beriberi great imitator

Beriberi: The Great Imitator

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Because of some unusual clinical experiences as a pediatrician, I have published a number of articles in the medical press on thiamine, also known as vitamin B1. Deficiency of this vitamin is the primary cause of the disease called beriberi. It took many years before the simple explanation for this incredibly complex disease became known. A group of scientists from Japan called the “Vitamin B research committee of Japan” wrote and published the Review of Japanese Literature on Beriberi and Thiamine, in 1965. It was translated into English subsequently to pass the information about beriberi to people in the West who were considered to be ignorant of this disease. A book published in 1965 on a medical subject that few recall may be regarded in the modern world as being out of date and of historical interest only, however, it has been said that “Those who do not learn history are doomed to repeat it”. And repeat it, we are.

Beriberi is one of the nutritional diseases that is regarded as being conquered. It is rarely considered as a cause of disease in any well-developed country, including America. In what follows, are extractions from this book that are pertinent to many of today’s chronic health issues. It appears that thiamine deficiency is making a comeback but it is rarely considered as a possibility.

The History of Beriberi and Thiamine Deficiency

Beriberi has existed in Japan from antiquity and records can be found in documents as early as 808. Between 1603 and 1867, city inhabitants began to eat white rice (polished by a mill). The act of taking the rice to a mill reflected an improved affluence since white rice looked better on the table and people were demonstrating that they could afford the mill. Now we know that thiamine and the other B vitamins are found in the cusp around the rice grain. The grain consists of starch that is metabolized as glucose and the vitamins essential to the process are in the cusp. The number of cases of beriberi in Japan reached its peak in the 1920s, after which the declining incidence was remarkable. This is when the true cause of the disease was found. Epidemics of the disease broke out in the summer months, an important point to be noted later in this article.

Early Thiamine Research

Before I go on, I want to mention an extremely important experiment that was carried out in 1936. Sir Rudolf Peters showed that there was no difference in the metabolic responses of thiamine deficient pigeon brain cells, compared with cells that were thiamine sufficient, until glucose (sugar) was added. Peters called the failure of the thiamine deficient cells to respond to the input of glucose the catatorulin effect. The reason I mention this historical experiment is because we now know that the clinical effects of thiamine deficiency can be precipitated by ingesting sugar, although these effects are insidious, usually relatively minor in character and can remain on and off for months. The symptoms, as recorded in experimental thiamine deficiency in human subjects, are often diagnosed as psychosomatic. Treated purely symptomatically and the underlying dietary cause neglected, the clinical course gives rise to much more serious symptoms that are then diagnosed as various types of chronic brain disease.

  • Thiamine Deficiency Related Mortality. The mortality in beriberi is extremely low. In Japan the total number of deaths decreased from 26,797 in 1923 to only 447 in 1959 after the discovery of its true cause.
  • Thiamine Deficiency Related Morbidity. This is another story. It describes the number of people living and suffering with the disease. In spite of the newly acquired knowledge concerning its cause, during August and September 1951, of 375 patients attending a clinic in Tokyo, 29% had at least two of the major beriberi signs. The importance of the summer months will be mentioned later.

Are the Clinical Effects Relevant Today?

The book records a thiamine deficiency experiment in four healthy male adults. Note that this was an experiment, not a natural occurrence of beriberi. The two are different in detail. Deficiency of the other B vitamins is involved in beriberi but thiamine deficiency dominates the picture. In the second week of the experiment, the subjects described general malaise, and a “heavy feeling” in the legs. In the third week of the experiment they complained of palpitations of the heart. Examination revealed either a slow or fast heart rate, a high systolic and low diastolic blood pressure, and an increase in some of the white blood cells. In the fourth week there was a decrease in appetite, nausea, vomiting and weight loss. Symptoms were rapidly abolished with restoration of thiamine. These are common symptoms that confront the modern physician. It is most probable that they would be diagnosed as a simple infection such as a virus and of course, they could be.

Subjective Symptoms of Naturally Occurring Beriberi

The early symptoms include general malaise, loss of strength in knee joints, “pins and needles” in arms and legs, palpitation of the heart, a sense of tightness in the chest and a “full” feeling in the upper abdomen. These are complaints heard by doctors today and are often referred to as psychosomatic, particularly when the laboratory tests are normal. Nausea and vomiting are invariably ascribed to other causes.

General Objective Symptoms of Beriberi

The mental state is not affected in the early stages of beriberi. The patient may look relatively well. The disease in Japan was more likely in a robust manual laborer. Some edema or swelling of the tissues is present also in the early stages but may be only slight and found only on the shin. Tenderness in the calf muscles may be elicited by gripping the calf muscle, but such a test is probably unlikely in a modern clinic.

In later stages, fluid is found in the pleural cavity, surrounding the heart in the pericardium and in the abdomen. Fluid in body cavities is usually ascribed to other “more modern” causes and beriberi is not likely to be considered. There may be low grade fever, usually giving rise to a search for an infection. We are all aware that such symptoms come from other causes, but a diet history might suggest that beriberi is a possibility in the differential diagnosis.

