SCURVY - CONNECTIVE
TISSUE NUTRITIONAL DEFICIENCY DISORDER
. . Dr. S. R. Ameerkhan Babu., M.D. (Hom)
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.
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.
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.
References
- Harrison's
Principles of Internal Medicine
- http://en.wikipedia.org/wiki/scurvy
- Davidson’s
Principles and Practice of Medicine,
- Lilienthal
S., Homoeopathic Therapeutics
- http://disease.disease.com/Diseases/Connective-Tissue-Disease/dense-connective-tissue.html
- A Treatise on the Scurvy. London: A. Millar.
- http://emedicine.medscape.com/article/985573-overview.
- Homeopathic
Materia Medica by Boericke
- http://www.innovateus.net/innopedia/what-causes-scurvy
- http://www.cabdirect.org/abstracts/19711401152.html;jsessionid=00F4BD3C06C5FA3DE27411AF8E3B3106
- http://www.knowhomeopathy.com/15_scurvy.php
- http://www.a-healthy-balance.com/homeopathy-and-nutrition.html
- http://www.home-remedies.info/home-remedies/scurvy.htm
- Dewey W.
A., Practical Homeopathic Therapeutics
Dr. S. R. AMEERKHAN BABU., M.D. (Hom) (Prac. of Med), MBA Reader,
Dept. of Practice of Medicine Vinayaka
Mission’s Homoeopathic Medical College & Hospital, Salem, Tamilnadu.
