Scurvy resurgence highlights issues of food insecurity in Canada’s rural and remote areas

A disease often thought to only affect 18th century sailors is reemerging in Canada.

Earlier this week, doctors identified 27 cases of scurvy caused by prolonged and severe vitamin C deficiency in northern Saskatchewan. Experts say the confirmed diagnoses highlight a broader issue with poverty and food insecurity in rural and remote communities across the country.

“Vitamin C comes from lots of different food sources, but if you don’t get those food sources, the body can’t do what it needs to do,” said Dr. Jeff Irvine, a physician researcher with Northern Medical Services in La Ronge, Sask.

Irvine was asked to help investigate the prevalence of scurvy in his northern community of La Ronge after his colleague confirmed a single case of the disease.

Irvine looked back at the last 51 vitamin C blood tests performed on patients in La Ronge over the last 14 years. Fifty of the tests took place between mid-2023 and spring 2024, with 27 of those results showing low levels of vitamin C. Those blood results paired with physical exam results indicated the 27 patients were positive for scurvy, Irvine said.

The patients’ ages ranged from 20 to 80 years old. Nearly eight in 10 were Indigenous.

“We have reason to believe that the scope of the problem might be larger than we think at this point,” said Dr. Nnamdi Ndubuka, a medical health officer with the Northern Inter-Tribal Health Authority.

Common symptoms of scurvy include fatigue, joint pain, bruising, bloody gums and loose teeth. The disease can be difficult to diagnose due to its rarity and the fact that vitamin C levels aren’t routinely tested, Irvine said.

The main source of vitamin C is fruits and vegetables, like oranges and broccoli. Daily recommended doses vary based on age and sex. Adult men should consume 90 mg of vitamin C each day while adult women should get 70 mg per day.

“It’s sort of a canary in the coal mine,” Irvine said.

“If they’re lacking nutrients of vitamin C, they’re bound to be lacking other nutrients as well.”

Last month, a study published in the Canadian Medical Association Journal detailed a recent case of scurvy treated in a Toronto hospital.

 A 65-year-old woman went to the emergency department after eight days of progressive leg weakness and poor mobility, according to the study. Her gums were bleeding, and she had large patches of bruises on her legs. Prior to hospitalization, the woman’s prolonged diet consisted of processed and non-perishable canned food.

The study’s authors called it a “complex example of food insecurity manifesting as an uncommon diagnosis.”

Food insecurity across the provinces rose to 22.9 per cent in 2023, an increase from 18.4 per cent the year before, according to data from Statistics Canada. Nova Scotia, Prince Edward Island and Saskatchewan saw the highest rates of food insecurity between 28 and 29 per cent. Black and Indigenous populations were the most affected.

“If you go to northern communities and rural communities, you see that the situation is even much worse,” said Hassan Vatanparast, a professor in the College of Pharmacy and Nutrition at the University of Saskatoon.

Transportation costs and food shelf life play a role in what foods are stocked in rural and remote grocery stores. It’s easier and more economical for grocers to sell non-perishable foods, Vatanparast said, which can mean vitamin-rich food are less accessible.

Another challenge is the high cost of fresh produce in these communities.

A 2022 report from the Saskatchewan Health Authority found an average family of four in a northern community paid roughly $80 more for nutritional groceries each week compared to a family in the southern part of the province.

“We have bigger issues than vitamin C deficiency. It’s about health equity, it is about food insecurity, it is about equitable distribution of resources and accessibility and availability,” Vatanparast said.

It can take one to three months of low vitamin C intake to lead to scurvy, according to Irvine. But patients can start to see improvements in a few days once the vitamin is reintroduced either through food or supplements.

All patients were treated with vitamin C supplements in La Ronge.

“It is a very easy thing to prevent and very easy thing to treat. You just need to have vitamin C available to do that,” Irvine said.