dementia thiamine

Dementia and Thiamine Deficiency

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In this post I will try to indicate how you might detect cognitive changes in a loved one and how you might help defer the onset of severe neurological disease. Every person developing dementia goes through mild cognitive impairment first. A given symptom might be short-term memory loss, difficulty in finding a particular word or forgetting well-known procedures. We expect such changes in people in their nineties, but if they develop in the fifties, you can suspect that this is the beginning of dementia that is a disease, not normal aging.

What Do We Know About Dementia?

A study published in 2017 reviewed the observational studies examining associations between non-genetic factors and dementia. A total of 76 unique associations were examined, of which seven presented convincing evidence. They found an association with use of benzodiazepines (common drugs for mental disease), depression at any age, late-life depression and infrequency of social contacts for all types of dementia. Late-life depression and type  2 diabetes were associated with onset of Alzheimer’s disease (AD). Emotional stress causes brain function that consumes energy.

A review assessed the effect of the drug metformin (used in the treatment of type 2 diabetes) on the risk, progression and severity of AD and other forms of dementia, as well as any measures of cognitive performance or impairment. A case of encephalopathy (brain disease) occurred in a patient receiving metformin who was in end-stage diabetic renal failure. The drug was withheld and signs and symptoms quickly resolved. The authors hypothesized that metformin induced thiamine deficiency (TD), based only on their use of brain imaging that has a characteristic pattern caused by TD. Although metformin has become a drug of choice for the treatment of type 2 diabetes, some patients may not receive it “owing to the risk of lactic acidosis (increased concentration of lactic acid in blood or urine)”, a significant finding in critically ill patients who often respond to thiamine administration . Diabetic patients taking metformin may be predisposed to thiamine deficiency that  is common in diabetes anyway . There is epidemiological evidence linking type 2 diabetes and its related conditions (obesity, insulin resistance, metabolic syndrome) to AD and it has recently been proposed that AD can be considered as “type 3 diabetes” because of disturbed glucose metabolism in that disease .

Mental Versus Physical Disease

It is probably absurd to separate the body from the brain. As has been said on this website many times, the body is composed of between 70 and 100 trillion cells, all of which have individual responsibility. I have used the analogy of a symphony orchestra where the brain is the conductor and the body organs are like banks of instruments that have to work together. The cells in each organ can be compared to the instrumentalists. They all know what to do but must work together “to play the symphony of health” under “the baton” of the “brain conductor”. Hence, for example, the immune system is an extremely complex union of mental and physical, requiring the brain, the nervous system and a variety of cells that carry out function. Assuming that the genetically determined genome”blueprint” is perfect (without mistakes in the DNA) all the cellular machinery requires is energy and that comes from an enormously complex list of nutrients.

Resulting from a great deal of personal experience and the genius of Hans Selye, I have concluded, like him, that energy metabolism is the focal point of health and disease. Selye developed the idea of what he called the “diseases of adaptation”. He coined the phrase the “General Adaptation Syndrome (GAS) in which he described the processes by which an animal adapts to physical and mental impositions of stressors. A stressor is any form of threat encountered  by us on a day-to-day basis. It may be mental (a divorce) or physical (infection, trauma). He concluded that energy was required to drive the GAS (the ability of the brain/body orchestra to face the stress and adapt to it). One of  Selye’s students was able to support this idea by producing the GAS in an experimentally induced thiamine deficient animal. The remarkable thing about this work was that in Selye’s time, little was known about energy metabolism. Today, the biochemistry is well outlined, if not complete, and thiamine stands out as a vitally important component. In continuing the analogy of the orchestra, I have nominated it as “the leader” (the chief violinist in an orchestra).

The Demands of an Active Brain

By far and away the best example of an energy defect in human disease is that of thiamine deficiency beriberi. Because energy deficiency is the underlying cause, it can imitate virtually any collection of symptoms that are regarded as those of a specific disease in the present medical model. Also, because it has many “psychological” symptoms, a long morbidity (continuation of symptoms) and a low mortality, it is dismissed as trivial. Since the brain and heart are the most energy consuming organs, it would be an obvious conclusion that a well endowed functional brain (genius) might be more at nutritional  risk than someone less well endowed. I turned to the medical histories of three historical characters, all of whom were acknowledged geniuses. Their health problems have been debated without any conclusions. It was their similarity that appeared to me to be so striking.

