Transcription
Hey, welcome to Golden Health Method. My name is Dr. Sean Golden, and I use natural, research-based strategies to help people overcome their chronic health conditions.
In this episode, we're going to be talking about the relationship between thiamine and fatigue, especially chronic fatigue. Thiamine now has an impressive amount of research building up, showing that it can improve chronic fatigue in a wide variety of different health conditions, or sometimes even without a health condition.
Fatigue isn't something that's unusual in modern-day living. Most of us, to some degree or another, undergo some type of fatigue. But for many of us, it's sometimes an ongoing thing that occurs on a daily basis. It becomes chronic and severely limits the quality of our lives that we could experience. So, when there are options that are available to help overcome fatigue, I want to share them with you so you're able to have these tools under your belt and explore them for yourself.
Now that we know thiamine has such an impressive relationship with fatigue, we want to understand why and exactly how it works, and what we can do with it. You see, with various disease conditions such as multiple sclerosis, fibromyalgia, Hashimoto's and hypothyroidism, inflammatory bowel disease like Crohn's disease and ulcerative colitis, all of those conditions now have multiple clinical trials under their belt showing that thiamine helps reduce fatigue, and sometimes drastically, in those conditions. In all of those conditions I just mentioned, one of the key features that is usually associated with the disease is fatigue.
So, instead of just focusing on the disease, we want to also focus on some underlying issues, one of which could be thiamine deficiency. Thiamine deficiency isn't uncommon in modern-day living. Most people think that we generally don't have vitamin deficiencies anymore, but that's simply not true. Sometimes supplementing with higher dosages of certain vitamins can drastically improve our quality of life.
So first of all, what is thiamine? Thiamine is vitamin B1. It was actually the first B vitamin that was ever discovered. If you're deficient in it, very bad things happen. The classic syndrome is called beriberi. There are different forms of wet and dry beriberi, but we're not really going to get into those symptoms today. Most of us don't experience all of those symptoms of beriberi, but a subclinical thiamine deficiency—meaning you might not get full-blown thiamine deficiency symptoms—could still lead to fatigue.
Now, why would so many of us have thiamine deficiency in the first place or be low on thiamine? The reason is actually because of what we're eating, for the most part. Nowadays, we rely on a lot of different types of processed and refined foods.
When we turn, for example, a whole grain type of bread into white bread or a different type of refined bread, the problem is that when we eat whole grains—or not just whole grains, but unrefined food in general—thiamine comes with that food. We’re eating carbs, which thiamine is very important in processing. Natural carbs always have thiamine associated with them, but when we refine those foods, we lose the thiamine.
Sometimes, medical doctors don't think that this is a problem because they believe thiamine is getting fortified back in. On the back of the label, it says that it’s fortified back with the vitamins lost during the processing and refining process. We're being told there shouldn't be any problem. With some of those vitamins, that's true; they get added back in just fine.
The problem with thiamine, in particular, is that as a supplemental form, it has a very hard time absorbing. In clinical practice, this is very easy to see because the amount of thiamine we want to get from our diet is usually just a handful of milligrams. If someone has a thiamine deficiency and you're trying to make up for it with a supplement, you have to get anywhere between 600 to sometimes 1,200 to 1,800 milligrams to overcome that deficiency.
The reason you have to use such a high dose is because of how difficult it is for thiamine, in a supplemental form, to absorb. What we don't realize is that when you take thiamine in a pill, like thiamine mononitrate— for example, which is the most common form of supplemental nitrates—you can get that in pill form, but that's the same type of thiamine they sprinkle into refined foods to fortify thiamine back into them.
That form of thiamine does not absorb well at all. So, even though it says that the food is making up for the thiamine, in physiological terms of absorption, that isn't true. You can become deficient in thiamine because the supplemental form isn't getting absorbed like the natural form would. Yes, it is the same molecule; both are thiamine, the supplement and what's in the food, they're both thiamine, the exact same molecule.
However, when it's in food, it's encapsulated in a food matrix. We know now that when it's inside that food matrix, it absorbs much more effectively. So, we don't develop a deficiency because it has a high absorption, whereas in a supplemental or refined form, the absorption is incredibly low. This can lead to subclinical thiamine deficiencies.
All of this would really just be theory or anecdote, but we now know that this is absolutely true because of all these clinical trials that are coming out. All of those different disease conditions—IBS, hypothyroidism, multiple sclerosis, fatigue, or fibromyalgia—all of those conditions responded very well to high-dose supplemental thiamine.
Now, just because the supplement doesn't absorb well, it doesn't mean you shouldn't use it. It just means you have to use a higher dose. But sometimes we get scared of high doses because, for certain supplements, like vitamin D or vitamin A, you can overdose by using a high dose. It varies on a case-by-case basis, depending on what supplement you're talking about. Some are safe to use at very high doses and some are not; sometimes they have side effects.
