acne Acne Vulgaris Is a Special Clinical Type of Pellagra and I believe DH in Celiac disease is too!

[Posterboy]

To All,

I don't have as much time as I once did.....to focus on the forum but I wanted to share this new research that I came across that explains (summarizes)  perfectly (IMO) all the research I have done on this topic over the years.

Entitled "Acne Vulgaris Is a Special Clinical Type of Pellagra"

https://www.sciencepublishinggroup.com/journal/paperinfo?journalid=254&doi=10.11648/j.ajcem.20210906.13#:~:text=Foam cells are an important pathological change in,that patients with acne are deficient in niacin.

This is “SMOKING GUN” research that proves that Acne Vulgaris is sign of Pellagra…..or as they say is a “Sub-Type” or Special Clinical form of Pellagra!

And I would say (IMHO) that the DH of Celiac disease is a special "Sub-Type" of Pellagra that shows up in Celiac patients......or if you prefer their terminolgy....

that DH is a "Special Clinical" form of Pellagra in Celiac's....

Now to be fair.....I wasn't the first to seize on this idea.....the International Journal of Celiac Disease more than 7 years ago now.....I was just the one....who has beat the drum the most.....I agree!

Here is the original researsch.

http://pubs.sciepub.com/ijcd/3/1/6/#:~:text=Celiac Disease%3A Intestinal%2C Heart and Skin Interconnections The,versa%2C multiple cardiac manifestations exist in celiac disease.

Here is the article Scott graciously agreed to publish on this topic...

If someone wants to read the whole article just click on the PDF link.....which I highly recommend you do if you have DH....the special form of Pellagra in Celiac disese (IMHO)....

Where they make a great point!!!! and this is the same in Beri Beri (to a great degree as well).....unless you are an alcoholic or homeless you can't have Beri Beri or Pellagra in America (it commonly thought and taught)....but what if the wrong people got.....like GI patients.....then the doctor's can't see it....they are EYE Blind too it!

quoting

"The current diagnostic approach to pellagra does not provide a basis for early warning, definitive diagnosis, timely treatment, nor prevent pellagra from
deteriorating and aggravating. Medical doctor cannot diagnose a patient as mild and moderate pellagra clearly."

Until a doctor can SEE Pellagra they can't diagnosis it......and if they see Acne, Psorsias, Ezcema, DH etc.....then they can't see the forest for the trees!

As a matter of fact a/this link between Ezcema (skin issues) in babies has been tied to Niacin levels in the Mothers Children has been established but the doctors can't SEE it today.....beause this form of Niacin deficiency is subclinical and being diagnosed as a seperate skin disease.....totally unaware of these established connections...

Not surpisinlgy this research is 5+ years old.....but mothers and babies still suffer from low Niacin levels going clincially unregnozied as metabolic Pellagra....

https://www.thehealthsite.com/news/high-levels-of-vitamin-b3-during-pregnancy-may-lower-the-risk-of-eczema-in-babies-ag0916-436755/

Which I think this research conclusively proves IMO!

Where they summarize it well...

"Summary: Based on an analysis of the clinical feature of acne patients, pathological changes in acne lesions and the therapeutic effects of niacin on acne, we propose that acne can be diagnosed as a specific clinical type of pellagra, and niacin is the first choice for the treatment of acne vulgaris."

Note: Similar studies have been found in the study of DH in Celiac disease as well.....but these conditions are no longer assoicated......and therefore it goes un/misdiagnosed too this day!

I hope this is helpful as always but it is not medical advice.

2 Timothy 2:7  As always, “Consider what I say; and the Lord give thee understanding in all things”

Posterboy by the grace of God,

[Rogol72]

This is very interesting. So what is the therapeutic dose of Niacin to correct a deficiency or a subclinical deficiency? Is it a case that the cells need to be saturated with Niacin to be of significant benefit as is the case with Thiamine? Is there a helper mineral or nutrient that helps Niacin to do it's thing similar to Thiamine and Magnesium?

[Scott Adams]

I think you are using pellagra, which is caused by nutrient deficiencies, very broadly here, as many other diseases can also cause nutrient deficiencies, like celiac disease. I think it's more likely that some cases pellagra are caused by undiagnosed celiac disease.

