HLTB21H3 Lecture Notes - Lecture 11: Pellagra, Thiamine, White Rice

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31 Oct 2010
Dietary-deficient diseases - ‘Hidden Hunger
-some date back to the 15th century
-most are specific to the 19th century - time when the ‘germ theory’ won the battle
-the quests in searching for the causes of nutrition-deficient diseases was masked by the
overwhelming confidence in ‘one germ, one disease’ theory
Pellagra - ‘Red plague’
-First described in Spain in 1735
-‘pelle’ ‘agra’ – Italian for ‘skin’ ‘rough’
-Appears first as a skin rash; skin then crusts and peels away
-Clinical symptoms – 4D’s: dermatitis, diarrhea, dementia, and death
-1909 – epidemic in US: reported in 26 states
-1912 – high fatality rates; e.g. 40% in S America
-20th century – 3M cases in the US and 100,000 deaths
-Belief that pellagra was an infectious disease specific to the poor
-By 1939 – evidence established that disease was due to niacin-deficiency (a water-soluble B
vitamin – vitamin B3)
-Niacin needed for normal oxidative metabolism of sugars
-lack of niacin implies sugars are not able to be metabolized - illness
Beriberi - ‘white rice’ plague
-First described in 1616 as a neurological disorder characterized by paralysis of the hands and
-Also named ‘kakke’ meaning ‘leg disease’
-White rice - observed to be related to an increase in prevalence of beriberi
-Early 1900s – Eijkman (Dutch scientist) established that disease is not germ-related
-By 1926 – deficiency in vitamin B1 (thiamine) was established as cause of Beriberi
-Thiamine – necessary for the normal cell metabolism of sugars and alcohol
-Deficiency leads to malfunction in cell activity and cell death
Scurvy - ‘Explorers’ disease’
-Early records of the disease date to the end of the 15th century
-Related to sea exploration that was characteristic of long ocean voyages – also named ‘plague
of the sea’
-Mid to late18th century, disease was related to nutrition and lemon juice intake was adopted as a
practice in seamen; James Lind (English naval surgeon) played an instrumental role
-19th century – outbreaks of scurvy appeared on land: Ireland, California, New York
-Led to the identification and synthesis of vitamin C (1920s and 1930s)
-Vitamin C deficiency shuts down the synthesis of collagen, a major component of connective
tissue found in tendons and ligaments and in the walls of blood vessels
-Old disease – became epidemic in England after 1650 and spread through the countries of
northern Europe
-Late 19th century, scientists realized that rickets seemed to be restricted to large industrial cities
in Scotland, England, and northern Europe
Lecture 11 - Plagues w/out germs
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