Vitamin C Deficiency (Scurvy): Nosebleeds and Capillary Fragility

The whole truth about vitamin C and nosebleeds fits in one sentence: vitamin C cures the nosebleeds it causes, and not the ones it didn't. When the body runs out of vitamin C, the collagen reinforcing your smallest blood vessels stops being built properly, and the thin, dry, constantly-bumped lining of the nasal septum is one of the first places that failure shows. So yes — real scurvy genuinely produces recurrent nosebleeds, and replacing the vitamin genuinely stops them, often within days. But scurvy is an uncommon cause of nosebleeds, and virtually every nosebleed has a different explanation: dry air, nose-picking, steroid nasal sprays, allergies, a deviated septum, blood thinners, or a hereditary vessel disorder — and no amount of vitamin C will touch those. This page shows you how to tell the difference.

Table of Contents

1. What a Vitamin C Nosebleed Looks Like
2. The Mechanism: No Vitamin C, No Collagen
3. Why the Nose Is So Vulnerable
4. Clues That Point to Deficiency Rather Than Dry Air
5. Who Actually Gets This Today
6. Getting Diagnosed
7. How Fast It Reverses
8. What Vitamin C Will Not Do
9. When to Seek Care / Red Flags
10. Key Research Papers
11. Connections
12. Featured Videos

What a Vitamin C Nosebleed Looks Like

A nosebleed from vitamin C deficiency is not dramatic — it is persistent. People describe a nose that has quietly become unreliable: it starts bleeding while they blow it gently, or after a sneeze, or on a morning when nothing happened at all. A slow ooze from the front of the nose that stops with pressure, then comes back three days later.

• It repeats over weeks, because the underlying fragility never resolves between episodes.
• It happens on trivial provocation — a gentle blow, a rub, a hot shower. The threshold for bleeding has dropped, which is the whole point.
• Over time it involves both nostrils. One vessel breaks at a time, so any single episode is one-sided; but the weakness is body-wide, so over weeks the bleeds alternate. A nose that bleeds from the same side every time for months is a local problem instead (see red flags).

And in scurvy the nosebleed almost never travels alone — the most useful thing on this page. Vitamin C deficiency is not a nose disease; it is a body-wide collapse of collagen production, and the nose is simply an early casualty. By the time it bleeds, so does the rest:

• Gums swollen, spongy and dark purplish-red, bleeding on brushing or spontaneously (Bleeding Gums and Tooth Loss).
• Perifollicular haemorrhage with corkscrew hairs — pinpoint red-purple dots on the thighs and shins, each centred on a follicle whose hair has coiled tight. Close to a signature finding, visible with nothing but good light.
• Bruises from nothing, and wounds that will not close — even old healed scars can split open, because a scar is collagen that needs constant re-making (Bruising and Poor Wound Healing).
• Aching legs and joints with exhaustion, often the earliest symptom of all (Fatigue and Joint Pain).

So: a lone nosebleed in an otherwise well person eating a normal diet is essentially never scurvy. It is dry air, a fingernail, or a nasal spray. If your gums are firm and pink, your legs unmarked and your energy normal, vitamin C is not your answer — the Epistaxis page will serve you better than a supplement. Scurvy earns consideration only when nosebleeds arrive in a cluster, on a diet that has genuinely had no plants in it for months.

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The Mechanism: No Vitamin C, No Collagen

Collagen is the body's rope. It gives tensile strength to skin, tendon, gum tissue, scar tissue and — critically here — blood-vessel walls and the membrane beneath them. Its strength is its shape: three protein chains wound into a tight triple helix. A single strand is floppy; the braid carries the load. But the braid will not hold unless the chains are modified first. Before three procollagen chains can zip together, specific proline and lysine residues must have an oxygen atom bolted on — hydroxylation. The resulting hydroxyprolines form the hydrogen-bond lattice that locks the helix at body temperature; the hydroxylysines anchor the cross-links welding one collagen molecule to the next.

