Anna*, 26, prepares a meal of fish fingers, oven chips, and baked beans.
She’s had variations of this dinner every evening for the last week. Sometimes the fish fingers are replaced with chicken nuggets, the chips are swapped for potato waffles, or the beans are traded for carrots, in an attempt to get some additional vegetables into her diet.
Anna is a picky eater. It’s simpler to list the foods she does eat, rather than the ones she doesn’t. She lives on a diet mostly comprised of fish fingers, breaded cod, chicken nuggets, carrots, peas, baked beans, potatoes, mild cheddar sandwiches on white bread, and chocolate.
‘I’ve always been like this,’ she says. ‘I don’t really go out for meals or have people round for dinner because I’m embarrassed of what I eat.
‘I can’t stomach anything else. I’ve tried so many things but I feel so anxious I throw up.’
This month she decided to go to the doctor and ask about supplements, after reading about a man who lost his sight thanks to a diet of chips, chocolate, and crisps.
We’re all aware of the importance of healthy eating. We know we’re supposed to have at least five portions of fruit and vegetables a day, that eating too much salt and saturated fats is bad for us, and that we need to make sure we’re getting enough protein to look after our bodies.
We know this, but it’s the sort of knowledge that slips to the back of our minds. The fatphobia present in our culture often means that unless your weight indicates excess, your diet doesn’t ring alarm bells, and we’re often told to work on our diets for the purpose of weight loss and improving our appearance rather than to reduce the risk of longterm health issues.
One health issue few of us consider is scurvy.
Scurvy is a severe vitamin C deficiency with a bit of an image problem. Say scurvy and you’ll get reactions related to pirates and sailors.
But scurvy didn’t die out in the 18th Century. It’s alive, kicking, and on the rise. Experts think our beige diets might be to blame.
The numbers are small, but they have been increasing. In 2016 the Health and Social Care Information Centre issued a report that between 2009 and 2014, admissions related to scurvy had increased by 27%, while NHS data shows that hospital admissions for scurvy rose from 82 to 167 between 2010 and 2018.
While NHS data only shows 12 hospital admissions for scurvy for 2018/2019, there have been 5,108 admissions for deficiencies of other nutritional elements.
It’s not that we’re all in terrible danger of developing scurvy. It remains quite a rare illness, as the majority of people manage to get enough vitamin C in their diet.
But the reality is that scurvy is a possibility, and it’s one anyone who’s a picky eater needs to be aware of.
Lisa Borg, a nutritional therapist at Pulse Light Clinic, says we all need to think more critically about our diets.
She tells us: ‘Scurvy, a preventable condition caused by Vitamin C deficiency and associated with seamen who spent long periods without access to fresh foods, is now on the increase in the UK. This is clearly due to poor dietary intake of fresh fruits and vegetables.
‘Picky diets can lead to nutritional deficiency and poor health. The stable rule of thumb is the diet which contains the widest variety of foods has the best potential to provide all the nourishment your body needs.
‘Equally, the diet which contains the least variety of foods has the greatest potential to cause disease.’
Sierra, a 20-year-old university student, was diagnosed with scurvy when she was 15.
She doesn’t consider herself a picky eater, but avoided the majority of vegetables throughout her teens. She went to the doctor after she began to feel incredibly tired, her gums loosened around her teeth, and she began to bruise more easily than normal, and was shocked to be diagnosed with scurvy.
‘I was very surprised,’ Sierra tells Metro.co.uk. ‘Aside from the fact that I’d only heard of people at sea being affected, I’m from the Southern US, where I can’t escape fresh fruit if I tried, so it really threw me for a loop.’
Sierra was prescribed vitamin C supplements for a year, and now has to carefully monitor her levels of nutrients to make sure she doesn’t become ill again.
Not all scurvy cases are due to a poor diet.
Hannah*, 28, a biologist, was diagnosed with scurvy back in 2016, at the same time as she discovered she had coeliac disease.
