More thoughts on thiamine deficiency

More Thoughts on Thiamine Deficiency

It should not surprise anybody when I question the current medical model for its accuracy and the use of potentially toxic compounds that often make things worse or do little or nothing toward relieving the disease.

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Thiamine Dependency and Intermittent Ataxia

Readers of this blog will recognize that there are many posts concerned with thiamine deficiency and that is associated with a huge number of symptoms. I want to use this post to illustrate the difficulties experienced by a boy whose thiamine deficiency was proved. His case was written up in the medical literature because it was the first example of thiamine “dependency“. That meant that he was required to take massive doses of the vitamin in order to prevent intermittent recurrences of the brain disease known as cerebellar ataxia. Curiously, each episode was self-limiting, but as they recurred, each one left him with a little bit more brain effect. It was this case that forced me to devote myself to library study and change in medical practice throughout the remaining years before my retirement.

Although this boy’s problem was an example of a condition, thought to be extremely rare, it illustrated the kind of medical problems that occur as a result of dietary deficiency. In fact, I have come to the conclusion that prolonged dietary deficiency of this vitamin will make it difficult to restore health by its administration as a supplement. The enzymes in the body that require it seem to degenerate over time if the deficiency persists. Huge doses are required and it is not a simple vitamin replacement. We are using the vitamin as a drug in an attempt to coerce the enzymes back into a healthy state. We know from the history of beriberi, the traditional vitamin B1 deficiency disease, that large doses of the vitamin were required to restore health.

This case was reported in 1969 and the last time that I saw him was in the 70s. He had grown into a handsome boy with a marvelous personality. For example, he cut the grass for the neighbors without charging them and his customers were delighted with him on his paper route. This escape from a potentially lethal disease by the use of what might be called a megadose of vitamin B1 was incredibly impressive to me, making me wonder whether a healthy dose would benefit everyone. Is the modern diet so artificial that vitamin deficiency is common, in spite of their enrichment by the food industry?

I recorded the fact that the family had visited Florida. While they were in a store that was cooler than the outside temperature, it was without air conditioning and John became suddenly unconscious and was taken to an emergency room where his examination proved to be quite normal. On the following day, he went from a 95° temperature into a store with an estimated air-conditioned temperature of 60 to 65°. He immediately experienced difficulty in breathing and produced a kind of strident asthma that was self-limiting. He was again taken to the emergency room where his examination once again proved to be quite normal. The diagnosis given at the time was that it was due to “nerves”. A similar episode occurred on the way home when the air-conditioning was put on in the car. Note that an environmental temperature difference was enough for him to lose consciousness on one occasion and produce asthmatic breathing in another similar situation. He had never been known to experience asthmatic breathing previously. One can readily see that he would be a complete mystery to the doctors in the emergency rooms to which he was taken.

My interpretation would be as follows: as repeatedly pointed out in various posts on this website, his brain had an energy problem from the poor association of thiamine with its energy enabling enzymes and the stress of a sudden change in temperature, requiring an energy surge to adapt, could not be met. The energy deficiency affected the functions of the brain, causing syncope in one example and asthma in another. The diversity of this response illustrates the fact that different parts of the brain can be affected by the overall deficiency, perhaps even on a day to day basis. It is not surprising that such episodes are a diagnostic problem for ER physicians or any physician for that matter.

Syncope and Sudden Death

A very common incident occurring in dietary deficient people is a sudden fainting attack, known as a syncope. They invariably wind up in the ER where it is usually written off as being due to “nerves”. It is impossible to understand this without knowing the chemistry involved. It reminds me of two siblings, a boy and a girl, both of whom had been surviving on a junk-filled diet. The girl was a champion swimmer and was practicing one day by swimming laps. She swam the last lap, touched the pool wall and remained still. When she didn’t start to climb out of the pool, someone investigated and found that she had evidently died as she touched the pool wall. Her brother had been climbing ropes in a gymnasium. After he came down from a climb, he passed out and was taken to a hospital where he received intravenous fluids. It was recorded that he had 11 bloodstained bowel movements and expired. Although there was no proof that thiamine deficiency was the cause of death, I would be willing to bet that the fluid given intravenously to the boy was glucose saline and we know that an excess of sugar will seriously precipitate marginal thiamine to a deficiency state that would produce symptoms. It strongly suggests that the death was from thiamine deficiency.

Febrile Lymphadenopathy

In another post, I recorded the history of two boys with recurrent acute febrile lymphadenopathy (fever, swollen neck glands and high-temperature), both of whom responded completely to thiamine supplementation. The story bears repeating. This kind of illness is inevitably thought of as throat infection and treated with an antibiotic. Both boys had a marked increase of folate and vitamin B 12 in their blood that returned to normal levels after thiamine administration. I won’t go into the mechanism but it is interesting to speculate on how often children with a very common condition like this would have a similar underlying cause that would never, under any circumstances in the climate of modern medicine, be considered. The two cases were published in a medical journal but I have never seen a reference to it, probably because it is totally unbelievable.

I kept a diary at the time and want to make a few comments about one of these boys. When the supplemental thiamine was removed to see what would happen, he relapsed about three weeks later. The relapse began with recurrent abdominal pain, irritability, and a return of the fatigue, causing him to nap during the day as he did when he had his recurrent episodes. There were some abnormalities in his blood pressure, which are too technical to describe here. When I stroked the skin of his leg gently, it provoked a white streak that gradually faded, a phenomenon that is associated with abnormal activity of the autonomic nervous system, a system that is inevitably damaged with thiamine deficiency. He had large lymph nodes in his neck and there was an elevation of folate and vitamin B12 measured in his blood. All of this resolved when the thiamine was restored. It is interesting that he had a first cousin who suffered from Hodgkin’s disease, a malignant form of lymphadenopathy. I wondered whether this recurrent swelling of glands was potentially precancerous. From my reading of the vitamin B1 deficiency disease beriberi, I found that swelling of the glands in the neck could be seen in infants dying from the infantile form of the disease and fever was almost always present.

Mononucleosis: A Mistaken diagnosis?

