thiamine deficiency - Page 8

Pancreatic Divisum with Gastroparesis and Bowel Dysmotility Requiring TPN

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My health issues began 10 years ago, after a holiday Turkey. I was 29 and had just experienced a relationship break up. At the time I was eating bad food and drinking lots of alcohol. On the last night, we went to a different hotel. After visiting the mud baths, we were starving and ventured to a food vendor outside. This was a mistake. On the second day home, I didn’t feel well and had developed a very bad urinary tract infection. The infection had cleared but then at about two weeks, I developed a weird scratching feeling under my right rib. When the pain worsened, I saw doctor. I said that I had just returned from holiday and so he ran some general blood tests, but found nothing.

The pain continued to worsen and I struggled to eat. It felt like I had gas in my upper intestine and it’s pushing on my vagus nerve and diaphragm so I can’t breathe. Then, due to low acid, nothing can leave my stomach. I was sent for an endoscopy and colonoscopy. These two came back negative. The doctor said I was depressed, as I was now down 8 stone, and that I had IBS.

During this time, I was nauseous and became anxious for no reason. My vision was blurry and I felt like the food I ate wasn’t digesting. I was becoming so ill, that I could not function, so I left my job and returned to my parents’ house. The doctor there put me on Zoloft. Within a few weeks, I slowly managed to eat. Within two months, I was back to normal but would get these massive flares up now and again. I would become nauseous develop severe anxiety for a day, but then it would then pass. I noticed even though I went to the toilet I would never pass gas, but didn’t think much of it.

As I felt better, I stopped Zoloft. Within three months the pain was back, but I could still eat. This time the Zoloft didn’t work. My friend had tramadol and that was the only thing that stopped the pain. So the GP then gave me tramadol.

I was on tramadol for 4 years. I couldn’t drink alcohol, as this made it worse. I continued to have tests and the pain was still bad. I had MRI with secretin that showed pancreatic divisum, a congenital condition where the ducts have not fused but doctor didn’t feel it was the problem. Maybe he was wrong. Pancreatic divisums are associated chronic pancreatitis, which is in turn is associated with gastroparesis and upper bowel dysmotility, both of which I had. I also went to a pain clinic, but nothing worked. I had a gallbladder function test and CT scan, and again, everything was fine. Nothing showed up anywhere.

Gallbladder Removal, Metronidazole, and My Continuing Decline

In 2017, the decision was made to remove my gallbladder. I was told it might not help, but I felt I had no other option and so out it came. I had cholestasis but no stones. The doctor commented that I was constipated all the way round my colon and thought that might be the issue. I was okay for a few weeks and then things turned bad. I can no longer digest fats. Attempting to eat any fat gives me agony. I get cramping in my bowel.

After my gallbladder was removed, I couldn’t eat due to the pain. I decided to see a nutritionist and had a stool test. The test showed Klebsiella, a few other nasties, and candida. I was put on grapefruit seed extract and Uva Ursi. I started passing foul smelling gas and a lot of stool was coming out. I began to improve. I felt hungry again and began eating the rainbow, as they say. I told the nutritionist that I felt better on the grapefruit seed extract and was told begin taking it every day. This was too much and it led to increased bowel cramps and then vomiting. Every time I took the herb, I would get nauseous and vomit. She told me to stop and take probiotics. This too made me feel worse. I now could not tolerate anything. She gave up told me to go to a doctor.

So I went to a doctor and she gave me metronidazole (Flagyl). I took it. It was awful. The anxiety was terrible and the pain was insane. When I finally stopped, I was in agony whenever I ate, so I took some marshmallow root and slippery elm. This seemed to help a lot. For one week, I could eat. By the end of the week though, I was awful and back to not being able to eat or go to the toilet.

I would get electric shocks and jolts in my sleep to sounds and noises. I had intense nausea and pain and could only tolerate liquid sugary drinks. I finally got a referral to a gastrointestinal specialist. She agreed to do gastric emptying study. I have severe gastroparesis to solids and liquids and was given Domperidone. I took some probiotics and stayed on a soup diet. This helped for 4 weeks but then it all fell apart again and I was back to the point of needing a feeding tube.

I had a nasal jejunum (NJ) tube in the intestine in 2018. This made me worse and the pain in my gut was insane. I also had a foggy brain and experienced body jolts. They gave me a lot laxatives. I was left in this state for a year until my weight dropped to 42 kg. At that point, I was put on total parenteral nutrition (TPN), with a central line that sends nutrients directly to the bloodstream. Pancreatic divisum, gastroparesis, nasal jejunal tube

At this point, I did find a functional doctor, who was pretty sure I had SIBO. So just before TPN, we tried Rifaxamin and metronidazole. I only lasted two days. I felt so drugged. I didn’t feel better until I stopped. Then I felt ok for a few days but that was it.

On TPN, I gained some weight but still felt drugged. A few months later, I got a line infection, developed sepsis, and again in April. I also had a fungal infection, and was given high doses of antifungals by IV. I actually felt a bit better on this. I was craving chocolate, crisps. I wasn’t hungry but just wanted crap food.

Unexpected Pregnancy

I went back to my parents. I was with my partner and I was very ill now. After a month, my bloods were all over the place I didn’t feel right. Then in the August 2020, I picked up. I was very tired, but I felt a little happier. Then I started getting a bulge in the bottom of my gut. The doctor sent me to hospital. The next day was a shock. I was pregnant. With twins!

We decided to go ahead as I was already 20 weeks pregnant and this was my only chance of having children. When I hit the 3rd trimester my gut was gurgling. Gas came out and I could taste food but still couldn’t swallow as I would fall in to a coma type sleep.

I had the children by caesarean section. Afterwards, my body was just pouring out orange bile in the toilet. I was in agony. A few days later, I got Covid. I experienced no real symptoms, but my liver enzyme was over 400. Disaster struck again few weeks later when I developed sepsis again, and then again, a few weeks later. Both times I was treated with antibiotics, however the second time I went in to anaphylaxis.

Since pregnancy, my symptoms have worsened with increased anxiety and heart palpitations, especially in the morning. I still cannot eat or drink, as I fall in to my coma sleep. Every night I’m sweating and getting horrendous nightmares.

Treatments and Tests

Below are things I’ve tried and tests I have taken.

Alternative Treatments

  • Acupuncture – I pass out in my coma sleep after, have horrible nightmare and feel terribly anxious.
  • Cognitive behavioral and eye movement desensitization and reprocessing therapy
  • Visceral massage – Calmed me a little but the gas just got stuck and wouldn’t come out.
  • Hypnotherapy
  • Reiki
  • Chinese herbs again pass out asleep

Medications and Supplements

  • I currently take 2 mgs Motegrity but need an enema to get just gas out. But now it’s just passing through as water
  • Magnesium threonate. This helps with the anxiety
  • Ginger
  • Any herbs or supplements and I’m passing out asleep. It’s like my body can’t cope with processing it and shuts down.

Tests

  • Oats – shows high arabinose aspergillus, candida (I have pityriasis versicolor all over my body – a skin yeast infection) and low, B12, B2, B6. Again, I pass out or react with massive anxiety feeling when I take supplements
  • High oxalates
  • Methylation test shows that I slightly over-methylate.
  • B1 checked normal
  • Genova stool test: massive dysbiosis with high Bacteroides, Klebsiella candida, a few other really bad bacteria and hardly any good bacteria

Armin Labs Test

  • Low cd57 – it was 8
  • Coxsackie virus
  • Echo virus
  • Previous Epstein Barr virus not current

As I mentioned, I am on TPN. The ingredients of my nutrient packs are below.

The doctors have run out of ideas and so I am publishing my story here in the hope that someone out there will be able to help. Any suggestions on how to resolve these issues are appreciated. Thank you.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Modern Thiamine Deficiency: A New Review Article

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We are pleased to announce the publication of a new review article exploring thiamine deficiency in food secure countries. As we have written on many occasions, including an entire book on the topic, the expression of thiamine deficiency in the western world is different than in countries with food insecurity. In the US especially, where the predominant diet is comprised largely of processed, but thiamine fortified foods, thiamine deficiency emerges not from the classically defined, starvation-based malnutrition, but from a sort of high calorie malnutrition. Here, calories are plentiful, and by current RDA standards, so too is thiamine, but somehow broad swaths of the population still develop deficiency. In the article we argue that it is not the absence of thiamine but rather regular exposure to anti-thiamine factors in the diet and environment that precipitate deficiency. It is a different starting point, a different chemistry, and ultimately, a different symptomology. The article is called: Hiding in Plain Sight: Modern Thiamine Deficiency.  Enjoy.

From the abstract:

Thiamine or vitamin B1 is an essential, water-soluble vitamin required for mitochondrial energetics—the production of adenosine triphosphate (ATP). It is a critical and rate-limiting cofactor to multiple enzymes involved in this process, including those at the entry points and at critical junctures for the glucose, fatty acid, and amino acid pathways. It has a very short half-life, limited storage capacity, and is susceptible to degradation and depletion by a number of products that epitomize modern life, including environmental and pharmaceutical chemicals. The RDA for thiamine is 1.1–1.2 mg for adult females and males, respectively. With an average diet, even a poor one, it is not difficult to meet that daily requirement, and yet, measurable thiamine deficiency has been observed across multiple patient populations with incidence rates ranging from 20% to over 90% depending upon the study. This suggests that the RDA requirement may be insufficient to meet the demands of modern living. Inasmuch as thiamine deficiency syndromes pose great risk of chronic morbidity, and if left untreated, mortality, a more comprehensive understanding thiamine chemistry, relative to energy production, modern living, and disease, may prove useful.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Image by Hands off my tags! Michael Gaida from Pixabay

Severe Postpartum Anxiety, Suicidality, and Polypharmacy

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Early Health History

I was vaccinated as a kid. I got ear infections, stomach bugs, and I had mononucleosis. I ate a pretty good diet for half of my childhood. My mom always made sure to have meat and vegetables at dinner. I had the flu in high school once, and once in college. In high school, I was very active in the marching band and I was a twirler. I was always a healthy weight and ate reasonably. I believe that I had the flu shot and meningitis shot in college.