In the case of thiamine, there's never been a study that showed at any dose there were any significant negative side effects. The most common would be maybe a little bit of tummy aches and sometimes a little bit of a sulfur smell. That's essentially the side effects you're going to get. It's an incredibly safe supplement, and it's been used for literally a hundred years or more at this point, so it has an incredible safety history behind it. It’s nothing that you should be afraid of.
So using high-dose thiamine can be an option because you can use a high enough dose to overcome the limited absorption. Studies have shown that high-dose thiamine does overcome that absorption problem, if you do use a high enough dose.
If you want to see the actual research itself that I’m referring to or the images of the results of that research, it’s in the description below. I linked them in there so you can see for yourself the type of results that they got. In many of these cases, the results are not small; there are sometimes very significant large results that improve the quality of these people’s lives.
It’s important to take this into account when we’re dealing with fatigue. An especially interesting case is one that I already talked about, which is hypothyroidism and Hashimoto's. The fatigue in this condition is almost universally just blamed on low thyroid hormones. When someone goes on thyroid medication and they get their thyroid up to, you know, a better lab value, and their doctor says, “Your lab values are now perfect,” but the patient says, “But Doc, I still don’t feel good. I still have crushing fatigue. I still have to sleep 10 hours a day to feel normal," the doctor might sometimes ignore the person’s subjective experience and say, "Well, you know, maybe it’s all in your head," or "Nothing’s wrong; your lab values are perfect, so I don’t know what to tell you."
Unfortunately, that's a case, in my opinion, of thinking too much inside the box. What limits us in our thinking are our assumptions. The assumption in this case is that the fatigue in this patient must be coming from their thyroid because they were diagnosed with hypothyroidism.
If we get their thyroid values back to perfect, then they should have no more fatigue, and if they do, well, maybe it's just all in their head. That's an assumption that the fatigue is coming from thyroid hormones, when there are actually many other options. I mean thiamine, iron; I could give you a list right now. But thiamine is proving to be a big one, and it's one that a lot of people don’t know about or don’t suspect. Medical doctors aren't suspecting it because what medical doctors are being taught in school is that vitamin deficiencies, by and large, no longer exist in the United States because we're fortifying food, and so we should all be getting our daily value of the vitamins we're consuming.
I just explained the fallacy of that logic regarding poor bioavailability. So people do have vitamin deficiencies, and they are a real thing. In this case, thiamine is an important or particularly important player in the whole spectrum of fatigue.
Of course, it's not the one cause of all different types of fatigue, but it is a tool that I want you to have in your toolbox so that you can test out for yourself to see if it is a contributor. From my personal experience—I've worked with others as well—but I just want to share mine. For those of you who know, I used to have hypothyroidism. Through my own natural strategies, I was able to overcome hypothyroidism, but even though my lab values were now all perfect, I still had this little sense of underlying fatigue.
It wasn’t crushing, it was way better than before, but it was still there. It really wasn't until I tried a type of thiamine therapy, thiamine supplementation, that I was able to make that fatigue once and for all completely go away. That was the last straw. For those of you who know, I also had iron deficiency at one point. Correcting that also improved my fatigue.
So, again, there are sometimes more than one cause, but in this episode, we’re going to focus on thiamine. Now that we know the research and the theory, let's get into the how-to. If you want to experiment with thiamine, knowing that it's very safe, how would you do so? What's the most effective way to do so?
I’ll tell you what's not effective: buying a regular B complex pill and just taking one or two of those a day is not an effective way to supplement with thiamine. Even though that pill is going to tell you you're getting like a thousand percent of your daily value, the reason is that, even though it's technically high dose compared to what's in food, it's not high dose in terms of what works because of how poorly available or bioavailable it is. It has low absorption.
So, even though it seems high dose, the amount that actually gets into your system is still pretty low. Taking a B complex pill can definitely help some people through other vitamins and a little bit of thiamine, but it's not going to be the most effective strategy.
In general, when looking at both the research and clinical practice, there are essentially two different ways you can supplement with thiamine. One is to supplement with regular thiamine. I prefer, in this case, thiamine HCl because the HCl increases the stomach acid a little bit, which helps absorption a little too.
Thiamine HCl should be taken with a meal, and you would want to start at something like 600 milligrams, working up to 1,200 or even 1,800 milligrams a day, usually split into three servings. So, at the highest dose, you’d be doing 600 milligrams three times a day.
This is a perfectly fine way of supplementing thiamine, and in fact, the majority of the clinical trials I mentioned earlier used this exact strategy: regular thiamine at a very high dose to ensure enough got into the system.
