Diabetes wounds that won’t heal could indicate vitamin C deficiency

By Amanda Sheppeard

2 Dec 2016

People living with diabetes with wounds that won’t heal should be tested for vitamin C deficiency, says a leading Sydney endocrinologist and researcher.

And doctors should start asking all of their patients about their fruit and vegetable intake, and how they cook their vegetables, as evidence points to a resurgence of scurvy in Australia – a disease long thought to be a scourge of the past.

Professor Jenny Gunton’s advice follows the release of a research paper she co-authored which revealed a spate of her diabetes patients with problem wounds had turned out to have scurvy, a disease usually considered to be of only historical interest.

Scurvy is known as a sailors’ disease, and was common in sailors on long voyages who had not access to fresh citrus fruit and vegetables. It was thought to have been largely eradicated in the developed world.

But the research published in the journal Diabetic Medicine, revealed it appears that scurvy is making a comeback due to poor modern dietary habits.

And the problem could be much more widespread, with little data and no formal red flags for doctors to test for the disease.

“While diabetes is not traditionally a risk factor for vitamin C deficiency, the research suggests that clinicians should have a high index of suspicion, particularly if their  patients present with unhealed ulcers, easy bruising or gum bleeding without obvious cause,” Professor Gunton said.

Professor Gunton, who heads the Centre for Diabetes, Obesity and Endocrinology research at The Westmead Institute, told the limbic she believed the condition was unlikely to be limited to people with diabetes.

Her team has applied for a grant to test everyone who attends Westmead’s high risk foot and oral health clinics, and she said she expects there will be more researchers joining the quest to learn more about prevalence rates.

“I don’t think it’s going to be common common but I don’t think it will be as rare as we would like to think it will be,” she said.

Professor Gunton embarked on the research when she discovered several of her patients at Westmead Hospital with long-running unhealed wounds were cured by a simple course of vitamin C.

“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.

Another red herring is the discovery that patients can 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,” Professor Gunton said.

The research found no predominant social pattern to the incidence of scurvy and that patients with poor diets were observed to be from a range of socio-economic backgrounds.

“This result suggests that despite the plethora of dietary advice readily available to consumers, there are still plenty of people – from all walks of life – who are not getting the messages,” she said.

Human bodies cannot synthesise vitamin C, so people need to eat foods containing it. A lack of vitamin C in the body results in defected formation of collagen and connective tissues, the results of which may include bruising, bleeding gums, petechiae (blood spots in the skin), arthralgia (joint pain) and impaired wound healing.

Common foods which are high in vitamin C include oranges, strawberries, red and green peppers including capsicums, broccoli, kiwi fruit and grapefruit. But overcooking any food is likely to destroy the vitamin C.

The retrospective cohort study was carried out over a two-year period until late 2014.

Patients with ulcers that had been present for 3–22 months and were found to be Vitamin C deficient were treated with Vitamin C supplements of 500 or 1000 mg/day.

Healing occurred within 2–3 weeks of starting replacement in all but one patient.

“Vitamin C deficiency should be considered in people with diabetes who have poor diets, and ulcers with delayed healing, as well as classic factors of easy bruising and bleeding gums,” the authors concluded.

“This report indicates that a high index of suspicion is needed, especially in people with non-healing ulcers or bruising without obvious cause. Treatment of vitamin C deficiency is cheap, safe and is likely to improve wound healing.”

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