Madeleine Hull
Pellagra, a chronic niacin deficiency, is associated with a corn-based diet. Pellagra causes four progressively catastrophic Ds: diarrhea, dermatitis, dementia, and death. It was first described by Gaspar Casal in 1735 in Spain, and its name derives from the Italian pelle agra, meaning rough skin. In the 1800s, pellagra was common among poor Americans whose diets consisted mostly of corn. Native Americans traditionally prepared corn by nixtamalization, treating the grain with an alkali solution, which makes the niacin nutritionally available. However, when corn was cultivated worldwide and eaten as a staple without nixtamalization, pellagra became common. In the early 1900s, pellagra reached epidemic proportions in the American South, affecting over 3 million people and causing over 100,000 deaths. Degerming corn reduces its niacin content, and diets heavy in cornmeal and low in fresh fruits, vegetables, and meat are deficient in tryptophan, an essential amino acid that makes niacin.
| Characteristics | Values |
|---|---|
| Niacin deficiency disease | Pellagra |
| Cause of Pellagra | A corn-based diet low in tryptophan, an essential amino acid that makes niacin |
| Symptoms of Pellagra | Diarrhea, dermatitis, sensitivity to sunlight, enlarged heart, peripheral neuritis, dementia, mental confusion, glossitis, alopecia, vomiting, irritability, inflammation of the mouth and tongue, scaly red rash on the neck and hands |
| Treatment | Niacin supplementation, a diet rich in protein, and food fortification with niacin |
| Prevention | Nixtamalization, a process used by Native Americans, makes niacin nutritionally available |
| Regions affected | Rural South America, Southern United States, Angola, Zimbabwe, Nepal, Italy, Spain, Southern Europe |
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What You'll Learn
Nixtamalization
Pellagra, a chronic niacin deficiency, is associated with a corn-based diet. Pellagra causes four progressively catastrophic "Ds": dermatitis, diarrhoea, dementia, and death. The condition was first described in Spain in 1735 by Gaspar Casal, who noted that the disease causes dermatitis in exposed skin areas such as the hands, feet, and neck. The name pellagra is derived from the Italian words "pelle agra", which mean "rough skin".
Native American cultivators who first domesticated corn prepared it by nixtamalization, a process that treats the grain with an alkali solution, such as lime. Nixtamalization makes niacin nutritionally available and prevents pellagra. The process was first developed in Mesoamerica, where maize was originally cultivated, and is still commonly used in present-day Central and Southern Mexico and Central America.
The process of nixtamalization improves the nutritional quality of maize by making it more digestible and increasing its nutritional value. It also improves the flavour, aroma, and texture of maize products. In addition, nixtamalization removes fumonisins, resulting in tortillas and other maize-based foods being substantially free of mycotoxins.
Without nixtamalization, it would be impossible to make tortillas or any other food made with masa. Cornmeal made from untreated ground maize cannot form a dough when water is added, whereas nixtamalized cornmeal produces a flexible masa that is used to prepare culturally significant foods like tortillas, tamales, and hominy.
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Corn-based diets and tryptophan
Pellagra, a niacin deficiency disease, is often associated with corn-based diets. This is because corn is a poor source of tryptophan, an essential amino acid that can be converted into niacin. Tryptophan is necessary to maintain adequate niacin levels.
Native American cultivators who first domesticated corn prepared it by nixtamalization, treating the grain with an alkali solution such as lime. This process makes the niacin nutritionally available and prevents pellagra. However, when maize was later cultivated and eaten as a staple worldwide without nixtamalization, pellagra became common.
In the 1800s, pellagra was prevalent among poor Americans whose diets consisted mainly of corn, molasses, and salt pork, all of which are poor sources of niacin. Similarly, in the early 1900s, pellagra reached epidemic proportions in the American South, affecting sharecroppers, orphans, mental hospital patients, and those living in coal-mining camps and cotton-mill towns. These populations often had diets high in cornmeal and low in fresh fruits, vegetables, and meat, leading to a deficiency in tryptophan.
The link between corn-based diets and pellagra was further studied by Dr. Joseph Goldberger, a Hungarian-born infectious disease specialist, in 1914. He proposed that pellagra was a dietary disease and conducted an experiment where a group of prisoners ate only corn and corn-based foods. The results supported his theory that a diet high in corn could lead to pellagra.
In addition to dietary factors, other conditions can contribute to niacin deficiency. These include alcoholism, gastrointestinal tract diseases, malignancies, and disorders that affect the absorption of niacin or tryptophan, such as Hartnup disease. It is important to note that niacin deficiency can be prevented with a balanced diet and, if necessary, appropriate supplementation under medical supervision.
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Pellagra
In the 1800s, pellagra was prevalent among poor Americans whose diets consisted largely of corn, and it reached epidemic proportions in the early 1900s in the American South. Between 1906 and 1940, more than 3 million Americans were affected by pellagra, with over 100,000 deaths. The epidemic was attributed to the low availability of corn, the primary dietary source of niacin. Degerming corn, a practice introduced in the 20th century, further reduced its niacin content. Today, pellagra still affects populations with limited access to nutritious food, such as refugees and other displaced people.
