Vitamin C deficiency is uncommon, but it can still develop when someone gets very little vitamin C for many weeks.
Early symptoms may include fatigue and feeling generally unwell, before more noticeable problems develop, including swollen or bleeding gums, skin changes, joint pain, and poor wound healing.
Severe vitamin C deficiency can lead to scurvy, a serious condition that can become life-threatening if left untreated. Fortunately, eating a varied diet that regularly includes fruits and vegetables can help prevent vitamin C deficiency.
In this article, you’ll learn what vitamin C deficiency is, the early and later symptoms to watch for, who is more likely to develop it, how much vitamin C you need, and how to get enough from food.
Signs and Symptoms of Vitamin C Deficiency
Vitamin C deficiency doesn’t necessarily produce all of these symptoms at once. Early symptoms tend to be less specific, while more advanced deficiency can cause noticeable changes in the gums, skin, hair, joints, and wound healing.
1. Fatigue
Feeling unusually tired or lacking energy can be one of the earlier signs of vitamin C deficiency.
Vitamin C is required for the production of L-carnitine, a compound involved in energy metabolism. As vitamin C levels become severely depleted, fatigue and weakness can develop, possibly partly because of impaired carnitine biosynthesis.
Fatigue is extremely common, so it shouldn’t automatically be attributed to vitamin C deficiency.
2. Swollen, Inflamed, or Bleeding Gums
Changes in the gums can become an important sign as vitamin C deficiency progresses.
Your gums may become red, swollen, tender, or inflamed, and as the deficiency becomes more severe, they may bleed easily.
Vitamin C is essential for collagen production, which helps maintain the connective tissues supporting the gums. Prolonged deficiency can weaken these tissues and contribute to inflammation and bleeding.
A study of 11 healthy men found that periods of low vitamin C intake were associated with greater gingival inflammation and bleeding, even though plaque accumulation and periodontal probing depths did not change. The findings suggest that vitamin C status may influence early gum inflammation, particularly bleeding.
However, gum disease and poor oral hygiene are much more common causes of these symptoms, so persistent gum inflammation or bleeding should be evaluated by a dentist.
3. Small Red or Purple Spots on the Skin
Tiny red or purple spots can appear when small blood vessels leak blood beneath the skin.
These tiny spots are called petechiae, while larger areas of bleeding under the skin are known as purpura. Both can occur in advanced vitamin C deficiency and scurvy.
These aren’t typical signs of a brief period of eating fewer fruits and vegetables. They can occur with significant vitamin C deficiency but also have many other possible causes, so they should be medically assessed.
4. Easy Bruising
Do you seem to develop bruises without remembering an injury?
Severe vitamin C deficiency can make bruising more likely. Prolonged deficiency can weaken connective tissues and contribute to fragility of small blood vessels due to poor collagen production. This can lead to easy bruising and small red or purple spots under the skin.
A case report of two elderly men with diets low in fresh fruits and vegetables found scurvy accompanied by small red or purple spots around the hair follicles, bruising, and swollen, red gums. Treatment with oral vitamin C led to a dramatic improvement in their signs and symptoms.
Frequent unexplained bruising can have many other causes, so it deserves proper evaluation..
5. Slow Wound Healing
A cut that seems to be taking unusually long to heal can have many possible explanations, but severe vitamin C deficiency is one of them.
Vitamin C is essential for collagen production, which plays an important role in repairing damaged tissue. When vitamin C levels are severely depleted, wound healing can be impaired.
Research has also found lower vitamin C levels among people with chronic leg ulcers, while a 2021 study found that vitamin C supplementation improved healing of chronic foot ulcers, with significantly greater healing after 8 weeks than in the control group.
Diabetes, poor circulation, inadequate protein intake, certain medications, and other conditions can also slow wound healing..
6. Joint Pain or Swelling
Joint pain can develop as vitamin C deficiency becomes more advanced. Some people with severe deficiency may also experience swollen joints, particularly when bleeding occurs in or around the joint. These are recognized features of scurvy.
Impaired collagen production and weakened connective tissues can contribute to joint and muscle pain, while bleeding into or around joints can contribute to swelling.
A 53-year-old man with undetectable vitamin C levels developed muscle weakness, joint swelling, and bleeding into the knee. His symptoms improved markedly after vitamin C supplementation.
Persistent joint pain or unexplained swelling can have many causes and should be medically evaluated rather than automatically attributed to vitamin C deficiency.
7. Dry, Rough, or Thickened Skin
Vitamin C deficiency can affect the skin because vitamin C is essential for collagen production.
As deficiency progresses, hyperkeratosis, or excessive thickening of the outer layer of the skin, may develop. One form seen in scurvy is follicular hyperkeratosis, where excess keratin builds up around hair follicles, causing small, rough, raised bumps.
In one study, four men developed scurvy after following a diet completely lacking vitamin C. They developed follicular hyperkeratosis, bleeding gums, and small hemorrhages around the hair follicles as their vitamin C stores became severely depleted. Earlier research also found that 10 mg of vitamin C daily could cure and prevent clinical scurvy.
