paradoxical reactions with thiamine

Vitamin Therapy Paradox: Getting Worse Before Getting Better

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Does modern medicine accept the idea of vitamin therapy? The answer is a resounding no!  It has only been a little over 100 years since vitamins were synthesized. Of course, as everybody knows, all of these chemical substances were found to exist in natural food. They were very much part of the mystery of evolution. Essential to all animal life, they were there for the picking. Later, it was also found that a number of essential minerals were required. Both the vitamins and minerals need to be present in minute doses, covered under the eponym of recommended daily allowance (RDA). All we had to do was to obey the rules set out by Mother Nature. Our ancestors were classified as “hunter gatherers”. They hunted animals and gathered the bounty of nature. Yes, we were primitive savages and life was not the ideal by any means, but the food contained all that was necessary for life.

An Evolutionary Imperative To Eat Real Food

To ascertain what kind of food is required by an animal, you simply look at the teeth. We have front teeth called incisors for cutting, the pointed teeth called canine for tearing meat and the back teeth molars, used for grinding. Cows and horses are vegetarian and only have molar grinders. Human beings are omnivores (all foods edible) meaning that we are designed to eat meat, fruit and vegetables. Some of the vitamins are recycled through eating other animals. Others are recycled by being returned to the soil and passing into plants. That is why I have said to many people in answering the question as to what diet they should pursue, eat only nature made food and leave the man made food alone. Well, of course, you know that we didn’t do that.

We now have a food industry and it is quite unbelievable, at least to me, to see some of the stuff that passes as food, based solely on taste and appearance. Sometimes I find a person with these typical symptoms who is very careful with diet and does not practice taste hedonism, but because farming practices have changed in modern times, the produce does not have the same kind of non-caloric nutrient content. It may not be coincidental that such persons are almost invariably intelligent and physically and mentally active. It is reasonable to assume that their nutritional demand exceeds supply and they need non-caloric nutrients.

Sugar and the Vitamin Paradox

Now let me turn to the reason that I used “vitamin paradox” in the title. Anyone that wants to follow my reasoning can look back at previous posts on this website. You will find that there is a significant emphasis on the calamity of sugar ingestion and its association with vitamins, particularly thiamine. I am sure that I will look like a broken record to many people, but here is what happens to your health. Although it is obvious that all the vitamins and essential minerals are required, I am taking the example of thiamine because of its close association with the wide consumption of things called “goodies” or “sweets”.

All simple carbohydrate foods are broken down in the body to glucose. Research has shown that overloading the metabolism with sugar overwhelms the capacity of cellular machinery to burn (oxidize) it by producing a relative deficiency of thiamine, the vital catalyst that ignites (oxidizes) glucose to synthesize cellular energy for function. Recently it has been found that thiamine is required for the oxidation of fats, making the doughnut a perfect example of high calorie malnutrition. This is so important in the brain that I simply cannot overstate it.

High Calorie Malnutrition, Oxygen Deprivation and Brain Function

High calorie malnutrition is exactly equivalent to a mild degree of oxygen deprivation, so it is sometimes referred to as pseudo-hypoxia (false oxygen deprivation). If this is induced by poor diet where the pleasure of taste (hedonism) overrides appropriate nutrition, a curious thing happens! The lower part of the brain that deals automatically with your ability to adapt to a hostile environment becomes much more susceptible in its responsiveness.

I will give you one example: panic attacks, so extraordinarily common in our culture, are simply fight-or-flight reflexes that are triggered by pseudo-hypoxia. Messages go out to the body from this part of the brain, falsely initiated as though you were actually being “chased by a tiger”. Such an affected person will begin to experience the following symptoms as examples: palpitations of the heart, unusual sweating, a sense of anxiety or panic, irritable bowel syndrome, manifestations of allergy, emotional lability (emotions out of control) etc.  He or she will go to the doctor who will do a series of tests. If they are all normal, you will then be told that this is “all in your head” (psychosomatic). On the other hand, the doctor might find evidence for “mitral valve prolapse” (MVP), now known to be an early sign of “wear and tear” damage in the heart and the focus becomes “heart disease”(often used to explain heart palpitations) rather than its original cause, associated with nervous system dysfunction. I have seen MVP disappear in people from correcting their nutrition. It is rare for a patient to be asked about diet and rarer still to question the possibility of a vitamin deficiency.

Vitamin Deficiency: The Walking Sick

This kind of health situation may go one for a long time. The patient has symptoms but is not really a sick person. I refer to people like this as the “walking  sick”. Life continues as usual, but medications have failed to relieve the symptoms, or worse yet have introduced side effects. Over time, the loss of metabolic efficiency gradually leads to damage in cellular machinery (e.g. MVP) because the energy need to drive daily function is not being met. Thiamine activates the most important enzyme in energy synthesis and, in the early stages of nutritional deprivation, a thiamine plus multivitamin supplement would quickly abolish the symptoms. If neglected and the marginal malnutrition continues, it will be gradually more difficult to repair the damage.

Vitamin Therapy With Chronic Deficiency: Expect a Decline Before Improving

Physicians who practice Alternative Medicine have found that it is possible sometimes to retrieve function at this late stage of development by the use of a course of vitamins given intravenously. They have also learned that the symptoms of the patient actually get worse (paradox) in the initial stages of intravenous treatment but begin to get better following an unpredictable period of worsening. Naturally, the patient concludes that the treatment is bad or that it is causing side effects as in the use of vitamins. That is why I have christened it paradox, meaning that the unexpected happens.

Over the years of administering intravenous vitamin therapy for all kinds of conditions, irrespective of conventional diagnosis, I quickly learned to inform a patient about paradox before instituting treatment. Surprisingly, this paradoxical response usually heralds a good outcome. I do have some ideas about the cause of paradox, but it is so technical that I cannot attempt it here, perhaps in future posts. Intravenous vitamins are tremendously effective in the improvement of most chronic diseases, an effect that is almost impossible to achieve with the standard treatment of drugs as used in modern medicine today.

