1. Pellagra Jamaica Phan Bio 200 March 6, 2012

2. What is it? -Pellagra is a systemic disease caused by vitamin B3 (niacin) deficiency. -Tryptophan can be converted to niacin. -There are two types: 1. Primary Pellagra: Caused by the deficiency of niacin rich foods. 2. Secondary Pellagra: This occurs when there is a sufficient amount of niacin being taken in but something prevents the body from absorbing and processing the vitamin. Such as: -liver cirrhosis -alcoholism -prolonged diarrhea -Pellagra is a vitamin deficiency (dietary and not genetic).

3. Functions and Needs of Niacin -Niacin is a member of the B-complex vitamins. -Water soluble (niacin is lost with diarrhea because of this). -Functions as either nicotinic acid or nicotinamide. -Extremely important for energy production. -Important for processing fats in the body. -Niacin is often used by the synthetic pathways in the cell. -Adult RDA of Niacin: -14 to 16 milligrams per day -Upper level of Niacin: -35 milligrams per day of the nicotinic acid form

4. Symptoms of Pellagra -The symptoms can vary in intensity from person to person. -Symptoms may occur alone or in combination. -Known as the disease of the four “d’s” dermatitis, dementia, diarrhea, and death. -CNS symptoms: -psychosis, depression, paranoia, impaired consciousness. -Mucous membrane symptoms: -Mostly affects the mouth but can affect the vagina and urethra. Glossitis and stomatitis. -GI symptoms: -During early deficiency may include burning sensation of the pharynx and esophagus, and abdominal discomfort. Later symptoms include nausea and vomiting. -Skin Symptoms: -Includes skin rashes, lesions, and thickened skin

5. Population Distribution “Pellagra is the only dietary deficiency disease ever to reach epidemic proportions in the United States” (Contemporary Nutrition pg. 313). People at risk for Pellagra today: -Rare in Western Societies -In the U.S., alcoholics are at risk. -Populations who use corn as a main source of energy. -Developing Countries -Common in India, Africa, and China -Does not show age or gender preferences History in the United States: -Existed in Europe for about two centuries before having any recognition in the U.S. -First reported in 1902 -Occurred in huge epidemic proportions in the South. -Pellagra was at it’s peak in 1912. -There was an estimation of 25,000 cases of Pellagra since 1907 with a 40% mortality rate.

6. Treatments of Pellagra -First step is prevention by eating foods rich with niacin (and tryptophan). -Foods rich in niacin are poultry, beef, tuna, breakfast cereals, asparagus, coffee, yeast and other. -Foods rich in tryptophan are milk, eggs and other. -Returning niacin and tryptophan (if needed) back to normal levels. -Niacinamide given orally: 300 to 500 milligrams each day (with consultation with medical professional). -Through injection:100 to 250 milligrams two to three time daily (with consultation with medical professional). -High protein diet supplemented with B-group vitamins are needed for complete recovery. -Skin lesions may be treated with topical emollients. -Caution: High amounts of Niacin is toxic to the body and can cause serious consequences.

7. Three Day Breakfast Plan mg

8. Three Day Lunch Plan

9. Three Day Dinner Plan

10. Question Time 1. What are the two types of Pellagra? -Primary and Secondary 2. What are the four “D’s” of the Pellagra symptoms? -diarrhea, dermatitis, dementia, and death 3. What is the adult RDA of Niacin? -14 to 16 milligrams per day.

11. Resources Food Composition Table. Boston: McGraw-Hill Higher Education, 2009. Print. Johnson, Larry E. "Niacin: Vitamin Deficiency, Dependency, and Toxicity: Merck Manual Professional." The Merck Manuals. Merck Sharp & Dhome Corporation, Apr. 2007. Web. 28 Feb. 2012.. "Pellagra." - Modern Medical Guide. Web. 28 Feb. 2012.. "Pellagra." - Symptoms, Causes, Treatments. Health Grades Inc., 2 May 2011. Web. 28 Feb. 2012.. Wardlaw, Gordon M., and Anne M. Smith. "Vitamins." Contemporary Nutrition. New York: McGraw-Hill, 2009. 312-315-476. Print.