From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history

Thiamine (Vitamin B1) is a B complex] vitamin important in the metabolism of energy from carbohydrates, the production of RNA and DNA, and nerve function.

Thiamine pyrophosphate (TPP) is part of the conversion of acetyl coenzyme A (CoA).

The symptoms of thiamine deficiency include fatigue, paresthesia,muscle weakness, nausea, changes in heart rate, and delirium. Derrick Lonsdale and Chandler Marrs argue that thiamine deficiency is more common than generally understood and an important contributor to dysautonomia.[1] Without adequate and usable thiamine intake, the citric acid cycle necessary for aerobic respiration cannot be completed. In its extreme forms, thiamine deficiency manifests as beriberi and Wernicke's encephalopathy.

High-Dose Thiamine[edit | edit source]

In a series of small case studies published between 2013 and 2018, Alberto Costantini and colleagues found that high doses of thiamine substantially reduced fatigue in people with a range of neurological and inflammatory conditions, including Parkinson's Disease,[2][3] multiple sclerosis,[4] fibromyalgia,[5] inflammatory bowel disease,[6] and cluster headaches.[7] Costanini and colleagues generally reported amounts between 600 and 1,800 mg of oral thiamine hydrochloride in their case studies, eventually articulating a dosage regime based on weight and sex. (They have developed a different dosage for Parkinson's Disease.) In 2020, Bager and colleagues applied a similar approach in a double-blind crossover randomized controlled trial, finding 600 to 1,800 mg of oral thiamine hydrochloride to be effective in relieving fatigue in patients with quiescent IBD.[8] Bager and colleagues found that the reductions in fatigue were not limited to patients with thiamine deficiency, a result also found by Costantini and colleagues.

In their articles on high-dose thiamine, Costantini and colleagues offered a number of explanations for why high-dose thiamine might reduce fatigue, including a hypothesis that high doses of thiamine might be compensating for defects in the active transport mechanism that allows thiamine to enter the cell and be used by the mitochondria to produce energy. Under this hypothesis, which Bager and colleagues also posit, large doses of thiamine are necessary to allow blood thiamine levels to rise to the point where thiamine could enter the cells through passive diffusion.

An alternative explanation, summarized in a letter to the editor commenting on the Bager study,[9] focuses on high-dose thiamine's property as a carbonic anhydrase inhibitor, which has been proven in vitro,[10] though not yet studied in vivo. As hypothesized in the letter, "The inhibition of carbonic anhydrase isoenzymes by high-dose thiamine and the resulting production of carbon dioxide could lead to reductions in fatigue and other symptomatic improvement through one or more of four potential pathways: (a) by reducing intracranial hypertension and/or ventral brainstem compression; (b) by increasing blood flow to the brain; (c) by facilitating aerobic cellular respiration and lactate clearance through the Bohr effect[11]; or (d) by dampening the pro-inflammatory Th-17 pathway[12], again through the Bohr effect, potentially mediated by reductions in hypoxia-inducible factor 1.[13][9]. A more complete explanation of this hypothesis can be found here.[citation needed]

Studies have also examined the potential of the thiamine derivative, sulbutiamine, to reduce fatigue.[14]

Chronic fatigue syndrome[edit | edit source]

One very small study found decreased functional status of several B vitamins including pyridoxine, riboflavin and thiamine.[15]

To date, high-dose thiamine has not been studied formally in patients with ME/CFS. However, an informal retrospective survey on the use of 200 mg or more daily of thiamine among 55 individuals with ME/CFS, fibromylagia or Ehlers-Danlos Syndromes was reported in Health Rising in 2021.[16] Among the 55 individuals responding to the survey -- 49 of whom reported having ME/CFS -- nearly two-thirds reported large benefits from high-dose thiamine, with another 5 percent reporting smaller benefits. The most commonly reported benefits were reductions in fatigue, post-exertional malaise and brain fog. While the incidence of side effects was generally low, and most people reporting mast cell activation syndrome (MCAS) reported benefitting from high-dose thiamine, a number of respondents reported that high-dose thiamine made their MCAS symptoms substantially worse, suggesting that caution be exercised by those with severe MCAS or active flares.

Formal research is needed on the potential of high-dose thiamine to benefit people with ME/CFS.

Type of Thiamine[edit | edit source]

There are a number of different forms of thiamine used in supplements. The most common forms are thiamine hydrochloride, thiamine mononitrate, and benfotiamine. Benfotiamine is reportedly better absorbed than the other two forms, but a study of the pharmacokinetics of thiamine hydrochloride found that when taken regularly, oral thiamine hydrochloride produced blood levels similar to that of intravenous administration.[17]

Several thiamine derivatives are reported to cross the blood-brain barrier, including sulbutiamine and allithiamine.

