Vitamin C deficiency

The signs and symptoms of Vitamin C deficiency start to develop 8 to 12 weeks after inadequate intake of Vitamin C. The major characteristic signs of Vitamin C deficiency are:

• Corkscrew hair (dry, brittle, and coiled hair)
• Perifollicular hemorrhage (bleeding around hair follicles)
• Gingival bleeding (gum bleeding)

The other signs and symptoms include:

• Weakness
• Fatigue
• Poor wound healing
• Shortness of breath
• Poor appetite
• Fever
• Anemia
• Swelling of gums
• Loss of teeth
• Mucocutaneous petechiae (pinpoint-sized spots of bleeding under the skin or mucous membranes)
• Ecchymosis (discoloration of the skin resulting from bleeding underneath)
• Hyperkeratosis (increased thickness of the skin)
• Swan-neck hair (bending of hair)
• Edema (swelling caused by excess fluid trapped in the body's tissues)
• Koilonychia (depression of the central portion of the nails)
• Painful hemarthrosis (bleeding into the joint cavity)
• Dry eyes
• Hair loss

Vitamin C, also known as ascorbic acid, performs the following functions in the body:

• Helps in synthesizing collagen, the primary building block of skin, muscles, bones, and connective tissues.
• Supports blood vessels by managing the structure of collagen.
• Serves as an antioxidant, helping to prevent the deposition of cholesterol in the blood vessels.
• Aids in the absorption of iron in the small intestine.

Humans are unable to produce Vitamin C. Deficiency occurs as a result of sustained dietary deficiency for several months. Symptoms begin to develop when the total body stores are reduced from 1500 mg to 300 mg.

• Diet Deficient in Vitamin C
  • Exclusive cow’s milk diet (in children)
  • Exclusive tea and toast diet (mostly seen in the elderly)
  • Absence of fruits and vegetables in the diet
  • Restrictive diets
• Medical Conditions
  • Eating disorders
  • Food allergies
  • Type 1 diabetes
  • Gastrointestinal disorders such as inflammatory bowel disease, celiac disease, and Crohn's disease
  • Iron overload
  • Cancer
  • Psychiatric illnesses such as depression
• Smoking

  Smokers have been found to have lower concentrations of Vitamin C in the blood. Want to quit smoking? Explore the smoking cessation products in our cart. Buy Now.

• Excessive Alcohol Intake

  Alcohol increases the excretion of Vitamin C. Excessive consumption of alcohol (>80 g/day) is associated with an increased risk of Vitamin C deficiency.

• Pregnancy

  Pregnant women are more prone to Vitamin C deficiency due to increased requirements.

• Hemodialysis

  Hemodialysis increases the risk of Vitamin C deficiency due to its loss during the procedure. Studies have shown a 50% decrease in Vitamin C after dialysis treatment.

• Low Socioeconomic Status

  Fresh fruits and vegetables are the major dietary sources of Vitamin C. Individuals with low socioeconomic status are more likely to develop Vitamin C deficiency due to limited access to these sources.

Did you know? Children who skip breakfast may have poor nutritional profiles.

The diagnosis of Vitamin C deficiency is made primarily by evaluating risk factors. Physical examination is also required to assess the symptoms and their severity. In most cases, the disease is confirmed with the recovery following supplementation.

I. Blood Tests

• Vitamin C: This test measures the blood concentration of Vitamin C. A concentration below 0.3 mg/dl indicates deficiency. However, this test is not very reliable as it reflects recent intake rather than body stores.
• Other Nutrients: Other nutritional deficiencies can be concomitantly associated with Vitamin C deficiency. The levels of other nutrients such as Vitamin B12, folate, calcium, zinc, and iron are also assessed during the evaluation.
• Leukocyte Test: Leukocytes, a type of blood cell, can maintain Vitamin C concentrations several times higher than those in blood. This test indicates long-term dietary intakes of Vitamin C. A leukocyte Vitamin C level of less than 7 mg/dL indicates deficiency.

II. Dermoscopy

This procedure involves the examination of skin lesions using an instrument called a dermatoscope. It helps evaluate follicular purpura and corkscrew hairs, which are characteristic features of Vitamin C deficiency.

III. Skeletal X-ray

This imaging technique is used to confirm skeletal changes in children resulting from Vitamin C deficiency. Most changes are observed at the ends of long bones, specifically at the knee.