Two enzymes do that bolting, and both run on iron. Prolyl 4-hydroxylase and lysyl hydroxylase each carry one iron atom at the active site, which must be in the reduced ferrous form, Fe(II). Every so often a catalytic cycle misfires, the enzyme burns its co-substrate without hydroxylating anything, and the iron is left oxidised to Fe(III). The enzyme is then dead, and stays dead until something hands the iron an electron.

That something is ascorbate. Vitamin C's structural job in one line: it resets the iron in the collagen-building enzymes so they keep working (Pinnell 1985; Vasta 2016). It is not a building block of collagen — it is the maintenance crew. Which is why a shortage is so quietly catastrophic: production does not halt on day one, it stalls one enzyme at a time, and the collagen still being made is under-hydroxylated — chains that cannot form a stable helix, unravel at body temperature, and are largely degraded inside the cell before they are ever secreted.

Now apply that to a blood vessel. A capillary is a tube one cell thick with no muscle to hold it together. What holds it together is the collagen-dependent basement membrane beneath it and the perivascular collagen around it, both continuously rebuilt. Starve the body of vitamin C, that mesh thins, and the vessel tears under pressures it used to shrug off. Under the skin, escaping blood makes a bruise or a perifollicular dot. Under a mucous membrane open to the outside world, it does not stay hidden. That is a nosebleed.

An analogy. Your capillaries are hoses buried in packed soil, and the soil — the collagen matrix — is what stops a hose splitting under pressure. Vitamin C is neither hose nor soil; it is the crew that re-packs the soil, every day, forever. Send them home and nothing happens on day one, but the soil erodes, and eventually a hose that was fine for forty years splits where the soil was thinnest and most weather-exposed. In the body, that spot is the front of the nasal septum. The clock is short, too: humans cannot make vitamin C, and the body pool is only about 1,500 mg, so zero intake empties it in one to three months — exactly when bleeding signs appear.

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Why the Nose Is So Vulnerable

If every capillary is weakened equally, why is the nose one of the places that shows it soonest? Because the front of the nasal septum is the worst-designed tissue you own — a paper-thin skin over a bone-dry crossroads of arteries, sitting exactly where fingers and weather can reach it.

Four arteries converge on one square centimetre. Just inside each nostril, on the septum, sits a dense arterial network called Kiesselbach's plexus, in the region clinicians call Little's area. Branches of four arteries meet there: the anterior ethmoidal (from the internal carotid system, via the ophthalmic artery), and the sphenopalatine, greater palatine and superior labial (from the external carotid). The posterior ethmoidal artery runs higher and further back, which is part of why bleeds from there behave so differently. Two separate arterial supplies shake hands in that one patch — and roughly 90–95% of all nosebleeds, scurvy or not, start there. That is why first aid says to pinch the soft part of the nose: you are compressing Little's area directly.

The lining over it is a fraction of a millimetre thick, lying directly on cartilage with almost no soft-tissue cushion. Elsewhere a torn vessel bleeds into surrounding fat, which tamponades it — trapped blood presses the tear closed. On the septum there is nowhere for blood to go but out. It is also the driest tissue in the airway: the nose warms and humidifies inhaled air, so the front of the septum meets the coldest, driest air of the whole respiratory tract twenty thousand times a day, and heating, air conditioning and altitude dry it further. Dry mucosa crusts, crusts crack, cracks expose vessels — which is why ordinary nosebleeds spike in winter. And it is the most-touched mucosa in the body: picking, forceful blowing, sneezing, and a nasal steroid spray fired straight at the septum, the commonest avoidable cause — aim it away from the septum, toward the outer wall of the nostril.

So Little's area runs with almost no mechanical safety margin even in a healthy person. Remove the collagen reinforcement and it is the first thing to give, which is why nosebleeds sit beside bleeding gums in the classical descriptions of scurvy.

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Clues That Point to Deficiency Rather Than Dry Air

Most nosebleeds have a boring explanation, and boring explanations are usually right. You are not looking for one matching row below — you are asking which column your whole situation lives in.

