Today we interview Health and Wellness Show co-host Elliot about the deep dive he's done recently on the topic of vitamin B1: Thiamine. In the mainstream health paradigm, thiamine deficiency is a thing of the past. The manifestations of vitamin B1 deficiency are termed 'beriberi' and it was widespread in Japan in the 19th century when people had switched to polished rice (white rice) for aesthetic reasons, removing the bran from the rice that contained B vitamins, which lead to deficiency. By fortifying foods with vitamin B1, the problem was thought to be solved.

However, low grade thiamine deficiency may not lead to overt beriberi symptoms, and is a vastly under-recognized problem. According to the work of Dr Derrick Lonsdale and Chandler Marrs, in their book "Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition", thiamine deficiency is extremely common in a whole host of people who suffer from a wide variety of diseases - so many, in fact, that the deficiency is often referred to as "the great imitator". As a result, thiamine therapy has proven very effective in the authors 40 years of clinical work for a wide variety of conditions including cases of nervous system disorder, dysautonomias, insomnia, depression, schizophrenia, along with cardiovascular disease, excessive vomiting, gut issues, and many more.

Join us for this episode of the Health and Wellness Show, as Elliot tells us all about this important and vastly underrated nutrient.

And stay tuned for Zoya's Pet Health Segment, where she shares important information about anemia in cats.

Running Time: 00:53:32

Download: MP3

Here's the transcript of the show:

Doug: Hello and welcome to the Health and Wellness Show on the SOTT Radio Network. Today is November 16, 2018. I am your host Doug. With me in our virtual studio from all over the planet is actually nobody. I'm flying solo today. Well that's not entirely true. Recently Gaby, Elliot and I were all in the same location and we decided to do a pre-recorded interview with Elliot. Elliot has been doing a deep dive on thiamine, vitamin B1 recently. He's done a lot of research on it and had some pretty interesting things to say about it so we decided to do a bit of a pre-recorded interview with him about that. So I'm going to play that now. Afterwards we will come back for Zoya's pet health segment. So here we go. Enjoy.

So Elliot, tell us all about vitamin B1.

Elliot: Well it's quite a complex topic. Where would you like to start.

Gaby: It think a good start actually would be what got you interested in this subject.

Elliot: I became interested in looking at thiamine because when I was trained in nutrition, I never really learned much about it. I came across an author, he's a physician working over in the United States and his name is Dr. Derrick Lonsdale. I came across a book that he recently wrote and he was talking about thiamine deficiency and the various effects that that can have on people's health.

Now when I was told about thiamine, I originally thought that this was a thing of the past, that deficiency was common in the early 20th century but then they eradicated that. It turns out that that's not the case and that thiamine deficiency is quite common in the western world. So I did quite a lot of research in this area and most of the research was published by Dr. Lonsdale and his colleagues and it turns out that in the past have treated multiple different conditions using thiamine therapy. I think it's a very important topic in today's world.

Gaby: When people think about thiamine deficiency, what are the usual classical diseases that come up?

Elliot: That's a good question. Thiamine deficiency first presented I believe, in Japan and this was when the higher classes of Japanese started refining rice. So instead of eating brown rice they would eat white rice because it was more aesthetically pleasing. This was almost like a status symbol in society. What they didn't know was that when you remove the husk from the rice you actually remove most of the vitamins.

So you present with just the starch and what they started finding was that all sorts of symptoms started cropping up. Typically a thiamine deficiency can lead to beriberi. That's one of the peripheral nervous system disorders. Likewise another one is called Wernicke's encephalopathy. This is like a psychosis. It can present in many different ways. It can present with cardiac arrhythmias or heart palpitations. There can be many different symptoms involved. It can affect the gastrointestinal systems so you can have constipation or diarrhoea or something like that, Gastroesophageal reflux disease (GERD). But there's also breathlessness and inability to concentrate, inability to regulate your emotions and eventually it can lead to heart failure and many different things like that.

So once it was discovered that the reason why people were coming down with these nervous system disorders might have been due to this vitamin, they started fortifying the grains and fortifying the rice with the vitamin and they found that actually it very quickly eradicated this disease. Since that point onwards there's been a lot more research into the various B vitamins and it's been found that when you refine foods you take out the vitamins, it can really lead to deficiency states and it can lead to all sorts of diseases.