Beriberi and the Cardiovascular System

In the early stages of beriberi the patient will have palpitations of the heart on physical or mental exertion. In later stages, palpitations and breathlessness will occur even at rest. X-ray examination shows the heart to be enlarged and changes in the electrocardiogram are those seen with other heart diseases. Findings like this in the modern world would almost certainly be diagnosed as “viral myocardiopathy”.

Beriberi and the Nervous System

Polyneuritis and paralysis of nerves to the arms and legs occur in the early stages of beriberi and there are major changes in sensation including touch, pain and temperature perception. Loss of sensation in the index finger and thumb dominates the sensory loss and may easily be mistaken for carpal tunnel syndrome. “Pins and needles”, numbness or a burning sensation in the legs and toes may be experienced.

In the modern world, this would be studied by a test known as electromyography and probably attributed to other causes. A 39 year old woman is described in the book. She had lassitude (severe fatigue) and had difficulty in walking because of dizziness and shaking, common symptoms seen today by neurologists.

Beriberi and the Autonomic Nervous System

We have two nervous systems. One is called voluntary and is directed by the thinking brain that enables willpower. The autonomic system is controlled by the non-thinking lower part of the brain and is automatic. This part of the brain is peculiarly sensitive to thiamine deficiency, so dysautonomia (dys meaning abnormal and autonomia referring to the autonomic system) is the major presentation of beriberi in its early stages, interfering with our ability for continuous adaptation to the environment. Since it is automatic, body functions are normally carried out without our having to think about them.

There are two branches to the system: one is called sympathetic and the other one is called parasympathetic. The sympathetic branch is triggered by any form of physical or mental stress and prepares us for action to manage response to the stress. Sensing danger, this system activates the fight-or-flight reflex. The parasympathetic branch organizes the functions of the body at rest. As one branch is activated, the other is withdrawn, representing the Yin and Yang (extreme opposites) of adaptation.

Beriberi is characterized in its early stages by dysautonomia, appearing as postural orthostatic tachycardia syndrome (POTS). This well documented modern disease cannot be distinguished from beriberi except by appropriate laboratory testing for thiamine deficiency. Blood thiamine levels are usually normal in the mild to moderate deficiency state.

Examples of Dysfunction in Beriberi

The calf muscle often cramps with physical exercise. There is loss of the deep tendon reflexes in the legs. There is diminished visual acuity. Part of the eye is known as the papilla and pallor occurs in its lateral half. If this is detected by an eye doctor and the patient has neurological symptoms, a diagnosis of multiple sclerosis would certainly be entertained.

Optic neuritis is common in beriberi. Loss of sensation is greater on the front of the body, follows no specific nerve distribution and is indistinct, suggestive of “neurosis” in the modern world.

Foot and wrist drop, loss of sensation to vibration (commonly tested with a tuning fork) and stumbling on walking are all examples of symptoms that would be most likely ascribed to other causes.

Breathlessness with or without exertion would probably be ascribed to congestive heart failure of unknown cause or perhaps associated with high blood pressure, even though they might have a common cause that goes unrecognized.

The symptoms of this disease can be precipitated for the first time when some form of stress is applied to the body. This can be a simple infection such as a cold, a mild head injury, exposure to sunlight or even an inoculation, important points to consider when unexpected complications arise after a mild incident of this nature. Note the reference to sunlight and the outbreaks of beriberi in the summer months. We now know that ultraviolet light is stressful to the human body. Exposure to sunlight, even though it provides us with vitamin D as part of its beneficence, is for the fit individual. Tanning of the skin is a natural defense mechanism that exhibits the state of health.

Is Thiamine Deficiency Common in America?

My direct answer to this question is that it is indeed extremely common. There is good reason for it because sugar ingestion is so extreme and ubiquitous within the population as a whole. It is the reason that I mentioned the experiment of Rudolph Peters. Ingestion of sugar is causing widespread beriberi, masking as psychosomatic disease and dysautonomia. The symptoms and physical findings vary according to the stage of the disease. For example, a low or a high acid in the stomach can occur at different times as the effects of the disease advance. Both are associated with gastroesophageal reflux and heartburn, suggesting that the acid content is only part of the picture.
A low blood sugar can cause the symptoms of hypoglycemia, a relatively common condition. A high blood sugar can be mistaken for diabetes, both seen in varying stages of the disease.

It is extremely easy to detect thiamine deficiency by doing a test on red blood cells. Unfortunately this test is either incomplete or not performed at all by any laboratory known to me.

The lower part of the human brain that controls the autonomic nervous system is exquisitely sensitive to thiamine deficiency. It produces the same effect as a mild deprivation of oxygen. Because this is dangerous and life-threatening, the control mechanisms become much more reactive, often firing the fight-or-flight reflex that in the modern world is diagnosed as panic attacks. Oxidative stress (a deficiency or an excess of oxygen affecting cells, particularly those of the lower brain) is occurring in children and adults. It is responsible for many common conditions, including jaundice in the newborn, sudden infancy death, recurrent ear infections, tonsillitis, sinusitis, asthma, attention deficit disorder (ADD), hyperactivity, and even autism. Each of these conditions has been reported in the medical literature as related to oxidative stress. So many different diseases occurring from the same common cause is offensive to the present medical model. This model regards each of these phenomena as a separate disease entity with a specific cause for each.