The one question that actually finds scurvy. This diagnosis gets missed because nobody asks about food. “Do you eat a healthy diet?” does not work — everyone says yes. The question that works is blunter: “When did you last eat a fruit or a vegetable?” Ask it exactly that way, then wait. In real scurvy the answer is not a number of days. It is a pause, then “I don't really eat those,” or “months, I think.” In someone with recurrent nosebleeds and bleeding gums, that answer is worth more than any single blood test — and a habit of eating fruit or vegetables most weeks makes scurvy very unlikely, though one orange yesterday does not rule it out, because a few days of eating better can refill the blood level long before it refills the tissues. Ask a parent the same question about a child, since severe selective eating is the commonest route to modern paediatric scurvy and parents rarely volunteer it.

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Who Actually Gets This Today

Scurvy is not a historical curiosity, and treating it as one is exactly why it gets missed. It is diagnosed in modern hospitals in wealthy countries every year, usually after weeks of the wrong workup. A 2009 BMJ paper is titled simply “Unrecognised scurvy” (Choh 2009). A 2017 retrospective review from a large American children's hospital, “Modern American scurvy,” identified 32 children with low serum ascorbate, most of whom had been imaged repeatedly before anyone thought to check the level — and every one of them had an underlying medical condition rather than simply a poor diet, most commonly iron overload from repeated transfusions for sickle cell disease or thalassaemia (Golriz 2017). These are not reports from 1902. Alongside those medical risk groups, the people who get it today are not people without access to food — they are people whose food has narrowed:

• Restrictive eating and ARFID — severe selective eating, especially in autistic children and adults, where a diet narrows over years to a handful of beige, plant-free items. One of the commonest routes to scurvy in children in high-income countries, and often dismissed because the child “eats plenty.”
• Alcohol use disorder — the classic adult setting: alcohol displaces food, and the calories arrive with no micronutrients attached.
• Smoking — oxidative stress raises turnover, which is why the US recommendation is 35 mg/day higher for smokers. It will not cause scurvy alone, but it removes the margin.
• Dialysis — every session strips out this small, water-soluble vitamin, and these patients are often also told to restrict fruit and vegetables for potassium.
• Isolated older adults — the “tea and toast” pattern: living alone, not cooking, chewing difficulty making produce unappealing. Bleeding gums get blamed on age or dentures.
• Severe mental illness — depression, schizophrenia and dementia all collapse food variety, and the deficiency is written off as part of the psychiatric picture.
• Food insecurity — fresh produce is the first thing cut from a shrinking budget: expensive per calorie, and it spoils.
• After bariatric surgery — reduced intake, altered absorption, and intolerances that quietly eliminate whole food categories. B12 and iron get monitored; vitamin C usually does not.
• Inflammatory bowel disease — Crohn's and colitis reduce absorption, and many patients avoid fruit, vegetables and fibre because those foods trigger symptoms. A 2022 case report describes exactly this, corrected with high-dose repletion (Murphree 2022).
• Iron overload — in haemochromatosis and transfusion-dependent anaemias, excess free iron accelerates the destruction of ascorbate, so stores run low despite reasonable intake. Supplementing here can mobilise free iron and worsen oxidative injury, so it needs specialist input. See Iron.

Notice the common thread: none of these people look like sailors. They look like an autistic eight-year-old who eats crackers and chicken nuggets, a seventy-nine-year-old widower who has not cooked since his wife died, a dialysis patient doing exactly what he was told about potassium. If that is you or someone you care for, and the nose has started bleeding, say this diagnosis out loud — the treatment costs almost nothing and works fast.

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Getting Diagnosed

Scurvy is fundamentally a clinical diagnosis: the story plus the signs. A diet with no plants in it, plus bleeding gums, perifollicular haemorrhage with corkscrew hairs, nosebleeds and bruising, is scurvy until proven otherwise. Blood tests support it; they rarely make it.

