Pellagra

Pellagra General Information

Pellagra is a serious medical condition caused by the deficiency of a nutrient known as nicotinic acid or niacin (vitamin B3), part of the B-complex vitamins. This vitamin plays a crucial role in the respiration of cells. The dietary lack of proteins, especially those that contain an essential amino acid called tryptophan can lead to this vitamin deficiency. In the human organism, tryptophan is easily converted into vitamin B3 and this is why doctors advise us to consume foods rich in tryptophan, but without niacin, for example meat, milk, fish, poultry, eggs and other similar products. The fresh vegetables, whole-grain cereals, yeast and breads are rich in niacin. But this amino acid is not always converted into the respective vitamin; dietary tryptophan may be used in the production of proteins and then the deficiency of vitamin B3 can still result.

Pellagra affects more often people who live in China, Mexico, Africa and Indonesia. In these societies, the patients are all very poor, suffer from alcohol addiction, have no where to live and some of them are psychiatric patients who refuse to eat healthy food. Also, Pellagra appears in parts of the world where people’s diet is basically based on consuming corn. The necessity of consuming this vitamin in order to prevent this medical condition varies with size, gender, age and level of activity of the respective individual. An infant may need 5-6 mg of niacin/day, while adults should have in their diet each day at least 30 mg of niacin.

Pellagra Symptoms

The signs and symptoms specific for this vitamin deficiency called Pellagra vary in intensity from mild to severe ones and depend on the health status, age and sex of the patient. The four main manifestations of this medical condition are easily remembered as “the four D’s”: dermatitis, diarrhea, dementia and finally, death. We will present you a list of the most important signs and symptoms that characterize this medical disorder: aggression, weakness, tiredness, insomnia, high sensitivity to intense sunlight, diarrhea, red lesions visible with the eye on the surface of the skin, alopecia (the loss of hair), mental confusion, dermatitis, edema, peripheral neuritis, ataxia, smooth pink glossitis, dementia and paralysis of extremities. Pellagra may also provoke some psychological manifestations, for example: emotional disturbances; psycho-sensory disturbances, for example dizziness after a sudden movement, nausea and vomiting provoked by intolerance to certain odors, impressions of pain etc; other common symptoms of this disorder include the presence of psycho-motor disturbances, such as increased preparations for motor actions, desire to quarrel, restlessness, and tension.

Scientists affirm that there are two forms of Pellagra. The primary form of the disease is a result of a very poor diet in foods that are rich in niacin. This is usually encountered in India where people consume maize in a form that can hardly be absorbed by the intestines. The secondary form of this disease appears when the patient consumes adequate quantities of vitamin B3, but he suffers from different illnesses that interfere in the absorption and processing of this vitamin, for example alcoholism, malignant carcinoid tumors or Hartnup disease.

Pellagra Treatment

Pellagra is not very easy to detect. But the diagnosis is usually based on the signs and symptoms specific for this medical condition and on the information about the patient’s daily diet. As soon as you start complaining of any of the signs and symptoms listed above, we strongly advise you to call your health care provider and establish a date for the examination. It is extremely important for the patient’s general health that this disease is diagnosed and treated properly in time. Once the niacin deficiency is clear, the health care provider can proceed with a replacement therapy. The diagnosis is easily evaluated after the patient’s response to the therapy with increased amounts of vitamin B3. This is necessary because there are no chemical exams that show if the patient is indeed suffering from Pellagra. This vitamin deficiency is very dangerous for the individual’s life. Without being detected in time and without the right treatment, this disorder can kill the person in a matter of five or six years. Every treatment includes doses of Niacinamide. The amount of this supplement depends on the progress of the disease in every patient. Niacin is never administrated itself because it can cause several unpleasant side effects, for example sensations of burning, itching or flushing. Niacinamide can be given orally (by mouth) or IV (intravenous, by injection), in the case that diarrhea interferes with the absorption of the medicine. Usually, an oral dose is around 400-600 mg of Niacinamide per day, while the injections have only 150-250 mg, given for at least three times a day. 

In the cases that Pellagra advances to a more critical stage, these doses must be quickly increased. If the patient reaches to the point of encephalopathic syndrome, he will receive 1000 mg of niacinamide by mouth and 200-300 mg by injection. If the signs and symptoms of this medical disorder are gone or become milder, the treatment must still be maintained and calculated and the health care provider must also try to make the right and necessary changes in his/her patient’s diet. Sometimes, the majority of B-complex deficiencies appear simultaneously and then the patient will need administrations of other vitamins from the B-complex as well. Pellagra is a disease that progresses rapidly over the years if the adequate treatment is not received and always becomes fatal. But death can also occur as a complication from severe encephalopathic syndrome, important blood loss due to gastrointestinal tract hemorrhage, severe malnutrition caused by continuous diarrhea or infections. Pellagra can be very easily prevented. The people who live in sites where this disorder is very often met should be informed about the importance of a diet rich in many foods containing important amounts of niacin. Supplementation is also a very important factor in fighting against this vitamin deficiency that is so dangerous for a person’s life. In the geographic locations in the world where people are too poor to afford a change of their diet, this medical condition can not be avoided and death often occurs.