1.2: History of Nutrition Science

Most of what’s known about nutrition was discovered in the past century. In 1900, only four nutrients were known—carbohydrate, protein, fat, and ash (minerals). But when these were purified from milk and then recombined and fed to mice, the mice didn’t survive. Something else in milk— vitamins—was required for life and was missing.

Before the discovery of vitamins, it wasn’t generally accepted that the lack of something in food could cause disease. It seems incredible that for centuries people suffered from severe nutritional deficiency diseases, such as scurvy, beriberi, and pellagra, that had such simple cures.

Scurvy

A severe vitamin C deficiency causes scurvy. A dramatic degeneration of many body tissues causes muscular weakness and pain, bleeding gums, mental depression, and ultimately, death. Scurvy was described in 1500 B.C. and has been a part of many historical events. It was rampant among crusaders, explorers, soldiers, and sailors who went on long journeys where fresh food wasn’t available.

Sailors left on long voyages knowing that many of them would die of scurvy (this didn’t speak well for life at home). In 1498, Vasco da Gama completed his historical voyage around the Cape of Good Hope. About half of his original crew of 140 men died of scurvy. In 1535, when the crew of the explorer Cartier had to stay in Canada for a winter, many crewmen with scurvy were cured by a local Indian remedy—the juice from tree leaves (probably white cedar, which we now know has vitamin C).

In 1747, James Lind, a Scottish surgeon with the British navy, did a classic experiment. On a ship, he took 12 sailors with scurvy and divided them into 6 pairs. Each of the pairs was given either sea water, vinegar, sulfuric acid, hard apple cider, a medicinal paste, or oranges and lemons. Only those who were given oranges and lemons were cured.

On Captain James Cook’s historic voyage of 1772‑1775, the captain and crew avoided scurvy by restocking the ship with fresh fruits and vegetables at ports along the way. In 1796, daily supplements of lemon or lime juice became standard issue in the British navy, and the sailors were nicknamed limeys. Preventing scurvy with citrus juice and fresh fruits and vegetables is thought to have contributed to the superiority of the British navy at that time. It wasn’t until 1932 that vitamin C was identified as the substance that prevented and cured scurvy, and named ascorbic acid [ascorbic = ascorbutic (without scurvy)].

Beriberi

Beriberi, caused by a deficiency of the Bvitamin thiamin, was described in the Chinese medical literature more than 3,000 years ago. But its cause wasn’t known to be related to diet until late in the 19th century. Symptoms include difficulty in walking with subsequent paralysis of the legs, malfunctions of the heart, and mental confusion.

In the late 19th century, beriberi was common wherever the diet was mainly white rice, produced in newly developed “polishing machines” that removed the thiamin-rich outer coat (bran). In Indonesia, then a Dutch colony, beriberi became common amongst Indonesians because their diet was mainly white rice. But the Dutch in Indonesia didn’t suffer from beriberi because their diet was more varied—other foods provided what the white rice lacked.

In 1890, Dutch physician Christiaan Eijkman, assigned to a military hospital in Indonesia, saw chickens developing a similar disease. He found that they were being fed day-old cooked rice discarded from the hospital. When they were fed brown rice, with the bran still attached, they remained healthy. He did more experiments and, in 1929, received a Nobel Prize for his pioneer work on the existence of vitamins.

In 1926, thiamin was purified from rice polishings—the first time that a vitamin in pure form was extracted from food. By 1936, thiamin could be made in the lab (rather than tedious extraction and purification of tiny amounts of a vitamin from huge amounts of food), providing an inexpensive way to obtain large amounts of a vitamin in pure form—a forerunner of our vitamin pills.

Availability of purified food components enabled their individual effects to be studied. From experiments using pure vitamin C, for example, we know that it—and not the other substances in vitamin C-rich food—is what prevents scurvy.

Using newly-available lab-made thiamin to enrich white rice, a study was done in the Philippines, where beriberi was common. On the Bataan Peninsula, a mountain range geographically divided the population into two groups. One group was given thiamin-enriched white rice (the experimental group). The other group (the control group) continued to eat unenriched white rice.

After 9 months of eating thiamin-enriched rice, 90% of those who earlier had symptoms of beriberi got better, and the death rate from beriberi in the experimental group was a third of the control group’s. After 2 years, there were no deaths from beriberi among those eating the enriched rice.

Pellagra

Pellagra, caused by a niacin deficiency, is characterized by what’s known as the 3 Ds—diarrhea, dermatitis (skin inflammation), and dementia (mental impairment). Its name comes from the Italian pelle agra, which means painful skin.

In the early 1900s, there were about 200,000 cases of pellagra in the U.S. Many people in mental institutions were there because of pellagra dementia.

In 1914, Joseph Goldberger, a U.S. Public Health Service physician, was sent to the South to investigate the cause of pellagra, which was

Figure \(\PageIndex{1}\): Age-adjusted rise in obesity

Figure \(\PageIndex{2}\): Age-adjusted rise in diabetes

epidemic among the poor. His observations led him to believe that it was caused by a dietary deficiency.

The diet was mostly cornmeal, molasses, fatback (fat from a hog’s back) and some greens, but very little meat, eggs, or milk. The prevailing theory was that pellagra was an infectious disease since it “spread easily” in the unsanitary and cramped quarters of the poor and the institutionalized. Although Goldberger clearly demonstrated that he could prevent and cure pellagra in orphanages and jails simply by providing foods like milk and eggs, many skeptics still weren’t convinced.

To demonstrate that pellagra wasn’t infectious, Goldberger recruited 14 healthy volunteers, mostly physicians. He, his wife, and the volunteers were “infected” with various secretions taken from 17 people with pellagra. Nasal secretions from pellagra patients were applied to the nasal linings of the volunteers; skin scrapings, urine, and feces were ingested by mixing these with flour to make pills; and blood from pellagra patients was injected into the volunteers’ muscles. None of the volunteers developed pellagra. This was convincing evidence that pellagra wasn’t infectious.

Niacin was identified in 1937 as the substance that prevents pellagra. But well before then, pellagra was less common because of education to improve diets, more income to buy nutritious foods, etc. The Red Cross even loaned milk cows to needy families. Pellagra virtually disappeared in the U.S. in the early 1940s when we began enriching refined corn and wheat flour with niacin, iron, thiamin, and riboflavin.