In high school, I could take or leave any kind of food or sweets. However, in my second year of college, I crossed over the imaginary line of addiction with food. I began to binge eat, especially sweets. I noticed I was overeating but I couldn’t control it. Eventually, I found help in 12-step programs for my food addiction. I gained weight here and there over a few different times during college. However, since then, I’ve always been able to maintain a healthy weight by not bringing home my binge foods.

A Healthy Pregnancy but a Difficult Postpartum: No Sleep, Anxiety, Suicidality, and a Whole Bunch of Medications

In November 2020, I had my baby.

I took high dose vitamin C throughout my pregnancy and had a very healthy pregnancy and birth. It was supposed to be at the birth center, but that fell through when I tested positive for COVID. I forgot to pack my vitamin C when I went to the hospital, which I think may have affected me. At the hospital, I only got 4 hours of sleep over two days. On the third day, we came home. I got another two hours of sleep, but I became suicidal due to lack of sleep. So I had to go to the mental hospital on my baby’s third day of life.

I was put on Zoloft and Ativan and trazadone in the hospital. I came home from the hospital and things were okay. I had to get a medication adjustment by switching to Seroquel.

Due to my significant other not allowing me to make medical decisions for my baby, I went into fight or flight mode and I became suicidal again on December 7. I had to go back to the mental hospital for about two weeks. None of the anxiety medicine (Buspar, hydroxyzine, and maybe another one) I was taking away resolved the fight or flight. The anxiety was so bad that I could feel my insides shaking from head to toe. I couldn’t sleep at all for days. The only way I was able to sleep was when they finally prescribed me the extended release version of Seroquel. During both hospital stays, I did have a UTI and was treated with antibiotics. I don’t know which antibiotics I was given at the hospital. In February of this year, I had another UTI and was given Macrobid 100mg.  

Crushing Fight or Flight Anxiety

When I came home from the hospital, my fight or flight anxiety was still so bad that I couldn’t even change the baby’s diaper. When I got some Xanax, I was finally able to get stuff done and function. My anxiety finally calmed down to where I could function without Xanax, however, I still had anxiety pretty bad.

On January 8, 2021, I started eating an all whole foods diet, nothing processed, no sugar, flour wheat, dairy, or high fat.

When I eat, I getting very foggy, despite eating a whole food diet. After posting in the orthomolecular group on Facebook, some people pointed out histamine intolerance (HI). So I’ve come to learn that I have HI and probably salicylate and oxalate intolerances too. I’m assuming this because the fogginess after I eat is bad. Also, after meeting with a nutritionist, she pointed out that my prolonged anxiety probably affected how I digest food, hence now causing me to have all these food intolerances. I have found research, a Harvard study, that prolonged fight or flight can cause HI/ digestion issues and actually cause digestion to stop. I have been unsuccessful with a low HI diet due to lack of freezer space/ stress of freezing/defrosting.

I’m also jaundiced. I can’t gain weight and my eye twitches every so often. I’m 5’7” and about 109/110 pounds. It is very scary how thin I am. You can see my sternum and my spine, despite eating three whole food meals a day that are weighed and measured, plus whole food snacks throughout the day.

I went to a natural chiropractor and he told me I was still in fight or flight, which didn’t surprise me because my anxiety was still bad, even though I could function. The anxiety is in my shoulders and is a constant throughout my day. It’s not like the head to toe fight or flight anxiety I had, but it is still bad. It caused me to have these intolerances that I’ve never had in my life. So I’ve officially been in fight or flight mode for over 6 months.

A few months ago, I tried taking Niacinamide for the anxiety. I took about 1500-2000mg a day for about 2-3 weeks but I didn’t notice any difference, so I stopped taking it since it was increasing my metabolism.

I have started a very low dose of thiamine HCL (1 mg- if that) but I noticed it is causing me to be foggy just like when I eat. This is very concerning to me because if I plan to titrate up, that means I’m going to be experiencing fogginess to a very great extent and pretty much all day. I do have magnesium and a B complex vitamin, and plan to supplement with potassium as well. I also magnesium lysinate. I’ve been drinking coconut water for potassium, however, I’ve slacked off because it was causing worse mind fogginess. I have magnesium malate in powder form, but I need to get an encapsulation system. I started the b-complex vitamin today. I have potassium chloride in powder form to supplement with if I don’t use the coconut water. I believe I’m taking about 12 mg of thiamine a day. I also take Nutrigold’s fish oil, and a prenatal vitamin.

My doctor allowed me to wean off Zoloft a few months ago. I’m currently taking Seroquel and Seroquel ER.

Will the thiamine control the anxiety once I’m able to take it in high doses and rid my food intolerance? My anxiety is situational and unfortunately, the situations aren’t going to change, so I’m curious if you think it will help me. Due to my body being in fight or flight mode and not rest and digest mode, I’m not sure the high dose thiamine will help, since my body isn’t absorbing any nutrients and I can’t keep weight on.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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An Open Letter Regarding Thiamine and COVID

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Prior to the US election, in October of 2020, I found that the Biden campaign was interested in emailing me. I decided to try and get this letter setting out my concerns about COVID to Mr. Biden. I have no idea if he saw it or not. It is being published here as an open letter to whomever might consider implementing thiamine therapy in the prevention and treatment of COVID and other disease processes. It has been edited to fit the format of the website.

Dear Mr. Biden,

Greetings from Canberra Australia. I am writing to you because I believe I have something important to say about the pandemic, but find myself in somewhat of a dilemma. It may sound hard to believe but I think you may be the only person who can help.

I want to begin by telling you about Dr. Derrick Lonsdale. He is 96 years old, born in 1924. He began his medical career in England in 1948 and after emigrating to the U.S. spent 20 years practicing as a pediatrician at the Cleveland Clinic, which you visited recently. After leaving there he practiced privately, retiring at the age of 88 in 2013. He has written over 100 published papers. To this day he writes articles and helps people with their health problems through a website called Hormones Matter run by his colleague Dr. Chandler Marrs.

As a result of his experiences at Cleveland Clinic, Dr. Lonsdale became particularly interested in the subject of thiamine deficiency. As you may know, in the same way that vitamin C deficiency is linked to the disease scurvy and vitamin D deficiency is associated with rickets, thiamine, or vitamin B1, deficiency is responsible for the wasting disease beriberi. The common understanding is that this is a disease of the past and of a third world beset by malnutrition, which has been eliminated in the West by fortifying processed food such as flour with thiamine. As such it has seemingly passed out of the collective memory of modern medicine. Dr. Lonsdale on the other hand made the biochemical study of thiamine deficiency his life’s work.

Understanding Thiamine in the Context of Mitochondria

Each of the trillions of cells that make up the body contain mitochondria – self-contained electrochemical machines which take in fuel and oxygen supplied by the blood and use them to generate an electric charge – effectively a battery. This charge is used to supply energy in a chemical form usable by the cell to allow it to function. The other end-products are water and carbon dioxide – this is respiration at the cellular level. The process involves a series of chemical reactions, each reaction requiring the presence of an enzyme specific to that reaction, provided by the mitochondrion. Each enzyme also requires one or more cofactors to be present for the associated reaction to proceed efficiently. These enzyme cofactors are supplied via the blood and are none other than the vitamins and minerals we are all familiar with, particularly the B vitamins – thiamine, riboflavin, niacin, folic acid, B12 and others, and minerals like magnesium, zinc, copper, manganese and iron. If anything interferes with this chemical “symphony”, such as a deficiency of one or more of these cofactors, energy production will be impaired and the cell will not be able to function as it should.

Thiamine has been found to have a particularly important role to play. It acts as a cofactor in five of these enzyme moderated reactions, one of which occurs right at the beginning of the whole process, converting the supplied fuel (glucose) into a form usable in subsequent steps. In one of Dr. Lonsdale’s analogies, thiamine is like the spark plugs in an internal combustion engine (the mitochondrion), igniting the fuel/air mixture, turning the released energy into, in this case,  mechanical rather than chemical energy, which is used to propel the car (the cell) forward. If the spark plugs are not working properly (if thiamine is deficient), the car will run poorly, if at all.

It is not hard to see the implications of this. At the level of a human being, thiamine deficiency results in beriberi (meaning “weakness”, or “I can’t”). The cells of the body are unable to provide the energy the body needs to function. If the deficiency is not corrected death may follow. At the cellular level, if a virus or bacterium attacks, or if certain cells start to misbehave, the body has cellular defenses to deal with the situation. But if the cells lack energy, these defenses are likely to fail and the body will be overwhelmed. Drs. Lonsdale and Marrs concern themselves with ensuring the mitochondria are in the best shape possible, identifying anything which affects their performance, such as drugs and other chemicals which might cause deficiencies, or genetic defects, and trying to correct such problems generally by means of nutrition, thus maximizing the body’s natural defenses.

This is where the trouble begins. According to Dr. Lonsdale, ever since Louis Pasteur’s discoveries about microorganisms, the paradigm under which medicine has operated is “kill the enemy”, in other words find ways to kill the bacteria and viruses and wayward cells which threaten us with disease, generally using drugs. The idea of helping to strengthen the natural defenses of the body is dismissed out of hand, on the assumption that the issue of nutrient deficiency belongs to the distant past. As the future commander-in-chief of the armed forces of the United States, if one of your military heads came to you and said that you only need offensive weapons and there is no need to worry about the state of your defensive capability, I’m sure that you would send them on their way. Yet that accurately depicts current medical practice. Dr. Lonsdale has for many years tried to persuade his colleagues that thiamine deficiency in particular is a very real problem of the present and the future, particularly in Western societies, for reasons I will go into, and that much of the disease we see is in fact due to it. For his trouble, he has been resolutely ignored, deemed irrelevant and consigned to history by all but a few. All, that is, except perhaps for the many people he has helped. As he tells it, every time he cured someone orthodox medicine had declared incurable, it was put down to “spontaneous remission”.

