calorie rich versus nutrient rich

The Paradox of Modern Vitamin Deficiency, Disease, and Therapy

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In order to understand why this article is about “paradox”, the concept of vitamin therapy must be appreciated. Hence, the explanation of the title is deferred to the end. Although vitamin deficiency disease is believed by most physicians to be only of historical interest, this is simply not true. When we think of a vitamin deficiency disease, we envision an individual living in a third world country where starvation is common. Such an individual is imagined as being skeletal, whereas an obese person is considered to be well fed with vitamin enriched foods. For this reason, common diseases, some of which are associated with obesity, are rarely, if ever, seen as potentially vitamin deficient.

The Calorie Rich and Nutrient Sparse Modern Diet

Our food is made up of two different components, the caloric and the non-caloric nutrients.  When we ingest high calorie foods (e.g. a doughnut) without even a vestige of non-caloric nutrients, we refer to this as “empty” or “naked” calories.  For our food to be processed into energy that enables the body and brain cells to function, there must be a ratio of the calorie bearing component to that of the non-caloric nutrients.  When we load the calories together with an insufficiency of non-caloric nutrients, we alter this ratio and produce a relative vitamin deficiency.  The trouble with this is that it does not result in the formation of the classic vitamin deficiency diseases as recorded in the medical literature. There is a gradual impairment of function, resulting in many different symptoms. Because modern medicine seeks to make a diagnosis by the use of imaging techniques and laboratory data and because of the physician’s mindset, if the tests used are normal, the possibility of a relative vitamin deficiency is ignored.

The Brain as a Chemical Machine

We have two different nervous systems. One is called “voluntary” that enables us to do things by will-power.  This is initiated and controlled by the upper brain, the part of the brain that thinks. The other system is known as the autonomic nervous system (ANS).  This is initiated and controlled by the lower part of the brain, the limbic system and brainstem.  This system is controlled automatically.  Although it collaborates with the other system, it is not normally under voluntary control. The limbic system and brainstem are highly sensitive to oxygen deficiency, but since the oxygen is useless without the non-caloric nutrients, their absence would produce the same kind of phenomena as oxygen deficiency. Thiamine (vitamin B1) has been found to be of extreme importance as a member of the non-caloric nutrients. The brain, and particularly the limbic system and brainstem, is highly sensitive to its deficiency.

Since the ANS is automatic, we are forced to think of the limbic system and brainstem as a computer.  For example, when it is hot, you start to sweat.  Evaporation of the sweat from the skin produces cooling of the body, representing an adaptive response to environmental hot temperature. When it is cold, you may start to shiver. This produces heat in the muscles and represents an adaptive response to environmental low temperature. If you are confronted by danger, the computer will initiate a fight- or- flight reflex.  This is a potential lifesaving reflex.  It is designed for short term use, consumes a vast amount of energy and prepares you to kill the enemy or flee from the danger.  Any one of these reflexes may be modified by the thinking brain. For example the lower brain, also known as the reptilian system, initiates the urge to copulate.  It is modified by the upper brain to “make love”.  The reptilian system, working by itself, can convert us into savages. There is an obvious problem here because our ancestors were faced with the dangers of short term physical stress associated with survival.  In the modern world the kind of stress that we face is very different for the most part.  We have to contend with traffic, paying bills, business deadlines and pink slips. The energy consumption, however is enormous, continues for a long time and it is hardly surprising that it is associated with fatigue, an early sign of energy depletion. It has been shown in experimental work that thiamine deficiency causes extensive damage to mitochondria, the organelles that are responsible for producing cellular energy.

Autonomic Function

The autonomic nervous system, controlled by the lower brain, uses two different channels of neurological communication with the body. One is known as the sympathetic system and the other is the parasympathetic. There are also a bunch of glands called the endocrine system that deals with the brain-controlled release of hormones.

