thiamine preeclampsia

It All Comes Down to Energy

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The Threat Around Us

Animals, including Homo Sapiens, survive in an essentially toxic environment, surrounded by microorganisms, potential poisons, the risk of trauma, and adverse weather conditions. Evolutionary development has equipped us with complex machinery that provides defensive mechanisms when any one of these factors has to be faced. Before the discovery of microorganisms, medical treatment had no rhyme or reason, but killing the microorganisms became the methodology. The research concentrated on ways and means of “killing the enemy”, the bacteria, the virus, the cancer cell. The discovery of penicillin reinforced this approach. We are now facing a period of potential impotence because of bacterial resistance, failure of attempts to kill viruses, and the resistance to chemotherapeutic agents in cancer. Louis Pasteur is purported to have said on his deathbed, “I was wrong, it is the terrain that matters”, meaning body defenses.

Hans Selye, whose research into how animals defend themselves when attacked by any form of stress, led to his description of the General Adaptation Syndrome (GAS). He recognized the necessity of energy in initiating the GAS and its failure in an animal that succumbed to stress. He labeled human disease as “the diseases of adaptation”. In Selye’s time, there was little information about energy metabolism but today, its details are fairly well-known. The suggestion of a new approach depends on the fact that our defenses are metabolic in character and require an increase in energy production over and above that required for homeostasis. If the GAS applies to human physiology and that we are facing the “diseases of adaptation”, it is hypothesized that research should be applied to methods by which energy metabolism can be stimulated and mobilized to meet the stress.

Energy Deficiency, Defective Immunity, and COVID-19

There is evidence that energy deficiency applies to each of the diseases described here. It may be the unrecognized cause of defective immunity in Covid-19 disease. Although in coronavirus disease the clinical manifestations are mainly respiratory, major cardiac complications are being reported involving hypoxia, hypotension, enhanced inflammatory status, and arrhythmic events that are not uncommon. Past pandemics have demonstrated that diverse types of neuropsychiatric symptoms, such as encephalopathy, mood changes, psychosis, neuromuscular dysfunction, or demyelinating processes may accompany acute viral infections or may follow infection by weeks, months, or longer in viral recovered patients. Electrocardiographic changes have been reported in Covid-19 patients. The authors suggest that it may be attributed to hypoxia as one possibility. Because the total body stores of thiamine are low, acute metabolic stress can initiate deficiency. Thiamine deficiency has a clinical expression similar to that observed in hypoxic stress and the authors referred to it as pseudo-hypoxia. It is therefore not surprising that defective energy metabolism can express itself clinically in many different ways.

The present medical model regards each disease as having a separate cause, but the large variety of symptoms induced by thiamine deficiency suggest the ubiquitous nature of energy deficiency as a cause in common. Obesity, a reflection of high calorie malnutrition, has been published as a risk factor for patients admitted to intensive care with Covid-19. Thiamine deficiency was reported in 15.5-29% of obese patients seeking bariatric surgery. Hannah Ferenchick M.D. an emergency room physician commented online that many of her patients with Covid-19 had what she called “silent hypoxemia”. These patients had an arterial oxygen saturation of only 85% but “looked comfortable” and their chest x-rays “looked more like edema”  It has long been known that patients with beriberi had low arterial oxygen and a high venous oxygen saturation. All that would be needed to support the hypothesis of thiamine deficiency in some Covid victims would be finding a high venous oxygen saturation at the same time as a low arterial saturation. Also, edema is a very important sign of beriberi, and thiamine deficiency has been noted in critical illness.

Disrupted Autonomic Function

There have been many articles in medical journals describing dysautonomia, mysteriously in association with a named disease, but with no suggestion that the dysautonomia is part of that disease. More recently, there is increasing evidence that dysautonomia is a feature of chronic fatigue syndrome (CFS), manifested primarily as disordered regulation of cardiovascular responses to stress. Manipulating the autonomic nervous system (ANS) may be effective in the treatment of CFS. Dysautonomia is also a characteristic of thiamine deficiency. Patients with Parkinson’s disease begin to lose weight several years before diagnosis and a study was undertaken to investigate this association with the ANS. Costantini and associates have shown that high dose thiamine treatment improves the symptoms of Parkinson’s disease, although the plasma thiamine concentration was normal. They have also shown that high dose thiamine treatment decreases fatigue in inflammatory bowel disease, Hashimoto’s disease, after stroke, and multiple sclerosis. As already noted, it is also an important consideration in critically ill patients.

Multiple System Atrophy is a devastating and fatal neurodegenerative disorder. The clinical presentation is highly variable and autonomic failure is one of its most common problems. Dysautonomia was found to be a clinical entity in Ehlers-Danlos syndrome, a musculoskeletal disease, and this syndrome frequently coexists with Postural Orthostatic Tachycardia Syndrome (POTS), a disease that is included in the group of diseases under the heading of dysautonomia. Some cases of POTS have been reported to be thiamine deficient. This common condition often involves chronic unexplained symptoms such as inappropriate fast heart rate, chronic fatigue, dizziness, or unexplained “spells” in otherwise healthy young individuals. Many of these patients have gastrointestinal or bladder disorders, chronic headaches, fibromyalgia, and sleep disturbances. Anxiety and depression are relatively common. Not surprisingly the many symptoms are often unrecognized for what they represent and the patient may have a diagnosis of psychosomatic disease.

