Gastrointestinal Bleeding, Occult: definition

What Is Vitamin B3 (Niacin)?

[dropcap]N iacin is an essential water-soluble B vitamin that is required by all cells of the body.

During digestion of food containing it, niacin (the form in food) is changed in the small intestines to the active form niacinamide (niacin plus an amide group), which is then absorbed into the bloodstream. 

Niacinamide is converted by the body into co-enzymes which are present in all cells. These are niacinimide adenine dinucleotide (NAD) and NADP. NADP is formed when the body adds a phosphate to NAD.

Q: How do these enzymes work?

A: These enzymes function in oxidation-reduction reactions essential for release of energy from carbohydrates, fats, and proteins and are needed as components for more than 200 enzymes involved in metabolism.

In addition to producing energy, niacinamide is essential for healthy skin and the mucosal lining of the digestive tract, normal functioning of the brain and nervous system, and production of steroid hormones in adrenal glands and hormones in sex glands.  Functions are more fully described below.

Urinary excretion of niacin cannot be detected when vitamin intake is below the required levels. On the other hand, when intake exceeds saturation in the body, the vitamin and/or its metabolites are actively excreted into urine to prevent excessive toxicity of the vitamins.¹

What Is Niacin Deficiency In Celiac Disease and/or Gluten Sensitivity?

• Relationship between niacin deficiency and celiac disease. Niacin deficiency is a symptom of celiac disease that results when the level within cells is too low to meet needs of the body for this vitamin which is caused by malabsorption.
• Relationship between niacin deficiency and features. Niacin deficiency is characterized by these features: 1) impaired metabolism of foodstuffs for energy; 2) health of oral, esophageal, and gut mucous membranes; 3) production of adrenal steroid hormones; 4) production of the sex hormones estrogen, progesterone and testosterone due to failure to build sterols and fatty acids as required; and 5) altered brain and nerve function due to their failed high energy needs.
• Relationship between niacin deficiency and other nutrients. Deficiencies of thiamin (vitamin B1), riboflavin (vitamin B2), and pyridoxine (vitamin B6) commonly accompany or can cause niacinamide deficiency.

How Prevalent Is Niacin Deficiency in Celiac Disease?

Niacin deficiency is common in patients with untreated celiac disease.²

What Are The Symptoms Of Niacin Deficiency?

Early niacinamide deficiency includes these symptoms:

• Weakness.
• Loss of appetite.
• Distorted taste.
• Indigestion.
• Burning of mouth, throat and esophagus.
• Abdominal discomfort and distention.

Followed by these later symptoms:

• Nausea.
• Vomiting.
• Diarrhea.
• Dizziness.
• Cracking and scaling skin that blisters.
• Poor memory.
• Change in intellect or reasoning.
• Headache.
• Anxiety.
• Apathy.
• Depression.
• Tremors.
• Urinary discomfort.
• Non-infectious vaginitis in females.

Severe deficiency causes the disease called pellagra, which is characterized by the classic 3 D’s (dermatitis, dementia, and diarrhea):

• Dermatitis: worsening redness followed by blisters, crusting and peeling of skin in sun exposed areas, itching, red, wet areas from chafing such as under breasts, in the groin area and armpits, and inflammation of vagina and urethra, deeply pigmented areas over bony prominences such as elbows, scarlet, swollen tongue, and sore mouth;

• Dementia: worsening memory impairment, disorientation, confabulation, and hallucination;

• Diarrhea: watery which may become bloody from ulceration. Other signs are cogwheel rigidity of extremities and sore (black) tongue. Pellagra untreated progresses to death.

 

 

How Does The Body Get Niacin?

• Niacin is obtained from the diet.
• Dietary niacin must be digested to release the absorbable forms, niacinamide and nicotinic acid which are absorbed from the small intestine by carrier-mediated facilitated diffusion.³
• Extra niacin is stored by the liver.
• Niacin can be made by the body from tryptophan (amino acid), although with low efficiency because conversion of tryptophan to niacin requires adequate levels of tryptophan and adequate levels of co-factors iron, riboflavin, and vitamin B6. Tryptophan-to-niacin conversion can easily be subverted if tryptophan itself, or the co-factors are deficient. Lack of tryptophan is due to avoiding foods that are rich in tryptophan, such as eggs and meat.

What Does Niacin Do In The Body?

• Essential for energy production from foodstuffs.
• Required as part of an enzyme to convert met-hemoglobin (which is not able to carry oxygen) to hemoglobin (which properly does carry oxygen in blood).
• Acts in the enzyme form NAD (nicotinamide adenine dinucleotide) to accept electrons in metabolic reactions;
• Required for healthy skin.
• Required to maintain healthy mucosal lining of the digestive tract.
• Required for normal brain and nervous system function.
• Required for repair of certain key cell processes.
• Essential for production of steroid hormones at demand levels from adrenal glands. 
• Essential for production of the hormones estrogen, progesterone and testosterone from sex glands.

How Does Niacin Deficiency Develop In Celiac Disease and/or Gluten Sensitivity?

• Niacin deficiency in celiac disease results primarily from malabsorption of this vitamin due to inflammation of intestinal lining.
• Deficiencies of thiamin (vitamin B1), riboflavin (vitamin B2), and pyridoxine (vitamin B6) can cause niacinamide deficiency.
• As a consequence of low stomach acid.

Does Niacin Deficiency Respond To Gluten-Free Diet?

