It all comes down to energy

It All Comes Down to Energy

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The Threat Around Us

Animals, including Homo Sapiens, survive in an essentially toxic environment, surrounded by microorganisms, potential poisons, the risk of trauma, and adverse weather conditions. Evolutionary development has equipped us with complex machinery that provides defensive mechanisms when any one of these factors has to be faced. Before the discovery of microorganisms, medical treatment had no rhyme or reason, but killing the microorganisms became the methodology. The research concentrated on ways and means of “killing the enemy”, the bacteria, the virus, the cancer cell. The discovery of penicillin reinforced this approach. We are now facing a period of potential impotence because of bacterial resistance, failure of attempts to kill viruses, and the resistance to chemotherapeutic agents in cancer. Louis Pasteur is purported to have said on his deathbed, “I was wrong, it is the terrain that matters”, meaning body defenses.

Hans Selye, whose research into how animals defend themselves when attacked by any form of stress, led to his description of the General Adaptation Syndrome (GAS). He recognized the necessity of energy in initiating the GAS and its failure in an animal that succumbed to stress. He labeled human disease as “the diseases of adaptation”. In Selye’s time, there was little information about energy metabolism but today, its details are fairly well-known. The suggestion of a new approach depends on the fact that our defenses are metabolic in character and require an increase in energy production over and above that required for homeostasis. If the GAS applies to human physiology and that we are facing the “diseases of adaptation”, it is hypothesized that research should be applied to methods by which energy metabolism can be stimulated and mobilized to meet the stress.

Energy Deficiency, Defective Immunity, and COVID-19

There is evidence that energy deficiency applies to each of the diseases described here. It may be the unrecognized cause of defective immunity in Covid-19 disease. Although in coronavirus disease the clinical manifestations are mainly respiratory, major cardiac complications are being reported involving hypoxia, hypotension, enhanced inflammatory status, and arrhythmic events that are not uncommon. Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction, or demyelinating processes may accompany acute viral infections or may follow infection by weeks, months, or longer in viral recovered patients. Electrocardiographic changes have been reported in Covid-19 patients. The authors suggest that it may be attributed to hypoxia as one possibility. Because the total body stores of thiamine are low, acute metabolic stress can initiate deficiency. Thiamine deficiency has a clinical expression similar to that observed in hypoxic stress and the authors referred to it as pseudo-hypoxia. It is therefore not surprising that defective energy metabolism can express itself clinically in many different ways.

The present medical model regards each disease as having a separate cause, but the large variety of symptoms induced by thiamine deficiency suggest the ubiquitous nature of energy deficiency as a cause in common. Obesity, a reflection of high calorie malnutrition, has been published as a risk factor for patients admitted to intensive care with Covid-19. Thiamine deficiency was reported in 15.5-29% of obese patients seeking bariatric surgery. Hannah Ferenchick M.D. an emergency room physician commented online that many of her patients with Covid-19 had what she called “silent hypoxemia”. These patients had an arterial oxygen saturation of only 85% but “looked comfortable” and their chest x-rays “looked more like edema”  It has long been known that patients with beriberi had low arterial oxygen and a high venous oxygen saturation. All that would be needed to support the hypothesis of thiamine deficiency in some Covid victims would be finding a high venous oxygen saturation at the same time as a low arterial saturation. Also, edema is a very important sign of beriberi, and thiamine deficiency has been noted in critical illness.

Disrupted Autonomic Function

There have been many articles in medical journals describing dysautonomia, mysteriously in association with a named disease, but with no suggestion that the dysautonomia is part of that disease. More recently, there is increasing evidence that dysautonomia is a feature of chronic fatigue syndrome (CFS), manifested primarily as disordered regulation of cardiovascular responses to stress. Manipulating the autonomic nervous system (ANS) may be effective in the treatment of CFS. Dysautonomia is also a characteristic of thiamine deficiency. Patients with Parkinson’s disease begin to lose weight several years before diagnosis and a study was undertaken to investigate this association with the ANS. Costantini and associates have shown that high dose thiamine treatment improves the symptoms of Parkinson’s disease, although the plasma thiamine concentration was normal. They have also shown that high dose thiamine treatment decreases fatigue in inflammatory bowel disease, Hashimoto’s disease, after stroke, and multiple sclerosis. As already noted, it is also an important consideration in critically ill patients.