Charles Darwin

His medical history is discussed online. Apparently he suffered repeatedly throughout life, suggesting “genetic risk”. His symptoms included chest pain, heart palpitations, stomach upsets, headaches, malaise, vertigo, dizziness, muscle spasms, tremors, vomiting, cramps, bloating and fatigue, all described in beriberi. He was treated by a Dr. James Gully, whose therapy included “a strict diet” that was reported to give Darwin “improvement in his symptoms”. In September 1849 his symptoms increased, apparently “during the excitement of a British Association for the Advancement of Science”. Excitement is a brain perception whose function elevates the brain from a resting state and requires increased energy to adapt. Between the ages of 56 and 57 symptoms were reportedly continuous and the text described “copious and very pallid urine”. Cellular energy is dependent on an efficient consumption of oxygen (oxidation) and the yellow pigment that gives urine its characteristic color is known as urochrome, an oxidation product of hemoglobin. It suggests that the pallid urine may well have been an indicator of decreased oxidative function. Perhaps we can hypothesize that the exacerbation of symptoms related to virtually any form of stress may well have been from a combination of dietary deficiency and genetic risk.


The medical history of this genius is less clear online than that of Darwin. He suffered poor health throughout life, again suggesting genetic risk. Between 1789 and 1790, the symptoms described were weakness, headaches, fainting and hyperactivity and he reportedly had many falls. A left temporal fracture was described in his skull, examined after his death, suggesting a fall injury. Also, it was reported that “drinking was a well-known weakness of Mozart”. The association of alcohol with thiamine deficiency is well documented. It produces functional changes  in the automatic brain controls of the autonomic  nervous system  that might not necessarily result in loss of intellectual function, at least in the early stages.


His medical history is also less clear but apart from his well known deafness, the text reported repeated diarrhea, abdominal pain, migraine, rheumatism, nosebleeds and he died in delirium at the age of 56.

Of course, I am well aware of the multiple theories to explain the medical problems of these three geniuses. My point is that the workload exercises the brain and its function requires energy. It seems reasonable to suggest that the brain of a genius requires more energy than one less well endowed. Furthermore the passion that goes into the work often makes diet a secondary issue that is frequently neglected by such individuals. In the case of Mozart, the depletion of thiamine by alcohol would also have a deleterious effect on energy metabolism.

Neurodegenerative Disease and Thiamine

We know that thiamine metabolism is involved in the pathology of Alzheimer’s and Parkinson’s diseases. This has been shown in many papers published in the medical literature. An Italian doctor by the name of Costantini has published a number of manuscripts using high-dose thiamine in no less than seven different disease conditions, most of which are described as neurodegenerative diseases. Obviously, this is extremely offensive to the present medical model that believes each disease has a separate cause demanding specific treatment for each. If we look at the biochemistry of the human body, think of its complexity, its extraordinary dependence on a combination of genetic integrity, nutrition and lifestyle, it becomes easier to understand how a single molecule (thiamine) can be so vital. It stands at the gateway of the biochemical machinery that synthesizes energy in the form of ATP.

What is Energy?

Let us take a very simple analogy, that of rolling a stone up a hill. The point is that energy is consumed by overcoming the force of gravity trying to keep the stone at the bottom of the hill. We are imbuing it with what Newton called “potential energy”. When it gets to the top of the hill a simple push can cause it to roll down the hill and this would be referred to as “kinetic” energy. Although the principles in the human body are exactly the same, the mechanism is widely different. An electric force rolls electrons up an electronic gradient that converts ADP to ATP (the top of the electronic hill). ATP is a chemical that stores energy and is sometimes called “the energy currency”. Natural food contains all the ingredients that provide us with fuel. But it also contains vitamins and essential minerals that enable our cells to turn the calorie bearing part of the food into chemical energy. The chemical energy has to be transduced to electrical energy, so the body can be defined as an electrochemical “machine”.

Dr. Marrs and I have long been concerned that concentration on many artificial foods, particularly those concerned with sugar in all its different forms, results in manifestations of disease that are being constantly overlooked and misdiagnosed. We have hypothesized that the symptoms experienced in the early stages of this kind of malnutrition are multitudinous and do not fit into our categories of so-called organic disease. Often attributed to psychosomatic causes, and the prevailing inability to recognize its true underlying mechanisms, has led to frequent doctor shopping by people that have genuine disability. They go from specialist to specialist, all of whom have resolutely decided that vitamin deficiency in America is a thing of the past.