But again, if you speak to any conventional medical doctor they would say that thiamine deficiency is a thing of the past. Now that we fortify our food it's no longer a problem. Whereas again, this isn't necessarily the case.

Gaby: I think our mainstream doctors will always think like people who are alcoholic, or Korsakoff's syndrome, "Oh thiamine deficiency". Korsakoff's syndrome is also related to that.

Elliot: As you said, it presents with long-term chronic alcoholism. Also anorexia. That is one of the things where if an anorexic begins to refeed they refeed on lots of carbohydrates. Typically they will need extra thiamine and I think that is something that medicine does acknowledge.

However, when we're talking about thiamine deficiency it needs to be noted that the end stage of deficiency is presenting with beriberi or Korsakoff's psychosis. But ultimately there are many stages along that. You can have early stages of thiamine deficiency which wouldn't necessarily present as those syndromes.

Gaby: What was the name of this doctor that you mentioned?

Elliot: His name is Dr. Derrick Lonsdale. And he practiced at the Cleveland Clinic. I believe he was part of the pediatric unit and he worked with children but throughout his time there he was also working with various adults. He no longer practices from what I believe. I think he's retired. But he wrote a very interesting book, co-authored with an endocrinologist, Dr. Chandler Marrs and it's called Thiamine Deficiency: Dysautonomia and High Calorie Malnutrition. It's a very comprehensive book.

Gaby: So the question is, it is not a thing of the past, thiamine deficiency...

Elliot: No.

Gaby: ...because it applies to people today in the western world who think they're eating enough nutrients entirely.

Elliot: Again, that's a good question. I think we need to go back to some basics and try to understand why we actually need thiamine before I can answer that question. When we eat certain foods, our body breaks them down into their basic components. You have glucose, fats and proteins. Now to be able to turn those things into energy, we need enzymes. Let's say you consume some sugar and your body will transport it into the cells and it will go through lots of different stages and they require lots of different enzymes. The end product will be usable energy in the form of what we call ATP. That's what the cells need to do things.

So for those enzymes to work you need cofactors. These are like helping hands. These are vitamins and minerals. This is the reason why anyone who knows anything about nutrition emphasizes the importance of getting vitamins and minerals. When we talk about thiamine or vitamin B1, thiamine is a very important part of those enzymes. So to be able to take energy from food you need to have enough thiamine.

Now if we look at how nature works, it's quite clever really because any food that we eat that contains glucose, protein or fat will also contain lots of different vitamins and minerals. So it comes in the perfect package where we get everything that we need.

Gaby: The rice husks of the Japanese.

Elliot: That's exactly it. If you're going to eat brown rice, or your going to eat grains, if you eat whole grains, whilst it may not be optimal, you're still getting all of the vitamins to be able to process that food. Now the problem is that when we start refining the food, when we take out the nutrients, we take out vitamins and minerals then you get the pure energy. You get the pure glucose or the pure fat but you don't get all of the things that you need to break it down and that becomes a bit of a problem.

If you look at the western world today, what do people typically eat a lot of?

Doug: Refined foods.

Elliot: Refined foods. So we eat fast food. We eat sugar. We eat white sugar. If you look at sugar cane, this comes with a vast array of different vitamins and minerals. The problem is white sugar does not. So with the B vitamins, thiamine is one of those. They're water soluble. So what this means is you need a constant supply of them and they're essential so your body can't make them. So you need to get them from somewhere.

If you think about it, at any one point you have a certain amount of thiamine. Let's say you have a cupful of thiamine, a cupful of B vitamins and every time you have sugar or every time you have fats, you're using up some of that thiamine. Ordinarily if you're eating whole foods like potatoes or pork or any of the things that thiamine is found in - and it's found in many different foods - then every time you're using up the sugar, you're also adding in some thiamine. So you're keeping it in a balance. The cycle can keep going round.

The problem is when you start consuming refined foods you're using up all of the stored thiamine that you have and you're continuing to put in loads of glucose and it can get to a point where the body can no longer metabolize the energy because it doesn't have enough tools to do so in the form of vitamins and minerals.

So if we look at the uses of these vitamins, it's not only in energy metabolism. As I've said, you use vitamins and minerals to be able to break down energy. But if you look at thiamine, it's actually involved in many different things. It's involved in the breakdown of amino acids. It's involved in the metabolism of fats as well. But really, what's very interesting is it's essential for the production of brain chemicals called neurotransmitters. One of them is acetylcholine. Acetylcholine is very important in nerve transmission, in thinking, in cognition and in nervous system functions.

