The Forgotten Epidemic:
How Pellagra Shaped Modern Nutrition
Disclaimer: The information shared here is for general awareness and education only. If you’re experiencing ongoing symptoms, it’s always best to check in with a qualified health professional.
Diarrhoea, dermatitis, dementia, and death.
The disease of the four Ds – also known as pellagra.
The name comes from two Italian words: pelle (skin) and agra (rough). It was first used by Italian physician Francesco Frapolli in 1771.
The disease itself had been described earlier, in 1735, by Spanish physician Don Gaspar Casal, who called it mal de la rosa (sickness of the rose). Casal correctly linked it to poor diets dominated by maize, which was a significant step, though he lacked the scientific framework to identify the precise deficiency.
That breakthrough came much later through Joseph Goldberger’s research.
Between 1900 and 1950, pellagra caused around 7,000 deaths a year for several decades across 15 southern states in the USA. (according to PubMed Central – https://pmc.ncbi.nlm.nih.gov/articles/PMC2589605/)
By 1912 South Carolina alone had reported 30,000 cases, with a fatality rate of 40%.
(according to PubMed Central – https://pmc.ncbi.nlm.nih.gov/articles/PMC2586852/)
In total, over 3 million cases occurred in the USA during this period, leading to between 100,000 and 250,000 deaths, mostly in the south, where the population was about 35 million.
Death was the most tragic outcome.
But dementia was not much better.
Many sufferers ended up in psychiatric hospitals (then called asylums).
Pellagra filled those institutions during the height of the epidemic.
It’s important to note that pellagra persisted between 1900 and 1950, not just between 1900 and 1915 or 1900 and 1937.
Why does this matter?
Because Joseph Goldberger identified the cause of pellagra as a dietary deficiency as early as June 1914.
His findings were ridiculed and resisted – both politically and professionally.
It took another 23 years, and the suffering of millions more people, before niacin (vitamin B3) deficiency was finally confirmed as the cause. In 1937, Conrad Arnold Elvehjem and his colleagues showed that supplementing with nicotinic acid reversed the condition.
(according to PubMed Central – https://pmc.ncbi.nlm.nih.gov/articles/PMC2586852/)
Niacin and Tryptophan
Niacin can be obtained from food, but the body can also synthesise it – provided it has enough of the essential amino acid tryptophan. Tryptophan is found in milk, cheese, fish, meat, and eggs.
Here’s the irony: maize actually contains niacin, but in a form that the human body cannot absorb – even when cooked.
Ancient Wisdom Ignored
When Europeans took maize from Native Americans, they ignored the knowledge that made it safe and nutritious. That neglect eventually caught up with them.
Native Americans used a process called nixtamalisation, cooking maize in a limewater (alkaline) solution. This made nutrients – particularly niacin – bioavailable. They also developed the ingenious Three Sisters agriculture: planting maize, beans, and squash together in a mutually supportive system.
Nixtamalisation
- The process: treating maize with limewater or another alkaline solution.
- Nutrient availability: breaks down the maize’s outer shell, improves digestibility, and releases niacin.
- Health benefits: prevents pellagra – the very disease that plagued early European settlers who skipped this step.
Three Sisters Agriculture
- Companion planting: maize, beans, and squash grown together.
- Mutual support:
- Maize provides stalks for beans to climb.
- Beans fix nitrogen in the soil, enriching it.
- Squash spreads wide, shading the ground to retain moisture and suppress weeds.
- Maize provides stalks for beans to climb.
- Efficiency: a sustainable, small-scale system for hand-cultivated gardens.
The Modern Parallel
It’s no secret that modern diets are often lacking in key nutrients. Even people with health-conscious, varied diets may still experience low energy or imbalances.
Food contains many nutrients, but the way we prepare it – and the time or knowledge required – makes a huge difference. Today, both know-how and time are often missing.
Those who supplement smartly can fill these gaps, improve their energy, and maintain good health more consistently.
Still curious? Here’s more
Why Your Muscles Might Be Starving Even on Keto
There are a few common problems that can sneak in and stop your body from doing what it needs to.
Amino Acids Are Useless!
Discover why amino acids seem useless without applying 2 key factors. Learn about protein utilisation rates and how to maximise their benefits.