[Posterboy]

14 hours ago, Rogol72 said:

This is very interesting. So what is the therapeutic dose of Niacin to correct a deficiency or a subclinical deficiency? Is it a case that the cells need to be saturated with Niacin to be of significant benefit as is the case with Thiamine? Is there a helper mineral or nutrient that helps Niacin to do it's thing similar to Thiamine and Magnesium?

Rogol72,

These are great questions!

Yes and No is the answer.....I saw from another thread on DH you have had flare up in the past....

I see you are aware of this thread......so I am quoting this thread for the others who might also come across this thread....

It explains in  more detail how this happens.....

To answer your question.....So now Niacin or Niacinamide does not need other Vitamins/Minerals for it too work....in and of itself?

But Yes, Niacin needs other Vitamins and Minerals etc. for the body to synthesize it etc.

@knitty kittyknows alot of these same things too.....

She often talks about Beri Beri and/or a Thiamine deficiency because Thiamine is where the body's "Energy Producing Machine" better known as the Krebs Cycle breaks down.....it is essentially (for animals) the same as Photosynthesis is for plants....

We can't make energy without Thiamine, and Magnesium and Niacin etc.....and why we wither away with out these critcal B-Vitamins and the Mineral Magnesium for example......being low in any three of these Nutrients will cause the Krebs Cycle to break.....

Niacin can reset the cycle.....by restoring the Kynurenine Pathway....it does this Via Trytophan.

It is trytophan is essential to development of IBS etc.

See this article about it....

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4266036/

When they Kynurenine Pathway breaks......Illness follows you around.....because you can no longer produce enough energy to maintain or repair your cells....

See this article about it entitled "Kynurenine pathway metabolites in humans: disease and healthy States"

https://pubmed.ncbi.nlm.nih.gov/22084578/

IN the strictest since......Niacin acts like a hybrid between a Vitamin and an (Essential) Amino Acid.....by the strictest definition......we can't synthesize Vitamins and why Knitity Kitty focusing on Thiamine......it is where the link breaks intially (and we can't synthesize) internally Thiamine......it can only be obtained from our food our Bacteria/Biome etc...

But Niacin is soooooooo important we will die (the 4th D of Pellagra) without it if our body can't synthesize it......if this Pathway breaks.....you will be haunted by Illness!

Our body will use Vitamin B2 (Riboflavin), B6 and Tryptophan to synthesize Niacin.....so our Mucus Membranes can stay healthy......which includes our GI tract and our Skin as examples.....approx. 80% of our Niacin is produced this way....and why we often don't have Skin issues right away....beause our back up pathways.....keep it under control (Mostly).....BUT

Wherever HIGH turnover of cells are invovled Pellagra or a Niacin deficiency will rear its "Ugly Head" like with Low/NO stomach Acid or Skin issues etc...(Especially when we are STRESSED OUT).....hence our Flares!

(and is exactly what we find in GERD/Heartburn).....

6 months before we get STRESSED Out of our B-Vitamins and Heartburn/GERD Develops....

See this rearch about it... Entitled "The effect of life stress on symptoms of heartburn"

https://pubmed.ncbi.nlm.nih.gov/15184707/

(I explain how Stress effects us negatively more in this thead) so I wont' have to retype everything again.....and So I don't get too far off topic....

Back to the main question at hand....so to speak...

Essentially every body knows Stress KILLS right.....well it MAIMS Us First!

BUT With High Stress our deficiency Shines through (shows up or becomes more evident)....you might say...

OR High energy activities where we burn alot of energy......Like our Brains to manage our body (Dementias of the brain) and our GI tract etc.....to make Stomach acid.

 Combine them both, High Energy and High Cell turnover and  BINGO!......Almost always Pellagra or a Niacin deficiency mainly (though not always) shows up first as GI problems.....

If you read the Acne Vulgaris full citation.....he explains welll why this is....

Quoting From Paragraph 4.

"4. Pellagra, Acne and Dyspepsia Chronic or recurrent diarrhea is a symptom of dyspepsia in the pellagra.Other gastrointestinal disturbances include anorexia, nausea, and epigastric discomfort [33]. Acne vulgaris and acne rosacea are also frequently accompanied by gastrointestinal disturbances, of which constipation is most frequently recorded, and less often, (so-called dyspepsia or indigestion) [34-37]. Approximately 68.5% of acne patients display symptoms of functional dyspepsia or gastrointestinal disorders, including halitosis, distension, pain, belching, acid reflux, diarrhea, and constipation [38]"

I am sorry I rambled again (in the electic way I am knonw for) (sorry for the long reply I didn't expect to be this long!!!).....maybe it will help someone else....

