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. 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 on line 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 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. 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 in 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 headache, 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 at 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 diagnosis or treatment. Migraine occur 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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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. 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.

  2. 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”.

  3. 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.

  4. 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.

  5. 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.

  6. 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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