Multiple System Atrophy is a devastating and fatal neurodegenerative disorder. The clinical presentation is highly variable and autonomic failure is one of its most common problems. Dysautonomia was found to be a clinical entity in Ehlers-Danlos syndrome, a musculoskeletal disease, and this syndrome frequently coexists with Postural Orthostatic Tachycardia Syndrome (POTS), a disease that is included in the group of diseases under the heading of dysautonomia. Some cases of POTS have been reported to be thiamine deficient. This common condition often involves chronic unexplained symptoms such as inappropriate fast heart rate, chronic fatigue, dizziness, or unexplained “spells” in otherwise healthy young individuals. Many of these patients have gastrointestinal or bladder disorders, chronic headaches, fibromyalgia, and sleep disturbances. Anxiety and depression are relatively common. Not surprisingly the many symptoms are often unrecognized for what they represent and the patient may have a diagnosis of psychosomatic disease.

Immune-Mediated Inflammatory Diseases (IMIDs) is a descriptive term coined for a group of conditions that share common inflammatory pathways and for which there is no definite etiology. These diseases affect the elderly most severely with many of the patients having two or more IMIDs. They include type I diabetes, obesity, hypertension, chronic pulmonary disease, coronary heart disease, inflammatory bowel disease, rheumatoid arthritis, Sjogren’s syndrome, systemic lupus, psoriasis, psoriatic arthritis, and multiple sclerosis. The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain. These new findings support the disease as a primary neurological entity.

Energy Deficiency During Pregnancy: The Cause of Many Complications

Irwin emphasized the energy requirements of pregnancy in which the maternal diet and genetics have to be capable of producing energy for both mother and fetus. He found that preventive megadose thiamine, started in the third trimester, completely prevented all the common complications of pregnancy. Hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalization in pregnancy overall. This disease has been associated with Wernicke’s encephalopathy, well known to be due to brain thiamine deficiency. The traditional explanation is that vomiting is the cause, but since vomiting is a symptom of thiamine deficiency, it could just as easily be the cause rather than the effect. In spite of the fact that migraines are one of the major problems seen by primary care physicians, many patients do not obtain appropriate diagnoses or treatment. Migraine occurs in about 18% of women and is often aggravated by hormonal shifts. A complex neurological disorder involving multiple brain areas that regulate autonomic, affective, cognitive, and sensory functions, it occurs also in pregnancy. Features of the migraine attack that are indicative of altered autonomic function include nausea, vomiting, diarrhea, polyuria, eyelid edema, conjunctival injection, lacrimation, nasal congestion, and ptosis.

The Proteopathies: Disorders Involving Critical Enzymes

The earliest and perhaps best example of an interaction between nutrition and dementia is related to thiamine. Multiple similarities exist between classical thiamine deficiency and Alzheimer’s disease (AD), in that both are associated with cognitive deficits and reductions in brain glucose metabolism. Thiamine-dependent enzymes are critical components of glucose metabolism that are reduced in the brains of AD patients. Senile plaques and neurofibrillary tangles are the principal histopathological marks of AD and other proteopathies. The essential constituents of these lesions are structurally abnormal variants of normally generated proteins (enzymes). The crucial event in the development of transmissible spongiform encephalopathies is the conformational change of a host-encoded membrane protein into a disease associated, fibril forming isoform. A huge number of proteins that occur in the body have to be folded into a specific shape in order to become functional. When this folding process is inhibited, the respective protein is referred to as being mis-folded, nonfunctional, and causatively related to a disease process. These diseases are termed proteopathies and there are at least 50 different conditions in which the mechanism is importantly related to a mis-folded protein. Energy is required for this folding process. Because of their reported relationship with thiamine, it has been hypothesized that mis-folding might be related to its deficiency on an energy deficiency basis.

It All Comes Down to Energy

A hypothesis has been presented that the overlap of symptoms in different disease conditions represents cellular energy failure, particularly in the brain. If this should prove to be true, the present medical model would become outdated. An attack by bacteria, viruses or an oncogene might be referred to as “the enemy”. The defensive action, organized and controlled by the brain, may be thought of as “a declaration of war” and the illness that follows the evidence that “a war is being fought”. This concept is completely compatible with the research reported by Selye. It underlines his concept that human diseases are “the diseases of adaptation”, dependent on energy for a successful outcome in a “war” between an attacking agent and the complex defensive actions of the body. Killing the enemy is a valid approach to treatment if it can be done safely. Unfortunately, the side effects of most medications sometimes makes things worse and that is offensive to the Hippocratic Oath. We badly need to create an approach to research that explores ways and means of supporting and stimulating the normal mechanisms of defense.

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This article was published originally on May 11, 2020.

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. Hello Doctor,
    I am suffering from non-allergic rhinitis in which turned on at the beginning of my covid infection August 29th. I have never had sinus issues before and now have relentless post nasal drip and nostril clogging at night one side only at a time. Since I do not have my baseline b1 what is a safe dose to start at?

