Riboflavin Deficiency

The vitamin B complex includes not only niacin and thiamin but also riboflavin and other substances. When riboflavin is deficient the symptoms noted include principally fissures and soreness at the corners of the mouth, redness of the white portion, or cornea, of the eye with pain on seeing strong light, and also some changes in the tongue and skin.

Seldom is a deficiency of riboflavin observed alone, since it is so closely associated with other portions of the vitamin B complex. Most of the symptoms are regularly associated with pellagra, which is chiefly the result of lack of niacin.

Dr. William Darby has described the appearances around the comers of the mouth which are typical. First the lips get pale at the corners, then they seem chewed or softened, after which the fissures appear. As these heal, pink scars appear. The sore spots may become covered with crusts. The surface of the tongue gets a mushroom-like appearance and the color has been described as magenta.

Patients with ariboflavinosis complain of a sandy feeling of the eyelids, with blurring of vision and burning on exposure to strong light. As in pellagra these patients have a record of failure to include in their diets such substances as lean meat, green leafy vegetables, milk, eggs or liver.

Once the diet of the patient is supplemented with adequate amounts of the food mentioned, the symptoms disappear. In difficult cases doctors prescribe a normal dosage of riboflavin itself. Since, however, few patients have an uncomplicated shortage of riboflavin, but rather a shortage of all of the vitamin B complex and since B complex is so easy to secure and administer, the whole B complex is given.

Thiamin Deficiency

The chief symptoms of a disease called "beriberi" are due to a lack of one of the portions of the vitamin B complex called thiamin. Thiamin is soluble in water, damaged by heat and found chiefly in whole cereals, peas, beans, lean meats, nuts and yeast. Refined sugar, milled rice and low-extraction flour have lost most of their thiamin.

People whose diets are low in protein and high in carbohydrates are likely to show symptoms of thiamin deficiency. In the United States the condition is seen often among chronic alcoholics who get insufficient amounts of the right foods because of their displacement by alcohol.

The chief damages to tissues of the body seen in thiamin deficiency are found in the nerves and in the heart and blood vessels. Often these tissues become swollen with water. After about three months on a diet really deficient in thiamin the symptoms begin to appear. Gradually the person becomes tired and irritable and the muscles, particularly those of the calf of the leg, become painful. Later serious inflammations of the nerves appear, and these may go on to the point of loss of sensation and paralysis. When neuritis becomes so prominent, the doctor must make sure that it does not result from some other cause, since lead or arsenic poisoning or various infections may also cause neuritis.

As soon as a sufficient intake of thiamin is assured the patient begins to improve. Thiamin is now available in the form of tablets or capsules that can be taken internally, and also in forms that can be injected into the body when prompt action is desired. If treatment is begun sufficiently early most patients recover rapidly and completely. If treatment is delayed until actual destruction of nerve tissue has occurred, results are doubtful.

Vitamin B12 Deficiency

A disease quite recently included among the deficiency diseases is sprue, observed chiefly in the tropics but seen occasionally also in the United States. Most authorities now classify sprue among the conditions associated with the absence of sufficient vitamin B12 or the animal protein factor in the diet. Similar conditions to those prevailing in sprue are also seen, however, in a rather unusual condition called celiac disease, which occurs in infants, and in idiopathic steatorrhea. In these latter conditions the patient has difficulty in handling fats in the digestive tract. The primary symptom in sprue is difficulty in the formation of the blood, and with it inflammation of the mouth and tongue and difficulty in absorbing fat.

Most frequent among the symptoms of sprue are diarrhea, indigestion, distention of the abdomen, soreness of the mouth and tongue, loss of weight and, with all this, weakness. The condition is likely to come on gradually in people who have been long on a monotonous low-protein diet. The patients are pale, thin, and sometimes have eruptions of the neck, face and hands and extreme redness of the tongue and mouth. Doctors make certain of the diagnosis by using the X-ray and by making studies of the blood and the bone marrow, where the red blood cells are formed.

Fortunately such preparations as liver extract, folic acid, vitamin B12, vitamin K, and a good diet high in protein bring prompt relief to patients with sprue. The symptoms begin to disappear in a few days and in a few weeks, unless there has been too much damage to the tissues, the patient is well on the way to complete recovery.