• Consume fruits and vegetables regularly: Fresh fruits and vegetables such as guava, strawberry, papaya, kiwi, spinach, carrots, and bell peppers are excellent sources of Vitamin C. A balanced diet is the best way to prevent Vitamin C deficiency.
• The daily requirement of Vitamin C is:
  • 45 mg per day for children
  • 90 mg per day for men
  • 75 mg per day for women
  • 120 mg per day for lactating women
• Five servings of most fruits and vegetables (recommended daily) provide more than 200 mg of Vitamin C. People who smoke should consume an additional 35 mg/day.
• Treat underlying medical conditions: Individuals with underlying health conditions such as celiac disease and cystic fibrosis may experience impaired nutrient absorption. Treating these conditions can help maintain optimal levels of Vitamin C.
• Avoid restrictive diets: Fad diets often lead to vitamin deprivation. Avoiding restrictive diets can help prevent Vitamin C deficiency.

I. Vitamin C Supplementation

Vitamin C supplements are primarily available in tablet form; however, they can also be administered intravenously or intramuscularly as needed. The recommended patterns for supplementation are:

• 300 mg daily for children
• 500 mg to 1000 mg daily for adults for 1 month
• 1 to 2 g for up to 3 days, followed by 500 mg daily for a week, and then 100 mg daily for up to 3 months

The duration of treatment can be extended if symptoms persist.

Explore our wide range of Vitamin C supplements. Shop Now.

II. Treatment of Associated Symptoms

1. Transfusion: Severe Vitamin C deficiency can lead to anemia due to persistent bleeding in some individuals, necessitating blood transfusion.
2. Vitrectomy: This procedure is performed in individuals with severe eye problems, such as dry eyes, resulting from prolonged Vitamin C deficiency. During the surgery, the vitreous fluid (a gel-like substance filling the eye) is replaced with another solution.
3. Bone Surgery: Children with bone disease may require surgery if symptoms do not resolve with supplementation.

Dietary recommendations

• Citrus fruits: Citrus fruits such as lemon and orange are excellent sources of Vitamin C.
• Papaya: An excellent source of Vitamin C, papaya is known as a powerhouse of nutrients and can be consumed in salad or juice form.
• Guava: A good source of Vitamin C, fiber, and antioxidants. A single guava fruit (100g) contains approximately 200 mg of Vitamin C.
• Tomato: Should be included in daily cooking as they are also a very good source of Vitamin C and Vitamin A.
• Indian gooseberry (amla): Known for its medicinal properties, amla is a rich source of Vitamin C. It can be eaten raw, in salads, or as juice.
• Cruciferous vegetables: Broccoli, cabbage, and cauliflower are examples of cruciferous vegetables that are rich in Vitamin C.

The severe Vitamin C deficiency can cause:

• Bleeding
• Iron deficiency anemia
• Jaundice
• Hyperthyroidism

Vitamin C deficiency mostly resolves within 3 months with conscious eating and dietary supplements. The following measures might help in faster recovery:

1. Eat Vitamin C rich foods: Vitamin C is abundantly found in fresh fruits and vegetables. Common sources include:
• Oranges
• Green peppers
• Watermelon
• Papaya
• Grapefruit
• Strawberries
• Kiwi
• Mango
• Broccoli
• Tomatoes
• Cauliflower
• Cabbage
• Green leafy vegetables such as turnip and spinach
• Red and green peppers

These foods are easily accessible and should be included in the daily diet.

2. Avoid overcooking: It is advised to eat fruits and vegetables raw or very lightly cooked for maximum effect, as Vitamin C is sensitive to heat and overcooking can degrade it.
3. Abstain from smoking: Smoking serves as a trigger for Vitamin C deficiency. It is advised to completely avoid smoking or limit it. Individuals who smoke require higher amounts of supplements.
4. Go for screening: In most cases, Vitamin C deficiency develops as a result of poor dietary intake, which may lead to other deficiencies. It is important to screen for other nutritional deficiencies.
5. Do not self-medicate: It is advised to consult healthcare professionals before starting supplements. The doctor prescribes the right dose as per your needs. Vitamin C also interacts with other medications, which a doctor can help you identify and address.
6. Keep yourself hydrated: Vitamin C supplements can increase urination. Make sure to stay hydrated to compensate for water loss.
7. Be aware of overdosage: Higher doses of Vitamin C can cause diarrhea, gas, or stomach upset. It is always advised to take the recommended amount of Vitamin C. Seek immediate medical consultation if you experience any such signs.