How I Found Thiamine

I became interested in this subject because of what happened to my elderly mother, now 90. Early in 2019 she came down with a nasty virus. Prior to that she’d had some health problems but was in pretty good shape overall. She recovered but never really got over it. Her longstanding breathing problems became worse. She started to have digestion problems and was back in hospital a few months later with pancreatitis. Back home, every morning after breakfast she had to sit for a few hours because she felt too weak to do anything. On one occasion she had an attack of vertigo, fell and couldn’t get up again. She was seeing several doctors and they were examining her and doing blood tests and trying different drugs on her but I felt they weren’t really helping her much. I resolved to try and work out what was going on. It wasn’t long before I came across Dr. Lonsdale and the subject of thiamine deficiency. What I learnt was that an event that was stressful to the body such as an infection could trigger a state of thiamine deficiency, and that the elderly were particularly vulnerable. I began to think that this was what happened to my mother.

I also had one or two health issues. In 2010, I was diagnosed with thyroid cancer and had it removed. I had occasional heart palpitation episodes, and remembered hearing that the answer for this was vitamin B1. I also have restless legs syndrome. As a result of this new interest in health, I learned about low-carb diets. Around March 2020 I started on a “healthy keto and intermittent fasting” diet and started taking thiamine regularly, along with magnesium, another essential cofactor which is needed for thiamine to work, and encouraged my mother, and my family, to take it. Purely coincidentally, this was also when the COVID crisis was ramping up.

As I learned more, I began to suspect that there was a connection between thiamine deficiency and COVID and that taking thiamine and magnesium might be protective against it. By this time the world was in lockdown, and I thought this would defeat the virus, so there was no need to say anything. By mid-August it was clear that things were spiraling out of control. Around this time, I realized that Drs. Lonsdale and Marrs were very well aware of what was happening and had done what they could to make it known to the world, but it had fallen on deaf ears. I decided I had to try and do something. Having had very little to do with social media, I started using Twitter to try and tell as many people and organizations as I could about the connection between COVID and thiamine deficiency, and have continued doing so to the present, learning more in the process. Everything I have learnt has only strengthened my conviction. Like them, I have had absolutely no response from anyone in a position to be able to do anything and as far as I can tell I have had absolutely no impact and am not going to. I don’t feel like I can just leave it, so that is why I have now turned to you.

Thiamine and Dysautonomia

In 2017, Drs. Lonsdale and Marrs published a book entitled “Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition”, which more or less represents Dr. Lonsdale’s life’s work. The premise of the book is that thiamine deficiency, beriberi, affects the autonomic nervous system, leading to dysautonomia. The autonomic nervous system controls all of the functions that the body carries out automatically without conscious thought, such as breathing, cardiac function, digestion, sleeping, reacting to stimuli and so on. Basically, this system goes out of whack, resulting in all sorts of strange and seemingly unrelated symptoms particularly affecting the brain, heart, nervous system and digestion. “High calorie malnutrition”, the end result of the typical western diet, is largely responsible.

Beriberi is normally associated with just straight malnutrition or lack of food, and conjures up images of emaciated people. Using the above term Drs. Lonsdale and Marrs are making the point that a diet high in “empty” calories, especially from sugar, but low in micronutrients, predisposes one to the disease, because the available thiamine required to process the fuel is overwhelmed by the amount of fuel being supplied. In terms of the car analogy, the engine is flooded. So the obese could have beriberi. Anyone else nutritionally challenged, such as diabetics, could have it. Basically anyone, young or not, whether they look ill or not, could have it if their nutritional status is compromised. Dr. Lonsdale has for many years been trying to warn us that the Western world is primed for an epidemic of beriberi, waiting for something to come along that would trigger it.

Thiamine, COVID, and an Epidemic of Beriberi

About two weeks after I began tweeting about thiamine, I learned about COVID long-haulers for the first time. These are the people who get over the initial infection, only to find that they continue to have problems for many months afterwards. By now there are perhaps hundreds of thousands in this category. Having learned about the many and varied symptoms of dysautonomia associated with thiamine deficiency, I was stunned to realize that the symptoms of long-haulers, described in an endless succession of media reports as the bizarre and mysterious symptoms of COVID, are exactly the same as those of mild thiamine deficiency. Despite my numerous efforts to point this out, such reports continue to appear to this day. Of course when I checked back with what Dr. Marrs had been saying on Twitter, I found she was already pointing all this out months earlier.

To me the implications of this are enormous. It suggests that the world has completely misunderstood the nature of the pandemic and as a result of this wrong understanding the wrong decisions are being made. While undoubtedly highly contagious, I believe COVID is not the highly novel, pathogenic and virulent virus we are led to believe. Rather it is similar to, but somewhat more severe than, what we have experienced previously, the effect of which has been to unleash an epidemic of, not the version we know from history, but a modern-day equivalent form of beriberi, attributable to our generally poor nutritional status and any other environmental contributors to poor mitochondrial function.

As one example of the decisions being made, one could consider what has been happening in intensive care units around the world. Perhaps the most characteristic aspect of COVID is loss of pulmonary function, known as Acute Respiratory Distress Syndrome (ARDS). While I am no expert, it seems an assumption being made is that to overcome this just requires an increased supply of oxygen by means of a ventilator. Earlier I described respiration as it takes place at the cellular level. In terms of normal combustion everyone knows one needs three things: fuel, oxygen, and a source of ignition. It’s the same at the cellular level – it’s not enough to have glucose and oxygen, you need thiamine to act as the spark plug, followed by the chain of reactions that take place inside the mitochondrion. Perhaps thiamine deficiency, and therefore failure to initiate this reaction chain, rather than lack of oxygen, is what’s really going on. While I could find numerous general references to the use of thiamine in clinical care, when I looked at ICU protocols specifically for COVID promulgated by organizations such as WHO and CDC and in Australia, I did not find any reference to using thiamine.

There are other observations one can make. One of the seemingly mysterious features of the pandemic is that many people who get infected are completely asymptomatic. I interpret this as meaning these people have good nutritional status, and mitochondria that are working efficiently, and their cellular defenses are consequently able to deal with the virus. Also, people with a lower socioeconomic background seem to be more severely affected. This is understandable as they might only have access to cheaper, less nutritious food and are therefore more likely to be in a state of incipient thiamine deficiency when they encounter the virus. And of course, as Boris Johnson learned and as many doctors are starting to understand, a poor diet, despite access to plenty of food, leading to obesity, makes one vulnerable, the answer being to improve the diet, which doctor Lonsdale tells us should be a low carbohydrate, “real food” diet, which even now is not what nutrition guidelines recommend.

Consider Thiamine

This brings me to the main purpose of this letter. In the absence of, or in addition to, a vaccine, I believe that an emergency program of mass daily supplementation with thiamine and magnesium, and a longer term aim of improved diet, could help to protect the U.S. and indeed the world population, from the virus. One might put it as a policy goal of ensuring thiamine sufficiency in the general population. This could provide an alternative to the devastating human and economic consequences of the actions currently being taken or contemplated, whether lockdowns, border closures, or so-called “herd immunity” options. I imagine this would be a very large undertaking, more than just education as this would probably result in all existing supplies vanishing, but presumably much less than the expected vaccination program, given that both micronutrients are well-known, cheap and non-toxic. Of course, all this would need to be verified before taking action. If one can measure the level of intracellular thiamine sufficiency or deficiency in the body it should be straightforward to test hypotheses, e.g. that long-haulers are in a state of deficiency, that those who were asymptomatic have a good level of sufficiency, and so on. One difficulty with this is apparently that because of the lack of interest in this subject there is currently almost no laboratory where such measurements can be made.

The Stress of Illness

It was only a couple of weeks ago that I realized Dr. Lonsdale actually made this suggestion himself. In an article published on March 20, 2020 on the Hormones Matter website, entitled “What Can Selye Tell Us About COVID-19? Survival Requires Energy”, he said:

We believe that we have shown evidence that thiamine and magnesium supplementation are inherently necessary in a population in which nutrition is imperfect. … Moreover, if we consider the requisite ‘energy’ required to stave off any illness, might we also consider bolstering the nutrient stores e.g. host defense in at-risk populations, as a way to reduce the risk and severity of the illness? Doing so may help ensure the adequacy of energy in meeting the unseen enemy.

You will recall that this was right at the beginning of the period when deaths started to ramp up in the U.S. One wonders how different things might have been if he had been listened to.

The biggest challenge, however, could lie elsewhere. This pandemic has brought us to an extraordinary place. Suppose that Dr. Lonsdale is right. This gives rise to an incredible dichotomy. On one side there is 96 year old Dr. Lonsdale, who has few resources and at his age may not be in a position to advocate for himself, but who with a vast amount of experience behind him has a simple idea that explains an awful lot, including many diseases which medical orthodoxy cannot explain or treat, which therefore get labelled psychosomatic. He has a proposal which is easily testable, could easily be trialled, is simple and relatively cheap to implement, and could have enormous health and economic benefits. Without going into details, it could potentially lead to generally improved mental health, reduced levels of crime and reduced vulnerability to virtually all forms of disease, including viral threats that we have yet to encounter, with consequently greatly reduced health costs and productivity benefits for all economies. This would usher in a science based health renaissance, the likes of which has never been seen before.

