Vitamin B1. You may have heard it called
thiamin. This is all about how to manage
your thiamin status.
Hi. I'm Dr. Chris Masterjohn of
chrismasterjohnphd.com.
And this is Chris Masterjohn Lite,
where the name of the game is
"Details? Shmeetails. Just tell me what works!"
And today we're going to talk about
managing vitamin B1 status.
Thiamin is very important for energy
metabolism in general, but it's especially
important for carbohydrate metabolism.
So one of the things that you'll see in a
moderate thiamin deficiency is poor
glucose tolerance, hyperglycemia,
or doing better on a low-carbohydrate diet
than on a high-carbohydrate diet.
Classically there are three thiamin
deficiency syndromes that dominate what
we know about thiamin. These are
beriberi, Wernicke's encephalopathy,
and Korsakoff's psychosis.
These generally involve signs and
symptoms like peripheral neuropathy,
which is weakness, numbness, pain, or
tingling in the hands and feet,
impairments in your reflexes, weakness, or
paralysis of the muscles around the eye,
sometimes changes in your heart rate
and heart output. And in the case of
Korsakoff's psychosis, you can get very
severe cognitive changes like amnesia,
making false memories, and being
overcome by apathy.
In these severe cases, thiamin
deficiency can cause seizures, paralysis,
and death, but what we're more likely to
encounter are the moderate deficits that
lead to poor glucose tolerance and poor
ability to handle carbohydrate in the diet.
Why might you get a thiamin deficiency?
Well, this is the interesting
case because most of what there is to
say is not about diet. Dietarily you need
several servings per day of meat, legumes,
whole grains, or enriched grains, meaning
refined grains that have been fortified
with thiamin, which is most refined grains.
If you don't get these foods, you could
have a dietary thiamin deficiency.
This was common back in the day when refined
foods started dominating the diet before
we started fortifying them with thiamin.
It's not so common anymore. Nowadays, you
can imagine that if you're on a high-fat,
ketogenic diet, and you are scared of
protein, and so you're not eating very
much meat, then that, a diet that is
mostly fat, could give you a thiamin
deficiency. But a carnivore can get
enough thiamin. Eat the meat. A vegan can
get enough thiamin. Eat the legumes and
grains. So most people are not going to
have a thiamin deficiency from diet.
With that said, there are several cases where
we know very well that non-dietary
phenomena can lead to thiamin
deficiency. That's with persistent
vomiting, alcoholism, and HIV or AIDS.
In diabetes, the need for thiamin goes up.
There are other things that are less
well understood but are still quite
fascinating that can cause thiamin
deficiency in the environment.
These include thiaminases, which are
enzymes that break down thiamin, and
these can be found in raw fish and
shellfish. Not all of them—we don't
really know all the things that causes
the level of thiaminases to vary in
raw fish and shellfish, but if you eat
a lot of raw fish and shellfish, that
could theoretically contribute to a
thiamin deficiency. Microbes in your gut,
indoor toxic molds, amoebas polluting the
water, varieties of microbes can produce
thiaminases that degrade thiamin.
Sulfite, which is used as a food additive
and which we also produce in our body
when we don't have enough of the mineral
molybdenum in our diet, can also degrade
thiamin. So if you have any signs and
symptoms of thiamin deficiency, and you
have any of these plausible risk factors
that make it make sense that thiamin
could be your problem, the best thing to
do is to verify this with blood testing.
The simplest and easiest test to get that
I would recommend is LabCorp's
thiamin pyrophosphate test in whole blood.
I do not recommend the test that Quest has.
If you want to dive deeper into this
than that, there is a company called HDRI,
or Health Diagnostics Research Institute.
Your doctor would have to order this.
Your doctor can go to their website, get
the requisition form, and check off the
box that says ETKA. That stands for
erythrocyte transketolase activity.
And if that's low, that's an indicator
of poor thiamin status.
In addition, if you get plasma
amino acids or urinary organic acids, you
could look for elevations of the amino
acid alanine or pyruvate or more
commonly lactate. And in the urine, you
could look for lactate, pyruvate, and
alpha-ketoglutarate, which is also called
2-oxoglutarate. If you see these patterns,
or if you simply see low whole blood
thiamin pyrophosphate, those are all
consistent with thiamin deficiency.
The ultimate test is to see whether these
symptoms and the blood work or urine
work respond well to fixing the thiamin
deficit. If the problem is dietary, fix
the diet first. If the problem is a
medical condition, work with your doctor
on the medical condition. Either to get
better faster or because the underlying
solution is not clear, thiamin
supplementation is a safe and effective
way to replete thiamin status. So in
most cases, 100 milligrams of
thiamin hydrochloride is probably
adequate. There's also a thiamin
supplement called benfotiamine that
might work better for the neurological
problems seen in alcoholism and
diabetes. And there's a thiamin
supplement called thiamin
pyrophosphate, TPP, or thiamin
diphosphate, TDP. This is the active form,
and that's best if you have a problem
activating thiamin to the active form.
We don't know if that happens outside of
alcoholism, but we know that it does happen in
alcoholism, so maybe it also occurs in
other situations. So the simplest thing
is to start with thiamin hydrochloride,
but if you want to trial-and-error your
way through these other thiamin
supplements to see if they give you
more benefit, then that makes sense.
There are no known risks to taking
Signing off, this is Chris Masterjohn of
chrismasterjohnphd.com. This has been
Chris Masterjohn Lite, and