June 24, 2024

A significant niacin(vitamin B3) deficit is the cause of pellagra, a systemic disease. It can ultimately result in death and impact the entire body. The main cause of primary pellagra is a food deficiency in niacin. It typically affects underprivileged and food-insecure people. When your body is unable to absorb the niacin you eat, secondary pellagra may develop.



What is pellagra?

Niacin, or vitamin B3, deficiency is the cause of the condition pellagra. It’s a type of malnutrition, more precisely undernutrition in micronutrients. Lack of niacin causes symptoms in the skin, mouth, bowels, and brain. Niacin is essential for healthy cell function throughout the body. Pellagra can result in permanent harm to your neurological system and possibly death if left untreated.

Many food sources contain niacin, and most people who consume a balanced diet obtain enough amounts of it. However, primary pellagra, which results from insufficient food consumption, continues to be a serious issue in communities that are food insecure and disadvantaged. In the industrialized world, illnesses or drugs that interfere with the body’s ability to absorb or use niacin are the most common secondary causes of niacin insufficiency.

What is the purpose of niacin and why do I need it?

Niacin, or vitamin B3, is used by the body to transform meal calories into energy. Eaten niacin enters your body through the small intestine and is transformed into the coenzyme nicotinamide adenine dinucleotide (NAD) in your bodily tissues. An enzyme agent is called a coenzyme. It catalyzes chemical processes in concert with enzymes. The coenzyme NAD is essential to the operation of over 400 distinct enzymes in your body.

Coenzyme NAD facilitates the conversion of macronutrients’ potential energy, such as adenosine triphosphate, or ATP, into a form that can be used by your cells. It provides the energy that your cells need to function, and bodily systems that demand more energy are more dependent on it. Additionally, NAD is engaged in a number of specialized cellular processes, such as cellular communication and DNA repair.

How does niacin deficiency affect my body?

Since NAD plays a major role in giving cells fuel, deficiencies in it typically manifest first in bodily systems with the highest energy needs or cell turnover rates. This includes your brain, your gastrointestinal tract’s mucous lining, and your skin. The symptoms of classic pellagra are referred to by medical professionals as the “3 Ds”: dementia, dermatitis, and diarrhea. Some include death by adding a fourth “D.” If pellagra is not treated for several years, it may result in death.

Diarrhea (gastrointestinal mucositis)

When the mucous lining your intestines does not regenerate quickly enough, diarrhea results. The intestines cannot adequately digest food or defend themselves against irritation and inflammation without this mucosa. The mucous lining of your whole gastrointestinal tract—from your mouth to your bowels—is impacted by chronic inflammation. This results in symptoms of oral mucositis, such as mouth ulcers and a red, swollen tongue, as well as gastrointestinal symptoms including indigestion and stomach ache.

Dermatitis (skin photosensitivity)

Additionally, pellagra causes a unique kind of dermatitis, especially on parts of the body exposed to the sun, like the hands, feet, arms, legs, and face. When skin cells lack energy resources, they become more susceptible to light. Sunburn-like rashes are the first signs of dermatitis, which later develop into rough, scaly, hyperpigmented plaques. A neck collar that is black and highly pigmented is one distinguishing characteristic. The name “Casal’s collar” comes from Don Gaspar Casal, a Spanish physician who discovered pellagra among Spanish peasants in 1735.

Dementia (brain and nerve damage)

Pellagra is a systemic illness that affects the entire body because it deprives cells of the energy necessary for normal biological processes. Eventually, this will have an impact on the nerve system and brain. Early signs could be ambiguous. They could appear more like anxiety or despair, or they might include apathy, tiredness, and trouble focusing. The symptoms intensify over time, leading to delusions and bewilderment. In addition to neurological impairment that causes balance and coordination issues, muscle spasms, and tremors, severe cases can result in irreversible dementia.

Where is pellagra most commonly found?

Pellagra has historically affected impoverished communities in Europe, Africa, Asia, and the South of the United States. It typically happens in societies with extremely restricted diets, particularly those where maize is the main food source and protein is in short supply. Niacin metabolism depends on protein and the amino acids derived from it. Although niacin is present in many grains, it is difficult for human bodies to absorb the niacin in maize because it is in a “bound” state.


Soaking corn in limewater for an entire night is the custom for preparing corn tortillas in Central and South America. The niacin in the maize is released from its binding by this mechanism, enabling absorption. Pellagra has so seldom been observed in these groups. However, this was not the case in the early 1900s in the Southern United States, when pellagra was so widespread that the U.S. Congress requested that the Surgeon General look into the illness.

Joseph Goldberger, a US Public Health Service medical officer, was designated by the Surgeon General to head the inquiry. Goldberger’s studies revealed that a poor diet was the cause of pellagra (published in 1923). American biochemist Conrad A. Elevjhem found that niacin was the missing nutrient in the ensuing ten years. In the United States, niacin was frequently added to bread and cereal goods by the middle of the 20th century, and this practice is still in place today.