Gaby: So that's where the symptoms of cognitive decline come from, from a deficit of thiamine.

Elliot: Yes! Not only that but - this is a relatively unknown thing - there is research to suggest and Derrick Lonsdale does talk about this - that thiamine is not only important for the synthesis of neurotransmitters but it's also important to maintain the health of the myelin sheath and to maintain the health of the neurons themselves.

There is a part of the brain called the limbic system and as part of the brainstem it's a very primitive aspect of the brain, and this controls...

Gaby: The emotional brain.

Elliot: Yes. And this really has quite a large control of the autonomic nervous system as well. So the cells in that part of the brain are particularly sensitive to thiamine deficiency and when there is no longer thiamine in that part of the brain it acts in a similar way to the way it would if there was a deficiency of oxygen. So we know what happens when there's a deficiency of oxygen. The cells die and they can no longer function. This is similar to what happens in that part of the brain when thiamine becomes low.

Gaby: Does that mean that people who get more emotional, reactive or who have mood problems?

Elliot: Yes. Some of the symptoms of thiamine deficiency in its early stages are emotional instability, mood changes, feeling of depression, even schizophrenia and bipolar. These are all very common findings. But at the same time while it can affect our emotions it can also affect every other part of our body because you have to understand that the nervous system is really in control of the vasculature so it can determine how well the cardiovascular system is functioning. It can control really how many of the organs functions.

So if we look at early stage thiamine deficiency, it can manifest in multiple different ways. One of the first symptoms is heart palpitation but eventually the heart can enlarge to try to make up for what is perceived as an oxygen deficit. Again, this can eventually lead to heart failure. But you also have more benign symptoms such as Reynard's. Reynard's is the uncontrolled constriction and dilation of the blood vessels in response to different temperatures.

But when there is a thiamine deficiency it means that the nervous system can no longer effectively adapt to the environment. Temperature regulation becomes skewed. There is a condition called postural orthostatic tachycardia syndrome(POTS) and this typically involves the nervous system being able to control what the blood vessels do and it can result in all kinds of symptoms. This can also affect the gut as well because we have to understand that the gut, to propel food from the stomach down the intestine, requires the nervous system to contract.

So in thiamine deficiency, one of the aspects of that can actually be a small intestinal bacterial overgrowth(SIBO) or some kind of other gut dysfunction and this can go unrecognized. So it's certainly very interesting. Pins and needles in the arm or any kind of neurologically-based symptoms can actually be due to a thiamine deficiency.

Gaby: And this is at the level of the nervous system and its complexity.

Elliot: Yes.

Gaby: Does it affect another system like for example hormonal or can it make you susceptible to infections?

Elliot: When we look at thiamine, I've spoken about it being important in the nervous system but also what can't be overlooked is its function in energy metabolism. Energy metabolism occurs in every single cell. We have to understand that for cells to be able to do what they need to do, they need enough energy. This applies to every single cell. When you look at various diseases, what they're finding now is that there is actually a condition which is fairly similar in all of them and this is defective energy production. It's called mitochondrial dysfunction. That's what the technical name is, but essentially what it refers to is that the cells can no longer make energy as well as they could before.

So if we look at what thiamine actually does, to keep it simple, you have various enzyme complexes and thiamine sits at the top of the cells' ability to make energy. If there's not enough thiamine, then the energy production is really quite halted. This, again, can be a really big problem. When you look at something like susceptibility to infection, what Derrick Lonsdale found was that the immune function of people he was treating was completely skewed so they would be highly susceptible to various infections. This is because the immune system, like every other system in the body, actually requires energy.

So regarding the integrity of the tissue, let's say for instance the bladder. The cells lining the bladder, the mucosa, to maintain healthy mucosa and healthy immune functioning in that system, you need enough energy to do so. What he found was that really, many of the conditions that he was treating, he was treating in the same way and this was actually with the aim of restoring energy production. This is quite a novel idea in medicine but the general gist of what I took from the book and the ideas that the authors were suggesting was that many different kinds of diseases have a very similar origin. It has to do with energy.

This can explain how something like thiamine can actually improve so many different conditions which seem unrelated.

Gaby: Everything that is related to mitochondrial dysfunction can be improved with thiamine supplementation. How about these diseases which involve chronic fatigue syndrome?