Without the correct balance of glucose, oxygen and thiamine, the mitochondria (the engines of the cell) that are responsible for producing the energy of cellular function, cannot realize their potential. Because the lower brain computes our adaptation, it can be said that people with this kind of dysautonomia are maladapted to the environment. For example they cannot adjust to outside temperature, shivering and going blue when it is hot and sweating when it is cold.

So, yes, beriberi and thiamine deficiency have re-emerged. And yes, we have forgotten history and appear doomed to repeat it. When supplemental thiamine and magnesium can be so therapeutic, it is high time that the situation should be addressed more clearly by the medical profession.

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Image: Print ad from 1930; Public Domain.

This article was published originally on November 4, 2015.

Dr. Derrick Lonsdale passed away on May 2, 2024. He will be missed. 

Derrick Lonsdale M.D., is a Fellow of the American College of Nutrition (FACN), Fellow of the American College for Advancement in Medicine (FACAM). Though now retired, Dr. Lonsdale was a practitioner in pediatrics at the Cleveland Clinic for 20 years and was Head of the Section of Biochemical Genetics at the Clinic. In 1982, Lonsdale joined the Preventive Medicine Group to specialize in nutrient-based therapy. Dr. Lonsdale has written over 100 published papers and the conclusions support the idea that healing comes from the body itself rather than from external medical interventions.


  1. Prior to this 3-4 year long “mystery illness” of stomach and abdominal pain, indigestion, bloating, belching, constipation, weightloss and anxiety, the only long-term prescription medication I’ve taken is Sertraline (since 2017 for anxiety, OCD and depression)

    (I assumed that work-related stress was the cause, which, in part, may very well have been)

    Six months ago, I began taking a shot of Apple cider vinegar before meals as well as drastically improving my diet by switching to mostly organic foods consisting of leafy greens, broccoli, spinach, arugala, brussel sprouts, raw sprouted pumpkin seeds, garbanzo beans, eggs, chicken, alaska salmon, artichokes, avocado, saurkraut, carrots, red onions, garlic, beets, sweet potatoes, celery and occasionally cilantro, walnuts and kiwi. I regularly use ceylon cinnamon, oregano, rosemary and garlic powder as seasonings and none of these foods or seasonings seem to irritate me at all, they have all drastically improved my bloating and sibo. I eat no junk food, refined sugar or soda.

    For the past ~four months, I’ve regularly taken Magnesium glycinate, Zinc Carnosine, vitamin C as Ascorbic acid, Artichoke extract, Ginger extract and magnesium citrate. 

    Suspecting black mold and heavy metals exposure may have been the cause, I’ve occasionally taken binders such as charcoal capsules, chlorella, and seldomly drink one tspn of pharmaceutical grade Bentonite clay powder mixed with water. Binders have seemingly cured all of my facial and chest eczema rashes and dandruff with no adverse reactions.

    Two months ago, I began taking Betaine HCL capsules (6) during meals, which helped tremendously with digestion. One month ago I began taking Organic milk thistle capsules, Liposomal Glutathione and NAC. Three weeks ago I began taking Annatto vitamin E.

     Everything I had taken up to this point had only positive effects on my health and digestion, despite my continued constipation and gradual weightloss.

    I learned about Vitamin B1 deficiency and the crucial role it plays in digestive function, so 2 weeks ago, I began taking 50mg of TTFD-B1 MAX Thiamine Vitamin B1 per day (this is a half dose). After day one, I noticed better digestion and the next day, I produced a normal, effortless bowel movement for the first time in over a year. I’ve been having regular bowel movements for these past two weeks.

    I was very excited to have finally discovered the cause, however, over the course of these next two weeks I began feeling ever-worsening body aches, especially severe arm and leg pain, extreme fatigue, terrible anxiety and insomnia. This reaction is apparently very common in those treating a B1 Thiamine deficiency. I believe what I’m experiencing is something called “refeeding syndrome” or “paradoxical reaction” to a deficient vitamin. I stopped taking TTFD-B1 on June 8, as the symptoms were too extreme and quite frightening. I thought that a half-dose was proceeding cautiously, but it seems not cautious enough. Maybe 1/8 or even 1/16 capsule would be more appropriate for my body. It seems I may be deficient in other co-factor vitamins and micro-nutrients needed for this cellular process to function and to avoid such an extreme reaction in the future. 

    Over the past 3 days, the reaction symptoms have greatly subsided. 

    Yesterday, I was seen in the emergency room at Cayuga Medical Center. They took blood samples, took a urine sample, and conducted a liver, gallbladder, pancreas and kidney ultrasound. Everything was determined to be normal, and I was released from their care.

