Pellagra: Niacin Deficiency and Mental Illness

In our previous post, we stated that a single nutrient is unlikely to have a profound effect on a serious mental health condition, but the fascinating story of niacin and pellagra is an exception to that rule.

Pellagra (meaning rough skin) was first described in 1735 by a Spanish physician, Don Gaspar Casal, and was called “mal de la rosa” due to the characteristic red rash on the hands and feet. Early researchers linked pellagra with poverty and a corn-based diet, suggesting that spoiled maize was at fault. Almost 2 centuries later, a pellagra epidemic occurred in the southern United States. Despite the link to the poor person’s diet , the wisdom at that time was that pellagra was contagious and perhaps hereditary, and pellagrins, as they were called, were shunned.

The relevance of pellagra to psychiatry is that symptoms can include confusion, psychosis, and depression. Pellagra typically affects the skin, the gut, and the brain, with a characteristic manifestation referred to as the 3 Ds—dermatitis, diarrhea, and dementia—and it may lead to death.

In 1914, Joseph Goldberger, a physician and clinical epidemiologist, was invited by the US Surgeon General to investigate pellagra. Careful reviews of the literature indicated to him that pellagra was a dietary disease , not an infectious one. Cases were being reported in mental hospitals and orphanages in which the residents, eating a mainly corn-based diet, would get the disease, whereas the staff, despite daily contact with the patients, would not. Outbreaks also appeared in cotton mill villages where the diet was mostly cornmeal, molasses, salted pork, and lard.

Goldberger began running trials in orphanages and asylums by manipulating their diets, and those given fresh meat, milk, and legumes were no longer sick. He also conducted experiments in which he showed he could induce pellagra in healthy men (prisoners who were offered pardons for participating) by feeding them a corn-based diet. Thus, Goldberger established that pellagra was a disease of a faulty diet, not infection.

Despite his repeated controlled experiments using diet manipulation, people continued to hold to the prevailing wisdom that pellagra was infectious. And so, in 1916, he and volunteers (his wife being one of them) were exposed to the blood, urine, feces, and epidermal scales of people with pellagra, and not a single person developed it. Goldberger, however, was unable to isolate the ingredient that was causing the condition. In 1937, another scientist, Conrad Elvehjem, determined that niacin was the essential dietary factor. Fortification of food with niacin began in 1941.

Although underreporting of pellagra was typical, records suggest that at least 3 million cases had occurred, with over 100,000 deaths, in America in the 40 years until its true cause was determined. One state hospital, in Goldsboro, NC, estimated that nearly 1 in 5 admissions between 1930 and 1932 were solely because of pellagra psychosis, an easily preventable/treatable nutrient deficiency.

The Diagnostic and Statistical Manual of Mental Disorders acknowledges that nutritional conditions such as niacin deficiency can cause neurocognitive disorders. But, we wonder, while niacin therapy has been accepted for the eradication of pellagra, is it not possible that a combination of nutrients may have had far superior effects? And, if Walter Mertz was correct when he declared in 1994 that the era of single-nutrient cures for disease was over, what other mental symptoms might be eradicated with combinations of nutrients as treatment? We will cover these topics in future blog entries.

This blog entry is adapted from a previous entry that can be found at http://www.madinamerica.com/2013/05/jeopardizing-your-wife-to-prove-a-theory-pellagra-as-an-example-of-a-nutrient-deficiency-disease/.

Financial disclosure:Drs Kaplan and Rucklidge had no relevant personal financial relationships to report, and no company has ever funded any of their studies.