In summary......Beri Beri (happens in a Pellagra Diagnosis first) and why Knitty Kitty focuse on it first!)

I didn't know about Beri Beri.....happened first (in the beginning)......but Knitty Kitty is highlighting the Cornerstone nutrient, I am highlighting the Capstone nutrient.....or vice Versa (depending on how you look at it /or  think about it)....

In summary......Pellagra doesn't happen in an Uncomplicate way.....IT will always happen as/with Beri Beri FIRST!!!

Most of us (see blog post below) never go past Pellagra Sine Pellagra but those who develop Skin Issues such as DH......the Kyneurine Pathway has broken and we can no longer synthesize enough Niacin naturally to kee our Mucus Membranes IE our Skin (as the final straw) that breaks the Camels back and the Doctor's can SEE Acne, Ezcema, Psorsias and yes DH as Pellagre IF and WHEN they are made aware of these connections.....

"But don't kid (ourselves/youself) they will laugh you out of their offices.....if you mention it ......because you are not Homeless or an Alcoholic".......just trial the Niacinamide for 3 months and let the results speak for t hemselves....

See Dr.  Haneys' nice article about this topic as well......

http://blogs.creighton.edu/heaney/2013/11/18/pellagra-and-the-four-ds/

Where he says quoting....at least in North America...IE the US and Western Medicine etc.

"In the United States, at least, pellagra is a disease of the past – fortunately – and it is doubtful today that most health professionals would recognize it if a case happened to come to their attention."

And is exactly what the research on Acne and Pellaga showed.....unless Pellagra is in its most advanced state....

The Dermatitis State.....Pellagra is often overlooked.....even when Niacinamide supplementation has proven it is effect in 80% of those who take Niacinamide for 3 months.

I summarized all of this in this blog post......if you have the interest....it is kind of long winded but it should answer most if not all of your questions....

Rogol72,  this blog post might be of help to you too!

It explains why you would want to take Niacin/Niacinamide and how to for best your best results when you take it...

I  need to stop for a while but I hope this is helpful but it is not medical advice.

As always I hope you “Consider what I say; and the Lord give thee understanding in all things” this included.

2 Timothy 2:7

Posterboy by the Grace of God,

[Blue-Sky]

15 hours ago, Rogol72 said:

This is very interesting. So what is the therapeutic dose of Niacin to correct a deficiency or a subclinical deficiency? Is it a case that the cells need to be saturated with Niacin to be of significant benefit as is the case with Thiamine? Is there a helper mineral or nutrient that helps Niacin to do it's thing similar to Thiamine and Magnesium?

Niacin in any form can cause diabetes and insulin resistance when taken at "therapeutic" dosages. There are a few warnings about it on the government health page.

https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/

You can also get elevated liver enzymes if someone is eating a western diet. Niacin depending on the dosage could potentially aggravate that.

Since the body can't keep minerals like zinc, magnesium and selenium very long, and they are lowered by stress I take extra of those, along with a multivitamin as malabsorption is common with Celiac disease.

Tryptophan is another healthy way of aiding in gut repair and boosting niacin levels.

Very few people probably take therapeutic dosages of niacin. A lot of people take multivitamins though and those people tend to eat healthier to start with.

[Russ H]

Pellagra is symptomatic B3 deficiency, which may include inflamed skin. Dermatitis herpetiformis is a cutaneous manifestation of coeliac disease where auto-antibodies are deposited in the skin and cause inflammation. They are separate conditions, although undiagnosed coeliac disease could lead to pellagra. Skin samples for DH show characteristic deposits of auto-antibodies, which do not occur with pellagra.

[Rogol72]

6 hours ago, Blue-Sky said:

Niacin in any form can cause diabetes and insulin resistance when taken at "therapeutic" dosages. There are a few warnings about it on the government health page.

https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/

You can also get elevated liver enzymes if someone is eating a western diet. Niacin depending on the dosage could potentially aggravate that.

Since the body can't keep minerals like zinc, magnesium and selenium very long, and they are lowered by stress I take extra of those, along with a multivitamin as malabsorption is common with Celiac disease.

