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With Thiamine Paradox Symptoms Patience Is Key

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thiamine paradox

I wanted to share my experience going through thiamine paradox so that others may find hope as they navigate the process. In November of 2019, my life was completely flipped upside down. My full story is here, but briefly, I had taken an antibiotic called Tinidazole, the less popular but almost identical sister drug to Metronidazole. Within days of taking the antibiotic I began to experience frightening symptoms like loss of mobility in my hands, heart palpitations and intense feelings of depression and doom. Less than two weeks later, I went into surgery to get my wisdom teeth removed and was put on a course of penicillin for two weeks.

Within weeks, my health was in a total spiral. I began to experience constant bouts of tachycardia and panic, low blood sugar, dizziness, blurry vision and the inability to sleep. I went from somebody who sleeps 8 hours a night to sleeping for less than an hour on various nights. When sleep did come, I was jolted awake in a panic attack. At times, I was feeling symptoms that mimicked asthma…it was like I couldn’t breathe.

I had no idea what was going on. Multiple trips to the ER did nothing. I continued to get worse. It wasn’t until I traced back what drugs I had taken that I made my way to a Facebook group called “Metronidazole Toxicity Support Group.” It was in that group that I discovered that thousands of others were dealing with the same set of symptoms caused by this horrendously neurotoxic antibiotic. I had known for years that one should avoid fluoroquinolone antibiotics, but research has shown that metronidazole and others in its class present some of the same catastrophic side effects.

Through her own research and contact with Dr. Lonsdale and Dr. Marrs, the founder of the group discovered that metronidazole and other drugs in its class block thiamine in the body. The symptoms of the toxicity mimic those of Wernicke’s encephalopathy.

The solution? Take thiamine.

I thought it was going to be an easy fix. It wasn’t.

Like many posts on Hormones Matter, the topic of paradox frequently comes up, and I am the perfect case study.

In retrospect, I had longstanding symptoms of mild beriberi for a lot of my life. I was constantly dealing with low blood pressure and strange heart symptoms that date back to my teenage years. I grew up eating a typical American diet and started drinking large amounts of coffee in my teens. I loved sugar.

With longstanding thiamine deficiency, the human body changes its chemistry to adapt and survive. When thiamine is reintroduced and things get turned back, your body goes haywire until the chemistry can normalize.

For me, it took three attempts. Every time I would start even the tiniest dose of thiamine HCL, I would erupt in panic, tachycardia, feelings of “seizures” and doom and gloom, chest tightness and head pressure. It was akin to the feeling when somebody knows that they ingested way more marijuana than they should have. Sheer terror. When I took too much one time, I almost landed in the ER because I thought for sure that I was going into cardiac arrest.

My first attempt was in January 2020. I failed miserably and stopped because of the side effects. But I wasn’t getting better and my health continued to spiral. I tried again in March 2020 and made it for 2 weeks before dropping out again. I would crumble pills to get just a little thiamine HCL in my system and I would still feel like a total wreck.

Finally, on my third attempt in May 2020, I made it.

The solution is to start LOW and SLOW. I found a company in the UK that has a liquid form of thiamine HCL that allowed me to do this. I started with 10 mg per day and gradually increased by 10-20 mg over the course of many weeks. I also spread my dose out throughout the day. Dr. Lonsdale predicted the paradox will lift within a month, but for me, it took a bit longer. Within 8 weeks I began to notice that I could safely take a 100mg thiamine HCL pill without experiencing too many symptoms. It continued to get better with time.

Now, almost a year later, I’m taking 300-400mg of thiamine HCL a day and mixing in benfotiamine and allithiamine. In the last 6 months, my health has slowly started to trend upward. I’ve added in a B complex at times and I’m also working on my B12. The heart palpitations are significantly better, I’m less prone to panic attacks than I have been in years, and my brain fog has lifted. What I’m left with is some slight dizziness (though it is significantly better), blurry vision that waxes and wanes, and my blood sugar is still presenting some issues. Still, I feel like I’m trending in the right direction and that things continue to slowly improve.

My advice for those of you encountering paradox symptoms is this: BE PATIENT. It sucks. But the rewards on the other end are so worth it. I would also advise you to dramatically increase your potassium through food. This didn’t eliminate the paradox feelings entirely but it did help reduce them.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Photo by Aron Visuals on Unsplash.

This article was publish originally on January 26, 2021. 

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Virginia Woolf and Me – Moments of Being Misunderstood

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Did Virginia Woolf Suffer from Thiamine Deficiency

Virginia Woolf, an English writer who pioneered the use of stream of consciousness narration, was a tremendous diarist. Her diaries and her collection of autobiographical essays, ‘Moments of Being’1, reveal her longstanding struggle with health issues that today might be classified as Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS). Reading her work for a creative writing class, I realized that her unrelenting fatigue, brain fog, and memory issues might have been due to unrecognized thiamine deficiency; an issue that I have struggled with, and published articles here and here and written two books about: The Missing Link in Dementia and Swimming in Circles.

‘My Brain Is Like a Scale’ – A Familiar Symptom of Thiamine Deficiency

Virginia’s diaries logged, in vivid detail, the symptoms she experienced – a condition which, like many today, had no clear diagnosis or treatment. She suffered with severe fatigue, ‘such an exaggerated tiredness’2(p.121), which fluctuated, ‘My brain is like a scale: one grain pulls it down. Yesterday it balanced: today it dips’2(p.260). The fatigue was noticeably worse after physical exertion, ‘But I am too tired this morning: too much strain and racing yesterday’2(p.263), but also deteriorated after socializing, ‘I’m too tired to go on with [reading]. Why? Talking too much I daresay. I thought, though, I wanted “society”’2 (p.230). Her symptoms recovered with rest – ‘A day off today’2(p.230).

In my memoir, ‘The Missing Link in Dementia’, I describe an illness characterized by extreme fatigue, insomnia, post-exertional malaise and significant memory problems. My condition progressively deteriorated, and I became extremely tired all the time. Severe insomnia left me restless most nights, and I would awake each day feeling unrefreshed and permanently exhausted. Any physical exertion, even walking, worsened the fatigue, my legs would feel heavy like dead weights, powerless and clumsy.

The most frightening symptom was short-term memory loss. I would spend hours reminiscing; spectacularly clear distant memories were more easily retrieved than any recent event. I experienced brain fog, reminding me of my pregnancy-induced woolly brain. I was forgetting things – outcomes of discussions or meetings at work, names, and then faces. I struggled to concentrate. I feared I was developing early dementia, and that my brain was becoming encased in amyloid plaques. In my memoir I described how I imagined these smothering my brain like a fleece in winter. Over time I steadily deteriorated with frightening moments of being unable to recognize my surroundings.

I wrote my memoir before reading the description of Virginia’s vivid memories of a happy childhood that were, ‘more real than the present moment.’1(p67). She tried to rationalize this experience – the strength of simple childhood memories compared with the weak later memories, describing ‘non-being’ as everyday activities that did not assimilate into our memory banks. She wrote, ‘I’m brain fagged’2(p.309), ‘I have already forgotten what we talked about at lunch; and at tea;’1(p70) but she knew that ‘although it was good day the goodness was embedded in a kind of nondescript cotton wool.’1(p70). Shortly before the end of her life she wrote: ‘I can’t concentrate’, ‘I can’t read’3. She had cognitive decline with short term memory loss.

