A recent Slate article recalled a patient who baffled doctors in Springfield, Massachusetts, in 2009, until a doctor named Eric Churchill cracked the case:
The middle-aged man had shown up with bleeding gums, unexplained swelling, bruises, and fatigue. His team of internists suspected a skin infection, but every bacterial test came up negative. They were stumped until, Churchill recalls, “someone eventually thought to ask about this person's diet.”
It turned out that the man had subsisted on nothing but white bread and cheese for years, and his low vitamin C levels were consistent with scurvy—“the same scurvy made famous by pirates and British sailors from the 1700s,” according to Slate.
Indeed, those seafaring men often went without fruits and vegetables for long stretches in between ports of call. But, in large numbers, contemporary landlubbers are going without produce, too. Last summer, the CDC reported that 76 percent of Americans eat too little fruit, and 87 percent consume too few vegetables. According to the USDA, 14 percent of U.S. households were food-insecure at some point during 2014, meaning that they struggled to obtain varied, nutritious food for all members of a family.
These dietary problems are translating to a resurgence of a handful of preventable diseases. In the U.K., for instance, about 3 million people are malnourished, and malnutrition-related hospitalizations spiked by more than 50 percent between 2010 and 2015. Between 2014-2015, more than 100,000 patients were hospitalized with gout, another disease that’s associated with poor nutrition habits, the Telegraph reported. Gout—typically related to a buildup of uric acid due to over-consuming alcohol and rich foods—is a problem in the U.S., as well. A study published in the journal Arthritis & Rheumatism found that the prevalence of gout in the U.S. has steadily risen over the past two decades, affecting more than 8 million Americans in 2011.
Rickets are also back on the scene. Associated with knobby-kneed, bow-legged kids, the bone-weakening disease became much less common in America more than a half-century ago, when doctors realized that it could be prevented with vitamin D. But recently, doctors report an uptick.
The vitamin can be obtained through sun exposure—which isn’t recommended for little humans—or nutritionally. Folks who eat solid foods might be ingesting vitamin D through store-bought milk or ready-to-eat cereals, which are routinely fortified with it. In the 1960s—following a survey that found that 50 percent of school kids in British Columbia and Saskatchewan had experienced rickets—Canada made it mandatory for producers to fortify milk with vitamin D, according to the Canadian Public Health Association.
Though breast milk has lots of health benefits, it has much less vitamin D than the store-bought variety. As an article in Pediatrics pointed out, data is scant on the number of rickets cases that present each year. But researchers estimated that vitamin D insufficiency or deficiency affects between 10 and 65 percent of babies, infants, and toddlers in the U.S. Of course, most of those children don’t develop the disease. And though the number of cases isn’t high, noted the Los Angeles Times, it’s “particularly alarming because the condition was considered vanquished.”
And that’s just it: Though the American Association of Pediatrics recommends doling out vitamin D supplements to breastfed infants, some doctors don’t do so—often because the condition isn’t on their radar.
At least part of the problem could be ameliorated through education—both in terms of improving understanding of nutrition, and helping patients identify red-flag symptoms. “Older people and professionals often incorrectly assume that losing weight and having a reduced appetite are just a normal part of aging,” Dianne Jeffrey, chair of the Malnutrition Task Force, explained to The Independent. They don’t realize when their symptoms are out of the ordinary.
But as my colleague Laura Bliss has pointed out, curbing unhealthy eating in places with limited food options is more complicated than simply opening up a store that stocks fresh produce and expecting shoppers to fill up their carts. In one study of a town’s eating behaviors before and after the opening of a grocery store, researchers found that “overall consumption of fruits, vegetables, and whole grains actually declined” when the store opened, although residents consumed fewer overall calories and less added sugar. The market wasn’t a simple fix.
Eating choices are complex, and tangled up in notions of family, community, and tradition, in addition to convenience. They’re part of a lifestyle. And in order to tackle the resurgence of illnesses tied to nutrition, we’ve got to look at the bigger picture.