thiamine deficiency - Page 12

Why a sermon? The title was suggested from a breakfast discussion that I had with a resident in the retirement home in which I live, a retired minister of the United Christian Church. In the nearly 5 years that I have been living here, I have repeatedly sat and listened to my friends talking about their various handicaps and how they are being treated. I was a pediatrician at the Cleveland Clinic for 20 years and left it in 1982 to practice what has become known as “Alternative Complementary Medicine”. Because few people apparently understand the meaning of this, I am trying here to inject a little bit of science to explain it.

From the Unexplainable Comes Insight

In 1982, I began to see adults as well as children. I thought that there might be some interest in why my perspective changed and why I took early retirement from a prestigious orthodox medical institution. As a consultant pediatrician at the Clinic, I was exposed to the referral of children with strange diseases. There is a group of genetically determined rare conditions known as inborn errors of metabolism. The strange thing about them in common is that if they are not recognized at birth, some of these diseases cause the affected child to become mentally retarded. That is why there is a laboratory in each state capital that tests every newborn child for one of these inborn errors. It demands only a finger stick of blood on a strip of filter paper that can be mailed to the laboratory. Perhaps even stranger, many of them can be protected from mental retardation by starting them on a special diet that they have to maintain throughout life. It forced me to understand the necessary biochemistry, the nature of the special diet and why it prevented mental retardation.

One day, because of my studies in biochemistry, I was confronted with a 6-year old child with a weird story. I will refer to him as JV. He had suffered from infancy with intermittent episodes of a condition known as cerebellar ataxia (ataxia is a fancy word used to describe a lack of balance and coordinated movement). The cerebellum is part of the brain that deals with balance amongst many other responsibilities. Each one of these episodes lasted about 10 days, rose to a clinical climax and subsided automatically without treatment, just as though he had been drinking alcohol. Each episode left him a little bit more mentally affected. His clinical presentation was exactly like that of a drunk. He was unable to walk a straight line and his speech remained slurred as long as the attack lasted.

Alcohol has its major effect by inducing vitamin B1 deficiency in the cells that make up the cerebellum. He had been tested with every known method by neurologists and neurosurgeons, all of which produced no information.

To cut a long story short, I had to wait two years before he had one of these episodes when I admitted him to hospital for study. All I did was to collect urine that was subjected to biochemical testing. His urine was collected continuously for 12 hours during the night and separately for 12 hours during the day to see if it reflected differences in night/day metabolic processes. The ataxic episode lasted about 11 days, rose to a symptomatic climax at about the sixth day and gradually subsided without any treatment whatsoever. Of some interest, during the last few days the symptoms would be much less in the morning and gradually worsen as the day advanced. The abnormal chemical changes were reflected in the urine by being alternately high during the day and much lower during the night. Thus, the day/night rhythm of the brain known as circadian (circadian means about 24 hours) was affected. Yes, our brains are constructed to dovetail with the day/night seasonal rhythms of our world.

Without going into complex details I was able to show that he had vitamin B1 dependency. The chemical name for this vitamin is thiamine. Vitamin dependency means that a much greater amount of the vitamin is necessary for its normal action. Vitamins act as what are called cofactors to enzymes. The connection between the vitamin and its respective enzyme is under genetic control and it was this mechanism that was defective.

High Dose Nutrient Therapies to Compensate for Energetic Demands

From this case, I learned that this genetic defect might be overcome by using pharmacological doses of thiamine. It seemed as though the vitamin acted as a drug by stimulating the inefficient enzyme back to a more normal state of function. In a fanciful analogy, some man-made machines require cogwheels that transmit energy from the power source to the action. Enzymes in the body may be roughly compared with cogwheels. They transmit energy derived power to physical and mental action. To continue the analogy, cogwheels require oil and vitamins may be roughly (and I mean roughly) compared to oil given to a cogwheel. They are each essential components that engage with their respective enzymes. Without the appropriate vitamin, the corresponding enzyme gradually becomes dysfunctional.

As I have already noted, the connection between a vitamin and its respective enzyme is controlled by a genetically dependent mechanism. It is the breakdown of this mechanism that introduces dependency. Each of this child’s episodes of ataxia was triggered by a simple infection like a cold, a mild head injury or even an inoculation. I will refer to this as some form of stress. Several reports in the medical literature describe intermittent clinical episodes of their respective disease entity being exacerbated by an otherwise mild infection. This is important because sometimes a mild head injury or an infection is thought to be the cause of the generated symptoms on its own, whereas it may well be triggering the clinical situation in relationship to hitherto marginal energy availability.

The point that I am trying to make is that the injury, and indeed the defense against infection, automatically demands an energy-dependent response. That marginal energy availability may not be enough before the injury to cause symptoms, or perhaps mild symptoms in such an individual might be ascribed to other causes as conceived within our present medical model. For example, a given symptom may be “written off” as an allergy, thus confounding the situation even more. Energy is always required by the brain in order to respond to any form of mental or physical stress. Just as a car consumes more energy when climbing a hill, stress to us is like a hill to be climbed. This action takes place automatically when our capacity to synthesize energy is healthy.