Tryptophan is another healthy way of aiding in gut repair and boosting niacin levels.

Very few people probably take therapeutic dosages of niacin. A lot of people take multivitamins though and those people tend to eat healthier to start with.

I think we focus on getting the main minerals like Magnesium, Zinc Iron and Calcium and tend to forget about the trace minerals which are just as important, especially Selenium. I know I do!!

[Posterboy]

17 hours ago, Blue-Sky said:

Since the body can't keep minerals like zinc, magnesium and selenium very long, and they are lowered by stress I take extra of those, along with a multivitamin as malabsorption is common with Celiac disease.

Blue Sky,

I know your focus is on Zinc.....I looked it up once....how long does Zinc stays in the body.....I want to say about 20 days.

You mentioned the other Minerals as well do you know their Half Lifes as well?

I would be interested in knowing how long our body can hold Minerals in reserve......I tend to think our mineral reserve was longer than 20 days......but I think (if my memory serves me correctly)......I looked up the Zinc once bfore and was suprised by how quickly we can become low in Zinc and/or our other minerals....

If approx. 20 days is a good number then it can be a predictor/proxy of 1) low stomach acid and 2) a predictor of low Niacin levels....

Because Niacin helps control iron and Zinc levels in the liver.....leading to deficiency in they body.

See this research about it

Entitled "Effect of nicotinic acid on zinc and iron metabolism"

https://pubmed.ncbi.nlm.nih.gov/9353874/

quoting from the absract

"When mice were fed with nicotinic acid-deficient, -adequate and -excess synthetic diets for four weeks it was observed that, in comparison with the nicotinic acid-deficient diet, percent zinc absorption, intestinal zinc, percent haeomoglobin and liver iron increased significantly under nicotinic acid-adequate and -excess conditions. The results obtained suggested that nicotinic acid, in addition to its known effect on growth and metabolism, may be playing an important role in enhancing zinc and iron utilization."

Low Iron is common in Celiac's and I don't think almost anybody knows that too can be a sign of low Niacin levels....

I hope this is helpful but this is not medical advice.

Posterboy by the grace of God,

[Posterboy]

To all,

Here is the study on Niacinamide as potential treatment for Psorsias.

Entitled "Nicotinamide: a potential addition to the anti-psoriatic weaponry"

And yet.....everybody seems to have forgotten the role Niacin can play in healthy skin....

https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fj.03-0002hyp?journalCode=fasebj&legid=fasebj%3B17%2F11%2F1377&related-urls=yes

And not suprisingly it (Niacin) does this by down regulating "Antibodies" to Psorsias in the body.

quoting from the abstract....

"Nicotinamide is an inhibitor of poly (ADP-ribose) polymerase-1 (PARP-1) that, through enhancement of nuclear kappa B-mediated transcription, plays a pivotal role in the expression of inflammatory cytokines, chemokines, adhesion molecules, and inflammatory mediators. Through interaction with CD38 and inhibition of IL-1, IL-12, and TNF-α production, nicotinamide produces a mild TH2 bias."

Th2 Bias.....is homeostasis or a quieting or our immune system......and that is exactly why it can help "Auto-Immune" conditions by restoring our immune system to a state of balance.

I hope this is helpful but it is not medical advice.

Posterboy,

[Posterboy]

17 hours ago, Blue-Sky said:

Niacin in any form can cause diabetes and insulin resistance when taken at "therapeutic" dosages. There are a few warnings about it on the government health page.

https://ods.od.nih.gov/factsheets/Niacin-HealthProfessional/

You can also get elevated liver enzymes if someone is eating a western diet. Niacin depending on the dosage could potentially aggravate that.

Since the body can't keep minerals like zinc, magnesium and selenium very long, and they are lowered by stress I take extra of those, along with a multivitamin as malabsorption is common with Celiac disease.

Tryptophan is another healthy way of aiding in gut repair and boosting niacin levels.

Very few people probably take therapeutic dosages of niacin. A lot of people take multivitamins though and those people tend to eat healthier to start with.

Blue Sky,

No one mentioned taking Niacin or Niacinamide in "Therapuetic Doses"......

For those who haven't had time to read the link they posted it is doses between 2 to 3 gram a day for 2 or 3 years etc...

But the use of Niacinamide or Niacin for 3 months (In divided doses IE with Meals is best) has shown marvelous results.....and not just Niacin but other B-Vitamins as well....Like Thiamine for example.