The Emotional Component of Inadequate Thiamine

In contrast to my numbed senses, my emotions were far from muted, I was overly excitable or would burst into tears or become inappropriately angry at minimal provocation. I suffered with palpitations which were disconcerting, and at times, disturbing. Virginia wrote that she, ‘felt such rage’1(p125) and that her, ‘heart leapt: and stopped: and leapt again…and the pulse leapt into [her] head and beat and beat, more savagely, more quickly.’2(p.179)

I was scared, not knowing where to turn to for help. My quality of life was extremely poor. I had always been an optimist, but I could see no future living like this. I even contemplated suicide, because I did not wish to become a burden. I thought I was going to die anyway, and I was extremely sad that I wouldn’t see my children grow-up, but I thought that they would be better off without me. It seems terrible now – selfish even, but I was unable to control how I felt.

Virginia had suffered with an illness that had features of depression, she felt ‘such anguishes and despairs’2(p.94).  She wrote that she was spoiling Leonard’s life. Tragically, she committed suicide in 1941 shortly after completing the manuscript of her last novel. She was 59. In her suicide note she wrote that: ‘Everything has gone from me’3(p.481).

Anorexia: A Cause and Consequence of Inadequate Thiamine

As a young adult Virginia had a stressful seven years with multiple deaths in the family1(p.117), sexual abuse during adolescence1(p.69), and probably had anorexia according to her great niece, Emma Woolf. Virginia was almost 6 foot and weighed 7st 6lb (104lbs) when she was institutionalized for rest and feeding, her body mass index (BMI) was 14.5, a marker that she was significantly underweight.

I found out in my forties that I had a congenitally malrotated gut, presenting unusually as an adult. I had developed marked slowing of my guts, so that it was becoming impossible to eat. The slowing of my guts meant that I no longer felt hungry. I had to remember to eat, to force myself to eat. I lost weight, dropping from size 12 to 6. I lost muscle mass; where previously I had muscles there were now gutters. The muscles were constantly twitching – fasciculation’s, tics, tremblings or flutterings.

Neurasthenia: The ME/CFS of the Time

It is likely that Virginia was influenced by Jane Austen. Virginia’s first novel has many links to Austen’s novels, including the names of characters. Famous quotes from Austen’s Pride and Prejudice hint at Mrs. Bennet’s underlying condition: ‘Mr. Bennet…You have no compassion on my poor nerves.’4(p.7), ‘…I am frightened out of my wits; and have such tremblings, such flutterings, all over me, such spasms in my side, and pains in my head, and such beatings at heart, that I can get no rest by night nor day’4 (pp.273-4).

Virginia Woolf and Jane Austen’s Mrs. Bennet were both thought to have suffered with neurasthenia, literally weak nerves, a term originally used in the nineteenth century United States, when it was associated with busy society women and overworked businessmen. The first description of neurasthenia was published by American neurologist Beard in 1869. Virginia wrote that she was ‘extremely social…for ever lunching and dining out…or going to concerts…and coming home to find the drawing room full…of people.’1(p.163) She was obliged to participate because the ‘pressure of society was now very strong.’ 1(p.128) She repeatedly spoke of a ‘world of dances and dinners’1(pp.170, 172).

Low Thiamine Causes Low Energy Levels

One of the problems in ME/CFS/neurasthenia is that there are no tests. A clue is that the predominant symptom is fatigue. After excluding other causes of fatigue, a prime suspect must be faulty energy production. Another problem in ME/CFS/neurasthenia is that there is a lack of understanding about the basic energy producing processes or the fact that thiamine, or vitamin B1, is crucial.

ATP (adenosine with three phosphates) is the main energy currency. Energy is released each time a phosphate group is removed from adenosine, becoming ADP (adenosine with two phosphates). This is the human equivalent of a rechargeable battery.

Respiration is the breakdown of food-fuel to release energy. The predominant fuel, glucose, is broken down to produce pyruvate via glycolysis – literally glucose breakdown. This pathway doesn’t require thiamine (or oxygen). It produces two ATP. This is just small change in comparison with the energy produced in the battery factory – mitochondria.

Entry into the battery factory is through the gatekeeper enzyme – pyruvate dehydrogenase. This enzyme breaks down pyruvate, and importantly, requires thiamine as a co-factor – it malfunctions without thiamine.

Once inside the factory there are two production lines: one continuously uses recycled components (tricyclic acid cycle) and the other is a chain of reactions (electron transfer chain). These processes make significantly more ATP, producing more charge, more efficiently – like ultra-rapid charging for EVs. Obviously, this is a simplified version to hammer home the message that thiamine matters. A more accurate, detailed and scientific (less creative) description can be found here.

A shortage of thiamine (or oxygen) results in the excess pyruvate being converted to lactic acid. A familiar sensation to anyone who has sprinted 100m, when the demand for energy is higher than production, is the build-up lactic acidosis in the muscles, causing cramping, burning or weakness. This diversion of metabolism to an anaerobic (without oxygen or thiamine) pathway is inefficient, because another chemical reaction, requiring yet more energy, is required for the muscles to remove the lactic acid and recover. This results in an energy debt as it costs more energy to return the lactic acid to the usable pyruvate – akin to buying back the family silver from the pawn shop.

During exertion thiamine is required to ensure the higher power charge is readily available. Excess lactic acid results when energy requirements outstrip production, whether from a lack of oxygen or thiamine. In patients with ME/CFS, lactic acid accumulates more readily during exercise and before oxygen supplies are exhausted, and an elevated lactic acid level is found in the fluid surrounding the brain. Malfunctioning pyruvate dehydrogenase has been identified as key in ME/CFS. These patients feel like they are doing a 100m sprint whenever they try to walk. The (now debunked) treatment of patients with ME/CFS with exercise therapy, shows that their condition was misunderstood.

For those with a more sedentary existence, falling asleep with an arm above your head gives the same sensation. When the blood starts to circulate the arm temporarily feels like a dead weight. The arm is incredibly weak and lacks coordination. This is because the nerves no longer respond to the instructions from the brain.

Weak Nerves? Think Thiamine.

Nerves are highly susceptible to thiamine deficiency. The poorly insulated nerves – the autonomic nerves – are particularly vulnerable to thiamine deficiency. These autonomic nerves control the fight and flight response and regulate gut movement, sweating and heart rate – the ‘housekeeping’ functions which are outside voluntary control. After prolonged thiamine deficiency, eventually all nerves are affected, including the larger, better-insulated sensory and motor nerves. Arguably, the term neurasthenia is more appropriate than ME, it indicates the underlying problem – reduced nerve function.

According to the hypothesis that I describe in my memoir, excess thiamine-destroying bacteria, in the part of the gut responsible for absorbing nutrients, reduce thiamine availability. Vitamin D deficiency is common in bacterial overgrowth; it makes sense that it is a surrogate marker for thiamine deficiency. Vitamin D deficiency often occurs in patients with ME/CFS.

Rest, Recover, and Recharge

Back then, the best treatment for neurasthenia was the ‘rest cure’. Beard, a sufferer himself, astutely remarked that it was due to the body being drained of nervous energy due to an overtaxed supply of energy. Virginia was treated with rest and recognised that her nerves required respect: ‘Only nerve vigour wanted’2(p230). She was also treated with a high protein diet. Similar approaches have been popularised today. Diets such as paleo, South Beach and Mediterranean support a higher protein consumption. I ate a low carbohydrate diet for years and still avoid sugar now. I also took thiamine supplements, had corrective gut surgery and antibiotics. Popular techniques for resting the mind and body include meditation, yoga, relaxation and mindfulness. Resting helped me. It wasn’t easy, because I felt agitated and compelled to move. I spent hours doing jigsaws, aware that I was recharging my batteries – a term I’ve used but not reflected on. Strangely, this is the underlying problem: low charge, faulty charging, poor battery capacity. We have a far better understanding of modern technology that has been around for a few decades than the human system in existence for millennia which is reliant on thiamine.