On the other side is the entire medical establishment with its vast resources, having an entrenched position, which is unable to, indeed cannot afford to, so much as entertain the possibility that Dr. Lonsdale could be correct. You also have the pharmaceutical industry pouring billions into drug development and searching for a vaccine. A vaccine may well be found, which might head off this crisis of credibility. Or it may not. Or the virus may mutate regularly, rendering a vaccine next to impossible as with cold viruses. One thing to note is that, if the pandemic at its core is the result of a nutrient deficiency, then no drug or combination of drugs that does not correct the deficiency can possibly overcome it. On top of that, you have the food industry with its vested interests in keeping the world hooked on its cheaply made, highly addictive products based on sugar and processed carbohydrates, which Dr. Lonsdale tells us lies at the core of the problem. The pandemic is forcing us to face the inconvenient truth that this entire edifice may be unsustainable.

I’m sure you can appreciate why I think you may be the only person who might have a chance of getting us from where we are to where we could be. I’m sure you would have people to advise you on health matters. If Dr. Lonsdale is right, and you ask them for advice on this, it seems likely they will just dismiss the entire notion out of hand. If we are to avoid unthinkable levels of human and economic loss, you may have to shake the foundations of the medical establishment to its very core, to get it to accept that we need defense as well as offense in order to successfully do battle with the invisible enemy.

In the end, it may simply be a matter of going back to where it all began – back to Hippocrates, who, as Dr. Lonsdale likes to remind us, said “Let food be thy medicine and medicine be thy food.”

A Few Final Observations

I hope you get to meet Dr. Lonsdale. I strongly suspect the fact that he is still active at such an advanced age is not an accident. I imagine he has been taking his own advice. I would not be at all surprised to learn that he has lived most of his life without any significant disease. I would very much like to see him get the recognition he deserves before he dies.

If I’m right about thiamine deficiency leading to weakness in the response of cellular defenses, this could have an impact on the effectiveness of any vaccine that may be developed, since it has to piggyback on the existing cellular mechanisms. It may turn out that the underlying problem of thiamine deficiency has to be recognized and addressed even if a vaccine is produced.

I am very much a layman, so am not someone from whom to seek advice. If I hear that you are interested in pursuing this I will let Dr. Marrs know. She would be the best person to contact in the first instance.

Lastly, it seems to me that, if dealt with wisely, this has the potential to demolish the foundations of the incredible tower of disinformation that besets the American people and bring it crashing to the ground, perhaps ushering in a new, sorely lacking respect for science. Exactly how and when that might be brought about I have no idea. I’ll leave that up to you.

Good luck in your new adventure.

Robert Olney

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Rapidly Deteriorating Health With Thiamine Deficiency

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In May 2020, I experienced my first symptoms with what I now believe to be thiamine deficiency (beriberi). I believe other nutrient deficiencies played a role as well. This was preceded by an especially difficult several months that included a marital separation and possible COVID infection. In addition, I experienced a mild head injury during this time when my son and I accidentally collided while picking up toys together. I have a history of traumatic brain injury, so am susceptible to post-concussive syndrome from mild head trauma.

It was these factors that precipitated the downward health spiral that first began in May 2020 when I was 38 years old. Prior to this time in life, I felt my health to be good. I had gone through some very challenging mental health struggles in the past, a TBI and post-concussive syndrome, as well as a few other issues related to physical health, but for the most part, I would have considered myself to be a fit, healthy, and resilient person. I consumed a paleo diet, which I thought very nutritionally dense, and I exercised regularly. However, looking back on my history suggests risks for thiamine deficiency. Here are some factors that are part of my overall health history:

  • Five pregnancies and nine years of breastfeeding with very little multivitamin supplementation
  • Former short-term fruitarian and vegan diets for purposes of detoxification
  • Former sporadic heavy binge drinking from age 15 to 33
  • Former tobacco smoker from age 15 to 33
  • Consumed extreme amounts of candy as a child
  • Overdosed on pills three times between ages 15 and 17. The third overdose involved Serzone, which has a warning for liver damage
  • Was prescribed antibiotics at least 75 times from age 5 to 33 for chronic UTIs and bronchitis
  • Prior health problems: chronic urinary tract and kidney infections as a child and young adult, chronic bronchitis as a child, candida overgrowth, digestive problems, insomnia, anxiety, depression, PTSD, and depersonalization disorder

In May, the combination of stressors, along with likely longstanding nutrient deficiencies, precipitated a rapid downward spiral leading to multiple hospitalizations, and ultimately, what I believe was severe thiamine deficiency. At its worst, I believe I was headed toward Wernicke’s encephalopathy and heart failure. Since the best physicians could offer was Ativan, antidepressants, and a presumed multiple sclerosis diagnosis (despite a lack of evidence), it was up to me to save myself, particularly because I am a parent to five children. Through extensive internet research, I learned about thiamine deficiency and began to treat myself. This is my story.

Rapidly Disintegrating Nerve Function

The first symptom I remember experiencing was a strange tingling in the center of my chest upon standing. The next symptom was flank pain. I thought perhaps I had a kidney stone and made an appointment with my primary care. During this time, I was also intensely tired in a way I’d never been before, very pale, anxious, uncharacteristically irritable, shaky, short of breath, thirsty, lost weight, and became sweaty at random times.

At the appointment with my primary care, it was decided I would get an ultrasound of my kidneys to check for kidney stones. I didn’t make it to the ultrasound appointment because that same day I stood up after a nap and experienced sudden debilitating chest pain that felt like I was having a heart attack. It started in the area of my heart and moved to my left arm and up to the left side of my neck. I called an ambulance and was taken to the emergency room. They ruled out a heart attack and proceeded with the kidney ultrasound after I shared with them the other strange symptoms I’d been experiencing. Nothing of significance was found on the ultrasound, and I was sent home.

Shortly after that incident, I started experiencing numbness in my legs at random times during the day and night, as if they’d fallen asleep. I went into the ER again after a particularly intense experience of numbness where I felt uneasy about even standing to walk. Again, nothing was found, and I was sent home. My arms began to go numb at night while in bed, in addition to my legs. I’d wake up to this numbness, and shortly thereafter I could feel the numb sensation in my head as well.

I began to experience gastroparesis, and my intestinal motility seemed frozen at times but then would go into overdrive during the night, requiring urgent bowel movements in the middle of the night, which was not normal for me. At the same time, I could feel the sudden rapid digestive motility, I could also feel the blood flow dropping from my brain. As soon as I’d have a bowel movement, the blood flow would return to my brain. These sensations were all so strange and unnerving and unlike anything I’d previously experienced in life.

Loss of Consciousness, Compromised Speech, and Vision Changes

I went to an acupuncture appointment and shared with the practitioner what was happening. She treated me for yin deficiency. That night I woke to use the bathroom, and on the way back to my bedroom, I nearly lost consciousness for the first time. It was a terrifying experience. My ability to speak was compromised, and I tried to communicate to my daughter what was happening, but my voice was in slow motion. My vision was growing tunnel-like and dark. I thought I was having a stroke. My daughter gave me my phone, and I called an ambulance and was able to very slowly articulate what was happening as I lay on the floor, wondering if I was going to die. I was taken on a stretcher to the ER, and the diagnosis from that trip was that I’d had a panic attack. I was given Ativan and sent home. I knew that a panic attack was not the correct explanation, although I was indeed in a state of panic over my current health. I felt very strange, with strange sensations throughout my body and brain, severe anxiety, erratic heartbeats, and tachycardia.

Things grew progressively worse over the next couple days, and my mother drove me to a better hospital four hours away to hopefully get answers. By the time we arrived, I could not walk due to the total body numbness. I was given a neurological exam and had no reflexes in my knees, ankles, and feet. I was then given two bags of IV saline and felt relatively normal a few hours later. Many labs were done, but no nutrient levels were checked. I was kept overnight and examined by a neurologist, but I wasn’t experiencing symptoms during the exam. It was found that my blood sugar was abnormally low during the night (65), and I was told to improve my nutrition and sent home with no real answers.

Was it B12 Deficiency?

I started taking a B complex and multivitamin and tried to eat as healthy as possible, but during the following weeks, I continued to experience near syncope, dizziness, cardiac and GI issues, strange body sensations, and severe anxiety. I’d have pockets of time where I felt relatively normal, but symptoms always returned, and night numbness was a regular occurrence. I often felt ataxic, like I was about to lose my balance or fall. My hearing seemed to change, and my right eyelid began to twitch relentlessly. Nerve pain began in my joint junctions and felt like sparking, electrical, stinging sensations. Over the course of several days, these nerve pains began to affect the base of my spine and slowly moved up my spine to my head. It was a very painful and frightening experience.

When researching symptoms, I came across information about B12 deficiency and wondered if that is what I was dealing with, so I asked my naturopath if he would prescribe methylcobalamin that I could inject at home, and I began daily B12 injections. The nerve pain resolved after a few weeks, which was a tremendous relief. As a result of this resolution, I believed a B12 deficiency to be at the root of my problems. I continued with B12 injections after the nerve pain healed but dropped down to once weekly injections.

Another Hit to My System

Shortly after the nerve pain resolved, I got very sick with a Campylobacter infection. It was strange because no one else in my family got sick, and we’d all been eating the same meals. I went to the ER after several days of relentless diarrhea and high fever. I was given fluids and my stool was tested, which revealed the Campylobacter bacteria, and I was prescribed azithromycin. In hindsight, I wish I’d not taken the antibiotic because I believe it made my condition worse.

After the antibiotic, I felt like I was in a permanent state of semi-consciousness. I felt hypoxic, like I was being asphyxiated. When I’d start to fall asleep, I’d wake up with a jolt because it felt as though I were falling and losing blood flow to my brain. I had constant high-pitched ringing in my ears. Life became a total nightmare. My arms and legs were swirling with strange sensations I’d never felt before – paresthesias and cramping muscles. My heart was in a near constant state of palpitations with alternating bradycardia and tachycardia. When I’d roll from one side to the other in bed or stand up, my heart rate would go from 40s and 50s to 120s and 130s. It felt like my heart was constantly pounding, no matter if the rate was slow or fast. The sound was audible to me day and night, and the pounding seemed to shake my entire body. Sometimes it felt like my heart would stop for an abnormally long amount of time, then sluggishly start thumping again. I would wake up in extreme pain on whichever side I slept on. I recall using my finger oximeter one night and getting a reading of 84% oxygenation.