On May 14, 1976, I made a note that we had a new patient admitted under the care of another physician. He had massively swollen lymph glands in his neck and the diagnosis was mononucleosis. The history recorded that his brother had also “died from mononucleosis” the previous April. A biopsy of one of his glands was reported that it was definitely not malignant. His case was discussed among my pediatric colleagues and I asked the responsible physician what he would do if the lymphocytes in the gland were reported as healthy and mature. The answer surprised me because it was obvious that the diagnosis of mononucleosis had been rejected. He stated that the boy would be treated for cancer “but we would soft-pedal it” I found his answer extremely confounding. We were confronted by a familial situation with an unknown diagnosis and yet he was to be treated as though it was known.

This reminded me of a situation that affected one of my granddaughters. She came home from school and went white water rafting with her friends. Evidently she fell in the water and when she got home she was so fatigued that she went to bed. Her mother, who was a university nurse took her to her workplace where a diagnosis of mononucleosis was made. I persuaded my son to bring her to my office where I gave her several infusions of intravenous vitamins. Her response was so good that she was able to return to school well. The obvious question that I asked myself was whether the diagnosis of mononucleosis was valid or whether it was an inappropriate mistake. The reader may or may not know that a diagnosis of mononucleosis, also known as “kissing disease” is associated with extreme fatigue and can prevent the unfortunate adolescent from returning to school sometimes for months. Once again I am confronted with the question, is our present medical model even close to being accurate?

I am reporting actual cases of thiamine deficiency that are a sampling of literally hundreds of similar cases that I encountered over the years. It should not surprise anybody when I question the current medical model for its accuracy and the use of potentially toxic compounds that often make things worse or do little or nothing toward relieving the disease. It is high time for sick people to seek the services provided by Alternative Medicine physicians whose medical societies are known as the American College for the Advancement of Medicine (ACAM) and the International College of Integrated  Medicine (ICIM).

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This article was published originally on September 17, 2020. 

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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.

61 Comments

  1. Hi Dr. Lonsdale , it’s been a month since I started taking Thiamine hcl as you recomended below, i begun with 50 mg then 100 and since two weeks a take 200 mg split dose and since then my hair started to fall even more, started to have dry eyes , dry lips , and i’ve decided to start today to take 50 mg of riboflavin and 500 mcg of biotin , and after that i felt that my symptoms that I have worsen,brain fog, my balance problem, drunk vision with some dizziness , ear pressure , feeling like my brain is not receiving oxigen, is this a paradox reaction ? What should I do ?

    • You were too impatient.The present dose needs to be reduced. Wait for paradox and then try to find the ideal dose.

      • Yes I admit that, i’m impatient and i’m trying to keep it under control, but onestly I can take very well a split 200 mg of Thiamine hcl, it doesn’t give me a paradox anymore or i didn’t even reach the paradox reaction yet , i don’t know, but yesterday when i’ve tried 50 mg of b2 and 250 mcg of biotin (hair loss, dry eyes , dry and cracked lips) i felt it right after like a paradox reaction

  2. Hi Dr. Lonsdale – First, want to say how deeply appreciative my family and I are of your work and research. You have made the world a better place and there is no greater compliment to be given than that. So, thank you.

    I recently connected with your colleague Dr. Marrs on some of this for my health situation but wanted to reach out to you regarding my son who is now 10 years old. He developed some minor tics in the form of eye blinking around age 7 and also bedwetting a few times a week that often smelled like maple syrup. The following is the recent medical history for me and him.

    April 2018 – Towards the end of a business trip in Tokyo, I start feeling nauseous and not sleeping well.  Land back home and within 24 hours have a white, foamy substance coming up my throat and start having trouble breathing.  Go to ER, they give me a shot of Prednisone.  Throat clears up quickly.  In the ensuing days I develop a peripheral neuropathy in fingers and toes, become very fatigued and very anxious.  The neuropathy slowly dissipates along with the anxiety over a 3 month period and fatigue resolves in about 5 months.  Doctors never came up with an explanation of what happened.  A neurologist at Cornell told me it was “proabably some virus that attacked my brain and spinal cord”.  Shoulder shrug.

    October 2020 – Sell house in NJ (history flooding, mold remediation) with intention of moving to TN and building a new home.  Decide to spend the last couple months of 2020 in CO near wife’s family.  Rent a home in CO.

    November 2020 – In CO, I have a fainting episode one evening.  Begin to have trouble sleeping and some difficulty breathing.  I blame it on the altitude and to wait it out until we head to TN in about a month.  Later found out this house was riddled with mold.

    Early January 2021 – Arrive in TN in rental home.  I start feeling a little better.  First week there, wife and kids test positive for Covid.  Wife is sick for a week, kids are asymptomatic.  I test negative (not sure how that is possible) and have no symptoms.

    Mid January 2021 – Wife recovers, I herniate a disc in my back and start feeling unwell in general. My son starts saying things like he’s “not feeling right”, “I feel anxious”, “my stomach hurts”.

    Late January 2021 – I start feeling like I am not breathing well.  Doctor gives me Azithromycin and Methylprednisolone (steroid link like previous episode).  Two days after, I am driving and heading to dinner with my wife.  I have to pull over into a parking lot in the pouring rain and get out of the car and just start crying uncontrollably.  Something doesn’t feel right.  We go to ER.  They run a bunch of tests, CT scans, x-rays, EKG, etc.  Everything looks normal and they send me home.  I know something is wrong because now I am really having difficulty breathing.

    February/March 2021 – I wind up back in the ER two more times the next week, having rolling, panic-like, hyperventilation attacks that won’t stop and I can’t take anywhere close to a full breath, sometimes just gasping for air.  More tests, everything normal.  They label me with “Generalized Anxiety Disorder”.  My body proceeds to fall apart.  I lose 40 lbs. in 6 weeks.  Can’t breathe, sleep or eat.  Body stuck in fight or flight mode.  Anxiety through the roof, borderline manic.  See several specialists, tried lots of different medications.

    April 2021 – Start seeking out alternative type treatments outside of conventional medicine. Move into brand new construction “dream house” in TN.