Thiamine Deficiency, Modern Lifestyle, and Sugar Cravings

Humans have some design glitches predating our modern lifestyles. The first anomaly is that ATP is not stored, and the ATP generated is used 1000 times over each day – the body must constantly produce and recycle ATP. The second design fault is that thiamine, despite being essential, is not stored and is only poorly absorbed through the gut. Low thiamine levels are prevalent in society, leading to faulty recharging of our internal batteries.

Beard, who wrote about his neurasthenia in 1869, thought it was due to American modernization. He was right; we have made poor lifestyle choices. In the United States, sugar became readily available after 1864, following the civil war, with the construction of the biggest sugar refinery in the world on Long Island and a reduction in taxes. In the UK, sugar consumption escalated a century earlier, Britain was described as the ‘sweetshop of Europe’, thought to be in part due to our tea-drinking habit. By the time Jane Austen was writing, sugar was Britain’s most valuable import. Originally a condition affecting the upper classes, neurasthenia spread to the lower classes, as sugar became more affordable, although this may reflect access to medical care.

I had been craving sugar for years to gain short bursts of energy as I flagged, adding sugar to tea, one teaspoon became two, then three. Like topping up a meter constantly with small change, the sweet tea momentarily cleared the brain fog, allowing me to see another patient or simply make it to the end of the day. I experienced the same sensation in my colleague’s office after a dose of intravenous thiamine – the cotton wool vaporized.

The brain only uses glucose for energy production, whereas muscles can use protein as a fuel. I now understand that by drinking sugar-charged tea I had been supplying my glucose-dependent brain with glucose for the glycolysis pathway but because I was deficient in thiamine, the products of glycolysis could not enter the TCA cycle and progress to the electron transport chain where most of the ATP is made. The sugar craving was a sign that my brain was starving – desperate for energy – for titbits of ATP.

Factors Affecting Women

ME predominantly affects women. In many cases there is a deterioration during the peri-menarche or perimenopause, times of marked growth and/or hormonal changes. Progesterone slows gut motility. Estrogen improves nerve connections in the hippocampus – the part of the brain responsible for working or short-term memory, it also increases glucose uptake into the brain.

Being perimenopausal, my falling estrogen levels meant that the brain uptake of glucose was less efficient. Glucose offered short-term relief but exacerbated the bacterial overgrowth and malabsorption. It was clear that I had been breaking down muscle and using it as a protein source to produce energy outside my brain, contributing to the muscle wasting I experienced.

Thiamine is depleted during pregnancy, breast feeding, growth, infections and exercise. Having had four children, all breast fed, I had started exercising to get fit, and lost weight, initially intentionally. Other familial factors, immune deficiency causing recurrent infections or defective thiamine uptake genes, might have contributed. I had multiple factors, any one of which would deplete thiamine.

Was Virginia Woolf Deficient in Thiamine?

We will never know. What we do know though is that thiamine deficiency leads to poorly functioning housekeeping nerves and slow guts, predisposing to small intestinal bacterial overgrowth. This causes reduced appetite, trouble eating, reducing thiamine intake further. It is a physical problem caused by vitamin deficiency, poor nerve function initially, and eventually, nerve damage. Thiamine deficiency is treatable. It is not a psychiatric illness – the mental symptoms I experienced were caused by thiamine deficiency. Virginia Woolf was probably thiamine deficient too, having suffered with anorexia nervosa. She had a diagnosis of neurasthenia, now known as ME/CFS. Millions of people suffer with ME/CFS. Perhaps it is time we look into thiamine.

References

  1. Woolf V. Moments of being unpublished autobiographical writings. Schulkind J (ed). New York and London: Harcourt Brace, Jovanovich; 1976.
  2. Woolf V. A writer’s diary: being extracts from the diary of Virginia Woolf. Woolf L (ed). New York: Harcourt inc.; 1953.
  3. Woolf V. The Letters of Virginia Woolf. Vol. 6, 1936-1941. Nicolson N, Trautmann J (ed). London: The Hogarth Press; 1980.
  4. Austen J. Pride and prejudice. Vivien Jones (ed). London: Penguin Classics; 2003.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Image credit: Harvard University library, Public domain, via Wikimedia Commons.

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Health Shattered By Poor Diet and Conventional Medicine

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shattered health

My health has declined over the last few decades, to the point that I am totally disabled and haven’t driven in 10 years. I have severe POTS with high blood pressure while sitting and laying down. Previously, it was low. I am not able to stand up as my heart rate goes too high and I feel as though I’ll pass out. I have coat hanger pain, jaw tension, and headaches daily. I am very irritable and impatient. Emotional outbursts crying spells, depression. I feel like I am a completely different person. I am in survival mode. My body cannot shift out of sympathetic dominance. All of this has developed over the last 20 years; a progressive decline until everything hit the fan.

I thought I had a relatively healthy childhood and into my early 20s. I did have mono in 7th grade. Looking back though, I ate poorly growing up and did a lot of crazy starvation diets. I also consumed a lot of alcohol in my later teens through my early 20s. I stopped drinking in 1994. However in 2006, I started drinking on and off again and the night I had the severe vertigo attack, I had been drinking. Since then I haven’t touched alcohol.

My mom passed away when I was 22 and I had my first child at 23, which was a C-section. At 26, I developed rosacea. This was really my first health problem. At 27, I was divorced (1993). I remarried a year later and had another child at 30 years old. Three months later, I had my gallbladder removed. With all of this, I was still active and healthy with only rosacea that would come and go, but it would get really bad on occasions and was very distressing. This was until 2007, when life stressors, poor diet and illness caught up with me.

Unending Vertigo and the Protracted Decline of Health

I started working again in 2000 after we relocated to Arizona. I was a preschool teacher, a wife, and was raising my two sons. I had a very full schedule. I was always a high achiever. In 2004, I opened my own school with another teacher. Things got even more stressful. In January 2007, I had a very emotional falling out with my father and a couple weeks after that I was diagnosed with viral pharyngitis. Within a couple weeks of this diagnosis, I was thrown out of bed with the worst vertigo you can ever imagine. This went on for three days and I was unable to walk for over two weeks. As things were improving, the dizziness never did go away. I sought out multiple practitioners, including neurologists and audiologists, but none were able to help.

I went back to work but I was never the same, having to deal with constant dizziness and feeling of being off-balance. In October of 2007, I wound up in the ER with a resting heart rate of 160. This had come on out of nowhere over the day and by the evening I was very frightened. They gave me lorazepam and sent me on my way. I continued with the constant dizziness and then the anxiety and panic attacks started. My GP gave me a script for benzodiazepine and offered an anti-depressant. I tried the antidepressant and I had a bad reaction. I  felt completely numb. I couldn’t laugh smile or have any sort of reaction. That was after just try half a tablet. I never tried that again.

In 2009, I had an ankle injury and was wearing a boot for most of that year. In October, of that year I ended up having a surgery on it. What was interesting is that I was not experiencing much of the dizziness for most of that year. It wasn’t until a couple months later when I had a sudden onset of the dizziness during my physical therapy session. So the dizziness had come back and the anxiety and panic attacks were getting worse. In September 2010, I basically collapsed at work. It was about four or five days later at home, I experienced a severe shift of my energy. I was severely fatigued and now was experiencing POTS.

Is it Lyme? Maybe. Maybe Not.

November 2010, I was diagnosed with Lyme, however, my test was not conclusive. The Lyme literate doctor said my immune system was so weak that it was hard to get a positive result. He diagnosed me clinically. This set me off on a seven year journey of protocols that included benzodiazepines, two IV chest ports, supplements, herbs, homeopathics, bio-hormones, coffee enemas, detoxification therapies, chelation, IV and oral antibiotics, Flagyl, anti-fungal drugs, and every diet imaginable. You name it I did it. We had spent our life savings and I was still disabled and incredibly ill.

