Should I take niacin or niacinamide if 50 mg of niacin in my multi-vitamin caused me to flush within 1 to 2 hours of taking it?
Low doses of niacin (25 mg twice a day after meals) should not cause flushing, is sufficient, and is easily metabolized. However, if you are hypersensitive, you can take ½ (81 mg) of a pediatric aspirin just before each niacin dose to prevent flushing or…READ MORE
What about other vitamin or dietary supplements?
I do endorse a multiple vitamin supplement and all patients with carcinoid syndrome should take low doses of niacin to prevent subclinical pellagra.…READ MORE
Do you believe that foods containing xanthines or theobromine, such as coffee, interfere with Sandostatin?
Xanthines and theobromines, as well as various foods and wines, contain substances that are provocative for carcinoid crisis and hence can interfere with the effectiveness of Sandostatin. I do agree with Dr. Woltering in recommending carcinoid patients…READ MORE
Have you ever had patients report getting diarrhea from drinking coffee or tea?
Occasionally patients get diarrhea from coffee, but it is uncommon.…READ MORE
Would you consider amending your recommendation of supplementing one’s diet with niacin to supplementing with niacinamide?
Niacin synthesis is deficient in carcinoid syndrome because of metabolic diversion of its precursor, tryptophan, to form serotonin. In some untreated individuals this can even lead to pellagra. Hence the recommendation for niacin supplementation. …READ MORE
What about fat — if red meat is tolerated is it okay to eat?
The only reason for carcinoid patients to eat a low fat diet would be to reduce steatorrhea (fat-containing diarrhea) if they have malabsorption due to short bowel syndrome or as a side effect of Sandostatin. If fat malabsorption is present or even suggested,…READ MORE
Should carcinoid patients take niacin? If so, how much? Does it cause any side effects?
The nutritional deficiency disease pellagra results from niacin deficiency. Diarrhea is one symptom of pellagra. All carcinoid syndrome patients have subnormal blood levels of tryptophan, an evidence of its depletion by being diverted to make …READ MORE
Is food intolerance very patient-independent?
Food tolerances are highly individual and not necessarily related to carcinoid.…READ MORE
Do you prescribe pancreatic enzyme replacements and if so, how much and how often?
Pancreatic enzyme replacement varies from 1-3 Viokase tablets with each meal and at bedtime, or 1-2 Creon or Pancrease capsules taken with each meal and at bedtime.…READ MORE
What about alcohol? What forms should be avoided and why?
All alcohol should be avoided because of its ability to trigger carcinoid crisis.…READ MORE