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


  1. Any thoughts as to why the skin all over my body is burning after taking benfotiamine? Didn’t happen at first but noticed it a few months in and it’s getting worse. Benfo helps my energy/shortness of breathe/ ability to move but I can’t take much anymore. Taking w/magnesium. Just started a b-complex 2 days ago in case that is the issue. Think it might help the burning a little bit but then it’s also made me start to shake and feel weak in my major muscles (biceps/thighs/etc). Any thoughts would be appreciated!

    • Firstly, what dose?
      Then, consider the formulation. Is there an additive/preservative or some other extraneous compound in the formulation that you are reacting too.
      Next, electrolytes? Besides magnesium, are you getting sufficient calcium, potassium, salt, phosphate?
      Finally, consider a different form of thiamine, perhaps a TTFD version – Thiamax is the cleanest among the TTFD brands.

      • Used to take about 75mg of Benfotiamine/daily. Now, around 15 mg once every 2 or 3 days depending when my body stops feeling like my skin/head is burning and when I start to feel short of breathe / hypoxic. I deal with other symptoms since I have CFS (like poor digestion, energy, SFN). Definitely curious about making sure I get enough calcium and phosphate. Think I’m good w/salt and potassium. For phosphate, all I see is ‘phosphorus’ supplements on Amazon. Is that the same? Looked online at symptoms of low phosphorus and I think a hit many of the symptoms. Can you just get a blood test for low phosphorus? Or different test? Or just recommend trying the supplement, dosage idea? Appreciate the info.

  2. Dear Dr. Lonsdale, I hope this message finds you well as I have consumed much of the content here regarding Thiamine and Paradox over the past month or so (as well as all of the comments in those articles) and don’t recall reading anything regarding EXTENDED reemergence of paradox symptoms AFTER tirating a potentially high dose DOWN. If you have indeed covered it and I missed this please forgive me.

    I began high dose oral thiamine on approximately 6/5/22 after coming across Dr. Costantini’s website. Naturally, I intended to get my dose up per his guidelines as quickly as possible so I went out and bought a bottle of 500mg Thiamine HcL tablets. I started out with a single 500mg tab and had planned on adding an additional 500mg per day until I reached the recommended 2-2.5g per that website. I experienced severe paradox by 1.5g (prolonged feelings of being of the verge of cramp or impending paralysis/body-wide-lock-up espectially in the hands and muscles of the face/head and neck). It was at this time that I came across this website and the wonder of TTFD so I placed an order for Lipothiamine immediately. I continued HcL at 500-1000mg per day with definite paradox until my TTFD arrived on 6/11/22. I began Lipothiamine at a single 50mg tablet with moderate but tolerable paradox and slowly worked my way up to 250mg daily as of about 2 weeks ago. During that time I noticed some improvement but have never had relief of some of my longest standing and unsettling symptoms. After feeling OK on 250mg for a few days and with improved sleep I increased to 300mg and felt a surge in severe restlessness at night so I tirated back down to 250mg for a few days but still extreme restlessness and hypnic jerking making for many terrible sleepless nights as of late. I began to tirate down and down until eventually being at 50mg TTFD again with no real relief. I should note that before starting high dose oral Thiamin I had been taking a B complex with 100mg Thiamine daily for about 2 years. I had also been taking weekly IVs for approximately 9-10 weeks of which one of the ingredients was a B-Complex containing 100 mg of Thiamin (not TTFD). I stopped the IVs about 2 weeks ago as well as the last one I did also increased symptoms and I feared that perhaps I was going overboard with the other B vitamins. In the past 2 weeks I have added Liposomal Glutathione at 750mg daily and Phosphatidylcholine at 1640mg daily after coming across an Elliot Overton video regarding Paradox. In addition I’m taking 125mg daily of Magnesium Taurate (plus some in my multivitamin) and an oral B-complex as well as a low dose CMP and 2 oral liquids for supposed parasites. After seeing no improvement at even 50mg TTFD I decided to try 1000mg HcL today divided in 2 doses and after the second dose I got almost immediate feeling of flushed burning skin followed but the dreaded cramping/lock up feeling and pressure/pulling inside my skull. I hope this amounts to more than incoherent babble and you can please lend some direction.

    • I have some similar issues. Started 75mg of benfotiamine 6 months ago, but started getting a burning sensation all over and eventually left my muscles overworked/hot and weak. Now down to very very little (maybe 5mg) of benfo on average b/c I can’t tolerate it anymore. However, now I’m starting to feel more hypoxic when I don’t take benfo. Think the b1 (not to be dramatic) might have saved my life 6 months ago but now I’m having trouble taking it. Guessing I need more vitamin support but it’s tough to know. Been taking magnesium for a long time but just started a b-complex with mixed results. But yeah, my experience is the opposite of feel bad, before improving.

    • It is likely that you need manage electrolytes, not enough potassium, magnesium, calcium, salt and/or phosphate. The cramping is a lack of one or more electrolytes. Alternatively, the dose may simply be too much, too soon. High for the sake of high dose makes no sense. Start a lower dose and work up slowly to a dose where you see improvement and hold. More will not necessarily yield additional improvement. Sometimes it makes things worse.

      • When I first started to feel really bad after pushing to 300mg TTFD, I tried to add Potassium (at the same time that I added Glutathione and Choline) at 400mg daily and I felt an increase in the cramping/paralysis symptoms. I messed around with the dosing of the potassium for the next week and still had adverse effects at the minimum dose of 100mg, at that point I chalked it up to the potassium being the culprit and dropped it. About a week ago I started taking a calcium/magnesium/potassium (Bio-CMP by Biotics Research) at 4 tablets a day and believed it to make my symptoms worse again over the past several days. Yesterday, I decided to not take the CMP and today I attempted to water fast as I am cycling off my parasite supplement for the next two days. About 18 hours into the fast all symptoms are heightened to the point where I almost am afraid of possible hospitalization. I broke the fast about 20 minutes ago and took a single Bio-CMP tablet, wish me luck. Is it possible that I need even more electrolytes and that is causing the ill effects or does it mean I don’t need them at all. I’m really feeling lost in all of this at the moment