    May 2021 – Our son, 9 years old at time, develops severe, almost seizure-like, motor tics and other symptoms seemingly overnight.  Find out new house is riddled with mold due to standing water in crawl space and poor ventilation throughout home.  Realize pretty quickly that son has developed PANDAS and we get him to a specialist that puts him on antibiotics and steroids immediately which gets him out of his flare but doesn’t help the underlying problem. His symptoms include motor and vocal tics, rage episodes, food and school refusal, OCD type behaviors, nausea, stomach pain, dizziness and others.

    July 2021 – I have run many labs and tried many treatments with different functional medicine docs at this point.  Figure out I am having a cytokine storm.  None of the Doctors seem to know what to do about it and they suspect Long Haul Covid.  Son is on a roller coaster and not improving. We make a decision to sell house in TN and move back to NJ.

    August and September 2021 – I spend 2 months at clinic in AZ with Lyme/Mold specialist.  Detox process breaks me down further and makes me feel worse.  We focus on more nourishing treatments during second month which makes me feel a little better.  Boderline POTS after HRV testing and have a clear dysautonomia where I seem stuck on the sympathetic. I still can’t breathe well at all and my blood pressure starts to dip very low. We bring my son to a pediatric neurologist in AZ who specializes in treating PANDAS. She puts him on a homeopathic protocol.

    October 2021 – Back in NJ in rental apartment.  We have a rough winter health-wise as a family but especially my Son and feeling stuck in recovery process.  Lots of ups and downs for me.  Turns out that apartment had a water leak above and mold was growing rapidly in our bathroom.

    November 2021 – Son wakes up one night vomiting blood, we rush him to ER. He has procedure to repair bleeding ulcer in stomach, likely a result of being on NSAID/antibiotic for long period. He stops taking these medications after this and is almost entirely on homeopathic products, gluten-free, dairy-free diet.

    January 2022 – Finally move into new home after renovations and thorough mold scrubbing. 

    February/March 2022 – Begin noticing little signs of improvement in my son. Shorter and less extreme symptoms and flares. Tics are almost negligible.

    March 2022 – I have continued to try various treatment plans over last several months.  Not sure any of it helped.  I have done Neurofeedback for 20+ sessions now and the guy says he “has never seen a brain like mine’.  Apparently Alpha waves are sky high and Theta waves are non-existent, similar to PTSD coping mechanism.  Very little activity in occipital region.  He says that I am responding to treatment slowly but haven’t broken through yet.  I began working with a group focusing on mitochondrial health and building myself back up more naturally.  Reducing EMF’s, Plenty of sunlight and time outside, meditation, diet high in DHA, regulating circadian rhythm, improving the Pentose Phosphate Pathway.  Supplements include Thiamine, magnesium malate, d-ribose, l-serine, increased salt intake.  I feel that has been the most helpful thing I have done.  Spent time working with Respiratory Physiotherapist.  Figure out that my diaphragm is much weaker than the average person.  Start doing Inspiratory Muscle Training which I think has also been helpful.   

    Today – Both me and Son have been making a steady climb in healing process.  I am 6 weeks in with the mitochondrial health plan and IMT.  I am still having breathing issues but they seem to be improving slightly for the first time.  For the first time in probably 18 months I have started to be able to fall asleep without taking any drug or other aid.  I don’t stay asleep long, maybe 1-2 hours but it seems like progress.  My digestion has improved a bit and I don’t feel bloated after every meal.  Still in cytokine storm according to latest blood work this week but I have more energy and I am able to get things done around the house and drive my kids around and show up at their activities and play with them at home.  All seems like it is heading in the right direction but it is very slow and I still feel like I am a long way off from being “healthy”.

    That is the high level story and thank you again for taking the time. More than anything, hoping that you may have some insight or recommendations that can help my Son.

    All The Best,

    Justin

    • There is a major clue. Maple syrup urine disease is caused (usually) by a thiamine dependent gene defect. In the case of your son, he may have the gene defect but it is recessive and would mean that you and your wife are carriers of a single copy. I tend to favor a massive thiamine deficiency in you that you passed on during pregnancy. However, the solution for you both is megadoses of thiamine. Start with a daily dose of 100 mg and wait for the paradoxical symptoms to subside. Then up the daily dose and try to find the “ideal dose”. If you find it, increasing the dose will bring back symptoms. There is a genetic influence but you can overcome it by the epigenetic use of megadose thiamine.

    • I have already made my comments but I want to say this. If m y analysis in this case is correct, then you must be aware of the appalling state of American medicine. I would be willing to bet that few doctors would even be aware of Maple Syrup Urine disease. Even fewer would know of the thiamine connection. They believe that each disease has a separate cause for which a “cure” must be found, whereas the evidence strongly suggests that cellular energy deficiency is responsible for each and every disease. Maple Syrup disease is no exception. Since thiamine is a necessity for energy synthesis, it is possible that megadoses of thiamine would be a successful treatment for ANY and ALL diseases, where energy deficiency is expressed in a myriad of ways depending on the distribution and severity of the deficiency

  3. Dr. Lonsdale,
    I have 8 year old twins, academically gifted but both emmotionally immature and diagnosed with anxiety, depression and severe ADHD. They are tall and lean, about 130cm tall and weigh 23kg. Their diet has been mediocre: they eat healthy dinners, fruits and vegetables but also processed snacks and occasional fast food. I’ve read your book and everything on this website I could find relative to our issues. I am working to remove the junk from their diets and I started them each on 50 mg Lipothiamine + B-complex + 150 magnesium + multivitamin daily 11 days ago. I have also continued giving them 50 mg setraline and 40 mg methylphenidate CD, which they have been taking daily for about 2 years. I would like to ween them off the medication but I am afraid because of an incident when one of the children tried to commit suicide by jumping off the roof of their school. They seem to be more out of control since starting the ttfd. Regarding my family history, I have struggled with ADHD, anxiety and depression since I was a child. My father has a severe case of essential tremor. I have also been diagnosed with essential tremor, first visible when I was approximately age 5 but much less severe than my father’s. I had an eating disorder in high school. I was addicted to alcohol but overcame my addiction using naltrexone and have not consumed alcohol in over 15 years. My Dad is probably autistic but never diagnosed. He is extraordinarily gifted in mathematics. He is now in his 70’s and has type 2 DM and has been declining cognitively. My sister has bipolar 1. My brother is extremely bright and is the CFO of a major company. He is also an alcoholic. Despite taking 40mg escitalopram and 60mg Adderall daily I still lack motivation and feel depressed, however, I do both strength and cardio exercise daily. I started taking 50 mg Allthiamine (with mag, b-complex and multivitamin) 25 days ago and am still experiencing a paradox. I have the following questions (I apologize if they have already been addressed elsewhere and I missed your answer):
    1.) In your experience, when starting ttfd, did you see a similar “paradox” in children as that seen in adults? If not, what is the expected timeframe for an observable improvement in behavior?
    2.) Would you recommend a different starting dose for children such as mine? What dose of Lipothiamine would you expect to be the most beneficial for them?
    3.) Do you think the pharmaceuticals my children and I are taking will influence our response to ttfd therapy and if so, how?
    Thank you for sharing your knowledge!
    Colleen

