Pellagra

Classification according to ICD-10
E52	Niazin deficiency Pellagra
ICD-10 online (WHO version 2019)

Pellagra is a disease caused by a deficiency in nicotinic acid , a vitamin from the B complex . Pellagra ( nicotinic acid avitaminosis ) has historically occurred frequently when the diet consisted mainly of corn or sorghum . The bound form of nicotinic acid (niacytin) present in it cannot be used by the body. This disease was widespread in poor regions of southern Europe and America before knowledge of the connections . In the countries of origin of the corn, it was processed alkaline for consumption ( nixtamalization ), which made nicotinic acid available.

history

Corn was after the discovery of America by Christopher Columbus brought one of the first plants to Europe, where they rapidly spread due to high crop yields. Soon a strange disease developed in areas with high corn consumption, which was called 'rough skin' after the main symptom pellagra . The term first appeared in scientific literature in 1771 in a paper by the Milanese doctor Francesco Frapolli. However, it had already been popularly used in the northern Italian lowlands , where the disease spreads.

"The little medical knowledge and the first suspicion that pellagra is caused by hypothetical toxins in corn, by contagion or by genetic predisposition, led to large pellagra epidemics in Europe and the United States for years."

The connection between pellagra and high corn consumption was suspected as early as the 18th century . Explanations at the time were moldy or poisoned corn, contagion or heredity.

It was not until the beginning of the 20th century that Joseph Goldberger and colleagues proved that both the so-called pellagra in humans and the black tongue disease in dogs are caused by malnutrition, more precisely ( Conrad Elvehjem only proved this in 1937) by a lack of nicotinic acid. Nowadays, pellagra usually only occurs in poor areas of Africa or in cases of extreme malnutrition or malnutrition , for example anorexia . The discovery that pellagra can be treated with brewer's yeast led to a sudden decrease in the number of mental hospital inmates in the affected areas. In analogy to this, doctors Abram Hoffer and Humphry Osmond used high doses of nicotinic acid to treat schizophrenia in so-called mega-vitamin therapy . They assumed that if treatment with nicotinic acid resolved the symptoms of schizophrenia that occurred as part of pellagra, it might also influence schizophrenia from other causes. Their considerations led to orthomolecular psychiatry , a form of orthomolecular medicine , which, however, is not part of modern evidence-based medicine due to the lack of evidence of effectiveness .

root cause

In general: one-sided, low-nicotinic acid diet. Special: Mainly diet with alkaline untreated or unroasted maize, or mainly diet with sorghum, since it only contains one form of nicotinic acid that cannot be used by the human organism (without chemical changes or molecular splitting) , niacytin , which is unchanged from human Body cannot be absorbed.

Every patient who suffers from pellagra-like symptoms and in whom the diet-related niacin deficiency typical of this disease cannot be understood should be examined for the presence of the genetic defect for Hartnup disease .

consequences

Nicotinic acid is necessary for numerous oxidation and reduction processes (hydrogen transfers) in the body. The consequences of a deficiency are diseases such as pellagra, which manifest themselves in itching, reddening of the skin, inflammation of the mucous membranes of the digestive tract, painful thickening of the skin as well as brown discoloration and damage to the central nervous system.

Symptoms and course of the disease

Features include:

• diarrhea
• Dermatitis (skin disease)
• Dementia ( organic psychosyndrome ).

“ Under body aches, fatigue, headache and fever, there are mainly intestinal disorders, nervous symptoms such as tremor, paralysis, cramps and psychological disorders, as well as symptoms on the part of the skin; in severe cases, the clinical picture can lead to death in weeks, but usually the course extends over years ”. Skin changes typically form in areas exposed to sunlight (hands, forearms, face, neck). The mental illnesses are associated with the tryptophan deficiency .

treatment

Treatment usually includes direct administration of nicotinic acid or nicotinamide (also known as PP factor, pellagra preventing factor ). Therapy should also include B vitamins, zinc, magnesium and a high-calorie diet.

Foods rich in nicotinic acid can be used preventively: eggs, bran, peanuts, meat (poultry, fish, red meat), legumes and various seeds. Alcohol should be avoided.

literature

Books

• MC Latham: A historical perspective. In: A. Berg, NS Scrimshaw, DA Call (Ed.): Nutrition, National Development and Planning. The MIT Press, Cambridge, Massachusetts 1973, ISBN 0-262-02092-0 , pp. 313-328.
• Benjamin Reilly: Disaster and Human History: Case Studies in Nature, Society and Catastrophe. McFarland, 2009. ISBN 978-0-7864-3655-2 . P. 315ff.
• Arlene Spark, Lauren M. Dinour, Janel Obenchain: Nutrition in Public Health: Principles, Policies, and Practice. CRC Press, 2015. ISBN 978-1-4665-8995-7 . P. 41 ff.
• Ludwig Weissbecker: Nicotinic acid avitaminosis (Pellagra). In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition ibid. 1961, pp. 1092-1095.

Magazines

• JS Hampl, WS Hampl: Pellagra and the origin of a myth: evidence from European literature and folklore. In: Journal of the Royal Society of Medicine. US National Library of Medicine, November 1, 1997.

Web links

• A mysterious patient Twelve times unsatisfactory

Individual evidence

1. ^ Renato Mariani-Costantini, Aldo Mariani-Costantini: An outline of the history of pellagra in Italy . In: Istituto Italiano di Antropologia (Ed.): Journal of Anthropological Sciences Vol. 85 (2007) p. 166
2. ↑ See on this: A. Berg, N. S. Scrimshaw, D. A. Call (Ed.): Nutrition, National Developmant and Planning.
3. ↑ vitalstoff-lexikon.de Niacin (vitamin B3) definition, synthesis, absorption, transport and distribution.
4. ↑ Quotation from: Medicine book, skin diseases .
5. ↑ Maurice Edward Shils, Moshe Shike: Modern Nutrition in Health and Disease. Lippincott Williams & Wilkins, 2006. ISBN 978-0-7817-4133-0 . P. 1371
6. ↑ ^{a b} Pitche: Pellagra. In: Sante 15 (3), July-September 2005. pp. 205 ff.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !