Vitamin C deficiency? The unknown causes and the solution
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Leesduur: 5 min
Did you know that a vitamin C deficiency can not only make you tired and depressed, but can even damage your teeth? Scurvy, the disease that once plagued sailors, is an extreme example. Thanks to limes, they were once called "limeys" and saved from this dangerous deficiency.
Many people think vitamin C deficiencies are a thing of the past. Yet, in the Netherlands, smokers and the elderly are still particularly at risk. Smoking doubles your need for this well-known immune-boosting vitamin.
Curious how to recognize a deficiency and what you can do to quickly replenish your vitamin C? Read on.
A vitamin C deficiency can lead to fatigue, depression, gum problems and lower resistance; in severe cases even to scurvy.
Risk groups are mainly smokers, the elderly and people with a one-sided diet, stress or illnesses that affect absorption or needs.
Deficiencies can be prevented by eating fruit and vegetables daily, limiting smoking and alcohol, and possibly taking a supplement.
Symptoms of a vitamin C deficiency
A vitamin C deficiency develops slowly. Initially, you might notice some vague symptoms, but over time, the signs become clearer.
Recognizable symptoms include:
- Fatigue and listlessness
- Sadness or irritability
- Reduced resistance
- Swollen or bleeding gums
- Slower wound healing
- Dry skin or rough patches
- Painful joints (due to reduced collagen production)
In severe cases, scurvy can develop, causing loose teeth and bleeding. Fortunately, this is almost non-existent in the Netherlands, but mild deficiencies are. (1) (2)
Main causes of vitamin C deficiency
A vitamin C deficiency can have several causes:
- Not enough fruits and vegetables – Do you eat too few vitamin C-rich fruits and vegetables, such as bell peppers, citrus fruits, kiwi, or berries? Then you're at risk of a deficiency. Vitamin C is also partially lost during cooking or storing, so keep this in mind. (3)
- Older age – Older people often eat a less varied diet and absorb nutrients less well. (3)
- Smoking - Cigarette smoke contains harmful substances that deplete your vitamin C faster. (4)
- Alcohol - Drinking a lot causes you to absorb less vitamin C and lose it more quickly through your urine.
- Illness and stress – Diabetes, cancer, infections or long-term inflammation require additional vitamin C and can quickly deplete reserves. (5)
- Digestive problems – With intestinal diseases such as celiac disease or Crohn's disease, a vitamin C deficiency can occur because the intestines are less able to absorb nutrients and the body uses more due to inflammation.
- One-sided eating or crash diets – This is especially common among young people or those following strict diets. A well-known example is the keto diet.
Keto and Vitamin C: What's the Connection?
If you're following a keto diet, you'll often get less vitamin C because fruits and many vegetables are limited.
In ketosis, your body also switches to fat burning and produces ketones. This can cause additional oxidative stress, making antioxidants like vitamin C especially important.
In short : Your vitamin C needs are likely higher on a keto diet, even though you're eating less of it. (6)(7)
Step-by-step plan in case of a shortage
Think you have a vitamin C deficiency? Here's what you can do:
- Take a supplement - A dose of 150–300 mg per day is often enough to quickly replenish your supplies.
- Eat more vitamin C-rich foods - Eat at least 250 grams of vegetables and two servings of fruit daily. Red bell peppers, broccoli, and kiwi are good sources.
- Adjust your lifestyle - Stop smoking, drink less alcohol and incorporate moments of relaxation to reduce your vitamin C consumption.
How much vitamin C do you need?
The following guidelines apply in the Netherlands:
- Adults : 75-90 mg per day, which is about the size of an orange and a bell pepper. (8)
- Smokers: 110 mg per day, because smoking destroys your vitamin C. That's an extra kiwi. (4)
- Pregnant women : 85-100 mg per day, and 100-155 mg if breastfeeding, for you and your baby.
- Seniors or Keto Diet : There's no higher standard, but seniors and keto eaters should eat extra vitamin C-rich fruits and vegetables to avoid deficiency.
Good to know : It's best not to take more than 1000 mg of vitamin C per day (as a supplement), as it can cause diarrhea or stomach upset. With fruits and vegetables, you're always safe. You almost never get too much from food. (9)
My personal advice
I make sure I get enough vitamin C every day. My favorite? A morning smoothie with lots of vitamin C-rich fruit. I like to nibble on some bell peppers as a snack, and during the winter months I also take a vitamin C supplement from rosehip extract.
Do you recognize these symptoms? Then now's the time to increase your fruit and vegetable intake. And remember: supplements are helpful, but nutrition remains the foundation.
My favorite vitamin C boost smoothie
Want to make sure you're getting enough vitamin C from your diet? Then try this smoothie. I drink it almost daily:
- 2 kiwis - 120 mg vitamin C
- ½ mango - 30 mg vitamin C
- Juice of 1 orange - 50 mg vitamin C
- 100 ml coconut water or plain water
- A small piece of fresh ginger
Blend everything and you're done! Fresh, fruity, and together good for about 200 mg of vitamin C (almost three times the daily requirement).
Tip : Vary the types of fruit with seasonal fruit, so it remains surprising every time and you get even more variety.
Ebrina van der Bijl
Ebrina is a nutritionist with a deep commitment to healthy eating and a sustainable lifestyle, based in beautiful Portugal. Her passion for natural and organic products is at the heart of her work. With a background in Nutrition & Dietetics and experience in product development and writing, she translates complex scientific information into practical advice for a balanced lifestyle.
Sources used
- Health Council of the Netherlands (2018). Dietary reference intake: vitamin C. The Hague: Health Council of the Netherlands.
- Maxfield, L., Daley, SF, & Crane, J. S. (2023, November 12). Vitamin C deficiency. StatPearls - NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK493187/
- Carr, A.C., & Rowe, S. (2020). Factors affecting vitamin C status and prevalence of deficiency: A global health perspective. Nutrients, 12(7), 1963. https://doi.org/10.3390/nu12071963
- Golder, J.E., Bauer, J.D., Barker, L.A., Lemoh, CN, Gibson, S.J., & Davidson, Z.E. (2024). Prevalence, risk factors, and clinical outcomes of vitamin C deficiency in adult hospitalized patients in high-income countries: A scoping review. Nutrition Reviews, 82(11), 1605–1621. https://doi.org/10.1093/nutrit/nuad157
- Hamid, M., Mansoor, S., Amber, S., & Zahid, S. (2022). A quantitative meta-analysis of vitamin C in the pathophysiology of Alzheimer's disease. Frontiers in Aging Neuroscience, 14, 970263. https://doi.org/10.3389/fnagi.2022.970263
- Crosby, L., Davis, B., Joshi, S., Jardine, M., Paul, J., Neola, M., & Barnard, N. D. (2021). Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. Frontiers in Nutrition, 8. https://doi.org/10.3389/fnut.2021.702802
- Churuangsuk, C., Griffiths, D., Lean, M.E.J., & Combet, E. (2020). Impacts of carbohydrate-restricted diets on micronutrient intakes and status: A systematic review. Obesity Reviews, 21(8), e13039. https://doi.org/10.1111/obr.13039
- Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of randomized controlled trials. British Journal of Nutrition, 110(7), 1178–1187. https://doi.org/10.1017/S0007114513000548
- EFSA Panel on Dietetic Products, Nutrition and Allergies. (2009). Scientific opinion on dietary reference values for vitamin C. EFSA Journal, 7(9), 1226. https://doi.org/10.2903/j.efsa.2009.1226
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