Pellagra has largely been forgotten. This is unfortunate as important lessons are to be learnt about the diseases and social and economic consequences of poverty – and for the root cause of poverty (and of affluence) – that involve dietary nicotinamide and nicotinamide adenine dinucleotide (NAD) homeostasis. NAD disruption can occur not only from poor diet but from increased consumption from genotoxic, infectious and metabolic stresses. NAD deficiency is closely linked to poor physical and intellectual development, premature ageing and diseases of ageing. Acute infections, many with NAD-consuming toxins, that may differentially affect the NAD-depleted, now include COVID-19. Some Covid manifestations, such as myoclonic encephalopathy and “Long Covid,” resemble pellagra clinically and biochemically as both have disturbed nicotinic and tryptophan metabolism. Symbionts that supply nicotinic acid, such as TB and some gut micro-organisms, can become dysbiotic if the diet is very deficient in milk and meat, as it is for 1–2 billion or more. High doses of nicotinamide lead to inhibition of NAD-consuming enzymes and excessive induction of nicotinamide-n-methyl transferase (NNMT) with consequent effects on the methylome: this gives a mechanism for an unrecognised hypervitaminosis-B3 with adverse effects of nicotinamide overload for consumers on a high meat diet with “fortified” foods and “high energy” drinks. Methods of measuring NAD metabolism routinely for screening the populations at risk of deficiency and in metabolically ill or infectious disease patients should be developed urgently. Successful intervention should improve human capital and prevent many aspects of poverty, reduce discrimination and even the drive to emigrate.
Part of the book: B-Complex Vitamins
We evolved from herbivores to a meat eating “commons” in hunter-gatherer days and then to a non-egalitarian meat power struggle between classes and countries. Egalitarian-ism, trans-egalitarianism and extremes of inequality and hierarchy revolve around the fair-unfair distribution of meat surpluses and ownership of the means of meat production. Poor people on poor diets with too few micronutrients may explain many inequalities of human capital, height and health and divergent development of individuals and nations. Learning from past successes and collapses from switching trophic levels the lesson is that meat moderation toward the top of Engel’s curves, not calorie-centrism, is the best recipe for countries and classes. Improved health with longer lives and higher crystallised intelligence comes with an ample supply of micronutrients from animal products namely iron, zinc, vitamin A, vitamin B12 and other methyl-donors (such as choline), and nicotinamide (vitamin B3). We concentrate on nicotinamide whose deficits cause the degenerative condition pellagra that manifests as poor emotional and degenerative cognitive states with stunted lives and complex antisocial and dysbiotic effects caused by and causing poverty.
Part of the book: B-Complex Vitamins
Pellagra is caused by a dietary deficiency of milk and meat leading to insufficient nicotinamide (vitamin B3), the precursor to nicotinamide adenine dinucleotide (NAD). “Pellagra sine pellagra” was well recognised and may be common as supplementation was never globally implemented and a screening test never developed. Meat and milk intake varies 30-fold globally so there are perhaps 2 billion at risk of deficiency. Such patients will have physical and cognitive stunting, poor conduct and be prone to acute and chronic infections, including TB, and premature ageing, including dementia. Resilience may be poor to NAD-consuming insults whether chemical, microbial or traumatic that conspires to cause brain injury but comes with the opportunity for pre-conception dietary corrections breaking cycles of deprivation and poor educational outcomes. Such individuals may otherwise be subject to discrimination as was the pellagra ridden “Butterfly” caste causing racial and ethnic tensions. Poor countries with many having to spend 50-80% of income on food and very little on animal produce cannot develop properly unlike wealthier meat rich empires, past and present. The many benefits of experiments with food programmes and basic income support are because, as Engels curves predict, more is spent on milk and meat enabling demographic, epidemiological, and economic transitions and modernity.
Part of the book: Vitamin B and Vitamin E
North-South variation in the supply of meat has always been present. Sharing of meat was the rule but in the multi-centric Neolithic revolution when domestication of animals and plants co-evolved class differences became pronounced-aristocrats and inferior proletariats and “lesser breeds and lower orders” started to form. The distribution of natural domesticates was uneven with the near-east and a temperate band across Europe well off compared with Africa and the Americas. The Columbian exchange changed this as meat became abundant in the New World who then exported to Europe. Wars, expropriations and genocides were over the meat supply and acquiring pastureland or water. Colonial plantation profits paid for meat imports from “settler colonies” indigenous or poor peoples on low meat pro-pellagrous diets were considered inferior whatever their colour and had poorer health and life expectancy. Attempts to correct hunger in the resultant ramshackle “Third world” concentrated on calories fuelling population booms and busts and delaying demographic, epidemiological and economic transitions. High meat variances are narrowing in China and Asia but need help elsewhere in the South. Dangers of not developing with a safe and sufficient meat supply include the emergence of zoonoses and mass migration. Reparations, rehabilitation and rejuvenation should concentrate on reconstituting a meat commons giving us a shot at redemption and survival.
Part of the book: Vitamin B and Vitamin E
Pellagra is caused by a diet with little meat or milk and a reliance on maize. Pellagrins suffer from poor cognitive and social skills. Pellagra was cured with nicotinamide (vitamin B3) but before that pellagrins were considered inferior and dangerous degenerates and were known as the “Butterfly Caste” after the characteristic sunburn rash. Quests for meat drove the diaspora “out of Africa” with meat sharing being the social norm. After the domestication of animals “meat elites” across classes, castes, sexes and continents emerged. Nomads migrating to northern Europe created mixed pastoralist-farmer populations whose fermentation cultures and genetic innovations allowed lactose tolerance. Skin lightened as sunlight, needed to synthesise vitamin D. and sunburn was rare. Conquests encouraged their view that they were a superior race rather than that they were blessed with a superior diet. Ruling classes on a high meat diet combined forces with cereal dependant workers (with higher fertility) whilst the “lumpenproletariat” were economic vegetarians. Social contracts broke down with rebellions, but slaves, oppressed sharecroppers and refugees bore and bear the brunt of (subclinical)pellagra often in ex-colonial subjects—to whom dietary reparations could bridge international inequality gaps.
Part of the book: Bridging Social Inequality Gaps - Concepts, Theories, Methods, and Tools [Working title]
Pellagra is caused by nictotinamide, the precursor to NAD, dietary deficiency. Pellagrins suffer from poor cognitive and social skills and was cured with nicotinamide (vitamin B3). Before then pellagrins were considered inferior and dangerous degenerates known as the “Butterfly Caste” after the diagnostic sunburn rash—Casal’s necklace. Subclinical pellagra is an effect and a cause of poverty, social inequality gaps and friction. Dehumanising diets becomes a justification for ostracising or killing people paving the way to an even worse diet in vicious cycles that lead to war and pandemics. Livestock farming and meat for the rich has been an enduring “megatrend” over the last 6–8000 years and acquiring the necessary resources, such as pastureland, is behind colonisation and trade wars. A consequence is NAD—disadvantaged “inferior” people. This would be cost-effective to correct and create a safer world by reducing (civil) war, and migration, and by improving health and wealth reducing risk of pandemics in a more ecologically sustainable world.
Part of the book: Bridging Social Inequality Gaps - Concepts, Theories, Methods, and Tools [Working title]