Scurvy isn't history: more than half of 48 adults tested for vitamin C at one northern Canadian clinic had levels in the deficiency range

Scurvy sounds like a sailor's disease from the age of sail, but it never fully went away. Vitamin C is needed to make collagen, the protein that holds skin, gums and blood vessel walls together, and the body cannot make it, so it has to come from food, mainly fresh fruit and vegetables. Within weeks of very low intake, people can start to bruise easily, heal slowly and develop swollen gums; earlier on, the signs can be as vague as tiredness, low mood or aching joints. A study published in PLOS Global Public Health on 28 October looks at how common low vitamin C turned out to be among patients tested at a family medicine clinic in northern Saskatchewan, Canada.

The clinic in La Ronge serves the town and a number of remote First Nations communities, a region of about 16,000 people where, by the 2021 census, about three in four identify as First Nations and about a quarter live on low income. Local doctors had been seeing patients they suspected of scurvy, so the team, from the University of Saskatchewan working with Lac La Ronge Indian Band Health Services and the Northern Inter-Tribal Health Authority, went back through the clinic's records for every serum vitamin C test from January 2011 to March 2024. Almost all of them, 50 of 51, were ordered between August 2023 and March 2024, after the doctors' suspicions grew. In that period 7,709 different patients used the clinic, so about 0.65% were tested.

Three samples could not be read, which left 48 results. Twenty-seven (56%) were below 11 micromoles per litre, the laboratory cut-off for deficiency, and another 10 (21%) were in the low range of 11 to 23. Only 11 were normal. Deficiency was more common among patients identified as First Nations than among other patients, 66% against 20%, a gap that held up statistically even in this small group. There was no real difference between women and men (56% and 57%) or across age groups, although most of the people tested, and most of those deficient, were in their 30s and 40s.

Why the doctors tested is telling. The most common reasons in the notes were skin signs such as bruising or poor wound healing (11 patients), mouth problems such as swollen gums or poor teeth (10), muscle and joint pain (6) and tiredness or weakness (5). But the classic picture did not separate people well: 7 of the 11 patients with typical scurvy signs were deficient, and so were 20 of the 37 without them. The authors suggest doctors in places like this keep vitamin C in mind for vague complaints too, when diet, smoking or money troubles point that way.

The authors are careful about what this does and does not show. These were people a doctor already suspected, not a random sample, so 56% is not the share of the region that is deficient. Vitamin C breaks down quickly once blood is drawn, and these samples travelled on dry ice to a laboratory in Regina more than 600 kilometres away, which could make some results read low. Inflammation can also lower blood levels for a while, and markers of it were not routinely measured. Smoking, which raises the body's need for vitamin C, and diet were too patchily recorded to analyse. The team still judges that the pattern is unlikely to be a lab artefact alone.

They also do the arithmetic for remote clinics. A vitamin C blood test costs CAD 15.78 before the special transport, while a month of 500 mg tablets costs under CAD 2.50 and is safe, so for patients with suggestive symptoms and clear risk factors, simply treating may make more sense than testing first. The longer-term answer, they argue, lies in food: high prices and limited fresh food in the north, changes to harvesting, and heavier reliance on cheap packaged food. The two partner health organisations have already folded the findings into their clinical guidance and nutrition programmes.