The catch matters. Plasma ascorbate reflects what you ate recently far more than what your tissues hold. Eat one orange on the morning of the draw and the number climbs into the normal range while the body pool is still empty — and someone about to see a doctor about frightening symptoms is exactly the person who has just started eating better. Leukocyte ascorbate, the vitamin C inside white blood cells, tracks tissue stores far better, but few hospital laboratories offer it, so do not delay treatment waiting for it. The sample is fragile too: ascorbate oxidises in the tube, so a specimen not protected from light, kept cold and separated quickly reads falsely low.

Which is why a trial of repletion is often the real diagnostic test. Vitamin C is cheap and safe at these doses, and scurvy responds fast — bleeding signs typically begin settling within days, a speed close to diagnostic in itself. If someone with a plant-free diet, spongy gums and recurring nosebleeds is dramatically better after ten days, you have your answer whatever the number said. Where possible: draw the level first, start treatment immediately, and you end up with both.

What it gets mistaken for

• Vasculitis — the commonest and most consequential error. Perifollicular haemorrhage looks convincingly like palpable purpura, and the misdiagnosis can persist through several consultations: a 59-year-old man with perifollicular petechiae, a leg haematoma and sacral osteopenia was repeatedly diagnosed with leukocytoclastic vasculitis until a diet history revealed months of virtually no vitamin C intake, after which he improved rapidly on replacement (Francescone 2005). The stake is that vasculitis is treated with immunosuppression, so the wrong label carries real risk where the right one costs a few pence.
• A bleeding disorder — but in pure scurvy the platelet count, PT and aPTT are all normal, and that normal panel in someone visibly bleeding from several sites is itself the clue pointing back at the vessel wall.
• Arthritis or a bone tumour in children — leg pain and reluctance to walk come from bleeding under the periosteum, and the imaging is genuinely alarming: metaphyseal bands at the knee, periosteal reaction, and marrow and soft-tissue oedema on MRI, a picture readily read as infection, malignancy or juvenile arthritis. In one children's-hospital series, affected children were imaged extensively for diffuse musculoskeletal pain before an ascorbate level was checked, which the authors argue should come before further invasive tests (Golriz 2017). Child abuse is also considered when the bruising is unexplained — one more reason the diet history is not optional.

Supporting bloods are worth doing: a complete blood count and a Comprehensive Metabolic Panel, since anaemia frequently accompanies scurvy and vitamin C strongly enhances absorption of non-haem iron, so iron-deficiency anaemia often rides along (see Iron Absorption and Anaemia). In anyone whose diet has been that poor for that long, vitamin C will not be the only thing missing — thiamine, folate, B12, vitamin D and zinc deserve a look.

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How Fast It Reverses

This is the good part, and it is genuinely good. Scurvy is one of the most satisfying diagnoses in medicine to treat — the deficiency is total, the treatment is a cheap vitamin, and the response is fast enough that people notice it themselves.

• 24–48 hours: mood, energy and the deep leg ache start lifting, before any physical sign has changed.
• Days to two weeks: the bleeding stops — nosebleeds stop recurring, gum bleeding settles, no new bruises appear. The fastest visible change, because it only requires the body to resume making competent collagen.
• Two to six weeks: bruises and purpura fade, gums firm up and regain normal colour, stalled wounds begin to close.
• One to three months: full remodelling — corkscrew hairs replaced as follicles cycle, joint and bone pain resolved, and teeth that had loosened but not been lost frequently tighten again.

Note what is not on that list: an active nosebleed stopping because you took a tablet. Repletion prevents the next bleed; it does nothing for the one happening now, which still needs pressure — see red flags, and Natural Nosebleed Relief for technique.