I became addicted to the benzodiazepines that he prescribed. He never told me about how addictive they were. I was on them for three years and they made me so much worse! I tried to come off of them several times. They turned me into a 3 year old. I was so fearful I couldn’t leave my bedroom even to cross the hall into bathroom. Finally, in 2014 I was able to kick the addiction. It took me six months of liquid titration.

As If Things Weren’t Bad Enough: Cancer Too.

Also in 2014, I had a huge fibroid and had a procedure called UFE ( uterine fibroid embolization ) to cut off blood supply so it would shrink. I know now I had severe estrogen dominance.

In 2017, I hit menopause and stopped menstruating. I was using sublingual progesterone at the time. The doctor also had me on hydrocortisone for adrenals and a time-release thyroid supplement. These supplements never helped and only made me worse. I was in such bad shape. I wasn’t sleeping for 3 to 4 days at a time and then when I would sleep it was only couple hours. This sleep regime went on all year.

In May of that year, I woke up one morning and left breast had shrunk significantly overnight!! The doctor I was seeing, had me come in. He physically examined me and felt that it was not anything to worry about. He said that I needed to detoxify my breast because it was probably blocked lymph. He told me to do skin brushing on it. I was in such bad shape that I wanted to believe him but I was so frightened. In October, I saw a different doctor and she said I had to get a biopsy. It was cancer. I did not see an oncologist. I did not have any lymph nodes removed or chemo radiation. I just had a surgeon remove it. I left the rest up to God. At this point, I could not endure anything else mentally or physically. The pathology report indicated the cancer was 98% estrogen driven.

A Dysautonomia Specialist Prescribed More Antibiotics

In 2018, I tried one more doctor. He was an autonomic dysfunction doctor and his protocol was quite simple. It was focused on lowering inflammation in the brain and body and balancing gut bacteria. At this point, I had suffered from chronic constipation for at least 10 years, on top of POTS and all of the other health issues. I was put on fish oil, olive oil, Rifaxamin and Flagyl for the possible SIBO and a vagus nerve stimulator. He told me not to use any other supplements of any kind. He claimed that most all supplements were fraudulent and using them would interfere with progress. I could not finish the Flagyl. I was feeling severely agitated and I thought it was due to the drug. I took most of it though. He assured me that the Rifaxamin was very safe and that they actually have renamed this antibiotic as a eubiotic. I did see my rosacea clear up. I had read some research and trials were they used Rifaxamin for rosacea and had a very positive outcome. So over the last 2 1/2 years I’ve been faithful on this protocol. It seemed like I had periods of time where I was able to stand up longer and do more around my house but I always relapsed. I was using the Rifaxamin on and off as per his direction for 10 days at a time. This year he put me on it indefinitely to use daily. I’ve been on it now for 8 months straight, but in July I started to go downhill very fast. I was having a decent spell able and had been able walk around for a a bit, do some limited chores and even able to be out in the pool, but one night my heart just went crazy and began to race. The vertigo came back too. I have been bedridden again since.

Discovering Thiamine Deficiency

After going back to doing some research, I came upon Dr. Lonsdale and Dr.  Marrs’ book Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition. I am thinking thiamine deficiency could be a piece of my puzzle. After reading one of Dr. Lonsdale’s articles on high B12 correlating with thiamine deficiency, I remembered two of my B12 tests. One in 2014, where it was 2000 and one in 2017 was 1600. The max upper range is 946.

Although my ill health was progressive at first, over time, everything has just become unbearable. I have been bedridden now for 10 years. The POTS symptoms are severe and I think I have the hyperadrenergic POTS. My blood pressure is very high when both sitting and laying and when I stand up, both my blood pressure and heart rate climb. I feel as though I’ll pass out. As I mentioned previously, I also have coat hanger pain, jaw tension, and headaches daily. I am very irritable and impatient. Emotional outbursts crying spells, depression. I feel like I am a completely different person. I am in survival mode. My body cannot shift out of sympathetic dominance. I am hoping to get some direction and advice on using thiamine to possibly help my condition.

Supplements, Medications, and Diet

Upon learning about thiamine and mitochondria, I stopped taking the Rifaxamin about two weeks ago. Below is a list of supplements I currently take and some information about my diet.

  • Magnesium hydroxide, Magnesium glycinate, 100mg, magnesium citrate, 100mg and some magnesium oxide in an electrolyte drink, in some variation for the past 3 years
  • 3000mg daily (6caps) DHA 500 by Now Foods for past 3 years
  • Liver capsules 4 daily past 3 months
  • Camu Camu powder, a natural Vitamin C, 100-300 mg just started about two weeks ago
  • Rice bran 1 tsp before bed started two weeks ago
  • Bee pollen 1/2 tsp daily, started 3 months ago
  • I follow gluten free diet. I eat beef, chicken, raw liver, raw dairy, raw kefir, cheese, bone broth, some fruit, oatmeal and some vegetables like tomatoes, green beans, onions.

Since learning about thiamine, I have begun using Thiamax but am having a rough time of it. I took my first half dose (50mg) of Thiamax on December 26, 2020 and continued that dose through December 31st. It seemed to increase my fatigue more than my normal, which is already pretty debilitating so I switched to 50mg thiamine HCL on January 1st. By January 3rd, I had a big crash. Hoping to minimize these reactions, on January 4th I took 25 mg thiamine HCL with 12 mg Thiamax in two divided doses. The next evening, however, I rolled over at 2 AM and my heart rate went crazy. I was shaking and went into a panic attack. It took hours to settle down. I haven’t had anything like this in quite a few years and I can’t imagine this would be from the tiny doses of thiamine I’ve been taking. I also took 600mcg of biotin that night at around 6pm. This was for a longstanding fungal infection. The biotin may have contributed to my reaction, but I do not know. I skipped the thiamine and biotin the next day and was able to sleep. I have resumed the thiamine once again and so far, I am tolerating it. I understand that people with chronic health conditions have difficulty adjusting to thiamine and I am trying my best make it through to the other side, but these reactions are difficult to manage. Any input from others who have been through this would be appreciated. I desperately want to recover my health.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Rest in peace Tawnya, 2023.

This story was published originally on January 11, 2021.  

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Poor Diet, COVID, and Thiamine Deficiency: A Perfect Storm

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A bit of information about me:  I am 24 year old man. I have always been fit, always exercised at least 5 times a week, and have had physical jobs. I never really cared about what I ate and my diet consisted of a load of protein (mainly protein shakes and chicken) with massively high carb/sugar consumption. I went out drinking with friends on most weekends. About two years ago, I had COVID and since then my health seemed to decline massively. I did not see a doctor initially, because I was not aware of how bad my health would become.

About a year after having COVID, my anxiety levels were through the roof. It was so bad, I couldn’t even leave the house without worrying something was going to happen. The symptoms I developed included: a change in personality, hand a feet neuropathy, shocking circulation to hands and feet, severe bowl issues, really low body temperature, extreme fatigue to the point where I was unable to get off the sofa after work most days, memory problems and an inability to think.

A year into this, I realized that I had to do something about my health. I was literally at breaking point. I did not know what was going on with my body or mind. At first, I thought I was diabetic because I matched so many symptoms but blood test showed normal sugar levels. I went back to the doctors numerous times. They basically told me that I was mad. They told my family all my symptoms and that I was really struggling, but no one believed that I was ill. They said it was all in my head and led me to believe that I was actually going mad.