Current day

In the United States today, pellagra is rare—less than 1% of cases occur—and is typically brought on by secondary factors like alcohol consumption. Other developed Western countries, many of which have embraced the practice of fortifying bread and cereal goods, have realized this as well. Nonetheless, primary pellagra is still a major problem in less industrialized parts of the world, particularly among tribal groups where corn is still the main crop. Nowadays, the most common places to find it are sub-Saharan Africa, China, and India.

Symptoms and Causes

What are the symptoms of pellagra?

1. Sometimes bloody, Chronic diarrhea.
2. Abdominal pain and indigestion.
3. Loss of appetite, nausea and vomiting.
4. Mood changes, depression.
5. Delirium and dementia.
6. Red, swollen tongue and mouth sores.
7. Weakness, exhaustion, and malaise.
8. Neurological signs including tingling and numbness in the hands and feet, or tremors.

What are the causes of pellagra?

Pellagra is primarily brought on by an inadequate diet. There are many different meals that contain vitamin B3, but individuals with limited food options may not be getting enough of these nutrients.

Secondary causes of pellagra include numerous medical problems that impede the body’s ability to absorb or utilize niacin.Some of them are included in this.:

1. Intestinal conditions such as cirrhosis of the liver or inflammatory bowel illness that result in malabsorption.
2. Alcohol use disorder. Heavy drinking can harm organs, resulting in malabsorption and overall malnourishment, which can lead to pellagra.
3. The gastric bypass procedure. Damage to the intestinal mucosa during bariatric surgery may result in pellagra and other nutritional deficiencies.
4. Hemoglobin deficiency. Niacin must be converted and used by your body using iron.
5. Hartnup illness. Because of this hereditary condition, your body is unable to absorb amino acids, which are required for the body to make vitamins from meals.
6. Syndrome Carcinoid. Niacin synthesis is lowered by aggressive tumor cells, which is the hallmark of this condition.
7. The body’s niacin metabolism can be interfered with by some medications, especially antispasmodics and chemotherapy treatments.
8. Your body loses niacin when you have HIV.

Diagnosis and Tests

How is pellagra diagnosed?

In addition to examining you and your symptoms, your healthcare practitioner will inquire about your diet and medical history. In order to confirm a suspected case of pellagra, they could request a urine test. Your body’s niacin levels can be determined by looking at the amounts of specific substances in your urine. Additionally, they might treat you with niacin supplements to see if it improves, which would confirm pellagra.

Management and Treatment

What is the cure for pellagra?

Since pellagra is caused by a niacin (vitamin B3) deficiency, the deficiency must be replenished. When using niacin tablets, most people start to feel better immediately. For symptoms like mouth and skin sores, you might require further care. You will also require treatment for any underlying medical conditions that may have contributed to your pellagra.

Are there any side effects to the treatment?

You shouldn’t have any negative effects from the supplements if you take them as directed. Overdosing can have negative effects, however it’s difficult to overdose when inadequate.

Side effects can include:

1. Itching and rashes.
2. Bloating and indigestion.
3. Skin flushing.
4. Headaches and dizziness.


How do you prevent pellagra?

The simplest approach to guarantee sufficient nutrition is to eat a well-balanced diet. Dietary supplements and fortified foods might be helpful when eating options are restricted. For most healthy adults, a B-complex vitamin supplement supplies an adequate amount of niacin. Niacin should be taken at a daily dose of roughly 15 milligrams.

The best food sources of niacin are:

1. Beets.
2. Brewer’s yeast.
3. Beef liver.
4. Peanuts.
5. Potato.
6. Poultry.
7. Rice.
8. Sunflower seeds.
9. Spaghetti sauce.
10. Enriched bread and cereals.
11. Oily fish, like tuna and salmon.

See your healthcare practitioner about long-term prevention if you have a chronic health condition that puts you at risk for pellagra. This could entail adjustments to your medicine, diet, or supplements.

Outlook / Prognosis
How much time does pellagra recovery take?

Most people start to feel better after taking vitamins within a few days. Within the first week, digestive issues typically go away first. Sores on the skin and lips usually recover in two weeks. It could take longer for certain advanced cases to heal. Dementia and severe nerve injury might not recover.

In the future, medical professionals advise sticking to a balanced diet to avoid primary pellagra. A lack of niacin frequently coexists with deficits in other micronutrients. A healthy diet can help with all of them. Some folks might require extra help or education on nutrition.

Treating secondary pellagra can be more difficult. Even while supplements frequently assist, their effects cannot be sufficient if your body is unable to properly metabolize niacin. In many situations, the key to recovery is identifying and treating the underlying cause of pellagra. The length of the process varies according to the condition.

A note from Blogjug

Primary pellagra remains endemic in less developed countries with inadequate food sources, while being mostly eradicated in the developed world. The same sorts of nutritional support—fortified foods, supplements, information, and other resources—that helped us defeat pellagra not too long ago could also be beneficial for these communities.

In the modern world, those who suffer from alcoholism or other illnesses that stop their bodies from metabolizing niacin are still at risk for secondary niacin insufficiency. It’s crucial to keep in mind that, although diet plays a major role in nutrition, the body is ultimately responsible for ensuring optimal health. Seek medical attention if you experience symptoms that indicate anything is amiss, especially with your digestive system. A minor vitamin deficit can have a major impact on your overall health.

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