Showing posts with label niacin. Show all posts
Showing posts with label niacin. Show all posts

Causes of Pellagra disease (niacin deficiency)

› › Causes of pellagra disease

Causes of pellagra disease are or malabsorption of niacin (vitamin B3), and/or tryptophan (an essential amino acid). Depending on the formative factors pellagra may be primary or secondary.

Primary pellagra

Primary pellagra is the acute nutritional deficiency of niacin and/or tryptophan in the diet in freely available form.
Vitamin B3 (niacin, nicotinamide or nicotinic acid) deficiency causes pellagra disease

The deficit of vitamin B3 deranges all cellular functions and all biochemical mechanisms of the body systems go haywire and leads to the resultant debilitating symptoms. These causes of the disease are primary. Poor people are generally under nourished and their food may not include vitamin B3 and protein rich foods like organ meat, poultry, egg, milk, yeast etc..

This borderline deficiency leads to pellagra in them when there is a slight slide in their health. Populations, who depend mainly on maize as staple food tend to develop pellagra.
Maize food has niacin in biologically unavailable forms and causes pellagra disease.

Earlier populations boiled maize with lime before eating and it is found that this process makes niacin biologically available. People in low income groups, prisoners, people affected by famine and refugees are in the risk group. These people are to be monitored for symptoms of deficit and are to be helped with supplementation of vitamins.

Tryptophan (an essential amino acid) deficiency causes pellagra

Human body can produce vitamin B3 from the amino acid tryptophan.
Tryptophan is one of the amino acids which human body cannot synthesize and hence it is called as an essential amino acid. It has to be sourced only from food. The deficiency of tryptophan in diet causes pellagra disease.

Food of animal sources has sufficient levels of tryptophan.
In the food of plant origin tryptophan is available in nuts especially groundnuts and also in various beans.
Vegan food habit causes this malady. Vegans who do not include beans and nuts in their food are in the risk group.

Secondary pellagra disease causes
In a number of situations vitamin B3 may be present in available form and in sufficient quantities in the food. However extraneous factors lead to pellagra.
The presence of other diseases, assimilation disorders, utilization disorders and altered biosynthesis processes in the body may give rise to pellagra symptoms.

Leucine (an essential amino acid) can precipitate pellagra if present in high concentrations in the diet
People who frequently eat millet (sorghum or jowar) and whose staple food is millet are found to be affected by pellagra disease.
Millet contains both niacin and tryptophan. The causes of pellagra in millet eating populations are found to be the excessive leucine availability in millet and its interference in tryptophan metabolism and in the subsequent synthesis of niacin.

Chronic diarrhea causes pellagra

Chronic diarrhea, if not diagnosed and treated may lead to pellagra. As the individual's digestion and absorption mechanism gets affected in chronic diarrhea nutritional deficiency and dehydration sets in. This is not only the precipitating factor for pellagra but also many deficiency complications.

Elderly people are prone to develop pellagra
Elderly people's digestive system slowly gets impaired and the digestion and assimilation process slows down. Their condition is to be monitored closely and niacin and other vitamin supplements are to given. They are in the risk group of developing vitamin B3 deficiency.

Impaired digestion and gastrointestinal disorders causes pellagra

Persons with impaired digestive systems, celiac disease and tropical sprue develop nutritional deficiencies.They are prone to get deficit of vitamin B3.

Chronic alcoholism causes pellagra disease
Alcoholics due to their careless and erratic food habits, may not eat . The absorption and utilization of the niacin also gets affected in the alcoholics and they are prone to develop vitamin B3 deficiency.

Anorexia nervosa and pellagra
Anorexia nervosa, is a mental illness in which the patient suffers from low body weight. He evaluates himself to be overweight and starves himself with an obsessive fear of putting on weight.

In this mental disorder apart from starving, the patient may also exercise excessively and follow weight control measures. This naturally leads to nicotinic acid deficiency. Vit. B3 deficit leads to production of hunger suppressing endorphins and lack of appetite. The patient may develop skin and early psychiatric symptoms.

Carcinoid syndrome and pellagra

Carcinoid tumors are malignant tumors occurring on the intestinal wall and lungs. In these patients tryptophan is excessively converted into serotonin. This altered protein metabolism results in negligible niacin synthesis and causes this disease.

Hartup disease and pellagra
Hartups disease is a genetic autosomal disease caused by recessive trait. This impairs absorption of tryptophan in the intestines as well as kidneys. Very little amounts of tryptophan is absorbed in the intestines and excess of tryptophan is lost in the excretion. With this, there is no conversion of tryptophan into niacin and hence its deficiency disease.

Certain drugs and medications causes pellagra
The production of niacin from tryptophan depends on a co enzyme which is derived from vitamin B6. Isoniazid (used in the treatment of tuberculosis) and 3-mercaptopurine (used in the treatment of leukemia interfere with the metabolism of vitamin B6 and causes nicotinamide deficit. Some medications like chloramphenicol, hydantoins, phenobarbital, pyrazinamide and 5-fluorouracil have been found to become causes of nicotinamide deficiency disease.

