The B3 Story: Pellagra 1271 High Street, Auburn, CA 95603 Phone (530) 823-7092 order line (800) 359-6091 Hours: Tues. – Fri. 10 a.m. – 4 p.m. E-mail: [email protected] web: www.ImageAwareness.com August 2014 Volume 10: Issue 8 Introduction and mental problems. This suggests The cure for pellagra was actu- that some of these conditions which ally discovered by Casimir Funk, a Vitamin B3 or niacin is associated are not as severe as what is seen in Pole, at the Lister Institute in London with one of the most horrible nutrient pellagra may benefi t from supplemen- about 1911. Funk isolated the cure defi ciency diseases. About three mil- tation with the nutrient. for beri-beri (thiamine) from rice and lion Americans contracted pellagra suggested that these new substances and 100,000 died of the disease be- Pellagra was associated with the which caused diseases when they tween 1907 and 1940. adoption of corn, a new world plant, as a dietary staple. Corn became so were missing in the diet should be Through the strenuous efforts of popular that people gave up other called “vitamines.” Vitamins are not Dr. Joseph Goldberger the disease foods such as fruits, vegetables, and really amines, but the name stuck. was conquered. Foods were fortifi ed dairy products. In 1786 Johann Wolf- The “e” was later dropped. Funk dis- with niacin and the medical profes- gang Goethe, a well-known German covered nicotinic acid, the cure for sion relegated this important vitamin writer and naturalist, wrote “I believe pellagra, while seeking to isolate the to a place in the history books. Some the cause of this sickly condition is cure for beri-beri. He set it aside be- researchers feel that failure to obtain found in the continued use of Turk- cause it was not the focus of his inter- optimal intake of this nutrient is more ish and heath corn.” Corn is defi cient est. Nicotinic acid or niacin would not common than most imagine. in niacin, but it is also defi cient in the be identifi ed as the cure for pellagra Physician Francesco Frapolli amino acid tryptophan which the body for another quarter century! called it “pellagra” which means can convert into niacin. A diet high in rough skin in Italian. This description corn readily induced pellagra. does not even begin to describe the Pellagra was not a problem among severity of the condition which came the Aztec and Mayan peoples where to be identifi ed with the four “D’s”— corn originated. The corn (or maize) diarrhea, dermatitis, dementia, and was soaked and cooked in an alkaline death. Pellagra so frequently began solution, usually limewater. The hull with digestive symptoms that one was also removed. This process was individual wrote, “Pellagra begins in called nixtamalization. It increased the stomach.” the availability of niacin, improved The dermatitis included scaling, the fl avor and aroma of corn, and re- hardening, peeling, and reddening of duced fungal toxins. the skin, especially in areas exposed Several individuals identifi ed pel- to sunlight such as the neck (called lagra as a nutritional problem. Some Casal necklace) and hands. Gasper thought it was tied to a corn poison Casal fi rst described the skin lesions or moldy corn. Others observed that a of pellagra in 1762. more varied diet would eradicate the Note carefully that severe defi cien- disease. Explosive outbreaks of pella- cy of vitamin B3 is associated with gra began to take place in the United skin conditions, intestinal problems, States after 1905. Copyright © 2014 by Jim McAfee. All rights reserved. 1 contracting the disease himself. Here demonstrated by Louis Pasteur. Pel- he met and married the love of his life, lagra was generally considered an Mary Farrar who was the daughter of infectious disease. Goldberger had a wealthy New Orleans attorney. a mind of his own. By July of 1915 Goldberger studied typhoid fever. he had concluded that pellagra was a He was then sent to Texas to deal nutritional disease. Young babies who with an outbreak of dengue fever. He drank milk were protected and those who cared for sick children never Goldberger, Mary Farrar, “Dr. Joseph Goldberg- contracted the disease. He then was er: His Wife’s Recollections,” in Essays on History sent to Mexico to fi ght typhus. He contracted the disease. But how was of Nutrition and Dietetics, ed. Beeuwkes, Adelia, contracted this disease as well. Gold- Goldberger to persuade the medical Todhunter, E. Neige, and Weigley, Emma Seifrit, berger was in Detroit in 1914 battling establishment that lack of a nutrient Chicago: American Dietetic Association, 1967, 284- could cause the disease? 