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Corn as a staple food
Corn, or maize, has been a staple food for millennia in some parts of the world, particularly in Central and South America. However, in the 1700s, corn became a staple food for many peasants in Europe, especially in areas bordering the Mediterranean. This shift in diet coincided with the emergence of pellagra, a chronic disease with catastrophic symptoms often referred to as the "four Ds": dermatitis, diarrhoea, dementia, and death.
Pellagra is caused by a deficiency of niacin, or vitamin B3, in the body. Niacin is essential for controlling blood sugar, processing fats, maintaining healthy skin, and making new DNA. While corn naturally contains niacin, it is often in a non-bioavailable form, meaning it cannot be absorbed and utilised by the body. This is particularly true for corn that has not been nixtamalized, a process in which the grain is treated with an alkali solution, such as lime, to make the niacin nutritionally available.
Native American cultivators who first domesticated corn prepared it through nixtamalization, preventing pellagra. However, when corn was later cultivated and consumed as a staple food in Europe and other parts of the world without this crucial step, pellagra became common. The lack of nixtamalization, combined with a diet low in animal foods and other sources of niacin, left many corn-dependent populations vulnerable to the disease.
In the early 1900s, pellagra reached epidemic proportions in the American South, affecting over 3 million people and causing more than 100,000 deaths. Poverty, malnutrition, and a monotonous diet high in corn and low in fresh fruits, vegetables, and meat were significant contributing factors. The invention of the Beall degerminator in 1901, which reduced the processing time of corn but further lowered its niacin content, also played a role in the spread of pellagra.
Today, pellagra is rare in the developed world, as most people obtain sufficient niacin from their diets. However, it still affects vulnerable populations, including refugees, displaced people, and those in poverty, who rely on limited sources of niacin and often have restricted access to varied and nutritious food. Fortification of food with niacin and improving access to balanced diets are essential strategies to prevent pellagra in at-risk communities.
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Fortification of food
Pellagra, a chronic niacin deficiency, is associated with corn-based diets. Niacin, also known as vitamin B3, is a micronutrient that aids in controlling blood sugar, processing fats, maintaining healthy skin, and making new DNA. While niacin is naturally present in many foods, including animal products, plant-based sources, and fortified grains, it can be poorly absorbed from corn due to its binding to carbohydrates or small peptides in the small intestine.
Fortification of Staple Cereal Grains:
Refined grain products, such as white bread, pasta, and ready-to-eat breakfast cereals, are commonly fortified with niacin. This practice is particularly prevalent in the United States, where these fortified products contribute significantly to the average American's niacin intake.
Nixtamalization of Corn:
Native American cultivators who first domesticated corn practiced nixtamalization, a process that treats corn with an alkali solution, typically lime. Nixtamalization increases the bioavailability of niacin in corn and has been a traditional method to prevent pellagra in Central America and Mexico.
Fortification of Bread and Flour:
In the early 20th century, pellagra reached epidemic proportions in the American South, affecting millions of people. Federal recommendations to fortify bread and flour with thiamine, niacin, and iron led to the eradication of pellagra in the South by 1945.
Fortification of Specific Food Items:
In addition to cereals and grains, other food items can be fortified with niacin. For example, energy drinks may contain added B vitamins, including niacin. Fortified foods can help ensure adequate niacin intake, especially in populations with limited access to a variety of fresh foods.
Fortification in Vulnerable Populations:
Populations at risk of niacin deficiency, such as refugees and displaced people, can benefit from food fortification. Providing fortified foods in aid packages can help address nutritional deficiencies and reduce the incidence of pellagra in these vulnerable communities.
In summary, food fortification has been a successful strategy in combating niacin deficiency, especially in regions with limited access to diverse diets. Fortification of staple cereal grains, nixtamalization of corn, and targeted fortification of vulnerable populations are some of the key approaches to enhancing niacin intake and preventing pellagra.
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Frequently asked questions
Corn, or maize, is often a staple food for many people, especially in rural areas. However, if it is not prepared correctly, it can be a poor source of niacin and tryptophan. The process of nixtamalization, where the grain is treated with an alkali solution, makes the niacin available for absorption and prevents niacin deficiency.
Niacin deficiency can lead to a condition called pellagra, which causes a range of symptoms, including skin issues, digestive problems, and nervous system disorders. Pellagra can be fatal if left untreated, but it can be reversed with niacin supplementation prescribed by a doctor.
Pellagra was historically common among poor populations with limited access to nutritious food, particularly in the 1800s and early 1900s. It has affected people in various regions, including the southern United States, Europe, South America, and Africa. Today, pellagra is rare in developed countries, but it still affects vulnerable populations, such as refugees and displaced people.
Niacin deficiency can be prevented by ensuring a balanced and varied diet rich in protein and niacin-rich foods. Fortification of foods with niacin has also been effective in preventing pellagra. In cases where dietary intake is insufficient, niacin supplements or multivitamins containing niacin can be recommended under medical supervision.
