Dementia or Pellagra? Niacin Deficiency in the 21st Century
First and foremost, the word PELLAGRA refers to a severe niacin deficiency. And quite honestly, this post could have easily been titled “ADHD or Pellagra?” or “Alopecia or Pellagra?” or “High Cholesterol or Pellagra?” or even “Violent Tendencies or Pellagra?”!! Okay, that all may seem over the top, but the truth is that niacin is responsible for so many functions within the human body that the consequences of not having enough of it are incredibly far-reaching. So, rather than attempt to cover the why and how of every niacin-deficiency-based issue, I’m going to try to provide a basic overview, with an emphasis on dementia toward the end.
A bit about niacin
Niacin is an extremely small molecule that plays a role in over 500 biochemical reactions within the human body. It was originally named “nicotinic acid” but that was changed due to concern that it would be confused with nicotine in cigarettes. It is also termed Vitamin B3 although it is argued that it better resembles an amino acid than a vitamin. This is because niacin can be manufactured by the human body from the amino acid tryptophan which is obtained from foods like cheese, turkey, fish, peanuts, whey and eggs.
What happens when our body lacks niacin?
Pellagra is a serious condition resulting from a deficiency of Vitamin B3 (niacin) and characterized by issues of the skin, the digestive system and the nervous system. It was epidemic in the early 20th century, especially among the poor in the southern United States. Overconsumption of corn seemed to be the cause, as corn contains niacin that the human body cannot digest. In order to make it bioavailable to our cells it must be soaked in an alkaline solution prior to cooking and eating, as the Mexicans do when preparing traditional corn tortillas (as a result, pellagra was unheard of within the Mexican population at that time).
So pellagra may not sound like a modern-day malady, but, for various reasons not necessarily having to do with corn consumption, it is alive and well in the 21st century. We are a malnourished culture, deficient in lots of important nutrients, and niacin is but one of them. We don’t lack food, but our food does lack nutrition. Then when you add impaired digestion, aging and high amounts of stress to the equation, we’ve really got a recipe for health-impairing nutritional deficiencies.
Niacin deficiency in today’s world.
So as I stated above, pellagra, as well as less severe cases along the continuum of niacin deficiency, can be seen in our society today due in part to processed food, impaired digestion and aging. Alcohol and cigarette use or the presence of diabetes or heart disease may also increase vulnerability to niacin deficiency.
Today niacin deficiency may be easily misdiagnosed (or simply not diagnosed) allowing the focus to remain on treating what may be considered “mysterious” symptoms with a plethora of pharmaceutical drugs rather than getting to the root of the issue. Nutritional deficiencies like this are the reason we are plagued with chronic illness despite living longer lives. The sad part is that these conditions often could be reversed or avoided altogether simply through the addition of specific nutrients, like Vitamin B3 (niacin) into our health regimen.
Check out some of the symptoms of pellagra . . .
The full manifestation of pellagra, or niacin deficiency, is often marked by “the 3 D’s”: dermatitis, diarrhea, and dementia. If pellagra remains untreated, a “4th D” comes into play, and that is death.
First, those lacking niacin can develop severe sun sensitivity. The skin develops a thick, dark rash when exposed to the sun. “Pellagra” is actually derived from “pelle agra,” the Italian phrase for rough or raw skin. Digestive symptoms that may accompany the skin issues include an inflamed mouth and tongue (the tongue often presents as bright red), vomiting, constipation, stomach pain and diarrhea. These digestive effects, especially diarrhea, can contribute to a vicious cycle of malnutrition simply because food doesn’t have time to be fully processed in the body. Finally, neurological symptoms of headache, fatigue, depression, disorientation, and memory loss can manifest. So you can see how this can become a very serious deficiency. That said, it’s important to note that the symptoms of pellagra can vary quite a bit, so the “3 D’s” are merely guidelines.
What about minor deficiencies?
The concern for our modern society revolves around more of a “subclinical” deficiency issue, meaning that niacin levels are not necessarily at pellagra levels, but they are low enough to cause subtle functional issues for the individual. Things like anxiety, ADHD, depression, even hallucinations can be caused by a simple niacin deficiency. Dementia, Alzheimer’s Disease and schizophrenia have been successfully treated with niacin therapy in some cases. In fact, there are physicians out there who believe that schizophrenia is pellagra! Despite that, the practice of correcting nutritional deficiencies to improve neurologic symptoms, which was very common up until the 1940s, has been pushed out of most psychiatry in favor of antipsychotic drugs at this point in time. Thankfully, the benefits of nutrient supplementation in modern medicine (termed “Orthomolecular Medicine”) is is being revisited as of late due to the positive results of many current scientific studies.
Check out the following excerpt from Dr. Joseph Mercola’s 2012 interview with Dr. Andrew Saul on the subject of niacin and schizophrenia on Mercola.com:
When vitamin B3 or niacin was first added as an enrichment or as a fortification to flour, about half of the people in mental institutions went home. This is not a well-known fact. They were there not because they were mentally ill – because of genetic, environment, or social reasons – but because they were malnourished… He wondered about the half that didn’t go home.
What about the people that had a little bit of niacin, but didn’t get better? … [H]e started giving what at the time were preposterously high doses of niacin: 3,000 milligrams a day. And he was curing schizophrenia in 80 percent of the cases.
