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Pellagra and Dietary Deficiency

Pellagra and Dietary Deficiency. History. 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.

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Pellagra and Dietary Deficiency

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  1. Pellagra and Dietary Deficiency

  2. History • 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.

  3. Diagnosis • Clinically, pellagra is identified by the “four D’s.” dermatitis dementia diarrhea death

  4. Signs • 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 parchment-like texture.

  5. Symptoms • 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.

  6. 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.

  7. Nicotinic acid (Nicotinamide) (Niacin) • 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.

  8. Nicotinic acid (Nicotinamide) (Niacin) • 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.

  9. Essential amino acids` • 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)

  10. Interactions of Niacin, Vitamin B6 and Tryptophan • 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

  11. Interactions of Niacin, Vitamin B6 and Tryptophan • 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)

  12. Interactions of Niacin, Vitamin B6 and Tryptophan • 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

  13. Interactions of Niacin, Vitamin B6 and Tryptophan • 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

  14. Interactions of Niacin, Vitamin B6 and Tryptophan • 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

  15. Interactions of Niacin, Vitamin B6 and Tryptophan • 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!

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