See this nice article about to  use B-Vitamins to help treat Pyschiatry issues

Entitled "Understanding nutrition, depression and mental illnesses"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738337/

quoting their paragraph on B-Vitamins...

"B-complex vitamins

Nutrition and depression are intricately and undeniably linked, as suggested by the mounting evidence by researchers in neuropsychiatry. According to a study reported in Neuropsychobiology,[42] supplementation of nine vitamins, 10 times in excess of normal recommended dietary allowance (RDA) for 1 year improved mood in both men and women. The interesting part was that these changes in mood after a year occurred even though the blood status of nine vitamins reached a plateau after 3 months. This mood improvement was particularly associated with improved vitamin B2 and B6 status. In women, baseline vitamin B1 status was linked with poor mood and an improvement in the same after 3 months was associated with improved mood."

So, to summarize a B-Vitamin plateau is reached after 3 months......essentially what is "Homeostasis" or balance from which the patients mood improved.....

And seemingly suprising to them.....(But not to me).....that Riboflavin and B6 was particualrly associated with a healthy mood (and presumbly mind)......because they are in the Kyneureine Pathway that allows us to synthesize or own Niacin....

For others who are following this thread.....this thread also might be of help.....because it expalins the best form of Niacin and/or Niacin to take....

And it is worth noting here again (In case you missed above).....at even up to the length of 1 year at a rate of 10x the RDA for the B-Complex the regimen only produced good and healthy results in mind and body!

I hope this is helpful but it is not medical advice.

Posterboy,

[Posterboy]

To All,

This is just a follow up to the STRESS that happens before a Celiac disease diagnosis.

This is what you would expect IF your B-Vitamins are important for your Stomach Acid production......and the commonly low Stomach Acid in NCGS/Celiac disease patients.

See this research about it....

Entitled "Gastric morphology and function in dermatitis herpetiformis and in coeliac disease"

https://pubmed.ncbi.nlm.nih.gov/3992169/

This article shows (IMO) shows that NO Stomach acid aka Achlorhydria is predictive of DH in Celiacs....

I hope this is helpful but it is not medical advise.

As always  "Consider what I say; and the Lord give thee understanding in all things.", this included.

2 Timothy 2:7

Posterboy by the Grace of God,

[Posterboy]

To All,

At least you think.....I came up with this on my own.....I didn't I just went out and found the research that confirms my hypothesis.

Showing it is a "Working Theory".....that time has forgotten.....IMO who's time has come again.....to discuss and time for it to rediscovered because patient's can't wait another 15 or 20 years for the doctor's to figure it out and do more studies on this topic.

Once upon a time.....they knew this -- that Nicotinic Acid aka Niacin today or Vitamin B3 was used to treat DH succesfully nearly 20 years before DH was even associated with Celiac disease.

I am quoting this because it is the best article I know about it currently....

https://www.jidonline.org/article/S0022-202X(15)50482-X/pdf

IF some intrepid researcher want to find more up to date research about it.....

@Blue-Skyor @knitty kittyI would like to see it....

I currently don't have the time to do more research on the topic but IMHO this is conclusive enough for me!

Trialing Niacinamide (the natural non-flushing form of Niacin) or a small dose Niacin say 100mg with meals is all somebody would have to do....in those who have DH to see if goes into remission....

Then add a B-Complex or a Multivamint or a Multivain in the morning and B-Complex at night for 3 or 4 months is all it would take to see IF first the DH rash doesn't go away (go into remission) and your GI symptom's don't improve in 2 or 3 months....

Blue Sky and/or Knitty Kitty go back and read this blog post if you haven't read it already......and it summarizes this Niacinamide protocol for NCGS and/or Celiac disease well....

YOU dont' have to take it for years at HIGH doses......6 months seems to be  "Goldilocks" amount of time....

Often a 100 count bottle of a B-Complex is enough to put DH in remission!.....but I do recommend it twice a day or 3/day with meals for best results....

But over the years I've found it is best to be conservative and takea 300 count bottle (about a 3 or 4 month supply) of either a B-Complex or just Niacinamide by itself to confirm this working Theory .....to build up your livers (bodys) reserve.....against future stress(es)....

