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Pellagra is a disease of malnutrition caused by dietary lack of niacin and protein. A deficiency in Lysine can result in a deficieny in niacin (which is a B Vitamin) and can result in pellagra.

Symptoms of pellagra are red skin lesions, diarrhoea, dermatitis, weakness, mental confusion, and eventually dementia. This disease can be common for persons who obtain most of their Calories from maize, as maize lacks lysine, and any lysine it contains is chemically bound. Therefore this disease can be common amongst people who live in rural South America where — during winter — they live off maize. Usually the symptoms show during spring, and disappear over summer, to return the next spring, after another long winter. It is also one of several diseases of malnutrition common in Africa.

The traditional food preparation method of maize by native new world cultivators, who had domesticated maize, required treatment of the grain with lime, an alkali. It has now been shown that the lime treatment makes lysine nutritionally available and reduces the chance of developing pellagra. When maize cultivation was adopted worldwide this preparation method was not accepted because the benefit was not understood. The original cultivators, who often depended heavily on maize, did not suffer from pellagra. Pellagra became common only when maize became a staple that was eaten without the traditional treatment.