Elliot: Right. It's interesting that you ask that because there's quite a lot of research on thiamine being used in various different conditions. One of those is chronic fatigue syndrome. If we look at chronic fatigue, its basis really seems to be mitochondrial dysfunction. The onset of chronic fatigue syndrome, along with fibromyalgia actually started to show its face after the onset of a specific kind of antibiotic called the fluoroquinolone antibiotic. There's lots of information around that but one of the aspects of that potentially is that fluoroquinolones are known to deplete thiamine.

Researchers have used thiamine successfully to treat people with chronic fatigue syndrome and they've gotten very interesting results. There was one study on individuals with fibromyalgia and it was a very small study. There were only three people in the study but he found up to 80% in all three people. It was 60, 70 and 80% improved in fatigue and malaise and subjective feeling of well-being. This was just with the vitamin B1 and so they concluded this should be first point of call in many of these kinds of conditions.

Gaby: I wanted to know more about this fluoroquinolone problem because fluoroquinolones are antibiotics that became very popular and right now they're telling us again, "Oh wait! Too many side effects. Leave them as the last option." Fluoroquinolones include Ciprofloxacin, Levofloxacin and all these antibiotics. Why does thiamine get depleted when we use these?

Elliot: I don't know if anyone really knows that. I can't say that I know the exact mechanism. Perhaps it is known. I'm sure that it does have a depleting effect. That's been documented. From what I suspect or from what I understand, it could have something to do with oxalate. That is another mechanism. However that's quite complex in and of itself.

Gaby: Biochemically speaking.

Elliot: Biochemically speaking, yes. What we know is that fluoroquinolones do have an effect on the body whereby thiamine becomes depleted and that they may inhibit the absorption of thiamine as well.

Gaby: Will that contribute because one of the most common side effects is ruptured tendons. Will supplementing thiamine help reverse that problem?

Elliot: This again is a very difficult topic to tackle because that I think has to do with the metabolism of glycine, vitamin B6 and vitamin C. It does get quite complicated when we're talking about that. What I can say is that I think there is a trickle down or downstream effect that can affect the metabolism of various B vitamins which does have an effect on collagen synthesis and also other things like energy metabolism. I think that has to do with multiple mechanisms and one of those is oxalates and another one is destruction of the microbiome.

Gaby: Because we do need B vitamins, enzymes, thiamine in order to get all the nutrients into our tendons and our body tissues.

Elliot: That's true. Aside from the fluoroquinolones there are other medications that are typically prescribed for other things which are shown to have a detrimental effect on thiamine metabolism. The oral contraceptive pill is one of those, metformin is another. There are many others. I think non-steroid anti-inflammatories may have an effect but I'm not 100% sure about that.

Gaby: Is thiamine something that you usually get from food or does gut bacteria, the microbiome also produce it?

Elliot: I think it works both ways. Generally with a lot if not all of the B vitamins, they are produced by the microbiome. They contribute toward a certain percentage of our daily B vitamin intake but from what I understand the majority of thiamine intake will be from the diet and that is assuming that the diet contained it because if you're consuming refined foods there's a good chance that you're not going to have as much in your diet.

Another problem is the absorption. There can be many things which can actually mess with the body's ability to absorb thiamine. There are various tannins or polyphenols in tea which can have an effect. Coffee can also inhibit the absorption of thiamine in the gut. There are also sulphites and hydrogen sulphide. Let's say that someone does have particularly imbalanced gut bacteria and they produce a lot of a gas called hydrogen sulphide. In animals studies this has been shown to potentially degrade thiamine in the gut before it's absorbed.

Now if you've got someone who has absorption issues in the digestive tract like celiac or Crohn's disease, this is also potentially going to inhibit the absorption of thiamine. Aside from that there are also genetic transporter problems. You have transporters which allow the absorption of these things. There are potentially going to be enzymes or mutations in genes which means that certain people might not be able to absorb as much as others. Not a lot is really known about that yet though.

Doug: Given that there are so many things that can interfere with it, if somebody was thinking that maybe they had some symptoms of thiamine deficiency or they had some tests done, what kind of dosages are we looking at if they wanted to start supplementing?

Elliot: To answer that question I think we need to look at the different forms of thiamine first of all. The typical type of thiamine that you would find in a multivitamin is a thiamine salt and this is thiamine hydrochloride. This typically has very low bioavailability and when it's prescribed at so-called physiological doses, there's good reason to believe that not much of it is absorbed. However, Derrick Lonsdale did find that in certain cases for children he could mega-dose hydrogen chloride, say 300 to 600 mg per day. This is a very high dose for thiamine. He found that this could have beneficial effects.