        • Why take such high doses of everything right out of the gate and why water fast if you are already having problems. Neither seem wise. If one has chronic health issues, long term thiamine issues, and is attempting to replete thiamine on one’s own, without assistance, it is best to begin at a low dose and titrate up very slowly in a stair step fashion. Find a dose of thiamine that is tolerable and hold for a period of time, maybe a week, maybe a month, it depends upon your body. Then increase a little again and hold. For some people, the dose can be as small as a single milligram for others they can tolerate 50 or 100mg fairly easily. Regarding the electrolytes, once again, everyone is different in their needs. If you are getting sufficient potassium from diet, you will not likely need to supplement and shouldn’t, as it could cause all sorts of problems. Most folks do not get enough magnesium and have to supplement that, but again, there is no need to go to a high dose if you do not need it. Ditto for calcium. Sometimes salt is also required, but again, it depends upon your diet, your health/symptoms and other medications etc. So, don’t assume that just because something works for someone else that it will work for you. You have consider the totality of your health and your needs. Finally, don’t assume that one requires a high dose of anything to heal. Sometimes a higher dose does more harm than good.

          • Thank you for the prompt replies, it is much appreciated. I suppose I’ve just been trying to get to a “mega” dose as quickly as possible to end the suffering, in my mind this number was 400mg TTFD. I’ve been living in hell for not even 3 years yet (had more mild issues for a few years before that) but it feels an eternity, I’ve been to doctor after doctor in that time, given them months to years and have gotten little direction/relief of symptoms, or even a real diagnosis. I came across beriberi and saw the high coincidence of symptoms and right now have to believe that thiamine could be the answer for me. I later found this website and it is literally all I have to go on, I’ve informed my current doctor but he’s not familiar with the treatment and I don’t know who else to go to. I’m close to my breaking point as I’m sure are many others who have found themselves here at hormonesmatter, the information on this website may be all we have to hopefully save ourselves. Unfortunately, the self experimentation is a daunting task as it is, let alone for people who already suffer so greatly. How might we go about finding someone with experience in thiamine as a therapy to advise us?

            • I am afraid doctors knowledgeable about thiamine repletion are few and far between. That is one of the reasons we wrote the book (advertised on the site). Most folks have to figure it out on their own through a fair amount of trial and error. It’s difficult, but not impossible. If you are interested, consider writing your full case story to be published on this site. That way, I and others may offer some insight. It won’t be medical advice, but perhaps we point to some clues that you hadn’t considered.

              • I own and have read the book and believe I’ve learned much from it. As I have said before I was already taking 100mg thiamine hcl (part of a B-complex) for a period of 2 years before I began weekly IVs (which also contained thiamine as part of a B-complex) and later oral thiamine TTFD. I worked my way up to 250mg TTFD feeling pretty good however, at this current point I’m struggling at even 50mg TTFD (and about 30mg hcl in my current B-complex). I thought I was already through paradox, however, now (about 2 months after adding TTFD) I’m struggling even more than I was through what I thought was paradox, which was already difficult and lasted 5-6 weeks. Obviously, I have added many supporting supplements in the past few weeks hoping it would allow me to tolerate the thiamine at higher doses but I’m as bad as ever. At this point it feels I’m sensitive to all of them and I don’t know what is causing the issues, I have tried removing or reducing certain supplements but haven’t been able to pinpoint anything with certainty. Would it be wise to drop everything for a period of time and resume with TTFD alone at 50mg after x amount of days? Or should I just hold on taking everything else as is with 50mg TTFD and wait for some symptoms to hopefully subside? I know you can’t give me medical advise but what would you do if you found yourself in this predicament given your vast knowledge? Also, I would be happy to share my story and hope that it can provide some insight.

                • Write up your full story, narrative form in word file. Include current health issues but also health history, diet, lifestyle, medications, alcohol use, smoking or tobacco use, supplements, symptoms -everything. Send it to me at I will take a look and prepare it for publication. Until I have your full story, I cannot make any suggestions. It is possible that something you are taking is creating problems.

  3. I began drinking fresh raw organic Bovine colostrum 26 days I am tapering Diazepam and I was feeling good getting great energy , and doing things I hadn’t been able to for a very long time , my good days are getting a little better but my bad days are a lot worse since I began the colostrum is this whats know as paradoxical or a healing crisis that’s happening due to all the good stuff in the colostrum?

    I know even though I ate a good organic diet I’ve been nutritionally depleted by this drug over 20 plus year’s of being prescribed it , and am wondering is it because the colostrum of feeding my body missing nutrients that the bad days are awful as their being replenished and also because its healing my body, guts and brain, and immune system ? Thank you

  4. Hello Dr. Lonsdale,

    I’m a 34 years old male who’s had chronic fatigue syndrome for the last 4-5 years and I’ve started taking high dose thiamine 3 weeks ago. I weight 60kg and take 800mg a day and the two first weeks were fine (I felt sleepy during the day but also felt like I had more energy when waking up). Just before starting the third week, I’ve started to have troubles breathing (as if I’m not breathing enough air) and really bad anxiety (with my arms and legs shaking sometimes !!). I’m a very calm person so it’s highly unusual for me. Do you think that it could be a paradoxical reaction ? The weird thing is that I didn’t have anxiety and trouble breathing for the first two weeks.
    I’ve been really anxious and having trouble breathing for the last week now and I’m wondering what I should do. I don’t wanna drop thiamine because I felt an almost immediate rise in energy.

    Thanks a lot for reading me.

    • That is called air hunger and it is often related to a riboflavin deficiency. One of the enzymes that uses thiamine also requires riboflavin and when you increase thiamine, more riboflavin is required to keep everything working. Consider also that as you bring thiamine levels back, other vitamins will be required as well. A good multi-vitamin is useful.

  5. I began with Benfotiamine 250mg and after 90 minutes I had to lie down while my body shook uncontrollably in waves. I felt like I was experiencing hypoglycaemia. 15g if dextrose over 45 minutes did not help but 30 minutes after 400mg of magnesium citrate the shaking stopped and I became warm, relaxed and exhausted.

    I continued with 250mg benfotiamine daily and later added 50mg TTFD and did not experience any further negative symptoms but also did not improve further.

    I am also using methylated b vitamin complex daily.