287. diptheria when he was asked by the http://emedicine.medscape.com/ surgeon general to turn his attention The Experiments article/1095845-overview to pellagra. The Orphanage Experiment https://en.wikipedia.org/wiki/Nixtamalization An associate, Dr. Russell M. Wild- Joseph Goldberger A key turning point in Goldberg- er, wrote, “Every disease he studied, er’s understanding of pellagra re- Joseph Goldberger was born in Gi- he acquired himself. He almost died sulted from an experience at a Baptist ralt, Hungary. He was the son of sheep from yellow fever in Tampico. He de- orphanage in Jackson, Mississippi. herders. His parents emigrated to the veloped dengue fever in Texas, and The children between the ages of 6 United States after their sheep were diphtheria in Detroit. I knew him fi rst and 12 were consumed with pellagra. decimated by illness. They opened a when he was desperately ill with ty- Older and younger children were free grocery store in New York. Goldberg- phus fever in Mexico…” of the disease. Children over 12 were er was the fourth of seven children Goldberger knew nothing about allowed to do odd jobs in the neigh- born to the family. He began his col- pellagra. He wrote his wife that he borhood. They spent the money they lege education with the plans of be- had never faced a task with greater re- earned on better food. Goldberger coming an engineer. In 1892 He heard luctance. He had four young children added eggs, milk, lean meat and vege- a lecture by Dr. Austin Flint, Jr., that and had been separated from his wife tables to the diets of the children. Pel- resulted in his enrollment in medical for six months. lagra disappeared in a few months. school. He immediately set about learning The Prison Experiment Goldberger began his medical what was known about the condition. The medical community was un- career in private practice in Pennsyl- He spent his days visiting orphanag- impressed by Goldberger’s ability to vania, but he was soon drawn to the es, insane asylums and hospitals in the cure pellagra in an orphanage. For United States Marine Hospital Service Southern United States where the dis- this reason he set himself the task of which later became the U.S. Public ease was epidemic. He studied what inducing pellagra in prisoners at the Health Service. The Hygienic Labo- was known about the disease at nights Rankin Farm Prison in the Mississip- ratory for which Goldberger worked in hotel rooms and aboard trains. pi State Penitentiary. The state gov- would later become the National In- Goldberger learned that 10,000 stitutes of Health. people died from the disease every Goldberger’s fi rst government task year and more than 200,000 suffered was to inspect immigrants coming into with the condition. Goldberger noted New York for diseases. He earned the staggering gates, discoloring and irri- reputation of being a clever and unre- tation of parts of the skin exposed to lenting fi ghter of epidemics. sunlight, and insanity including one Goldberger became well-known woman running along a country road for the way in which he addressed a as if pursued by demons. This last ob- serious problem with typhoid fever in servation inspired Abram Hoffer to Washington about 1902. This success experiment with niacin as a treatment was followed by work with other in- for schizophrenia. fectious diseases. Between 1902 and The medical establishment of 1906 he battled yellow fever in the Goldberger’s day was heavily infl u- southern part of the United States, enced by the germ theory of disease Copyright © 2014 by Jim McAfee. All rights reserved. 2 have done, will be a milestone in the the nose and naso-pharynx of pella- history of preventive medicine. The gra patients and transferred to the re- knowledge we have gained will be searchers. sure to save thousands of lives annu- Mary Goldberger begged her hus- ally—thousands of lives of your own band to allow her to participate in the Southern people, not to mention the experiment. The men refused to allow misery of many years of suffering and her to take the pills, but she was al- ill health of thousands of others.” lowed to receive an injection of the Disbelief blood of a woman dying of pellagra. Old medical ideas die a slow and The results made headlines. No diffi cult death. Goldberger was vi- one died. No one even became ill. ciouisly attacked by his medical col- With one bold experiment Goldberger leagues. One physician accused him of buried the concept of the infectious or- concocting “half-baked experiments. igin of pellagra. Even with this proof A professor of medicine accused him , however, some physicians remained ernor was persuaded to offer twelve of faking his prison experiment. Gold- staunch opponents of the dietary the- prisoners a pardon if they were will- berger did not respond publically to ory of pellagra, but Goldberger had ing to participate in an experiment to the criticism, but he wrote his wife of turned the tide of the debate.