Certain diseases and health conditions causes nicotinamide deficiency

Patients with liver cirrhosis, chronic ulcerative colitis, prolonged febrile illness, diabetes mellitus, AIDS, patients on intravenous fluids and patients on maintenance haemodialysis are prone to develop it. Liver cirrhosis, if untreated causes pellagra.
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pellagra disease (niacin deficiency) - diagnosis, treatment and prevention

› › Diagnosis, treatment and prevention of pellagra disease

Diagnosis of pellagra disease (niacin deficiency) is very difficult, whereas its treatment and prevention are simple.

Diagnosis of pellagra

For diagnosis of pellagra, earlier we had to rely on the symptoms narrated by the patient, signs observed and the nutritional deficiency status and diet of the patient.
In the early stages fewer of the niacin deficiency signs may be present and it becomes very difficult for the diagnosis of pellagra.
It will be easier for diagnosis and confirmation of the presence of pellagra disease, if all the three "D" symptoms (dermatitis, diarrhea and dementia) are present.
Nowadays the diagnosis can be confirmed by the measurement of excretion of N-methylnicotinamide per day in urine and treatment can be started.
However the facilities may not be easily available for the analysis and diagnosis in the developing and underdeveloped countries to start pellagra treatment with niacin supplements to remove deficiency.
If the patient has some of the signs and symptoms of pellagra the following steps may help in treatment and prevention.
The first step in diagnosis, treatment and prevention is to find out whether the patient is coming from pellagra prevalent region with niacin deficiency.
Next step in diagnosis and prevention is to ascertain the patient's food habits and find out whether maize is his staple food.
Persons afflicted by pellagra disease generally appear weak, underweight and poorly nourished.
It has to be ascertained whether the patient has dermatitis, diarrhea or dementia and nervous impairment.
Therapeutic doses of nicotinamide may be given for a few days to investigate for improvement in the condition.
If the disease is pellagra there will be marked improvement and the diagnosis of the disease is complete and treatment can be started.
Low serum levels of niacin and tryptophan may also confirm the disease and treatment can be started.
Low levels of pyridone and N-methylnicotinamide in urine can be due to niacin deficiency confirming the diagnosis for pellagra.
If less than 1.5mg of these organic compounds are excreted in a day, diagnosis of severe niacin deficiency is confirmed and immediate treatment is required.
The presence of three "Ds" (dermatitis, diarrhea and dementia) confirms the diagnosis of pellagra disease.
Dermatitis in pellagra patients has a characteristic appearance.
The exposed regions of the skin to sunlight get inflamed and red in appearance initially with marked margin with the unexposed skin.
This is a clear cut diagnosis of pellagra.
The swelling of tongue and mouth and oral sores also help in the diagnosis.
The chronic diarrhea and bleeding from intestine also help in diagnosis and treatment.
Symptoms like diminished sensitivity to touch, irritability, and tremor help in diagnosis.

Treatment for pellagra disease

If the patient is fairly in the advanced stage of pellagra, hospitalisation is required for of acute niacin deficiency.
Patient with milder symptoms may undergo treatment at home for niacin deficiency.
Patients with dementia are preferably given treatment at hospital for prevention of complications with niacin deficiency.
Oral administration of nicotinamide or nicotinic acid helps in the reversal of symptoms of niacin deficiency.
The exact dosage will be recommended by physician considering the stage of the disease and the age and weight of the patients.
Persons who are comatose, uncooperative or with severe swelling and blocking of the mouth may be given injections of vitamin B3 to resolve niacin deficiency.
For patients with dementia and severe pain tranquilizers may be given.
Anti-inflammatory antibiotic creams must be applied to skin conditions till the niacin deficiency resolves.
During treatment, prevention to exposure to sunlight is very important.
There can be dramatic change and healing after a few days of treatment for niacin deficiency.
With the treatment dermatitis slowly disappears, the gastrointestinal inflammation goes and the patient will be able to eat.
The neurological disorders slowly disappear and the patient becomes normal.
As the pellagra afflicted person will be malnourished, he should be given easily digestible protein rich, well followed by multivitamin supplement.
Though the primary pellagra responds well to treatment the secondary pellagra disease is harder because of the causes for its occurrence.

Prevention of pellagra disease

In the maize eating population relying on maize only as staple food has to be discouraged and addition of other cereals has to be encouraged for prevention of pellagra disease, affecting populations as a whole.
An inducement and requirement to fortify milled maize flour with niacin must be emphasised and regulated for prevention of pellagra.
For the prevention of nutritional deficiency caused diseases, it is very important to have diversity in the food consumed.
Food from animal sources like milk, egg, meat and fish is rich in vitamin B complex and tryptophan and this resource is to be included in daily consumption for prevention of deficiency.
Niacin rich plant food like nuts especially groundnuts must be included in diet for prevention deficiency and pellagra.
Prisoners, refugees and famine affected may not have and protein rich food and they are to be given nicotinamide supplements for prevention of pellagra disease.
Education on nutrition must be emphasised to spread awareness among people for prevention of Pellagra disease.
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Niacin flush - side effects - cholesterol control

Home > Niacin flush side effects during cholesterol control
Benefits of niacin like increase in good cholesterol and lipid management and control outnumber its side effects - niacin flush.