    At this point, I am overwhelmed with information and need your expert advice on how to proceed

    Thank you so much, -Ben

  2. I had to take 6000 mg of b1 to feel better, is it dangerous to take 2000mg three times a day. It’s the only way I feel like my energy comes back. I have type 2 diabetes, low energy, depression, gastroparisis, and other symptoms with muscles siezing up and muscle confusion. I’m doing a very low carb diet which keeps my blood sugar down. But even then my energy level is non existent. I’m off the metformin. I quit coffee too which was causing havoc on my health. Just wanted to make sure it’s not too much.

  3. Dear Dr Lonsdale,
    I have been taking allithiamine (1000 mg/day) together with magnesium and multivitamin-mineral. For a long time that went well, but then I started getting bloating, red and itchy skin, as well as very dry and wrinkly skin and lightheadedness.
    I then added B complex and potassium, based on what I have read on this site and Dr Overton’s site.
    For a while this improved things, but then worse again. Then I stopped potassium, and it improved, but now it’s getting worse again, and if I add the potassium back in, it becomes even worse.
    So I am really quite unsure now as to whether I should supplement potassium, or keep it out, especially since there are also articles about the danger of hyperkalemia.
    Many thanks for your work!

    • Thiamine governs potassium metabolism. I advocate starting low dose thiamine alone. Build up to try to find the ideal dose. Then add magnesium and a multivitamin

    • The danger of hyperkalemia comes from how quickly we absorb supplemental potassium when it’s not in food. If it’s too fast, the body can’t keep up with it, and either dispose of it via kidneys or shuffle it into the cells where it belongs. If you spread a potassium supplement of, say, 2g a day out among 8 doses, 1.5 hours apart each, there should be no danger barring some other medical condition interfering. Alternatively, focus on eating high potassium foods like potatoes / quinoa / milk / chicken / bananas / avocados / etc. Sprinkle in a little on your food at each meal (200mg, probably max in one go, even with food.)

      Obviously if you’re on dialysis or have poor kidney function, then this is not an option and even potassium intake from food may have to be monitored.

      Also, as all the literature points out, TTFD analogues (like allithiamine) are immensely demanding on your body’s glutathione / methylation processes, on top of the electrolytes. 1g / day seems an outrageous number, at least to me, to try and sustain for your body. Most studies I’ve seen would do something like 600mg Benfotiamine / 300mg TTFD if they were really pushing the dosages. That way a lot of the thiamine load comes from a form that’s a lot easier on your system to utilize (benfotiamine.)

  4. Hello Dr. Lonsdale,
    My father who suffers from a debilitating essential tremor, among other symptoms of dysautonomia, runs a nonprofit to support others with ET. Through this, he has become close to a number of individuals researching the topic at both NIH and around the country. I have passed along your book, as well as some articles from the late Dr. Constantini, and they are very interested!
    In addition, I was wondering if you could explain your best theory for how high dose oral thiamine therapy would be different for someone also taking a SSRI and a stimulant.
    Thanks so much!

    • Megadose thiamine works because it stimulates the synthesis of ATP. It is an entirely new way of treating disease and bears no resemblance to pharmaceutical therapy. I came to the conclusion that all diseases are expressed as a variable presentation of energy deficiency. For example, thiamine tetrahydrofurfuryl disulfide (TTFD) has been shown to give protection from the lethal effects of cyanide in mice and protects the liver from carbon tetrachloride poisoning. Although the idea that TTFD could be used to treat any and all disease is offensive to the present medical model, I have questioned the truth of the present model by suggesting that disease can be explained by genetics, stress and energy as 3 overlapping circles (Boolean Algebra). A disease can be determined purely by expression of an abnormal gene. However, it may require another factor(stress) to become clinically expressed. Type 1 diabetes has a genetically determined background but does not become clinically expressed for many years and is often initiated by some form of stress (as defined by Selye, whose General Adaptation Syndrome is energy dependent). Louis Pasteur is said to have uttered the words “I was wrong, it is the terrain (body defenses) that matters”.

      • Thanks for the reply. I have noticed that since I’ve been taking TTFD, when I take Aderall, the Adderall seems less potent; it feels like the TTFD is correcting the unnatural effects of the drug. I am trying to ween myself off the SSRI and stimulant I’ve been taking for many years but I feel it’s best to do this slowly.
        I could be way off but I feel like it’s impossible to reach the full benefits fromTTFD when taking such pharmaceuticals because the thiamine has to constantly counter the actions of the drug in addition to stimulating cellular energy/repair.
        Thanks again and good health to you!

      • Hi Dr Lonsdale,

        I am working though your book but like the one sentence summary above: “Megadose thiamine works because it stimulates the synthesis of ATP.”

        Many other supplements might also raise energy levels: NAD+ precursors, methylene blue, hyperbaric oxygen, chlorine dioxide, hydrogen peroxide, etc. Why is high-dose thiamine supplementation a better intervention than these supplements?

