fever swollen glands - Febrile Lymphadenopathy.

Recurrent Fever With Swollen Glands: Febrile Lymphadenopathy and Thiamine

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Every profession has its jargon and the medical profession is no exception. Perhaps it is even more addicted to jargon than other professions. The title used here refers to an extremely common disease, particularly in children. Febrile is the word used to describe fever. Lymphadenopathy simply means that lymph glands are swollen. The mechanism is as follows: the throat becomes infected, often with streptococcus and may affect the tonsils or adenoids. A message is sent from the throat to the brain that reacts to cause the body temperature to be raised. We will see why later. The lymph glands in the neck are stimulated to get bigger as part of the immune response. The child feels sick and accepts bed rest and these essentially defensive reactions are referred to as the “illness”. Often a treatment such as aspirin is given to the child to bring the temperature down under the mistaken concept that this is the dangerous part of the illness. A previous post on this website described a case of Reye’s syndrome, a deadly disease known to occur as a result of giving aspirin to bring the fever down. It is of course true that a very high temperature such as 106°F is considered to be dangerous. But this is because the brain mechanism that initiates this temperature is itself in an abnormal state and may be the actual source of the danger.

Understanding Fever as an Immune Response

If we look at this situation in the cold light of day, we can come to false conclusions. Yes, this is the expected situation with an infected throat and it is invariably treated with antibiotics. But let us see what is really happening in all cases of this common affliction. The brain has received a message from the throat that an attack by a microorganism is occurring. The brain sets up a defense mechanism and I refer to the microorganism as a “stressor” (the enemy). The brain is programmed to recognize the attack as dangerous to the organism. The physical aspects of the infection and the brain mechanisms that receive the message and activate the defense are in constant communication. The body temperature is raised by the brain as part of this defense.

Microorganisms, the stressors, are programmed by Mother Nature to operate at maximum efficiency at 37°C, the normal temperature of the human body. By raising the body temperature, the environment for the microorganisms is detrimental to its action and decreases its virulence. No rise in body temperature indicates that the brain is sick!

Inflammation Is an Immune Response: Resting Boosts Immune Function

The inflammation of the throat makes it harder for the microorganism to gain entrance and is also part of the defense. Strangely enough, we now know that inflammation is controlled and governed by the brain. A message to the lymph glands in the neck increases their size to cope with the expected passage and trapping of bacteria from the infected area and is part of the immune response.

The bed rest or fatigue that occurs with illness is yet another part of the immune mechanism. Bed rest conserves the cellular energy needed to activate the defense mechanisms.

You can readily see that all of these reactions that we call sickness are scripted and controlled completely by the brain. It may come as a surprise to many readers, but fever, inflammation and energy conservations are necessary immune reactions. Diminishing or overriding those reactions, usually by trying to reduce fever with a drug or failing to rest rather than assisting the body’s defense systems, may only prolong the illness and perhaps even create new ones.

The modern method of treatment is, of course, to kill the organism. Little thought is given to whether the supply of energy in the brain is sufficient to run the complex organization of defense. It also assumes that the genes that oversee the immune response are intact and functionally healthy.

Nutrient Interactions With Immune Response

Now I must tell you about two children, both of whom had suffered from repeated episodes of febrile lymphadenopathy (Lonsdale D. Recurrent febrile lymphadenopathy treated with large doses of vitamin B1: report of two cases). Each child had been treated by antibiotic therapy with their recurrent episodes over a two or three-year period on the assumption that they were caused by bacterial infection. Both were medical puzzles because evidence of bacterial infection was lacking and it was assumed that the recurrent episodes were viral in nature. I had the opportunity to study one of them in detail.

The child had been admitted to a prestigious hospital and a swollen gland in the neck had been biopsied under the impression that it might explain the disease. The pathologist had reported an enlarged but otherwise perfectly normal gland structure. The mother told me that at this hospital he had also had the concentrations of vitamin B12 and folic acid measured in the blood, presumably because they were looking for evidence of deficiency. She volunteered that “the doctors told me that I was giving him too many vitamins”, apparently because the two vitamins had been found to be in an unusually high concentration. She also volunteered that this was very strange to her “because I had not been giving him any vitamins at all. The doctors didn’t believe me”. This naturally intrigued me.

Without going into the technical details, I found that he had evidence of abnormal thiamine metabolism. The folic acid and B12 concentrations were indeed extremely high. When I gave him the big daily doses of thiamine, these two vitamins each fell into its range of normal blood concentration. I discharged him from the hospital where these studies had been carried out, continuing the high dose treatment with thiamine. Two or three months later, the mother called me to say that her child had not had any episodes of fever and was extremely well. I responded to her by asking if she was interested in stopping the thiamine in the interests of science. She did stop it and three weeks later he had an episode of sleep walking, spontaneous urination as he went down the stairs and another episode of febrile lymphadenopathy.