  2. Dr. Lonsdale, Thank you for your work! I feel I am finally on the right path to recovery regarding nervous tension, abnormal sweating, brain fog, fatigue, depression and anxiety. My question is that I know taking large amounts of thiamine is using it as a drug, so once my symptoms disappear, do I ever lower the dose or is this something I will be taking the rest of my life?

    currently taking 450 mg Benfotiamine
    192 mg elemental magnesium threonate
    plus b complex, vitamin d and a multimineral

    PS. things got so much better when I switched from magnesium citrate to threonate

  3. Hi Dr. Lonsdale, I have ADHD, depression, anxiety, gut issues and my 8yr old daughter is showing signs of ADHD as well. She’s becoming more oppositional, doesn’t eat much, doesn’t want anything healthy and has meltdowns if we let her get hungry at all. I started taking Allithiamine 3 days ago. Do you think it will help me with my symptoms? Do you think it could help my daughter? If so, would 50mg/day be too much to start her with?

  4. Hi Dr. Lonsdale.

    I have been having strange, somewhat mild(liveable) symptoms for probably a decade that come and go. I just discovered this website today, am starting to think I may finally be connecting the dots.

    My main symptoms/conditions are:
    Gout (treating with allopurinol)
    Allergies and Oral allergy Syndrome (birch family at least, possibly more)
    Chronic Sinusitis (Just finished a round of Doxycycline which depletes thiamin, and had a massive rebound infection)
    Very high triglycerides despite improved (70%+ whole food and vegan) diet
    Possible but undiagnosed gallbladder or pancreas problems
    Reduced immunity, frequent fevers and chills

    This seems like a ridiculous list to be connected, but I have made some progress today in connecting them all to a possible thiamin (energy?) deficiency. Possibly its due to damage from previous poor diet and alcohol/tobacco use (all clean now), genetics, or a combination.

    My question is about the best way to proceed from here. I already have a doctors appointment scheduled to discuss these issues. If I ask her for a thiamin deficiency test, would that be conclusive? In another comment, you mentioned TKA followed by TPPE. Would she know what that meant?

    Is it safe to start supplementing Lipothiamine without a diagnosis? Any other supplements?

    Thank you for everything you do here. This is a life’s work to be proud of. I will keep learning and reading. I will also grab a copy of the book.

    Thanks, Brandon

    • The diversity of symptoms is because they are ALL caused by cellular energy deficiency, particularly in brain. All you need is Lipothiamine until symptoms disappear. Then add magnesium and a multivitamin. Then titrate symptoms to the “ideal dose” of Lipothiamine.

      • Thank you Dr. Lonsdale!

        My Lipothiamine, and a copy of your book should both be arriving today. Hoping for a better future for myself! I forgot to mention that I also have unusually high triglycerides… over 500. Cholesterol slightly strange, but not out of range. Do you think this could be related as well?

        I also have a family… My wife had a AAA(Abdominal Aortic Aneurysm) in 2015, apparently due to some unclassified genetic abnormality in the ACTA2 gene. Long story short, she recovered with multiple surgeries, but also had infections and many rounds of different antibiotics. She also had gardasil as a kid. She’s still on antidepressants and thyroid medication.

        She has major fatigue, frequent headaches, migranes, and ongoing GI issues. We presumed the GI issues are due to adhesions, and a suspected partial obstruction, from the surgeries, but I think there is more at play, as she has had times o. improvement over the years.

        My reading here has led me to believe that in addition to her structural problems, she very likely has thiamine problems as well. Would you agree?

        Thanks, Brandon

      • Hello Dr. Lonsdale. I’ve never spoken to you before, but I really need your help and advice. I found out about you, Dr. Marrs, and Elliot Overton while I was online while reading about dysautonomia. I haven’t read your Dysautonomia & Thiamine book from 2017 yet, but I’ve been reading up as much as I can online about you and by by reading alot or articles on this website, watching a bunch of Elliot’s YouTube videos, reading posts and blogs on Reddit, and also by joining the “Understanding Mitchochondrial Nutrients” group on Facebook. I’ve been suffering with about 30+ symptoms ranging from 24/7 lightheadedness/dizziness, slight blurry vision, light sensitivity, noise sensitivity, severe depression, extreme panic and anxiety feelings (impending doom), constant adrenaline surges, body tremors where my hands always shake and my body vibrates with these buzzing sensations, heart palpitations, chronic constipation (since I was young), sensitive stomach and always bloated and gassy, temperature regulations issues with always being hot and sweating and then my feet and hands get cold, shortness of breath, SEVERE debilitating fatigue, terrible insomnia that even sleep medication can’t completely help, trouble swallowing sometimes, increased heart rate and palpitations whenever I eat or swallow something (even water), brain fog, short and long term memory issues, sugar cravings, joint pain and stiffness, body pain, body weakness, numbness in extremities, feel like I have the flu all the time, urinary incontinence (for several minutes each and everytime after I urinate), plus some other symptoms that I can’t remember at the moment. I am a 35 y/o male and I have literally seen and been tested by over 20+ doctors since 2014. I have seen almost every specialist there is and have pretty much ruled out almost all medical conditions that could be causing my symptoms. But this is what I have been diagnosed with and what I DO have:

