Pellagra in the United States: A Historical Perspective

Kumaravel Rajakumar, MD, Department of Pediatrics, West Virginia University School of Medicine, Morgantown.

South Med J. 2000;93(3) 

In This Article

Eradication of Pellagra

Pellagra was a rural disease among the sharecroppers, tenant farmers, and cotton mill workers of the South. Its occurrence in epidemic proportions was linked to the economic depression of the times and the monoculture of cotton cultivation. Depression meant less money for food and subsistence on an inadequate diet. The cotton monoculture and nonexistent animal husbandry resulted in a lack of locally produced food. Along with poverty, corn was the common denominator among pellagrins in the United States and Europe. Corn had been the staple diet among the natives of Mexico and Central America for several centuries without causing pellagra. Why had corn suddenly become pellagragenic in United States and Europe? The answer to the problem lay in the methodology of corn processing, cooking, and milling.[36] The natives of Mexico and Central America had always soaked the corn in alkali before cooking. The alkali treatment liberates the bound niacin in corn, thereby enhancing the niacin content of the diet to the point of being protective against pellagra. The process of degerming in the preparation of cornmeal became feasible with the development of the Beall degerminator in 1905.[36] The process of degermination reduces the niacin content of corn and could have precipitated the development of pellagra among a vulnerable population.

Public awareness campaigns, agriculture diversification, change of food habits, and food fortification with nicotinic acid were all responsible for the eradication of pellagra in the South.[8] The recommendation of the Food and Nutrition Board regarding the enrichment of bread and flour with thiamine, niacin, and iron was endorsed by the members of the baking and milling industries in 1941.[37] Soon the food fortification program played a crucial role in eliminating pellagra. The consumption of enriched flour and bread ensured that the dietary intake of niacin and thiamine was adequate, thus ensuring the prevention of pellagra and beriberi. Pellagra was truly conquered in the American South during the Second World War.[38] Paradoxically, there was relative prosperity during the war. The economy improved, there were more jobs, and almost everyone had an income. The wartime rationing also made the people conscious of eating high quality food. By 1945, pellagra had become extinct in the South, and the pellagra producing 3-M diet of southerners had become a relic of the past.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.