Tag Archives: differential diagnosis

A Differential Diagnosis: How Pellagra Can be Confused/is Confused with Celiac Disease Today by the Celiac Posterboy

A Differential Diagnosis: How Pellagra Can be Confused /is confused with Celiac Disease Today by the Celiac Posterboy

* Published 01/17/2017 * Journal of Gluten Sensitivity Winter 2017 Issue , Additional Celiac Disease Concerns

Rating:  ****** Five Stars

As Published in the International Journal of Gluten Sensitivity originally appearing on Celiac.com 01/17/2017  See this Link https://www.celiac.com/articles/24658/1/A-Differential-Diagnosis-How-Pellagra-Can-be-Confused-with-Celiac-Disease/Page1.html

A diagnosis of Pellagra will likely have many other disease presentations, not limited to acne, rosacea (dermatitis) skin rashes, depression, anxiety, dementia, etc., as well. Seventy-five or more years ago the symptoms of Pellagra were commonly diagnosed as separate diseases that were known to be of a common cause. Similarly celiac disease today is often referred to as the “tip of the iceberg,” not only because of the large number of undiagnosed people, but also due to the vast range of symptoms and associated diseases and disorders that can be caused by untreated celiac disease. I assert that Pellagra could be, in some cases, related to Celiac disease, and might even cause it.

Today Pellagra has mainly been reserved for subgroups of people like alcoholics or disadvantaged groups like the homeless, who lack good protein sources in their diet to stave it off. Quoting Niki Frost from the Pellagra Disease Blog: “Since pellagra is such a rare disease today, few people recognize it based on their symptoms alone (any of the three D’s: dementia, dermatitis, and diarrhea). Pellagra patients are consequently referred to specialists in fields that are ultimately unrelated to the underlying nutritional deficiency and metabolic nature of the disease.” (1)

Dr. Heaney, Professor of Medicine at Creighton University, actually echo this fact when he says “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.” (2) Why is this? Because, as mentioned above, doctor’s don’t recognized it today unless they are a specialist, and even then, according to Nicki Frost: “specialists (are) in fields that are ultimately unrelated to the underlying nutritional deficiency and metabolic nature of the disease.” (3) So the cycle repeats.

Since these specialists might not consider people with celiac disease/Non-Celiac Gluten Sensitivity (NCGS) to be in a subgroup which is prone Pellagra, is it possible that some people are misdiagnosed? Skin conditions like acne, dermatitis, eczema, psoriasis, skin lesions, and mouth ulcers can be related to both Pellagra and celiac disease or NCGS. Some of the other signs of Pellagra, other than digestive distress, are dementia related symptoms such as depression, anxiety, brain fog, mental confusion, etc., which are also present in 40 percent of celiac patients. What if doctors haven’t made the right diagnosis in some cases? Many people who might be misdiagnosed with celiac disease but who actually have Pellagra might not get better because they are not treating the right disease.

Pellagra and its associated skin and GI problems are totally reversible with supplementation, which is one of the reasons that many foods are enriched with niacin. Glutenfree Works covers this topic well by noting a casual relationship, but not a causal relationship. They even note that a niacin deficiency itself can cause some of these symptoms. According to Glutenfree Works:

“Intriguing animal research by Sandhur et. al. has shown that niacin deficiency itself sensitizes the intestinal mucosa of rats to gluten in wheat, barley, rye, oats and corn and induces susceptibility to gluten toxicity by means of cellular dysfunction. Human research needs to investigate this effect of niacin deficiency in human celiac disease.” (4)

But no one else seems to take note of this amazing fact. The research by Sandhur et. al. is 30+ years old, but is it possible that people are suffering from all kinds of GI problems, possibly even celiac disease, because they are ignorant of this fact?

Around 15 years ago Prousky did follow up human research (5) that supports the idea that Niacinamide can indeed treat different digestive problems. It was this initial research which I read 10+ years ago that lead me to the hypothesis that Pellagra today is might be misdiagnosed as Celiac disease, because doctors are no longer able to recognize Pellagra in a clinical setting, having not seen it 75+ years.

