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BASIC INFORMATION
DESCRIPTION
Pellagra is a vitamin deficiency disease. It is caused by a long-term shortage of B vitamins, particularly vitamin B-3 (niacin). Pellagra is a common disease, especially in underdeveloped countries. In developed countries, the disease is mostly confined to the alcoholic population.
CAUSES
Pellagra may result from the deficiency of either nicotinic acid (vitamin B-3) or the amino acid and protein, especially proteins containing the essential amino acid tryptophan. Some sources also claim a relationship between lysine and pellagra, but more research is necessary to support this claim. The neurological symptoms are most likely due to pyridoxine deficiency.
It is prevalent in populations for whom corn, which is devoid of niacin, is the basis of the diet. Pellagra is rare in the United States, thanks to our more varied diet. When it does occur, it is most often the result of diseases that deplete the body of niacin, riboflavin, and thiamine, such as chronic gastrointestinal disturbances or alcoholism. It also can follow a long course of treatment with antibiotic isoniazid (INH, Laniazid, Nydrazid, Tubizid), which is used to treat tuberculosis. Poor and/or homeless people, recent immigrants, and individuals in special circumstances, such as repatriated prisoners of war, may be at some risk due to poor diet.
Pellagra can be either primary or secondary.
PRIMARY PELLAGRA
Primary pellagra results when the diet is extremely deficient in niacin-rich foods. A classic example occurs in geographic locations where Indian corn (maize) is the dietary staple. Maize does contain niacin, but in a form which cannot be absorbed from the intestine (except when it has been treated with alkali, as happens in the preparation of tortillas). People who rely on maize as their major food source often develop pellagra. Pellagra can also occur when a hospitalized patient, unable to eat for a very prolonged period of time, is given fluids devoid of vitamins through a needle in the vein (intra-venous or IV fluids).
SECONDARY PELLAGRA
Secondary pellagra occurs when adequate quantities of niacin are present in the diet, but other diseases or conditions interfere with its absorption and/or processing. This is seen in various diseases that cause prolonged diarrhea, with cirrhosis of the liver and alcoholism, with long-term use of the anti-tuberculosis drug called isoniazid, in patients with malignant carcinoid tumor, and in patients suffering from Hartnup disease (an inherited disorder which results in disordered absorption of amino acids from the intestine and kidney).
SYMPTOMS
The symptoms of pellagra include:
- Anxiety, Nervousness.
- Irritability.
- Difficulty sleeping.
- Depression.
- Dementia.
- Diarrhea.
- Dizziness.
- Headaches.
- Inflamed and sore red tongue.
- Loss of appetite.
- Weakness, tingling, and numbness may occur in the extremities.
- Fatigue.
- Weight loss.
- Itchy dermatitis on the hands and neck is a prominent characteristic.
Symptoms of subclinical pellagra are sometimes misinterpreted as mental illness. Disturbed or hyperactive behavior in children might signal a deficiency of niacin and other B vitamins.
Pellagra causes a variety of symptoms affecting the skin; mucous membranes (moist linings of the mouth, organs, etc.); central nervous system (including the brain and nerves); and the gastrointestinal system.
The classic collection of symptoms includes redness and swelling of the mouth and tongue, diarrhea, skin rash, and abnormal mental functioning, including memory loss.
While early patients may simply have a light skin rash, over time the skin becomes increasingly thickened, pigmented, and may slough off in places. Areas of the skin may become prone to bacterial infection. The mouth and tongue, and sometimes the vagina, become increasingly thick, swollen, and red. Abdominal pain and bloating occur, with nausea and vomiting, and bloody diarrhea to follow.
Initial mental changes appear as inability to sleep (insomnia), fatigue, and a sense of disconnectedness (apathy). These mental changes progress to memory loss, confusion, depression, and hallucinations (in which the individual sees sights or hears sounds that do not really exist).
The most severe states include stiffness of the arms and legs, with resistance to attempts to move the limbs; variations in level of consciousness; and the development of involuntary sucking and grasping motions. This collection of symptoms is called "encephalopathic syndrome."
PREVENTION
All that is needed to prevent pellagra is a diet that provides adequate amounts of niacin, thiamine, riboflavin, folic acid and vitamin B-12.
Prevention of pellagra is completely possible; what is required is either a diet adequate in niacin-rich foods, or appropriate supplementation. However, in many geographic locations in the world such foods are unavailable to the general population, and pellagra becomes an unavoidable complication of poverty.
DIAGNOSIS & TREATMENT
DIAGNOSIS
Diagnosis is purely based on the patient's collection of symptoms, together with information regarding the patient's diet. When this information points to niacin deficiency, replacement is started, and the diagnosis is then partly made by evaluating the patient's response to increased amounts of niacin. There are no chemical tests available to definitively diagnose pellagra.
CONVENTIONAL MEDICAL TREATMENT
Treatment of pellagra usually involves supplementing the individual's diet with a form of niacin called niacinamide (niacin itself in pure supplementation form causes a number of unpleasant side effects, including sensations of itching, burning, and flushing). The niacinamide can be given by mouth (orally) or by injection (when diarrhea would interfere with its absorption). The usual oral dosage is 300-500 mg each day; the usual dosage of an injection is 100-250 mg, administered two to three times each day. When pellagra has progressed to the point of the encephalopathic syndrome, a patient will require 1,000 mg of niacinamide orally, and 100-250 mg of niacinamide by injection. Once the symptoms of pellagra have subsided, a maintenance dose of niacin can be calculated, along with attempting (where possible) to make appropriate changes in the diet. Because many B-complex vitamin deficiencies occur simultaneously, patients will usually require the administration of other B-complex vitamins as well.
