Pellagra: Down Not out If down and out (Part 1)

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 ethic 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.