From Dr. Heaney’s blog: “2014 marks the 100th anniversary of the war on pellagra, a war that lasted nearly 25 of those years before victory could finally be declared. You have not heard of the war on pellagra? The celebration is not on your calendar? You’re not alone. Why did it take so long? Was the science so intractable, like the current “war” on cancer? No. It was politics and pigheadedness that were the obstacles.“ Dr. Heaney says: “Nutritional deficiency was not an accepted category of disease when Goldberger started work” on his cause/cure for Pellagra, and I must also mention that it is not looked at today in those diagnosed with celiac disease. (6)

Let’s look into this more if we can. Let’s see what other expert’s say about this. If we look at back issues of The International Journal of Celiac Disease we see a casual link that indicates a co-morbidity of Pellagra in celiac patients of 58%. (7) Note they the International Journal of Celiac Disease is not looking for a causal link but they only report casual association. In the article entitled “Two Exceptional Complications Revealing Celiac Pellagra” the author notes: “pellagra is essentially affecting tissues with a high rate of cell turnover, such as the digestive tract and the skin, and tissues with high energy needs, such as the brain”. (8) If the symptoms are so similar, it might be easy to confuse one disease for the other.

How is this possible? The International Journal of Celiac Disease muses on this point too. When discussing the “exceptional” and not well understood reasons why Pellagra might show up in a celiac diagnosis, they say “Little progress has been made in our knowledge of pellagra…since Goldberger discovered that nicotinamide was a preventive factor in 1926…(P)roof of this is that there have been no changes in treatment or diagnostic criteria in the last 90 years.” The International Journal of Celiac Disease summarizes this case of “Exceptional complications revealing celiac disease and Pellagra illustrates…rare complication revealing celiac disease”. (8)

Since up to 58 percent of celiac patients might be co-morbid with Pellagra, could it be possible that Pellagra is the “parent disease,” and the those diagnosed with celiac disease have symptoms derived from Pellagra? If we follow most normal paths for adoption it will take another 20 years (a generation) for the medical community to accept Pellagra as perhaps the proper diagnosis in some cases. So there is some evidence to suggest that medical science is, perhaps in many cases, identifying the wrong disease. If one is critically low in niacin, the 3 D’s of Pellagra (Dementias, Dermatitis’s, and Digestive Issues) show up.

Take the “Niacin (Niacinamide) Challenge” and see if taking it three times a day for six months don’t cause a healthy GI pattern, including a once per day bowel movement that sinks and healthy burping without bloating. Taking the niacinamide Challenge may put co-morbid cases of Pellagra, including its digestive symptoms, into remission, and provide relief for many who do not recover on a gluten-free diet alone. The number one mistake people make when taking niacinamide is they don’t take it for long enough. It takes 4 to 6 months to overcome a serious deficiency of this vitamin, and for your mucus membranes (GI lining) to heal itself.

Once you recover you can maintain your health, barring some future stress/trauma that depletes your reserves, at which time heartburn/GERD/IBS/diarrhea/constipation symptoms will return, and you will lose your ability to burp easily again. And the cycle repeats and the Pellagra symptoms come back with a vengeance.

Read more at https://celiacposterboy.wordpress.com/2016/02/19/when-myth-becomes-medical-fact-people-suffer-unnecessarily-the-case-of-mistaken-identity-how-pellagra-now-thought-to-be-rare-became-known-as-celiac-disease-a-white-paper/


1. https://pellagradisease.wordpress.com/

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

3. https://pellagradisease.wordpress.com/

4. http://glutenfreeworks.com/blog/2010/06/23/niacin-vitamin-b3-deficiency-in-celiac-disease/

5. Prousky, Jonathan E. Is Vitamin B3 Dependency a Causal Factor in the Development of Hypochlorhydria and Achlorhydria? Journal of Orthomolecular Medicine, Vol. 16, No. 4, 4th quarter 2001, pp. 225-37. http://www.orthomolecular.org/library/jom/2001/articles/2001-v16n04-p225.shtml

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

7. International Journal of Celiac Disease. Celiac Disease: Intestinal, Heart and Skin Interconnections. 2015, 3(1), 28-30 doi:10.12691/ijcd-3-1-6 http://pubs.sciepub.com/ijcd/3/1/6/

8. International Journal of Celiac Disease. Two Exceptional Complications Revealing Celiac Disease: Ischemic Cardiomyopathy and Pellagra. International Journal of Celiac Disease. 2015, 3(1), 31-32 doi:10.12691/ijcd-3-1-5. http://pubs.sciepub.com/ijcd/3/1/5/

One reviewer/forum member on Celiac.com gave it Five Stars.