Usually, they did start at a lower dose, like 600 milligrams, and worked up to between 1,200 to 1,800 milligrams a day total, again split usually into three servings. Thiamine is water-soluble, which means you have to take it every day. It doesn't stay in your system; you lose it and need to replenish it.
There is one side effect that makes this method sometimes a little difficult, and that is that a very high dose of thiamine can give you a weird body odor type of smell. In this case, it’s not really a sulfur smell; I would describe it as a metallic smell. It usually comes from the armpit area. It doesn't smell like BO, and sometimes it’s very hard to smell it on yourself. You might smell it on the shirt you wore, and it can leave an odor that stays on that shirt for a while. You’d have to wash it a few times for that smell to really get out.
We don’t know entirely what's causing the smell, but it could be thiamine reacting with a heavy metal in your body or with iron, helping to excrete the heavy metal or iron, which would be a positive thing. The binding or loosening of that iron could be creating this metallic type of smell.
Now, for some people, this doesn’t happen, so I'm not saying it necessarily has to happen to you. If you try this method and after a few days to a week you start noticing a weird smell coming from your armpits that you don't like, you could try a different method of thiamine supplementation.
This other method involves using a different form of thiamine. It's actually lipid-soluble, so it’s a thiamine derivative that was created, but once it gets in your body, it turns into regular thiamine. This is called either lipothiamine or ally thiamine. I don’t think there’s an ‘h’ in that one: lipothiamine or ally thiamine (A-L-L-I thiamine).
So lipothiamine or ally thiamine—both of those are the same molecule, the exact same, and they absorb very, very well. They're just different brand names, and both are very good. Benfotiamine is another type of thiamine, but that one doesn't have quite as good of a job entering into the nerves. It’s great in the peripheral nervous system or extremity nerves, but as far as the central nervous system goes in the brain, it doesn’t always have the best ability to be bioavailable, which would probably be more important for fatigue.
That’s why I’m focusing more on lipothiamine and ally thiamine. To summarize again: you have regular thiamine HCl as one option, and you would want to use a relatively high dose of 600 to 1,800 milligrams per day, split into three servings. Or you could use lipothiamine or ally thiamine, which are the same thing, and they are very, very bioavailable, so you need a much lower dose.
Each pill is usually about 50 milligrams, and you can go anywhere from like 50 to 150, or maybe a maximum of 200, but that’s getting up to a high dose. Usually, people are okay around 50 to 150.
When you supplement with lipothiamine or ally thiamine, I would start at 50, which is just one pill, and then over the course of a week or one to three weeks, add in another pill, or up to maybe three or four pills tops. Three pills is usually the maximum that most people need. This could be one pill three times a day, or two pills in the morning and one pill at night—that type of thing works just fine.
This other strategy tends to get fantastic results, sometimes even better results than regular thiamine because of how well it absorbs. Sometimes, with these lipid thymines (ally thiamine and lipothiamine), you can get another smell. This time, it comes from your breath and it's more of a sulfur type of smell. It’s not terrible; it’s not something that stinks up the room, but if someone is close to you, they might be able to smell it.
If that side effect occurs to you and you want to avoid it, the way you can do so is by taking all of your lipothiamine or ally thiamine with your evening meal, at dinner. It takes a couple of hours for that smell to actually come out of you, and it doesn’t last for a whole day. Usually, by the time you wake up and start your day, the smell is already gone; it comes out of your breath during the nighttime.
One last thing I want to mention, just for completeness, is that with lipothiamine—especially—this happens more often: If you drastically elevate your thiamine level suddenly, which can happen with these ally thiamine and lipothiamine, then sometimes you get this paradoxical reaction where you can actually get more fatigued for a period of time. We don’t fully understand this counterintuitive reaction that happens, where you actually get more fatigue at first.
It's not common, but it does happen. If it does happen to you, don’t give up on thiamine right away because that’s usually a good sign. It means that later on, you’re going to experience a significant lessening of fatigue. You might have even been more thiamine deficient than most people, so I would stick with it. Stay with one pill and wait until the fatigue gets better before moving up to two pills. When you move up to two or three pills, the fatigue might come back again. Again, just stick with it until it improves.
For the majority of people, that isn’t the case, but sometimes it can happen. I want to let you know that’s a possibility.
One final thing, especially to avoid this paradoxical reaction, may be linked to magnesium deficiency. Many of us are deficient in magnesium as well, which is a mineral involved in over 300 enzymatic reactions in the body. It’s very important and involved in so many reactions; thiamine is also involved in many reactions.