Maybe Multiple Sclerosis?

During this time, several doctors suggested I might have Multiple Sclerosis (MS). I had an MRI of my brain that showed no lesions, so MS was ruled out. I was eventually diagnosed with POTS by the medical community. I researched POTS and saw that extra salt was often helpful for minimizing dizziness, so I started adding salt and electrolytes to my water. It did seem to help some, so I began drinking about a gallon of water a day with 2-3 extra teaspoons of Celtic or Pink Himalayan salt and added electrolytes.

In late September 2020, my POTS symptoms resolved. My heart had normalized, and I was no longer dizzy or experiencing near syncope, but I was left with “stocking and glove” peripheral neuropathy. I had numbness from my feet up to my calves and numbness in my hands and forearms. I was relieved that the POTS symptoms were gone and felt I could tolerate the numbness and paresthesias. I still felt very weak and struggled with bacterial infections in my ears and sinuses as well as cold intolerance.

Discovering Thiamine Deficiency

Life continued this way until early November, when I decided to try R-Lipoic acid for the peripheral neuropathy and occasional spinal pain and tingling that periodically occurred. This was a devastating mistake. I ingested the first capsule in the morning and second in the evening, and within an hour of the second capsule, nerves all over my body felt like they were on fire. The only thing I’d changed that day was the lipoic acid, so I started researching contraindications to lipoic acid online and found that thiamine deficiency was a contraindication. Lipoic acid and thiamine work in tandem in the Krebs cycle, so by adding one with a deficiency of the other, it creates a draw on an already almost empty tank. In one study, when thiamine deficient rats were administered alpha lipoic acid, it created a toxic reaction. Unknowingly, I’d taken a supplement that made my situation go from difficult to much worse.

I then looked up thiamine deficiency symptoms and recognized my experience immediately in beriberi disease. I found the website, Hormones Matter, run by Dr. Derrick Lonsdale and Dr. Chandler Marrs. I began reading through the information and stories, and my belief that thiamine deficiency was the root of my problems grew stronger. Dr. Lonsdale suggests using a type of thiamine called Allithiamine (thiamine tetrahydrofurfuryl disulfide), as it crosses the blood brain barrier superior to other forms of thiamine. I ordered a bottle and took a large dose of thiamine hydrochloride I had on hand before going to bed.

I didn’t sleep well that night. My nervous system felt like it had been severely damaged. I was shaking, my heart was once again beating erratically with tachycardia upon movement. The nerve pain was intense and spread throughout my entire body. The next day, I went for a short walk and nearly blacked out. The muscles in my legs were painfully cramping. I had no energy. I couldn’t even read. I went to bed that night feeling like I had a head injury.

Each day was progressively worse. I was taking thiamine hydrochloride and benfotiamine every couple of hours, but it didn’t seem to be stopping the downward spiral of symptoms. I felt like I was going to collapse. My brain was not functioning well. I was nauseous and had severe GI distress. All the symptoms I had experienced before, in addition to many new symptoms, manifested again in rapid succession. I went into the ER and attempted to explain that I believed I had a severe thiamine deficiency, hoping I would be given IV thiamine, but I was only handed a thiamine tablet, given some IV fluids and sent home.

Five days went by, and the Allithiamine arrived in the mail. By this point, I was vomiting, could barely walk, and felt like I had a traumatic brain injury. I took one 50 mg capsule and felt relief of the extreme brain injury sensations within half an hour. Encouraged, I continued to take a 50 mg capsule each time I would start to decline. The nerve pain lessened, I stopped vomiting, and my heart rate somewhat normalized, but the most profound effect of the Allithiamine was in reducing the intense brain injury sensation.

I’ve experimented with dosage and arrived at 100 mg every two waking hours being the most effective for keeping most symptoms at bay. In addition to the 100 mg of Allithiamine, I also take 150 mg benfotiamine and 50 mg magnesium glycinate every two hours, a daily high dose B complex, multivitamin, phosphatidylcholine, ubiquinol, digestive enzymes, probiotics, and fish oil. Five weeks out from taking lipoic acid, I still experience constant moderate nerve pains all over my body, problems with bacteria (eye infections, ear pain, sinus infections, sore throat), mild tachycardia upon sudden movement, pounding heart, random sweating, high fasting blood glucose (between 110 and 120), shakiness, dizziness, anxiety, weakness, and exercise and cold intolerance. The Allithiamine and benfotiamine have improved my brain function, nerve pain and paresthesias (from severe to moderate), digestion, and my ability to sleep, and I’m hopeful that with time I’ll see more improvements.

Recovering But Disillusioned With Modern Medicine

I believe the work of Dr. Chandler Marrs and Dr. Derrick Lonsdale and supplementing with Allithiamine saved my life. I believe I was headed toward Wernicke’s encephalopathy or high output heart failure before taking Allithiamine. My quality of life is currently very poor, but I have hope that recovery from beriberi and mitochondrial damage is possible. Some damage may be permanent, but I see small improvement each day, which indicates to me that more improvement is possible.

I wish so much I’d found the Hormones Matter website earlier in the course of my disease, as I’m certain things could have been more easily reversed. I hope that others might benefit from my story and avoid the horrendous decline that I experienced. Just by taking such a simple nutrient as vitamin B1, so many devastating health consequence can be avoided. Why don’t more doctors have awareness of this?

I am disillusioned with the medical community in not identifying my illness despite dozens of trips to the ER with comprehensive symptom lists in hand and visits to internists, cardiologists, and neurologists with detailed descriptions of my ailments. No one ever checked my nutrient status beyond vitamin D, iron, and zinc levels, and B12 and folate at my request. I was treated as though I had an anxiety disorder and offered anxiety medication and antidepressants.

How is it that in 2020, the only thing that comes to mind for the medical community when presented with complex neurological symptoms is MS? Time and time again, I was told I likely had MS, but my MRI clearly showed I did not. Beriberi is a well-documented condition that’s been known for hundreds of years, yet the medical community doesn’t consider it other than Wernicke’s encephalopathy in alcoholics. I hope this can change. Awareness needs to grow. I know there must be many others who have experienced similar symptoms to my own and sought help. We deserve better medical care in what is supposed to be among the most technologically advanced countries in the world. Until and unless things change, websites like Hormones Matter serve as beacons of hope. I am profoundly grateful to the work of Dr. Chandler Marrs and Dr. Derrick Lonsdale.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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COVID Notes: A Calcium Tsunami in COVID Infected Cardiomyocytes

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In July 2020, I became ill with what may have been something related to COVID, or not, as there was no testing that was easily available to confirm. The illness affected my heart function. Since then I have been following the research on COVID-related heart damage. Over recent months, several studies have been published showing the mechanisms of viral-related heart damage. It appears that viral heart infection is not exclusive to COVID. So it is entirely possible that what I experienced was not COVID, but just some random and bizarre viral infection. Nevertheless, my experience was odd enough that it may be of use to someone and so I am publishing it here along with some thoughts on potential mechanisms.

Some Background

I am a 53-year-old, generally healthy, though overweight by traditional standards, powerlifter with several world records in my federation, age, and weight class. I train 4-5 days per week and have for the last several years. Before that, I did Crossfit and before that, I played water polo for decades. Physical fitness has always been a part of my lifestyle. I eat healthy, and largely organic, and I don’t drink or smoke. I have not taken any medications in over a decade, not even ibuprofen. Although as a young woman, I, like so many young women, inhaled ibuprofen on a monthly basis along with a laundry list of other medications prescribed by physicians. My one remaining chemical vice pre-infection was a cup of iced coffee every morning after workout. Now, post-infection, I cannot tolerate even a minimal amount of caffeine.

As the pandemic was approaching, we purchased some home gym equipment and put a gym in our living room to keep training. We have continued to train at home throughout. For the first few months, we rarely left the house. Prior to the closures, I would access a variety of bodywork modalities to help my body maintain its ability to lift heavy and to manage longstanding neck and shoulder injuries. This included regular massage and several different forms of chiropractic care. With the closures, I did not access these services for months and it was taking a toll. In May, I began accessing some chiropractic care again. At the end of June at one particular appointment, I think I was exposed. A few days later, I became ill, but not in the traditional manner described by the media or the studies.

Asymptomatic COVID or Something Else?

It began with odd bouts of breathlessness when climbing stairs or doing normal everyday activities. Since I had no fever or cough and felt fine, I went on with life. A few days passed and just before we were to drive to our cabin for some rest and relaxation, I developed lower GI symptoms such that I remained home. That also passed within a few days and I thought whatever it was had resolved. I was wrong. Soon after, absolute exhaustion hit, and my blood pressure and heart rate climbed. Over the next few weeks, I battled increasingly high blood pressure (150-160s/110-120s), heart rate (90s – my normal is in the 50s), edema, and pounding pressure in my head. I had no fever but experienced intense hot flashes or flushing. My pulse ox remained in the mid-90s throughout.  It felt like everything was out of sync, including my autonomic system.

Among the oddest experiences were the episodes of pressure, swelling, and blood pressure spikes. I would get these seemingly random bouts of pressure in my head and heart. I would be sitting or standing, it didn’t matter, and all of a sudden everything would go haywire. I could watch my hands and feet swell up multiple times their normal size over a matter of minutes. The pressure in my head would increase, and along with it, my blood pressure would spike. On several occasions, I worried that I would stroke out or have a heart attack. Additionally, my pulse was irregular and thready. My heart fluttered and skipped beats. I could feel the missed beats and arrhythmic patterns through the blood pressure cuff. Needless to say, I could not function for several weeks and mostly slept, well more than normal.