        1) Ezcema (Since my teenage years)

        2) Dry Eyes (Since my teenage years or early 20’s)

        3) Hemochromatosis (carrier) -diagnosed in 2020

        4) MTHFR gene mutation (found this out in 2015)

        5) GERD (within past 2 years or so)

        6) small Hiatal Hernia (found within past 3 months after having an Upper Endoscopy w/ biopsy)

        7) Small Fiber Neuropathy (did a nerve biopsy in 2021)

        8) Autoimmune-related arthritis (seems to be possibly Psoriatic or Rheumatoid, but my Rheumatologist is not 100% sure yet of which type). (I was diagnosed one year ago after my bloodwork and MRI’s of my hand and foot.

        8) Dysautonomia (unknown which type exactly, but in June 2021 I did a bunch of autonomic testing with my FOURTH Neurologist and it confirmed this.

        9) POTS – I have all the symptoms of POTS, but two Tilt Table tests were done and unfortunately my heart rate didn’t go high enough to qualify me for a POTS diagnosis, but the symptoms are still “identical” with my dysautonomia and I still believe I have it. And my current Neurologist even thinks I have it still too.

        10) Bipolar (Type 2) (diagnosed in 2019)

        11) Severe Depression (since 14 y/o)

        12) Severe Anxiety & Panic Attacks (since 14 y/o)

        13) PTSD (for awhile)

        14) Low Vitamin D (all the time). For some reason when I would take this in the past I would get increased anxiety, irritability, and heart palpitations while taking 2,000 IU (once a day). I don’t know why and I never used to take other vitamins besides my Vitamin D, but this always happened. I have a new bottle with 5,000 IU and I’m assuming because I wasn’t taking magnesium with it, this is why I was getting this reaction? Or it was maybe the fillers inside the product? That’s all I can think of. My new vitamin D doesn’t have any fillers in it.

        *******Two days from now it will be exactly one month since I started thiamine (THIAMAX) supplementation and this is my current dosage of Thiamax and all the other supplements that I started as well (along with the dates I started taking them).

        1) THIAMAX (Thiamine TTFD) – 400 mg – once a day) – started on April 19, 2022

        2) MAGNESIUM complex (this supplement contains Glycinate, Taurate, Orotate, & Malate) (300 mg – twice a day) – started on April 27, 2022

        *****I just bought Magnesium Taurate and started it yesterday actually and took 400 MG (twice a day). Total of 800 mg for the day). I’m gonna stop the other magnesium supplement and just take the Taurate one.

        3) POTASSIUM CHLORIDE (297 mg – twice a day) – started May 2, 2022

        When I first started taking the Potassium I started to feel crappy with mild stomach aches/discomfort, back pain and body pains and joint pains, and now I’m getting short of breath and it feels like my breathing is constricted and that makes me kind of nervous. The SOB is worse when I’m lying down or sitting down and it feels like I’m not getting enough air. Everything was going ok so far until I started the potassium, but MAYBE it’s the magnesium doing this instead? I already am short of breath all the time from my dysautonomia, but this feels different. And even when I started the magnesium (before starting the Potassium) I was getting more heart palpitations than I already do and my body vibrations and tremors (which I also already experience everyday) have become worse and I thought magnesium is supposed to stop these anyways? Im so confused about that.
        *******UPDATE: this has calmed down a bunch, so I’m assuming it was my body’s reaction to taking magnesium and potassium?? It seems like each time I increase one supplement it depletes another one.

        -should I be taking a supplement containing ONLY magnesium Taurate (this is what you suggest, Dr. Lonsdale). And if I’m deficient in magnesium, how much do you suggest I take each day? Because as of today I’m currently taking 800 MG total for the day and I still don’t feel any better and my palpitations haven’t gone away and my anxiety has actually increased.

        – how do I stop this breathing issue? Is an imbalance of potassium, magnesium, sodium or calcium causing this? How do I fix it?

        3) CALCIUM CITRATE 250 mg) – twice a day – started May 15, 2022

        4) TRACE MINERALS supplement – I have it, but haven’t started it yet. It doesn’t contain Iron or Magnesium or phosphorus, but it contains almost every other important mineral. I bought it like that for a reason because I heard IRON is not good to take and I only want magnesium from one supplement instead of 2 and I only want Taurate because u recommend that version. Do I take a trace mineral supplement only once a day?

        4) Vitamin E – 180 mg (how many times a day?). I bought it, but haven’t started it yet.

        5) Vitamin C (timed- release version) – 1,000 mg (once a day?) I haven’t started it yet.

