Transcript Pellagra and Dietary Deficiency






First recognized in 1735, pellagra was the scourge
of Europe and then the United States for two
centuries.
Still seen occasionally in scattered populations of
southern Africa, Egypt and India.
After American corn was introduced to Europe,
food calories yielded per acre increased greatly
over that yielded by rye and wheat.
Cornmeal became the main energy source for poor
people.
Where corn went, pellagra followed.

Clinically, pellagra is identified by the “four
D’s.”
dermatitis
dementia
diarrhea
death




Pellagrins are hypersensitive to sunlight.
Sun-exposed areas at first become red and
thick with hyperkeratosis and scaling.
Followed by inflammation and edema, which
eventually leads to de-pigmented, shiny skin
alternating with rough, brown, scaly areas.
With repeated episodes of erythema, the skin
becomes paper-thin and assumes a parchmentlike texture.



Because niacin is not available for metabolic
processes, neurons in the brain degenerate with
development of dementia.
Clinical symptoms: insomnia, anxiety,
unjustified aggression and depression, are of
the manic-depressive type.
Pellagrins can have unpredictable behavior.


Often referred to as “the springtime disease,”
pellagra increased in the spring when the new
crops were not yet ready and cornmeal was
large part of the diet.
Main protein in corn lacks two essential amino
acids.



A heat resistant preparation from liver was first
used to treat pellagra.
It was found that the active ingredient is
nicotinic acid (first named niacin) which can
be synthesized by oxidizing nicotine from
tobacco plants.
In 1935, it was found that nicotinic acid occurs
throughout animal life associated with an
enzyme.



Derived from amino acid tryptophan.
Sources include yeast, meats, liver, fish,
whole-grain products, peas, beans, nuts.
Functions: Essential component of NAD and
NADP, coenzymes in oxidation-reduction
reactions. In lipid metabolism, inhibits
production of cholesterol and assists in
triglyceride breakdown.

Of the 20 amino acids in the human body, ten
are essential amino acids:

Isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan, valine (not
synthesized at all) and arginine, histidine
(inadequate amounts – especially for young)






Niacin (Vitamin B3) and Vitamin B6 are part of
B-family vitamins
They have multiple forms (different function!!!)
Tryptophan is the amino acid which gets
converted into 5-HTP (a neurotransmitter) and
Serotonin
Serotonin is then converted into Melatonin
Serotonin is a neurotransmitter that affects
mood and appetite
Melatonin facilitates sleep





B6 is converted to a co-enzyme used in a WIDE
variety of biochemical reactions
B6 is found in vegetable and greens
Niacin (B3) is found naturally in the husks of
seeds such as brown rice
Niacin is also synthesized by the body from
tryptophan using B6
It takes about 60 mg Tryptophan to make 1 mg
Niacin (daily requirement: 14-16 mg per day)



Niacin (and some of its forms) are converted to
NAD and NADP which are necessary for
catabolism of fats, carbohydrates, proteins and
alcohols
Niacin in available in a wide variety of foods
It has been added to bread flour since the
1930’s to prevent pellagra


The body uses Tryptophan for many reactions
About 7% of tryptophan one consumes is
available to be converted to Serotonin and
Niacin



Tryptophan + Vitamin B6 → Niacin
Tryptophan → 5-HTP → Serotonin
Serotonin is converted to Melatonin





Your body prioritizes what it needs
You need Niacin more urgently than Serotonin
If you are not getting enough Niacin, you will
often end up being deficient in Serotonin and
Melatonin because the body will switch to
making Niacin
Enriched foods may or may not have the
proper form of Niacin
Niacinamide is cheaper and more stable and it
will prevent pellagra




Niacinamide (as opposed to Nicotinic acid)
does not trigger the switch in pathways back to
making Serotonin once Niacin needs are met
If the deficiency is being met with Niacinamide
enriched foods, your body will continue to use
up available tryptophan for Niacin synthesis as
if you still have a niacin deficiency
This could leave you with a lower amount of
Serotonin and a decrease in available B6.
A balanced diet DOES make a difference!