Fatigue, sleep disorders, depression, anxiety, fibromyalgia and cardiac troubles are some of the symptoms we see as the expression of a classic mild thiamine deficiency. Thiamine deficiency is very under-rated and under-recognized, and can have far reaching ramifications. And a magnesium deficiency and high dose magnesium can actually cause a thiamine deficiency. There are also many other causes of thiamine deficiency that may not be on your radar: a high carb/processed food/sugar diet, coffee, tea, alcohol, genetics, environmental toxins, medications, celiac disease, leaky gut, bariatric surgery and malabsorption.
It’s for this reason that I invited Chandler Marrs, PhD to speak on the Anxiety Summit 5: Gut-Brain Axis. We had so much to cover and it ended up being so long, that we split it into part 1 and part 2.
This is what we cover in Thiamine Deficiency in Anxiety and Gut Health (Part 1)
- Excessive carbs, alcohol, medications and genetics as causes of low B1/thiamine
- Dysbiosis, dysmotility, constipation, anxiety, depression, panic attacks, low energy
- Psychiatric and digestive effects: research, history and other symptoms
This is what we cover in Thiamine Deficiency in Anxiety and Gut Health (Part 2)
- The mitochondria, dysautonomia and POTS
- Other symptoms: hyperemesis, exercise intolerance, muscle pain, neuropathy
- Thiamine supplementation – forms, dosing and paradoxical reactions
Thiamine deficiency is under-rated and under-recognized
We start with why it’s an under-rated and under-recognized deficiency and Dr. Marrs shares that the assumption is that deficiency is not common and even when you test it looks like you are not deficient:
- “The assumption is that there is no such thing [as a thiamine deficiency] and that it’s rare unless you are a chronic alcoholic. And even then, it’s missed 80% of the time. Or you have a severe injury or illness that depletes thiamine rapidly.
- The presumption is that we’ve solved it, and it’s rare, and it only happens in countries where food availability is problematic.
- The reality is that the chemistry of our foods, the chemistry of our environment, the medications that we take all combine and accrue to not only deplete the available thiamine on the basis of intake but to increase the need and to damage a lot of the enzymes involved in the processing of thiamine.
- So a lot of folks are functionally deficient in that even though by definition they meet the daily requirement and they may, based upon lab testing, show up as being sufficient and not frankly deficient.
- And so, I think that we just have taken our eye off of the ball with regard to this particular nutrient.”
Magnesium deficiency (and high dose magnesium) can actually cause a thiamine deficiency
Dr. Marrs also shares how a magnesium deficiency (which is very common) can actually cause a thiamine deficiency:
- “One of the things that’s interesting is it requires magnesium to activate thiamine into its active form.
- If someone is thiamine sufficient and magnesium deficient, then they are actually functionally deficient in thiamine because you cannot take the free thiamine and activate it into thiamine pyrophosphate.
- So magnesium deficiency itself can cause thiamine deficiency. And there’s a good percentage of the population that doesn’t get enough magnesium.”
And she also shares how when taking high dose magnesium it’s so crucial to also be addressing low thiamine in order to prevent them becoming more thiamine deficient:
- “Now, the flip side of that is really interesting. And I think this is important for your audience, in particular, is that magnesium supplementation, when someone has a problem with thiamine, will actually shut down thiamine processing and mitochondrial processing at one of the enzymes. Because if you don’t have thiamine with magnesium, then the enzyme α-ketoglutarate dehydrogenase kind of shuts the whole sequence down.
- So if you are giving someone high dose magnesium, which is common to supplement, and not tackling the thiamine as well, you risk them becoming more thiamine deficient and reducing ATP output, energy output even further. So everything has to be in balance to some extent or another.”
I can think of one situation where this could be common. You use high dose magnesium due to constipation. Low thiamine may be one of the underlying causes of your constipation and now high dose magnesium is going to make the low thiamine situation worse.
Up to 30% of psychiatric patients have a thiamine deficiency
We talk about how up to 30% of psychiatric patients have a thiamine deficiency but that there hasn’t been enough work on psychiatric disorders which Dr. Marrs says “is strange given the fact that some of the strongest symptoms involve brain function and the most dangerous or some of the more dangerous damage is relative to areas of the brain.”
I share some quotes from a 2019 paper that does actually look at the psychiatric aspects – Neurological, Psychiatric, and Biochemical Aspects of Thiamine Deficiency in Children and Adults:
- “The brain is highly vulnerable to thiamine deficiency due to its heavy reliance on mitochondrial ATP production. This is more evident during rapid growth, i.e., perinatal and children.
- Thiamine deficiency contributes to a number of conditions spanning from mild neurological and psychiatric symptoms, confusion, reduced memory, sleep disturbances, and severe encephalopathy, ataxia, congestive heart failure, muscle atrophy, and even death.”
