This article reminded me, as an endocrinologist of the very important role that Vitamin C plays in our health. The collagen matrix of our bones needs good nutrition and vitamin C to be strong, just as our tissues need vitamin C for good function.
Vitamin C deficiency is classically known to cause scurvy. However it can contribute to osteoporosis and bone marrow edema, due to its effects on collagen matrix. We know that 42% of women have secondary reasons for osteoporosis and we screen for these routinely. In general we do not screen for Vitamin C deficiency. The problem is that testing can be misleading and affected by recent intake. This is why most of us believe that is helpful to obtain 24-hour food questionnaires to identify individuals that require further assessment of macro or micronutrients. If the decision to measure Vitamin C is made, the level of vitamin C in leukocytes is more accurate when assessing the sparse vitamin C stores as they are less affected by acute dietary changes. A leukocyte vitamin C level of 0 mg/dL is indicative of latent scurvy. Zero to 7 mg/dL is consistent with deficiency, and greater than 15 mg/dl is adequate.
In this case report a boy who has seizures and is benefiting from a ketogenic diet, unfortunately becomes nutritionally deficient due to a series of events that affect this tube feedings. He presents with classic findings of scurvy : gingivitis (swelling of the gums), bleeding at various sites, gastrointestinal symptoms. In addition, he had bone marrow edema (swelling inside the bone) detected in new fractures in his foot. The key reminder here is about the essential nature of Vitamin C. Many people partake in ketogenic diets or other protocols that avoid fruits that provide Vitamin C. As discussed It’s not cost effective to check vitamin C in everyone, but it is quite simple to include citrus or vitamin C in your diet most days.
https://www.nejm.org/doi/pdf/10.1056/NEJMcpc2211358?articleTools=true