Scurvy, a disease caused by severe vitamin C deficiency and once thought to be an illness of the past, has never truly disappeared in Canada.

Most recently, 27 cases were reported in Saskatchewan, shedding light on the ongoing risk, particularly among those facing food insecurity or limited access to fresh produce, experts warn.

The disease is both preventable and treatable, but without proper nutrition, a person can develop scurvy, which can lead to symptoms like bruising, gum disease, tooth loss and even death.

Despite the seriousness of scurvy, it is highly unlikely to develop in people who maintain a diet rich in fresh vegetables, fruit and meats, all of which are excellent sources of vitamin C, explained John Neary, an associate professor of internal medicine and McMaster University in Hamilton.

“It’s not exactly a disease of the past, but it still can happen,” he said.

“But the amount of vitamin C human beings need for their diet to not develop scurvy is quite low. Essentially, it’s impossible to get scurvy if you eat any fresh fruit or vegetables or meat.”

Scurvy is a disease caused by a severe deficiency of vitamin C, a vital nutrient that supports the production of collagen and is essential for maintaining the health of skin, blood vessels, bones and cartilage, according to Health Canada.

Without sufficient vitamin C, the body cannot properly heal wounds, and the structural integrity of blood vessels and connective tissue deteriorates.

Vitamin C also plays a crucial role in the formation of blood vessels, tendons, ligaments, bones, teeth, and gums, while helping the body absorb iron and recover from wounds and burns.

“Vitamin C’s biological role in the human body is to help stabilize connective tissue,” Neary explained.

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“When the human body is lacking vitamin C, connective tissues are weaker than they should be, and that leads to phenomena such as bleeding gums, loosening teeth and easy bruising.”

Other symptoms can also develop, he said, such as fatigue, weakness, lightheadedness, fainting, and in the end stage, it can lead to cardiovascular collapse and death.

Historically, Neary explained, scurvy was primarily associated with sailors and early explorers who, during long sea voyages, were deprived of fresh food sources. This lack of nutrition often led to severe cases of scurvy, as the sailors’ diets consisted mostly of preserved foods that lacked the essential nutrients necessary to prevent the disease.

“It has been rare since the mid-19th century. It was primarily seen on long sailing voyages when people had no fresh fruit for months on end. And the advent of steamships largely did away with that,” he said.

Since then, Neary said episodic cases of scurvy have emerged throughout the 20th and 21st centuries, often linked to socio-economic factors such as social isolation.

The most recent case in Canada involves a community in northern Saskatchewan. On Nov. 15, it was reported that doctors in La Ronge, Sask., treated 27 cases of scurvy within the last six months.

In May, the Lac La Ronge Indian Band hired a doctor to investigate a potential vitamin C deficiency within the community. Blood tests on 50 people revealed that 27 were deficient in vitamin C, indicating scurvy, while 10 had low levels. All participants were over 20 years old, and 79 per cent were Indigenous.

In October, the Canadian Medical Association Journal (CMAJ) issued a warning to doctors to be vigilant for signs of scurvy, following a case of a 65-year-old woman from Toronto diagnosed with the disease last year.

The woman, who had difficulty shopping and preparing balanced meals due to various mobility and health issues, had limited social support and relied heavily on canned soup, tuna, white bread and processed cheese.

The study also said data from the 2017 to 2018 U.S. National Health and Nutrition Examination Survey showed that the prevalence of vitamin C deficiency in the U.S. was 5.9 per cent, while reports from the United Kingdom suggest that the prevalence of the deficiency may be as high as 25 per cent in some groups with low socioeconomic status.

A 2020 study from McMaster University looked at local hospital data between 2009 and 2017 in Hamilton. It found 52 cases of low vitamin C levels, including 13 that met the criteria for a diagnosis of scurvy. Another 39 cases tested positive for scurvy but were asymptomatic. These conditions were most prevalent in people experiencing malnutrition due to factors such as persistent vomiting, mental illness, social isolation, restrictive diets or reliance on others for food, the study added.

“The most commonly documented findings in our clinical scurvy cohort were easy bruising, gingival bleeding, and perifollicular hemorrhages,” the authors said.

Senior author of the CMAJ study Sally Engelhart, a doctor in general internal medicine at Toronto’s Mount Sinai Hospital, said it’s hard not to consider rising food costs as a likely factor in this case.

“It is a diagnosis that people associate with sailors in the 18th century and not something that is relevant in 2024 in Canada and Toronto,” she said.

While a daily vitamin can help, Engelhart said fresh fruits and vegetables are the best sources.

She said scurvy would take “several weeks to months” of poor diet to emerge, but notes “there are people who can go several months without getting fruits, vegetables or other sources of vitamin C in the diet.”

When discussing isolated cases of scurvy, such as the 65-year-old woman in Toronto, Neary emphasized that social isolation and food insecurity are often significant contributing factors.

“When scurvy comes up in large urban areas, it’s usually in people who eat a completely monotonous diet. The same thing every day, often extremely socially isolated, don’t eat with other people, and what they’re eating happens to not contain any vitamin C,” he said.

In the case of the 27 people in northern Saskatchewan diagnosed with scurvy, Neary described it as far more concerning, as it suggests the presence of a systemic issue within the community rather than an isolated incident.

“There’s more public health implications in this Saskatchewan case,” he said.

“This is likely a community where food is largely shipped in and fresh food is likely very expensive, which creates an economic barrier.”