        6) THIAVITE (B vitamin Complex) – Elliot Overton’s product. (I take one pill a day, but do I need a higher dosages of the B vitamins then I’m currently getting?). (Started on May 6, 2022)

        ******between the THIAMAX and the B-complex I feel pretty revved up and more anxious and jittery. I only tried taking B vitamins once before and my body couldn’t handle them. I finally realized (after reading online) that it seems that my body CANNOT tolerate “Methylated” vitamins. I think that’s what it is. I took a supplement with methylated B vitamins over a month ago and boy did I feel pretty sick and full of extreme panic. I took them for 6 days and I thought it was the paradoxical reaction, but then I read online that it was probably this reason and I’m under the assumption that my body would never adjust to these versions of the vitamins, so I bought non-methylated vitamins with no other fillers. So that’s what made me buy Elliot’s THIAVITE B-complex.

        7) VITAMIN A, D, and K (it’s a 3 in one supplement)

        *****I bought it, but haven’t started it yet. Vitamin D (5,000 IU), Vitamin A (900 mcg), and Vitamin K1(1,000 mcg) and K2 (1,800 mcg).

        *******I definitely need a mineral/trace mineral supplement? If so, must it contain EVERY mineral? Even Iron? How important is this because online I’ve never really seen you (Dr. Lonsdale) tell patients they need to take this. But then again I don’t have your book and have only read very small parts of chapters from your 2017 book online.

        *******As I’ve already said I started the B Complex about 11 days ago and I started it about 17 days after I started the Thiamax because I didn’t want to start everything at once and then not know which supplement is causing which side effects. I’m usually very sensitive to most supplements and pharmaceutical medications and I’m shocked that I’m not really experiencing too much of a paradox (if that’s what this is because it’s hard to tell). Maybe I’m not deficient in thiamine or B vitamins? Although I have had a very poor diet and consumed a lot of sugar and fast food for several years. I’m not an alcoholic though, so that’s not an issue and I barely drink alcohol. I don’t use recreational drugs. But once again I feel kinda crappy again after taking B vitamins, but DEFINITELY NOT as terrible as the multivitamin I tried over one month ago including the methylated B vitamins. That made me think that I was experimenting a paradoxical reaction. But anyways since starting everything else my skin has been flushed and I feel more hot, I’ve had an increase in anxiety and panic, an Increase in depression, and the joint pain and body pain that got a lot better with my arthritis medication I’ve been taking for the past year is now returning.

        *******Besides the vitamins I also take TRAZODONE (for insomnia), PASSIONFLOWER supplement (250- 750 mg a day – twice a day) for anxiety, and SULFASALAZINE (500 MG twice a day) for my arthritis. Is the passionflower possibly interfering with my vitamin supplements? If I don’t take the passionflower then I really have nothing to help with my anxiety and it’s even more unbearable.

        *******You suggest for people take a B complex AND a multivitamin as well, but isn’t that too much B vitamins between the both of them? Why do you suggest taking both? Instead of a multivitamin, I just bought all the vitamins separately (some of them). But I still feel that because of my battle with depression and anxiety, I might be the type of person who needs more B12 (for example). I’ve been on over 20 antidepressants and psych medications over the years and I don’t do well on them and they don’t do much for me. And plus they are no good for you and I agree with you on pharmaceuticals being toxic for your body. I’d rather not be on any at all to be honest.