    • 1. If symptoms worsen, it is paradox
      2. Start with one tablet of lipothiamine and gradually increase to find the “ideal dose”. Do not increase beyond that.
      3. Yes

      • Thank you Doctor! I have recommended your book to all my friends and family.

        Update: One twin is doing much better. The other twin is about the same. Do you think I should increase his dose? He is still taking 50mg Lipothiamine. They are fraternal twins.
        I am still experiencing paradox symptoms despite starting TTFD more then a month ago.

      • Thank you doctor! I’ve recommended your book to all my friends and family.

        Update: I have now been taking 50mg Allithiamine for over a month and I am still experiencing paradox symptoms, some days worse then others.
        My children haven been taking Lipothiamine for 2 weeks but after a day or two of increased hyperactivity, they are about the same as before. Do you think it is too early for me to increase their dose?

  4. Dear Dr. Lonsdale,

    I bought your book and did not find a case like mine mentioned, so I am writing to you with the hope that I’ll hear back from you.

    6 months ago while I was taking metronidazole I developed body wide dryness overnight. No improvement to this day. I have dry eyes, nasal passages, mouth, ear canals, etc. Dry flaky skin on my entire body. Ability to sweat vanished at the same time. Now only my underarms can sweat and it is only when I am nervous, and a tiny bit when exercising. I have tears when crying but otherwise no reflex tears and my eyes are dry. No unstimulated saliva. No ear wax. No nasal mucous lining the inside of the nose. At the same time as sudden dryness onset, many of the hairs inside my nose fell out and have not grown back. The hairs that remained are at the wings of the nostrils. I didn’t have any health issues prior to metro toxicity.

    I am in the metro toxicity facebook support group, and there are 5 others who developed body wide dryness from metro toxicity. So only 6 of us out of almost 2000 people in the group. We’d be very grateful to you if you could give us your thoughts.

    Thank so much you for your time. Best wishes to you.

      • Dear Dr. Lonsdale,

        I have one question. If you could please answer it, I and others in the group with this problem of dry everything (eyes, mouth, nose, skin, GI tract, etc) would all be grateful:

        If metronidazole damaged or destroyed the M3 muscarinic receptors that are required for all our exocrine glandular secretions, do you think high dose thiamine could help repair that damage or restore the lost M3 muscarinic receptors?

        Thank you, and all the best to you.

        • Metronidazole simply replaces thiamine in brain cells. High dose thiamine is the only treatment.

  5. Hi, for about two years i suffered from POTs i think, i mean that is where i find myself described, i tested my heart rate at home, sitting i have 75 HR, when i got up, it’s 105, i hhave like a constant dizziness but not really a vertigo,like a drunk vision, sensation of faint, short memory problems, balance problems,anxiety, i took all the testes, cerebral MRI, blood test, tyroid, parasites etc. after i’ve consulted my cardiologist he said that i should take magnesium orotate , in the same time i choosed to take a b-complex from GNC, and for the first time i saw that my brain and body finally responded, i started to feel really better, like 85-90%, but this did not last too long because i started to feel weaker than before, i started to have a weakness in my legs, sudden anxiety, especially at night when i wanted to fall asleep, muscle twiches more intens than before, loss of apetite, when i lay down i feel like an intense muscle twiches all over my legs, i started to add in my diet , potassium, magnesium, all from food because i became hypersensitive to supplements like magnesium lactate, magnesium orotate, they are making me more dizzy, so i started to have a b complex after i read your posts, after i took it , i received like goosebumps all over my body, high blood pressure, dizziness, i am insuficient in vitamin D which is 25,3 . Can I have your opinion ? what should I do ? i’m a barber and this affects my work. I have to say that this appeared after a period when i was in a high psycological stress , alcohol, a lot of grains, bad alimentation.

    • This is typical thiamine deficiency. Start taking 100 mg a day thiamine HCl and wait for paradox if it occurs (see posts on HM). Then gradually increase thiamine by titrating symptoms to try to find the ideal dose. If you go beyond the ideal dose, symptoms will increase

    • Start taking 100 mg a day thiamine HCl and wait for paradox if it occurs (see posts on HM). Then gradually increase thiamine by titrating symptoms to try to find the ideal dose. If you go beyond the ideal dose, symptoms will increase

      • Should I take only thiamine ? now i’m taking magnesium malate about 175 mg, and Vitamin D3 + K2, only 2000-3000 iu, my curiosity is why am i so hypersensitive to every supplement, most of them minerals that boost my dizziness and the sensation of faint, could be due to magnesium supplementation that made my thiamine deficiency worse ? God bless you and give you everything you need !