We can think of the sympathetic branch of the ANS as the action system. It governs the fight-or-flight reflex for personal survival and the relatively primitive copulation mechanisms for the survival of the species. It accelerates the heart to pump more blood through the body.  It opens the bronchial tubes so that the lungs may get more oxygen. It sends more blood to the muscles so that you can run faster and the sensation of fear is a normal part of the reflex. When the danger is over and survival has been accomplished, the sympathetic channel is withdrawn and the parasympathetic goes into action. Now in safety and under its influence, body functions such as sleep and bowel action can take place.  That is why I refer to the parasympathetic as the “rest and be thankful system”.

Dysautonomia, Dysfunctional Oxidation and Disparate Symptoms 

When there is mild to moderate loss of efficiency in oxidation in the limbic system and/or brainstem they become excitable. This is most easily accomplished by ingesting a high calorie diet that is reflected in relative vitamin deficiency.  The sympathetic action system is turned on and this can be thought of as a logical reaction from a design point of view.  For example, if you were sleeping in a room that was gradually filling with carbon dioxide, the gradual loss of efficiency in oxidation would be lifesaving by waking you up and enabling you to exit the room. In the waking state, this normal survival reflex would be abnormal.

High calorie malnutrition, by upsetting the calorie/vitamin ratio, causes the ANS to become dysfunctional. Its normal functions are grossly exaggerated and reflexes go into action without there being any necessity for them. Panic attacks are merely fragmented fight-or-flight reflexes.  A racing heart (tachycardia) may start without obvious cause.  Aches and pains may be initiated for no observable reason. Affected children often complain of aching pain in the legs at night. Unexplained chest and abdominal pain are both common. This is because the sensory system is exaggerated. One can think of it as the body trying to send messages to the brain as a warning system.

Nausea and vomiting are both extremely common and are usually considered to be a gastrointestinal problem rather than something going on in the brain. Irritable bowel syndrome (IBS) is caused by messages being conveyed through the nervous system of the bowel, increasing peristalsis (the wave-like motion of the intestine) and often leading to breakdown of the bowel itself, resulting in colitis.  Of course, the trouble may be in the organ itself but when all the tests show that “nothing is wrong”, the symptoms are referred to as psychosomatic. The patient is often told that it is “all in your head”.

Emotional instability seems to be more in keeping with psychosomatic disease because emotional reactions are initiated automatically in the limbic system and thiamine deficient people are almost always emotionally unstable. A woman patient had been crying night and day for three weeks for no observable reason. A course of intravenously administered vitamins revealed a normal and highly intelligent person.  Intravenously administered vitamins are often necessary for serious disease because the required concentrations cannot be reached, taking them by mouth only.

The Vitamin Therapy Paradox

The body is basically a chemical machine.  But instead of cogwheels and levers, all the functions are manipulated through enzymes that, in order to function efficiently, require chemicals called “cofactors”. Vitamins are those essential cofactors to the enzymes.  If a person has been mildly to moderately deficient in a given vitamin or vitamins for a long time without the deficiency being recognized, the enzyme that depends on the vitamin for its action appears to become less efficient in that action.  A high concentration of the vitamin is required for a long time in order to induce its functional recovery.

Although the reason is unknown, doctors who use nutritional therapy with vitamins have observed that the symptoms become worse initially.  Because patients expect to improve when a doctor does something to them and because drugs have well-known side effects, it is automatically assumed by the patient that this worsening is a side effect of the vitamins. If the therapy is continued, there is a gradual disappearance of those symptoms and overall improvement in the patient’s well being. Unless the patient is warned of this possibility he or she would be inclined to stop using the treatment, claiming that vitamins have dangerous side effects and never getting the benefit that would accrue from later treatment.  This is the opposite effect that the patient expects. This is the paradox of vitamin therapy. 

If we view dysautonomia as an imbalance in the functions of the ANS and the vitamin therapy as assisting the functional recovery by stimulating energy synthesis, we can view this initial paradoxical as the early return of the stronger arm of the ANS before the weaker arm catches up, thus worsening an existing imbalance. However, this is mere speculation. I did not learn of the “paradox” until I actually started using mega dose vitamins to treat patients.