Like Sierra, she had the typical symptoms of scurvy but never considered it as a possibility.
Symptoms of scurvy:
- Feeling very tired and weak all the time
- Severe joint or leg pain
- Swollen or bleeding gums, or gums that feel loose around the teeth
- Having skin that bruises easily
- Red or blue spots on the skin, usually on legs
‘I had a lot of gut symptoms, I was tired all the time, my gums did bleed a bit but I thought I was just brushing too hard,’ Hannah tells us.
‘I was so sick. I didn’t think things were that bad until they were, you know? It was gradual until it wasn’t. I figured it was the stress of grad school.’
Hannah went to the doctor after losing a lot of weight without explanation. She was told that her intestines had essentially shut down, causing multiple deficiencies – including in vitamin C.
As a result, Hannah’s doctor recommended she get checked for coeliac disease. She was eventually diagnosed with the condition, which explained why her body wasn’t absorbing any nutrients.
‘The doctor was surprised because I was eating a pretty balanced diet,’ says Hannah. ‘He said it was usually grad students with a really poor diet, not undiagnosed coeliac, that got scurvy in grad school. I think he was trying to be reassuring.
‘The scurvy was a wake-up call. The treatment was immediate gluten-free diet and then basically maximising the nutritive value of my diet. I drank a lot of those bottled protein shakes.
‘I recall laughing at it because who the heck gets scurvy these days? I think I made pirate jokes when I told my family.’
The idea that scurvy is just an old-fashioned pirates disease is dangerous because it means people could be ignoring the symptoms and failing to consider the risk of the illness when making food choices.
More education is needed so people know that having a restricted diet or intolerances may require consultation with a doctor to ensure good health.
Sonami is a 35-year-old psychology research assistant who’s currently dealing with the picky eating of her son, who’s two-and-a-half years old.
‘Ryan became a fussy eater about six months ago,’ Sonami tells us. ‘He used to eat everything before but since he has started talking he has become more and more fussy.
‘He refuses to eat a lot of things, for example, sandwiches, tomato-based sauce such as in pasta, and vegetables except for sweetcorn and peas.’
Sonami worries that her son’s diet isn’t varied enough, but has never considered the risk of scurvy.
She provides her son with special vitamins and, thankfully, his diet hasn’t caused any issues as of yet. But like many parents, Sonami isn’t being provided with any additional support or medical advice on how to ensure her child doesn’t become deficient in vitamins when he simply refuses to eat certain foods.
A lack of awareness of the risks of a restricted diet and picky eating means that unhealthy habits can go unchecked for years.
Edward Greening, a 35-year-old English teacher living in St Petersburg, has been a picky eater since he was three.
Despite his restricted diet, when asked if he has ever worried about scurvy Edward responds: ‘No, because I’m not a 16th Century sailor.’
Luckily for Edward, his food preferences allow him to eat vegetables, and he’s been told that his daily glass of orange juice will keep him perfectly healthy.
‘I eat potatoes, bread, cereal, peas, avocado, lettuce, carrots, cod, apples, white grapes, chocolate, biscuits, cake, red Leicester cheese and lobster,’ says Edward.
‘My reluctance to eat different foods definitely feels like a psychological problem. There are some foods, like curry, that I couldn’t imagine eating for a million pounds.
‘Slowly but surely I’ve added a few more items to [the list of foods I eat]. Some came about through dares from friends, others from me thinking I needed more vegetables in my diet.
‘So long as I can take time to prepare and rewire my brain to accept what I’m about to do, I am willing to try something new – I’m a great believer in cognitive behavioural therapy.’
Edward used to take vitamin supplements but stopped because he didn’t feel any different. He no longer worries about how his eating habits might affect his health.
‘I take the view that I’ve lived this long without any issues, so it’s probably fine,’ he says.
The good news about scurvy is that – in theory – it’s relatively easy to both treat and prevent – you just need to get enough vitamin C in your diet, either through varied food choices or taking supplements.