          • Should I introduce some fat soluble form of thiamine after 1 month of thiamine hcl ? I have to say that for the moment i take only 100mg in the evening because of a little paradox reaction , i will try to raisr the dose to 200-300 mg , but i was wondering if i should switch it or combine it with some benfotiamine because i’m from Romania and here we don’t have TTFD

              • Am i could be wrong if i would try benfothiamine just to see the reaction? I know from you that this one is good at passing blood brain barrier , I started today to take a split 200 thiamine hcl after a week and a half of 100 mg, it gives me a slight head pressure and some dizziness that i can handle, i know it is to early to see a clear sign but i’m just curious to see how benfo is gonna act, i’m sorry, i don’t to disturb you too much

  6. Dr. L,
    I was recently diagnosed with Clostridia HPHPA (organic acids) and connecting to this to a thiamine deficiency as well as a PST pathway blockage. All steming from a surgery 4 years ago that catalyzed my system-wide symptoms and constant ‘sailor drunk’ feeling. No wonder why I am sensitive to sulfur/phenols. Now that we have the culprit trying to figure out how to attack this. Slow n steady. Low carb/keto diet, limbic work, etc. is on the list along with B1/Mag combo. Two questions: are any objective tests available to confirm and if you have an infection how would you treat? Too much risk in anti-biotics I would think.
    Thank you,
    Sally

  7. Dr Lonsdale,

    My uncle had a stroke 2 years ago and has gotten progressively worse. Hes’s has a very unsteady gait even with the walker, extreme fatigue and has developed spasmotic dystonia
    where is voice is breathy sounding and strained. He can’t speak over a minute without being short of breath. When you have a stroke does your thiamine go down? Could the fatigue and gait problems be b1? Oh, also he developed a very slow pulse rate as a result of the stroke. Thank you for your help.

    Cathy

  8. Hello Mr Lonsdale, how are you doing? I have three questions if you would be so kind:

    First is what’s your opinion on ozone therapy for the activation of mitochondria?
    Second is, if TTFD isn’t available, what kind of thiamine would you recommend (sulbutiamine, benfotiamine, hcl, mononitrate)?
    Third is that I know magnesium should be taken with B1, but do you also need to take B-complex? Or should you take a multivitamin?

    Thanks.

    • I have not studied ozone therapy and it was not available when I was in practice. However, it is a good question and I will try to do some research on it and maybe write a post. Your second question is about the type of thiamine. The natural way in which thiamine was ordained was of course in food. There are three ways in which thiamine can be taken In a megadose if prolonged deficiency has existed and please understand that under these circumstances it is being used as a drug. Thiamine hydrochloride and thiamine mononitrate are water-soluble salts and are readily available. There are two types of thiamine derivative, a group of disulfides ( Lipothiamine, Allithiamine, Sulbutiamine) whose chemical name is thiamine tetrahydrofurfuryl disulfide and a group known as S acyl derivatives, the best known of which is Benfotiamine. There are minor differences between the benefits of the two groups but they all have only one action and that is to deliver thiamine to cells. If the ingestion of the chosen derivative results in benefit, it simply means that the thiamine dependent machinery Is functioning better. Once that has occurred, it is necessary to add magnesium, B complex and a multivitamin for continued use and it may be necessary to add vitamin D.

      • Thank you so much! I have just one more question out of curiosity. I’ve been studying about metabolism and I reached the theory of cancer as a metabolic disease. What’s your take on that? Because as I understand, cancer metabolism is basically fermentation of lactate (just like normal metabolism of pyruvate sans thiamine) or glutamate in the presence of oxygen. I’m not a medic, nor am I on the biological fields, so please pardon my ignorance. Could it be related to thiamine deficiency and if so, how could that relationship occur?

        I’ve been dealing with chronic sibo/ibs for about 10 years and got really good results with a carnivorous diet, but even then added back carbs to my diet it seemed like all of my symptoms came back. I’m currently exploring the theory of a thiamine deficiency that couldn’t be fullfilled through diet alone and my mood/energy levels/digestion have really improved since I started taking sulbutiamine/magnesium malate/b-complex.

        I find it intriguing how simple this concept is, but I was never taught that: Food has three macronutrients (proteins, carbs, fat) and micronutrients (vitamins and minerals). If you eat something like an icecream, you get the carbs and the fat, but you don’t get the micronutrients required for the metabolism of carbs and fat, thus creating a deficit. This is just so simple it blows my mind when I think about it, how is this not common sense?

        In anyway, I really appreciate the work you do and I hope to read your book in the near future. God bless you.

  9. Dear Dr Lonsdale,
    What does it mean if allithiamine or lipothiamine cause an “old tire” taste in the mouth? My 17 yo daughter, who experienced an acute onset of gastroparesis and POTs symptoms about a year and a half ago, is experiencing this weird taste in her mouth with the supplement. She took it once by mouth and once through her feeding tube which goes into her jejunem. Obviously she knew about it when she took it by mouth, but the second time I mixed a powder into her feeding tube without her knowing. Same taste in her mouth occurred both ways.
    Thank you!

  10. It is interesting that milk contains a substance that must be processed separately in the cell and requires thiamine. If there is thiamine deficiency this can result in production of something called phytanic acid that can influence brain function

  11. Dr. Lonsdale,

    Several family members and several friends are using Allithiamine, magnesium and a multi with very good results. I have a question about diet, especially for our teens and adults who travel. Is it acceptable to cover the body’s daily fruit and vegetable requirements by drinking a smoothie each day, along with a good dinner that includes protein and vegetables–but possibly a burger and fries for lunch, or a typical McDonald’s breakfast sandwich for breakfast?

    The diets of the teens especially can be very unbalanced, and they are not at home to manage. We are trying to add additional nutrients with things like smoothies, and a good multivitamin, to make up for the “junk” they routinely eat outside the home.

    You talk at length about the synergistic effects of multiple nutrients in the diet–do they need to be eaten at each meal, or can they just be added in anytime during the day? In your book you mentioned that thiamine, for instance, was found to be “stored” in the body for several days. I assume the body accesses it when it needs it, but I am not sure if that’s true for other nutrients as well.

    We certainly are trying to teach our kids to eat well, but it is a difficult fight. And the sugar is the biggest fight of all. Thank you for your book, but your articles are almost as valuable as they are an extremely useful tool to explain the thiamine problem to others.

    • I agree. Unfortunately I learned years ago that children and adolescents are totally committed to their lousy diets. That is why I have advocated vitamin supplements because that seems to be the only way in which one can restore the proper ratio between ingested calories and the catalysts that enable them to be oxidized. There is no question that, given an absence of a genetic risk factor, a natural diet is the best method by far. An additional problem is that a good diet is expensive and is the reason for an association between poverty and poor diet.

