References: Pellagra

Table of Contents

RED: Pellagra’s about as bad among the women as silicosis is with the men.

The Basics

Pellagra is a vitamin deficiency disease caused by dietary lack of niacin (vitamin B3) and protein, especially proteins containing the essential amino acid tryptophan. Because tryptophan can be converted into niacin, foods with tryptophan but without niacin, such as milk, prevent pellagra. However, if dietary tryptophan is diverted into protein production, niacin deficiency may still result. Tryptophan is an essential amino acid found in meat, poultry, fish, and eggs. If your diet contains these foods, your need for niacin from other sources will be reduced.

Pellagra can be common in people who obtain most of their food energy from maize. Alkali treatment of corn corrects the niacin deficiency, and was a common practice in native American cultures that grew corn. The disease can be common among people who live in rural South America and Africa. It was also endemic in the poorer states of the U.S. South, like Mississippi and Alabama, as well as among the inmates of jails and orphanages. The symptoms usually appear during spring, increase in the summer due to greater sun exposure, and return the following spring.

Treatment

Untreated, the disease can kill within four or five years. Pellagra can be treated by treatment with niacin (usually as niacinamide). The frequency and amount of niacinamide administered depends on the degree to which the condition has progressed.

History

Pellagra was first described in Spain in 1735 by Gaspar Casal, who published a first clinical description in his posthumous “Natural and Medical History of the Asturian Pricipality” (1762). This led to the disease being known as “Asturian leprosy”, and it is recognized as the first modern pathological description of a syndrome. It was an endemic disease in northern Italy, where it was named “pelle agra” (pelle = skin; agra = rough) by Francesco Frapoli of Milan.

Because pellagra outbreaks occurred in regions where maize was a dominant food crop, the belief for centuries was that the maize either carried a toxic substance or was a carrier of disease.

In the early 1900s, pellagra reached epidemic proportions in the American South. There were 1,306 reported pellagra deaths in South Carolina during the first ten months of 1915; 100,000 Southerners were affected in 1916. At this time, the scientific community held that pellagra was probably caused by a germ or some unknown toxin in corn.

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