Learn more[edit | edit source]

See also[edit | edit source]

References[edit | edit source]

  1. Lonsdale, Derrick; Marrs, Chandler (2017). Lonsdale, Derrick; Marrs, Chandler (eds.). Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition. Cambridge, MA: Academic Press. pp. 213–61. doi:10.1016/B978-0-12-810387-6.00006-X.
  2. Costantini, Antonio; Fancellu, Roberto (2016). "An open-label pilot study with high-dose thiamine in Parkinson's disease". Neural Regeneration Research. 11 (3): 406. doi:10.4103/1673-5374.179047. ISSN 1673-5374. PMC 4828997. PMID 27127471.
  3. Costantini, Antonio; Pala, Maria Immacolata; Grossi, Enzo; Mondonico, Stella; Cardelli, Luisa Ercoli; Jenner, Carina; Proietti, Sabrina; Colangeli, Marco; Fancellu, Roberto (December 2015). "Long-Term Treatment with High-Dose Thiamine in Parkinson Disease: An Open-Label Pilot Study". The Journal of Alternative and Complementary Medicine. 21 (12): 740–747. doi:10.1089/acm.2014.0353. ISSN 1075-5535.
  4. Costantini, A.; Nappo, A.; Pala, M.I.; Zappone, A. (July 16, 2013). "High dose thiamine improves fatigue in multiple sclerosis". Case Reports. 2013: bcr2013009144–bcr2013009144. doi:10.1136/bcr-2013-009144. ISSN 1757-790X. PMC 3736110. PMID 23861280.
  5. Costantini, A.; Pala, M.I.; Tundo, S.; Matteucci, P. (May 20, 2013). "High-dose thiamine improves the symptoms of fibromyalgia". Case Reports. 2013 (may20 1): bcr2013009019–bcr2013009019. doi:10.1136/bcr-2013-009019. ISSN 1757-790X. PMC 3669831. PMID 23696141.
  6. Costantini, Antonio; Pala, Maria Immacolata (August 2013). "Thiamine and Fatigue in Inflammatory Bowel Diseases: An Open-label Pilot Study". The Journal of Alternative and Complementary Medicine. 19 (8): 704–708. doi:10.1089/acm.2011.0840. ISSN 1075-5535.
  7. Antonio, Costantini; Massimo, Tiberi; Gianpaolo, Zarletti; Immacolata, Pala Maria; Erika, Trevi (2018). "Oral High-Dose Thiamine Improves the Symptoms of Chronic Cluster Headache". Case Reports in Neurological Medicine. 2018: 1–5. doi:10.1155/2018/3901619. ISSN 2090-6668. PMC 5932500. PMID 29850313.
  8. Bager, Palle; Hvas, Christian; Rud, Charlotte; Dahlerup, Jens (October 2020). "Randomised clinical trial: high-dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease". Aliment Pharmacol Ther. 53 (1): 79–86. doi:10.1111/apt.16166. Retrieved August 22, 2021.
  9. 9.0 9.1 Lubell, Jeffrey (March 2021). "Letter: future studies of high-dose thiamine should consider whether its effects on fatigue are related to the inhibition of carbonic anhydrase isoenzymes". Aliment Pharmacol Ther. 53: 851–852. Retrieved August 22, 2021.
  10. Özdemir, Zafer Ömer; Şentürk, Murat; Ekinci, Deniz (April 1, 2013). "Inhibition of mammalian carbonic anhydrase isoforms I, II and VI with thiamine and thiamine-like molecules". Journal of Enzyme Inhibition and Medicinal Chemistry. 28 (2): 316–319. doi:10.3109/14756366.2011.637200. ISSN 1475-6366.
  11. Vesela, A; Wilhelm, J (2002). "The role of carbon dioxide in free radical reactions of the organism". Physiol Res. 51 (4): 335–33. PMID 12449430.
  12. Vatsalya, Vatsalya; Li, Fengyuan; Frimodig, Jane; Gala, Khushboo S.; Srivastava, Shweta; Kong, Maiying; Ramchandani, Vijay A.; Feng, Wenke; Zhang, Xiang (March 2, 2021). "Repurposing Treatment of Wernicke–Korsakoff Syndrome for Th-17 Cell Immune Storm Syndrome and Neurological Symptoms in COVID-19: Thiamine Efficacy and Safety, In-Vitro Evidence and Pharmacokinetic Profile". Frontiers in Pharmacology. 11: 598128. doi:10.3389/fphar.2020.598128. ISSN 1663-9812. PMC 7960760. PMID 33737877.
  13. Nutsch, Katherine; Hsieh, Chyi (September 2011). "When T Cells Run Out of Breath: The HIF-1α Story". Cell. 146 (5): 673–674. doi:10.1016/j.cell.2011.08.018.
  14. Sevim, Serhan; Kaleağası, Hakan; Taşdelen, Bahar (August 2017). "Sulbutiamine shows promising results in reducing fatigue in patients with multiple sclerosis". Multiple Sclerosis and Related Disorders. 16: 40–43. doi:10.1016/j.msard.2017.05.010.
  15. Heap, L.C.; Peters, T.J.; Wessely, S. (April 1, 1999), "Vitamin B Status in Patients with Chronic Fatigue Syndrome", Journal of the Royal Society of Medicine, 92 (4): 183–185, doi:10.1177/014107689909200405, ISSN 0141-0768, PMID 10450194, retrieved November 9, 2016
  16. Lubell, Jeffrey. "Nearly 2/3rds of Survey Respondents Report Large Benefits from High-Dose Thiamine (B-1)". Health Rising. Retrieved August 22, 2021.
  17. Smithline, Howard A; Donnino, Michael; Greenblatt, David J (December 2012). "Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects". BMC Clinical Pharmacology. 12 (1): 4. doi:10.1186/1472-6904-12-4. ISSN 1472-6904. PMC 3293077. PMID 22305197.