    • Yes, unfortunately children and adolescents are completely glued to their lousy diets. That is why I have advocated supplements. It is the ratio of calories to the catalysts that enable them to be oxidized. That is one of the reasons that when a person has obvious thiamine deficiency, the measurement of thiamine in the blood is found to be normal. The excess calories creates the imbalanceYes, unfortunately children and adolescents are completely glued to their lousy diets. That is why I have advocated supplements. It is the ratio of calories to the catalysts that enable them to be oxidized. That is one of the reasons that when a person has obvious thiamine deficiency, the measurement of thiamine in the blood is found to be normal. The excess calories creates the imbalance

  12. I started supplementing thiamine 100 mg benfotiamine and stopped eating processed carbs and sugar and I get paradoxical reaction. I do eat whole grain carbs and fruit like banana and plums and pears, but have lost appetite with the supplementation of thiamine, so I don’t eat a ton these days.
    I tried ketogenic diet a couple of times and always got a keto rash on my chest, that’s how I knew I was in ketosis.
    And now with the thiamine and no simple carbs and sugar I again got the keto rash and upon testing my urine, it’s full of ketones!
    Anyone else get this? Is this a good/bad sign or does it not matter at all?

    Also, when I feel calm and I take benfotiamine, I get paradoxical reaction and feel awful, but when I am in ketosis like that (even after having eaten a sweet banana!) and feel awful in ketosis, and THEN take benfotiamine it makes me feel better immediately. Isn’t that paradox?

  13. When increasing the dose of thiamine does one increase the dose of magnesium too? For example 100mg Lipothiamine to 200-300mg magnesium, 200mg Lipothiamine to 400-600 magnesium, etc.

  14. Dear Dr. Lonsdale, dear Dr. Marrs,

    Is it still possible that I have a thiamine deficiency if I have been supplementing thiamine for years?

    For 3 years now I have been taking 2 antidepressants (SNRI and SARI) for my lack of energy and sleep trouble including restless legs and palpitations at night. In the years prior to that I have occasionally experienced panic attacks. I also used to take a lot of pain medication for back pain (for approx. 2 years) until I finally had surgery 2 years ago, and together with this I had to take proton pump inhibitors to protect the stomach.

    Together with the SNRI and SARI (Trazodone) my doctor prescribed me Vitamin B1 in the form of Thiamine Disulfide (100 mg a day) together with B6 and B12, which I have been taking also for a couple of years.

    Only recently have I started to add Magnesium.

    I am still tired a lot, am lacking energy and can not fall asleep without the Trazodone. My nerves seem to be getting weaker and weaker, I can not manage things anymore that seemed easy to me 5 years ago.

    Via a friend I came to learn about Thiamine deficiency and paradoxical reaction and out of curiosity I tried her Benfotiamine 100 mg and had an immediate reaction to it: heavy brain fog. The next day I took another one and felt nothing. So I took a second one a couple of hours later and got palpitations, feeling of cold shivers in my chest and suddenly feeling very restless and tired like before you get a flu. This effect lasted several hours.

    Is it even possible that I do still have a thiamine deficiency if I have been taking 100 mg of Thiamine Sulfide daily for a couple of years (although without magnesium), or how can it otherwise be that I react to Benfotiamine in such a way?

    I would love to come off the antidepressants and was hoping that maybe I could if I supported the mitochondria by providing them with what they really need.

    Your advice or any input is highly appreciated!

    Thank you!

    Melanie L.

    • Yes, I think you still have thiamine deficiency. Two antidepressants, proton pump inhibitor and trazodone all may contribute. Panic attacks are typical of energy deficiency in the brain. When you took Benfotiamine you had at classical paradoxical reaction. This occurs when you take a big dose of thiamine after long-standing deficiency. You can look up “paradox” as a post on “Hormones Matter”. Paradox can last as long as a month while taking the thiamine but you have to persist through this period in order to get relief

      • Thank you, Dr. Lonsdale! This is great information! I will read up on it and keep taking the benfotiamine then. Thank you!

  15. Dr Lonsdale,

    Thank you very much for all your work!! I am a 32 year old COVID Long Hauler… came down with the virus in March and have been suffering a variety of “post COVID” issues ever since. Chest pain, horrible fatigue, cold hands/feet, sleep disturbances, brain fog, swollen glands, sore throat, amongst other minor things.

    Have you read about the COVID Long Haulers? Many are young and previously fit and in good health.

    Do you think the Long Haulers may just be suffering from a post-viral mild/moderate beriberi? Thiamine defiency? Since viruses are a severe stressor that can deplete stores of B1.

    I also have a history of somewhat “unexplained” GI problems and array of mild neurological things.

    Many other Long Haulers I talk to have POTS, dysautonomia, GI problems, skin issues, SOB, air hunger, just an incredible range of symptoms that seemingly overlap Thiamine deficiency.

    Please let me know your thoughts!

    Thank you!

    • This is very interesting because I have been thinking for some time that thiamine deficiency represents the ultimate pathology of Covid. In fact, I sent a letter to the editor of a newspaper suggesting that TTFD might be used as a treatment. Whether they will publish it or not remains to be seen .TTFD (thiamine tetrahydrofurfuryl disulfide) is a derivative of thiamin and has a very powerful biologic effect on stimulating energy. If you cannot get it I suggest that you look into getting it from Ecological Formulas, a vendor in California. It also needs to be taken with magnesium and a multivitamin

      • Thank you!! There are thousands of Long Haulers in the USA and doctors cannot figure us out with traditional organ scans and bloodwork.

        I feel like thiamine deficiency could be the cause because of the symptom overlap and the fact that western medicine would never consider a thiamine deficiency as the cause.

        I will order the TTFD. What do you suggest for dosing as a trial? I already take a methylated B complex and Magnesium Glycinate.

