PRYING OPEN ANOTHER BLACK BOX
“Betel (areca) nuts change thiamine chemically so it doesn’t work as well. Regular, long-term chewing of betel nuts may contribute to thiamine deficiency.” In the musical called “South Pacific” there is woman named Mary who chews betel nuts which turn her mouth bright red, so her nickname is “Bloody Mary.” I do not chew betel nuts but I occasionally sing the song (badly).
https://www.youtube.com/watch?v=k67Yh0Nmr-o
(NOT Lady Gaga.)
Chasing thiamine information is bloody hard. First of all, when most docs went to med school they were taught about beriberi as rare and exceptional, a disease of drunks, and then told that only the lowest levels of thiamine are needed and they are usual in the “American diet” which presumably was then not from Macdonalds or 7–11. But also things like bread were supposed to have supplements added. For instance, Wonder bread. But the wrapper says there are no B vitamins, including B1. It’s unclear who checks to see that supplements happen.
- Foods with wholewheat are available, but it took my little local store weeks to order some wholewheat noodles. They don’t sell. Neither does brown rice.
- Caffeine and tannins in coffee and tea can cut down thiamine. Large amounts of vitamin C will work to protect thiamine.
- Raw freshwater fish and shellfish contain chemicals that destroy thiamine. Eating a lot of raw fish or shellfish can contribute to thiamine deficiency. (Note the popularity these days for sushi.)
- No mention that Metformin curtails thiamine though many use Metformin now because of the prevalence of Diabetes II. Metformin competes for the same transporter molecule.
- Cooking destroys thiamine.
- Birth control pills interfere with thiamine.
Many of the afflictions that thiamine is supposed to address are shadowy and don’t register on most measures except subjective feelings. This causes them to be largely waved away. Fibromyalgia, fatigue, GI probs are some of my issues.
Some people think thiamine helps menstrual cramps but it hasn’t been tested properly. Same with preventing cataracts and preventing kidney damage in people getting dialysis.
“A total of 20 articles were reviewed and summarized in detail. While more research is needed to fully elucidate the clinical thiamine deficiency in HF patients, recent evidence has indicated that supplementing with thiamine in HF patients has the potential to improve left ventricular ejection fraction.”
“Only about 20 days of thiamine are stored in the body, and thiamine deficiency can start to manifest in as little as three weeks.” (Others say thiamine begins to disappear in 24 hours. It must be constantly consumed.)
“The findings reveal a long overlooked link between vitamin B1 — also known as thiamine — and tumor-cell growth. The results suggest that too much thiamine may actually help tumors grow. They also suggest that rational use of dietary thiamine may help slow tumor growth.”
Alzheimer’s disease (AD) is the most common form of dementia in elderly individuals and is associated with progressive neurodegeneration of the human neocortex. Thiamine levels and the activity of thiamine-dependent enzymes are reduced in the brains and peripheral tissues of patients with AD.
In short, new research is much more detailed and proceeds on two levels: daily minimum for good health and mega-doses for special issues.
New research is able to get into the cells which is where the thiamine is active. Good testing has not been available nor wanted until recently.
Another angle of investigation comes from animal health, as dogs, cats and horses can have thiamine issues. It is not unusual that veterinarians often have a lot of insights to offer MD’s.
https://www.healthrising.org/blog/2021/04/15/thiamine-b-1-chronic-fatigue-syndrome-fibromyalgia/
Thiamine, also known as Vitamin B-1, is an essential nutrient that plays a critical role in aerobic cellular respiration. A thiamine derivative, thiamine pyrophosphate, is necessary for the citric acid cycle to function properly and produce an adequate amount of the ATP molecules that the body uses for energy. Thiamine deficiency is a serious health problem, but most people in the western world get all the thiamine they need through a healthy diet.
The recommended daily allowance of thiamine is 1.1–1.2 mg/day. By contrast, the 2013 study on fibromyalgia used 600 to 1,800 mg of thiamine daily, more than 500 times this amount. This is the first clue that the study may involve something other than simple supplementation to remedy a vitamin deficiency.
The fibromyalgia study was one of a series of case studies published by the Italian physician, Antonio Costantini, and colleagues in 2013–2018, finding reductions in fatigue from high-dose thiamine among individuals with a range or neurological and inflammatory conditions, including Inflammatory Bowel Disease (IBD), Multiple Sclerosis, Parkinson’s Disease, and chronic cluster headaches.
These studies were all fairly small, and none compared the results against a control group of individuals who did not receive the treatment. Without the rigor of a randomized controlled trial, it was impossible to know for sure if the benefits were due to thiamine, the placebo effect, or some other explanation.
With the publication in November 2020 of a randomized controlled trial of high-dose thiamine by Palle Bager and colleagues at the Aarhus University Hospital in Denmark, that criticism has largely been addressed.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/apt.16166
This randomized trial confirmed the results of one of the earlier Italian studies, finding significant reductions in self-reported fatigue from high-dose oral thiamine hydrochloride over a four-week period among patients with quiescent (i.e., non-active) IBD and long-term fatigue.
In this guest post for Health Rising, I describe the results of this new study, explore potential explanations for why high-dose thiamine might relieve fatigue, and describe why I think some people with ME/CFS, Fibromyalgia, and the neurological complications of Ehlers-Danlos Syndrome (EDS) might benefit from it.
HIGHLY TECHNICAL
Jeffrey Lubell speaking.
In a letter to Alimentary Pharmacology and Therapeutics, the medical journal that published Bager’s study (the authors’ reply is here), I offered a different hypothesis that builds on two other recent studies of high-dose thiamine.
In 2013, Özdemir and colleagues found that high-dose thiamine inhibited three carbonic anhydrase isoenzymes nearly as well as acetazolamide (Diamox). Inn 2021, Vatsalysa and colleagues found that high-dose thiamine tamps down the pro-inflammatory Th-17 pathway believed to play a role in the COVID-19 cytokine storm.
Building on these findings, I propose that the benefits of high-dose thiamine in relieving fatigue and generating other symptomatic improvement in patients with a diverse range of neurological and inflammatory conditions may be due to thiamine’s role as a carbonic anhydrase inhibitor.
I hypothesize that the benefits accrue through one or more of four potential pathways:
- by reducing intracranial hypertension and/or ventral brainstem compression;
- by increasing blood flow to the brain;
- by facilitating aerobic cellular respiration and lactate clearance through the Bohr effect; or by
- tamping down the pro-inflammatory Th-17 pathway, again through the Bohr effect, possibly mediated by reductions in hypoxia-inducible factor 1.
Jeffrey Lubell writes a blog on Medium.
Thiamine deficiency is indicated by alterations in dopamine metabolism” by “D D Mousseau 1 , V L Rao, R F Butterworth” saying:
“thiamine deficiency… …other regions also known to be involved in sensory processing and intellectual function (e.g., frontal cortex, hypothalamus, thalamus), but having a greater noradrenergic input, had increased levels of 3,4-dihydroxyphenylacetic acid (DOPAC) and decreased levels of other dopaminergic metabolites including noradrenaline.”
Have we got a winner here?
www.youtube.com/watch?v=-DxvSUEVT_4
Managing side effects. This is heavy duty .
