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Suggest treatment for facial flushing and constipation

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Posted on Thu, 21 Jul 2016
Question: I have heavy wet flushing. it repeats all day and all night. i control it with two 50 mg of nicotinamide ribose daily, with additional 50 mg tabs taken when the wet flushing occurs following ingestion or imbibing of foods and drinks that stimulate it. it is consistent with carcinoid syndrome in many ways, but the flushing is whole upper torso and i do not have diarrhea. it's the opposite in fact, i have very hard stools that i have to drink vinegar water to ease the problem. I have had MRI's and CT's and OCT's, and colonoscopy and anterior and posterior endoscopies, without any findings at all. I do not know what in the heck I haver except it is an extreme, general from of hydrosis.
doctor
Answered by Dr. Nagamani Ng (5 hours later)
Brief Answer:
24 hour urine levels of 5 hydroxyindoleacetic acid

Detailed Answer:
Hi,
Welcome to HCM,
I would like to know how did you diagnose that you are suffering from carcinoid syndrome. You have flushing and constipation. In carcinoid it is FLUSHING
DIARRHEA
CARDIOMYOPATHY
ASTHMA
ABDOMINAL PAIN
RASHES
only with 2 findings you cannot put you under this diagnosis. The flush in most of the cases id due to familial allergic conditions. The constipation can be controlled by taking hive dietary fibers like flax seeds, fenu greak, spinach, brown rice, whole wheat. Have lot of fluids and 8 to 10 glasses of water per day.
If still you want to rule out this condition you can get 24 hour urine levels of
5 HYDROXYINDOLEACEETIC ACID levels tested.
hope the information was useful to you.
take care.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
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Follow up: Dr. Nagamani Ng (8 hours later)
It isn't useful at-all. The reaction to the list of foods that cause carcinoid reactions, plus, the heavy wet flushing, plus the reduction of symptoms by taking nicotinamide ribose, a carcinoid symptom reducer, plus the enormous fatigue that follows the flushing events, is what suggests the carcinoid. I tested for 5HIAA, and once was slightly high, and the second time was normal. The point is, I do not have food allergies to the exact foods referred to under carcinoid syndrome without it being a completely remarkable coincidence that they would all give me exactly the same level of flushing that starts in my lower back, and covers my entire torso, that would appear with carcinoid. I already stated that I had 5HIAA testing. I have four carcinoid issues, not one. Heavy general sweating following repeated day and night flushing, reaction to serotonin-laden and sweats in stimulating foods, severe fatigue after flushing, and symptom control induced by nicotinamide, which is only used to control carcinoid symptoms. So Mayo Clinic looked for carcinoid tumors. Didn't find any. I am diagnostically stuck, but do not have food allergies.


Plus, I developed this condition in the last two years. If I had food allergies, they would have just started when I became 62.

Plus, I have night flushing and sweats and day sweats that are just the same. If it was food allergies the would not be so generalized.
doctor
Answered by Dr. Nagamani Ng (14 hours later)
Brief Answer:
Cannot rule out carcinoid

Detailed Answer:
Hi,
Welcome back,
We cannot rule out that it is not carcinoid.
Don't bother too much about the diagnosis, right now you just take the symptomatic treatment and get a yearly check up to rule out carcinoid.
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Nagamani Ng (19 hours later)
Is there any other condition for which nicotinamide ribose would be an effective flushing palliative? I know this is not food allergies.
doctor
Answered by Dr. Nagamani Ng (5 hours later)
Brief Answer:
not found any such condition

Detailed Answer:
Hi,
Thanks for the follow up.
In my clinical practice i have not seen any such condition where flushing is reduced by nicotinamide ribose.

Instead i have come across the patients get flushing as a side effect of nicotinamide ribose.

Take care.
Above answer was peer-reviewed by : Dr. Sonia Raina
doctor
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Follow up: Dr. Nagamani Ng (5 hours later)
They may get flushing from niacin. But nicotinamide is supposed to be a non-flushing form of niacin. Plus, the flush from niacin, is a face flush. It is nit a general heavy wet flush, like I get, which is suppressed by the nicotinamide in my case, which I learned about from carcinoid.org, which had a published paper there that described the mechanism of nicotinamide ribose on reducing serotonin output from carcinoid.
doctor
Answered by Dr. Nagamani Ng (15 hours later)
Brief Answer:
you are right

Detailed Answer:
I didn't mean to say the flushing you are suffering from is a cause of nicotinamide.
I have come across some patients in my practice with nicotinamide induced flushing.

In your case i would ask you to continue nicotinamide ribose as a flushing palliative.

If i would be your treating doctor i would ask you get tested N-METHYL NICOTINAMIDE excretion levels to rule out PELLAGRA as in rare cases flushing is an initial symptom of pellagra.

Don't worry too much about carcinoid, cause right now you have not diagnosed it in CT or MRI AND somatostatin receptor scintigraphy.

But get regularly evaluated at least once in a year to rule out the carcinoid by testing 5HIAA and chromogranin A levels.

Take care.
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
Answered by
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Dr. Nagamani Ng

General & Family Physician

Practicing since :2010

Answered : 978 Questions

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Suggest treatment for facial flushing and constipation

Brief Answer: 24 hour urine levels of 5 hydroxyindoleacetic acid Detailed Answer: Hi, Welcome to HCM, I would like to know how did you diagnose that you are suffering from carcinoid syndrome. You have flushing and constipation. In carcinoid it is FLUSHING DIARRHEA CARDIOMYOPATHY ASTHMA ABDOMINAL PAIN RASHES only with 2 findings you cannot put you under this diagnosis. The flush in most of the cases id due to familial allergic conditions. The constipation can be controlled by taking hive dietary fibers like flax seeds, fenu greak, spinach, brown rice, whole wheat. Have lot of fluids and 8 to 10 glasses of water per day. If still you want to rule out this condition you can get 24 hour urine levels of 5 HYDROXYINDOLEACEETIC ACID levels tested. hope the information was useful to you. take care.