However, when we look at how thiamine is transported into the cells there are thiamine transporters on the cell membrane which help thiamine actually get into the cells. This is why testing can be problematic because someone could have normal blood levels of thiamine but the thiamine may not be able to get into the cells. Likewise it may not also be able to be used in the cells. So this is why typical testing for thiamine doesn't yield very good results.

Regarding the type of thiamine, you would want to find a thiamine that can get into the cells. Benfotiamine is one that's typically used for diabetic neuropathy with very good results. This can be very beneficial, especially at high doses and this has been shown to be more bioavailable or more readily absorbed than thiamine hydrochloride. This is something that you might want to use for things going on in the peripheral nervous system and the rest of the body. However, as I said before, many of the problems with the nervous system may actually be stemming from the brain. Research has shown that certain types of thiamine can get past the blood/brain barrier and into the brain better than others. There is a formulation which the Japanese studied many years ago and the actual chemical formula is tetrahydrofurfuryl disulfide. That's a really big word. TTFD for short. It's basically fat soluble and it's been shown to get into the brain.

That is typically needed in much lower doses however high doses of 100 to 200 mg can really help people. But what we need to know when we're talking about supplementing is that supplementing at normal levels, physiological levels which means the levels that you would store in your body at any one time, has been shown to be quite ineffective for long-stage chronic thiamine deficiency. The reason for this, Dr. Lonsdale and Chandler Marrs hypothesize is that what might happen is that when there is a chronic deficiency of a vitamin like thiamine, because you have various machinery in your cells which use those things, if you have low levels of the vitamin, the machinery, the proteins and enzymes, are naturally going to be down-regulated, less of them are going to be produced to match the deficit. Does that make sense?

Doug: Yeah.

Elliot: In that case, the enzymes may be down-regulated but likewise it may be that the transporters are also down-regulated. What that means is that you can give someone quite a high dose of thiamine but if there are not the transporters to get them into the cells and if once they are in the cells, there's not a high level of enzymes then the chances are the thiamine that someone has is not going to be used. You may not be able to absorb very much of it. What they've found, for instance if you've got a case of beriberi, whilst you can deal with most of the symptoms by administering thiamine for a couple of weeks, Dr. Lonsdale found that you may need to do it for up to a year at very high doses.

Gaby: Before you see the results, the time it takes for the transporters to get adapted.

Elliot: Yeah, that's exactly what it is. It's almost like sending a message to the body that 'we now have an abundance of this vitamin' and the body needs to adapt to that and it takes the body quite a long time to do that. So the body needs to understand that this is a consistent thing and that it can match the requirement and it can start to up-regulate all of the transporters, all of the enzymes to match the level of the vitamin that you're getting in the diet.

Doug: That can take up to a year?

Elliot: It can take up to a year apparently. In the case of beriberi there are cases where Dr. Lonsdale, if I remember correctly, was treating many of the different conditions, specifically children with postural orthostatic tachycardia syndrome(POTS) and he was finding that you may not see benefits until four or five months later and that was quite a common thing. Now you have to understand that the body takes time to adapt and when there has been a long-term chronic deficiency, it may take years to get to that point. So it may take years for the body to regain its balance.

Gaby: I'm actually curious about the results that the doctor got because there were results. So if somebody had a heart rate of 160 when standing up, will that be reversed eventually?

Elliot: Yeah, in many cases when there wasn't permanent structural damage or permanent structural changes to the body many of the symptoms could be eradicated permanently along with dietary changes as well. So if someone was consuming lots of sugar they would have to go on a diet which was not containing all of that because that was what led them to get to that point in the first place. But essentially what he found was that some of these conditions and symptoms, chronic nausea and vomiting, insomnia, headaches, migraines, as you said, blood pressure, heart rate abnormalities, digestive symptoms, chronic digestive issues, a wide variety of symptoms spanning every single body system could be eradicated with this treatment.

Now that's not to say that people are going to cure themselves with this vitamin but that it has extreme therapeutic potential. What I would like to say is that a chronic deficiency can go unnoticed for quite a long time. The reason I say this because it's important is if you look back at Japan, when you have this population that was chronically deficient, it was often in the summer time that they would actually develop many of the symptoms. They would suddenly come on. It's theorized that this is because of the stressor. You need an initial stressor to begin the cascade of things which ends in a disease state. Let me explain in a simpler way.

