Will Pellagra Make a Comeback?

Pellagra is a vitamin deficiency disease that is often reported in Africa, Central America, and South-east Asia. Caused by tryptophan and niacin-poor diets, it has also been identified in marginalized individuals in industrial societies (especially homeless, chronic alcoholic, and psychiatric patients who refuse food). Symptoms of pellagra include light sensitivity, dementia, diarrhea, and dermatitis. In advanced cases, pellagra can lead to psychotic delusions. Left untreated, pellagra cases die after several years without proper nutrition.

While first identified in Spain in the 18th century, it received its name from an epidemic in Italy ("pelle agra" means bitter skin in Italian). Pellagra was epidemic in parts of the US in the early 1900s before the nutritional basis for the disease was identified and niacin supplements made treatment possible. While easy to diagnose and treat, physicians often miss vital clues, especially in industrialized societies where pellagra is less likely to be encountered. Even in non-industrialized countries, improved standard of living and greater diversity in dietary sources have made pellagra less common.

But an article published a few years back in the American Journal of Therapeutics discussed the possible resurgence of pellagra in HIV patients and anorexia nervosa patients who neglect proper nutrition. The authors also reviewed a case f pellagra identified through the warning triad of "dermatosis, diarrhea, and dementia" and properly treated.   In the twelve years since that particular study was published,   there has been an upswing in new pellagra cases which have been largely linked to the popularity of certain restricted diets such as extreme veganism.   A 2021 article reviews a case of pellagra involving a strict vegan who was diagnosed and treated for pellagra and warns health professionals of the need to stay aware of how easily such a patient might be misdiagnosed.     

For all that it is considered extinct in affluent countries, pellagra has never completely gone away.    Something to think about if you are considering a new fad diet...

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