Vitamin B2 (Riboflavin) Deficiency

What Is Riboflavin?

[dropcap]R[/dropcap]iboflavin, also called vitamin B2, is fundamentally required for the breakdown of carbohydrates, amino acids, and fats in metabolism, enables oxygen to be used by cells, and acts as a component of more than a dozen enzymes involved in energy production and use.

Some enzymes needing riboflavin also require magnesium to properly function.

In other activities, riboflavin is required for healthy cardiovascular and nervous systems, eye health, and supports antioxidant protection.  Functions are more fully described below.

Urinary excretion of riboflavin 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

There is no specific name for riboflavin deficiency disease.

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

• Relationship between riboflavin deficiency and celiac disease. Riboflavin 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 riboflavin deficiency and features. Riboflavin deficiency is characterized by impaired metabolism of carbohydrates, amino acids, and lipids; low energy; impaired antioxidant protection; and reduced health of the cardiovascular and nervous systems. Deficiency first shows in tissues with rapid cellular turnover, such as skin which lines the outside of the body and mucosal cells of mucous membranes which line the inside of the body.
• Relationship between riboflavin deficiency and other nutrient deficiencies. Riboflavin deficiency commonly accompanies and can cause vitamin B3 (niacin) deficiency. Frequently, riboflavin deficiencies overlap with niacin (vitamin B3), pyridoxine (vitamin B6) or iron deficiencies.²
• Relationship between riboflavin deficiency and dysbiosis. Dysbiosis (imbalance of intestinal microbes) affects 100% of persons at diagnosis of celiac disease and must be managed to restore and maintain balance. Probiotic bacteria (friendly and necessary), especially the species Lactobacillus planterum and Lactobacillus fermentum, are vigorous producers of riboflavin.³ Low numbers of probiotics that produce riboflavin certainly impact nutrients levels in the body.

How Prevalent Is Riboflavin Deficiency In Celiac Disease and/or Gluten Sensitivity?

Riboflavin deficiency is common in patients with untreated celiac disease.⁴

What Are The Symptoms Of Riboflavin Deficiency?

Riboflavin deficiency is marked by these symptoms:

• Sensitivity of eyes to light.
• Itching or teary eyes.
• Blurry vision.
• Sores at corners of mouth.
• Reddening of lips that may develop tiny fissures which may scar.
• Glossitis (sore, purplish tongue with abnormal papilla – atrophied areas and/or swollen papilla that hurt, also called “geographic tongue”).
• Low strength.
• Anxiety.
• More severe symptoms are seborrhea dermatitis (red, itching and burning skin followed by greasy, scaly accumulations that may appear on sides of nose, ears, eyelids, perineum in females, and scrotum in males), inflammation of eye conjunctiva, uveitis, constipation, indigestion, gas, and abdominal pain.
• Prolonged deficiency leads to depression and normocytic (normal size blood cells) and normochromic anemia (normal color blood cells) with pallor and dizziness.
• In infants and children, growth retardation may occur.

How Does The Body Get Riboflavin?

• Riboflavin is absorbed from the diet in free form by a carrier-mediated process in the proximal small intestine (duodenum).
• It is not stored in any appreciable degree and must be supplied in the diet daily.²
• Genome studies now show that riboflavin is synthesized in appreciable amounts by certain probiotic bacteria (friendly and necessary)  that normally inhabit the colon, especially the species Lactobacillus planterum and Lactobacillus fermentum.³ Low numbers of probiotics that produce riboflavin negatively impact nutrients levels in the body..

What Does Riboflavin Do In The Body?

1. Essential for converting foodstuffs into energy.
2. Maintains the normal lifespan of red blood cells.
3. Converted into its active forms, flavin adenine dinucleotide (FAD) and flavin mononucleotide (FMN). These enzymes are primarily involved as cofactors in oxidation reduction reactions that are essential for cellular energy production and respiration.
4. Required for the conversion of pyridoxine (vitamin B6) to its functional form and the production of niacin (vitamin B3) from the amino acid tryptophan.
5. Essentail role in antioxidant status by activating glutathione reductase, which regenerates used glutathione, (a powerful antioxidant).
6. Maintains health of skin, eyes, hair, and the nervous system.

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

• Riboflavin deficiency in celiac disease results from malabsorption of this vitamin.
• Riboflavin deficiency may result from dysbiosis because certain probiotic microbes, in particular Lactobacillus planterum and fermentum, manufacture appreciable amounts of riboflavin.
• Riboflavin deficiency may develop from chronic diarrhea.

Does Riboflavin Deficiency Respond To Gluten-Free Diet?

Yes. Celiac disease-related riboflavin deficiency resolves quickly on nutritious gluten free diet.