You can have a chronic deficiency that goes relatively unknown. When something happens, you have an initial stressor. It can be a vaccine. It can be medication.

Gaby: An infection.

Elliot: Yeah, an infection was a common trigger. It can be UV light. It could be a life event, a loss of a loved one. Something happens which initially places a lot of stress on your system and the underlying deficiency begins to manifest. It's at that point that it starts to tumble downhill. It can be dose of fluoroquinolones. It could be Gardasil. There is a lot of work being done on females who've had the shock of the Gardasil vaccine and they've actually developed POTS and dysautonomic function and they've been treated with thiamine and that has helped quite a lot.

Gaby: And in diabetes would this also help because when you have neuropathic pain in a diabetic person, it's more thiamine deficiency. It's not that the nerve is completely destroyed due to high degree of pain, right?

Elliot: They've shown in type I and type II diabetics, one study I believe showed up to 50% less thiamine in the type I and up to 40% or 60% in the type II. So they had roughly half as much thiamine as the average population without diabetes. When you look at diabetes, what actually goes on in the cell in diabetes is very interesting. If the cell can no longer turn around energy very fast this is going to have downstream effects on whether it accepts more sugar into the cell. This can independently tell insulin to shut off. So treating thiamine deficiency has had very good results in diabetes. Actually in non-diabetes when you have imbalances in blood sugar, either hypo or hyperglycemia, thiamine has been shown to be low in both of those cases and it can induce those symptoms.

Likewise in different eating behaviours like bulimia or anorexia. It can cause you to have a voracious appetite or it can cause you to become disenchanted with food and not want to eat anything. So they have also treated these kinds of people with thiamine as well with good results.

It seems like there is a wide variety of different conditions and as per Dr. Lonsdale's experience, it's a very safe treatment. What needs to be said is that upon administering thiamine what we need to understand is that many of the enzymes and the activities that thiamine helps to perform in the body also need other things. One of those is magnesium. Magnesium is very important. What he found is that when administering thiamine to a patient, it could cause minor problems, maybe an exacerbation of some symptoms, heart palpitations and things, whereas when he administered magnesium at the same time he found that he got much more beneficial effects.

Likewise what he recommended was actually prescribing magnesium along with the rest of the B vitamins to mimic nature in that sense.

Gaby: But can you overdose in one of the B vitamins or was it relatively safe?

Elliot: Well I don't think he mega-dosed the other B vitamins. I think it was a standard multi-vitamin complex, maybe a methyl B vitamin where you have the standard doses and it was just a high dose of thiamine along with that. Thiamine appears to be very safe.

Gaby: That's a pretty interesting information about thiamine. The issues that Dr. Lonsdale typically saw was the POTS syndrome, right? Do you know about other cases where he applied the same research?

Elliot: There were cases of learning difficulties, what we would probably call autism now. There were cases of learning difficulties which seemed to improve significantly upon thiamine treatment. There were many cases, as I've said before, of gastrointestinal disturbances, chronic vomiting, nausea, headaches, migraines.

Gaby: That got better with thiamine supplements?!

Elliot: Yes, yes. So he was using it on many different patients and many of them improved, not all of them, and it didn't necessarily cure them of everything but it improved their symptoms significantly. Likewise, I believe he was also working with people with cardiovascular diseases - arrhythmias, palpitations, but also many other kinds of conditions.

Gaby: So the actual fibrillation.

Elliot: Yeah, things like that. His explanation was that much of the heart's electrical activity is coordinated by the autonomic nervous system.

Gaby: Through the vagus nerve.

Elliot: Through the vagus nerve and when there is low thiamine, this can potentially really break down the body's ability to regulate the stress system. Another symptom is an overactive fight or flight response, so chronic stress and these kinds of things may actually also be exacerbated by an underlying vitamin deficiency.

Gaby: That's interesting. Like the dark horse.

Elliot: Yeah.

Gaby: I think the key word here is the autonomic nervous system. Basically everything that is automatic in your body is ruled by the autonomic nervous system so that's where thiamine can help.

Elliot: Yeah.

Gaby: I just think it's very interesting because we hear a lot about many other vitamins through mainstream research or even alternative research, vitamin E, vitamin D, even B complex vitamins, even vitamin A, but you don't hear something specific about thiamine, "here I am". You hear about B complex. You hear a lot about B6 and B12, niacin. But what about thiamine? Why do you think?