  16. Dear Dr. Lonsdale and dear Dr. Marrs,
    in August 2019 I abruptly became very sick and after three very intense months (nine times in the hospital and multiple medical specialists) was finally diagnosed with Beriberi (dry and wet, unrelated to alcohol, as I drink very little) by an amazing functional medicine physician assistant who has read your book and started treating a lot of her patients according to your studies. I improved within a week of taking thiamine and magnesium. I felt good for 7/8 months but a month ago I started having daily abrupt episodes of fainting (mostly after eating – even small meals). My diet is very healthy: mostly veggies, grains, fruits, cereal, very little carbs and almost no sugar. I am currently taking 4 Allithiamine 50mg and 2 Magnesium Taurate a day. Could you please recommend what I could try? Many thanks, Stephanie

    • I am happy that you found some relief with the thiamine. I am afraid, grains, fruits, cereal are quite high carbohydrates and any alcohol consumption will be problematic. Is there not any protein or fat in the diet? Those are necessary for health. I suspect your reaction after eating is relative to these carbohydrates and will necessitate either additional thiamine and/or the reduction or elimination the carbohydrates, this along with the addition of protein and fats to your diet may help. It is also possible that you need additional B and other vitamins.

    • You need to remember that thiamine and magnesium are members of a complex team. They do not work on their own. I suggest that you add a well rounded mulltivitamin. If that doesn’t work then request I/V supplementation

      • Thank you Dr. Lonsdale. I am thankful for your answer and for your generosity sharing your knowledge.
        Stephanie

  17. Dear Dr. Lonsdale,
    have you ever come accross any thiamine deficient patient who’s had the following symptoms or does this sound plausible to you?:

    Waking up early morning like 4 or 5 a.m. (almost every morning) with palpitations (heart rate goes up to 140 – 160 according to holter monitor) plus shivering, sweaty chest, feeling like I’m about to die – and all of this ceases 10 minutes after ingestion of carbohydrates like fruit juice (which I keep at my bedside since this all started). It surely feels like hypoglycemia but when I take blood glucose levels upon waking up in this state, it always appears in the normal range between 80 and 100.

    I’ve called the ambulance several times when it happened, but ecg and blood work always come back normal, except for slightly low serum potassium (which never concerns any of the doctors, even if I tell them that my diet is rich in potassium). Holter monitor 24 hrs confirms high heart rate, but no dangerous arrhythmias or anything. The cardiologist says the heart is fine and the tachycardia is probably due to hypoglycemia and the extreme fatigue and weakness (not being able to walk even 1 kilometre in spite of looking healthy) I have been experiencing the last few months is probably a post viral thing or “psychological”. Regarding my nightly “hypoglycemic” episodes, he would want me to do a glucose tolerance test (5 hours), but there is no way on earth I would currently make it to the lab in the morning with the required empty stomach, as I can’t even get out of bed without the fruit juice/carbs.

    I have only recently been diagnosed with POTS and have had all the symptoms of Chronic Fatigue Syndrome for quite some time (years…), but they have gotten quite severe a couple of months ago.

    The POTS is way worse when my stomach is empty (like in the mornings) or if I forget to eat during the day (I have hardly any appetite these days).

    Is it plausible that my body or heart can’t make it through the night properly anymore without getting carbohydrates for glucose, if I’m thiamine deficient, due to impaired mitochondrial function?
    The cardiologist says he’s never heard of such a thing. He only seems to know postprandial hypoglycemia and it doesn’t make sense to him that my episodes come at 4 or 5 am in the mornings when I ate 7 or 8 hours ago.

    I have just come accross your work on thiamine deficiency and I am so hopeful that this is it in my case too. I am currently waiting for TTFD to be delivered to me via mail and am using Benfotiamine (50 mg) in the mean time. I got paradoxical reaction from Benfotiamine right away (palpitations even when I have eaten well, severe brain fog, feeling uneal, suddenly tired in a very heavy untypical way, POTS more severe than usual and a general feeling of anxiety).

    I understand this is a good sign and I should stick to it. I was just wondering if these early morning palpitations and feeling of impending doom that is stopped only by carbohydrates is something that you might have come accross at all and if you think it all makes sense.

    I’m particularily worried because it feels like I would die if I didn’t ingest the fruit juice when the palpitations happen, but I have no appetite/thirst for sugar or anything else whatsoever. I have to force it down every morning and am worried what would happen if I couldn’t one day, because I got sick or something and just couldn’t force them down anymore.

    Until recently I thought that in such case I would probably go to hospital and they would have to give me IV glucose and then I’d be fine, but then I read your account of how IV glucose probably killed a thiamine deficient boy. And now I fear that if I had to go to the hospital again with a pulse of 160 and feeling sick and tell them I just need IV thiamine hcl, they would probably think I am a mental health patient.

    I guess my questions are: have you come accross such phenomenon in thiamine deficiency and what is your opinion of what would happen if I didn’t manage one day to eat or drink carbs when my heart is going crazy like that in the mornings?

    I’ve only started to take Benfotiamine 2 days ago, so during paradoxical reaction I am probably looking at more palpitations like that happening in the next weeks.

    I’m very hopeful though that things will get better again with thiamine supplementation (I am also taking Magnesium, B complex, potassium, multivitamin).

    Thank you so much for your work and your relentless efforts to educate people on thiamine deficiency. It’s so unbelievable that doctors don’t seem to know about this at all!

    Thank you!

    Sincerely yours,
    Anna

    • You have classic beriberi and a combination of thiamin and magnesium will relieve you when the paradox has subsided. Your treatment with fruit juice will make things worse. Use fresh fruit rather than juice.

      • Dear Dr. Lonsdale,
        thank you so much! You don’t know how happy this makes me! I will spread the word as soon as I’m up on my feet again.

        Thank you and Dr. Marrs for your work and for saving peoples’ lives!

        Yours Anna

          • Anna,

            I know this is an older post. However, my recent symptoms were exact!! I began having symptoms when I waited an extended period of time between meals. Classic hypoglycemia symptoms but NO hypoglycemia, blood glucose normal! Visited ER with heart rate and arrythmia out of control and the only relief was an immediate juice, followed by a carb snack. I began carrying juice and a carb snack everywhere I went.

            No hypoglycemia, even after a 12 hr. nerve wrecking fasting glucose test. I am working with a new Endocrinologist to figure this out. In the meantime, I learned many individuals on the Keto Diet experienced the same cardiac symptoms when initially limiting carbs. I am not on that diet, but my carbs are limited when I skip or delay meals so same reaction.