Immune-Mediated Inflammatory Diseases (IMIDs) is a descriptive term coined for a group of conditions that share common inflammatory pathways and for which there is no definite etiology. These diseases affect the elderly most severely with many of the patients having two or more IMIDs. They include type I diabetes, obesity, hypertension, chronic pulmonary disease, coronary heart disease, inflammatory bowel disease, rheumatoid arthritis, Sjogren’s syndrome, systemic lupus, psoriasis, psoriatic arthritis, and multiple sclerosis. The recent recognition of small fiber neuropathy in a large subgroup of fibromyalgia patients reinforces the dysautonomia-neuropathic hypothesis and validates fibromyalgia pain. These new findings support the disease as a primary neurological entity.

Energy Deficiency During Pregnancy: The Cause of Many Complications

Irwin emphasized the energy requirements of pregnancy in which the maternal diet and genetics have to be capable of producing energy for both mother and fetus. He found that preventive megadose thiamine, started in the third trimester, completely prevented all the common complications of pregnancy. Hyperemesis gravidarum is the most common cause of hospitalization during the first half of pregnancy and is second only to preterm labor for hospitalization in pregnancy overall. This disease has been associated with Wernicke’s encephalopathy, well known to be due to brain thiamine deficiency. The traditional explanation is that vomiting is the cause, but since vomiting is a symptom of thiamine deficiency, it could just as easily be the cause rather than the effect. In spite of the fact that migraines are one of the major problems seen by primary care physicians, many patients do not obtain appropriate diagnoses or treatment. Migraine occurs in about 18% of women and is often aggravated by hormonal shifts. A complex neurological disorder involving multiple brain areas that regulate autonomic, affective, cognitive, and sensory functions, it occurs also in pregnancy. Features of the migraine attack that are indicative of altered autonomic function include nausea, vomiting, diarrhea, polyuria, eyelid edema, conjunctival injection, lacrimation, nasal congestion, and ptosis.

The Proteopathies: Disorders Involving Critical Enzymes

The earliest and perhaps best example of an interaction between nutrition and dementia is related to thiamine. Multiple similarities exist between classical thiamine deficiency and Alzheimer’s disease (AD), in that both are associated with cognitive deficits and reductions in brain glucose metabolism. Thiamine-dependent enzymes are critical components of glucose metabolism that are reduced in the brains of AD patients. Senile plaques and neurofibrillary tangles are the principal histopathological marks of AD and other proteopathies. The essential constituents of these lesions are structurally abnormal variants of normally generated proteins (enzymes). The crucial event in the development of transmissible spongiform encephalopathies is the conformational change of a host-encoded membrane protein into a disease associated, fibril forming isoform. A huge number of proteins that occur in the body have to be folded into a specific shape in order to become functional. When this folding process is inhibited, the respective protein is referred to as being mis-folded, nonfunctional, and causatively related to a disease process. These diseases are termed proteopathies and there are at least 50 different conditions in which the mechanism is importantly related to a mis-folded protein. Energy is required for this folding process. Because of their reported relationship with thiamine, it has been hypothesized that mis-folding might be related to its deficiency on an energy deficiency basis.

It All Comes Down to Energy

A hypothesis has been presented that the overlap of symptoms in different disease conditions represents cellular energy failure, particularly in the brain. If this should prove to be true, the present medical model would become outdated. An attack by bacteria, viruses or an oncogene might be referred to as “the enemy”. The defensive action, organized and controlled by the brain, may be thought of as “a declaration of war” and the illness that follows the evidence that “a war is being fought”. This concept is completely compatible with the research reported by Selye. It underlines his concept that human diseases are “the diseases of adaptation”, dependent on energy for a successful outcome in a “war” between an attacking agent and the complex defensive actions of the body. Killing the enemy is a valid approach to treatment if it can be done safely. Unfortunately, the side effects of most medications sometimes makes things worse and that is offensive to the Hippocratic Oath. We badly need to create an approach to research that explores ways and means of supporting and stimulating the normal mechanisms of defense.

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This article was published originally on May 11, 2020.

How to Have a Healthy Pregnancy: Avoiding Preeclampsia and Toxemia

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A few months ago, I received a book from a doctor who had retired from his specialty in obstetrics and gynecology. It was accompanied by a letter that began as follows, “I am writing to you, because I have found another mortal being who is particularly interested in the biological activities of thiamine. I had previously thought that I was nearly the lone believer in the benevolent effects of thiamine, particularly for the treatment and prophylaxis of the toxemias of pregnancy and its many associated problems”. In this letter, he went on to tell me that he had hired himself out, in his retirement, to the government of the Commonwealth of the Northern Mariana Islands “to improve upon their system of obstetrical care”.