What can you do?

First of all, recognize that dietary mayhem, particularly in children, is common. This results in loss of cellular energy that has its main relevance in the energy consuming brain. Chronic fatigue is perhaps the commonest symptom, but heart palpitations, headache, cold and heat intolerance and other functional symptoms may occur. The peculiarity of behavior observed in someone is because of distorted brain function that can vary enormously in the way it is expressed. I would suggest that if a loved one in his fifties begins to show the signs of aging discussed above, the first thing to do is remove sugar from the diet. Books have been written directing us toward a healthy diet but our pleasure loving brains have become addicted to sweet taste since the earliest beginnings of life. Therefore, because nobody objects to taking pills for their health, appropriate supplements can restore the balance between calories and vitamins. The most under appreciated vitamin (thiamine) may actually be the most important of all of them. However, if we look at the history of the treatment of beriberi, it took huge doses of vitamin B1 (thiamine) for months to restore health. A dose of 100 mg of thiamine hydrochloride, together with a similar dose of magnesium and a multivitamin might be better than all the pharmaceuticals in creation. There is abundant evidence to suggest that neglect of these functional symptoms may gradually lead to biochemical changes that are irreversible and we then call it a neurodegenerative disease.

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Image credit: Gerd Altmann from Pixabay


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


  1. Dr. Lonsdale, if metformin can cause risk of lactic acidosis why it is being used by oncologic naturopathic doctors in cancer patients even when they are not diabetics. Isn’t that really bad choice for them? What are the other options?

  2. Hi Dr. Lonsdale,
    I’m Brittani currently 25 years old. I got exposed to mold a few years ago in college. The exposure was for 2 years in one building and another 2 years more severely in another. Before all of this I was an extremely smiley and optimistic person and an avid learner. Loved life, truly. My husband and I got pregnant during the exposure as well and the symptoms especially cognitive continued to decline after I had my daughter even after moving to a mold free home. After this prolonged exposure I developed CFS, severe stomach pains, my menstrual cycle stopped for several months, joint stiffness, depression, anxiety, insomnia, sleep apnea, 24/7 DPDR, poor word recall, short term memory problems (I could read you a sentence & not even remember the general concept of what I just read), severe apathy, I couldn’t hold a thought longer than a couple seconds (it would just completely fade from my mind), lost my inner dialogue, couldn’t envision things anymore my mind was literally just black, I could not dive into a thought anymore like I use to, it felt like I was on the verge of going to sleep and never waking up, I had severe paranoia, became highly reclusive, hyper sensitive to light, sound, and touch, poor coordination, it felt like my body and mind just weren’t connected, low libido, constant mild headache, bloating, occasionally muscle spasms, twitches, tremors, constantly muffled ears going on over 3 years, & air hunger. I went from being an extremely kind and caring person to not wanting to go out because I would have these unfiltered thoughts come to my mind that I know I would never actually think, and I was terrified one day I would say something by accident and hurt someone’s feelings. I had dizziness and heart palpitations upon standing, tinnitus, swollen lymph nodes, and skin issues. I went from being an active person and a good eater weighing 135 to having no appetite and dropping to 118 which was my weight in 8th grade. I know a lot of it is mold related but I also know mold as well as pregnancy and other factors depletes thiamin. I started treating the mold and have seen many improvements but the congitive problems with my memory (I have seen improvements), DPDR, apathy, dizziness, low libido, poor focus, fatigue (it has improved but still present), insomnia, and anxiety (though not as bad). It has just made life feel so meaningless. And my functional medicine dr seems to be out of answers, just says it’s probably neuroinflammation causing it (which it definitely might be the case but I refuse to believe is the only issue) I started ttfd about a month ago and was told to stop because it depletes glutithione and in my case I highly need to avoid. I don’t know I’m just reaching out to receive some incite if I’m on the right track and where to go from here. All of your work has been highly inspiring and encouraging and has given me hope that my life will begin again.

    • all your symptoms are due to energy deficiency. Read the many posts on HM to avoid repetition.

