What is ariboflavinosis? Why is it important to know?


Ariboflavinosis is the medical condition caused by deficiency of riboflavin (vitamin B2). Ariboflavinosis is most often seen in association with protein-energy malnutrition, and also in cases of alcoholism.

It was originally known as pellagra sin pellagra, as it exhibits certain similarities to the niacin deficiency pellagra.

The most common cause of riboflavin deficiency is an inadequate diet; thus, it occurs most frequently in populations consuming limited quantities of riboflavin-containing foods such as meats, eggs, milk, cheese, yogurt, leafy green vegetables and whole grains. Riboflavin deficiency can also occur in those with impaired liver function, which prevents proper utilization of the vitamin.

Borderline riboflavin deficiency as a consequence of certain anti-retroviral medications has also been known to cause acute lactic acidosis.

The signs and symptoms of riboflavin deficiency typically include sore throat with redness and swelling of the mouth and throat mucosa, cheilosis and angular stomatitis (cracking of the lips and corners of the mouth), glossitis (magenta tongue with atrophy), seborrheic dermatitis or pseudo-syphilis (moist, scaly skin particularly affecting the scrotum or labia majora and the nasolabial folds), and a decreased red blood cell count with normal cell size and hemoglobin content (normochromic normocytic anemia).

Riboflavin deficiency is usually found together with other nutrient deficiencies, particularly of the other water-soluble vitamins. Phototherapy to treat jaundice in infants can cause increased degradation of riboflavin, leading to deficiency if not monitored closely. Persons with chronic alcoholism can have impaired absorption of riboflavin and other vitamins such as thiamine (Wernicke's encephalopathy).

One study of pregnant women has found that riboflavin-deficient women were 4.7 times more likely to develop preeclampsia, though the mechanism for this is not known.

Subclinical riboflavin deficiency occurs in:

1. Women taking oral contraceptives.

2. The elderly.

3. People with eating disorders.

4. Disease states such as HIV, inflammatory bowel disease, diabetes and chronic heart disease.

The fact that riboflavin deficiency does not immediately lead to gross clinical manifestations indicates that the systemic levels of this essential vitamin are tightly regulated.

Subclinical riboflavin deficiency in children.

Although the effects of long-term sub-clinical riboflavin deficiency are unknown in children, this deficiency has been proven to result in reduced growth.

Riboflavin Deficiency in animals

In animals, riboflavin deficiency results in lack of growth, failure to thrive, and eventual death. Experimental riboflavin deficiency in dogs results in growth failure, weakness, ataxia, and inability to stand. The animals collapse, become comatose, and die. During the deficiency state, dermatitis develops together with hair-loss.

Post-mortem studies in rhesus monkeys fed a riboflavin-deficient diet revealed that about one-third the normal amount of riboflavin was present in the liver, which is the main storage organ for riboflavin in mammals. These overt clinical signs of riboflavin deficiency are rarely seen among inhabitants of the developed countries.

About 28 million Americans exhibit a common 'sub-clinical' stage characterized by a change in biochemical indices (e.g. reduced plasma erythrocyte glutathione reductase levels).


Riboflavin deficiency (ariboflavinosi):

Riboflavin is continuously excreted in the urine of healthy individuals, making deficiency relatively common when dietary intake is insufficient. However, riboflavin deficiency is always accompanied by deficiency of other vitamins. Riboflavin deficiency may be primary or secondary.
A. Primary deficiency of riboflavin occurs when there are poor vitamin sources in one's daily diet.
B. Secondary deficiency of riboflavin may be the result of conditions that affect absorption in the intestine, the body not being able to use the vitamin, or an increase in the excretion of the vitamin from the body.

Signs and symptoms of riboflavin deficiency (ariboflavinosis)
1. Cracked and red lips, inflammation of the lining of mouth and tongue, mouth ulcers, cracks at the corners of the mouth (angular cheilitis), and a sore throat.
2. Dry and scaling skin, fluid in the mucous membranes.
3. The eyes may become bloodshot, itchy, watery and sensitive to bright light.

4. Oral-ocular-genital syndrome

Riboflavin deficiency is classically associated with the oral-ocular-genital syndrome. Angular cheilitis, photophobia, and scrotal dermatitis are the classic remembered signs.

5. Other signs of deficiency include corneal opacity, lenticular cataracts, hemorrhagic adrenals, fatty degeneration of the kidney and liver, and inflammation of the mucus membrane of the gastrointestinal tract.


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7/21/2009 8:14:23 PM
Syed Shahid MD
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Dr Syed Shahid MD Dr Shahid received his medical degree ( MBBS ) from Punjab University (Pakistan) in 1963. He did his post-graduation in Internal Medicine in UK. After that he proceeded to USA, where he got Board Certification in Family Practice, Psychiatry & Neurology. Dr Shahid also has extensive study in many o...
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Hi Amber, Thanks for sharing your views on Holistic Medicine and ariboflavinosis. Although the most effective and the most useful tool (and art) in medicine, yet "Holistic Medicine" still is one of the least understood and the most underated field of the healing arts. It is student like you who can upgrade its value in medical academy. Please continue to aspire in this direction. You are right. Proloned ariboflavinosis can cause severe anemia due to many factors associated with this deficiency. 1. Ariboflavinosis has been known to cause alteration in iron metabolism. Although the mechanism is not clear, research in animals suggests that riboflavin deficiency may impair iron absorption, increase intestinal loss of iron, and/or impair iron utilization for the synthesis of hemoglobin. In humans, improving riboflavin nutritional status has been found to increase circulating hemoglobin levels. Correction of riboflavin deficiency in individuals who are both riboflavin and iron deficient improves the response of iron-deficiency anemia to iron therapy. Iron deficiency anemia is hypochromic and microcytic anemia. 2. However, in prolonged ariboflavinosis, there is a decreased red blood cell count with normal cell size and hemoglobin content (normochromic normocytic anemia) as well. Mechanism of this change is still unclear. 3. Isolated deficiency of riboflavin is rare. It is usually associated with other deficiencies of water soluble vitamins. B1, B6, B9 (folic acid) and B12 deficiencies usually predominate. Anemia in B9 and B12 deficiencies is macrocytic and hyperchromic. Thanks for your curiosity and if you have any more questions, please don't hesitate to ask. Good luck to your pursuits. Have a good day, Sydshahid
Posted by Syed Shahid MD
Hello Dr Shahid, I'll give you a quick introduction before I take your time to ask my question. My name is Amber Parker and I am currently a dental hygiene student. I read a portion of your profile and found that we seem to have some similar ideologies. I am very interested in the study of holistic medicine, I believe our bodies are designed to handle and overcome most illnesses with the right fuel and focus to do so. I plan to study the field of holistic medicine upon completion of my dental hygiene studies. I am doing research on the effects of ariboflavinosis and the consequences if left untreated. I came across you post on wellness.com and am very impressed with the completeness of your discussion on vitamin B2 (riboflavin) deficiency. I was wondering if you would agree that, in a very small nutshell, if the condition is left untreated that it will progress from minor oral (relating to dental hygiene such as cheilosis) to more severe systemic states such as anemia? I know this is very basic and significantly downplays all the other factors that may be involved, but I do not wish to waste your time over a lengthy e-mail post. Thank you for your time, it sounds like you are very busy and I would appreciate any response you may be able to offer. Have a good evening, Amber Parker
Posted by Syed Shahid MD
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