Knitty Kitty

Rating:  Five Stars

said this on

18 Jan 2017 1:56:09 PM PST

Hurrah! Wonderful informative article. Should be required reading in the Newbie section. Thanks!

It should be noted that the forum member had already treated her DH with Niacin and already knew of its power to help Dermatitis problems.

Soon after the is article appeared on Celiac.com someone on my Celiac Posterboy blog began taking Niacinamide for her GI problems associated with her Celiac disease that were still having Constipation and Diarrhea problems despite being gluten free and got better (her C&D settled down) shortly after beginning the Niacinamide.

I will let her speak for herself.

1. Mairllyn February 7, 2017 at 3:18 am

I have Celiac and have been having a terrible time with “D” these past 3 months. Read Celiac. com and your article about the Niacinamide was very interesting. Due to the problems with the GI tract, I was using a BRAT diet more often than I should have. While I do take a multi with niacin in it, probably need a lot more. Added the Niacin and Niacinamide and already things are slowing down. Yea! Just had colonoscopy today and EGD to r/o any problems, Doc said that things looked good but he took biopsies to r/o SBIO and/or another type of colitis. Once I added the niacin things started to improve. I am going to take your article to his office when I do my follow up visit. Thanks for writing it.

Link provided below “To Educate is to Free Part 2: A Physician’s Guide where she enthusiastically comments and says thank you.  Be sure to read to the end of the thread/blog post to read her comments for your-self.


This reminds of a quote from a friend of mine J. Dan Gill who wrote the Theologic book for Laymen “The ONE: In Defense of God” that definitively describes The ONE God of Israel and his Son Jesus Christ (the Anointed “one”) as truly the good news of the Gospel.  In fact John 17:3 describes it as life Eternal.  “And this is life eternal, that they might know thee the only true God, and Jesus Christ, whom thou hast sent.”

Where/when he (Dan) talks about the difference between Truth and Error.

“The Truth is Always Better

The Truth, whatever it is,

Is always better than error,

Whatever it is.”

By J. Dan Gill

The Truth that there is  the FATHER who is the ONE God who had one begotten Son Jesus Christ/Messiah our Lord is truly good news for us. Because He (God) has raised that one man from the dead giving us assurance he someday will raise us too if we are in Christ (The Anointed Jesus)

Acts 17:31 Because he hath appointed a day, in the which he will judge the world in righteousness by that man whom he hath ordained (anointed); whereof he hath given assurance unto all men, in that he hath raised him from the dead.

While this issue of error of getting a wrong diagnosis does not raise to this error of being dead forever (the opposite of eternal life) it can lead to an early grave if you continue to have Pellagra and are not treated for it properly – the 4th D of Pellagra.

The knowledge (truth) that a Vitamin can help us is greater than the error of being misdiagnosed with the wrong disease.

If the International Journal of Celiac Disease is correct there is better than a 50/50 chance you will get better the way Knitty Kitty, Mairllyn, and the Celiac Posterboy has.

Won’t you be the next Celiac to get better (I speak as a man) i.e. come back from the Celiac grave you now find yourself in.

Gluten Juneteenth has been declared (look it up if you don’t know what it means)


Because Pellagra is progressive you will die from the 4th D of Pellagra in time.

Someone can be said to “die before their time” don’t let Pellagra steal your time away from you any longer.  You needn’t die before your time if you take the Niacinamide and get better from it.

Taking it and getting better is considered sufficient proof that a Niacin(amide) deficiency was causing the 3 D’s of Pellagra.

See this link from mdguidelines webite http://www.mdguidelines.com/pellagra

A simple urine test is all that is needed to determine if you have Pellagra and the doctors’ have not recognized it in a clinical setting.

They summarize it very well why Pellagra is not being diagnosed today in Doctor’s offices’ across the land.

Pellagra in Italian (the language it was first described in 250+ years ago) meaning “Rough/Sour Skin”

In their diagnosis section quoting  “The diagnosis of pellagra is straightforward when the classic rash is present but may be elusive if there are only gastrointestinal and/or neurological manifestations.”

Today if you fail to get the “classic symmetrical” sun (photosensitive) rash then you fail to get diagnosed as a Pellagrin in the first place then the other Ds’ of Pellagra present such as the Gastrointestinal issues associated with a Celiac diagnois and/or neurological problems like the 40% of those who are get a Celiac diagnosis and are depressed but are diagnosed with it as part of a separate diagnosis from  that of a Celiac diagnosis.