        But basically this is where I need your help……… I said I’m very surprised that my fatigue hasn’t improved on Thiamine and I’m on 400 mg of Thiamax right now at this moment. I started on 100 mg and I’ve worked my way up to 400. But NOTHING has improved. None of my neurological symptoms, nothing. And I see that that’s a good dose for most people. Some girl wrote about her POTS symptoms starting to reverse themselves after like 3 days and she was on 100 mg. What am I doing wrong here with my supplementation? I realize some of my 30+ symptoms are obviously from my neuropathy, arthritis, and psychiatric issues. But after feeling like I’m going crazy for years not knowing what the hell was going on with my body and my current neurologist testing me for autonomic dysfunction (which I pushed for by the way because I specifically searched for a neurologist who does this), I found out I have dysautonomia. But he said there’s not much to do for my symptoms besides going on medications (if I want to) for my symptoms. I don’t qualify for IVIG treatments, so that’s not even an option right now. This has put me in a sever depression because if there’s nothing to reverse all my neurological symptoms and fix my nervous system, I will either get sick or stay the way I currently am. I’m 35 years old but I feel like I’m 90. I can’t tolerate exercise anymore and I used to be a gym person. Besides my mental health issues (which have been very hard to treat as it is), I was a pretty physically healthy person about 3-5 years ago. I was on KLONOPIN for my severe anxiety and decided to come off it in 2019 after being on it for 5 years. It’s such a terrible drug and I came off it myself because I realized how bad of a drug Benzos are to be on. I made the hard decision to come off of it and It took me 8 months and It was complete HELL. But I had no backup drugs for anxiety. So I’ve bee suffering ever since and I’m on Passionflower now, but it doesn’t so much at all. I actually thought that maybe coming off KLONOPIN causes my dysautonomia, but no doctor seems to know the answer to that. But all hell broke lose once I came off it. It must’ve been masking my dysautonomia because since 2019 I got a lot worse and developed all these weird symptoms that I finally can put a name on it. I now know I’m not crazy and that it’s my nervous system. But anyways……. I have so much fatigue that I can’t do even much without getting extremely tired, short of breath, and have heart adrenaline surges and palpitations. The adrenaline surges are the WORST. I live in fear and constant dread 24/7 and even my therapist agrees with me that there’s a difference between having anxiety and having these adrenaline surges. That’s because my nervous system is messed up and faulty. But I still work full time and I’m amazed I still can (for now). I’m pushing myself, but I feel sick all the time and I call out ALOT. Most other jobs would’ve fired me by now. So I didn’t have any hope left until I stumbled upon you and your book and this whole Vitamin B-1 thing. But the point is I’ve been on thiamine (the best version – TTFD) for one month, I’m at 400 MG, I’m on magnesium and potassium, but yet I still have the heart palpitations. I thought this was the answer for me, but either I’m not at a high enough dose, or. NOTHING is working because I’m not taking every single vitamin yet and none of the other minerals.

        1) forget about me even being on 400 MG, is it possible that TTFD doesn’t work for everyone and I might need a different type of thiamine instead and then it might work? Not to mention that it’s very expensive to be on a high dose anyways because no matter what product I buy, that’s ALOT of pills and the bottles run out quick. I don’t care to spend it if this gives me back my life though.

        2) what dosages of every vitamin (A, C, D, E, K, and B’s) and minerals (potassium, calcium, magnesium) should I been on and what is the maximum dosage I should strive to be at for all of them?

        3) is it possible thiamine deficiency isn’t even the issue for me and it’s something else? Which I couldn’t even guess what that could be at this point. I’ve ruled out any cardiac or neurological conditions, respiratory conditions, etc. What do you think might be my problem here?

        4) should I be taking any other supplements? Do I need more dosages of anything to improve my mental health?

        5) do you or Dr. Marrs do consultations over the phone. I live in New York. I really would love to be able to speak to you (if possible). I need help and advice and wanna make sure that this is even a thiamine deficiency that I have. I really though 400 mg would of done SOMETHING by now. I feel no better and I’m really worrying now and I’m very angry and disappointed to be honest because I thought this was the answer.

        *****I’d appreciate your response because I just want to get better. Thank you.

        • Well, you have classic beriberi. Get Lpothiamine from CardioVascular Research. Stop everything and start with one pill (50mg). Wait for paradoxical worsening and if and when improvement occurs, start to escalate dose slowly to try to find the “ideal dose”. Then add magnesium and a multivitamin. Patience is required.

          • Just curious what the logic behind starting at one pill without magnesium and multivitamin is. If mag and multivitamin helps, why not start with that? And also why not start with a larger dose if escalation is often needed? How to you know where to stop with dosage?

          • I apologize for sending you a huge novel here, but I wanted to give you all the facts about everything.

            1)Can you explain to me why 400 mg of TTFD wasn’t doing the job?

            2) How long after starting Lipothiamine should I start the minerals, magnesium, B-complex, and everything else? A few weeks or months?

            3) how long (on average) before my fatigue neurological and dysautonomia symptoms improve?

            4) what’s the next step if the Lipo doesn’t work?

          • *******I apologize for sending you a huge novel here, but I wanted to give you all the facts about everything.

            1)Can you explain to me why 400 mg of TTFD wasn’t doing the job? You say I have beriberi but what if I don’t?

            2) How long after starting Lipothiamine should I start the minerals, magnesium, B-complex, and everything else? A few weeks or months? Am I wasting my money taking all the other supplements besides Thiamine, B-Complex, and Magnesium (such as trace minerals, calcium, etc.) ?

            3) how long (on average) before my fatigue, neurological symptoms, and dysautonomia symptoms improve?

            4) what’s the next step for me if the Lipo doesn’t work? I need as many ideas as I can to combat this dysautonomia because none of my doctors know how to rtreat me. Elliot Overton spoke to me briefly on Facebook yesterday and stated that Thiamine just doesn’t work for everyone and also mentions that sometimes dysautonomia patients need to take a high-dose of BIOTIN in order to get better and that Thiamine won’t work without it. Any thoughts on this and is this true?

