Pellagra Abstract: Pellagra is a nutrient-deficiency disease of major public health importance caused by inadequate intake or absorption the B vitamin niacin (nicotinic acid) or the amino acid tryptophan, which the body uses to synthesize niacin... Pellagra is often referred to as the disease of 4 D's: dermatitis, diarrhea, dementia, and death. Though the disease has been present since prehistory it was first medically identified in Spain in 1735. A horrible skin disease, it was called mal de la rosa and often mistaken for leprosy. Until the pioneering work of Dr. Joseph Goldberger during the early 20th century popular medical opinion held that pellagra was an infectious disease. Goldberger's research, though scientifically sound, was met with much criticism prompting him to go so far as to infect himself with the blood and phlegm of victims to prove the disease was not communicable.

In addition to a dietary deficiency, pellagra can also be brought on by chronic alcoholism, drug addiction, and some disease states. This disease is hallmark in people whose diet relies heavily on corn or maize as a staple such as many Native American populations, northern India, and the pre- WWII rural American South. Not only is such a diet very poor in niacin, but corn contains a substance which hinders the absorption of niacin. Fortification of food has all but wiped out pellagra in the U. S and other developed counties, but this affliction still presents a major threat in many third world nations. Eating a well balanced diet containing a variety of food offers the best protection. Good sources of niacin include lean meats, fish, nuts, legumes, and whole-grain cereals.

Early symptoms are fairly mild, including an inflamed tongue, soreness of the mouth, irritability, loss of appetite, and weight loss. Pellagra may be hard to diagnose in its early stages, especially if the patient is generally malnourished. As pellagra advances, however, it produces the classic symptoms - diarrhea, dermatological problems, and dementia / delusions. The diarrhea gets steadily worse as the disease progresses; it may be accompanied by vomiting. Patients also suffer red, dry, scaly skin lesions in areas exposed to sunlight.

The mental problems begin with insomnia and irritability. If the niacin deficiency persists, more severe symptoms appear, including memory loss, hallucinations, violent and irrational behavior similar to schizophrenia, and ultimately death. For more info see these web sites: web web web web web.