    I recently titrated up to 100mg riboflavin and this seems to have really woken my body up – finally my digestion is moving and I have an appetite again and my constant swelling and histamine issues are much improved.

    I am however still experiencing abdominal pain and I occasionally get periods of extreme nausea, dizziness, diarrhoea and fever (101-102f) which has happened previously when I’ve used other agents to get my guts moving such as prucalopride.

    I am about 2.5 weeks in now to benfotiamine and riboflavin.

    Restless legs got worse at first and now better.

    Acetylcholinesterase inhibitors also significantly improve my symptoms of brain fog pots dizzy weak muscles inflammation and food intolerances etc. I know thiamine is a required for Acetyl-CoA.

    Microbiome 16s testing shows overgrowth of Bacteroides Stercoris 38% relative abundance (mean <1% relative abundance. 98th percentile < 10% relative abundance.)

    Did bad microbiome cause bad digestion and my vitamin issues or did vitamin issues cause bad digestion cause bad microbiome?

    I am still very brain fogged, tired and with bloating pain and constipation, burning hands but there is much more digestive movement.

    Symptoms are very much gut related. Lactulose and any types of fibre (inulin,PHGG, FOS, GOS) make symptoms 10x worse an hour or two later. Keto helps after a few weeks, so did 6 weeks of physicians elements diet. SIBO positive initially, negative later. Rifaximin helped first time. Prokinetics such as prucalopride, 5HTP cause fever and diarrhoea and vomiting for a day or two.

    Feeing out of options other than tossing a coin with FMT.

  6. Hi. I’ve been a major consumer of sugar and junk food for over 20 years. For the past year and and a half or so I’ve been suffering from dizziness and sensory symptoms (feeling like I’m walking in a bouncy house all the time and sensing internal tremors in legs and spine), pressure headaches, neuropathy and IBS. Doctors have zero idea what’s wrong with me. I also suffer from acid reflux and had recently began using acid reflux medication when my main symptoms began. It turned out the drug I used Omeprazole is known to deplete thiamine and B12 in the brain. Do you believe I have thiamine deficiency? I quit sugar yesterday and I’ve already seen two symptoms virtually disappear over night, my internal tremors and the constant mucus discharge in my left eye.

  7. Whilst researching and looking for answers and cures for many years of ill health and a diagnosis of CFS I decided to try TTFD, 1 dose of 50mg and my symptoms were so much worse. Can I assume from this that I am deficient in B1? If so I’m willing to try again with low dose HCL. I have been treating myself with high doses of B12 for a few years, it brought some relief but I’m now suffering from dreadful vertigo. I take B complex, folate, potassium and magnesium. Could high dose B12 deplete B1?
    I have followed a low carb high fat and protein diet for a number of years

  8. Dear. Dr. Lonsdale,

    I have autoimmune pancreatitis type 1 and I can’t take magnesium. I tried all types of magnesium and they cause my stool to turn nearly white or clay colored and give me constipation and sticky stool. The same is true for transdermal magnesium oil. I assume that I am profoundly thiamine deficient: I suffer from GI motility problems (verified through ultrasound), indigestion, bloating, need to take enzymes with food, weakness, fatigue, edema, memory problems, POTS, heart palpitations, body temperature issues (suffer cold easily, hands and feet always cold). After an initial improvement with high dosages of thiamine (800 to 2,200 mg / day), I now crash badly after thiamine. I read one of your comments where a reader had exactly the same paradoxical reaction and you said it’s because lack of magnesium supplemenation. Yet, I can’t take magnesium. Should I then push through with the thiamine, but possibly reduce the dosage dramatically or how can I address this problem?

    • Dr. Lonsdale suggests pushing through with the thiamine, perhaps reducing the dose and gradually increasing back up.
      I would also consider a cal/mag 2:1. I have written a few articles on this site regarding calcium management in thiamine deficiency and in folks who have heart related symptoms, calcium relative to magnesium seems to be the issue. Often, when magnesium alone does not work, a cal/mag does.

      • Thank you so much for the quick answer, Dr. Marrs!

        I may have found a solution: I found a mineral water which has ca. 150mg of magnesium per liter (and around 140 mg/L of calcium. I also found another one with the 2:1 cal:mag ratio so I may experiment with it, too), which seems to allow me to take mini-dosages of thiamine at the same time of 10 to 20 mg without the negative magnesium side effects (knock on wood).

        Thank you again!

  9. Dear Dr. Lonsdale,

    I have autoimmune pancreatitis type 1 and I cannot take magnesium. Magnesium turns my stool nearly white or clay colored, gives me constipation, and my pancreas gets inflamed. I tried all kinds and even the transdermal magnesium “oil” – with the same effect. I do have clear signs of thiamine deficiency, like POTS, orthostatic intolerance, GI motility disorder (verified through ultrasound), indigestion, bloating, weakness, fatigue, pins and needles sensations in extremities, edema, memory problems (I was a sugar junkie the first 28 years of my life. The past 12 years I’ve been on the paleo and carnivore diet). I have greatly benefited from thiamine mononitrate and HCL in the first week, but I went too high and now when I take it, I crash badly. I read on another comment that you said this first getting better then worse with B1 is a sign of lack of magnesium supplementation. And that this leads to a metabolic crash. Unfortunately, as pointed out above, I cannot take magnesium. The only source I get is from food (I also don’t eat oxalate foods, so not to waste the magnesium in foods on oxalate excretion). My question: can I try to push through this crash by continuing to take thiamine without magnesium, or is this not a good idea?

  10. I know this is an old post, but wanted to add a bit of information I came across the other day. It is from the US National Library of Medicine/NIH website, in an article called “Challenges in the Diagnosis of Magnesium Status”.

    Here is the link–scroll down to figure 2.

    The graph shows that calcium, magnesium and iron in cabbage, lettuce, tomatoes and spinach dropped 80-90% between 1914 and 2018.

    I knew the soil was depleted, but I don’t think I would have guessed a drop of 90%!!

  11. Hey Doc! I am in desperate need of your input. Long story short, for years I’ve been experiencing slowly worsening dysphagia, which got really bad about a year ago. The doctors can’t find anything wrong, and my research revealed that could be from a thiamine deficiency? So my question is, have you ever seen that before, and can I expect that it could get better? I’m also suffering from multiple other physical and psychological symptoms, like fatigue, depression, etc. Your input is much appreciated!