However, hyperkeratosis is not specific to vitamin C deficiency. Rough or thickened skin should therefore be considered alongside other symptoms and a person’s dietary history.
8. Corkscrew-Shaped Hair
One of the more distinctive signs of severe vitamin C deficiency is corkscrew-shaped or tightly curled hair.
The hair can develop an unusual twisted appearance because vitamin C deficiency disrupts normal collagen formation and affects the structure of hair follicles.
In a case report of a 31-year-old man with scurvy, doctors observed corkscrew hairs along with follicular hyperkeratosis, bleeding around the hair follicles, and gum bleeding. His symptoms resolved after vitamin C treatment.
Corkscrew-shaped hair is a distinctive sign of scurvy and may appear alongside other symptoms of severe vitamin C deficiency.
9. Anemia
Severe vitamin C deficiency can be associated with anemia.
Vitamin C helps your body absorb non-heme iron from plant foods. In addition, bleeding caused by fragile tissues can contribute to iron loss. Together, these factors can increase the risk of iron-deficiency anemia in someone with severe deficiency.
Anemia can cause fatigue, weakness, dizziness, and shortness of breath, so blood testing may be needed to determine the cause.
10. Depression or Mood Changes
Mood changes can also occur with vitamin C deficiency, particularly when the deficiency is severe.
A 2020 review found that vitamin C deficiency, with or without scurvy, was linked to depression and cognitive problems. However, differing testing methods made comparisons difficult, and more research is needed to determine whether vitamin C replacement improves these symptoms.
However, depression and other mood changes have many possible causes. Vitamin C deficiency should not be assumed based on mood symptoms alone. Other signs, dietary intake, and overall health should also be considered..
11. Loose Teeth or Tooth Loss
In advanced scurvy, impaired collagen formation can weaken the tissues and small blood vessels in the gums and surrounding periodontal tissues.
This can lead to swollen and bleeding gums, as well as loose teeth and, in severe cases, tooth loss.
These oral changes are associated with significant vitamin C deficiency rather than being typical early symptoms.
12. Bone Problems in Children
Severe vitamin C deficiency can affect bone formation and growth, especially in children. Vitamin C is needed to make collagen, which helps build healthy bones. Severe deficiency can cause bone pain, difficulty walking, and swollen joints, especially in children.
A rare case shows how severe this deficiency can become. A 9-year-old girl with a severely restricted diet developed scurvy, with bone pain, bleeding gums, bruising, skin changes, and purpura. She also developed severe high blood pressure, which resolved after vitamin C treatment.
These bone problems are mainly associated with severe vitamin C deficiency or scurvy, rather than mild or short-term inadequate intake.
What Causes Vitamin C Deficiency?
The most straightforward cause is not getting enough vitamin C from food for an extended period.
Since fruits and vegetables are the main dietary sources, a diet with very little variety can make deficiency more likely.
Other factors can increase the risk, including:
- Smoking
- Exposure to secondhand smoke
- Very restricted diets
- Certain conditions that interfere with nutrient absorption
- Some chronic diseases
- Hemodialysis
- Certain types of cancer
People who smoke require an additional 35 mg of vitamin C per day compared with nonsmokers because smoking increases oxidative stress and vitamin C requirements.
Best Foods to Prevent Vitamin C Deficiency
Most adults need 75–90 mg of vitamin C per day, depending on sex. You can usually meet this need by regularly eating a variety of fruits and vegetables.
Some of the best options include:
- Guava
- Red bell peppers
- Kiwi
- Oranges
- Strawberries
- Broccoli
- Brussels sprouts
- Tomatoes
- Cantaloupe
- Potatoes
Adding a vitamin C-rich food to meals throughout the day can make it easier to consistently meet your needs.
For example, you could add bell peppers to eggs, strawberries to oatmeal, tomatoes to lentils, or kiwi to yogurt.
Can You Have Low Vitamin C Without Scurvy?
Yes.
Vitamin C deficiency can range from inadequate intake with few or no obvious symptoms to severe deficiency and scurvy. Early symptoms may include fatigue, feeling unwell, and inflamed gums. As deficiency becomes more severe, symptoms can progress to easy bruising, tiny red or purple spots, joint pain, and poor wound healing.
Scurvy occurs with severe vitamin C deficiency, when collagen production and connective tissue function become impaired. It can cause swollen or bleeding gums, bruising, poor wound healing, and, in children, bone problems.
The Bottom Line
Vitamin C deficiency can develop gradually, and severe deficiency can eventually lead to scurvy.
Eating a varied diet with fruits and vegetables usually provides enough vitamin C to prevent deficiency.
If you have unexplained bruising, bleeding gums, poor wound healing, or significant weakness, don’t assume vitamin C deficiency is the cause. Talk with a healthcare professional for proper evaluation.