You may well ask how the sleep disturbance could possibly be associated with the throat problem, so continue reading. I readmitted him to the hospital and clinical examination revealed the sore throat and a very large lymph gland in the neck. The folic acid and B12 concentrations were once more elevated. I restarted the thiamine and the two vitamin concentrations again fell into the normal range. The enlarged lymph gland disappeared and I discharged him from the hospital with instructions to continue the high dose thiamine. About a year later she reported that the episodes had begun again. I told her to add a multivitamin to the thiamine and again the episodes ceased. The other child also had evidence of abnormal thiamine metabolism that was resolved by the administration of large doses of thiamine, but unfortunately, I was not able to study him further. Please note that both children had been indulged with ad lib candy and soft drinks.

Nutrient Deficiency in the Face of High Sugar Intake: Altered Immune Responses

The explanation is construed from a rational approach to the genius of Mother Nature. I have already described the normal mechanism of defense to infection organized by the brain. Think of the body as being like an old-fashioned fortress. When an approaching enemy is spotted by soldiers on the Eastern battlements, a message is sent to the commander. The commander is then able to plan the defense and off duty soldiers are deployed to the scene of impending attack.  Imagine that the commander is drunk and he sends the reserve soldiers to the Western battlements. Or perhaps the commander imagines falsely that he has received a message and deploys his defensive soldiers throughout the fortress unnecessarily, a “May Day” without reason. Obviously the commander would be to blame.

This is an analogy for the brain/body response to infection. Messages throughout the body are automatically relayed through the autonomic (automatic) nervous system and by the hormones released from the endocrine glands. Hormones, carried in the blood stream, are messengers. White blood cells are “the defending soldiers”. Both the autonomic and endocrine systems are under the control of the more primitive lower part of the brain, the commander in the analogy and the part of the brain that is known to be peculiarly sensitive to thiamine deficiency. There is good scientific evidence that thiamine deficiency will make the “commander” much more sensitive to incoming signals from the “battlements”.  Like the “drunk commander”, it organizes a complete defensive reaction without there being any need.

To be a little more scientific, thiamine deficiency causes reactions in the lower brain that are exactly like a mild to moderate deprivation of oxygen. That is why thiamine deficiency is reported scientifically to cause pseudo-hypoxia (pseudo, false: hypoxia, deficiency of oxygen). These children had been indulged with ad lib. candy and soft drinks. Even if they had had the average intake of thiamine from the diet, essential to the processing of sugar, it was insufficient to metabolize the sugar. You might say that this was an increased sugar/thiamine ratio, equivalent to dietary thiamine deficiency with a normal healthy diet.

Microorganisms Attack: The Immune Response Defends

Each case of the usual form of febrile lymphadenopathy can be visualized as a hostile attack by a microorganism (a stressor) requiring a defense response. However, in the case of these two  children, when the brain ”commander” was exposed to thiamine deficiency  (pseudo-hypoxia), itself imposing  brain stress, it  became hypersensitive to virtually any form  of incoming signal from the environment. It is therefore possible that a change such as ambient temperature was being perceived falsely as a dangerous threat to the organism (the patient). Hence, it is hypothesized that any proposed minor form of stress initiated the defensive response, mediated and organized by the lower brain that is programmed to perceive danger. It is possible that a virus in each case may or may not have been responsible for being the “stressor” but it is more likely that the “commander” was initiating an unnecessary defense based on a false perception of a non-existent attack such as ambient temperature change.

I have to turn to analogy once more.  A car has an engine. Its essential function is to produce energy. The energy has to be transmitted to the wheels through individual mechanical parts that are connected together to form an energy consuming transmission. In the human body each cell has its own engines and they are called mitochondria. Their function is also to produce energy that has to be converted into mental and physical action. Thiamine is essential to energy production from the mitochondria and a series of enzymes are the equivalent of the mechanical parts of the transmission in a car and therefore can be thought of as an energy consuming biochemical device. Therefore, mitochondria produce energy; the transmission consumes it in mental and physical action. Folate (folic acid) and vitamin B12 are essential to this biochemical transmission. Because thiamine deficiency depletes cellular energy, the enzyme dependent (energy hungry) transmission developed problems. Folate and B12 accumulated in the blood simply because they were not being used. When thiamine was given to this boy, cellular energy improved and the two vitamins were consumed in their actions and their concentrations decreased in the blood.

Sleepwalking: An Example of Brain Dysfunction?

Sleepwalking has always been a puzzle. A sleepwalker is not consciously aware of what he or she is doing. I remember the case of a man who drove his car for 70 miles and had no recollection of doing it. I had found from my clinical experience that sleepwalking children would stop doing this with the administration of nutrients, particularly thiamine and magnesium. The fact that the subject of this discussion urinated as he descended the stairs indicated abnormal automatic autonomic nervous system activity. This was pretty good evidence that it was oxidative deficiency in the brain that was responsible for both physical and mental abnormal activity after therapeutic thiamine had been withdrawn.