Doses

• Repletion: typically 300–1,000 mg/day for one to two weeks in adults (children by weight, commonly 100–300 mg/day), until symptoms resolve. Regimens vary because the illness resolves so readily nobody has needed to optimise them. Refill the tank, then keep it full with food.
• Ongoing requirement: the US RDA is 90 mg/day for men, 75 mg/day for women, plus 35 mg/day extra for smokers — figures set by the Institute of Medicine's 2000 Dietary Reference Intakes, not guesswork: they rest on controlled human depletion–repletion studies in which volunteers lived in hospital for months on a measured vitamin C intake. Worth knowing that the investigators who ran those studies argued for more than the committee adopted — Levine's team concluded the adult RDA should be 200 mg/day (Levine 1996), and that the women's figure should be 90 mg/day rather than 75 (Levine 2001).
• Absorption plateaus near 200 mg/day — a single 200 mg dose is completely absorbed, while at 500 mg and above bioavailability falls and the surplus is excreted. Full plasma and cell saturation takes considerably more (around 400 mg/day in women, 1,000 mg/day in men), which is why dosing past a few hundred milligrams buys very little (Levine 1996; Levine 2001).
• Preventing scurvy takes almost nothing — about 10 mg/day, less than a mouthful of most fruit. Which is why the disease requires a diet near-totally devoid of plants for months, not merely a poor one.
• Kidney disease and dialysis are the one place these doses are not casual. Ascorbate is metabolised to oxalate, and failing kidneys cannot clear it — gram-level dosing in advanced chronic kidney disease and on dialysis has caused oxalate deposition in the kidney and other tissues. If you have CKD, are on dialysis, or have had calcium-oxalate stones, do not self-treat at repletion doses: supplementation in this group is usually held near 100 mg/day and the decision belongs to your nephrology team.

Whole foods, and why they win

Citrus is not the best source — it is the source with the best public-relations history. Red bell pepper beats an orange comfortably, guava demolishes it, a handful of blackcurrants matches it. And vitamin C is fragile: water-soluble and heat-labile, so long boiling destroys much of it, while raw, lightly steamed or quickly stir-fried preserves the most.

One caution if you take warfarin. Kale, parsley, broccoli and Brussels sprouts are also four of the richest sources of vitamin K, and warfarin works by blocking vitamin K — so a sudden large jump in leafy greens can pull your INR down and leave you under-anticoagulated. The answer is steady, not zero: keep your green intake roughly constant, tell your anticoagulant clinic before you change your diet, and ask for an INR check a week or two afterwards. If you would rather not move the greens at all, the fruit sources in the table above — guava, blackcurrants, red bell pepper, strawberries, papaya, orange, kiwifruit — carry very little vitamin K. This does not apply to apixaban, rivaroxaban or dabigatran, which are unaffected by dietary vitamin K, and it is never a reason to stop an anticoagulant on your own.

This is also why food wins over a bottle. A vitamin C tablet fixes vitamin C. It does not fix the folate, potassium, magnesium, fibre, carotenoids and polyphenols missing from the same empty diet, and it does nothing about the reason the diet became empty. You cannot out-supplement a diet with no plants in it. Supplements are the right tool for the two-week repletion phase and the wrong tool as a permanent substitute for eating. Full lists live on Vitamin C Food Sources; the mechanism above is covered in depth on Collagen Synthesis.

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What Vitamin C Will Not Do

This section exists because the internet is full of the opposite claim, and because being wrong here costs people real time while a treatable cause goes untreated. Vitamin C cures the nosebleeds it causes, and not the ones it didn't.