This paper also looks at the beneficial effect of thiamine supplementation in autism spectrum disorder (ASD) and other neurological conditions.
Below, I share some additional studies that we didn’t talk about in the interview but add value to the topic.
Fatigue, sleep disorders, depression, anxiety, fibromyalgia and cardiac troubles as the expression of a classic mild thiamine deficiency
This paper, High-dose thiamine improves the symptoms of fibromyalgia, states that “It is our opinion that fatigue, sleep disorders, depression, anxiety and cardiac troubles are the expressions of a classic mild thiamine deficiency.”
The authors share 3 cases where thiamine/vitamin B1 improved symptoms in all areas for all these women:
- Patient 1: Female, 58 years old, weight 59 kg. From 1998, the patient began to have widespread pain accompanied by severe fatigue, depression, anxiety, irritability, sleep disorders, trouble concentrating, dry skin, general sickness, continuous headache, intolerance to low temperatures and, more recently, episodes of tachycardia and extrasystolia [alteration in heart rhythm].
- Patient 2: Female, 37 years old, weight 74 kg. From 1999, the patient has had widespread pain and all the symptoms described for patient 1, with the only exception being that of cardiac symptoms.
- Patient 3: Female, 60 years old, weight 65 kg. From 2006, the patient began to have widespread pain, fatigue, depression, anxiety, sleep disorders. Trouble concentrating.
As you can see the symptoms can be very varied and this is what makes it challenging to identify low thiamine as being the issue.
Thiamine deficiency after bariatric surgery
Here one case study where thiamine deficiency occurred after bariatric surgery: Wernicke’s encephalopathy mimicking multiple sclerosis in a young female patient post-bariatric gastric sleeve surgery:
We describe a case of Wernicke’s encephalopathy secondary to thiamine (B1) deficiency in a patient status post-bariatric sleeve gastrectomy.
The presenting symptoms of new-onset weakness, diplopia [double-vision], and confusion in a young female patient raised suspicion for multiple sclerosis (MS), but given a history of bariatric surgery, thiamine levels were checked, revealing significant Vitamin B1 (thiamine) deficiency.
This case highlights the importance of thorough history taking, as a misdiagnosis of MS in this case could have resulted in irreversible neurological deterioration and hematological and infectious consequences associated with the inappropriate administration of disease-modifying therapies.
Bariatric surgery is one of many causes of thiamine deficiency.
Some of the other many causes of thiamine deficiency
Other causes of thiamine deficiency include factors that may not be on your radar: a high carb/processed food/sugar diet (and even consistent smaller amounts of “healthy” sweeteners), coffee and tea consumption, alcohol consumption (excessive consumption and even moderate consumption i.e. social drinking), genetics (we talk about specific genes in the interview), environmental toxins, certain medications, celiac disease, leaky gut and malabsorption etc.
We do a deep dive into all this in the two interviews (and much more).
Interviews that dove-tail well with this topic are these ones:
- Michael Collins – Sugar/Fructose Addiction: Anxiety, ADHD and Aggression (because sugar and carbs lead to low thiamine)
- My interviews, Glutamine, DPA and Tyrosine for Anxiety and Sugar Cravings and GABA & Tryptophan: Gut-Anxiety Connections (because the amino acids help you quit sugar/carbs, coffee and alcohol easily)
- Tara Hunkin, NTP, CGP, RWP – Mitochondrial Dysfunction in Anxiety (because low thiamine adversely affects the mitochondria)
I encourage you to tune in if you have:
- Anxiety & feel overwhelmed & stressed by little things
- Panic attacks &/or obsessive thoughts or behaviors
- Social anxiety/pyroluria
- Phobias or fears (flying, spiders or even driving on a highway)
And also if you suffer from…
- Food sensitivities, IBS/SIBO, parasites or gallbladder issues
- Constipation, diarrhea, bloating, gas, pain & other digestive issues
- Leaky gut, a leaky blood-brain barrier or vagus nerve issues
Join us if you are also an emotional eater with intense sugar cravings (and know you suffer from low blood sugar), experience insomnia, low mood, PMS, poor focus and/or low motivation.
This is THE online event to learn about the powerful individual amino acids – GABA, theanine, tryptophan, 5-HTP, glutamine, DPA and tyrosine – to quickly ease anxiety and help with gut symptoms while you are dealing with other root causes which take longer to address. (They also help with cravings as with this example, and sleep and immunity).
With research-based anxiety nutritional solutions and practical steps, you can determine your root causes, ease your anxiety and prevent it from coming back so you can feel on top of the world again!
If you are a practitioner, please join us too and find advanced solutions for your clients or patients too!
You’ve heard me say the Anxiety Summit has been called “a bouquet of hope!” My wish for you is that this summit is your bouquet of hope!