            *****Since starting the B-complex and Thiamax my skin is flushed, I’m more jittery and anxious, and just feel uncomfortable. Will this ever pass? I can’t tolerate methylated vitamins and I tried them over a month ago, but I’m starting to wonder if feeling really sick and weak on them was actually paradox and I need methylated vitamins instead of non-methylated (which make me feel crappy, but not as bad as the methylated ones). I’m currently taking the NON-METHYLATED B-complex vitamins from Elliot and like I said, feel revved up and anxious on them, but I felt REALLY bad on the multivitamin that had methylated B vitamins in it. I don’t know what to do anymore

  5. Hello! I have developed vitamin b6 toxicity, I have started taking thiamin (100 mg), although it will depend on the cases. How soon should I notice improvement?

    Thank you.

  6. Hi Dr Lonsdale,
    Your comment that cloggy sinuses can be a result of abnormal ANS activity (and therefore a dysfunctional nasal cycle) was an absolute revelation to me. The symptoms you mention in this article describe EXACTLY what I have. These symptoms arose two years ago and other seemingly unrelated problems arose for me concomitantly: chronic fatigue, varicocele, quad tendinopathy, occasional chest rashes & night sweats, and very dark circles under my eyes. I suspect I’ve been thiamine deficiency all my life despite otherwise being very fit and healthy (Male in early 20s). I’ve always felt like I have less energy than I should have and now I have perhaps hit the “tipping point”. I’ve been supplementing with high-dose TTFD, B-Complex, Magnesium & other recommended cofactors/electrolytes suggested by you/Marrs/Overton for two weeks now. I’ve always had a very good diet, exercised often, and got plenty of sunlight exposure so that’s not a problem. I had quite a big paradox when I first started (extremely tired), but I now feel back to normal. Is there anything else you would recommend I do? Or do I just need to keep being consistent and trust the process? Thanks for all the great work you do.

  7. Hi Dr Lonsdale,

    You write:
    “It has long been known that patients with beriberi had a low arterial oxygen and a high venous oxygen saturation. All that would be needed to support the hypothesis of thiamine deficiency in some Covid victims would be finding a high venous oxygen saturation at the same time as a low arterial saturation.”

    I’m a little confused by this. Since the venous blood is simply the returned arterial blood, how could the oxygen concentration go from low in the arterial blood to high in the venous blood? This would seem to imply that oxygen is somehow added to the blood out in the body somewhere. Wouldn’t it be more accurate to say that the indication of beriberi is either high venous oxygen, or no decrease between the arterial and venous if the arterial blood oxygen was low, resulting from a lack of oxygen uptake by the body’s cells? This seems to be borne out by these articles which diagnose beriberi from high venous oxygen with no mention of arterial concentration:

    I would appreciate your clarification. I’m interested in this because I am looking into whether there is any evidence of this sort linking beriberi with Covid (and/or ME/CFS) in support of your hypothesis.


    • The “low” arterial oxygen and “high” venous O2 are the opposite of what they should be. High arterial O2 and low venous O2 means that the blood is not picking up O2 at the lung and not unloading it at the tissues. It represents an unknown non enzymatic action of thiamine.

      • Hey Dr. Lonsdale, I talked to you almost a week ago on here and you responded to me and suggested Lipothiamine. I then wrote you a reply but you didn’t answer me. I sent you the same reply two times, but on the second reply I added additional information and questions for you. The one I would like a response to is the one I posted on May 19, 2022 at 7:36 AM. The conversation is on this page somewhere. Thank you.

        ******P.S. can a paradoxical reaction also include worsening depression and emotional problems (which I already suffer with)?.

  8. Hi Dr Lonsdale, just a question about your thesis. You say that modern medicine focuses on killing the enemy and neglects the body’s defenses, and you cite Louis Pasteur on his deathbed supposedly saying “I was wrong, it is the terrain that matters” meaning the latter. I daresay you would agree that vaccination is one of the main weapons in the armoury of modern medicine. Wouldn’t it be true to say the aim of vaccination is to increase the efficacy of the body’s defenses, and isn’t this therefore in contradiction of your theme? And since was Pasteur was one of the pioneers of vaccination, along with Edward Jenner, why would he say he was wrong when this part of his work was concerned with the body’s defenses? I’m sure there is something wrong with my understanding and hope you can enlighten me.

    • Vaccination protects by increasing the immunity only against a single organism. Mother Nature equips us all with complex defensive mechanisms that operate against infection, trauma ,weather etc. These defenses are all initiated and controlled by the brain and we call it an illness. Fever raises body temperature because microorganisms are programmed to operate most efficiently at 37 degrees. The white cells increase in number to fight the foe, The vagus nerve stimulates inflammation and controls it etc etc.These are defensive mechanisms at work and we call it “an illness”. In our ignorance we try to bring the temperature down and we used aspirin to drop the flu temperature and caused Reye’s syndrome that killed the patient. We try to treat the “illness” with drugs that are toxic to the mitochondria. There is in fact only one way of winning what is ostensibly a “war” and that is by increasing cellular energy because an “illness” requires a lot. You need to read the work of Hans Selye who showed that the General Adaptation Syndrome required energy. He called human diseases the “diseases of adaptation”.

