Vitamin C, A, D and Nicotinic Acid Deficiencies

Vitamin C

The discovery that the lack of certain essential substances in the body-either because they were not in the diet or failed to be absorbed and utilized-would cause serious disturbances of growth and health, was one of the most startling in all the history of medicine. Now these substances are called "vitamins"-a word coined by Casimir Funk around 1910.

Scurvy-a disease known for centuries-is now definitely established as resulting from a lack of vitamin C, also called ascorbic acid. The chief sources of vitamin C are the citrus fruits, the leafy green vegetables, Iris potatoes, and tomatoes.Milk contains a little vitamin C but even this little is lessened by pasteurization, or boiling, or any form of treatment that results in oxygenation.

Physicians see few cases of scurvy nowadays. Such cases as are reported affect chiefly people who live alone on greatly restricted diets, or people addicted to strange eating habits which interfere with normal nutrition. Sometimes the condition is seen in babies fed artificially, when mothers or nurses have failed to make certain that proper amounts of vitamin C-containing substances are included in the diet.

Among the chief symptoms of scurvy are bleeding from the gums and black and blue spots over the body, showing easy bleeding. Wounds of the skin heal slowly in those with vitamin C deficiency.

Scurvy can be controlled by taking plenty of vitamin C, which is now available in several medicinal forms. The material need not be injected into the blood but can be taken by mouth, after which the condition usually clears up promptly. Much better is the prevention of scurvy by the daily taking of some citrus fruit juice, tomato juice, or by eating leafy green vegetables, which add other important factors to the diet.

Nicotinic Acid Deficiency - Pellagra

The chief symptoms of pellagra, which is associated with a deficiency of niacin or nicotinic acid, include a red inflammation of the skin, a burning red tongue and mouth, diarrhea, and, in late stages, some mental disturbance. Many people in backward areas of the United States live on diets consisting largely of com meal, fat meat and molasses. The meat is usually salt pork or side meat. The chief deficiency in such diets is the lack of animal protein such as milk, cheese, lean meat, and eggs, and the failure of the diet in leafy green vegetables. Apparently exposure to sunlight of a person who is deficient in niacin brings out the symptoms.

Almost 7000 people died of pellagra in the United States in 1928. By 1946 the educational campaign on proper nutrition had been so effective that only 804 deaths were reported.

While few cases of the complete development of pellagra are seen nowadays, there may be many instances of beginning symptoms or what doctors call a "subacute condition." First come such symptoms as fatigue and loss of appetite. Then, following exposure to the sun, the burning and stinging of the skin appears and next the soreness of the mouth and tongue. With these symptoms the patient is nervous, irritable, and finds difficulty in sleeping.

Since the condition is a deficiency disease, the treatment is primarily the taking of adequate amounts of niacin, which is now available in several forms. If the condition is severe the doctor will inject the niacin rather than give it by mouth. The diet can be provided with the important niacin-containing foods. The doctor will look after the patient's skin condition and make sure that he gets proper nursing cafe during the severe symptoms of the disease. Some physicians give large doses of liver extract. With proper treatment patients improve rapidly.

Vitamin A Deficiency

The most prominent manifestations of a deficiency of vitamin A include difficulty in adapting to the dark, followed by night-blindness and a serious inflammation of the eyes that may end with loss of sight. Other important changes affect the skin. The deficiency may be due to an insufficient intake of vitamin A or carotene, from which it is formed in the body, or in failure of the body to absorb and utilize these materials. We know now that inflammations of the liver may interfere with the body's use of vitamin A. Mineral oil taken in large amounts prevents the absorption of vitamin A. The condition affects infants more often than adults, since infants require the vitamin both for growth and maintenance of certain structures. The liver can store enough vitamin A to carry the body along for six to ten months.

The changes in the skin associated with a deficiency of vitamin A include a generalized dryness and the growth of horny plugs called "hyperkeratoses" over the extensor surfaces of the limbs, the back, and the buttocks. Another manifestation is the appearance of grayish-white spots on the white portion of the surface of the eye.

When a shortage of vitamin A is noted, the condition should be corrected immediately by including in the diet such foods as butter, vitamin-enriched margarine and cod liver oil, which provide plenty of vitamin A. If symptoms have occurred, extra vitamin may be given as a capsule containing up to 25,000 units daily, which is about five times the usual required daily intake.

Cases are known in which people have taken tremendous quantities of this vitamin, even up to 250,000 units of vitamin A per day. Large excesses may cause serious changes in the liver, the spleen, the blood and the hair and nails.

Vitamin D Deficiency

Rickets, due to a deficiency of vitamin D, is far less frequent nowadays than formerly. Vitamin D may be taken into the body as such in foods or cod liver or halibut liver oil, or it may be formed by action of sunlight on the skin. The ultraviolet rays of the sun are important in this respect. In our industrialized cities most children get little direct sunlight. Dark skinned people get less ultraviolet than blond, thin-skinned Heavy clothing and window glass also prevent the passage of ultraviolet rays.

Children with rickets have beading of the ribs. They are irritable, restless, fretful, and pale. Most significant, however, are the failures of growth of bones and teeth. The head begins to appear overlarge, with prominent frontal bones; little soft areas may be felt in the bones of the skull. There appear enlargements in the region of the wrist and ankles and the legs get distorted into bowlegs, knock-knees, and there are pelvic deformities. The X-ray quickly reveals the extent of the deformities.

Rickets can be prevented by exposure to ultraviolet rays from the sun or an artificial source, but the giving of 400 to 800 units of vitamin D per day is much more certain. Nowadays milk containing vitamin D in adequate amounts is generally available in the United States. When a real deficiency is present vitamin D may be given in one of many different forms including fish liver oils, viosterol, tablets or other preparations.

Excessive vitamin D intake results in a condition called hypervitaminosis D, with many distressing symptoms. Excess calcium may be deposited in various tissues of the body. Stopping the vitamin D promptly gets rid of the annoying symptoms.