Poverty often leads to a poor diet, and poor diets can lead to a host of health problems. Doctors in Springfield, Massachusetts, think they’ve identified a diet-related condition that many thought disappeared hundreds of years ago.
The medical mystery began with what looked like a skin infection. Doctor Eric Churchill was examining one of his colleague’s patients. The man had been admitted to Baystate Medical Center with strange bruises, swelling, and bleeding gums. But the bacterial tests came back negative. The doctors were stumped.
“And someone eventually thought to ask about this person’s diet,” he says.
Turns out the man had psychiatric issues and would only eat a few types of food.
“So for years had been eating nothing but bread and american cheese. and this had led to these very severe nutritional deficiencies,” Churchill says.
In fact, the patient’s Vitamin C levels were so low he qualified for a diagnosis these doctors hadn’t thought about in years: Scurvy. Yes, the same scurvy rampant in the 1700s among British sailors who would go months or years without fresh food. They’d lose teeth, become lethargic, and sometimes hemorrhage to death.
“One of the problems of talking about scurvy in modern populations is no one thinks it’s a disease of modern times,” Churchill says.
At that point, in 2010, Churchill and the other Baystate doctors went ‘huh’. They figured it was an isolated case, prescribed vitamin C tablets, and moved on.
A few months later, Churchill saw a patient with a long history of stomach complaints. They learned this patient, who also had mental illness, had eaten nothing but ice cream for six months. With the previous case on their minds, they checked his vitamin C levels, and bingo. Scurvy.
“And we began to start asking a little bit more about people’s eating habits,” Churchill says, “and particularly in people who were isolated and who had a lot of significant issues with depression, schizophrenia, bipolar disorder, that sort of thing.”
Over the next five years, the team tested about 120 patients at the High Street clinic in one of Springfield’s poorest neighborhoods. They found at least 30 cases of scurvy — more than any previous study. This was especially surprising, Churchill says, since the nutritional bar for scurvy is so low. Never mind grapefruit and kale….
“You can have a handful of McDonald’s ketchup packets a day, and that’ll give you enough vitamin C to keep yourself from contracting scurvy. ”
In other words, these people were eating virtually no fruits or vegetables. And since their general fitness was poor, their symptoms — like fatigue, easy bruising, joint pain — had been attributed to other diseases. This was the first time anyone mentioned scurvy.
“Some people didn’t know what it was,” Churchill recalls. “Others were kind of shocked, because — ‘scurvy? is that ‘Aar! Pirates!’ I think certainly for some people it was a bit of a sobering moment.”
It was certainly surprising for Mark, a 49-year-old maintenance worker who did not want his last name used.
“I never heard of any of my other counterparts having it,” he says.
Mark is slightly overweight with a round face and sweet demeanor. He’s had poor health since childhood – including diabetes and heart disease. So last year when his gums started bleeding and he felt run down, he didn’t take much notice. Eventually he went for a check up at the High Street clinic, where Dr. Churchill tested his vitamin C levels, and diagnosed scurvy.
“After a little thinking about it, it’s like, OK, all the pizzas,” Mark says. “I really didn’t have a good diet.
Mark says he often left the house for work at 5am and didn’t return until late at night — so most of his meals were McDonald’s or Chinese take-out. When he did go grocery shopping, he went to Walmart – and would often pick out usual quick-meals from the frozen food section.
But he’s trying to change. The first weekend after his scurvy diagnosis, Mark headed to Walmart’s produce aisle.
“I started eating an orange in the morning, and an orange at night,” he says. “I started out there, and then some pineapples.”
Even a small change in diet can cure scurvy. The problem, Churchill says, is that few doctors think to look for it. Scurvy research over the past few decades is thin – no clinical trials, just case studies.
However, one major nutrition survey seems to support Churchill’s theory. In a report from the Centers for Disease Control, which collected Vitamin C levels from 2003 and 2004, 6 to 8 percent of the general population met the criteria for scurvy. The rate is higher for men and those with low-incomes, and higher still — about 18 percent — among male smokers.
“I’m really quite curious now,” says Elizabeth Bertone-Johnson, a nutritional epidemiologist at UMass-Amherst. “I mean the consequences of that level of deficiency for people’s basic functioning and quality of life is pretty dramatic.”
Until this interview, Bertone-Johnson hadn’t seen the Vitamin C data. The last time she thought about scurvy was in graduate school, when it was taught as a historic case study. And given how easy it is to get vitamin C – it’s added to a lot of foods, easy to get in multi-vitamins, Bertone-Johnson says it’s fallen off the public health radar.
“I think that Vitamin C deficiency just isn’t that interesting from a research point of view,” she says. “It’s a problem that has existed for so long. It’s old news.”
Even CDC researcher Rosemary Schleicher – who wrote the Vitamin C report – doesn’t worry much about deficiency rates.
“Well, it’s probably more than we’d like to see,” Schleicher says. But she says not everyone with severe deficiency will develop full-blown scurvy symptoms – and if they do, “just a little bit of Vitamin C will reverse it.”
That’s exactly why Eric Churchill wants more doctors to screen for it. He’s not ready to declare a scurvy epidemic — his own study, which has not yet been published, is a limited, anecdotal case series, but he hopes it sparks more research.
It’s already having an impact on Mark, the maintenance worker. Since his diagnosis, he’s gone beyond oranges at Walmart – and now buys grapes, strawberries, and the occasional fresh vegetable –
“My daughter, she likes carrots,” he says. “Now and then we buy the fresh broccoli.”
Granted, it often rots in his fridge, but it’s a start.
Mark hasn’t been rechecked for scurvy. His gums are still pink and puffy, but they don’t bleed. One thing he has noticed – ever since he started eating better, whatever the reason, he feels better too.