If the increase in energy is not forthcoming, the affected cells do not function properly, giving rise to what we call symptoms. Symptoms are inevitably generated by sensory mechanisms in the brain, another factor which can be very confusing. For example, an injury in an elbow would result in a signal to the brain that generates the sensation called pain. The brain acknowledges the signal by announcing to its owner “I have a pain in my elbow”. The point is this; pain is a brain effect and can explain why there is such a phenomenon as psychological pain.

The Irony of Psychosomatization

I want to impress you however that psychology is always due to electro-chemical brain cell reactions because it has a scientifically plausible explanation. That means that so-called psychosomatic disease is not an invention by the patient. The symptoms are being generated by chemical disturbance in those brain cells and in today’s world, high calorie malnutrition is responsible for polysymptomatic diseases that haunt many physicians’ offices. They are often referred to as “problem patients” and the patient is sometimes told that it is “all in your head”. The irony is that this is the truth. It certainly is in the head but it has a real underlying cause that is being misinterpreted.

I recently read a column in the Wall Street Journal entitled “Is your teen depressed”? With direct quotes from this column “statistics show that teen depression is on the rise. In 2016 around 13% of US teenagers aged 12 to 17 had at least one major depression episode in the past year compared to almost 8% in 2006. The American Academy of pediatrics has recently recommended screening all those youngsters aged 12 and older annually for depression.  They define major depressive disorder as having five or more of the following symptoms present for two weeks: depressed mood most of the day, irritability, decreased interest or pleasure in most activities, significant change in weight or appetite, change in sleep, increased educational sluggishness, fatigue or loss of energy, feelings of guilt or worthlessness, changes in concentration and recurrent thoughts of death. They sometimes complain of stomachaches or headaches that don’t have an identifiable cause”. My explanation is the combination of three factors, represented as three interlocking circles of health, genetic risk/stress/nutrition.

Genes, Nutrition, and Energy

Let me explain genetic risk a little. We now know that our genes can be manipulated by nutritional elements and lifestyle. Many genetic diseases do not appear until late in life. If it was only the gene to blame, one would expect it to appear at birth and indeed some do. For example, type I diabetes has genetic determination but the symptoms may not appear until middle age and are often associated with some form of stress such as a cold, a mild injury or even a telegram giving bad news. Some recent research has shown that pharmacologic doses of thiamine might well protect diabetics from their well-known complications.

Thiamine is a vital naturally occurring chemical (the word vitamin was used to express its vital need for life when it was thought to be an amine. When it was synthesized and found not to be an amine the terminal e was dropped) that enables body cells to produce the energy they require for function and we have between 70 and 100 trillion cells that make up the human body, all of which require energy. Vitamins act as what are called cofactors to enzymes. JV actually had intermittent episodes of a classical disease known as beriberi, long known to be caused by deficiency of thiamine. However, because of genetic mechanisms that were at fault, he required huge doses of thiamine in order to prevent his intermittent episodes of beriberi, hence the use of the term dependency.

The RDA (recommended daily allowance) for thiamine is 1 to 2 mg a day and he required 600 mg a day. If he should succumb to a cold, experience a simple injury or some other form of physical stress, he found that he had to double the dose to 1200 mg a day. Contrast this with 1 to 2 mg a day as the RDA indicated for normal healthy people. On one occasion an episode occurred following an inoculation, so I had to assume that the inoculation represented some form of physical stress. Note that the needle stick sends a sensory message to the brain, notifying it of some form of attack. The signal causes the brain to formulate any necessary defensive action. Therefore, if somebody passes out following a needle stick, it is a temporary lack of energy mobilization in the brain.

I must emphasize again: the brain requires energy mobilization to meet any form of stress. Therefore, our energy consumption is in a constant state of flux on a day-to-day basis, much like climbing hills and descending into valleys on a journey For example, when this child was under treatment he was walking in a local park, tripped on a stone and suffered a relatively mild head injury. He became unconscious and was taken to a nearby emergency room. His mother called to notify me of the event. I called the physician in the emergency room and tried to explain to him that this child represented a special case and that he required an injection of thiamine. He thought that I was quite mad: such is the trust that leads to failure of communication between physicians.

Thiamine and Energy

This was such an intriguing experience that I began to perform clinical and library research on vitamins that have continued to the present. Glucose is the “gasoline” that is the major fuel of our cells and thiamine is the equivalent of the “spark plug”. The energy requirement for the brain and heart is enormous because both of them function 24 hours a day throughout life. That is why energy deficiency disease dominates the brain and heart with varying degrees of severity. Because I was a consultant pediatrician, I received referrals from private pediatricians in Ohio and even out-of-state. Some of my common referrals were children with attention deficit, hyperactivity, learning disability and other curious distortions of behavior. Of course I discovered that their diet was atrocious and using pharmacologic doses of thiamine brought them back to normal behavior. Not only that, I found that some of the strange diseases referred to the Clinic also responded to vitamin therapy, so I offer this explanation.