IF you have DH......you will want to trial the Niacinamide to see if it puts the DH in remission otherwise if you just have GI problems like NCGS or Celiac disease without Skin Isuuses like DH, Acne, Psorsias, Eczema etc then just trailing a B-Complex should be enough to help your GI problems.....

Obviously there are others thing you can add to that to support your lingering symptom's.....

Becasue you will still have "Overt (Hidden) Vitamins Deficiencies" without Obvious Symptom's....

Like Vitamin D, and Magnesium Citrate and/or Magnesium Glycinate....

The ONE B-Vitamin you should add to this B-Complex regimen is Thiamine as Benfotiamine or another high quality Fat Soluble B-1 Thiamine supplement......because Thiamine is important in Celiac disease as well...

But is usually not the trigger for Skin issues....but as I said before and above.....YOU will also be low in B-1 and your other B-Vitamins like B2, and B6 and Tryptohan etc......if you have (also) developed Pellagra in addition to your Celiac disease or if you prefer your Celiac disease (due to low nutritent absorption) has also triggered Pellagra to COME to the surface via the DH diagnosis!

Until the liver is full of it's reserve STRESS will continue to be a problem for you.

IF you have a STRESS problem.....you have B-Vitamin problem!

I will quote again.....Prousky full citation for anybody who has the interst and time to read it....

He explains better than I can what a Vitamin Dependency is.....not a Vitamin deficiency...

Entitled "Is Vitamin B3 (Niacin) Dependency a Causal Factor in the Development of Hypochlorhydria (Low Stomach Acid) and Achlorhydria (NO Stomach Acid)"

http://orthomolecular.org/library/jom/2001/pdf/2001-v16n04-p225.pdf

Again I am sorry, I rambled (a little) but I stayed on topic (more I think this time).....but I had alot of "Ground to Cover" as they say.

Then report back when it helps you! and let other's know.....your Pellagra being diagnosed as DH in Celiac disease got better/went in to remission when you took some Niacinamide for your DH symptom's....

Or just a B-Complex if your prefer to take it that way......but you will only know IF it is the Niacin portion of the B-Complex that helped your DH.....if you only trial the Niacinamide alone or the Flushing Niacin form (though many (may find) the flusing uncomfortable....at first......I find it nicely relaxing and comforting.....once you know what it is....see this article on how to tritrate up Niacin as Nicotinic Acid to help Seasonal Allergies......So I won't have to type soo much......(again and again).....and this reply is already getting too long for even me!

http://getwellstaywellathome.com/blog/2015/06/seasonal-allergies-and-the-niacin-flush/

Again if you have GI problems.....and NO DH symtpom's.....a B-Complex will do just Fine!......but if you DH trial only the Niacinamide for 3 months THEN add a B-Complex to that regimen.....to address your remanig B-Complex deficiencies....for another 3 months......UNTIL your urine GLOWS.....then you can cycle off the B-Complex......because your are now bypassing Riboflavin aka Vitamin B-2 thorugh your kidneys......and you have refilled your liver!

One Final Note: Niacin works much better on the Itching of DH than Niacinamide does!

IF itching is your main complaint then Niacin aka Nicotinic Acid is the form you want to take.

See this article about why the "Niacin Flush" is good for us!

http://www.life-enhancement.com/magazine/article/3396-why-the-niacin-flush-may-be-surprisingly-beneficial-to-your-health

It is the release of Prostaglandins that build up in the skin that relieves the Itching of DH.

Here is an article about it....

Entiltled "Release of markedly increased quantities of prostaglandin D2 in vivo in humans following the administration of nicotinic acid" aka Niacin

https://pubmed.ncbi.nlm.nih.gov/2475889/

And this one shows how Niacin via this Prostaglandin recepter helps UC in the same way!

Entitled "Niacin ameliorates ulcerative colitis via prostaglandin D2-mediated D prostanoid receptor 1 activation"

https://www.embopress.org/doi/full/10.15252/emmm.201606987

IT is also why Slow Release Niacin as Inositol hexanicotinate is not as healhty for you as quick release Niacin.....

and Why Niacinamide will not quickly help the Itching of DH......because you don't release the build up Prostraglandins in the skin.....triggering unberable itching!

I have to stop for now!

Again, I hope this is helpful but this is not medical advice.

2 Timothy 2:7 "Consider what I say; and the Lord give thee understanding in all things.", this included.

Posterboy by the grace of God,