Heart Problems, Breathlessness, and Thiamine Deficiency

Then the heart problems started. I have always played football, since I was 10 years old, and I have always been extremely fit, but I began having trouble breathing when playing. It gradually got worse and I became unable to walk the stairs without becoming breathless. As the breathing problems worsened, I had to stop all exercise. The exertion seemed to make me worse.

At this point, I was positive my symptoms were not imagined and so I did endless research online and found a video by Dr. Berg about thiamine/vitamin B1. I ordered some Benfotiamine and it definitely seemed to help. The anxiety vanished almost instantly and most of my symptoms went away except neurological ones. So I took about 4 tablets, 250mg each, per day for about 9 months. After this time, I felt I was not progressing any further. I thought I would never get circulation back in my hands and feet. My brain was still confused all the time and my breathing became slightly better but it was still nowhere near where I wanted to be.

I returned to internet for research and found Elliot Overton’s YouTube channel and ordered some TTFD, b-complex, magnesium, potassium. Thiamega, the product from Objective Nutrients, has 100mg thiamine HCL, 200mg Benfotiamine, 50mg Sulbutiamine and 50mg TTFD. At first, the paradox reaction, getting worse before getting better, was absolutely shocking. I remember being on the sofa each weekend and just sleeping most of the day. The brain fog was the worst it had been for months but after maybe a month that seemed to clear up and my brain problems seemed to have massively improved.

I forgot to mention earlier that prior to beginning supplementation with Benfotiamine and then TTFD, I had a private MRI scan on my brain. It showed high T2W right signal – a sign of lesions and demyelination and confirmation that I had thiamine deficiency. So, I went for another MRI with contrast recently to see if I have improved any. I am still waiting for the results on that one.

Improved But Still Missing Something

I am at the point now, where I feel I am back to normal health with most of my symptoms improved. All that remains to be resolved are the circulation and breathing problems. The rest do seem nearly resolved.

I have recently tried the carnivore/keto diet, but I usually get to day 3 or 4 and have to stop because it seems to make my symptoms worse especially the breathing and circulation. My current diet is mostly whole foods, with high protein, high fat and lower carbs. I try and eat a lot of red meat and that seems to help.

I was wondering if there was anything I can do to repair this issue, or is it for life now? Sugar and alcohol definitely seem to make me worse, but then so does keto and so I am unsure what to do. Maybe if I manage to push past the first week on keto I would feel better and my nerves would start to repair? All I know is that I must have had a serious case of beriberi disease, which has caused all this damage to my body. Obviously, I know it is my fault for not taking care of my diet, but I also feel the doctors are partly to blame as they seem to know absolutely nothing about thiamine deficiency. All they want to hear about is anxiety and depression. Any help at all would be massively appreciated. Thanks.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This story was published originally on October 3, 2023.

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SIBO, IBS, and Constipation: Unrecognized Thiamine Deficiency?

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In many of my clients, chronic upper constipation and gastroesophageal reflux disease (GERD) are misdiagnosed as bacterial overgrowth. Unfortunately, they are often non-responsive to antimicrobial treatments. Yet, sometimes the issues are fixed within a few days of vitamin B1 repletion. This has shown me that often times, the small intestinal bacterial overgrowth (SIBO) is simply a symptom of an underlying vitamin B1 or thiamine deficiency.

GI Motility and Thiamine

The gastrointestinal (GI) tract is one of the main systems affected by a deficiency of thiamine. Clinically, a severe deficiency in this nutrient can produce a condition called “Gastrointestinal Beriberi”, which in my experience is massively underdiagnosed and often mistaken for SIBO or irritable bowel syndrome with constipation (IBS-C). The symptoms may include GERD, gastroparesis, slow or paralysed GI motility, inability to digest foods, extreme abdominal pain, bloating and gas. People with this condition often experience negligible benefits from gut-focused protocols, probiotics or antimicrobial treatments. They also have a reliance on betaine HCL, digestive enzymes, and prokinetics or laxatives.

To understand how thiamine impacts gut function we have to understand the GI tract. The GI tract possesses its own individual enteric nervous system (ENS), often referred to as the second brain. Although the ENS can perform its job somewhat autonomously, inputs from both the sympathetic and parasympathetic branches of the autonomic nervous system serve to modulate gastrointestinal functions. The upper digestive organs are mainly innervated by the vagus nerve, which exerts a stimulatory effect on digestive secretions, motility, and other functions. Vagal innervation is necessary for dampening inflammatory responses in the gut and maintaining gut barrier integrity.

The lower regions of the brain responsible for coordinating the autonomic nervous system are particularly vulnerable to a deficiency of thiamine. Consequently, the metabolic derangement in these brain regions caused by deficiency produces dysfunctional autonomic outputs and misfiring, which goes on to exert detrimental effects on every bodily system – including the gastrointestinal organs.

However, the severe gut dysfunction in this context is not only caused by faulty central mechanisms in the brain, but also by tissue specific changes which occur when cells lack thiamine. The primary neurotransmitter utilized by the vagus nerve is acetylcholine. Enteric neurons also use acetylcholine to initiate peristaltic contractions necessary for proper gut motility. Thiamine is necessary for the synthesis of acetylcholine and low levels produce an acetylcholine deficit, which leads to reduced vagal tone and impaired motility in the stomach and small intestine.

In the stomach, thiamine deficiency inhibits the release of hydrochloric acid from gastric cells and leads to hypochlorydria (low stomach acid). The rate of gastric motility and emptying also grinds down to a halt, producing delayed emptying, upper GI bloating, GERD/reflux and nausea. This also reduces one’s ability to digest proteins. Due to its low pH, gastric acid is also a potent antimicrobial agent against acid-sensitive microorganisms. Hypochlorydria is considered a key risk factor for the development of bacterial overgrowth.

The pancreas is one of the richest stores of thiamine in the human body, and the metabolic derangement induced by thiamine deficiency causes a major decrease in digestive enzyme secretion. This is one of the reasons why those affected often see undigested food in stools. Another reason likely due to a lack of brush border enzymes located on the intestinal wall, which are responsible for further breaking down food pre-absorption. These enzymes include sucrase, lactase, maltase, leucine aminopeptidase and alkaline phosphatase. Thiamine deficiency was shown to reduce the activity of each of these enzymes by 42-66%.

Understand that intestinal alkaline phosphatase enzymes are responsible for cleaving phosphate from the active forms of vitamins found in foods, which is a necessary step in absorption. Without these enzymes, certain forms of vitamins including B6 (PLP), B2 (R5P), and B1 (TPP) CANNOT be absorbed and will remain in the gut. Another component of the intestinal brush border are microvilli proteins, also necessary for nutrient absorption, were reduced by 20% in the same study. Gallbladder dyskinesia, a motility disorder of the gallbladder which reduces the rate of bile flow, has also been found in thiamine deficiency.

Malnutrition Induced Malnutrition

Together, these factors no doubt contribute to the phenomena of “malnutrition induced malnutrition”, a term coined by researchers to describe how thiamine deficiency can lead to all other nutrient deficiencies across the board. In other words, a chronic thiamine deficiency can indirectly produce an inability to digest and absorb foods, and therefore produce a deficiency in most of the other vitamins and minerals. In fact, this is indeed something I see frequently. And sadly, as thiamine is notoriously difficult to identify through ordinary testing methods, it is mostly missed by doctors and nutritionists. To summarize, B1 is necessary in the gut for:

  • Stomach acid secretion and gastric emptying
  • Pancreatic digestive enzyme secretion
  • Intestinal brush border enzymes
  • Intestinal contractions and motility
  • Vagal nerve function

Based on the above, is it any wonder why thiamine repletion can radically transform digestion? I have seen many cases where thiamine restores gut motility. Individuals who have been diagnosed with SIBO and/or IBS and are unable to pass a bowel movement for weeks at a time, begin having regular bowel movements and no longer require digestive aids after addressing their thiamine deficiency. In fact, the ability of thiamine to address these issues has been known for a long time in Japan.