PROGNOSIS
Untreated pellagra will continue progressing over the course of several years, and is ultimately fatal. Often, death is due to complications from infections, massive malnutrition brought on by continuous diarrhea, blood loss due to bleeding from the gastrointestinal tract, or severe encephalopathic syndrome.
CONSIDERATIONS
Individuals with diabetes should take supplementary niacin with caution, as it can raise blood sugar levels. Long-term niacin therapy may also increase the risk of gout. At least one study has pointed out the danger of taking too much niacin, especially for elderly people. The short-term side effects of niacin overdose include:
- Flushing.
- Itching.
- Skin disorders.
Over the long term, high doses of niacin can be dangerous. Taking as little as 500 mg of niacin per day over a period of several months may result in liver damage.
RECOMMENDATIONS
Eat plenty of foods that are high in B vitamins, such as avocados, bananas, broccoli, collards, figs, legumes, nuts and seeds, peanut butter, potatoes, prunes, tomatoes, and whole grain or enriched bread and cereal.
Include in the diet halibut, salmon, sunflower seeds, swordfish, tuna, and white skinless breast of chicken and turkey. These foods are good sources of the amino acid tryptophan, which is converted into niacin in the body.
NUTRITIONAL SUPPLEMENTS
Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.
NUTRIENTS Supplement Suggested Dosage Comments Essential Vitamin B Complex 100 mg daily. Amounts of individual vitamins in a complex will vary. All B vitamins are needed to correct deficiencies. B Vitamins work best when taken together. Sublingual forms are recommended. Injections under a health care provider's supervision may be necessary. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure.
Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs,
Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps,
PABA / Para-Aminobenzoic Acid, NOW Foods, 500 mg, 100 CapsVitamin B-1 (Thiamine) 50 mg 3 times daily, with meals. All B vitamins are needed to correct deficiencies. B vitamins work best when taken together.
Vitamin B-1 (Thiamine HCl), 100% Natural, 100 mg, 100 Caps
Vitamin B-1 (thiamine) is the precursor to the active metabolite thiamin diphosphate, which is essential for the conversion of glucose into energy.Vitamin B-2 (Riboflavin) 50 mg 3 times daily, with meals. All B vitamins are needed to correct deficiencies. B vitamins work best when taken together.
Vitamin B-2 (Riboflavin), 100% Natural, 100 mg, 100 Caps
Vitamin B-2 (riboflavin) is a precursor to coenzymes involved in the growth and repair of skin and tissues lining the gastrointestinal tract, as well as the synthesis of amino acids.Vitamin B-3 (Niacin / Niacinamide) 100 mg daily. Do not exceed this amount. All B vitamins are needed to correct deficiencies. B vitamins work best when taken together. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure.
NAD (Niacin), NOW Foods, 25 mg, 60 Lozenges
Vitamin B-3 (niacin) is widely regarded as one of the most effective nutrients in elevating mood, overcoming moderate depression and fighting the effects of fatigue. NOW's NAD complex is a highly effective and genuinely unique form of Vitamin B-3 that shares many of the same qualities as NADH at a fraction of the cost. In addition to its mood enhancing properties, NAD is being studied with regards to its positive effects on naturally increasing the brain's levels of dopamine, a neurotransmitter essential to brain health as we age.
Niacinamide, Non-Flushing Niacin, 100% Natural Vitamin B-3, Nature's Way, 500 mg, 100 Caps
The benefits of Niacin without the discomforts associated with a Niacin flush. Nature's Way Niacinamide is 100% natural.
Niacin Supplement (Vitamin B-3), 100% Natural, Nature's Way, 100 mg, 100 Caps
Niacin or vitamin B-3, is necessary for normal breakdown of fats and fatty acids and the release of energy from carbohydrates. It is also an excellent vasodilator and may be useful in maintaining proper cholesterol levels.
Flush Free Niacin, NOW Foods, 250 mg, 90 VCaps
This flush free Niacin is formulated to avoid Niacin flush, a red tingly rash.Vitamin B-6 (Pyridoxine) 50 mg 3 times daily. To correct deficiencies. B Vitamins must be replenished daily.
Vitamin B-6 (Pyridoxine), 100 mg, 100 CapsPlus
Vitamin B-121,000 mcg twice daily on an empty stomach. Injections: 1 cc twice weekly, or as prescribed by a health care provider. To prevent anemia and needed in tissue repair. To correct deficiencies. B Vitamins must be replenished daily. Injections (under a health care provider's supervision) are best. If injections are not available, use a lozenge, sublingual, or spray form.
Vitamin B-12 Complex Liquid, NOW Foods, 2 fl. oz.,
Vitamin B-12, Nature's Way, 2000 mcg, 100 Sublingual Lozenges,
Vitamin B-12 Liquid Supplement, 50 mcg, With Vitamin B-9 (Folic Acid), 400 mcg, 1 oz.
Vitamin B-12, California Natural, 1000 mcg, 60 Tabs,
Vitamin B-12 LipoSpray, NOW Foods, 2 fl. oz.,Folic Acid 400 mcg daily. To correct deficiencies.
Folic Acid (Vitamin B-9), 100% Natural, Nature's Way, 800 mcg, 100 CapsBrewer's Yeast As directed on label. A good source of B vitamins and other important nutrients to correct deficiencies.
Brewers Yeast, NOW Foods, 650 mg, 200 TabsPlus
Raw Liver ExtractAs directed on label. A good source of B vitamins and iron. Consider injections (under a health care provider's supervision).
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