis may be compressed. Healing subperiosteal hemorrhages may elevate and calcify the periosteum.

Prevention of Scurvy

Regular consumption of fruits and vegetables helps to prevent scurvy. Ascorbic acid is present in insignificant amounts in foods of animal origin.
Rich sources of vitamin C are: Oranges, Blackcurrants (small black berries), Tomatoes, Lemon, Brussels sprouts, Guava, Papaya, Carrots, Broccoli,  Potatoes, Spinach , Cabbage, Bell peppers, Watercress Extracts of rose hips, Pine needles, All citrus fruits, Fresh vegetables.

Recommended Intake for Vitamin C can vary on health factors. Pregnant and lactating women need higher doses of Vitamin C. Children (1 to 8 years) need 15 to 25 mg/day, Children and teenaged kid need 65mg to 90mg/day, Adults need 75mg to 90 mg/day

Research :

Research done by New England Journal of Medicine in 1970 to explain association between the Sjogren's syndrome and Scurvy. “Five men were given no ascorbic acid for 84 to 97 days, but had all other vitamin and mineral supplements necessary, after which vitamin C [ascorbic acid] repletion was begun. One man had 2.5 mg dietary L-ascorbic acid daily from day 85 to 213, the others from day 98 to 213. From day 214 to 244 they had 100 mg dietary ascorbic acid supplemented with 250 or 500 mg daily. Plasma ascorbic acid and serum vitamin A were estimated weekly and ophthalmological examinations were made 8 times during the study.

Sjogren's syndrome was apparent in 2 of the subjects while they were scorbutic, a third had keratoconjunctivitis sicca, and all 5 had one or more of the features described as components of the syndrome. As plasma values for ascorbic acid increased and the pool size rose during repletion the features of Sjogren's syndrome and the signs of scurvy regressed simultaneously. suggesting an association between the Sjogren's syndrome and Scurvy.

Management

Some of the Common Home Remedies for the Treatment of Scurvy:

Lime and Lemon: The use of lime and lemon is highly beneficial in the prevention and treatment of scurvy. Being rich sources of vitamin C, lime and lemon are regarded as foods of exceptional therapeutic value.

Potato: Potato is regarded as an excellent food remedy for scurvy.

Vinegar: Vinegar is very effective for the treatment of scurvy.

Aspirin: If there is pain in your body due to the deficiency of ascorbic acid, take 1 tab after meal.

Tomato: The presence of vitamin C in tomatoes helps it to fight diseases like scurvy. By drinking tomato juice everyday you can see the difference.

Homoeopathic Management:

Homoeopathy and Nutrition work together as synergistic healing modalities to bring about Holistic Health and A Healthy Balance. We need both to heal and for well-being. Classical Homoeopathy makes Nutrition therapy better. Good Nutrition helps Classical Homoeopathy.

Medicines like Arsenic al, Sulphur, Mercurius, Kreosote, Carbo veg etc are often found indicated in cases of Scurvy.

Arsenic Alb

Pronounced debility; child is emaciated; severe gastro-intestinal disturbances; exceedingly fetid smell from the mouth. 

Sulphur

Is indicated when in addition to the bleeding gums and fetid breath the patient has old, shrivelled, withered look and unhealthy state of skin. Discharge of blood and fetid pus from about the roots of the teeth. 

Mercurius

When gums recede from teeth and are blue and unhealthy in colour. Legs swollen and very painful. Unhealthy bluish ulcerations of the skin are the characteristic symptoms of the remedy. 

Kreosote

Mouth putrid and cadaverous; gums ulcerated; epistaxis and discharge from the genitalia. 

Carbo Veg

Persistent hemorrhage from gums and nose. It may also occur from kidneys and bowels.