TTFD and Gut Motility

While there are many formulations of thiamine for supplementation, the form of thiamine shown to be superior in several studies is called thiamine tetrahydrofurfuryl disulfide or TTFD for short. One study investigated the effect of TTFD on the jejunal loop of non-anesthetized and anesthetized dogs. They showed that intravenous administration induced a slight increase in tone and a “remarkable increase” in the amplitude of rhythmic contractions for twenty minutes. Furthermore, TTFD applied topically inside lumen of the intestine also elicited excitation.

Another study performed on isolated guinea pig intestines provided similar results, where the authors concluded that the action of TTFD was specifically through acting on the enteric neurons rather than smooth muscle cells. Along with TTFD, other derivatives have also been shown to influence gut motility. One study in rats showed an increase in intestinal contractions for all forms of thiamine including thiamine hydrochloride (thiamine HCL), S-Benzoyl thiamine disulphide (BTDS -a formulation that is  somewhat similar to benfotiamine), TTFD, and thiamine diphosphate (TPD). A separate study in white rats also found most thiamine derivatives to be effective within minutes.

Most interestingly, in another study, this time using mice, the effects of thiamine derivatives on artificially induced constipation by atropine and papaverine was analyzed. The researchers tested whether several thiamine derivatives could counteract the constipation including thiamine pyrophosphate (TPP), in addition to the HCL, TTFD and BTDS forms. Of all the forms of thiamine tested, TTFD was the ONLY one which could increase gut motility. Furthermore, they ALSO showed that TTFD did not increase motility in the non-treatment group (non-poisoned with atropine). This indicated that TTFD did not increase motility indiscriminately, but only when motility was dysfunctional. Finally, severe constipation and gastroparesis identified in patients with post-gastrectomy thiamine deficiency, was alleviated within a few weeks after a treatment that included three days of IV TTFD at 100mg followed by a daily dose of 75mg oral TTFD. Other symptoms also improved, including lower limb polyneuropathy.

To learn more about how thiamine affects gut health:

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This article was first published on HM on June 1, 2020. 

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Serotonin Syndrome and Thiamine: Is There a Connection?

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Serotonin syndrome is described as a drug-related condition and is commonly believed to be rare. Serotonin is a neurotransmitter, but its actions make it sound like a hormone. It is made in the central nervous system and the gastrointestinal nerve complex. The symptoms of serotonin syndrome arise as a result of an over-abundance of its release from the nervous system into the blood and can be mild to severe, depending on the amount of serotonin in circulation. For normal function, serotonin is stored in a tiny cavity at the end of a nerve, known as a synaptosome and is released by passing through the membrane that surrounds the synaptosome, into the brain. The syndrome is caused by medications, either alone or in combination that increase serotonin levels, e.g. antidepressants, migraine medications, opioid pain medications, or illegal drugs. It is treated by the withdrawal of the causative drugs. There are multiple symptoms arising from an excess of serotonin in the brain and there are also symptoms arising from a deficiency. It is perhaps the prime example of the importance of moderation in everything.

Too Much or Too Little Serotonin

Just as excess serotonin is linked with a variety of symptoms, including: shivering, diarrhea, irritability and/or restlessness, confusion, increased heart rate, high blood pressure, dilated pupils, twitching muscles, muscle rigidity, excessive sweating, headache, tremors, goose bumps, hallucinations, and in more severe cases, unresponsiveness, high fever, seizures, irregular heartbeat, unconsciousness or coma, too little serotonin may be linked to mood disturbances. Deficiency is associated with several psychological symptoms, such as anxiety, depressed mood, aggression, irritability, low energy and low self-esteem. It can cause carbohydrate craving, weight gain, fatigue and nausea, but also, digestive or gastrointestinal motility problems such as irritable bowel syndrome and constipation. It is also a key neurotransmitter in the sleep cycle and is an essential brain chemical.

Thiamine Deficiency and Serotonin

Since many of the posts on this website discuss the problem of symptoms that are frequently associated with deficiency of vitamin B1 (thiamine), I turned to the literature to see if there was any connection between this deficiency and the role of serotonin. I found two important studies that demonstrate the critical role of this vitamin and its association with serotonin. In the first study, researchers explored the role of thiamine deficiency in synaptic transmission, the high affinity uptake and release systems for neurotransmitters using synaptosomal preparations isolated from different parts of the brain in thiamine deficient rats. There was significant decrease in the uptake of serotonin by the synaptosomal preparations of the cerebellum. The administration of the vitamin in vivo resulted in a significant reversibility of the inhibition of serotonin uptake, coinciding with dramatic clinical improvement. The study supports the possibility of an important innervation of the cerebellum by serotonin and suggests a selective involvement of this system in the pathogenesis of some of the neurologic manifestations of thiamine deficiency.

The negative societal impacts associated with the increasing prevalence of violence and aggression needs to be understood. In the second study, researchers investigated the role thiamine using a mouse model of aggression. Ultrasound aggression in mice was induced and the molecular and cellular changes were studied. They found that the ultrasound-induced effects were ameliorated by treatment with thiamine and benfotiamine, both of which were able to reverse the ultrasound-induced molecular changes.

The clinical effects of both deficiency and excess of serotonin are all well described online. The deficiency symptoms described are exactly those associated with beriberi, the vitamin B1 deficiency disease. Serotonin cannot cross the blood brain barrier. Therefore, it must be produced separately in the brain and the gastrointestinal system. Its association with thiamine in the bowel amply reinforces the mystery of gastrointestinal beriberi.

The many posts on thiamine deficiency in Hormones Matter suggests that a mild deficiency of thiamine is responsible for the large number of the polysymptomatic illnesses reported. High calorie malnutrition is a common cause by its increase in the calorie/thiamine ratio. The relationship with drugs is another matter. Although the mechanism of an excess of circulating serotonin is described as the drug-related cause of this syndrome, I could not help but notice that I have seen some of these symptoms corrected by the use of megadose thiamine. For example, excessive sweating, dilated pupils, increased heart rate and “goose bumps” are all caused by increased activity in the sympathetic branch of the autonomic nervous system. Thiamine deficiency is a prime cause of imbalance in this system. Certain therapeutic drugs used in medical practice may trigger mitochondrial toxicity leading to a wide range of clinical symptoms and even a compromise of the patient’s life. Contemplating this made me wonder whether the vitamin might have an important bearing on maintaining serotonin in its median state of concentration, because of its vital role in energy metabolism.

Serotonin and COVID-19

Since it has been claimed that Americans consume a high calorie diet, it is important to stress the imbalance which is commonly high in carbohydrate and fat. Serotonin is synthesized from tryptophan, an amino acid that is found in first-class protein and is an essential component of the human diet. It plays a part in many metabolic functions including the synthesis of serotonin and melatonin. Supplementation of this amino acid is considered in the treatment of depression and sleep disorders. It is also used in helping to resolve cognitive disorders, anxiety, or even neurodegenerative diseases. Reduced secretion of serotonin is associated with autism spectrum disorder, obesity, anorexia and bulimia nervosa, as well as other diseases presenting with a variety of symptoms.

It has been hypothesized that aging occurs because of failure of the pineal gland to produce melatonin from serotonin. Evidence has been presented for a role of melatonin and serotonin in controlling the neuroendocrine and immune networks inhibiting the development of ischemic heart and Alzheimer’s disease, tumor formation and other degenerative processes associated with aging. However, a more modern concept for aging is that the production of intracellular reactive oxygen species is a major determinant of lifespan.