Yes. Celiac disease-related niacin deficiency responds quickly to a nutritious gluten free diet containing adequate niacin and other B vitamins. Supplementation may be required.

However, it was found that the nutritional composition of a gluten free diet in male and female celiac patients in Germany have inadequate nutrient intakes. The average daily micronutrient intake of male and female patients, specifically of vitamin B1, B2, B6, folic acid, magnesium and iron, was significantly lower in celiac patients. Based on these findings, regular (laboratory) monitoring of celiac patients should be recommended.⁴

6 Steps To Correct Niacin Deficiency:

• [dropcap]1 Meet, or Exceed the RDA (Recommended Dietary Allowances) for Niacin in milligrams (mg) per day:

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2 mg for infants birth-6 months; 4 mg for infants 7-12 months

10 mg for children 1-3 years

15 mg for children 4-8 years

12 mg for children 9-12 years

16 mg for teens 14-18 years

16 mg for adults 19-70 years

18 mg for pregnancy; 17 mg for breast-feeding women.[/box]

• [dropcap]2 Diet – Include Food Sources Richest in Niacin:

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Plant sources:

• Peanuts.
• Seeds.
• Almonds.
• Nutritional gluten-free yeasts.
• Lesser amounts are in mushrooms, black-eyed peas, potatoes, spinach, chestnuts, avocado, asparagus, broccoli, and brown rice.

Animal sources:

• Liver (all kinds, but beef is highest).
• Liverwurst.
• Tuna.
• Pork.
• Beef.
• Chicken.
• Trout.
• Oyster.
• Clams.[/box]

• [dropcap]3  Diet – Avoid, Limit, or Eat Separately These Foods That Deplete or Interfere With Absorption:

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• Refined sugars.
• Refined starches such as white flour used in making bread and baked goods.
• Alcohol consumption.

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• [dropcap]4 Monitor Medications That Deplete or Interfere With Absorption:

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Here are common medications that deplete niacin. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

FEMALE HORMONES disrupt intestinal permeability causing leaky gut.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete niacin and others.[/box]

• [dropcap]5 Manage Nutritional Supplements to Obtain:

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• Niacinamide is the preferred form of vitamin B3 supplementation. Other B vitamins should also be taken at the same time because these vitamins work together.
• Niacinamide has no observed toxicity for intakes up to 3,000-9,000 mg daily although this is an extreme amount that would cause the loss of minerals by excretion through the urine.
• Monitor if there is a history of gout, peptic ulcer, diabetes or liver disease.
• Natural preparations made from food are superior to synthetic ones that are chemically produced.
• Avoid any preparation that contains these harmful chemicals most of which are derived from benzene (a toxic hydrocarbon, C6H6): benzoic acid, methyparaben (found in breast cancer tissue, in eye drops it damages the eye surface), propylparaben, paraben, polyethylene glycol, propylene glycol (propanediol), polysorbate 60.

Caution: The form Niacin (nicotinic acid) may cause flushing (redness and itching of the skin around the face and neck) at doses above 50 mg whereas, the form Niacinamide does not. Other side effects are possible at higher doses of Niacin, which should be used under supervision of a physician.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet or the fridge – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Other Supplement Interactions With Niacin :

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• Black cohosh may cause liver damage and niacin increases this risk. Check with your pharmacist.[/box]

Medical Research Findings On Niacin Deficiency In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey.” This study investigating the nutritional composition of a gluten free diet and to compare it with non-gluten free diet in a representative German non-celiac disease population found that male and female celiac patients in Germany have inadequate nutrient intakes. Data from 88 patients aged 14-80 years who filled out a prospective 7-day food diary and a questionnaire were analyzed and compared to the DACH reference values and to data from the German National Diet and Nutrition Survey (NVS II).

The average daily micronutrient intake of male and female patients, specifically of vitamin B1, B2, B6, folic acid, magnesium and iron, was significantly lower in celiac patients compared to the NVS II. Based on these findings, regular (laboratory) monitoring of celiac patients should be recommended.⁴

CASE REPORT SUMMARIES

“A 70-year-old man with isolated weight loss and pellagra like syndrome due to celiac disease.” This case report describes presentation of celiac-disease in a 70 year old man with no prior GI symptoms or positive family history. Triggering of all symptoms followed a recent myocardial infarction and infective endocarditis. Presentation was marked by more than 20% weight loss and pellagra-like lesions despite nearly normal examination and laboratory tests. Symptoms were reversed by giving him intramuscular nicotinic acid (niacin).⁵

Sources:

1. Shibata K, Hirose J, Fukuwatari T. Relationship Between Urinary Concentrations of Nine Water-soluble Vitamins and their Vitamin Intakes in Japanese Adult Males. Nutr Metab Insights. 2014 Aug 5;7:61-75. doi: 10.4137/NMI.S17245. eCollection 2014. [↩]
2. Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365. [↩]
3. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩]
4. Martin J, Geisel T, Maresch C, Krieger K, Stein J. Inadequate nutrient intake in patients with celiac disease: results from a German dietary survey. Digestion. 2013;87(4):240-6. doi: 10.1159/000348850. [↩] [↩]
5. Schattner A. A 70-year-old man with isolated weight loss and pellagra like syndrome due to celiac disease. The Yale Journal of Biology and Medicine. Jan-Feb 1999; 72(1):15-8. [↩]