Rates of disease from vitamin deficiencies have been dramatically reduced in the past 100 years. That’s thanks to better food accessibility and to the fact that our processed foods are literally sprayed with a liquid multi-vitamin (a process called “fortification”). However, people with both moderate and severe vitamin deficiencies still show up in medical settings all the time.
One deficiency that, while rare, may be on the rise is niacin, or Vitamin B3, deficiency, possibly due to increasing “fad” diets, eating disorders, veganism, growing rates of HIV, chronic alcoholism, drug addiction, from the use of certain cancer drugs, and yes, problems with food access in impoverished communities.1Delgado-Sanchez, L., Godkar, D., & Niranjan, S. (2008). Pellagra: rekindling of an old flame. American Journal of Therapeutics, 15(2), 173–5. It is gaining new and growing interest to medical and nutritional clinician in several Asian countries and Scandinavia.2Pellagra (deficiency of vitamin B3 or of the amino acid tryptophan): a disease still extant in the Netherlands. (1998) Nederlands tijdschrift voor geneeskunde vol. 142 (33) p. 1880-2.
We have known that niacin (vitamin B3) deficiency causes a disease called “Pellagra” since the 1920s, and it was even known, though less so, that it could cause severe mental disturbances, including hallucinations, and all sorts things that looked like mental illness. In the early 1900s, it’s been estimated that 20% or more of those admitted to psychiatric institutions for psychosis actually had niacin deficiencies.3http://www.madinamerica.com/2013/05/jeopardizing-your-wife-to-prove-a-theory-pellagra-as-an-example-of-a-nutrient-deficiency-disease/3 new medical journal case reports on psychotic symptoms caused by Niacin (Vitamin B3) deficiency Click To Tweet
However, the tendency is for us to think these tales of psychosis from vitamin deficiencies are just relics of past, more primitive, times. But today I want to share some new case studies recently published in peer-reviewed medical journals that show psychosis and other mental disturbances from Vitamin B3 deficiencies are still something clinicians need to keep on their radar, even though it’s somewhat rare.
Some of the patients described below were treated for months until someone came in and tested them for niacin deficiency. I applaud the physicians and psychiatrists who wrote these recent case studies and published them. They dared to look deeper at their psychotic patients’ conditions, and rather than just drugging them endlessly with anti-psychotics, chose to look deeper.
But first, a little background.
What Niacin (B3) Deficiency Looks Like
The classic disease associated with Vitamin B3 deficiency is called Pellagra (etymology “bitter skin” in Italian). Symptoms of Pellagra are known as the “Four D’s” — dementia, dermatitis, diarrhea, and death. Other symptoms include rashes, tongue and mouth swelling, and skin discolorations.
In the early 1900s, about 3 million Americans (4% of the population) had Pellagra, and more than 100,000 people died, mostly in the American south, in prisons, orphanages, and mental institutions where they had primarily corn-based diets, which has low availability of niacin.
At the time Pellagra was thought to be due to an infection or that it was hereditary. Even after the doctor hired to find the cure to this epidemic, Dr. Joseph Goldberger MD, seemed to have proven Pellagra and many psychiatric symptoms were based on low intake of niacin, he wasn’t believed by authorities for another 16 years when foods began to be “fortified” with niacin and the epidemic ended.
Symptoms of Niacin (B3) Deficiency Often Missed That You Should Know
Another sign of low Vitamin B3 that is almost always overlooked: non-specific psychological symptoms that represent a functional change in a person and gradually get worse over time:
- severe irritability and edginess
- anxiety and restlessness
- depression and apathy
- psychosis and delusions
- One symptom that is very interesting: delusional parasitosis. This is the strong, persistent belief that you are infested with parasites or have bugs crawling under your skin. Haven’t we all had that at one time?
Even today this happens. But my hope is that each psychiatric patient be evaluated and tested for niacin deficiency (as well as other nutritional and biochemical imbalances) before they are drugged relentlessly for the rest of their lives. I don’t think that’s too much to ask.
Hopefully, this is changing and I’m encouraged by some very interesting recent case reports of some courageous physicians who dared to look deeper….
Recent Medical Case Reports Confirm Their Patients’ Psychological Symptoms Are Niacin Deficiencies.
1. Case Report of Mental Disorder Induced by Niacin Deficiency (2012).4Wang, W., & Liang, B. (2012). Case report of mental disorder induced by niacin deficiency. Shanghai Archives of Psychiatry, 24(6), 352–4. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4198903&tool=pmcentrez&rendertype=abstract
A fascinating story of a 45 year old man found on the streets naked, talking to himself, and cursing at anyone who walked by was brought to the local hospital. All lab tests were normal except for showing moderate cognitive impairment and delusions, so he was diagnosed with “Psychotic Disorder Not Otherwise Specified” and treated with anti-psychotic drugs.