Severe Preeclampsia

On his first day he attended an introductory meeting with a group of island doctors who were all American Board Certified in their specialties. Their purpose was to introduce him to a patient who was 36 weeks pregnant. He described her as “essentially moribund” with severe preeclampsia, gestational cardiomyopathy, and some separation of the placenta (preeclampsia is the term used for severe pregnancy toxemia and cardiomyopathy is the term used for a sick heart. Separation of the placenta would mean that there would be bleeding into the uterus). She  was so sick that she had orthopnea (breathlessness while lying flat on her back. She could only breathe when sitting up in bed, a characteristic of heart failure). Spontaneous labor and delivery, he said, most likely would cause maternal and fetal death and that she would fail to come through a cesarean section. All in all, this was considered by all of the island doctors concerned to be a hopeless case. He suggested that she had beriberi, the vitamin B1 deficiency disease. The letter went on to say “in a private huddle the doctors decided that if the patient died while they were holding me up, they would be found solely guilty, so with anger, sneers and audible comments they told me to go ahead!” He gave the woman 100 mg of thiamine daily in a pill and she was physiologically cured in six days, sleeping flat and hiking the long halls for exercise to shake off her prolonged immobilization. On the seventh day, because of fetal distress, she was subjected to cesarean section, with the delivery of a 3 lbs. 12 oz. baby with a normal Apgar score.

Yes, I know how many will react to this. They will say that this patient was on a tropical island where beriberi was much more likely. This could not happen in America where the science of nutrition is so well known and where all the foods are enriched with vitamins. Also, they might think that the doctor was deluded into thinking that all forms of toxemia were really beriberi and that he had treated this disease rather than toxemia. So the doctor started the clinic patients on prophylactic mega-thiamine for the second and third trimesters, preventing development of every type of toxemia completely, including eclampsia, preeclampsia intra-uterine growth retardation, premature delivery, fetal death, premature rupture of membranes, placenta previa and gestational diabetes, among other possible complications. Again, the reader might well say that these were all patients on a tropical island. Consider however that this doctor had spent his professional lifetime in his attempt to bring healthy babies into the world. He was conversant with all the complications of pregnancy. Did the island doctors fail to recognize beriberi or is toxemia of pregnancy merely a manifestation of thiamine deficiency? Our preconceived idea that each disease is a separate entity with a separate cause and an individualized treatment may very well be completely wrong. If energy metabolism is compromised, the dysfunctional effects will be related to the cells most affected. The symptoms and physical or mental deterioration will be as variable as the distribution of the energy deficit.

There is a lot more to this and I can only suggest that anybody wishing to be pregnant should obtain this book by John B Irwin M.D. “The Natural Way to a Trouble-Free Pregnancy” with the subtitle “The Toxemia-Thiamine Connection”.

It is, of course, mandatory for you to undertake this with the permission and care of your OB/GYN physician if you are pregnant. However, do not expect that the physician will automatically accept the idea. You may have to show him/her the book. As I have said many times in posts on this website, the emerging truth concerning the application of vitamins in the treatment of disease and the preservation of health has not yet reached the collective psyche of the medical profession. It has been hard won by the few pioneers that have begun to practice what is now called Alternative Complementary Medicine. They use few drugs and the results that they get are real.

Of RDAs and Mega-doses

It is quite obvious that you might ask the question, why, if this is so important in the lives and well-being of millions, it is not an acceptable practice in modern medicine by the majority of physicians? The answer is because of the teaching of biochemistry in medical schools. We all have known for many years that thiamine is acquired from the diet.  The recommended daily allowance (RDA) is 1 to 1.5 mg. This minute dose acts as what is called a cofactor to many enzymes. Without sufficient cofactor, the enzymes do not function properly. Thus, vitamin deficiency has long been regarded as a situation that requires simple replacement of the cofactor. Therefore, the only dose required is that recommended as the RDA and mega-doses are regarded as being completely useless.

Unfortunately, what has not sufficiently been considered is that an overload of simple carbohydrate empty calories overwhelms the ability of thiamine to process  glucose derived from the food. Glucose is used by body cells as fuel and the energy supply that results from it must meet physical and mental demands for maintaining healthy life. The modern diet is grotesquely unnatural and, because of the overload of empty calories the enzymes that are starved of their cofactors, begin to deteriorate. In order to resuscitate them, the cofactors must be used in a pharmacological way to stimulate the respective enzymes back into a healthy state.

Pregnancy Energy Demands are Significant

Pregnancy requires energy for the development of the baby as well as the health of the mother so the demand is greater. Cells will use what is needed of the mega-dose for the resuscitation to take place and will discard the excess in urine. The beauty of this new way of thinking about treatment of disease is that it is non-toxic and harmless. We even know now that some of the diseases, previously thought to be entirely genetic in origin, respond to mega-doses of vitamins. This has opened up a brand-new science called epigenetics that studies the effect of lifestyle and nutrition on genes. Genes are no longer considered to be solely in charge of our health destiny. We each have a responsibility towards the preservation of the blueprint (inheritance) by what we eat and our lifestyles.