  5. where can I get a clinician or reliable testing as to why I am exhausted, depressed and loaded with toxins.
    is it sugar, vaccines, or what. all the guru are destroying me

  6. My 76 year old mother was diagnosed with AFib and arthritis many years ago. She has many symptoms of wet beriberi (such as increased heart rate, fatigue, shortness of breath, insomnia, high carb/sugar diet…). She has had swollen knees (arthritis?) for a long time and recently one swollen pink foot. She had an ultrasound on her foot and there was no blood clot. Have you seen unilateral edema in thiamine deficiency/beriberi?

      • Dr. Lonsdale,

        If one is unable to be tested for thiamine deficiency but presents with several symptoms, is it safe to try TTFD supplements without knowing for sure that there exists a deficiency? If so, how would one go about deciding what dose to take, according to age, sex, weight, etc.?

        Thank you for your time.

        • There is the Spectracell test that tests micronutrients from red blood cells and not serum (can google it). I took it and saw I was deficient in B1 and B2. It’s an expensive test though, several hundred dollars.

    • Yes. Any stressor where the demands override endogenous resources can lead to deficiency. This includes viral infections or other illnesses even life stressors. Deficiencies are often initiated and/or exacerbated with medication. Many medications directly or indirectly deplete thiamine and other nutrients.
      There is a degree of thiamine insufficiency in the general population. Researchers have also noted a high incidence with critical illness.

      • Do you think there is a non-zero chance the COVID Long Haulers are actually suffering from Thiamine Deficiency? Many bizarre systemic problems they suffer from seem to overlap with B1 deficiency

    • Since any critical illness has been found to be commonly associated with thiamine deficiency— why ot Covid-19 ? Of course, that suggestion is not medically popular and the concept will be ignored.

  7. Hello dear Dr. Lonsdale.
    Can thiamine deficiency cause irregular heartbeat?
    Would you please elaborate a little bit on that?
    Thank you.

  8. I ser no references to mental health issues or alcoholism and B1 deficiency. I am certain my husbands long term alcoholism and B1 deficiency triggered visual and mental health issues ( possibly Wernicke Korsakoff? ). He has been on high dose Multi B Complex with 150mg B1 and all visual disturbances have gone. He only eats white bread and obstains from foods rich in b vitamins such as whole grains and eats poorly which doesn’t help. He is homozygous for MTHFR also.

    • I only just got this information since notification was sent to my junk email.Being homozygous for MTHFR seems to be commonly associated with defective thiamin metabolism. Did you find at any time that there was an increased concentration of folate and B12 in his blood?

  9. Does a history of undiagnosed celiac disease contribute to problems with the transketolase transporter? I likely had celiac for 30-40 years before being diagnosed and even though I have been strictly gluten free for 7 years my symptoms have not resolved. I thought by now all the enzymes would be working properly but I still can’t convert beta carotene to vitamin A and it would appear that I can’t utilise thiamine either.

    Curious whether these things relate to beriberi

    – slow heart rate 58-62 (I’m not an athlete)
    – blood pressure ranges 114/50 – 104/60
    – low blood volume
    – history of undiagnosed celiac
    – blood pooling in lower legs

    I also have slow ankle reflex which I see is a symptom of thiamine deficiency

    Thanks! Your work is eye opening. I just wish more doctors were aware of this. My last doctor dismissed the idea that thiamine deficiency might be the root causes of my issues of constant muscle pain, poor sleep, poor temperature regulation and orthostatic hypotension so I’m having to go it alone.

    • I suggest that you obtain the book by Dr. Marrs and myself, available online by typing in Derrick Lonsdale for Amazon books

      • Thank you Dr Lonsdale, I ordered your book a week ago from the publisher and am waiting for it it to wing it’s way down under. Hoping to find some answers!

          • Thank you so much! I am very curious about the extreme cold sensitivity with thiamine deficiency. In addition to wearing several layers of clothing in the height of summer I have persistent cold sensation in my chest immediately behind the breast bone which can spread out to encompass the whole chest area. I am cold in the core of my chest 24/7 and have been for more than a decade. The spreading happens in colder weather. I am negative for thyroid issues, Raynaud’s syndrome or obvious autoimmune conditions other than celiac disease. My standard blood work is pretty much in optimal ranges. Could this bizarre cold sensitivity be a symptom of thiamine deficiency or is it unlikely to be related?

            I am also curious about the impact of thiamine on dreaming as thiamine has a role in the production of GABA and acetylcholine which both affect dreaming. Have you observed any changes in dreaming frequency or the nature of dreaming for people who are thiamine deficient or who have transporter/enzyme issues?

