A standard dose of thiamine to start the treatment protocol does not exist. The dose that he and his group have been using is 4 g/day as tablets by mouth or 2 injections of 100 mg each, twice a week. Because he has had several years of experience, the right dose has always been tailored to the specific characteristics of the patient. On the basis of their observations the right dose is the one that suppresses the majority of the non-motor symptoms and at least 50% of the motor symptoms, without causing over-dosage symptoms. This is an important point because the dose of thiamine can be too little or too big, making me think of the ancient Chinese whose philosophy was expressed as Yin and Yang for too little or too much. The right dose is found when the disturbed balance is suppressed and the patient regains normal balance. On the basis of their experience, if symptoms are exaggerated at the beginning of treatment, it may mean that the dose of thiamine is already too high for the needs of the specific patient. One of the questions that was asked was whether thiamine could be administered in association with any of the existing therapies for Parkinson’s disease. The answer was that it is compatible with any drug on the market.
Course of Improvement
The oral therapy produces an appreciable improvement within a few days, but the patient may not realize it. Within 30 days in most of the cases, an appreciable improvement of the symptoms is detected by the patient as well. Further improvement is observed within the following 2-3 months. The effectiveness of one intramuscular injection of 100 mg is nothing short of impressive in all cases they have observed. It determines an almost sudden improvement, clearly appreciable by the doctor as well as by the patient. The tremor, one of the major symptoms in this disease, is strikingly reduced.
Obviously, one of the questions was whether there were any side effects from high dose oral thiamine. The answer was that the only known side effect associated with this therapy was from over-dosage. When the dose of thiamine is higher than the needs of the patient, there is worsening of the symptoms of the disease and reduction of the dose usually results in improvement. If high oral doses of thiamine are taken later in the day (evening or night) there may be difficulties in falling asleep. If taken in the morning or early afternoon, patients reported an improvement in their sleep. Patients reached the peak of improvement within 3-6 months and no further improvement was observed past that.
Thiamine is highly effective with all the symptoms, both motor and non-motor. It is best to start with low-doses, increasing gradually until the symptoms improve satisfactorily. More than 2,500 patients have been treated. All responded favorably, regardless of severity. Many have been following the clinic protocol for 3-5 years and progression of the disease appears to have been halted. This is truly an amazing story. How many more patients could be helped if their doctors would put aside their skepticism and humbly try to learn more about the use of high-dose thiamine?
Only one patient was unable to tolerate the high dose. Each time she tried, it caused vomiting. Finally, they state that they prefer to see how the high-dose thiamine performs before adding any more dietary supplements.
It is pretty clear that neurologists need to study this pioneering program for Parkinson’s disease. These results have been published in peer reviewed medical journals. Dr. Costantini unfortunately succumbed to Covid-19 but I have no doubt that his colleagues will continue to explore this remarkable innovation Of course, using a vitamin in large doses turns it into a drug, an entirely new concept in medical treatment and it is natural that skepticism will have to be overcome. However, the results are so dramatic that they cannot be ignored.
Mechanisms of High Dose Thiamine Therapy
Although we know a lot about the activity of thiamine in the body, there are aspects about it that are still shrouded in mystery. We have known for a long time that it is a cofactor for many enzymes that function to produce energy. There is little doubt that Parkinson’s disease, like many other human diseases, is an energy-deficiency condition, so the use of thiamine in its treatment would make sense. However, much more information is required concerning its non-enzymatic functions. To become active in the body, thiamine has to have two molecules of phosphate added to it to act as a cofactor. Its non-enzymatic form includes thiamine triphosphate about which we know surprisingly little, in spite of the fact that it was discovered 70 years ago. This treatment of a severe crippling disease forecasts the arrival of Orthomolecular Medicine as the orthodox form of therapy.
The use of a vitamin in megadoses to treat disease is brand new. It seems that enough clinical evidence of its benign, non-toxic effect has been reported by this Italian group to “set the world of medicine on fire”. The concept of using a molecule, essential to life, in large doses as a drug will undoubtedly require further confirmation, but it would be absurd to ignore these results. The “exactly right dose” seems to confirm the long held philosophy that “the truth lies between two extremes”.
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