    • The esophagus has an automatic peristaltic wave and yours has apparently been compromised, evidently without showing eosinophilic inflammation. Fatigue, depression etc indicate brain energy deficiency. Start taking about 10-25 mg of thiamine. If the symptoms get worse, persist. When symptoms begin to improve, start to escalate the dose and titrate it to the symptoms. Find the right dose and if the symptoms begin to recur, decrease the dose and add 125mg of magnesium taurate and a multivitamin

  12. Hi Dr. Lonsdale

    I have been reading the posts of your website about Thiamine Deficiency and they have been really useful. I started a gluten-free diet which was quite restrictive last year which seems to have lots of rice flour and maize in the processed products. I also had a lot of the gluten-free equivalent sweet products. This has resulted in symptoms such as loss of appetite (sometimes only having 1 meal a day as not hungry), Cloudy vision and sometimes find it hard to focus my eyes with some blurriness, tremor, nerve pain in my spine and upper back, muscle pains all over body, joints aching and clicking, numbness all over the body with loss of touch sensation on my skin and all hair, not feeling itching (can still feel pain, textures and hot/cold sensations), pins and needles in arms, body weakness, tiredness, fatigue, struggling with sleep, anxiety and irritability, always feeling cold, hair loss and flushing in my fingers. Following a blood test I discovered that I had a folate deficiency and after 2 weeks of supplementing (between 1-5mg) this has shot up to above reference range. I had also been taking a B12 supplement at the same time and this has made my B12 shoot up to above reference range in the 1,000s. I have had an MRI done and am awaiting the results. I have an EMG test booked as well.

    I started to take a multivitamin and some of these symptoms had started to subside including the numbness. I thought this may have been because of a B1 deficiency so I though I would supplement with additional B1 as I had read that folate deficiency as well as diet can cause B1 levels to decrease and abnormally high folate and B12 Levels could mean that B1 is not being utilised. I had 1 100mg tablet and almost after 1 hour all the symptoms came back instantly and I regressed back. Is this me hitting paradox as the symptoms are back to how they were before all the additional supplementation? How long does this normally last and is there anything I can do to get through it quicker? I am taking B1 Thiamine Mononitrate, a Multi-vitamin and B-Complex – I am convinced that other B vitamins are needed. Is it worth blood testing? It seems strange that as the symptoms appeared to be improving, taking 1 B1 tablet would knock progress back. Any thoughts would be appreciated. Thanks

    • You are experiencing paradox (refeeding syndrome). Take a low dose of thiamine and persist until the symptoms begin to improve. Then begin to titrate the dose to find your “right dose”. If you then increase the dose, symptoms will begin to return. Reduce to the “right dose” and add B complex, magnesium taurate and a multivitamin

    • You are clearly suffering brain energy deficiency. Start reading the many posts on this forum because I find myself repeating and repeating

  13. Dear Dr Derrick,
    I have been on ttfd (100mg) and benfotiamine (300mg) for 10 days and every day my symptoms get worse – all day long severe brain fog (like my brain is a boiled potato), severe light sensitivity, Vertigo, weakness and dizziness. I stopped ttfd as it caused vomiting (I could not eat garlic since I am a kid and ttfd caused exactly the same feeling). The problem is that when I took ttfd my brain fog would get slightly better but now I Stopped ttfd and am in continuous fog on benfotiamine only (300-450mg daily)… I am 33 and I was vegetarian for 10 years, ate a lot of white rice, sweets and carbohydrates, have elevated lactic acid and sibo… do you think That benfotiamine does not work for me and I need to take Lipothiamine in this case or try hcl? And also should one add other Bs while on high dose of benfotiamine (300-450mg per day)? Thank you so much!!!

    • Tatiana, that is a high dose to begin with. Some folks with longstanding issues have to begin with a lower dose and titrate up more gradually over time. You might consider also a thiamine HCL to begin with before switching to a TTFD or benfotiamine. It is tricky to find the correct dose and formulation for longstanding issues. Additionally, the diet has to change. Continuing on a vegetarian, high carb diet will not allow you to heal. Protein/meat is required.

  14. I believe that the accumulated evidence is that disease comes from either a general or local energy deficiency. Therefore, if I had MD I would give TTFD a trial. You can do no harm, thus obeying the Hippocratic Oath

  15. I went through alcohol withdrawal and had ciprofloxacin at the same time, I have gaba issues and suffer from dizziness and anxiety , I have started lipothiamine and benfothiamine , I am 27 years old I was wondering if my issues can be resolved ?

    • You don’t say whether you are experiencing paradox (refeeding syndrome). By taking lipo and benfo-thiamine it is virtually certain that your dizziness and anxiety will resolve, but expect them to get worse before they improve. The length of paradox is unpredictable but can last a month or so.

  16. Dear Dr. Lonsdale.

    Please can you help guide me through my severe paradox. I am the lady who had the spinal surgery and on colossal doses of minerals which maybe exacerbating everything.

    My blood pressure spikes are worrying, up to 180/110 but they do settle. My mood is very dark with awful insomnia and suicidal thoughts. I’m trying to navigate my minerals but it’s proving very difficult. I cannot tolerate the allithiamine at this stage, I’ve been battling and getting worse over 7 weeks so I’m looking at ? Hcl next week? I bought empty capsules to split use allithiamine but even then it’s too potent.
    My husband is very concerned about me as my mental health is in serious decline. I think this has been a lifelong issue as I’ve been a heavy drinker/carb binger with “dark” episodes throughout my life
    Have you any advice at all or words of reassurance particularly on weaning my minerals?

    On a positive note I no longer have a T wave inversion and my bloods are all normal.

    Thank you. We are blessed to have you and Chandler Marrs to help guide us

    Kind regards


    • Please explore the posts on this website. They answer all your questions. I have no idea how much damage you did with alcohol and sugar. Do you really think that you can reverse it by just taking a few pills?

