What is thiamine?
Thiamine (aka vitamin B1) is an essential water-soluble vitamin that plays a crucial role in how cells make energy.
It is also very important for how nerves send messages throughout the body, and how the brain makes specific neurochemicals. It is a key cofactor for enzymes involved in converting carbohydrates/fats/proteins into ATP, the body’s primary energy source.
Thiamine is especially needed for production of the neurotransmitter acetylcholine. It is therefore extremely important for the autonomic nervous system, and maintaining the balance between sympathetic and parasympathetic modes
Sources of Thiamine – Vit B1
It is found in a variety of foods in low amounts: meats, organs, legumes, whole grains.
From a conventional standpoint, a severe deficiency is known to affect the brain, heart, peripheral nerves, and gut.
However, a mild deficiency can lead to a wide variety of NON SPECIFIC symptoms, which vary from person to person: Fatigue, brain fog, nerve pain, muscle pain, insomnia, anxiety, restlessness, autonomic nervous system problems/dysautonomia (blood pressure imbalances, vertigo, circulation problems, heart rate problems, body temperature dysregulation), SIBO, stomach acidity imbalances, constipation, sometimes diarrhea, intestinal permeability and any number of function gut disorders.
What causes Thiamine / Vit B1 deficiency
There are many potential causes. Thiamine status depends on carbohydrate intake, meaning the more carbs/sugar someone consumes, the greater demand for thiamine.
High intake of refined carbohydrate/refined foods – Alcohol destroys thiamine – Tannins (not caffeine) in tea/coffee inactivate thiamine
Medications: Metronidazole/flagyl, metformin, diuretics, omeprazole – Sulfites destroy thiamine
Chronic gut conditions which involve nutrient malabsorption/gut inflammation
Any state of prolonged physical stress (excessive exercise, critical illness, hyperthyroid, etc)
In short, there are numerous things which can lead to/trigger a deficiency. A classical deficiency can be fairly straightforward to treat, but can take several months to manifest (depending on severity of the deficiency).
However, there are also many individuals who don’t display the risk factors, but respond to high-doses of thiamine.
What is a “Functional” or “Localized” Thiamine / Vit B1 deficiency?
Localized or Functional Deficiency – This occurs in people who have normal systemic levels of thiamine in their body. However, certain regions of the body can experience a localized deficiency.
For example, in neurodegenerative diseases, the research suggests localized “deficiency” in the brain. Without going into the mechanistic details, this can occur for various reasons, and can either be due to problems with transporting thiamine into the brain and into the cells.
Or it can be related to problems with enzymes in cells which use thiamine. It can occur in the heart, the brain, the gut, etc. In this scenario, taking normal doses of thiamine is not enough. For people to see improvements in their condition, they generally require anywhere from 300-2000x the RDA (300mg to 2000mg, depending on the form of thiamine used).
Here is where blood testing/functional testing becomes useless, because it doesn’t measure what is going on at the organ/cell level of the affected area.
Different forms of Thiamine / Vit B1
Thiamine HCL/mononitrate – Cheap but not well absorbed. Can be useful in high doses above 500mg
Benfotiamine – well absorbed and gets into brain, good for peripheral neuropathy, diabetes, body pain, fatigue, Alzheimer’s’. Usually dosed between 150-2100mg
TTFD (thiamine tetrahydrofurfuryl disulfide) – well absorbed and gets into brain – best for gut issues of any kind, POTS/dysautonomia and mood issues. Also good for fatigue, and neuropathy. Contains sulfur, so can trigger unwanted symptoms in some people. Usually dosed between 100-500mg
Basic Thiamine / Vit B1 Supplementation Protocol
Start low and go slow with whichever form of B1 (think 10-50mg). Take B complex, magnesium and potassium as well.
Gradually increase dose of thiamine over the space of days/weeks. Watch for changes in symptoms. As increasing the dose, symptoms can get temporarily worse (called the paradoxical effect). If symptoms worsen, stay at current dose until they return to baseline. – When symptoms return to baseline, work on increasing dose again.
