Nicotinamide is a water-soluble form of the vitamin B3 (known also as niacin), and is essential for healthy skin and a healthy nervous system. Sources of the vitamin include cereals, meat, beans, potatoes, yeast and fish, and deficiency occurs when too little is absorbed by the body.
Causes
Nicotinamide deficiency occurs when too little of the vitamin is ingested via an inadequate diet, or if a secondary condition causes malabsorption of the vitamin (such as anorexia or bulimia). Because it is water-soluble, it is not stored by the body, so a continuous supply must be ingested to avoid symptoms of deficiency.
In the developed world, deficiency is very rare, though one common cause is alcoholism. Because alcoholics tend to eat less-healthy diets comprised primarily of simple carbohydrates, and because vitamin B3 is used in alcohol metabolism, vitamin deficiency is often a result.
Symptoms
Mild nicotinamide deficiency can cause such symptoms as indigestion, canker sores, fatigue, vomiting and depression. As deficiency goes from mild to moderate, symptoms intensify and include oral inflammation, headaches, diarrhea and anxiety.
In severe cases of deficiency, a condition known as pellagra can develop. Pellagra starts as stomach discomfort, including diarrhea, which leads to dementia and the most common identifying feature: scaly, cracked, thickened, rough and dried skin that is sensitive to light. If left untreated, sufferers of B3 deficiency will inevitably die.
Diagnosis
Diagnosis of B3 deficiency can be done several ways. In a simple blood test, low serum levels of B3 in the blood may indicate a B3 deficiency. A doctor may choose to administer B3 and see if symptoms abate after administration. In addition, B3 is actively excreted in the urine when not used. As such, low or absent levels of B3 in the urine as determined by a urinalysis can lead to a diagnosis of B3 deficiency.
Treatment
Treatment for B3 deficiency generally follows one of the above methods of diagnosis. Because B3 deficiency is a symptom of malnourishment, it is oftentimes accompanied by other vitamin deficiencies, so a special protein-rich diet may be prescribed to introduce proper levels of vitamins into the body. This is often accompanied by a B-complex vitamin supplement. If the patient has developed pellagra, avoiding direct sunlight is advisable to prevent aggravation of the condition, along with bed rest to allow proper time to heal. In addition to a healthy diet, nicotinamide may be administered in larger doses to counter the deficiency and give the body the required levels of B3 immediately.
Prognosis
Generally, if the patient avoids the conditions that caused the deficiency in the first place (such as alcoholism, anorexia, bulimia or poor diet), recurrence is not an issue. Alternatively, supplementation can be used to ensure that proper levels of B vitamins are consumed. In cases where pellagra occurs, even after healing, the affected skin can remain disfigured. Overall, if treated properly and prevented in the future through proper diet or supplementation, B3 deficiency is generally not fatal.
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