Thiamin, or vitamin B1, is needed for energy metabolism but is especially important to carbohydrate metabolism. Its deficiency causes severe neurological problems, but moderate deficits may manifest more mildly as poor carbohydrate tolerance. Carnivores and vegans alike can get plenty of thiamin if they eat the right foods, but a diet based mainly on fat, or on refined foods that have not been fortified with thiamin, can cause deficiency. Nevertheless, thiamin is unusual in that most factors contributing to deficiency are not dietary, and many are actually environmental. In this video, I teach you how to assess your thiamin status and fix it if you have a problem.
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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 thiamin supplements. You can find more information about monitoring thiamin status in my e-book, Testing Nutritional Status: The Ultimate Cheat Sheet.