I recently listened to a webinar about nutrition for surgery patients. The speaker — a fellow Registered Dietitian Nutritionist — has years of experience evaluating surgical patients’ nutritional status. This evaluation is important, because several nutrients are essential for wound healing. Successful recovery from surgery depends on an adequate supply of these nutrients. Lack of one or more nutrients can lead to poor healing, prolonged recovery and complications like inflammation and infections. The list of critically important nutrients includes zinc, protein, vitamin A, omega-3 fats and vitamin C.
Her observation about scurvy –vitamin C deficiency — grabbed my attention. She sees patients with scurvy 3-4 times a week. This is pretty shocking. We live in an industrialized country with an abundant and reliable food supply. Vitamin C is concentrated in fruits and vegetables. It’s included in multiple vitamin formulas. Who doesn’t get enough vitamin C?
Effects of vitamin C deficit
Vitamin C is also a potent antioxidant and is essential for numerous enzyme systems. It’s essential for:
- Collagen synthesis. Skin and joint integrity depend on collagen.
- Immune function. White blood cell structure and function depend on a steady supply of vitamin C.
- Maintenance of gene integrity and regulation of gene expression.
- Protection of molecules from oxidative damage.
- Wound healing
- Energy metabolism
According to the Linus Pauling Institute, vitamin C deficiency occurs about 30 days after vitamin C is removed from diet. As body stores are depleted, many of these vitamin C-dependent functions are affected. As collagen production decreases, connective tissue deteriorates, leading to subcutaneous bleeding (under the skin), easy bruising, hair/tooth loss, joint pain and swelling. Fatigue and poor wound healing are other signs. Immune function is adversely impacted.
Vitamin C deficit isn’t an All-Or-Nothing problem. You don’t typically go from fine to scurvy in a day. People who eat a vitamin-C-poor diet could have chronic insufficiency rather than outright deficiency. The systems that depend on vitamin C might be operating at 50% or 30% rather than 100%. An immune system running at 30% capacity will be less effective dealing with infections or inflammation. If collagen production is reduced by half, joints, skin and blood vessel integrity will suffer.
Who is at risk?
Vitamin C is found in vegetables and fruit. Not in dairy foods, not in meat, not in bread or other grain-based foods. A person who avoids or limits vegetables and fruit will have a poor vitamin C intake. Why would someone avoid those foods? Aging can have a big impact thanks to:
- Taste changes
- Decreased appetite (vegetables and fruit can be filling)
- Chewing problems
- Lack of cooking skills
- Limited ability to shop
- Chronic medical problems can also interfere with food choices and nutrient absorption.
It’s not hard to envision a single elderly person, living alone, who prefers inexpensive convenience foods. A diet of frozen waffles, canned soup, toast, boxed mac and cheese, hot dogs, cold cereal, cookies, crackers and soft drinks is vitamin C deficient.
Just take a pill?
If that’s your diet, you might think you can just make up for poor vitamin C intake with a supplement. You could, but you’d be missing all the other key nutrients concentrated in vegetables and fruit, all equally important for health, such as vitamin A, vitamin E, potassium, magnesium, folate, fiber and most other vitamins and minerals.
Many older adults remember a time when orange juice was standard fare at breakfast. An 8 oz glass of OJ has 90 mg of vitamin C. The recommended daily intake for an adult is 75-90 mg, so you’re covered by a glass of orange juice. Maybe we should go back to that tradition instead of super-sized sugary lattés. Other high vitamin C foods include:
- melons (watermelon, cantaloupe, honeydew, casaba..)
- sweet and hot peppers
- Brussels sprouts
- some greens, like kale
Note that some popular fruit like apples and bananas do not have much vitamin C. A large apple has less than 9 mg. You’d have to eat 10 apples to equal the vitamin C in one glass of OJ. Many other juices are good sources of vitamin C. Many, such as cranberry, are fortified with vitamin C. However it’s always better to eat the whole food to get all the other nutrients and fiber.
If you’re scheduling surgery of any kind, think nutrition. Not all surgical practices do nutrition screens, so you may have to do your homework. If your daily intake of vitamin C-rich vegetables and fruit is significant, you at least shouldn’t have to worry about scurvy.