The Paradox and Thiamine

In this series of posts, we are particularly concerned with energy metabolism and the place that thiamine holds in that vital mechanism.  It is, of course, true that worsening of serious symptoms is a fact that has to be contended with and vitamin therapy should be under the care of a knowledgeable physician. The earlier the symptoms of thiamine deficiency are recognized, the easier it is to abolish them. The longer they are present the more serious will be the problem of paradox and a clinical response will also be much delayed and may be incomplete.

Beriberi and Thiamine Deficiency

I will illustrate from the early history of beriberi when thiamine deficiency was found to be its cause.  Many of the patients had the disease for some time before thiamine was administered, so the danger of paradox was increased. It was found that if the blood sugar was initially normal, the patient recovered quickly. If the blood sugar was high, the recovery was slow.  If the blood sugar was low, the patient seldom recovered.  In the world of today, an abnormal concentration of glucose in the blood would make few doctors, if any, think of thiamine deficiency as a potential cause. It is no accident that diabetes and thiamine metabolism are connected. Education of the doctor and patient are both absolutely essential. I believe that the ghastly effects of Gardasil, and perhaps some other medication reactions covered on Hormones Matter, can only be understood by thinking of the body as a biochemical machine and that the only avenue of escape is through the skilled use of non caloric nutrients.

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Image by Rochak Shukla on Freepik

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. My brother and I both have symptoms of active thiamine deficiency. My dad has read your book and articles. The problem is, there are no doctors that we can find that will help with such a problem or oversee us during thiamine administration. We both have bad symptoms, my brother can’t walk half the time, has muscle spasms, extreme constant nerve pain for 2 years, along with other issues. I have gastroparesis, rely on infusions, eosoniphilic esophagitis/colitis, extreme fatigue to the point now it makes me feel tired sometimes just trying to breathe, and brain fog. What do we do if we can’t find a doctor to help us with this? My next youngest brother now passes out as he gets older. He was diagnosed with vasovagal. My mom has fibromyalgia. Something is not normal with our genetics but no doctor looks into active deficiencies.

    • Unfortunately, there are very few doctors who understand this. That is why we wrote the book and publish articles on this website. Most folks have to navigate this themselves. It sounds like your family has a problems with thiamine. Use what is published here to help yourselves find a dose and formulation of thiamine that works for you.

  2. Dr. Lonsdale,
    I have had burning pain in my right foot and leg for about 7 years. I have taken three 50 mg doses of lipotheamine over a period of three days. My pain level today is sky high – maybe the worst it’s ever felt. Could this increase of pain be a paradox symptom? Is it even possible to have paradox symptoms after only 3 days of taking lipotheamine?

    Thank you, Dan

      • I’m taking 240 mg Pure brand magnesium, and Pure brand Methyl B Complete (25mg riboflavin, 15mg B6, 3400 mcg folate, 1,000 mcg B12), so it doesn’t have all the B vitamins. I’m heterozygous for the C677T in the MTHRF gene – I don’t know if that matters here.

        Any suggestions?

        I just now saw your response – I didn’t receive an email.

  3. Hello. I am a 75 year old woman with a history of neurological issues, spasmodic dysphonia, fibro muscular dysplasia, with severe chronic fatigue. I had polio when I was three but recovered with chronic leg aches which disappeared in my teens then reappeared in my late twenties. I now have nystagmus. I heard about thiamin deficiency and have ordered TTFD that has magnesium in it. I have great hopes that this will help my condition, but read that if it is long standing it might not help. I am hopeful.

  4. After years of poor eating habits and sugar cravings, I began with diagnosis of possible CFS, then abdominal myoclonus, sleep apnea, – eventually a diagnosis functional neurological disorder, and finally – deteriorating cognitively and physically and now unable to work, mostly housebound and extremely weak, was diagnosed with POTS/ dyaautonomia. I learned about thiamine and began oral mega doses of TTFD. Initially I felt better: quickly saw better sleep, end to palpitations, less polyuria… then after a week, I crashed hard and dysautonomia was more severe than Id ever seen – at times I couldn’t lift my body off the floor and was too tired to chew… it went on for 5 days including 3 days after my last dose. Would you say this was the P.R? I want to try again but if I’m going to feel that badly off for some time, I have to prepare as I live alone and it was tough. How long did the longest episode of a paradoxical reaction you’ve witnessed last? Thank you so much for all the wonderful information you’ve shared with us.