            • In my view, this is an important question. It is really asking, what is a symptom? In the present medical model, disease A is supposed to have X number of symptoms. Disease B also has Y symptoms, thus partially finding a diagnostic category. The reality is that all symptoms arise from sensory stimulation in the brain. Thus, if you have inflammation in your e.g. left elbow, a signal goes from the elbow to the sensory system in the brain where the pain is generated. The sensory system recognizes that a signal comes from the left elbow and the patient’s attention is drawn to the offending elbow. When seeing a physician, the patient says “I have a pain in my left elbow”. Of course, the patient doesn’t say “I have a pain in my brain arising from inflammation in my elbow”. What this really means is that a pain might originate spontaneously in the sensory system of the brain and be interpreted as arising from the left elbow when there is no causative agent affecting the elbow. Therefore, the physician examines the elbow and finding no causative factor, interprets the course of a pain as being psychological, “it is all in your head”.How does this apply to the question?
              Note that the question from Talia is about the extreme cold sensitivity that she experiences and wants to know whether this is connected to thiamin deficiency. If the sensory system in the brain is warped for any reason, this may be an associated symptom. Since thiamin deficiency causes energy failure in cells, she is experiencing the symptom of cold sensitivity from an abnormal signal generated in the brain. To illustrate this I remember a boy who went swimming in the summer. The temperature of the water was 84° and the ambient temperature was in the 90s. He came out of the water shivering with blue fingers and toes. His mother wrapped him in a rug and took him home in the car where he slept for 24 hours. Need I say it? He was thiamin deficient.She also asks about whether thiamin deficiency can cause dreams. I would like to refer readers to my post “Is eosinophilic esophagitis a sugar sensitive disease?” His thiamin deficiency had caused him to have dysautonomia that had resulted in growth retardation. After thiamine treatment for one year his weight went from 105 to 122 pounds. His stature increased from 64.5 inches to 68.5 inches. I want to bring a readers notice to this because you can see that our present concepts of health and disease are largely extremely unrealistic.

              • Thank you so much for putting this into context. “Since thiamin deficiency causes energy failure in cells” is a comment I will definitely remember. I have enjoyed the posts that yourself and Dr Marrs have done linking thiamin with mitochondrial failure.

                I also found your post on HACL1 gene and possible issues with dairy metabolism due to a thiamine dependent gene helpful and have noticed more improvements eliminating both dairy and sugar. Sugar alone or dairy alone don’t seem to do the job. Together it is having a modest but increasing impact. Yay!

                I had my genes tested and there were several mutations in the HACL1 gene (along with transketolase and the thiamin transport genes) so it encouraged me to try dairy free again. I’m glad to say it is helping, although there is a very long way to go before the sensory system starts behaving itself. Less daily dizziness and that’s big progress. Thank you so much!

                • Fascinating! HACL 1 is an enzyme, functionally dependent on thiamin pyrophosphate. one of the biologically active forms of thiamin. The enzyme occurs in an organelle in cells known as a peroxisome. It is essential for what is known as the alpha oxidation of a substance called phytanic acid, as well as a group of fatty acids. The precursor of phytanic acid is a substance known as phytol, occurring in foods. Milk and meat are its major sources. Therefore thiamin pyrophosphate (thiamin by itself won’t work: it has to be phosphorylated in the body) deficiency can lead to an accumulation of phytanic acid, associated with risk for some malignancies. This is what is known as an upstream effect from dysfunctional HACL 1. However, alpha oxidation precedes what is known as beta oxidation where the fatty acids are processed and transferred to mitochondria for use as fuel.Failure to process these fatty acids for fuel would obviously represent some of the aspects of energy deficiency, a downstream effect of HACL1 deficiency, leading to complex symptoms. I understand this is highly technical but what you must understand is how thiamin interferes with so many aspects of energy metabolism and it becomes quite obvious why so many symptoms can be generated by a simple deficiency of thiamin for any reason and there are many. The discovery of thiamin as a vital cofactor for HACL1 is a recent discovery and has completely altered our necessary approach to the importance of recognizing thiamin deficiency.If you read this carefully, you will come to understand how thiamin deficiency can lead to a malignancy. Talia’s case is unique because she has found the genetic mechanism. No one to my knowledge has reported a clinical case associated with a genetic disturbance of the enzyme HACL 1, let alone as a result of thiamin pyrophosphate deficiency. The science of epigenetics permits us to try a clinical use of high dose thiamin as cofactor to the genetic mechanism, together with the avoidance of milk and meat, in her case. Lipothiamin is by far the best supplement to use. Epigenetics is the relatively new science of the relationship between genetic mechanisms and nutrition. This Is a wonderful example of how biochemical knowledge can be applied to a clinical situation that is virtually foreign to the present practice of medicine. We desperately need research in an area of science that has long been despised.

                  • I agree with Dr Marrs. You should write up your case, because it is unique, being to my knowledge, the first example of a clinical effect from HACL 1 problems.

                    • Thanks for the encouragement. I will write something up next month. For now, I need to get a decent night’s sleep or three and then I will put together the genetic information and some history.

                      On the subject of my history I recently discovered that I was exclusively bottle fed from one month with Karilac which you are probably familiar with. It contains oils, dextrose and lactose. Although the sugar was probably around 2.0-2.5% of the liquid I am curious to know whether the dextrose at such a young age could be an issue given that mention has been made of the risk of dextrose in drips for individuals who are thiamine deficient.

                      Thanks! I will email the website when I have the other information together.