            I remembered how in the past, my arrythmia surfaced with a vengeance when my Thiamine was low so I had it tested. Low and behold, mildly low Thiamine! I have been taking 25mg Thiamine HCL for 1 week and began feeling better after 2 days. Literally, 2 days. Stopped all supplements of Mag/Cal and Vit D, reduced the juice and drastically reduced sugar intake and continuing with my usual diet of protein, veggies, fruits and limited dairy. Haven’t felt this good in 4 months. I know for a fact it was a Thiamine deficiency, although I have never consumed alcohol etc. I will re-introduce the supplements gradually, one by one but not the Calcium (history of kidney stones easily so I’ll get Calcium from food).

            Many blessings to you, this is some ride.

  18. Dr.Lonsdale, despite good (even great) initial reactions to TTFD, benfothiamine and cocarboxylase I repeatedly crash and can’t get onto consistent supplementation regime. I read everything you posted and your book as well, and aware of refeeding paradox, need for magnesium etc.
    Recently I found 1963 article which reviews vitamins effect on growth of Candida albicans. Thiamine (including allithiamine and cocarboxylase) and especially B12 significantly stimulated fungal growth. I have long suspected that candida is part of my problem so not sure what to do now. I clearly need thiamine, but 1-3 days after starting supplementation symptoms become unbearable. Last year I forced myself to continue supplementation with TTFD for a month hoping things will get better, they didn’t.
    Have you seen any connection between thiamine supplementation and candida infection? In your opinion, is there anything one could do to be able to supplement?
    Thank you.

    • You say nothing about diet, particularly concerning your intake of alcohol and sugar, both of which will precipitate thiamine deficiency. I was not aware of the connection between thiamine and yeast and have not got an explanation. When you state that you “crash” after two or three days of thiamine supplementation, I am not sure what you mean. What are the symptoms associated?

      • No alcohol for many years. Don’t tolerate even the smallest amount. No sugars for a year now, very low carb for last 7 months. Overall very clean diet without processed/junk food for many years – vegetables, meat, fruit.
        Started to have strong anxiety several years ago, with an avalanche-like worsening two years ago after stressful event. Extreme sensitivities, brain fog, lots of unrelated symptoms which are “all in my head” as they say.
        Intolerance of carbs, they make anxiety much worse very quickly.
        Some time after anxiety started couldn’t tolerate any supplements or foods, and by doing trial and error found that sublingval cocarboxylase clears most symptoms in 10 minutes.
        Read your book and articles, tried TTFD – feeling totally normal for a day, then crashing back to anxiety, brain fog, etc. Added magnesium, took ttfd+magnesium for a month, same reaction. Though magensium alleviated some symptoms. First two hours after taking TTFD were the worst.
        Now a year later, trying to take benfothiamine, or ttfd or sulbuthiamine in order to get rid of brain fog and other things. Benfothiamine is the most tolerable (lowest potency in the nervous system I assume). Fog clears after an hour, but the same reaction of increased anxiety, racing thoughts starts and accumulates over several days, so I quit, then try again and so it goes.
        Reaction to carbs and other foods is so quick that I suspect some weird flora high in the GI or even in the mouth.
        High functioning before onset of anxiety – university, phd, demanding work. Still work but brain fog is often overwhelming.
        The paper I mentioned says that B12 was the most powerful stimulator for candida, but thiamines also had some effect. I found that myself, taking any b12 during thiamine supplementation crashes me twice as strongly as thiamine alone.
        Here is the link to the abstract I mentioned:
        https://link.springer.com/article/10.1007/BF02052582
        Thank you!

        • I am not a doctor. I do, however, have a child (now in her 20s) who had a lifetime of severe anxiety issues, as well as the range of thiamine deficiency issues written about in this blog. I wanted to comment that we began to get ahead of her anxiety issues (of four possible levels of severity, hers was the worst level) when I began reading old medical texts that focused on the basics of nutrition to build a healthy, well-functioning body.

          One of the main things we changed was adding calcium back into her diet. Reading your post above, I suspect that you are doing what many young people are doing today (including my own kids)–meat and vegetables with some complex carbs, but possibly avoiding milk products. Many of my kids’ friends are vegan.

          We took milk out in the first place because we felt it made her feel angry and depressed. We thought that adding in a plant-based milk product fortified with calcium would be good enough to fill her calcium needs (the doctors thought so too, by the way.) But after a couple of years of 100% avoidance, we had a pizza–and she slept through the night for the first time in a long while.

          That was my introduction to the importance of the basics. I’d like to encourage you to find a REAL nutrition book–and that would probably be an old one. Read about the basics and check to make sure you have your important building blocks in place. One of the best fixes for the anxiety we found for my daughter was having a high-protein, high-fat breakfast, with no carbs; no carbs until after 3:00; and then loading carbs at night. This “technique” was written about in a book called “The Circadian Prescription” by Dr. Sidney M. Baker. It’s an older book and you could get it on Amazon for a few bucks–and it’s an easy and enjoyable read.

          Another discovery we made was the importance of rhythm in my kids’ lives–getting up at the same time each day, eating at the same times each day, and bed at the same time each day, or at least reaching toward that goal.

          And something very important for our times–media use is VERY stressful. And addictive. I have read good studies that say electronic stimulation of the brain by all kids of media cause similar brain changes and life issues as alcoholism and drug addiction. Sometimes worse. This means, I think, that you will see the same thiamine depletion issues as a result of electronic stresses as you see in alcoholism. But it has been almost impossible to manage this with my kids, and even we adults are forced to use these tools extensively–and run the danger of stress damage from them too.

          Anyway, I wanted to encourage you to think about the big picture, and look at older nutrition texts to guide your nutritional choices. I am a believer in supplements, and take allithiamine, etc. every day, but supplements are sort of like the antidote to poison. It’s been important here for us to rebuild basic health foundations along with taking the supplements. It’s really very easy to have big gaps in nutrition, even when you’re working hard on your food. I also think life’s stressors today are FAR beyond what we realize, and it’s important to try to recognize them and weed out what you can.

          Best of luck!

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