• It will not stop a nosebleed that is happening now. Nothing in the literature supports that, and the mechanism forbids it — rebuilding collagen takes days at minimum. What stops an active front-of-nose bleed is pressure: sit upright and lean forward — never tip your head back, which only sends blood down the throat, where it irritates the stomach and hides how much you have actually lost — then pinch the soft cartilage just below the bony bridge firmly between thumb and finger, breathe through your mouth, and hold without peeking for 10 to 15 minutes by the clock. Do not pack tissue, cotton wool or gauze into the nostril; it prevents proper pressure on the vessel and tears the clot out when you remove it. Most failed first aid fails because people let go early or pinch the bony bridge instead of the soft tip.
• It is not in the nosebleed guideline. The 2020 American Academy of Otolaryngology–Head and Neck Surgery clinical practice guideline on nosebleed (Tunkel 2020) is the definitive modern document on managing epistaxis, and vitamin C appears in it neither as treatment nor as prevention. Nor does it feature in current major reviews (Seikaly 2021). No modern trial has ever shown benefit in ordinary nosebleed, because none has been done.
• The supportive reports are seventy years old, and they are weak. The “capillary fragility” era of roughly 1946–1959 is the only period in which anyone reported giving ascorbic acid for nosebleeds, and even then it was never given alone: the single epistaxis report is a 1959 open series of hesperidin plus ascorbic acid in menopausal patients with leg cramps, easy bruisability and nosebleeds (Horoschak 1959). A companion 1956 epistaxis report from the same era used a citrus flavonoid compound combined with vitamin K, with no ascorbic acid arm at all (Scal 1956) — it is part of the bioflavonoid story, not evidence about vitamin C. Read both as history — they predate randomisation, blinding and modern statistics, and were open series in which a physician gave a compound and reported improvement. Nosebleeds improve on their own, seasonally and spontaneously, which is precisely what such a design cannot distinguish from a drug effect. None of it would be publishable as evidence of efficacy today, and none has been replicated since.
• If your vitamin C intake is normal, your nosebleed has a different cause — go find it. The realistic list: dry air, digital trauma, a nasal steroid or antihistamine spray aimed at the septum, rhinitis, a deviated septum, anticoagulants and antiplatelet drugs, alcohol, cocaine use, and — with lifelong nosebleeds plus small red spots on the lips, tongue or fingertips and often a family history — hereditary haemorrhagic telangiectasia, which needs specialist management. See Epistaxis and Natural Nosebleed Relief.
• Megadoses have downsides and no upside here. Past a single 200 mg dose absorption tails off — at 500 mg and above much of the extra is simply excreted — so gram doses mostly make expensive urine. They also cause diarrhoea, bloating and stomach upset, and — because ascorbate is metabolised to oxalate — raise calcium-oxalate kidney stone risk in susceptible people, particularly men with a stone history. The adult upper intake level is 2,000 mg/day.

Holding both halves honestly is the whole point. The deficiency is real, the mechanism is real, and the cure is real — for the people who actually have the deficiency. For everyone else, vitamin C is a nutrient they already have enough of, and the nosebleed is a nose problem.

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When to Seek Care / Red Flags

Most nosebleeds are handled at the kitchen sink. These are the ones that are not. Seek care the same day — or call emergency services — for any of the following:

• Bleeding beyond 20–30 minutes despite correct, continuous pressure. Correct means leaning forward, pinching the soft part of the nose, and not releasing to check. After two failed 10–15 minute attempts it needs cautery or packing, not more waiting.
• A posterior bleed — blood running down the back of the throat rather than out of the nostril, or both nostrils at once with nothing visible in front. These come from larger vessels deeper in the nose, do not respond to pinching, and can be dangerous.
• Bleeding after facial trauma — it can accompany a fracture, and clear fluid mixed with the blood needs urgent assessment.
• You take an anticoagulant or antiplatelet drug — warfarin, apixaban, rivaroxaban, dabigatran, clopidogrel or daily aspirin. Bleeding is harder to stop and blood loss adds up faster. Do not stop the medication yourself; get advice.
• Lightheadedness, faintness, palpitations, breathlessness, or looking pale and clammy — signs of meaningful blood loss, which people underestimate, since blood swallowed during a bleed is invisible until it is vomited.
• Recurrent bleeding from the same nostril in an adult with no other explanation. Repeated one-sided epistaxis is a mass until proven otherwise and needs an endoscopic look inside the nose. Most such masses are benign, but this is the presentation that must not be dismissed — and the best reason not to spend six months treating yourself with vitamin C.
• A child bleeding from more than one site — nose plus gums, or nose plus unexplained bruising or a petechial rash. Same-day paediatric assessment, to exclude a bleeding disorder or leukaemia alongside scurvy.
• Lifelong nosebleeds with small red spots on the lips, tongue, face or fingertips, especially with a family history — the picture of hereditary haemorrhagic telangiectasia.
• Nosebleeds together with bleeding gums, unexplained bruising, or blood in urine or stool — bleeding at several sites at once always deserves evaluation.