                  • Thank you for your comments. I have been thinking about writing up something on epic dreaming disorder for your site as I have that and am trying to recruit volunteers to share experiences, but you have my thinking in new directions now!

                    When I get the energy I will try to cobble together some of my genetic Information and experiences. The more I read and learn the more I am noticing things that are linked to thiamine. I had lamb for dinner and felt knocked out. I guess as some things are starting to improve, the things that make me worse are becoming more evident. So a step forward and a step backward but the direction is becoming clearer and I Know I am on the right track…

                    • PS I am hoping your book arrives soon. Elsevier were good enough to offer free international shipping but it must be taking the slow boat. I am hoping that will give me some additional clarity.

  10. This is fascinating. I have your book A nutritional approach to a revised model for medicine and am learning a lot.

    I used to think my symptoms were too generic to be beriberi but then after a long time off sugar I had some and within half an hour my skin was prickling and I felt weak and dizzy. It started prickling and hot and cold sensations around my ankles and hands but then got worse and even my lips felt numb. I tried sugar again another day and the same thing happened. I repeated the experiment and took thiamine with the food and hardly had any symptoms!

    I also have wide pulse pressure around 60 and postural hypotension.

    Your article talks more about peripheral neuropathy in the hands and feet. Can it sweep over the whole body with beriberi?

    • Symptoms of thiamin deficiency are many, none of which provide a diagnosis on their own. The fact that you react to sugar is interesting and presumably this means that you are highly sensitive to it. The direct connection between sugar and thiamin deficiency is that sugar seems to precipitate it but the exact mechanism is obscure. Your best bet is the use of Lipothiamin because this does not require the thiamin transporter protein that enables the absorption of thiamin into cells. Look it up online to find a vendor.

    • I know this post is already 5 years old, but I’m going through the same thing! I’ve ordered the book and am counting the days until its arrival. Finally some answers!

  11. Hi Dr. Lonsdale,

    I was wondering if you have a post or could possible write one specifically on how thiamine deficiency affects digestion?

    I have been referring so many people to your research and articles to help with things such as Chronic fatigue syndrome, diabetes, thyroid disorders, reflux, and especially bad digestion. I have tried so many different supplements over the years to help with my chronic indigestion problems, but nothing has ever helped quite so much as taking large doses of thiamine HCL. If you could write a post about how thiamine deficiency regulates the digestion system specifically, it would be a big help to me and so many others. Thank you for your time and God bless .

    • Thiamin deficiency beriberi produced many symptoms including what might be loosely called “indigestion”. In one stage of the disease, there could be a low acid content in the stomach. If thiamin was given to the patient the acid content of the stomach became excessive before it became a normal concentration. In another stage of the disease the stomach could have an excess of acid. If thiamin was given to the patient, the acid content would become low before it became normal. In other words hypoacidity (too little) or hyperacidity (too much) could be seen in a given patient according to the stage of the disease. I would assume that when you took thiamin, you may have gone through this process.

  12. I’m a 44 year old woman in the US. I have been battling a b-vitamin deficiency (self-diagnosed) off and on for the past nine months. The deficiency occurred because of a thyroid issue. But looking back, I think it was also the other way around as well. My thyroid issue occurred because of micronutrient deficiency.

    It’s such a breath of fresh air to read your articles. It’s been a real struggle dealing with the medical community. I’ve had a few doctors roll their eyes at me or worse, just stare blankly at me, when I ask about how vitamin and mineral deficiencies might be playing a role in my recovery. The more I learn, the more sad and frustrated I feel that none of the doctor’s I’ve seen know about this stuff.

    My thyroid started acting badly a year ago. I was diagnosed with hypothyroidism after I’d already started to feel better from certain foods, and supplementing with vitamins, so I decided not to take medication. I didn’t really know what I was doing when I started back then, and some of the things I tried made me go into hyperthyroid a little bit. I believe the hyper-metabolic state used up my stores of b-vitamins, maybe zinc and some other things. This was made very obvious last New Years Eve, after three cocktails led to me waking up the next day with more than just the usual hangover symptoms. Especially strange were my ruby red lips, and a rash on my hands and wrists. A week or so later, I developed a sore tongue and mouth.

    I slowly recovered from the New Years Even thing, but it took two months for my tongue to feel normal. But then new symptoms started, like zapping pain in my toes and fingers. At some point I read that B6 toxicity can cause nerve damage which feels like zapping in the toes and fingers. I was worried that was happening to me, so I tried taking a lot of all the b-vitamins and just a little of B6, and seemed to do well. But after three months of large doses of b-vitamins and just 4mg of B6, my tongue got sore again, and I got a headache that wouldn’t leave. I also felt very emotional and sad, and my period came and stayed, for several weeks. I decided I should try B6 again since it was the only vitamin I wasn’t taking much of.

    I started with 25mg of B6, and immediately felt happier, my period stopped, and I thought everything would be great from there. Well, it’s been very up and down. I think that I got so low in B6 that even just 25mg of B6 seems to make me hyperthyroid. I read that B6 brings iodine into the thyroid. And then when I get hyperthyroid, I get symptoms of thiamine deficiency again. Symptoms of both the wet and dry beri beri.