One important feature of Covid 19 pathophysiology is the activation of immune cells, with consequent massive production and release of inflammatory mediators that may cause impairment of several organ functions including the brain. In addition to its classical role as a neurotransmitter, serotonin has immunomodulatory properties, down regulating the inflammatory response by central and peripheral mechanisms. Although the interferon system is the first line of defense against viral infection in mammals, almost all viruses have evolved mechanisms to evade the interferon system by partially blocking their synthesis or action.

The Case for Thiamine Supplementation in COVID 19

Thiamine is an essential cofactor for four enzymes involved in the production of energy (ATP) and the synthesis of essential cellular molecules. The total body stores of the vitamin are relatively small and its deficiency can develop in patients secondary to inadequate nutrition, alcohol use disorders, increased urinary excretion and acute metabolic stress. Patients with sepsis are frequently thiamine deficient and patients undergoing surgical procedures can develop the deficiency. It can lead to congestive heart failure, peripheral neuropathy, Wernicke disease and gastrointestinal beriberi. It can result in the development of intensive care unit complications such as heart failure, delirium, critical care neuropathy, gastrointestinal dysfunction and unexplained lactic acidosis. Consequently clinicians need to consider thiamine deficiency in patients admitted to intensive care units and the development of this deficiency during the management of critically ill patients. Intravenous thiamine can correct lactic acidosis, improve cardiac function and treat delirium, without there being any possibility of toxicity. The many symptoms developed in Covid 19 patients are interpreted as a direct effect of the virus, whereas the evidence written in this post strongly suggests that deficiency or excess of serotonin are responsible and that intravenous thiamine could be given with impunity in the emergency room. The persistence of thiamine deficiency following the cessation of the acute phase of the disease would explain the long term symptoms that have been described, following what is generally accepted as recovery.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was published originally on Jun 13, 2023. 

Rest in peace Derrick Lonsdale, May 2024.

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Blood Brain Barrier Integrity and Early Thiamine Deficiency

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In my quest to understand oxythiamine (oxythiamine is an anti-thiamine molecule that appears to be synthesized in individuals with kidney disease), I stumbled upon a study from the mid-nineties where researchers examined blood brain barrier (BBB) integrity in early and late thiamine deficiency. They found that BBB breakdown not only preceded the pathogenesis of the more commonly considered white matter lesions associated with severe and chronic thiamine deficiency, but that BBB disintegration drives the deficiency-induced brain damage. This makes sense of course, given thiamine’s role in energy metabolism and the fact that barrier function is energy intensive. If metabolic energy declines then the barrier’s ability to prevent noxious molecules from reaching the brain will decline, as will its ability to filter out endogenously created waste products and other toxins. The entire exchange process will be weakened and across time, brain damage will accumulate.

Insofar as the gut barrier and the brain barrier are intimately connected, might we surmise that if BBB disintegration precedes and drives much of the brain damage evoked by thiamine deficiency, then would not ‘leaky gut’ and the symptoms therewith come before the leaky brain? I believe so. This was not part of this experiment and in no way indicated directly, but there were some hints that point me in this direction and certainly research published over the last decade or so supports this.

In this particular study, the investigators were looking at the patterns of dysfunction that arose when thiamine deficiency was induced by different mechanisms. To explore these differences, they used four groups of mice:

  • Group 1: Mice fed a thiamine-free diet and given pyrithiamine, a thiamine antagonist that readily crosses the BBB.
  • Group 2: Mice fed a thiamine-free diet and given oxythiamine, a competitive thiamine antagonist that blocks the transketolase enzyme, but does not appear to cross the BBB.
  • Group 3: Mice fed a thiamine-free diet and given pyrithiamine for 10 days, and then fed a normal diet and given thiamine (20mg/kg) injections. This was to determine whether recovery was possible.
  • Group 4: The control group fed a normal diet.

Groups 1, 2, and 4 were sacrificed on days 8, 9, and 10, while group 3 was sacrificed on day 14.

I should note that estimates equating mouse lifespan with human lifespan propose that 9 days in the life of a mouse is equivalent to about one human year. In contrast, for rats, researchers estimate that 13.2 days equal one human year. Keep these numbers in mind when considering animal research. Other differences apply, of course, but lifespan differences are huge.

With that in mind, in this particular study where thiamine was completely abolished from diet and blocked using anti-thiamine molecules, neurological symptoms appeared after 10 days of thiamine deprivation in mice and if thiamine was not repleted, the animals died within 48 hours thereafter. In contrast, rodents can live up to 4-5 weeks before succumbing to the effects of thiamine deficiency.

This would seem to suggest that we, as humans, might survive the complete absence of thiamine from diet, plus anti-thiamine blockade via pyrithiamine, for up to a year. This is unlikely. However, experiments using extremely low doses of thiamine (.15-.45mg p/day) have shown survival, with severe neurological deficits and damage, but survival nevertheless, for up to 6 months. We also have reports of patients with significant, lab tested deficiency who, though quite ill, live for years.

In contrast to the experimental conditions though, with human thiamine deficiency, especially as it develops later in life (genetic defects that appear at birth are a different story), there is rarely a complete blockade of thiamine or absence of thiamine from diet. Dietary consumption and anti-thiamine factors vary considerably from day to day and year to year and so the trajectory from deficiency to illness in humans will be prolonged and non-linear. That being said, there are some things we can learn from experimental protocols such as this one. Namely, that the mechanism of deficiency matters as it will affect which body compartments are affect most prominently in the early stages.

The Compartmentalization of Thiamine Deficiency

In this study, we saw the effects of long term thiamine deficiency in different tissues generated by the different anti-thiamine molecules. Pyrithiamine affected the brain and nervous system, while the effects of oxythiamine were most prominent in the periphery, likely the GI system and in the heart, although these were not tested.

We also see the time course of symptomology, where early on symptoms are not as noticeable until a certain threshold of damage is met. For example, neither histological lesions nor symptoms were obvious prior to day 8 of thiamine deprivation in the pyrithiamine group. This is roughly equivalent to almost a year in human life span. The animals showed an initial weight gain followed by a sharp decline on day 9 and the onset severe neurological symptoms at day 10. According to the researchers:

The initial neurological signs of thiamine deficiency appeared acutely and precisely on day 10, consisting of loss of activity, hyperactivity on acoustic or tactile stimulation, and ataxia.

Commiserate with the neurological symptoms in the pyrithiamine group, disturbed BBB function, necrosis, and numerous brain lesions were observed. If thiamine was withheld, the animals died within 48 hours. If thiamine was repleted (this was done only with the pyrithiamine group), most, but not all, of the animals survived and neurological symptoms abated. This is promising, but suggests there are still unrecognized variables that influence recovery.

In contrast, there were no lesions within this timeframe for the oxythiamine group. With oxythiamine, the only observable symptoms were weight loss and decreased activity. In fact, the oxythiamine animals maintained normal weight and activity until day 6 and then on day 8, there was observable weight loss, anorexia and decreased activity. There were no behavioral signs of neurological damage. It is not clear at what point the oxythiamine animals would have died naturally or by what means, as they were sacrificed at day 10 regardless of state.