I could not work out the first week at all. I could barely stay awake. The second week, I could lift a little, but had to rest for several minutes after each very light lift. I would become out of breath, my heart would pound out of my chest and pulse through the back of my skull and neck. Again though, my O2 levels per the pulse oximeter were fine. My heart rate was high for me, but otherwise fine. My blood pressure was not, so I was very careful. During this time, I could not put a barbell on my back to squat. When I did, it felt as if there was just too much pressure in my head. It was horribly disconcerting and harkened thoughts of stroke. It took about 5-6 weeks before I could put the barbell on my back without the excessive pressure and return to some semblance of a normal but light workout. It took another few weeks before I could do any volume.

While all of this was happening, I still took no medications, except aspirin periodically to thin my blood in the event I was potentially clotting. I continued my normal regimen of 200mg of Allithiamine. I may have upped it to 300mg a few times. I upped my magnesium from 100-200mg per day to ~400mg depending upon the blood pressure. When my pressure spiked, I would pop a magnesium or two to bring it down a bit. I began taking fish oil again, about 2 grams per day. I continued my normal multi-vitamin along with extra vitamins A, D, and K2 and added 1-2 g of vitamin C. I had been taking a zinc, and copper combination since March as well.

At about 3 weeks in, I sought more specialized chiropractic care where the practitioner adjusts the atlas. I had used it previously before everything shut down and hoped it would help relieve some of the pressure in my head and neck. Soon after, I also began acupuncture to help clear some of the edema and manage my blood pressure better. Over the next several weeks, everything gradually improved. It was probably 8+ weeks or so before I felt more normal, before the edema subsided completely, and everything stabilized.

The experience was so strange though that I am not sure what exactly happened. Was this what might be deemed an asymptomatic or mild expression of COVID or some other viral infection? Because I was not able to be tested I’ll never know but in recent weeks research has come out detailing more of the mechanisms involved in COVID-related heart infections. One particular study struck me as a possible mechanistic explanation of what I imagine might have been happening. This study, together with some insight into mitochondrial function, suggests a picture of heart stress, provoked by the virus that was functionally similar to wet beriberi despite the fact that I was taking thiamine. I suspect the mechanism identified in this study against the backdrop of the individual’s underlying mitochondrial fitness may determine COVID morbidity and mortality in cases where the heart is preferentially affected.

The Ca2+ Tsunami in COVID Infected Cardiomyocytes

The study, SARS-CoV-2 direct cardiac damage through spike-mediated cardiomyocyte fusion, involved a series of experiments investigating the physiological and electrochemical properties of COVID-infected cardiomyocytes. The cells were derived from an autopsy of a 35-year-old woman who died suddenly in her sleep. She was three months postpartum and in the week prior had experienced mild fever, and cough, and had been light-headed but no other symptoms. At autopsy, she tested positive for COVID but per the report had no evidence of lung infiltration. To clarify the cause of death, myocardial cells were examined. What they found was that while the virus had not affected her lungs, viral proteins were identified in her the cells of her heart.

Through a series of tests and experiments, the researchers discovered that the viral proteins infected the electromechanically coupled cardiomyocytes building a bridge between cells, such that the virus was able to disturb the electrical potential/rhythm of the heart muscle. These cell-to-cell conduits then provided the

…pathoanatomical substrate for aberrant electrophysiological activity, electro-mechanical dysfunction, and fatal arrhythmia.

Additionally, they found that the altered electro-physiology in the infected cells was marked by prolonged action potentials, delayed after polarizations, and erratic beating frequency e.g. notable dysrhythmia. Importantly, they observed a pathological calcium (Ca2+) flux, which they describe as ‘tsunami-like waves’.

We suggest that SARS-CoV-2 spike glycoprotein-induced membrane changes directly injure CMs [cardiomyocytes], heightening cardiac arrhythmia risk even at low viral load and in the absence of widespread lymphocytic myocarditis-mediated tissue destruction.

The low viral load and the Ca2+ tsunami are what struck me most. Could it be that in some individuals, who are predisposed either genetically or epigenetically, the virus preferentially affects heart cells largely bypassing the lungs? In this case, a low viral load would be sufficient to cause problems, particularly, if the mechanism identified in this case holds. While it is clear that viral-infused cardiomyocytes would wreak havoc on the electrical potential of the heart, a sudden influx of calcium, well, that could be deadly, particularly if, as the report suggests, the cardiomyocytes are fused. The electrical potential would quickly overwhelm the cells’ ability to re-establish rhythm.

COVID, Calcium, and Cardiac Function

Backing up just a bit, the activity of cells like the cardiomyocytes, neurons, and muscles, is dependent upon a tightly choreographed series of changes in ion flux. See figure 1. With stimulus, sodium (Na+) channels open and Na+ floods the cell. This is the action potential mentioned above. Immediately following Na+, potassium (K+) channels open and K+ flows out, slowly at first and then more quickly as more channels open, and with it, Ca2+ comes rushing into the cell. The outflow of potassium prevents additional repolarization for a brief period while the buildup of Ca2+ feedbacks and eventually closes the Ca2+ channels. All of this happens within milliseconds and is highly regulated. If the timing is off or any of these ions are out of balance, arrhythmias develop.

COVID Notes - calcium heart function
Figure 1. Action potential of the cardiomyocyte.

Of these ions, it is the Ca2+ influx that is responsible for signal transduction, for setting into motion pathways that tell the cell how to respond to external and internal stimuli. As such, calcium homeostasis is of critical importance for cell function. A rapid influx of supraphysiological levels of Ca2+, as was evidenced in the study above, would induce a hyper-contractible state, disturb the timing of the electrical signals, and eventually, completely overwhelm the capacity to clear the excess, invoking apoptotic and necrotic death pathways depending upon mitochondrial ATP availability. Each of these markers has been found in the COVID-infected heart. These same disturbances may be also found in a condition called wet beriberi – thiamine deficiency that affects the heart. Similarly, cardiomyopathy, dyspnea (breathlessness), and elevated troponin, other common findings attributed to the COVID heart, are also associated with cardiac beriberi. Given my research on thiamine deficiency/beriberi, I cannot help but wonder if what we are seeing in COVID heart patients is some manifestation of the same process.

Although electrochemical research on both COVID and thiamine deficient myocardial function is lacking, as much of the research appears to focus on gross morphological changes mediated by inflammatory infiltrates, and we do not know if the Ca2+ tsunami identified in the aforementioned study is common across both disease processes, it is logically possible. Inasmuch as mitochondria provide the energy substrate that permits contraction and relaxation of the cardiomyocyte as well as Ca2+ management and sequestration, mitochondrial function may sit at the nexus of virally mediated cardiac events. To the extent that thiamine is critical for each of the key pathways involved in ATP production, insufficiency would impair these actions. And finally, since mitochondrial fitness is unique to the individual, this might explain why, even when there is clearly visible cardiac damage, symptom expression is mild or absent altogether in some individuals but deadly in others. This may be what is happening with athletes who are COVID positive and display limited symptomology but develop myocarditis. This may have been the case with me as well. Again though, without proper testing, this is speculation on my part. Nevertheless, the Ca2+ tsunami aptly describes a potential underlying mechanism for what I experienced.

If this turns out to be correct, the questions then become 1) why does COVID preferentially affect the heart and not the lungs in some individuals, 2) are the mitochondria the determining factor of severity and survival, and if so, 3) are there things we can do to support the mitochondria and maximize survival? While I do not know the answer to question 1, I have argued from the beginning of this pandemic that the determining factor in COVID morbidity and mortality comes down to mitochondrial fitness. To the extent mitochondrial fitness is determined by nutrient availability, thiamine especially, the answer to question 3, is yes, we can do something to improve outcomes. In a subsequent post, I will explore these questions more closely.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, and like it, please help support it. Contribute now.

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Longstanding Thiamine Deficiency Ignored By Doctors

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I would like to begin sharing my story, hoping to help others. My journey is from a nurse’s perspective. I recently learned I am thiamine deficient and likely have been for years. Thiamine deficiency affects the mitochondria, causing a disease process known as beriberi. Beriberi mimics many other illnesses, making it very difficult to diagnose. Let me begin by giving you a background about the woman I was before thiamine deficiency depleted my entire being.

I have always been highly driven. I am perfectionist to a fault. I was an honor student in high school, an active- athlete, a cheerleader for four years. I loved swimming, ice skating, rollerblading, skiing, and all sports. I led many extracurricular activities throughout high school and college. As the oldest of 5 siblings, I was the family leader and caregiver as well. I was always strong mentally and physically. I had survived spinal meningitis at age 5 years, after receiving my last rites while hospitalized in isolation several months. I lost my father shortly thereafter, but I survived.

I was a successful RN for nearly thirty years; a gynecological oncology nurse the first 20 years, and a postpartum nurse caring for mothers and their newborns the last ten years. I was married and had two children and even though I worked full-time, I was an avid volunteer, for activities involving both daughters through their elementary and high school years. I was the first and only woman president of my neighborhood association, organizing many monthly events throughout the year. I cared for my mother through ten years of Alzheimer’s. No family member was hospitalized without me as their private duty nurse advocating. I cared for my father in-law through colon cancer, then moved my mother-in-law in with us for 15 years after he died. I watched over her into her 90’s. Then I suffered loss upon loss: my mother, my father-in-law, several aunts, and two beloved family pets, followed by an awful divorce from my high school sweetheart.

Looking back, I understand why my marriage fell apart, I became a woman I barely recognized. I was in pain all the time. I was tired unable to be the “active fun loving Jane,” I had once been.

In 2006, I developed degenerative disc disease (DDD) in my neck, which ultimately led to a cervical fusion. Nevertheless, I returned to hospital nursing 8 weeks later and worked until I could no longer get through the nonstop days without pain. My nursing manager talked me into management after 28 years as a bedside nurse, which I loved. Then, I suffered a lower back injury that, together with my neck issues, incapacitated me from my nursing career. After losing my career, my marriage, and my home, I moved away from the home town which I loved. Multiple losses, stressors, and what I now believe was thiamine deficiency had me suicidal.