Thiamine and magnesium actually work together in many cases. One theory about why we might get this paradoxical reaction with thiamine, especially with the lipid form that absorbs very well, is because with thiamine, you're increasing the enzymes responsible for energy production, which is a good thing. However, those same enzymes use up more magnesium because they’re now sped up in a sense because of the thiamine. So they use more magnesium.
If you’re deficient in magnesium, supplementing with more thiamine might, in a sense, be uncovering a magnesium deficiency that was already there. If you notice this, in my opinion—whether you notice it or not—you should most people should supplement with magnesium as well, but especially if you get fatigued and symptoms from thiamine or it makes the fatigue worse. You definitely want to suspect a magnesium deficiency and start supplementing with magnesium too.
Some doctors recommend actually starting magnesium supplementation for two weeks or more before starting high-dose thiamine or lipothiamine or ally thiamine to prevent any type of magnesium deficiency syndromes, because magnesium deficiency can also be associated with fatigue. These two nutrients interact with each other quite a lot.
We've known this for a long time because of something called Wernicke’s encephalopathy, which is a type of neurological condition that can occur from thiamine deficiency, especially when the deficiency gets severe. It occurs in the elderly and especially with heavy drinking because alcoholic beverages are completely empty calories that need to get processed and turned into energy, which uses up a lot of thiamine in the process.
In Wernicke's encephalopathy, the thiamine levels can get very depleted. We’ve known for decades that supplementing with both thiamine and magnesium gives a much better clinical response than just supplementing with thiamine alone.
So again, in summary, supplement with high-dose thiamine, 600 to 1,800 milligrams total split into three servings, or use the lipid-soluble ones, which are lipothiamine or ally thiamine. They’re the same thing, usually 50 to 150 milligrams per day total. If you get the sulfur breath or garlic breath, take all the pills at night to usually solve the problem.
Make sure you have enough magnesium in your body. That’s something that's super common now; magnesium is being depleted in our soil, and most people aren't eating very high magnesium foods throughout the day.
As for magnesium supplementation, you’ll find a separate video for that eventually, but just briefly, usually magnesium glycinate, gluconate, lysinate, and threonate are all okay. The two that have the most problems associated with them are magnesium oxide and magnesium citrate.
Magnesium oxide doesn't absorb very well, and magnesium citrate is more prone to give you diarrhea. Those two are the forms I usually avoid; any other form of magnesium is generally okay unless it's magnesium citrate or oxide.
So you don't have to memorize that first list I just named. As long as it's not magnesium oxide or citrate, all the other ones have minor differences in how they absorb. For magnesium supplementation, I usually recommend a minimum of 400 milligrams a day, sometimes more. That would be 200 milligrams twice a day at minimum. Sometimes 300 milligrams twice a day is necessary; make sure you check the serving size because most of the time, if it's, let's say, 200 milligrams of magnesium, that might be for two pills, not one pill, in which case you'd have to take four pills a day to get to 400 milligrams.
So make sure you check your bottle and see the actual dose that you're taking because sometimes people mistake that, especially with magnesium.
Okay, so I know this was a whirlwind of information about thiamine. I hope it was helpful, and I hope you see the value here. Many of us are just dealing with fatigue and are left without any answers. There are actually a lot of different reasons for fatigue that are very common. We didn't cover all of them in this video, but one of them is thiamine.
If you want to experiment with that, I encourage you to check it out. One last thing I want to say is that, unfortunately, there isn't a reliable lab marker available for thiamine status. It does exist, but the vast majority—99% plus—of labs do not carry it, and you cannot just get your standard thiamine levels checked in terms of blood value.
Unfortunately, that’s been shown repeatedly to not be a reliable marker. So honestly, your best bet is to just experiment for yourself and see what results you can get in your own body in terms of alleviating or getting rid of fatigue. I would give thiamine at least two months before you determine effectiveness.
Stick with it; it does take some time to replenish thiamine status. Give it two months, two and a half months, and just see if you’re noticing a difference. Fatigue can be tricky because we sometimes immediately get used to how we’ve been feeling the past week, and we think it’s always been our normal for some reason.
Sometimes you won't actually recognize the improvement in fatigue unless you write it down. I encourage my clients—and you as well—to rate, on a zero to ten scale, how bad your fatigue has been for a few days before you start thiamine. After a couple of months of thiamine, think to yourself over the past week or the past few days, "What number on a 0-10 scale has my fatigue actually been?"
That will give you a much more objective way to see if it’s helping because, again, sometimes we just get used to the ups and downs of fatigue, and we don’t recognize when we’ve been at a consistently lower level.
That’s my advice to you. I hope this video was helpful, and I hope it serves you. You can test it out and see if it works for you. If you have any questions, feel free to reach out to me or comment on the YouTube video below. Until I see you next time, take care.