I hope you’ll join me and these incredible speakers, be enlightened and find YOUR solutions! More about this summit and other Anxiety Summits here.
Here’s to no more anxiety and you feeling on top of the world again!
Please share if these thiamine deficiency symptoms are new to you.
Also let us know if you’ve benefited from thiamine in the past or are currently using some form of thiamine – and how helped/is helping.
Have you seen this correlation between low magnesium and low thiamine OR taking high doses of magnesium and low thiamine symptoms?
Feel free to post your questions here too.
I just heard of thiamine deficiency and watched a YouTube video with Elliot Overton (London, Overton Nutrients) on not being adrenal issues but a pituitary problem and lack of enough B1..I have been trying everything, now I’m trying Dr. Dean’s ReMag “The Magnesium Miracle” and adding B1..I awake early morning with a feeling of a panic attack, increased pulse/anxiety..for years…I’m so tired of this..doctor put me back on anxiety meds but that’s not the answer. I do NOT want to take meds. Looking forward to your summit Trudy on how much Thiamine works along with the magnesium..Elliot Overton suggests upward of 2,000mg..where do you get that much B1..seeking help. Thanks for your great work.
Eileen
Glad to hear you’ve been learning about thiamine from Elliot Overton. I’ve also learned so much from him. And glad you’ll be joining us on the summit for Dr. Marrs’ 2 interviews. They are brilliant and we do also talk about dosing in part 2. I’m still too new to all this so don’t feel comfortable making recommendations yet.
But I can comfortably and confidently share that I have great success using the amino acids tryptophan and GABA for anxiety and panic attacks. It’s where I start with all my clients while we are looking for other issues like low thiamine. We talk about the amino acids in many interviews on the summit. My first interveiw is a good one for an initial introduction – “GABA & Tryptophan: Gut-Anxiety Connections”
But here is some information to get started. The best way to determine if someone may have low GABA is to look at the low GABA symptoms, rate them on a scale of 1-10 with 10 being worst, do a trial of GABA and rate the symptoms again right afterwards (in the next 2 to 30 minutes). Here are the symptoms https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/
If you are new to the amino acids (and other anxiety nutrition solutions like gluten/sugar/caffeine removal, blood sugar control, gut health, pyroluria etc) my book “The Antianxiety Food Solution” is a great place to start. More here https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
It’s very interesting that Elliot Overton is mentioned . I’m not doubting anything or his great knowledge . I am so curious about his harsh requirements before taking someone as a patient , considering so many imbalances cause poor choices over a persons life and addictions . He refuses to treat a person unless they have given up their bad habits . It put me off as I’d hope for compassion and treatment to help loosen the bonds of addiction . Some addictions such as smoking can tamper the effects of copper. Drastic cold Turkey if many things can cause worse things to occur. Like diabetes as a main example of things I have seen in people. I am very curious about his methods but his mind set doesn’t seem toward compassion and support. If there’s a better point of view I’d like to hear it. I considered seeing him until I saw his harsh conditions which frankly lack any nurturing.
Agnes
I’m not familiar with his requirements for working with someone so can’t really comment on this. I do believe you need to resonate with the practitioner you’re going to work with so finding someone else would most likely be a better fit for you.
I do agree that addictions (to anything – coffee, drugs, alcohol and even sugar/carbs) require understanding and compassion. And there is a sound nutritional approach that helps with this aspect so pure willpower is not required – The individual amino acids glutamine, GABA, tryptophan (or 5-HTP), DPA and tyrosine are powerful for eliminating sugar cravings, often within 5 minutes https://www.everywomanover29.com/blog/the-individual-amino-acids-glutamine-gaba-tryptophan-or-5-htp-dpa-and-tyrosine-are-powerful-for-eliminating-sugar-cravings-often-within-5-minutes/
This is all so interesting, I’m wondering if i am thiamine deficient. I take a lot of magnesium to help my body manage with dietary oxalate.I suffer from fatigue, post exertion fatigue, fibromyalgia. Can’t exercise except for a short light walk. I take around
259mg magnesium in morning
140mg at lunch and again at dinner
Sometimes an extra 140mg a day for any Oxalate containing snacks.
=530 to 670 mg per day
Is this considered too high magnesium?
what dose B1 do you suggest testing. Looking forward to the summit and learning more. Thanks!
Phoebe
The high dose of magnesium can vary from person to person and is relative to their thiamine deficiency.
You may want to look into the fibro/thiamine research done by Dr. Costantini – “Some observations indicate that the large majority of symptoms of fibromyalgia could be the clinical manifestation of a mild thiamine deficiency due to a dysfunction of the active transport of thiamine from the blood to the mitochondria or to enzymatic abnormalities.” from High-dose thiamine improves the symptoms of fibromyalgia https://pubmed.ncbi.nlm.nih.gov/23696141/
He does use very high dose thiamine HCL – higher than anyone else but has seen incredible results. The current recommendations are to start low and increase slowly. Dr. Marrs share more about this in the interview.