It’s important for all of us – picky eaters and beige food fans in particular – to be aware of the very real risks our repetitive diets can pose and to take the possibility of vitamin deficiencies seriously.
Dr Clare Morrison, GP and Medical advisor at Medexpress, says: ‘There is a tendency for fussy eaters to stick to a “beige diet”, containing nothing but bread, chips, cakes, chicken nuggets, and cereal, for example.
‘This diet, lacking in colourful fresh plant-based ingredients such as fruit, veg and salad, will fail to provide enough essential micronutrients.
‘Taken to extremes, such a diet could lead to scurvy, which is caused by a deficiency of vitamin C. It causes spontaneous bleeding, fatigue, anaemia and aching limbs. We need around 40mg of vitamin C everyday. It can’t be stored by the body, so needs to be eaten regularly.
‘Fortunately, scurvy is quite rare, but it can be seen in those with extremely poor or restrictive diets. I did once diagnose it in a butcher, who ate nothing but meat.’
Clare says that scurvy is just one issue to be on the lookout for. Beige diets pose a whole load of other risks to our longterm health.
She tells us: ‘A failure to eat sufficient, fresh, plant-based foods, not only puts one at risk of scurvy. There may also be a deficiency of other micronutrients, and fibre, leading to poor health, impaired immunity, constipation, and even cancer.
‘Beige diets also tend to be too high in refined carbohydrates, increasing the risk of obesity, diabetes, fatty liver, and arterial disease.’
Lisa Borg doesn’t suggest those with food phobias force themselves to eat foods that cause them anxiety, but that if someone knows they’re missing out on one source of nutrition, they must fill those gaps.
‘If you don’t like broccoli and exclude it, while you are missing out on a potent source of nutrition, so long as you include a variety of other green vegetables you’ll be fine,’ she explains. ‘There are approximately 150 different species of fruits and vegetables and tomatoes alone have some 4,000 varieties.’
Her advice is simple – expand your diet as much as you can and add some colour to your plate.
How to get more vitamin C in your diet:
A healthy diet should include fresh fruit and vegetables to ensure you’re getting all the vitamins and minerals you need.
Adults need 40mg of vitamin C a day. This nutrient can’t be stored in the body so we need it in our daily diet or as a daily supplement.
Some foods that contain high levels of vitamin C are citrus fruits, strawberries, pineapple, sprouts, broccoli, potatoes, cauliflower, chilli peppers, artichokes, bell peppers, kale, Brussels sprouts, bok choi, watercress, cabbage, peas, swiss chard, parsley, tomatoes, turnips, berries, kiwi, and pineapple.
That’s quite the list, so it’s likely you’ll find at least one thing on there that you enjoy.
If not, talk to your GP about supplements.
For those who are picky eaters, ensuring a healthy, varied diet is rarely as simple as just eating more carrots.
The picky eaters we spoke to all report intense anxiety trying foods that aren’t on their ‘safe’ lists, alongside embarrassment about the way they eat.
That embarrassment could prevent picky eaters and those with food phobias from getting the help they need.
Alongside greater public understanding of the very real risk of scurvy and other dietary deficiencies, we also need to remove the shame around the emotional components of eating, so that anyone concerned about their nutrition feels comfortable asking for medical advice.
Those who exist on beige diets are rarely doing so out of active choice. Just as obesity isn’t down to a ‘lack of willpower’, being unable to consume all the nutrients you need cannot be dismissed as laziness or childish preferences.
Access – particularly in terms of finances and knowledge of preparing healthy food – is a major factor, along with the serious anxiety and mental distress than can go alongside a refusal to eat certain foods.
Greater understanding without judgement is essential in ensuring that everyone has a diet that keeps them in good health.
We shouldn’t be dealing with scurvy in 2019.
*Names have been changed.
Do you struggle with food phobias or picky eating? Get in touch at [email protected].
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