Or if you quoting again don’t have what they (according medical doctor’s diagnosing guidelines)  consider  “Poor dietary habits, such as those found among chronic alcoholics, individuals with severe eating disorders (e.g., anorexia nervosa and bulimia nervosa), and the malnourished also increase the risk of pellagra” then you are not diagnosed today as having Pellagra.  Today you will be diagnosed as a Celiac.

Since you are not one who consumes/relies on a quoting again “a diet high in corn products” then you the wheat consuming Pellagrin are diagnosed as having Celiac today instead.

See my celiac posterboy blog link that explains why this is today.


But if you don’t get the correct diagnosis/disease in the beginning then you don’t get better.

Oh you cope, manage, continue to have flares get more sensitive to other proteins lactose, soy, corn (there is that corn thing again) etc.

You are said to be a Celiac who is supersensitive?

There is no hope for you now?  The doctor’s don’t know why you continue to have problems.

You have removed gluten from your diet… you should get better.

But you never do . .. . you just get more sensitive and more sensitive to more food allergens (proteins) that your body can no longer digest.

Stop the Madness!!!!! (Errors)

Get the right disease Pellagra and get better the way other Celiac’s have!

Like myself and Mairllyn and Knitty Kitty has done by taking the Niacinamide Challenge


And have gotten better.

And my doctor’s IBS patients who have not yet received a NCGS diagnosis or a Celiac diagnosis in time because Pellagra is progressive and the conditions continue to get worse and worse …

Your flare up’s continue (think Chron’s) and the doctor’s don’t know why.  But you do my friend because you have been reading the Celiac Posterboy’s blog and have gotten better from Celiacs’ evil twin – Pellagra.

Please don’t be trapped by  error of  a misdiagnosis any longer!

Bee Freed by the Truth of a correct diagnosis!

Praise bee to God!

See my Celiac Posterboy blog post dedication about the Bee’s Story that I included in my “How to Fight Gluten and Win; Or How the Doctor’s Almost Killed Me” ebook  available on Amazon if this post isn’t enough to convenience you that ignorance might be killing you too maybe if you have been stung by their ignorance of Pellagra today and you are reading this blog.


Where I say quoting the Celiac Posterboy

“Learn from my mistakes.  

No man is so dumb as the man who won’t learn from other people’s mistakes.

Take as much honey (knowledge) as you can from my mistakes so bad (lack of knowledge) health will not sting your quality of life.

Is it any wonder God’s promised’ land was described as a land flowing with milk and honey?

Where knowledge (truth) flows there is health of mind and body.”

Don’t be trapped by this error (Medical Myth) any longer.

See my post about why/this is /came to be to our harm.

Linked again here for your convenience of how the Celiac Posterboy freed himself (God being his help) of Pellagra being diagnosed as Celiac Disease today of this medical myth!


Or as I have entitled this post “A Differential Diagnosis: How Pellagra can/is confused with/as Celiac Disease today!

SADLY! Few listen.  But some (Celiac’s) have heard (listened to) the good news that Pellagra is reversible and have gotten better.  Don’t be the Last!

Praise bee to God!

As always search for the “Celiac Posterboy” or “Celiac Poster boy” or “Fight Gluten Win” or “Fight GERD Win” if you want to read all my blog posts for as I have said elsewhere in this blog and it bears repeating “To Educate is to Free” Truly. See my Celiac Posterboy WordPress blog entry


If you want to try and educate your doctor and think he will listen.

Truth of the right diagnosis has freed us from the error of the wrong diagnosis.

*** This is not medical advice and should not be considered such. Results may vary. Always consult your doctor before making any changes to your medical regimen. But mine has taken the  Niacinamide Challenge

https://celiacposterboy.wordpress.com/2014/12/03/the-niacin-niacinamide-challenge/ and his digestive/GI problems are in remission.

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

The Celiac Posterboy by the Grace of God,

Joe “Rock” Pen Name

2 Corinthians (KJV) 1:3,4 3) “Blessed be God, even the Father of our Lord Jesus Christ, the Father of mercies, and the God of all comfort; 4) who comforteth us in all our tribulation, that we may be able to comfort them which are in any trouble,  by the comfort wherewith we ourselves are comforted of God.”