The Heart of the Matter

Another study using rodents, points to oxythiamine affecting the heart more prominently than pyrithiamine. Here, oxythiamine treated rats showed a similar pattern of weight loss beginning after the 7th day, but also developed bradycardia and cardiac hypertrophy, which progressively worsened over the next few weeks. In contrast, the animals treated with pyrithiamine did not show heart-related changes until after developing the neurological symptoms. Moreover, the heart-related changes were not as prominent as those in the oxythiamine group. I will discuss this study more fully in a subsequent post, but it seems to suggest different mechanisms for what we call wet and dry beriberi. That is, oxythiamine results in peripheral metabolic symptoms perhaps related first to the GI system (weight loss and anorexia) and then to the heart, while blockade of thiamine via pyrithiamine results in brain and nervous system symptoms and damage. In both cases, I suspect there is disruption to gut barrier function. With pyrithiamine though barrier dysfunction seems to begin in the brain and nervous system and progress to the periphery, whereas with oxythiamine preferentially targets tissues in the periphery and only later reaches the BBB and the nervous system. Again though, this is not clear. As most of the studies I have read seem to investigate only one or the other.

Obviously, the mechanisms by which these two molecules deplete thiamine differs significantly, which then explains many of the differences observed in the animals, but what intrigues me is how closely the ‘symptoms’ align with human cases of thiamine deficiency where neither compound is administered. This begs many questions, not the least of which is whether and how we might produce these molecules endogenously or be exposed to them in everyday life. How could these patterns observed experimentally so closely align with the human experience (wet beriberi – oxythiamine, dry beriberi – pyrithiamine), where neither compound is provided. I do not know the answer. Yet. In the meantime, here is some more information on the mechanisms of oxythiamine and pyrithiamine and how we might be synthesizing them endogenously: Can We Synthesize Oxythiamine and Pyrithiamine Endogenously?

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, and like it, please help support it. Contribute now.

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This article was published originally on September 7, 2023.

 

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Thiamine and the Microbiome

What is a Microbiome?Many people still refer to bacterial microorganisms as “germs”. Most are completely convinced that “germs” are the

How Can Something As Simple as Thiamine Cause So Many Problems?

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I have read a criticism that thiamine deficiency is “too simple” to explain the devastating nature of the post Gardasil illnesses or the systemic adverse reactions to some medications. Sometimes, it is the simple and overlooked elements that are the most problematic.

Understanding Thiamine’s Role in Complex Adverse Reactions – The Limbic System

The lower part of the brain, called the brainstem, is a like computer, controlling the most basic aspects of survival, from breathing and heart rate, hunger and satiety, to fight or flight and reproduction. This computer-like function within the brainstem is called the autonomic system (ANS). The ANS together with the limbic system act in concert to regulate our most basic survival functions and behaviors. Both require thiamine to function.

Postural Orthostatic Tachycardia Syndrome or POTS , a type of dysautonomia (dysregulation of the autonomic system) seems to be the among the commonest manifestations of the Gardasil effect. Many cases have been diagnosed already, while others present all of the symptoms but have yet to receive a diagnosis. Dysautonomia and POTS have also been observed with adverse reactions to other medications, as well. Dysautonomia and POTS, at the most basic level, represent a chaotic state of the limbic-autonomic system. Let me explain.

Fragmented Fight or Flight

The brainstem autonomic system together with the limbic system enable us to adapt to our environment, presiding over a number of reflexes that allow us to survive. For example, fight-or-flight is a survival reflex, triggered by perception of a dangerous incident that helps us to kill the enemy or escape. This kind of “stress event” in our ancestors was different from that we experience today. Wild animal predators have been replaced by taxes/business deadlines/rush hour traffic etc. These are the sources of modern stress. The beneficial effect is that the entire brain/body is geared to physical and mental response. However, it is designed for short term action and consumes energy rapidly. Prolonged action is literally exhausting and results in the sensation of fatigue. In the world of today where dietary mayhem is widespread, this is commonly represented as Panic Attacks, usually treated as psychological. They are really fragmented fight-or-flight reflexes that are triggered too easily because of abnormal brain chemistry.

Thiamine and Oxidative Metabolism: The Missing Spark Plug

Our brain computers rely completely on oxidative metabolism represented simply thus:

Fuel + Oxygen + Catalyst = Energy

Each of our one hundred trillion body/brain cells is kept alive and functioning because of this reaction. It all takes place in micro “fireplaces” known as mitochondria. Oxygen combines with fuel (food) to cause burning or the combustion – think fuel combustion engine. We need fuel, or gasoline, to burn and spark plugs to ignite in order for the engines to run.

In our body/brain cells it is called oxidation. The catalysts are the naturally occurring chemicals we call vitamins (vital to life). Like a spark plug, they “ignite” the food (fuel). Absence of ANY of the three components spells death.

Antioxidants like vitamin C protect us from the predictable “sparks” (as a normal effect of combustion) known as “oxidative stress”.  Vitamin B1, is the spark plug, the catalyst for these reactions. As vitamin B1, thiamine, or any other vitamin deficiency continues, more and more damage occurs in the limbic system because that is where oxygen consumption has the heaviest demand in the entire body. This part of the brain is extremely sensitive to thiamine deficiency.

Why Might Gardasil Lead to Thiamine Deficiency?

We do not know for sure how Gardasil or other vaccines or medications have elicited thiamine deficiency, but they have. We have two girls and one boy, tested and confirmed so far. More testing is underway. Thiamine deficiency in these cases may not be pure dietary deficiency. It is more likely to be damage to the utilization of thiamine from as yet an unknown mechanism, affecting the balance of the autonomic (automatic) nervous system. It is certainly able to explain POTS (one of the many conditions that produce abnormal ANS function) in two Gardasil affected girls. Beriberi, the classic B1 deficiency disease, is the prototype for ANS disease. Administration of thiamine will not necessarily bring about a cure, depending on time since onset of symptoms, but it may help.

Thiamine Deficiency Appetite and Eating Disorders

Using beriberi as a model, let us take appetite as an example of one of its many symptoms. When we put food into the stomach, it automatically sends a signal to a “satiety center” in the computer. As we fill the stomach, the signals crescendo and the satiety center ultimately tells us that we have eaten enough. Thiamine deficiency affects the satiety center, wrecking its normal action. Paradoxically it can cause anorexia (loss of appetite) or the very opposite, a voracious appetite that is never satisfied and may even go on to vomiting. It can also shift from anorexia to being voracious at different times within a given patient. That is why Anorexia Nervosa and Bulimia represent one disease, not two.

Thiamine Deficiency, Heart Rate and Breathing

The autonomic nervous system, responsible for fight or flight, regulates heart activity, accelerating or decelerating according to need. So heart palpitations are common in thiamine deficiency. Its most vital action is in control of automatic breathing and thiamine deficiency has long been known to cause infancy sudden death from failure of this center in brainstem.

Thiamine Deficiency and Sympathetic – Parasympathetic Regulation

The hypothalamus is in the center of the brain computer and it presides over the ANS, as well as the endocrine (hormone) system. The ANS has two channels of communication known as sympathetic (governs action) and parasympathetic (governs the body mechanisms that can be performed when we are in a safe environment: e.g. bowel activity, sleep, etc.). When the ANS system is damaged, sometimes by genetic influence, but more commonly by poor diet (fuel), our adaptive ability is impaired. A marginal energy situation might become full blown by a stress factor. In this light, we can view vaccines and medications as stress factors. From false signal interpretation, we may feel cold in a warm environment, exhibiting “goose bumps on the skin”, or we may feel hot in a cold environment and experience profuse sweating. The overriding fatigue is an exhibition of cellular energy failure in brain perception.

Sometimes, it really is the simple, overlooked, elements that cause the most devastating consequences to human health. Thiamine deficiency is one of those elements.

To learn more about thiamine testing: Thiamine Deficiency Testing: Understanding the Labs.

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Photo by Robina Weermeijer on Unsplash.

This article was published originally in October 2013.

Rest in peace Derrick Lonsdale, May 2024.

 

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