Which medical condition leads to a specific craving for vitamin C?

Scurvy (Vitamin C Deficiency) Causes Cravings for Vitamin C

Scurvy, caused by severe vitamin C deficiency, is the medical condition that leads to specific cravings for vitamin C-rich foods. This occurs because the body develops an instinctive drive to seek out the missing nutrient when deficiency becomes severe enough to cause symptoms. 1

Understanding the Mechanism

• Vitamin C (ascorbic acid) is essential for collagen synthesis through hydroxylation of proline and lysine, and humans cannot synthesize it due to lack of the enzyme gulonolactone oxidase. 2
• Scurvy develops after 8-12 weeks of consuming less than 40-45 mg/day of vitamin C, as body stores become depleted and symptoms emerge. 3
• The body's craving mechanism represents an adaptive response to severe nutritional deficiency, driving individuals to seek citrus fruits, fresh vegetables, and other vitamin C sources. 4, 2

Clinical Presentation That Triggers Cravings

The characteristic symptoms that develop alongside these cravings include:

• Mucocutaneous bleeding manifestations: petechiae, ecchymoses, bleeding gums, and perifollicular hemorrhages 1, 3
• Pathognomonic skin findings: perifollicular bleeding and "corkscrew" hair appearance 4, 5
• Systemic symptoms: profound fatigue, lethargy, bone and joint pain, and impaired wound healing 6, 7
• Advanced disease features: gingival swelling with spontaneous bleeding, joint contractures from periosteal hemorrhage, and severe weakness 4, 7

High-Risk Populations Most Likely to Develop Cravings

Scurvy predominantly affects disadvantaged populations with restricted diets, including:

• Individuals with alcoholism and poor nutrition 4, 7, 5
• The isolated elderly with limited access to fresh produce 7, 5
• Patients with severe psychiatric illness and restrictive eating patterns 6, 5
• Those experiencing homelessness and food insecurity 5
• Post-bariatric surgery patients with malabsorption 3

Diagnostic Approach When Cravings Are Present

• Clinical diagnosis based on characteristic symptoms is sufficient to initiate treatment without awaiting laboratory confirmation. 3
• Plasma vitamin C measurement is the preferred test when laboratory confirmation is needed, but results become unreliable when C-reactive protein exceeds 10 mg/L. 3
• The presence of perifollicular hemorrhages and corkscrew hair are pathognomonic findings that should immediately raise suspicion for scurvy. 4, 5

Immediate Treatment Protocol

Begin oral vitamin C 100 mg three times daily (300-500 mg/day total) for at least one month as soon as scurvy is suspected. 3

Alternative evidence-based regimens include:

• 250 mg twice daily for 3 weeks for clinical scurvy 3
• 500 mg once daily for 1 month 3
• For severe cases with malabsorption or critical illness, use intramuscular, intravenous, or subcutaneous routes at 2-3 g/day IV. 3

Expected Clinical Response

• Rapid clinical improvement occurs within 2 weeks of initiating vitamin C supplementation, with resolution of skin lesions, joint contractures, and restoration of mobility. 4
• Complete resolution of symptoms typically occurs within 3-4 weeks of adequate vitamin C repletion. 4, 7
• Untreated scurvy is inevitably fatal due to infection or sudden death from cardiovascular collapse. 7

Prevention of Recurrence

• Maintenance therapy requires only 75-90 mg/day for healthy adults, achievable with one medium-sized orange. 3, 4
• High-risk populations require continued supplementation of 200-500 mg/day indefinitely to prevent recurrence. 3

Critical Pitfall to Avoid

Do not delay treatment while awaiting laboratory confirmation if clinical features are present, as scurvy responds rapidly to vitamin C but can be fatal if untreated. 3, 7 The diagnosis is clinical, and laboratory testing for vitamin C concentration reflects recent dietary intake rather than tissue stores. 4