Every cell in the human body is a one-celled organism in its own right. Evolution has endowed each of them with special responsibilities in groups that make up the organs of the body. I think of the body as being somewhat like an orchestra where the groups of specialized cells represent the instrumentalists. The violins, as it were, are separated from the cellos, each representing a bank of instrumentalists. They all know what to do but require a conductor. The conductor in the body is of course that part of the brain that connects with all the organs through the nervous system known as autonomic. We have two types of nervous mechanisms: the voluntary system conveys will, thus allowing conscious control of body movement and thoughts. The autonomic nervous system is purely automatic. Its controls are in the lower part of the brain which is unusually sensitive to deficiency of thiamine. That is why alcohol addiction, heavily related to thiamine metabolism, results in a brain disease known as Wernicke encephalopathy that is well known to be caused by thiamine deficiency.

Signals from the brain to the body organs and from the organs to the brain enable us to adapt to all the vagaries of living in a hostile environment. This signaling system also requires a huge amount of energy and it is not surprising that the brain/body mechanisms deteriorate if there is insufficient energy.

I have come to the conclusion that thiamine is somewhat like the leader in an orchestra. Although the entire vitamin category represents the nutrient necessities of life and each has its own separate responsibility, they all work together. Because of its special place in energy metabolism it stands out with its clinical importance. Because energy metabolism is frequently inferior as the major cause of a disease, the diagnostic category, as we presently represent disease, ceases to matter. A reader might object by referring to genetically determined disease as a leading cause. However, the new science of epigenetics tells us that proper use of nutrients and adjustments of lifestyle can often correct the genetic mistake.

High Calorie Malnutrition: A Disease of Affluence

Now I would like to discuss what I mean by high calorie malnutrition because I believe it is an extraordinarily common cause of disease in our disorganized world. Malnutrition is usually thought of in relationship to starvation. The disease known as beriberi is a classic example of high calorie malnutrition. It was caused for centuries by the consumption of rice. Although the major effect has been in Eastern countries, it has appeared in many different parts of the world including America. The rice grain consists almost exclusively of starch that is broken down to glucose for use as fuel. The vitamins necessary for the metabolism of the glucose are in the cusp around the grain. When you remove the cusp you generate white rice and the Chinese peasants found that white rice looked nicer on the table. Therefore if and when they became more affluent they would take their rice to the rice mill for the removal of the cusps. The use of the rice mill was expensive, hence the association with affluence. They would place the white rice in silver bowls and invite their friends to dinner, not for culinary purposes but to demonstrate their new found affluence. Our constant deviation from the natural rules applied to health costs humanity dear. People with beriberi do not look starved. In fact they may be obese. Because they have bitter complaints and look relatively healthy they are often mistaken for neurotic complainers and treated indifferently. Not only that, if a physician might suspect his patient as having this disease and measure the level of thiamine in the blood he will probably find it to be normal. It is the ratio of calorie concentration to that of thiamine concentration, reminding me of what happens with too much gasoline in the cylinder of a car referred to as a choked engine.

I would like to give you a few examples. When I started my library research on thiamine, I discovered that a medical officer of health in England had been sent out to Hong Kong in the 1940s to investigate a form of sudden death that occurred in breast-fed infants of Chinese mothers. Hong Kong was then a British protectorate. She found that the rice consuming mothers gave their infants thiamine deficient breast milk. Although these infants were often considered to be the healthiest looking members of the family they suddenly died at the age of 3 to 4 months, exactly like sudden infant death syndrome that occurs today. Of historical interest, you may remember that the Japanese invaded Hong Kong and the Chinese people had their rice severely restricted. Although the breast feeding mothers were near to starving, the sudden infant death ceased to occur. When the Japanese were driven from the colony, the mothers had unrestricted rice and the sudden infant death began to reappear. This taught me the danger of empty calories.

At the Clinic, I kept seeing infants that had been classified as “threatened sudden infant death” and would place them on a breathing monitor that indicated when they had an episode of apnea (temporary cessation of automatic breathing) or slowing of the heart. When I gave them thiamine the monitors ceased to fire alarms. By special studies we found that the function of the brain stem in these infants was compromised, clearly indicating an electrochemical underlying mechanism. Although we published our work, it has been ignored. Advancing to my experience with adults after I had resigned from the Clinic a young woman came to see me from out-of-state. She had been diagnosed with a condition known as thrombocytopenic purpura, a disease in which platelets, one of the varieties of cells in the blood that have a function in clotting, were severely deficient. She had been receiving orthodox treatment for 10 years without success. I gave her a series of intravenously administered water soluble vitamins with complete resolution. I can provide lots more examples, but perhaps this has introduced to you the possibility of a different perspective in our constant search for what health really means and how it breaks down into disease. The bottom line, if you will, may come down to simple energy availability. If that is the case, then all disease processes, no matter their origins, would benefit from improving energy capacity.

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Image by Jeyaratnam Caniceus from Pixabay.

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