    • Your history of consuming junk food certainly sounds like you induced thiamine deficiency. The initial improvement taking thiamine, followed by a worsening of your symptoms, suggests to me that you did not take magnesium at the same time. Thiamine and magnesium are both essential to synthesis of energy in the body and one without the other will easily cause mitochondrial collapse. If you try again, take 125 mg of a magnesium salt with the thiamine

  5. I have full body neuropathy that is very difficult to find a reason for its cause. I did have tests that showed elevated pyruvate and lactic acid. Then I took a whole blood test that said my thiamin levels were low. I’ve since been supplementing and had two rounds of b vitamins through my veins. My B1 levels were rechecked and my levels are high now. But I’m feeling way worse a month after supplementing. What am I doing wrong? Can the paradox last a month or more? Should I keep looking at different causes?

    • I would guess that you have a genetic risk factor that obstructs the absorption of thiamine. Try using Lipothiamie that is absorbed into the cell very much more easily than other derivatives. You can look it up online

  6. ThNk you for writing about Thiamine! I have had Fibromyalgia, Chronic Fatigue Syndrome and IBS for over a decade. I did the Spectrcell Micro Nutrient test a few years ago and added or upped vitamins, minerals that were deficient. B1 was low normal so didn’t add at the time. But after seeing some articles on Thiamine I decided to try 500 mg this summer to see if made a difference with fatigue and i think it has helped somewhat and is worth continuing. “Normal” differs for us all and FMS and CFS often have normal range test results that don’t tell the real story!

    • This post includes several items that require comment. 1. note that she has had “three separate diseases” for a decade.Chronic fatigue, fibromyalgia and IBS are all different physical and mental representations of the same underlying cause—-defective energy metabolism. Chronic fatigue is supposed to be a “psychologic” condition. Fibromyalgia is supposed to be inflammation of soft tissues, and IBS is supposed to be a disease of the bowel, both of which are believed to have an unknown cause. 2. All three conditions are due to a breakdown in energy metabolism. Energy is generated by the mitochondria and although it is a complex process involving many components, the major item that governs this function appears to be thiamine. 3. The amount of organic damage that has accrued in a decade is completely unknown. If the symptoms had been recognized for what they represent when they began, treatment would have been easy and quick. 4. Thiamine is not a magic pill that “cures” anything. It is an essential component in maintaining every aspect of health. It is its deficiency in diet that has to be recognized as early as possible. The longer the deficiency wreaks havoc in our cells, the more likely is it to develop organic damage that cannot be treated at all. Sugar easily precipitates thiamine deficiency and is the curse of our present civilization, costing the health of millions!

  7. Dr. Lonsdale: just a quick question, what is the timeframe of recovery for a thiamine deficient individual after supplementation? Does it all very person to person?

  8. Dr. Lonsdale,

    Starting on the thiamine today (still waiting on the other supplement to be delivered). I am beyond excited to see what results I might achieve. Being disabled, and living on primarily frozen dinners for the last six+ years, B1 was never discussed by any of my doctors as necessary for me to take…so I NEVER did. Vitamins B12, D3, C – all those, yes. But reading everything you have written regarding the necessity of thiamine, that might explain why I’ve gone from walking without assistance, to having to use a cane, to now needing to use a walker…and even that device is problematic to navigate. I have no idea how I’m functioning at all with zero thiamine in my body (before this evening, of course), I can only imagine that the coming ‘paradox’ will be intense…but am willing to endure anything that might help me get my life back!

    With gratitude for your knowledge,
    Diana Howell

  9. Intriguing information. But I had a VERY hard time reading it, because of the choice of greyscale type. This is NOT a credit card statement where there is a criminal motivation to ensure the information is hard to read. Please change the font to a normal black type. (Don’t allow some 12 year old web master with perfect vision make your vital information hard to read! Thank you.

    • Well noted. No one has commented on the font color previously but I suspect you are correct, it is difficult to read. We are planning a redesign within the next six months and will take the font color into consideration.

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