    • After 4 1/2 years after using 600mg thiamine hcl daily (which made horrific symptoms of metronidazole caused thiamine deficiency disappear) our daughter decided to try taking only 400mg. She did this about five months and then two weeks ago suffered a relapse with ataxia and horrible anxiety. We have moved her up in dose every three days by 100mg hcl and at 600mg there was no relief. We upped to 700 and then if no change after 3 days, went up again. She is at 900mg hcl and is sleeping through the night but still some jerking and stuttering and of course fear of never getting better. We are thinking of switching over to lipothiamine (starting with 50mg we assume and supplementing with hcl if needed). Is this a good idea?

      • Just wondering how your daughter is 2 months later, perhaps not much change in such a short time.
        I have been reading all of the comments on this page, I see that Dr Lonsdale’s typical response is
        “Take a low dose of thiamine and persist until the symptoms begin to improve. Then begin to titrate the dose to find your “right dose”. If you then increase the dose, symptoms will begin to return. Reduce to the “right dose” and add B complex, magnesium taurate and a multivitamin.”
        So, I am pointing out, go slow, let symptoms be the guide, don’t forget the cofactors.

  17. Dear Mr. Londsale,

    As a metronidazole sufferer, I decided to use a B-complex with B1 250mg/B6 250mg/B12 1mg 1,5 months ago, after reading related articles on your website. I stopped it after two tablets due to paradoxical reaction, because I have to work and this paradox incapacitates me a lot. Later, I have tried lower doses by breaking tablets but they too caused some discomfort. Last time I have used it is two weeks ago. Now, I wait for a planned near future on which I will have two weeks of isolated time and being incapacitated won’t matter. On the other hand, I have recently withdraw from my antidepressants (to resolve the depression from its roots: Gut Microbiota – Probiotics, and it works!) and I have some discontinuation symptoms, mostly physically. Experiencing both them may be more challenging.

    My question is: Even by trying a single dose, I noticed some improvement, especially menthally, but could’t continue due to the paradox. For example, my depression, anxiety and insomnia get resolved (I was using Mirtazapine for insomnia and learned my relief by chance). But I still have a fatigue and headache like pressure, like an antidepressant withdrawal. So, Did my paradox triggered and is it still there, or it is experienced only by taking each tablet? Should I just continue to use B-complex and magnesium, or I should wait for my planned near future? Thank you in advance.

  18. Hi Dr Lonsdale, Thank you for your book, I am just reading it now. The short section on menstruation is the first description I’ve ever come across of exactly what I go through every month – due to “inefficient oxidative metabolism in hypothalamic control.” I grew up eating so much sugar and junk food for nearly 20 years. The sugar consumption during childhood was so extreme I used to wonder how I didn’t end up with dwarfism, to be honest! I always honestly wondered how I even grew, and it is not until coming across this phenomenon of B1 deficiency and the myriad of symptoms it brings, that I realise what the true cost of all that sugar consumption has really been. I have started thiamine hydrochloride and had immediate paradoxical reaction which I was quite overjoyed about, after reading your information about paradox and the associated prospects of recovery. However there is one thing I still don’t understand, I am wondering if you can clarify? During the first 4-5 weeks of unpredictable worsening, is the idea to find a dose of B1 you can remain somewhat “stable” on during this period? Or is it important to try and increase the dose to a certain level? In your book I read about a lady who gave her child extra doses of B1 when his symptoms returned. In the mornings now I wake up with mild racing heart, but I am still in the first 4-5 weeks of the low dose B1 therapy. I have tried to increase it a few times but end up with insomnia or heart palpitations at night etc (long term symptoms prior to B1). I am currently only on 100mg thiamine hydrochloride. I am about to order the Allithiamine powder directly from Ecological Formulas as it’s much more economical (5000 servings per bottle) and also I’m allergic to the pork in their gelatin capsules. I am a carer for someone with tardive dystonia and tardive akathesia (pharmaceutical drug-induced parkinsonism), and it certainly seems that B1 deficiency is a huge part of this picture for him also. These questions apply to him as well, in case you have the time to address them. I would love to pay you for a consultation but I guess you are retired and don’t take patients now I assume. Thank you.

    • The problem with paradox is that its length is unpredictable. With a lifetime of illness there may be at least some irretrievable damage, but I would expect prolonged paradox. The other aspect is the genetic potentiality involving absorption. Allithiamine will help that and don’t forget the magnesium.

  19. Dr. Lonsdale, if I am feeling a paradox from thiamine hydrochloride does that mean it will eventually help me? Or does that kind never work for a longstanding deficiency? I am 50 and realized I have had a decades long issue with thiamine. I’ve always loved sweets. I was diagnosed with MVP in my 20’s and have had numerous health issues that doctors felt were in my head. Panic attacks, numbness in feet and legs, dizziness, vertigo, shortness of breath, blue toes on and on. I started thiamine hydrochloride and feel even worse so I was wondering if that meant it would help. Thank you for your work.

    • You have classic beriberi and if you are having a paradoxical reaction from thiamine hydrochloride, it is predictable that it will finally give place to improvement. The length of the paradox is unpredictable but it can last as long as 4 or 5 weeks. The problem is that your undoing is your statement “I’ve always loved sweets”, because that is the cause of your beriberi. This is happening to millions of Americans because so many of them love sweets. It doesn’t matter what kind of thiamine derivative you are using. They all do the same, deliver the vitamin to the cells that need it.

      • Thank you for your reply, I will continue with the thiamine hydrochloride and supporting nutrients. Your work is making such a difference in peoples lives. I have suffered a long time, for decades. Thank you!