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.⁵

The gluten-free diet should include fermented foods like organic unpasteurized apple cider vingar, yogurt with living probiotics, and natural sauerkraut unpasteurized to supply fresh probiotics. Also, include adequate amounts of insoluble fiber (prebiotics) to keep probiotic organisms of the intestines healthy. Prebiotic fibers are found in plant sources such as fruits, vegetables, legumes, nuts, seeds, and GF grains. Milk products feed Lactobacillus strains.

6 Steps To Correct Riboflavin Deficiency:

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

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0.3 mg for infants birth-6 months; 0.4 mg for infants 7-12 months;

0.5 mg for children 1-3 years;

0.6 mg for children 4-8 years;

0.9 mg for children 9-12 years;

1.3 mg for teen boys 14-18 years; 1.1 mg for teen girls 14-18 years;

1.3 mg for males 19-70 years; 1.1 mg for females 19-70 years;

1.4 mg for pregnancy; 1.6 mg for breastfeeding women.[/box]

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

[box type=”shadow” ]Plant sources:

• Nutritional yeast.
• Spinach.
• Brown rice.
• Orange.
• Apple.
• Lesser Amounts: Almonds, Whole Grains, Mushrooms, Soy, and Green Vegetables.

Animal Sources:

• Liver is the highest.
• Eggs.
• Cheese.
• Lesser Amounts: Milk (any animal), Beef, Pork, Poultry.

Cook’s Note: Riboflavin is destroyed by light so cover the pot when cooking. Food should be stored in dark containers away from the light to protect their riboflavin content. This is the reason for the switch from glass milk bottles to cartons.

Riboflavin can be lost in water when foods are boiled or soaked, so be sure to consume the liquid. Riboflavin is not destroyed by heat, so vegetables are best steamed. It is best not to cook in oil. Canned vegetables suffer the loss of 55% of riboflavin.

Last, riboflavin is sensitive to alkali, so do not add baking soda when cooking.[/box]

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

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• Alcoholic consumption reduces absorption of riboflavin from the small intestine.

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

[box type=”shadow” ]Certain prescription drugs can cause deficiency. Ask your doctor or pharmacist about possible interactions between riboflavin supplements and medications you’re taking to make sure you time the doses correctly. Do not stop taking prescription medication without supervision.

Here are common medications that increase risk and should to be monitored for deficiency:

FEMALE HORMONES – Disrupt Intestinal permeability causing leaky gut.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others).
• Oral Estrogen/Hormone Replacement (®, Prempro®, Premarin®, Estratab® and others).

 ANTIBIOTICS

• Tetracycline (oral antibiotic).

  ANTI-MALARIAL DRUGS

•  Primaquin®

ANTI-DEPRESSANTS 

• Sinequan®, Adapin®, Aventyl®, Elavil®, Pamelor®, and others

ANTI-GOUT DRUG

•  Probenecid®. [/box]

 

• [dropcap]5[/dropcap]Manage Nutritional Supplements to Obtain:

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• Riboflavin is available in tablet form and is a usual ingredient in multivitamin supplements and B-Complex supplements.
• Natural riboflavin 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.

Toxicity: Riboflavin has no observed toxicity for intakes up to 3,000-9,000 mg daily, although these excessive amounts would be lost in urine along with needed minerals. There is no evidence of toxicity from oral administration of riboflavin, except for rare cases of sensitivity to the individual.

Taking excessive amounts of riboflavin while breastfeeding can be harmful to the baby.

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[/dropcap]Other Supplements That Deplete or Interfere With Absorption:

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• None reported. Check with your pharmacist.[/box]

Medical Research Findings On Riboflavin 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).

Results: 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.⁵

“Glossodynia in patients with nutritional deficiencies.” Various types of nutritional deficiencies can produce glossodynia and associated signs of inflammation. Changes such as swelling of the tongue, papillary atrophy, and surface ulceration are possible in most of the deficiency states. To further complicate the clinical picture, the patient commonly will suffer from multiple nutritional deficiencies. Therefore, it is not advisable to diagnose a specific nutritional deficiency on clinical impression alone. Specific tests for suspected riboflavin deficiency are available. Glossodynia related to nutritional deficiency is easily curable with replacement therapy. Identification of a vitamin deficiency through early oral symptoms can forestall development of serious and irreversible systemic and neurologic damage.⁶

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. [↩]
2. Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩] [↩]
3. Lehri B, Seddon AM, and Karlyshev AV. Potential probiotic-associated traits revealed from completed high quality genome sequence of Lactobacillus fermentum 3872. Stand Genomic Sci. 2017 Feb 1;12:19. [↩] [↩]
4. Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999; 69(3):354-365. [↩]
5. 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. [↩] [↩]
6. Huber MA, Hall EH. Glossodynia in patients with nutritional deficiencies. Ear Nose Throat J. 1989 Oct;68(10):771-5 [↩]