Niacin, when taken for cholesterol control, in its nicotinic acid form causes reactions which are called 'niacin flush'. The necessity and benefits of niacin in nutrition are well known.
There are other uses of niacin in achieving good health. Niacin, though in its nicotinic acid form has been found to control cholesterol.

Dyslipidemia

Dyslipidemia is the disorder of blood lipid levels. Usually dyslipidemia occurs as an elevation of lipid levels in the blood and is hyperlipidemia .
This increase and the lack of cholesterol control is due to many factors like genes, food habits, malnutrition and lifestyle. The side effects of chronic high levels of insulin is dyslipidemia.

Benefits of niacin in control of cholesterol

To reduce the blood serum lipids there are cholesterol control ways like exercise, regulated diet and medication.
Nicotinic acid helps in the regulation of lipid levels.
Niacin is very effective in lowering triglycerides, serum lipids and in low density cholesterol.
Niacin doses of 500 mg, 1000 mg and even 2 gm are prescribed for lipid control.
In high doses,though there is flush and side effects, serum levels of both 'very low density lipoprotein' (VLDL) and 'low density lipoprotein' (LDL) are reduced and the serum level of 'high density lipoprotein' (HDL) is increased with control of cholesterol .
Clinical trials have demonstrated that nicotinic acid effectively controls progress of atherosclerosis (fat deposits in arteries) and cardiovascular disease.
However it has these very unpleasant side effects.

Causes, signs and symptoms of niacin flush

Cutaneous reddening and pruritus (itch) are side effects of taking higher doses of nicotinic acid in cholesterol control.
Nicotinic acid adverse reactions occurs within 30 minutes of ingestion of the tablet, causing cutaneous reddening of face and neck and trunk.
Side effects like gastrointestinal upset, headache, warmth, tingling and itching of face and the trunk may also occur during flush.
There can be pricking and itching sensations on the body during the side effects.
Particularly the areas of the body which are covered by the dress show more adverse reactions like pricking sensations during the flush.
The side effects are due to dilation of the capillaries in the skin and greater blood flow to the skin.
Earlier it was believed that histamine was the cause of it. However it was found that histamine was not involved in the reactions.
It is found that Prostaglandin is the prime cause for inducing the adverse reactions like flush during cholesterol control; serotonin also has a role in the reactions.
These nicotinic acid symptoms and side effects last for about an hour and then they subside.

Treatment and remedies for niacin flush

Though niacin flush is harmless the severity of the symptoms sometimes deter people from continuing taking niacin effective cholesterol is not achieved.
The symptoms and side effects of 'niacin flush' usually subside after 60 minutes. Tolerance to nicotinic acid develops slowly and the reactions also usually taper off.
It is advised to take two to four split doses to reduce adverse reactions.
It is advised not to do exercise immediately after taking the tablets.
Starting the niacin dosage at low levels and gradually increasing it over a period of time may prevent the severity of side effects.
If there is a break in this treatment for cholesterol control, it is advised to go back to initial low doses and gradually increase it to avoid recurrence of severe side effects.
Taking aspirin or ibuprofen 30 minutes before taking niacin tablet helps in preventing it.
However as these drugs are notorious for stomach irritation and bleeding consult your healthcare provider about the dosage and suitability.
Taking hot beverages or alcohol around the time of niacin consumption may cause severity in these side effects.
Take niacin tablet along with food so that absorption will be slower and may reduce it.
Drinking up to 250 ml of water dilutes the vitamin and adverse reactions  are reduced.
If there are any indications of the start of flush, immediately take plenty of water to stop or to control it.

Say no to 'flush free' or no-flush' niacin

Inositol hexanicotinate is a very efficient vitamin B3 supplement. This vitamin B3 form is being branded and sold as 'flush free' and 'no flush' niacin.
This product is available in 200mg, 500mg and 1000mg strengths as reaction free tablets over the counter. They are only vitamin supplements.
Though it does not cause side effects, cholesterol reduction is not achieved and the purpose is not achieved.
Experiments have proved that, this 'no flush' vitamin B3 has no effects and there is no niacin reactions.
Nicotinamide and niacinamide also are not useful in cholesterol control and hypercholesterolemia management and do not cause side reactions.
The addition of amide group inhibits niacin reactions and vasodilation.
So there is no cholesterol control, no reactions and no side effects.
So the best way is to get around niacin reactions with precautions and control cholesterol for our healthy life.
Related topics:
Pellagra disease
Causes
Symptoms
Diagnosis-Treatment
Dr Joseph Goldberger

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