Alcoholism produces a range of possible harms in the brains and bodies of affected individuals. One of these potential harms is the onset of a condition called pellagra, which occurs as a result of a deficiency of a B vitamin called niacin (B3). The presence of pellagra can cause changes in several important body systems, including the onset of a brain disease known as alcoholic pellagra encephalopathy. Current evidence indicates that doctors should look for this disease in both active alcoholics and alcoholics going through withdrawal who display symptoms of delusions, delirium or dementia.
Pellagra Basics
Niacin plays critical roles in everyday health by helping the body do such things as break down carbohydrates for their energy content, assure the proper breakdown of proteins and fats, keep blood flowing efficiently through the circulatory system, make hormones that appear in both men and women, and make gender-specific hormones that only appear in men or women. The U.S. National Library of Medicine reports that globally, most people develop pellagra when their diets contain inadequate amounts of niacin, or when their diets contain inadequate amounts of an amino acid called tryptophan. This form of the disorder, known as primary pellagra, rarely appears in the U.S. or in other countries with a generally high nutritional standard. However, another form of the disorder, secondary pellagra, can appear when the body fails to properly use an adequate niacin supply. People throughout the world affected by long-term alcoholism are susceptible to this condition. There are three main sets of symptoms found in people affected by primary or secondary pellagra. These symptoms include significant changes in the normal health of the skin in various body regions, diarrhea and other substantial changes in gastrointestinal health or the ability to process food and a number of critical changes in normal brain and nerve function. Doctors can often reverse the effects of pellagra by prescribing oral or intravenous niacin supplements for their patients.
Pellagra Encephalopathy
Encephalopathy is a term that doctors and scientists use to identify serious changes in brain health that affect the overall function of this essential organ. The term itself does not denote the presence of a specific disease, and a wide range of problems can lead to the onset of a damaging decline in brain function. In the case of pellagra encephalopathy, lack of niacin or an ongoing inability to use the body’s existing supply of niacin leads to symptoms that commonly include the appearance of delusions (fixed, irrational beliefs or points of view normally found in individuals affected by schizophrenia or other psychosis-producing mental disorders), the decline in conscious thought processing known as dementia or the highly disorienting, rapid cycling of emotional states known as delirium.
Presence in Cases of Alcoholism
An individual affected by alcoholism can develop pellagra encephalopathy either while still actively consuming alcohol or while going through withdrawal symptoms when the intake of alcohol ceases or undergoes a steep decline. In a study and study review published in January 2014 in the journal Alcohol and Alcoholism, researchers from Great Britain and Spain looked at the ways in which alcoholism-related pellagra can manifest in people still actively consuming alcohol. These researchers undertook their study and accompanying review because they wanted to know if the consideration of pellagra encephalopathy can help doctors clarify the causes of delusions or other psychotic symptoms that appear in people with a chemical dependence on alcohol. After completing their work, they concluded that alcoholism-related pellagra encephalopathy does indeed cause psychotic symptoms strong enough to mimic the effects of psychosis-related mental illness. In line with this finding, they also concluded that doctors can increase the chances of a proper diagnosis by checking for niacin-related issues in any alcoholic who experiences psychosis-like mental changes. In a study published in July 2012 in the journal Addiction Science & Clinical Practice, researchers from Boston University Medical Center looked at the ways in which alcoholism-related pellagra can manifest itself during the withdrawal process. These researchers concluded that most affected individuals do not develop all possible symptoms of this condition. In terms of brain changes and encephalopathy, the most likely outcome is delirium, although symptoms of dementia also sometimes appear. The researchers note that doctors often fail to consider niacin deficiency and pellagra as potential complicating factors during the alcohol withdrawal process. This is critical since individuals going through this process can develop severe health problems or even die.