This is astonishing. The cure rate for schizophrenia with drug therapy is not particularly good. Dr. Hoffer saw again and again that niacin worked. Then he studied it, did the placebo-controlled, double-blind test, and started writing paper after paper on this. At that point, the American Psychiatric Association literally blacklisted him.
Dr. Saul goes on to point out that an individual can often tell if niacin will help in just a few hours after use. People with anxiety, depression, even schizophrenia will potentially feel better shortly after taking it.
Niacin and Dementia
As we age we begin to experience the cumulative effects of any continued malnourishment. In other words, if, for most of our life, we were not getting the necessary nutrients from our diet or supplement regimen, this likely begins to show itself in the form of mental and physical degradation. These changes over a period years may be subtle, but significant nonetheless. Sometimes this degradation can include dementia in one form or another. Most of the time, aside from medications to mitigate the symptoms, we feel there is nothing we can do to reverse or stop the progression of dementia. Interestingly though, dementia that occurs as a result of pellagra looks much like Alzheimer’s Disease. The aggression, apathy, confusion, depression, disorientation, hallucinations, insomnia, psychosis, and seizures that can occur with Alzheimer’s is also symptomatic of pellagra. So it turns out that niacin is a small but very important piece of the entire puzzle when it comes to mental health.
What does science think?
Several studies have been completed over the years that prove niacin to be protective against Alzheimer’s Disease, dementia and cognitive decline. One 2004 study spanning 9 years and using 6158 subjects aged 65 and older showed that higher food intake of niacin was associated with slower cognitive decline (Morris, MC et al). Decades before that, Aring and Spies reported that early Alzheimer’s-Disease-like symptoms including fatigue, nervousness, insomnia, unrest and anxiety, among others, were corrected by supplementing with 300 to 600 mg of niacin every day for 1-12 days (3-6 pills, with each pill providing 100 mg of niacin). So we have data suggesting niacin is potentially protective and corrective. That’s certainly good news!
The takeaway: Niacin supplementation
There are several forms of niacin out there, each with its own set of actions and idiosyncrasies, so to speak. Check out the following chart adopted from Niacin: The Real Story by Abram Hoffer, Andrew W. Saul and Harold D. Foster for a clearer picture of the differences:
A good rule of thumb with any vitamin is to take the smallest amount of it that gives you the greatest results. I always suggest starting any supplemental nutrient regimen very slowly and deliberately, and increasing as time goes on. Every one of us is biochemically unique so, although we all need the same nutritional tools to allow our bodies to function well, we don’t all need the same amount of these tools.
For a maintenance dose of niacin, 50 mg per day or even slightly less is fine. If you are dealing with cognitive decline or another targeted issue like cholesterol management, increasing that amount to more therapeutic levels will be helpful. So, 50-600 mg per day is acceptable though still much lower than that used by Dr. Abram Hoffer. His recommended therapeutic dose is 3,000 mg daily and, although I am not in disagreement with using such high levels of niacin, I suggest you refer to his book “Niacin: The Real Story”, which is a much more comprehensive resource than this short blog post, for more information prior to beginning such a megadosing regimen.
Regardless of the dose of niacin that you choose, divide it into thirds to be taken with each of three meals. Reason being, niacin is a water-soluble vitamin so it will exit the body rather easily throughout the day. Multiple doses assure it will remain effective and that the pipeline will continue to be full.
As far as how long one should take niacin, that depends on the specific needs and circumstances of each individual. While one person may notice improvement in just a few days, another may need several months to enjoy the optimum effects of niacin.
You should never continue to take levels of niacin that are making you nauseous. That is the sign that you have reached your upper limit and should reduce your intake immediately. And, although niacin is not toxic to the liver, keep in mind that, at high levels, it will cause elevations on liver function tests meaning only that your liver is working, not that it is diseased.
There are some contraindications and drug interactions involving niacin, so please CLICK HERE TO VIEW NIACIN INTERACTIONS.
One final bit of important information . . .
So you begin to take niacin and all of a sudden you feel like your face is on fire!!
You may know of, or perhaps you yourself have experienced, the side effect of niacin – the red, hot sensation on your face, arms and chest that usually lasts for a 15-30 minutes (or more, in some cases) after taking it, termed the “Niacin Flush”. This can occur initially with niacin supplementation even as low as 30 mg/day and is the most common reason for its discontinuation by the user. Although this flushing feeling can be quite disconcerting, it’s nothing to be concerned about. The niacin triggers certain molecules that cause blood vessel dilation and histamine release in the skin which, in turn, leads to flushing. This reaction is very common, especially when you first begin to take niacin. Again, it is not dangerous and usually ceases to occur after a couple of weeks of niacin supplementation. (Interesting to note is that those with schizophrenia tend not to experience the niacin flush!)
The good news is that there various ways for you to avoid “the flush”. You can supplement with inositol hexaniacinate along with the niacin. Or you can take niacinamide, a form of niacin that is equally as beneficial but doesn’t cause flushing. [Refer to the chart above for data on the various forms of niacin] Otherwise, the best way to rid yourself of the flush forever is to continue taking niacin so that the histamine can completely exit the body, stopping the vasodilation.
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Sue Hughes, MSEd, HHP, CNC
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