I also recommend low dietary oxalate intake especially for someone with the symptoms you describe.
Is there anyway to listen to this interview now, in 2022?
Sarah
It’s available as part of the Anxiety Summit which can be purchased
Hello Trudy,
I recently read about the use of THIAMINE for critically ill COVID patients. It was not stated whether these patients were thiamine deficient as a result of Covid or whether they were thiamine deficient prior to contracting Covid – hope more research is done on this subject.
Thank you so much for covering the topic of THIAMINE and making us aware of this often undetected deficiency and of the connection between Thiamine and Magnesium. Such critical information.
I am learning that there are several forms of Thiamine : water-soluble,
fat-soluble and even an active coenzyme form.
Do you have any thoughts on the various forms of Thiamine and which form might be best for someone starting a Thiamine supplement for the first time?
Thank you very much, Trudy.
Thanks for bringing Dr. Marrs into the conversation! I have learned SO much from her website “Hormones Matter” (which is about far more than just hormones). Binge-reading her blogs & articles is time well spent. I particularly enjoy the writing of distinguished guest writer, longtime Cleveland Clinic pediatrician Dr. Derrick Lonsdale, a. THANKS Trudy for mentioning Dr. Costantini. He is oft-mentioned by Dr. Lonsdale and nutritionist Elliott Overton. Some of Dr. Costantini’s published case studies include before-and-after videos of patients overcoming significant movement disorders such as ataxia and tremors via high-dose thiamine. (These patients were NOT deficient beforehand according to the established reference ranges.) After reading about Dr. Costantini’s work, Dr. Daphne Bryan tried this therapy and wrote a book about her experience with it (“Parkinsons and the B1 Therapy”). She’s also been interviewed on YouTube.
Thiamine figures prominently in gut health because as Dr. Lonsdale states, the first sign of deficiency is often autonomic dysfunction, which can affect (in addition to heartbeat, blood pressure, breathing etc.): gut motility, sphincter function, vagus nerve function, bile excretion, elimination and so forth. Because digestion is largely governed by the brain’s autonomic control center, gut health truly begins in the brain. Since the brain has very high numbers of mitochondria packed into each cell, mitochondrial nutrients like thiamin are paramount to the autonomic regulation of digestion.
ALSO: Dr. Lonsdale states the importance of taking a complete B COMPLEX (and magnesium) along with thiamine therapy. All of the B vitamins work in synergy. They are co-factors for enzymes that are needed for the mitochondria in each cell to use food for energy. Brain and heart cells have the highest energetic demand and therefore the most mitochondria!
A P.S. to my P.S.:
Thanks Trudy for mentioning the many causes of Thiamine deficiency. Doctors are trained to consider B1 deficiency only if a patient suffers from alcoholism or anorexia. Our thiamine requirements increase not only with alcohol consumption but also with carbohydrate intake. As Dr. Marrs states, the causes go far beyond diet, though, and they include any event that is energy-intensive: overexertion, pregnancy, extreme stress, toxin exposure, trauma, illness, injury, and hospitalization (long-term tube feeding can cause nutrient deficiencies, and a glucose drip can exacerbate B1 deficiency). Dr. Marrs’ website highlights which medications, including some antibiotics, diabetes medications & more, that can deplete thiamine; this is crucial information. I do also wonder if there are genetic SNP’s that prevent a person from utilizing thiamine, even if his/her diet is perfect and there are no obvious stress or toxic insults.
Carol
Thanks for contributing to the discussion! Agreed about Hormones Matter site and articles.
Her thiamine book, “Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition” with Dr Lonsdale is brilliant too. Reading it was like attending a week long thiamine conference (here is my Amazon link for folks not familiar with it https://amzn.to/3KpNB5a)
Great summary about the downstream effects of the autonomic system dysfunction caused by thiamine deficiency.
I hope you enjoy the rest of the summit!
Hi Trudy,
Thanks so much for this blog and the interview with Dr. Marrs on your summit. I happen to be a very committed coffee drinker who is finally willing to consider quitting with the help of amino acids. Do you know if it is coffee itself that depletes thiamine, or is it the caffeine? I’m just wondering if I could switch to decaf without continuing to deplete thiamine.
Thanks,
Kimberley
Kimberley
I’m afraid it’s the coffee itself although caffeine does contribute too because it’s dehydrating…. “Foods and beverages that contain high concentrations of polyphenolic compounds can also cause thiamine deficiency. Polyphenolic compounds are plant extracts including tannins and catechins, that are commonly found in coffee and tea.” http://thiamine.dnr.cornell.edu/Thiamine_causes.html