FOOD, FACTS and FADS

Exploring the sense and nonsense of food and health

Pellagra: A Story from Medical History

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Have you ever wondered why they add B vitamins (niacin, riboflavin, and thiamine) to flour, refined bread and pastas? We can recall the story of pellagra to answer this question.

In the early 1900’s, mental hospitals in the Southeastern U.S. treated many patients with dementia caused by a disease named pellagra. At that time, it was thought that an infectious agent or toxin caused the disease. Symptoms of a deficiency included skin rash, weakness, and mouth sores. When not treated, pellagra can lead to the 4 D’s: dementia, dermatitis, depression and death.

The disease was first noticed in Europe around 1720 and coincidentally during that time, corn or maize was beginning to be imported from the Americas to Europe where it was grown in many areas. Some physicians from Spain noticed that the disease may be associated with corn-based diets; others stuck to to the toxin theory and spent many years searching for its origin with no success.

It was not until 1907 that a major epidemic occurred in the Southeast U.S. that prompted the government to begin a series of pellagra studies. By 1928, the epidemic peaked with the number of cases reaching 7,000 deaths. One of the investigators was Dr. Joseph Goldberger who believed that diet played a role.

To show that the disease was not caused by a toxin, Goldberger and 15 others including his wife, voluntarily drank or injected themselves with blood, urine, feces and skin cells from pellagra patients and no illness occurred. They later put these materials in capsules.

It was observed that the disease struck people who ate diets  mainly of corn meal, salt pork, lard and molasses. When given meat, eggs and milk, the disease abated. Goldberger did just that in an experiment with volunteer prisoners. When most of the prisoners suffered from pellagra on the deficient diet, Goldberger concluded that the diet was the culprit and could be cured by what he called a “P-P factor.” More than 30 years later, an American biochemist, Conrad Elvehjem finally proved that the P-P factor was nicotinic acid, commonly known as the B vitamin,  Bniacin.

Not until 1936, did the Council on Foods and Nutrition of the American Medical Association recommended the fortification of food. This led to the voluntary enrichment of flour with thiamin, riboflavin, niacin and iron. This resulted in a decrease in deaths from pellagra of over 3,000 in 1938 to only about 1500 in 1943. Then mandatory enrichment in most states further decreased the death rate to nearly zero by1954.

How quickly we forget how severe a nutritional deficiency disease can become. Other deficiency diseases from B vitamins alone in the early days of refining flour included beriberi from a thiamine deficit and ariboflavinosis from a lack of riboflavin.  Refinement  stripped these nutrients  found in whole grains  resulting in a poor diet.

To this day, we still have severe problems in developing countries of death and blindness from a deficiency of vitamin A. It is estimated that 250,000 to 500,000 children go blind annually.   To alleviate the problem, food fortification and supplementation has been relatively successful in curbing the deficiency. For example, fortification of sugar in Guatemala maintains vitamin A status and in Africa and South-East Asia, growing fruits and  vegetables in home gardens complements dietary fortification. The story of pellagra was a lesson learned.

 

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