  3. Hello, Dr. Lonsdale,

    My brother has Dementia with Lewy Bodies and I have recommended he tell his neurologist to get him started on high dose thiamine (using TTFD). Can you give your thoughts on high dose thiamine for DLB? He also has OCD and has been on an SSRI most of his life. Will this be any problem if he begins thiamine since I read it reduces serotonin? I assume his doctors need to monitor this and his other meds as he improves. Any further advice is appreciated.

    Thank you for your wonderful work and your passion to educate patients and doctors.

    • I guess that you are familiar with the work of Costantini in Italy. He uses thiamine injections of 100 mg daily. TTFD is the best oral agent and is sold as Lipothiamine by Ecological Formulas

      • Yes, I am familiar with Costantini. Very inspiring.

        It is hard to find definitive information regarding the effect of thiamine on serotonin. Are you familiar with whether or not it lowers it? Have you used it on anyone taking medication for OCD?

        Thank you!

  4. Dr Lonsdale, let me first thank you for your dedication in bringing TD to the public attention. You may have saved my husband’s life.

    You mention Darwin’s “copious and very pallid urine”. Is this a symptom of TD? If so, in addition to correcting TD, are there other deficiencies of concern?

    Thank you,

  5. I’ve been using a nutrition analyzer to track my micronutient intake with and without supplementation. Even without eating any empty calories (my diet includes no sugars and few starches), I have noticed that I regularly fail to meet daily minimums of certain nutrients through diet alone (for me, these include B1, magnesium, copper, iron, and vitamin E). And the calculator assumes adequate digestion (in fact, I have low stomach acid and dysmotility and am suspected of having both pernicious anemia and celiac disease). Once you count GI conditions (which become more common with age), the orthodoxy that the “American diet” precludes deficiency becomes increasingly absurd.

  6. I like to blame capitalistic healthcare….two words that shouldn’t ever go together imo. The goal should be health not wealth when it comes to treating sick people. Endless prescriptions of mind altering crap that also raises your blood sugar and/or your bp, is about somebody else’s wealth and not our health.You would think the greatest capitalitalistic economy in the world could also have the best socialized healthcare system to back it up…. to keep production up, right ?! What we have now is problematic for most, but not those in charge I guess.

    Are you familiar with MTHFR genetic mutations doc?

    Why would salt stress the cells? Why not use sugar?

  7. Hello Dr Lonsdale. …What are your thoughts on this research they have been doing at Stanford on ME/CFS? Is thiamine deficiency the answer they are looking for? This Dr’s son has been bed ridden for years thanks to CFS. To me the causes for ME/CFS/Fibromyalgia could be many things, resulting in varied multi step approach to treatments. But are all the varied causes a result of the root problem of thiamine deficiency(thanks to eating sticky gunky sugar)? One example of cause : thiamine deficiency leads to heavy metal toxicity build up which leads to ME/CFS/Fibromyalgia ? How significant a role would certain genetic mutations( mainly mthfr) play in all of this gunk build up, then fibrosis, then disease progression? So would thiamine deficiency affect people different ly based on their genetic mutations?

    But to sum it all up …don’t eat sugar, if you have and are sick…stop and start taking thiamine along with some chelation therapy for your heavy metals or antibiotics(herbal:) for your lyme disease?

    As always thanks for sharing your knowledge with us


    • I have treated many people with CFS because I concluded years ago that it was caused by mitochondrial inefficiency. The leading supplement was always thiamin disulfide. It is interesting that the test stresses the cells with salt, but does not identify the underlying lack of energy as the primary cause. You always have to remember that failing to recognize the symptoms that are called “CFS” long enough probably leads to irreversible cellular damage. Then we diagnose another disease like Alzheimer or something, failing to recognize that we should not have labelled the unfortunate CFS patient as “psychosomatic” in the first place. I ask you—-whose fault is it that we have so much untreatable chronic disease?

  8. Excellent article. Wish I knew when my grandmother suffered from dementia.

    Hey anyways, you responded to one of my comments earlier on your previous article, and claimed the carnivorous diet at “incomplete.” Would you say including some form of carbohydrate would actually improve metabolic efficiency? Do carbohydrates have a diphasic effect where it’s more efficient up to a certain point that’s genetically and nutritionally determined? And what forms of carbohydrate do you reccomend?

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