  20. After five years of unexplained illness — weeks-long “episodes” of heart palpitations, dizziness, lightheadedness, unrelenting anxiety and panic attacks that could last for hours, numbness and tingling in my hands and feet, extreme chemical sensitivities, drug resistant high blood pressure, and worst of all, feelings of unreality like I’m on a “bad acid trip.” Numerous trips to the ER and doctor’s offices and many tests continued to show no abnormalities except for subclinical hyperthyroidism from a toxic thyroid nodule, which I have just recently got under control with medication. However, I did find these episodes always corresponded with attempts to go vegan or otherwise high carb diet, and assumed this meant I must have some kind of intestinal bacteria yeast or parasite that fed on carbs and made me crazy. Because of chemical sensitivity, I react negatively to just about every supplement and herb, so I have never been able withstand vitamins after many many attempts, (B-vitamins especially), let alone herbal treatments for intestinal bugs. But at least carb restriction would greatly improve the situation. The one carb I have allowed myself daily is unfortified white rice because I had read it was a “safe starch.” (I avoided fortification because I have high ferritin and didn’t want the iron). Three months ago these episodes became permanent and no amount of carb restriction helped, and now the mental symptoms are so severe I stopped being able to work. By looking up symptoms, I stumbled on your Thiamine Deficiency book and read it and was stunned to see myself described exactly, stunned at how thiamine relates to carb metabolism. I believe it likely I have a pretty severe long-term deficiency by now. I have learned that too much thyroid hormone can induce deficiency, as does all that unfortified white rice apparently, and I am sure my fairly frequent alcohol consumption, no matter how moderate, hasn’t helped. (I believed it helped calm my racy hyperthryoid nervous system and my doctor said it was fine) For the past week I have been attempting to take different versions of thiamine and magnesium (including Lipothiamine cut in quarters), but even these small amounts intensify all my symptoms to where I feel I am literally losing my mind along with all feeling in my fingers. I read Dr. Lonsdale’s comment here about vitamin paradox about how it is important to go low and slow and building up a dose gradually. But I also read how severe thiamine deficiency is dangerous to the brain and can cause irreversible damage from Wernicke’s encephalopthy or even death if one doesn’t get large doses of thiamine as soon as possible. So I have no idea whether I should be pursuing B-1 injections, or if such a large dose would be disastrous to me if only 10 mg of oral thiamine makes me feel so much worse. Is it too late for me? I feel stuck between such a rock and hard place that I am in terrible despair, and would appreciate any advice about what people in my situation can or should do.

    • Of course, it would always be better to prove thiamine deficiency but your symptoms are so typical. If you read history you will find that white rice, ingested primarily in Eastern cultures, was the major cause of beriberi and it took months of high dose thiamine for successful treatment. I have little doubt that they experienced paradox in many cases. Yes, you are getting severe paradox and your only recourse is to continue until the paradox completes its course. There is no gain without pain. This may last as long as a month or more. It is virtually certain that you have a genetically determined absence of a thiamine transporter or other genetic abnormality. Your best course of action would be to have repeated intravenous injections of water-soluble vitamins with high doses of B complex in the solution. You certainly need to keep up the Lipothiamine that is causing the paradox. I have seen many situations where thiamine hydrochloride did not correct the clinical or laboratory situation but Lipothiamine did.

      • Thank you for your thoughts, I am grateful. I will absolutely look for a doctor in my area that offers such vitamin IVs, and continue with the oral thiamine, although a little lower and slower! I have also wondered about some genetic abnormality that created some deficiency, as my mother committed suicide after years of mental illness and an inability to walk from unexplained pain, her siblings are both housebound with various neurological ailments, and all three of my adult children are on antidepressants. Wouldn’t it be something if I could help my children with the right vitamin bottle….

        • Lipothiamine (LPT)
          I think that it should be understood that LPT is really being used as a drug. It is obviously not simple vitamin replacement, even though the active principle delivered to cells is indeed thiamine. Let me try to explain. LPT is thiamine with an attachment called a prosthetic group. When it reaches a cell, the prosthetic group is broken off and without going into the biochemical details, it enables the thiamine, from which it has been detached, to pass into the cell without the necessary transporter required for dietary thiamine. This process has been well studied.The subsequent metabolism of the prosthetic group has also been well studied. It is therefore a means by which a large concentration of the vitamin can be built up in the cell. This is NOT an acceptable concept in modern orthodox medicine and is one cause of rejection. The present general belief is that a vitamin deficiency can only be replaced in the tiny amounts normally required for a healthy person taking a healthy diet and with NO genetic risk factors. To administer pharmacological doses for prolonged deficiency to a sick person with so-called “psychosomatic” symptoms is regarded as a waste of effort. The history of finding the cause of beriberi tells us that huge doses of the vitamin were required for months in order to achieve remission. Indeed, the blood sugar was found to be high in some cases and low in others and made a significant difference to whether the patient responded to thiamine or not.The death rate from this disease was known to be very low but the morbidity (chronic suffering) was known to be prolonged. The action of thiamine is to assist the function of enzymes to which it is bound (cofactor). Although it certainly requires much more research because of its valuable actions, I believe that the enzyme, without its cofactor, gradually deteriorates. The ensuing symptoms,sometimes lasting for years because of lack of recognition by physicians, are usually classified as psychosomatic. Unfortunately many such patients are referred to as “problem patients” by their physicians. When thiamine is at last recognized as being the missing factor, it has to be used in large doses to stimulate the activity of the enzyme that has been missing its assistance. Although this does not explain paradox, it does explain the prolonged need for the administration of LPT

          • I just have to update that after a rough slow start, thiamine supplementation has finally “kicked in” for me, and now I am up to 50 mg a day of allithiamine and some benfotiame as well (for some reason lipothiamine is still hard for me, maybe I have a problem with the alpha lipoic acid in it I don’t know.)
            But I am feeling more like my normal self every day, sometimes huge improvements one day to the next. I am getting my mind back, almost like a radio station tuning in more and more often, and more energy, and I am so thrilled. I feel like my life has been saved because I had no longer wanted to live in such a state. Thank you so much Dr. Lonsdale, you have done me and so many people a great service by bringing attention to this problem! A thousand thank yous.

  21. Dr. Lonsdale,

    Have just concluded my first full week of the thiamine + magnesium/ potassium/ aspartate supplements. Having read that a ‘healing crisis’ should only last a few days, I’m concerned that every day my areas of concern (feet/legs) are MUCH worse. Not having ingested any thiamine whatsoever for years, would it be logical to assume this ‘paradox’ would last for a longer period of time? Thank you for sharing your knowledge, and blessings to you for a happy and healthy New Year!

  22. Being on high dose B12 supplementation for the last two weeks, I am indeed experiencing what you have coined as ‘the paradox’. I am very interested on your thoughts as to what you believe causes this to occur. Thank you for your time.