    Because I was worried about taking B6, I also added Alpha Lipoid Acid along with the B6, but it made me even more low on thiamine, which I later read can happen to people who are already low in thiamine. I had heart palpitations, and chest pain, edema, joint pain, and a feeling like it was hard to breath. It took me two weeks to make the connection to the ALA. I stopped the ALA, and increased my thiamine dose to 500mg twice a day, and I’m doing much better.

    I’ve continued with the B6, and now I’m up to 100mg in a B-100 complex extended release tablet, which i take twice a day. I had been taking iodine for the past year, but it seems it’s not compatible with taking the B6, so I stopped. Amazingly, one month after starting a lot of B6, the three breast lumps that I had for the past four years have gone away. So that is kind of a miracle to me. My periods are more normal, and I just feel so much happier. But I still have this sore tongue every day. It comes and goes. I can’t figure out what is causing it. Thiamine? Maybe I’m not absorbing thiamine well, even at 500mg twice a day. I also still have a little bit of zapping in my toes, although that is much better than before.

    I just convinced my doctor to order a bunch of blood work and asked them to check my b-vitamins along with zinc and copper, iron and vitamin A and D. But I’m not sure how reliable some of those checks are.

    Do you have any experience with someone like me? Any recommendations for how to progress? I’ve been taking a 500mg thiamine supplement plus a co-enzymated carboxylase version. I also have taken benfothiamine, with no much noticeable change. But I saw you recommended lipothiamine for someone and I’m going to order that and see how I feel on it.

    After more than a year doing my own self-guided recovery, it would be awesome to hear from an expert on the subject.

  13. This is a very interesting comment. There are several questions and I will take them one by one
    1. It is true that dietary thiamine has a limited absorption. This is because of the transporters that are required. It is also true that there are a number of synthetic thiamine derivatives. The best one, in my view, is thiamine tetrahydrofurfuryl disulfide (TTFD). Without going into the technical issues, this derivative does not require the transporters and it can be used as a “drug” to stimulate enzyme activity that is dependent on thiamine. The trade name for this is Lipothiamine and it comes in a dose of 50 mg. The usual dose is one or two tablets a day but it has no toxicity and much bigger doses can be used if necessary.
    2. You are quite right about autistic children. The real name of the game is unquestionably in the consumption of junk food, particularly sugar. Although it is now well known that sugar is toxic the exact cause of the toxicity is unknown. My answer is that thiamine is an absolutely essential for its metabolism and the lower part of the brain is highly dependent on thiamine. This part of the brain organizes all our adaptive mechanisms, both mental and physical so it is hardly surprising that individuals affected by this are maladapted to the environment. But thiamine does not work on its own. It is a member of a massive team of nutrients although it might well be the most essential.3.Post sugar seizures—-NO SUGAR + thiamine/magnesium supplement.

    • I am a 76 year old male with many of the symptoms that you describe including neuropathy. You mention much bigger doses being used. How does one do this and what dose would be most advantageous? Should the dose be divided for the day? I have also heard of benfotiamine. Can both of these thiamines be taken together? I’m not familiar with supplements and I consider myself very lucky that I came upon your research. You really seem to be the only expert in this field as I found many references and all authored by you. Thank you.

  14. Hello Dr Lonsdale, I am a great admirer of your work and also believe that ‘simple’ nutritional support is the key to correcting metabolic imbalance that leads to disease. I had a couple of questions, if I may? There are a number of forms of B1 available, and the difficulty is in figuring out dosages. For most forms I have heard only about 5 mg can be transported out of the gut at one time. Is this also true of alliathiamine? It comes in only one dose, 50 mg. How much of that is actually crossing into the blood (assuming no transporter issues)? What is your take on the co-enzyme forms of B1, or ‘active’ B1?

    I am interested in how thiamine deficiency affects the autistic population, not just at the time of their initial regression into autism, but at other times of metabolic crisis. Often these kids experience immune system vulnerability and even those under the care of biomedical doctors who are supplementing, their poor gut health causes chronic malnourishment. I have observed that many will have sudden onset of issues post illness, which look similar to what is called PANDAS, or an auto-immune issue induced by strep, but it is NOT strep induced. What is your experience with thiamine and metabolic crashes resulting in tics and OCD type behavior?

    Finally, have you ever associated absence seizures with thiamine deficiency? For example, I know a child who experiences absence seizures shortly after eating sugary foods. He blanks out and stares into space. Could this be related to thiamine? No other known seizure issues other than the staring after or even while eating high carb/sugar foods.

    Again, thank you for your continued involvement in the health community! I have only recently come to connect some dots via copper dysregulation and its association with Wilson’s Disease and thiamine. Many ASD children have profound copper dysregulation that has not yet been found to have a genetic component. Your research is filling in the bigger picture for me and other parents seeking to help their children.


    • I did not see this comment at the time. There will be a new post published here that is relevant to this question.

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