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Pellagra: an important lesson from Italy

Until 1492, the agricultural societies of the Old and New World were separate. Average Europeans staple foods were wheat and minor cereals, while Native American staples were maize and potatoes.

Pre-Columbian Italy often experienced famine in poorer classes due to food scarcity. Even when there was food, the poor’s diet was often restricted. In fact, monophagy — eating only one kind of food — was commonplace. This single food of choice was one of several Old World cereals.

Still food shortages continued, as did the famines. That is, until Columbus discovered America. Why is this? Corn. Thanks to generations of sophisticated Native American farming, corn was a wonder grain. No European staple food offered the yield that corn did. Thus, corn made a swift and prevalent entrance into the European diet.

The poorer classes were especially enthusiastic about corn, since it greatly reduced the occurrence of famine. Corn-based polenta was born in Italy, and the poorer classes ate it almost exclusively. Italy’s hunger problem, it seemed, had been solved.

Then people started getting sick. And not just anyone: the poor, monophagous class was racked by a constant, then-unknown disease that left people with skin legions, dementia and ultimately death. The Italians dubbed it pelle agra or sour skin.

The authorities couldn’t figure it out and assumed obvious, yet incorrect, etiologies: being poor gave you pellagra, bugs spread pellagra, pellagra was a familial trait. Then, slowly, pellagra become associated with a corn diet, and prevailing theories stated that pellagra most likely came about from infected corn.

This conclusion would almost make sense, except pellagra was relatively non-existent in the New World, where corn was a major staple crop. Why were poor, corn-eating Europeans at high risk of pellagra? Why did Italy have 104,067 cases of pellagra in 1881, marking a nearly 300 year old pandemic?

The Native Americans, since time remembered, have treated corn with lime, a process known now as nixtamalization, whereby corn is soaked and cooked in an alkaline solution. The Europeans didn’t adopt this cultural practice when they incorporated corn in the 1500‘s as a widespread staple crop.

Corn is a natural source of niacin. Only, your body can’t absorb this niacin without nixtamalization. The Native Americans, whether directly aware of it or not, were preparing their corn in a way that allowed them to absorb critical niacin. The Europeans, on the other hand, were getting no niacin from the corn. In a corn-eating, monophagous societal class, that would lead to niacin deficiency. Niacin deficiency leads to pellagra.

The medical community eventually arrived at this conclusion, yet it wasn’t until the 1950’s that pellagra was finally eradicated in Italy, hundreds of years after it was first diagnosed.

The central lesson here is the relationship between bioavailability and hunger. Bioavailability is how available a substance is to being absorbed into the human body, irrespective of the actual presence of the substance. Hence, untreated corn contains niacin, but it has virtually no bioavailability.

In today’s modern world, bioavailability still plays a major role in hunger. Indeed according to the UN, the major cause of micronutrient deficiencies isn’t that people don’t have the nutrients…it’s that they are not bioavailable. This is exacerbated by the fact that commonly consumed foods — rice, wheat, corn — have additional substances that inhibit micronutrient absorption.

The way to overcome this hidden hunger for micronutrients in largely monophagous societies is to fortify existing staple foods, such as adding iron fortified powder to rice. Another option is to treat the foods to increase bioavailability, such as nixtamalization with corn.

To this end, we support groups like Valid Nutrition, which fortifies their life-saving nutrition packs with essential micronutrients. Additionally, we support the important work of educating communities about natural ways to treat their staple foods to increase bioavailability.

[This article is paraphrased from “An Outline of the History of Pellegra in Italy”, Journal of Anthropoligical Sciences, Vol. 85 (2007), pp. 163-171]

One Response to Pellagra: an important lesson from Italy


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