After 3 days of treatment at the psychiatric hospital, he got worse with increased diarrhea, so they gave him drugs to stop the diarrhea. After 15 days of treatment he had total fecal incontinence, became highly anxious and fearful, and was no longer able to feed himself.
He was then transferred to a general hospital where he had a 24-hour urinalysis that showed a niacin deficiency. He was given niacin, other B-vitamins, Vitamin C, and Glutamine, and over the next 35 days he improved with full resolution of all symptoms in 2 months.
This man was NOT a psychiatric patient and had no history of mental disorders. He was a full-time construction worker, and after niacin treatment returned to his job.
2. Pellagra in a Patient with Schizophrenia (2013). AP Journal of Psychological Medicine.5Mohukuri, J. M., Chennamsetty, S. K., & Bhogaraju, A. (2013). Pellagra in patient with schizophrenia: a case report and review of the literature. Andhra Pradesh Journal of Psychological Medicine, 14(1), 50–52. Retrieved from http://medind.nic.in/aag/t13/i1/aagt13i1p50.pdf
A 23 year old woman is brought to the hospital by her family with sleep disturbance, muttering to herself constantly, poor concentration, decreased appetite, poor hygiene, and increasingly loose bowel movements. She has no personal history of mental illness and had never been treated for a mental condition.
She was confirmed to have Pellagra, and while she was admitted to the psychiatric unit she was immediately given niacin, other B-vitamins, and Risperidone (an anti-psychotic drug). She recovered fully within 2-weeks. She was sent home with the Risperidone and a B-complex vitamin supplement. No follow-up is reported.
3. Rapid Resolution of Delusional Parasitosis with Niacin (2008) General Hospital Psychiatry Journal.6Prakash, R., Gandotra, S., Singh, L. K., Das, B., & Lakra, A. (n.d.). Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. General Hospital Psychiatry, 30(6), 581–4. http://www.ncbi.nlm.nih.gov/pubmed/19061687
A case of classic symptoms of pellagra alongside severe delusions of being infected with parasites under his skin. No previous history of mental illness. All symptoms were completely resolved within days of niacin treatment.
Interestingly, there was a very similar case reported in the Journal of the American Medical Association back in 1954.7Aleshire, I. 1954. Delusions of parasitosis: Report of successful care with antipellagrous treatment. Journal of the American Medical Association 155:15-17. That patient also had rapid resolution of his delusions after niacin therapy.
It’s worth pointing out that all of these recent case reports happened outside the United States, yet they affected people in various developed countries and of different socio-economic classes.
Cases of low and deficient niacin in fact exist in the United States and are likely due to restrictive “fad” diets, eating disorders, veganism, as well as alcoholism and HIV, as well as poverty.
It’s likely that physicians here are more likely to spot it when it is very severe and that mild cases are missed, and cases that present with psychological disturbances are missed even more. It’s also possible physicians in the U.S. are less likely to run a niacin test for someone with mental disturbances as it’s not currently part of American medical “standards of practice” and may be denied by insurance.
There is no question niacin deficiency is rare, and that psychosis from niacin deficiency rarer still, yet it is possible that for some of us even moderately low levels may cause symptoms that we just sort of live with.
Most people who eat meat, eggs, and dairy do not need to supplement beyond what is in a normal multi-vitamin. Yet there may be others who are experiencing mental disturbances, diagnosed with various psychotic and mood disorders, who could benefit from testing niacin levels and/or supplementing under supervision, and medical and mental health providers should be aware of the signs and symptoms.
References [ + ]
|1.||↑||Delgado-Sanchez, L., Godkar, D., & Niranjan, S. (2008). Pellagra: rekindling of an old flame. American Journal of Therapeutics, 15(2), 173–5.|
|2.||↑||Pellagra (deficiency of vitamin B3 or of the amino acid tryptophan): a disease still extant in the Netherlands.(1998) Nederlands tijdschrift voor geneeskunde vol. 142 (33) p. 1880-2.|
|4.||↑||Wang, W., & Liang, B. (2012). Case report of mental disorder induced by niacin deficiency. Shanghai Archives of Psychiatry, 24(6), 352–4. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4198903&tool=pmcentrez&rendertype=abstract|
|5.||↑||Mohukuri, J. M., Chennamsetty, S. K., & Bhogaraju, A. (2013). Pellagra in patient with schizophrenia: a case report and review of the literature. Andhra Pradesh Journal of Psychological Medicine, 14(1), 50–52. Retrieved from http://medind.nic.in/aag/t13/i1/aagt13i1p50.pdf|
|6.||↑||Prakash, R., Gandotra, S., Singh, L. K., Das, B., & Lakra, A. (n.d.). Rapid resolution of delusional parasitosis in pellagra with niacin augmentation therapy. General Hospital Psychiatry, 30(6), 581–4. http://www.ncbi.nlm.nih.gov/pubmed/19061687|
|7.||↑||Aleshire, I. 1954. Delusions of parasitosis: Report of successful care with antipellagrous treatment. Journal of the American Medical Association 155:15-17.|