I tell you this, because the thiamine deficiency was insidious. It accrued over time. I was performing and had more energy than most… until one day, I didn’t.

My Silent Demise: Unrecognized Thiamine Deficiency

As I mentioned above, I developed DDD in 2006, and as result, I have suffered for years with intermittent nerve pain and muscle weakness. Over the years, the pain and weakness progressed to the point where by 2019, I could no longer walk or function. I had great fatigue, insomnia, depression, anxiety, and lack of energy. This was in addition to GI distress and signs/symptoms of IBS irritable bowel syndrome. I also had serious bladder issues of great urgency, leaking and even incontinence at times. Over time, I developed significant brain fog and cognitive difficulties. This included a “loss of words,” an inability to read and retain information or eventually, to write; all of which I had always loved doing. I began having memory issues and my nervous system seemed to be shutting down.

Looking back on my history, I had been hospitalized for chest pain 3-4 times ruling out pulmonary embolism or heart attacks. I have had a vitamin D deficiency for over 10 years despite supplementation and good diet and plenty of sunshine. My platelets ran high on and off for years. A hematologist ruled out many disease processes through lots of blood work. He even did a hip bone marrow aspiration and never found answers.

My blood pressure at one point was 200/100. I had tachycardia documented on EKG and on my own nursing checks. Heart palpitations were common. I sought the care of a few cardiologists over the years and had a number of cardiac tests all with no answers. I was frequently dizzy, seeing stars, and nearly passing out on many occasions. Five years ago, I was severely depressed and suicidal. I had lost so much weight, and looked anorexic at 108 pounds. Looking back, I have no idea how or why I had such rapid weight loss. Then the weight issue shifted.

By the end of last year, I had difficulty walking. I gained weight and have now been walking that fine pre-diabetic stage. I seem to be insulin resistant now. Added life stressors, once again caring for my sick and aging 81 year old aunt with multiple medical issues, has led to self-neglect.  I became short of breath on exertion, weak and faint. I began losing my hair. Thankfully, I once had a thick full head and so the hair loss was not immediately noticeable. Even so, I noticed, and I begged my doctor to help me learn why my hair was falling out and thinning so much but my concerns were made light of.

I pleaded with many doctors, asking to learn the cause of my multi-organ system’s failings. I suspected they were medication effect or vitamin deficiency related but several good doctors rolled their eyes when I begged to be tested.

I grew weaker and weaker, sicker and sicker as 2019 came to an end.

The Laundry List of Tests and Doctors Conclude: Its All in My Head

An MRI in January 2020 showed cervical myelopathy but not significant enough to warrant more surgery (THANK GOD). The orthopedic surgeon and his nurse practitioner, offered Gabapentin (as did 5 other doctors) and physical therapy (PT). I refused the gabapentin because it had made me incoherent in the past. I agreed to try PT but was frustrated, since I had tried physical therapy more times than I can tell over the past ten years. This last time, in February, just the PT evaluation magnified all my symptoms and I barely walked back to my car. Returning to my vehicle, I felt like I was on fire with burning nerve/muscle pain all over.

Again, I adamantly refused meds without learning the cause.

I was sent to have an EMG (nerve-muscle functioning testing). The EMG showed multi-nerve damage, or “multiple peripheral neuropathies.” That was in March of this year. I had been twice before to this same physiatrist having EMG’s years prior due to ongoing “nerve pain.” Like many other doctors, he never suspected thiamine deficiency and implied that it was “all in my head.”

I was sent to another consult, a Brown University rheumatologist, who basically told me the same thing that my pain was “in my head,” as most docs do seeing history of “depression and chronic pain.”  On exam, I actually jumped when he touched my outer thighs and various areas on my body. I was super “nerve sensitive,” which he was attributing to “my mind.” Outer thigh pain/ sensitivity was a symptom of thiamine deficiency I’d later learn. After my RN daughter, acting as my advocate, spoke on my behalf asking for nutritional deficiency testing to rule out causes, he tried ordering labs but had little knowledge of what to order and “could not find the transketolase test or a simple Vitamin B1 test on my screen,” he replied. To appease me, he ordered multiple other labs and sent me on my way with no diagnosis and no return appointment.

For the multitude of GI symptoms, I was sent to a caring gastroenterologist who performed a colonoscopy and endoscopy with insignificant results and biopsies all normal. He too was empathetically puzzled, urging me to request a thoracic MRI due to my history of degenerative disc disease. Upon exam, this doctor was alarmed at my sensitivity at my breastbone area when touched. It was painful and clearly inflamed.

I had all the symptoms of multiple sclerosis (MS) too, so I had a brain MRI with and without contrast that I asked for after researching my symptoms, wanting to rule out MS too. The MRI showed: “a single small focus of flair hyper-intensity within the frontal lobe white matter, nonspecific and could not rule out demyelinating disease or MS…”

They ruled out “pinched nerves” in a thoracic MRI, recommended by the GI doc after not finding answers to my GI symptoms. I had repeated X-rays and a lumbar MRI having a lengthy history of lower back pain too.

The lumbar MRI incidentally found gallstones which sent me to a surgeon who recommended gallbladder removal. In this COVID environment, I have minimized symptoms with better diet and supplements thus far.

Discovering My Thiamine Deficiency: A Bit of Research and a Bit of Serendipity

In February 2020, I had begun reading the book “Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition,” written by Dr.’s Lonsdale and Marrs. From the case studies and the research, I knew that I had thiamine deficiency. The trick now was to get someone to believe me. I brought the book to an upcoming neurologist appointment. Although, with each of the 7 previous consults, blood work was done, it was this last consult, with an astute neurologist, that I found out why. He knew after examining me and listening to me that I was deficient in thiamine. He took the time to research my history and found that I’d been diagnosed as thiamine deficient 5 years ago, but sadly, no one told me. In 2015, lab tests showed that my thiamine was 6 nmo/L , below the lab’s reference range of 8-30 nmol/L. I was still deficient in thiamine in February 2020 with a result of 7 nmol/L. He explained that I “needed to take 100mg thiamine daily, starting immediately and that it would likely take 6-12 months to hopefully reverse symptoms.” He also indicated that I would need supplementation for life now. As I have continued to research and read about thiamine deficiency, I learned that I would likely need much higher doses of thiamine, in the form of something called TTFD. TTFD is a synthetic thiamine that crosses the blood brain barrier getting into the cells better.

A Possible Family History of Latent Thiamine Issues

I continued reading, researching, and learning from case studies and groups. Thiamine deficiency is much more common than thought today. It can be passed on at birth in an unknowing deficient mother. Looking back, I fully believe my mother was deficient given her history of problems in school, high anxiety, and severe depression on and off for years. Her symptoms worsened with divorce when she was still pregnant with her fifth child. Each of her children were born only 12 – 13 months apart! I recall her getting dizzy, feeling faint often. She suffered with leg pain for years.

I am most concerned over the genetic factors influencing me and my family. The first stages of thiamine deficiency see thyroid issues, which my mother, sister, and aunt all had/have. Diabetes runs in my family: my grandmother, aunts, sister, and I’m now at the pre-diabetic stage. Cardiac issues are often seen: my grandmother, mother, aunt, and I have had them. GI issues also are noted in multiple family members. The most worrisome disease is Alzheimer’s disease, which is often seen in late stages of thiamine deficiency according to research. My grandmother, mother, many of her sisters (now deceased) all had Alzheimer’s disease. I am currently seeing early Alzheimer’s and short-term memory loss in my 80 year old aunt and her 75 year old youngest brother.

I have been monitoring my aunt who could not tolerate the Alzheimer’s medications that she was given. I began using thiamine with her in March 2020. We began with a good B-Complex having 100mg thiamine mononitrate and then added 50 mg Allithiamine in mi- July when she got very sick with what I believe was Covid-19. I kept her on this dose through August and then upped it to 100mg in September. I am now seeing improvements. Her energy has improved greatly. Although still forgetful, her memory is improving. She recovered after three weeks with the virus, yet suffered with extreme fatigue many weeks to follow. I will write about her story in a subsequent post.

The Path to Recovery

As a nurse, journaling my symptoms, diet, supplements, and vital signs, etc., I have watched my symptoms, rated on a scale of 1-10 with 10 being worse, go from 7-8s down to 3-4s over the last 6 months, after beginning thiamine replacement. I have been thoughtfully self-experimenting, slowly increasing my TTFD, using the brands called Allithiamine and Thiamax along with magnesium and potassium for proper absorption. Since rebalancing thiamine often brings out other deficiencies, I alternate a good multivitamin/mineral supplement and B-Complex and take probiotics for good gut health and better absorption. Over the last 6 months:

  • My neuropathies, which were tested pre-thiamine in February 2020 and again in June 2020 after a little over 5 months into thiamine treatment, are reversing.
  • I am off all pain meds, antidepressants, and other scripts (weaned under supervision SLOWLY).
  • I am happier, calmer, healthier overall.
  • I am most impressed with my renewed desire and ability to read, write, and research and retain information learned!

I’m now so hopeful for a good recovery by next spring. I understand I will need thiamine supplementation for life now, hopefully in lower doses eventually. Time will tell.

Drugs Dont Solve Vitamin Deficiencies

With this experience, I have learned that there is no one easy answer for all as far as dosing goes. Replenishing thiamine requires careful rebalancing of other vitamins and minerals, as most people have multiple nutritional deficiencies. Prior to supplementing with TTFD, my labs showed Vitamin D deficiency for over ten years and low thiamine since 2015. If not for the COVID environment, I would have been hospitalized for IV thiamine treatment and looking back now, probably should have been.

