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Pellagra is a disease caused by a niacin or tryptophan deficiency, resulting in dementia, dermatitis, diarrhea, and death. It is common among poor people, alcoholics, anorexics, and those with mental illness. Pellagra can be treated with nicotinic acid and dietary modifications.
Pellagra is a disease that appears when people are in the late stages of a niacin or tryptophan deficiency. Doctors famously recognize pellagra by the four Ds: dementia, dermatitis, diarrhea, and death. In addition to these well-known symptoms, pellagra can also cause a number of associated health problems. If the condition is not treated, the patient will die in four to five years.
This extreme nutritional deficiency has been recorded in human populations since at least the 1700s. In many societies, it is most common among poor people with limited access to nutrition, along with chronic alcoholics, anorexics, and people with severe mental illness who may refuse to eat. Some digestive tract disorders can also lead to pellagra, as patients with these conditions may not be able to absorb the nutrients they need. Historically, pellagra has also been found in communities where people rely heavily on corn for nutrition, because corn lacks available niacin unless it is treated with lime in a process known as nixtamalization.
A notable outbreak of pellagra occurred in the American South in the early 20th century, prompting researchers to find out what was causing the rash of medical problems and deaths in the South. These researchers eventually identified the problem as a nutritional deficiency and developed treatments to address pellagra. Concerns about pellagra and other nutrient deficiencies have also led some governments to mandate the supplementation of certain foods with necessary vitamins and minerals to ensure that populations have access to all components of a healthy diet.
Patients with this condition start out with a simple nutritional deficiency. As the deficiency becomes more severe, a light-sensitive rash appears on the skin and the patient may begin to experience digestive discomfort. The next symptoms to emerge are neurological, with patients having problems with balance and eventually developing dementia. If pellagra persists, the patient will eventually die from tryptophan or niacin deficiency.
The treatment for pellagra is nicotinic acid, accompanied by dietary modifications to ensure that the patient is getting the nutrition they need in the future. Many foods provide sources of tryptophan and niacin, including poultry, organ meats, wheat, yeast and peanuts, and people eating a balanced diet can generally avoid developing this nutritional deficiency along with many others. Dietary supplementation can also be used for people who have limited access to fresh foods rich in necessary vitamins and minerals.
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