The Use of a Multivitamin: Completing the Nutrient Team

As the story above indicated, the episodes of febrile lymphadenopathy began to return about one year after he had been discharged with instructions to take only thiamine. There is a particular relationship between thiamine and magnesium because both of them are cofactors together for the same enzymes. However, vitamins and minerals are non caloric nutrients that work as a complex team. There might still be nutrients in naturally occurring food that await discovery. Mother Nature knows how they all should be balanced. The further we move from our biologic origins by the introduction of artificial foods in our hedonistic pursuit of pleasure, the more illness can be expected. Our present medical model is concerned only with killing the attacking agent. Rather simple clinical research revealed an anomaly of this nature in the organization of defense, without knowing how common it is. It should surely focus our attention on the role of nutrition in providing the raw materials for this organization. An infection gives rise to a battle. There are only three possible outcomes: the enemy wins: the defense wins: there is stalemate. The stalemate possibility suggests that chronic long term infection can be tackled by the use of energy producing nutrients that improve the efficiency of a defensive program.

Unfortunately, there are problems with what appears to be a simple solution. Even natural food does not have the nutrient density that it used to have because of changes in farming practices. Also, whether we like it or not, evolution is going on all the time and in the modern world, the smartest brains have the greatest evolutional advantage. Those interested in following the numerous posts on this website will note that post Gardasil thiamine deficiency appears to affect the brightest and the best. I have suggested that relatively poor nutrition, coupled with a smart brain, creates a greater risk of succumbing to a risk from vaccination, mild infection or trauma.

I have seen several articles that state the uselessness of dietary supplements, claiming that the numerous vendors are cheating the public. My own library research reveals numerous papers on the subject of supplementary nutrients coming from many parts of the world other than America. Although they are not cheap, the expense is very much less than the drugs issued by pharmaceutical companies and their curative or preventive properties are huge. Humanitarian research in this area of relative ignorance is a modern necessity.

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Photo by Kelly Sikkema on Unsplash.

This article was published originally on April 19, 2016.

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. Dr Lonsdale, You simply are a genius. No one could explain the autoimmune issues of present day better than this one article. So many people are getting diagnosed with auto immune diseases and I wonder if it is all because thiamine and other nutrient deficiency. Thanks for taking time to patiently explain the mechanisms involved. If you get a chance, please comment on hypo and hyper thyroid issues and if they are also connected to thiamine deficiency.

  2. My 22 yr old son is having reoccurring fevers for the past 6 months. He’s been on at least 4 different antibiotics at this time, and continues getting fevers and swollen nodes in neck and under armpits when he comes off the antibiotics. We are not sure where to go from here. He is being a functional doc for lyme, mold, but has been doing well, fit, etc. He has been losing some weight for the past 6 months, though. He inflammatory markers are down but his c4a is higher: 4, 000. cd57 is 52. He had covid in January but recovered. Had a hep b shot in march before all of this started……

    • Get folate and B12 in blood checked. If they are elevated it probably indicates thiamine deficiency. Readd the posts on HM that tellyou what to do

  3. Hi Dr Lonsdale,

    I posted this article on Twitter today and you might be interested to know it got a huge (for me anyway) response – over 8300 Twitter views at this time of writing. Then I saw this comment thread and wondered about torticollis. I thought you might be interested in these reports I found on treatment of dystonia and torticollis using thiamine:


  4. Hello Dr.Londsdale,
    I have a question and I am afraid no other Doctor can help me. I struggle with attention deficit/concentrating for a long time now. In fact there is/was a whole bunch of other problems as well. I finally started to look into the nutrition-matter myself and I was able to make some progress with Vitamin D and other stuff.
    But I still have problems with concentrating. One of the things which turned out to be helpful, were B-vitamins. And as far as I can pinpoint it with testing: Vitamin B1.
    I could not only concentrate a little better, I felt also like having more power, as you mentioned in several posts.

    But the thing is, I can only “handle” taking Vitamin B1 for a few days. Because I have a torticollis (head is constantly tilted to the right) since at least 5 years now. Usually it’s just cramped but doesn’t hurt so much. However when I take Vitamin B-complex or Vitamin B1, I get an unreal pain in my neck: When I lay down on a bed and attempt to lift myself upthe normal way, it feels like my throat ist ripping apart. this makes it impossible to have a real sleep at night.
    When I stop taking Vitamin B, the pain subsides within 2 days.

    I don’t even know if I got this from your blog or elsewhere on the web, but I read that B1 deficiency could even cause a torticollis.
    But as it is now, B-Vitamins help me but hurt me even more. Magnesium doesn’t help either.
    Is there anything you would advise me to do?

    • the clue may be “a whole bunch of other problems”. You almost certainly have mitochondrial disease. That is like having a car with an engine that is running badly. Vitamin B1 does not have side effects and the torticollis and ADD are related through chemistry in the nervous system. You may get benefit from a series of injections of vitamin B1, B6 and B12 but you would have to persuade your physician to use the big doses required. Vitamins work as a team and it requires extra knowledge from the physician in order to use them appropriately and adequately

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