There has been a resurgence of the rare condition of scurvy among a group of diabetes patients at a major western Sydney hospital.

It appears scurvy, a historical disease caused by a lack of vitamin C and generally associated with old-world sailors on long voyages, is making a surprise comeback in Australia, due to poor modern dietary habits.

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.

“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.

Diabetics may avoid fruit to avoid raising blood glucose levels

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.

When Penelope Jackson’s (R) leg ulcers refused to heal, Dr Gunton realised the problem was a chronic lack of vitamin C. Photo: ABC News.

“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.”

In a research paper she has just had published in the international journal Diabetic Medicine, she said there was no predominant social pattern to the incidence of scurvy and patients with poor diets appeared to be from a range of socio-economic backgrounds.

“This result suggests that despite the large amounts of dietary advice readily available to the community, there are still plenty of people — from all walks of life — who are not getting the messages.”

She is hopeful of getting funding to extend her research in the new year by testing all the patients at Westmead Hospital’s foot clinic, which will help determine whether it is limited to diabetes sufferers who are deficient in vitamin C or is a more widespread problem.

“I think it would be interesting to study it more broadly within Australia across a population group but it’s an expensive process; you need to go into the person’s history and have a lot of facts about them to make the result meaningful,” she said.

– ABC