  9. Hello Dr. Lonsdale,

    Do you have any opinions on epilepsy and if it is worth investigating Thiamine for that condition?

    Also I have psoriasis and want to know if your approach may help. Does your book cover multiple diseases or your overall philosophy that may be the same for many diseases as you view things from a systemic approach?

    Kind Regards.

    • Interesting questions! I have come to the conclusion that every disease is nothing more than a specific area of energy failure, particularly in the brain. I learned from a neurosurgeon that epilepsy was really due to brain hypoxia. I was presented with a 12-year-old boy who had had his epilepsy medicine suddenly withdrawn and he went into status epilepticus. I treated him with intravenous TTFD and he came out of the status quickly. The next day he was walking around talking to other patients and free of seizures. I would love to find a neurologist who would like to carry out a study using this agent for epilepsy.

  10. I am sorry; I was not notified of your question, so I hope that you return. This is a typical medical disaster and tells me that the medical model is a catastrophe, because all his problems are regarded as separate diseases. His ADHD was treated with a drug that induced anxiety, Now he has sleep apnea, ventricular tachycardia and the final Rx is omega 3 acids for his ADHD. He has only one disease– energy failure. Almost certainly there is a minor genetic background that requires an epigenetic approach. Sleep apnea is caused by energy deficiency in the brainstem and the tachycardia is a combination of cardiac energy loss and autonomic dysfunction. It also emphasizes that the average diet is insufficient for the brightest brains. Increase the lipothiamine and titrate to symptom Improvement, add 250 mg of magnesium taurate, a fat dose of B complex and a well rounded multivitamin. Be careful to avoid energy consumption (exercise/stress) until you shape up. You will not need CPAP or pacemaker eventually and you can judge your progress from the improvement in ADHD, because that has been a clear example of brain energy deficiency. You don’t need EPA. The medical ignorance is profound. There are millions like you in America.

  11. I would have to guess that you have acquired a mitochondrial gene from your mother or you have acquired it.Sleep apnea is a major clue because the brainstem that controls the autonomic/endocrine axis is notoriously sensitive to thiamine/magnesium deficienncy I suggest increasing thiamine and adding 125-250 mg of magnesium taurate. Titrate the thiamine dose to symptom improvement. Letr us know how it goes.

  12. Dear Dr. Lonsdale,

    I’ve been following and studying your work for a few months after being introduced by a friend.

    Let me give you a brief history…

    In 2005, I was diagnosed at 24 years old with ADHD and was treated with Adderal for years, with some success (although the Adderal significantly exacerbated my anxiety which was treated with benzodiazepines).

    I stopped taking Adderal in 2012.

    In 2017, I was diagnosed with sleep apnea and have since been using a CPAP machine nightly. I’m not overweight.

    Then in January 2019, I nearly died after a cardiac episode following exercise. I lost consciousness and stopped breathing, and was resuscitated with CPR. I had been an athlete all my life and never had any cardiac symptoms.

    After 3 months of diagnostic testing, I was diagnosed with idiopathic ventricular tachycardia. The definitive diagnosis came following an electrophysiology study where VT was induced. My heart rate shot up to 280 and I was shocked back into rhythm with an AED. A week later, I had a defibrillator surgically implanted.

    I’m happy to report that I have not had any cardiac symptoms since, but I’m still struggling with ADHD and sleep apnea.

    I’ve been on a plant-based diet for 5 years and stopped consuming all sugars, except those naturally occurring in whole fruits and vegetables since February of 2020.

    And I’ve been taking lipothiamine, 50mg daily.

    Should I be taking a higher dose of lipothiamine? Or combining it with anything else? (I’ve read you recommending magnesium salts to others).

    Lastly, my psychiatrist recently recommended using an Omega 3 supplement, but to 5 grams a day, to help with the ADHD.

    Because of my ventricular tachycardia, I have to avoid all stimulants.

    I would love to hear your thoughts on all of this.

    Many thanks,


    • Oh dear! Another complex misdiagnosis. It might interest you to know that every single occurrence that you record in your history was due to the underlying phenomenon of energy deficiency, particularly in the lower part of the brain. It probably has a combination of diet and genetics. What is interesting is that you have had very little response to the allithiamine. You need to increase the dose and add magnesium to your supplements. The lower part of the brain that control the autonomic nervous system is very prone to thiamine deficiency. It is always surprising to people who suffer this kind of thing to find that a single agent is responsible for multiple clinical events.

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