    • This is a complex answer. Of course, I do not know why paradox occurs. However, beriberi is the disease caused by vitamin B1 deficiency. We know from early studies of thiamin as the underlying cause that treatment could indeed result in paradox. For example, a beriberi patient with too little acid in the stomach would develop too much after treatment started, before becoming normal. The ancient Chinese knew that the symptoms helped by treatment with acupuncture could get worse again if the acupuncture continued for too long a period on a given day of treatment. They recognized that the word pictures of Yin and Yang represented two extremes and that the objective in all things, moderation was always the ultimate answer.

      • I’ve pondered your inciteful response for the last hour, and am heeding a key word you wrote…moderation. Having read a protocol on-line to take megadoses of methylB12 to heal the body, I’ve been taking many times the RDA listed dosage to heal faster, thinking I was just experiencing the ‘paradox’. I think that occurance is inevitable when starting the methylation process after it’s been dormant for many years, but 90,000 units per day is probably way too excessive (understatement), and I’m probably feeling sicker than I need to be. I can’t begin to imagine how ‘off’ my yin and yang are due to this extreme daily sublingual dosage. Moderation… thank you.

        • How did you arrive at the conclusion that you “required” methyl B12 when you read someone’s “protocol”? It makes no sense.

          • Suffering from unexplained foot numbness, my journey for an explanation eventually took me to a naturopathic doctor. In doing bloodwork, he said my B12 levels were unacceptably low – that the AMA criteria was faulty and the parameters should be lowered immediately. Consequently, he started me on ‘methyl’ B12 supplementation (as opposed to the other types available), saying that it is the only one that readily crosses the blood/brain barrier, and is the only one that could address my numbness issue. He prompted me to do further research to educate myself about the vitamin, which is what led me to the need to take higher doses to regain the feeling in my feet. Being that he had previously assured me that any excess B12 I ingested wasn’t detrimental to my body, that anything extra would simply be excreted through my urine, I had zero concerns until I read your article about the need for ‘moderation’. Sorry, I neglected to mention that he has had me on very high doses as well, each sublingual pill being 16,667%DV (looking at the bottle) and I was instructed to take 5 of those pills throughout the day. So beginning this new ‘protocol’ (as he has referred to them) didn’t seem remotely abnormal or out of the ordinary to me. I hope I’ve answered your question properly. Thank you for your time, Dr. Lonsdale.

            • Foot numbness is much more likely to be an energy deficit and I would expect it to respond to big doses of thiamin. You can try ordinary thiamin that you can get from the health food store and I would suggest 100 to 200 mg a day, together with 300 mg of a magnesium salt

              • Thiamin…how wonderful! Tablets I presume? I want to make sure I follow your recommendations precisely. And when you say ‘together’ with magnesium salt, am I looking for a supplement that contains both the MS and the thiamin? And lastly, do you suggest I consume these supplements on an empty stomach or with food? Thank you SO much for taking the time with me. Your knowledge/expertise on this matter has been phenomenal!

                • To say I’m in stunned disbelief would be an understatement. Out of curiosity I looked up ‘thiamine deficiency’ on the internet…and I have EVERY one of the listed symptoms, leg muscle weakness, lower leg swelling – right down to something I was never able to accurately describe…it feels like I’m wearing a sock when I’m not! I am flabbergasted that no physician ever considered this as a possibility before. Looking at which foods contain thiamine, I will sadly admit that I eat none of them. Dr. Lonsdale, from the bottom of my heart, THANK YOU!!! I will begin to take the supplements this evening – with sincere hopes that it’s not too late to address these issues. Thank you, again!!!

                  • Thank you, again. As I’m prohibited from taking folic acid (homozygous MTHFR 1298c), I am able to take everything except the multi-vitamin which generally contains this. And I’ll have to special order the magnesium compound as that is not an item (so I’m told) traditionally stocked.

                    I am so looking forward to getting back with you in the future with a positive update. Happy Holidays!!!

                    • Incidentally, have you authored a book on this subject? I’d rather refer to an expert on this subject, than arbitrary writings on the Internet.

                    • Sincerest apologies for my incredible ignorance. I had no idea that I’ve been speaking with a world renowned physician this entire time. I am beyond honored that you took the time to address my concerns, providing information that none of my other MANY doctors have been intuitive enough to discern might be the issue for my years of numb extremities. With deepest respect, Dr. Lonsdale – thank you!

  23. Dear Dr. Lonsdale!

    I’ve been eating a paleo diet the last 2 years and also experienced a lot of stress and was mentally as well as physically very active. I was probably undereating and found out the there weren’t hardly any sources of b1 in my diet. I’ve been experiencing a lot of symptoms which could be related to thiamine deficiency (although some of these symptoms I already had before this time). I was already checked by a neurologist, they also did an MRI, checked B1 in whole blood and didn’t find anything.
    They said to me that I don’t have to worry about it being Wernicke’s Encephalopathy, so I really hope that’s true (therefore I didn’t get Thiamin i.v.)!
    Nevertheless I am really concerned and not really sure what I should do about it, do you have any suggestions? I don’t think that I can get thiamine i.v. in my place and because I live in Europe I also can’t find allithiamine.
    Do you think it would be okay to take high dose benfotiamine or Thiamin HCL to reverse my symptoms? Because I think with high dose oral Thiamine HCL one could also achieve pretty high plasma levels (, (
    Would this be sufficient to penetrate the blood brain barrier enough if at all?
    My symptoms are pain in the calves, slight gait unsteadiness and problems with balance with closed eyes, brain fog, slow thinking, slight drowsiness, poor emotion control, poor concentration, fatigue etc…
    Do you think if it’s due to b1 deficiency that my symptoms are reversible?
    Would really appreciate a response and thank you a lot in advance!

    with best regards


  24. Dr. Lonsdale,
    Any suggestions for supplementation for mitochondrial damage or neuropathy caused by fluoroquinolones. Example b1, b6, b12 or coq10.

    • All of them. All non caloric nutrients work as a collective team. Suggest Fursultiamine + magnesium + multivitamin

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