I hope my story here can in turn help others find answers which sadly so many Western doctors seem to miss. Nutritional knowledge is barely taught in medical school. I hope that changes, as malnutrition is often the root cause of many diseases. I know all too well how frustrating it can be to go from doctor after good doctor who only know what they are taught: “treat symptoms with drugs.”  Sometimes, it takes one’s own persistence, research, and being proactive to regain wellness. Of course, wellness means cleaning up the diet by avoiding processed foods, carbs, and sugar. Recovery takes eating clean, whole organic foods mainly. It means balancing exercise, sunshine and good mental health. It takes looking at your environmental toxin exposures. It means DE-stressing and cutting back on EMF’s. It takes changing your lifestyle but most importantly, listening to your body and allowing rest and recovery and above all, a well-balanced life.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Thiamine: A Missing Piece of the COVID-19 Treatment Puzzle?

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Earlier this year, Hormones Matter published two posts suggesting that thiamine could be helpful in treating COVID-19, one by Dr. Lonsdale focused on the role of thiamine in facilitating the energy metabolism needed to fight disease and one by me focused on thiamine’s potential to increase oxygen levels through the inhibition of carbonic anhydrase isoenzymes. Since the publication of these posts, new evidence has emerged that further supports the potential benefits of thiamine for COVID-19. This post reviews the new evidence and argues for the accelerated execution of a randomized controlled trial to evaluate the potential of thiamine to slow the progression of COVID-19 in newly diagnosed outpatients.

Thiamine and COVID-19: New Evidence

The most important new data are: (1) a study which found that high-dose thiamine lowers the Th17 cell proinflammatory response believed to be associated with the COVID-19 cytokine storm and (2) data on mortality rates from two medical centers using the MATH+ protocol to treat COVID-19 hospitalized patients. I summarize each in turn.

  1. Modulation of Th17 proinflammatory response. Through a creative combination of in vivo and in vitro experiments, the authors of this study demonstrate that thiamine interrupts the cycle of inflammation believed to play a role in the cytokine storm associated with COVID-19, leading to reduced levels of IL-17 pro-inflammatory cytokines and increased levels of the anti-inflammatory IL-22 cytokines. They determined that a range of 74-474 mg daily of thiamine would achieve the desired response in COVID-19 patients. Notably, this study did not involve patients with COVID-19, but rather patients with alcohol use disorder, who also tend to experience a pro-inflammatory state characterized by elevated IL-17 levels. So thiamine’s effectiveness in preventing and treating COVID-19 still needs to be tested in a clinical setting. The study is in the pre-print phase only, and is currently under review by a peer-reviewed journal. This video by Dr. Mobeen Syed provides a helpful explanation of the study and its context.
  2. Reduced COVID-19 mortality rates in two hospitals using the MATH+ protocol. The MATH+ protocol for COVID-19 combines a range of substances to treat hospitalized COVID-19 patients: Methylprednisolone (a steroid), Ascorbic Acid (Vitamin C), Thiamine, Heparin (a blood thinner) and several additional components, including melatonin, zinc, vitamin D, atorvastatin and famotidine. Grounded in the experience Dr. Paul Marik and his collaborators gained in treating patients with sepsis, and other emerging evidence, the protocol has been endorsed by a group of physicians known as the Front Line COVID-19 Critical Care Alliance. The protocol is intended to be used as soon as hospitalized COVID-19 patients meet the criteria for oxygen supplementation. Dr. Marik’s version of the protocol, the EVMS Critical Care COVID-19 protocol, also includes recommendations for treatment at earlier phases of the disease and for prevention.

The MATH+ protocol has not been evaluated through a randomized controlled trial, but the authors have published a detailed scientific review of the protocol as well as data on the mortality of patients treated with the protocol.  According to their data, through July 20, 2020, the two hospitals using the protocol (United Memorial Medical Center, in Houston, TX, and Sentara Norfolk General Hospital, in Norfolk, Virginia) reported mortality rates for hospitalized COVID-19 patients of 4.4 and 6.1 percent, respectively. This compares with mortality rates for hospitalized COVID-19 patients of 15.6 to 32.0 percent reported in other studies.  Since this is not a formal controlled study, it is possible that explanations other than the use of the MATH+ protocol could account for the sharply lower mortality rates at the Houston and Norfolk hospitals. Nevertheless, the comparatively low mortality rates of the hospitals using the MATH+ protocols  represent very promising results.

Other recent articles suggesting a role for thiamine in treating COVID-19 include: an article on the potential role of B vitamins in treating COVID-19, a review of the potential of vitamins to treat COVID-19, and an article focused on famotidine, melatonin and thiamine. Many of the studies on the potential role of thiamine in treating COVID-19 are summarized in this review. This article focuses on the potential of the carbonic anhydrase inhibitor acetazolamide to prevent kidney damage from COVID-19.  As noted in my earlier post, an in vitro study suggests that thiamine may be nearly as effective as acetazolamide in inhibiting carbonic anhydrase isoenzymes.

Potential Mechanisms Linking Thiamine Deficiency to COVID-19

The exact mechanism through which thiamine may be contributing to the results discussed above is unclear. One potential pathway is thiamine deficiency, which is fairly common in severely ill patients and discussed by the authors of both the Th17 research paper and the scientific review of the MATH+ protocol. As the scientific review of the MATH+ protocol observes:

The human adult can store around 30 mg of thiamine in muscle tissue, liver and kidneys, however, these stores can become depleted in as little as 18 days after the cessation of thiamine intake. A thiamine deficiency syndrome, beriberi, bears a number of similarities to sepsis, including peripheral vasodilation, cardiac dysfunction, and elevated lactate levels. In critical illness, the prevalence of thiamine deficiency is 10–20% upon admission and can increase up to 71% during ICU stay, suggesting rapid depletion of this vitamin.

At the same time, however, the authors noted that “[b]ased on limited data, no association was detected between thiamine levels, markers of oxidative stress and mortality” in two studies.”   

There could also be benefits in using thiamine as part of a combination protocol with other agents. For example, the authors of the MATH+ scientific review note that the combined administration of thiamine and steroids may help to enhance the anti-inflammatory properties of steroids. “In experimental rheumatoid arthritis, thiamine increased the ability of corticosteroids to suppress production of TNF-á and IL-6.”

An intriguing role for thiamine in countering the inflammation associated with some viruses is raised by the authors of the paper on the Th17 proinflammatory response. They cite in vitro research which found, using feline models that some viruses rely on a thiamine transport protein in the disease cycle. In theory, occupying the thiamine transporter by providing thiamine to thiamine-deficient individuals could inhibit a virus which relied on this same transporter. While not specifically addressed in the paper, this raises the question of whether the use of high doses of thiamine in individuals without a deficiency could have a similar effect in interrupting the disease cycle of a virus that depends on the thiamine transporter.

Neither the Th17 study nor the scientific review of the MATH+ protocol mention thiamine’s role as a carbonic anhydrase inhibitor, but it is noted in two of the other articles referenced above as potentially contributing to reduced hypoxia. This pathway needs further study. Carbonic anhydrase inhibitors produce carbon dioxide, which can help to reduce the hypoxic conditions that produce inflammation. One way is through increased respiration.  Several other mechanisms for carbon dioxide’s protective effects are summarized in this article:

Numerous other mechanisms potentially exist whereby CO2 protects the tissues from hypoxic-ischemic damage. An increase in blood pCO2 shifts the oxygen hemoglobin dissociation curve to the right (Bohr effect), the result of which is a decrease in the affinity of hemoglobin for oxygen. Therefore, at the capillary level, CO2 would tend to raise pO2, increase the gradient for any given oxyhemoglobin saturation, and facilitate transfer of O2 to the tissue for oxidative processes. CO2 might also preserve cardiac function during systemic hypoxia. The inhibition of systemic lactate production by CO2 inhalation during hypoxia would serve to maintain optimal cardiovascular function.

Research Needed

Given the severity of the COVID-19 pandemic, and the expected challenges associated with the combined burden of flu and COVID-19 on hospitals this fall and winter, it is important to test all plausible treatment avenues for COVID-19.  The data reviewed in this post add to the evidence base supporting a randomized controlled trial (RCT) to test whether thiamine – alone or in combination with other agents – could help to slow the progression of COVID-19 and/or mitigate the cytokine storm associated with some of its worst effects.

Cognizant of the prevailing view that RCTs are the best way to build evidence about the effects of medical treatment, the authors of the scientific review of the MATH+ protocol specifically discuss their decision to forgo an RCT. They argue that the clinical value of each of the treatments included in their protocol has been well established and that they therefore do not have the clinical equipoise (“the belief by the investigator that neither intervention in the control or experimental group is more effective”) necessary to justify a trial. In essence, they argue that it would be unethical to deprive patients facing a deadly disease of treatments they believe to be effective. Instead, they are pursuing a different research approach: “the formation of a patient registry to measure and compare the outcomes of patients treated with MATH+, not only against the prevailing ‘supportive-care only’ strategy, but also against other novel proposed treatment approaches employed throughout the country and world.”

Even if the necessary clinical equipoise is not available to justify an RCT in hospitalized patients, I would argue that there IS sufficient clinical equipoise to justify an RCT testing the effects of thiamine and other agents in slowing the progression of COVID-19 in newly diagnosed outpatients. While there is a theoretical basis for believing thiamine could be helpful, we won’t know whether and to what extent it is helpful in a real-world setting until a trial is done. One approach would be to test a combination therapy that relies on oral versions of many of the substances used in the MATH+ protocol, such as vitamin C, thiamine, heparin or another blood thinner such as aspirin, vitamin D, melatonin, famotidine, and zinc. Due to concerns about possible harms resulting from the administration of a steroid too early in the progression of COVID-19, it would likely be advisable to omit a steroid from the earliest stages of treatment. The rationale for avoiding steroids in non-critically ill COVID-19 patients is discussed in the September 2, 2020 World Health Organization guidelines on the use of corticosteroids for COVID-19.

Many of these substances are already being evaluated in trials to assess their effectiveness in treating COVID-19, as reflected in the ClinicalTrials.gov database.  But not thiamine.

What are we waiting for?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

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