The counterweight, since most readers are in none of those categories: an occasional winter nosebleed that settles with one proper round of pressure — leaning forward, pinching the soft part of the nose for the full 10 to 15 minutes without letting go — in someone who feels well and eats normally, is not a sign of anything. Run a humidifier, stop picking, aim the nasal spray at the outer wall of the nostril, and it will almost always settle.

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Key Research Papers

1. Tunkel DE, Anne S, Payne SC, et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngology–Head and Neck Surgery. 2020;162(1_suppl):S1-S38. — The definitive modern guideline. Vitamin C appears nowhere in it.
2. Seikaly H. Epistaxis. New England Journal of Medicine. 2021;384(10):944-951.
3. Choh CT, Rai S, Abdelhamid M, Lester W, Vohra RK. Unrecognised scurvy. BMJ. 2009;339:b3580.
4. Golriz F, Donnelly LF, Devaraj S, Krishnamurthy R. Modern American scurvy — experience with vitamin C deficiency at a large children's hospital. Pediatric Radiology. 2017;47(2):214-220.
5. Francescone MA, Levitt J. Scurvy masquerading as leukocytoclastic vasculitis: a case report and review of the literature. Cutis. 2005;76(4):261-266.
6. Murphree J, Mulherin DW, Morton C, Adams D. High-dose vitamin C therapy for symptomatic deficiency in a patient with myasthenia gravis and Crohn's disease. Nutrition in Clinical Practice. 2022;37(5):1242-1245.
7. Pinnell SR. Regulation of collagen biosynthesis by ascorbic acid: a review. Yale Journal of Biology and Medicine. 1985;58(6):553-559.
8. Vasta JD, Raines RT. Human Collagen Prolyl 4-Hydroxylase Is Activated by Ligands for Its Iron Center. Biochemistry. 2016;55(23):3224-3233.
9. Levine M, Conry-Cantilena C, Wang Y, et al. Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance. Proceedings of the National Academy of Sciences. 1996;93(8):3704-3709.
10. Levine M, Wang Y, Padayatty SJ, Morrow J. A new recommended dietary allowance of vitamin C for healthy young women. Proceedings of the National Academy of Sciences. 2001;98(17):9842-9846.
11. Scal JC. Epistaxis; treatment with a new citrus flavinoid compound combined with vitamin K. Eye, Ear, Nose & Throat Monthly. 1956;35(11):719-721. — HISTORICAL. Uncontrolled and unblinded; cited as the record of what was tried, not as evidence that it works.
12. Horoschak A. Nocturnal leg cramps, easy bruisability and epistaxis in menopausal patients: treated with hesperidin and ascorbic acid. Delaware State Medical Journal. 1959;31(1):19-22. — HISTORICAL. The high-water mark of the “capillary fragility” era; open series, no control group, no randomisation.

PubMed Topic Searches

• PubMed — Scurvy, epistaxis and deficiency bleeding
• PubMed — Ascorbate, prolyl hydroxylase and the collagen helix
• PubMed — Capillary fragility, ascorbic acid and bioflavonoids
• PubMed — Epistaxis management guidelines
• PubMed — Adult scurvy misdiagnosed as vasculitis
• PubMed — Measuring vitamin C status: plasma vs leukocyte

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Connections

• Vitamin C Deficiency (Scurvy) Hub — the full symptom family
• Bleeding Gums and Tooth Loss — the same collagen failure, in the mouth
• Bruising and Poor Wound Healing — fragile capillaries under the skin
• Fatigue and Joint Pain — usually the earliest symptom
• Weakened Immunity — why infections travel with deficiency
• Vitamin C — the full overview
• Epistaxis (Nosebleed) — the causes of almost every other nosebleed
• Natural Nosebleed Relief — pressure technique and humidity
• Collagen Synthesis — the mechanism, in full depth
• Iron Absorption and Anaemia — why anaemia rides along with scurvy
• Vitamin C Food Sources — food lists and cooking losses
• Iron — and why iron overload destroys ascorbate
• Vitamin K — the vitamin that does act on clotting
• Vitamin C, Collagen & Why Sailors Fell Apart — interactive animation

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