Elliot: That's such a good question and in all honesty I ask myself that all the time because it seems bizarre that something with such wide-ranging effects for so many different conditions would not have more publicity. And it seems like many people do not know about this treatment and as you said, it's kind of like the dark horse or the lone wolf and it doesn't really get the attention that it deserves. But hopefully with this book and with some of the work that's coming out now, hopefully more people and more practitioners will be able to try this and hopefully we can have some more scientific research on the topic because, again, it seems like a very safe and effective treatment, especially in our modern world where we are consuming more sugar by the day.

Doug: Who is at risk of a thiamine deficiency? Is there anybody in particular?

Elliot: That's a very good question as well. Really, in clinical care in a hospital setting you would be looking at someone with kidney failure or who has had gastric bypass. They are very common for thiamine deficiency, anyone with anorexia or the elderly and in anyone who is young actually, so young children; typically children who are eating a very high sugar diet and who have a limited diet are at risk for thiamine deficiency.

But when we're talking about the general population it's also very applicable in our modern world and I think many people probably do suffer from subclinical thiamine deficiency and don't really know about it. So it needs to be understood that we come into contact with many different toxins. May of us take medications or over-the-counter medications which are non-prescription which also have a negative effect on thiamine metabolism including anyone who consumes refined sugar or refined starches or even refined fats. These are all people who are at risk for thiamine deficiency.

Now anyone who has any kind of gut issues, what we call dysbiosis or chronic diarrhoea, there is a good chance that they may be lacking in some of the B vitamins and thiamine is one of those. Aside from that, there is also mould. If someone suffers from mould toxicity which is quite a common thing I think. If you're living in a mouldy hose then some of the mould toxins can actually have an effect on thiamine. They can deplete thiamine. Aside from that, really most of us if we're eating a western diet or a standard American diet kind of thing, then we are going to be at risk for this.

So ultimately I think that in order to optimize your B vitamin status, if you're not going to supplement then I would recommend switching to a whole foods diet. Ideally if you're going to drink tea or coffee, drink it away from meals and try to maximize the intake via whole foods, as I've just said, but really cooking methods is another thing, so boiling potatoes. If you're going to boil potatoes a lot of the thiamine is actually going to be lost in the water, so baking it you would maintain that.

For pork, frying is going to maintain that rather than boiling it. There's various ways that you can try to maintain that.

Gaby: For supplementation, will the types that you described in their research into the liposomal version, will it be something that you can do with an ultrasonic cleaner or nobody has touched it?

Elliot: So it's not actually a liposomal form. It's just lipid-soluble. It just means it's fat soluble. From what I understand it's the kind of thiamine that you would find in garlic. Another name for it is allithiamine. So you do find small amounts in garlic and it just means it's got a prosthetic group on it if you look at the chemical formula and it's just slightly different, but it means it can pass through the cell into the cells without transporters.

So if you've got a situation where someone has been chronically deficient like we were talking about before, where they may have either a genetic defect in the transporters or the cells may just be so chronically deficient that they down-regulate the transporters, it's going to be difficult to get the thiamine into the cells whereas if you use the lipid-soluble form then you can actually bypass the membrane without any transporter proteins. That's the idea.

Gaby: Does Dr. Lonsdale use intramuscular shots or intravenously?

Elliot: Yeah he did in some cases and he actually found that in very severe cases which were resistant to oral formats, he did find that intravenous was actually necessary. However I believe in the majority of cases oral thiamine was effective. As I've said, in some cases thiamine salts-thiamine hydrochloride at high dose was effective. In other cases it wasn't and in those cases he would use a lipid-soluble form and he found that that generally worked and in the very difficult minority of cases he would use intravenous.

Gaby: Could you repeat the name of the book?

Elliot: Yeah. The book is called Thiamine Deficiency: Dysautonomia and High Calorie Malnutrition and it's by Dr. Derrick Lonsdale and Chandler Marrs.

Doug: This has been very interesting, really fascinating. Thanks a lot for sharing this with us Elliot.

Gaby: Yeah, thank you for sharing with us.

Zoya: Hello and welcome to the pet health segment of the Health & Wellness Show. This week I'm going to share a recording with you by Dr. Karen Becker where she talks about anaemia in cats, what symptoms to pay attention to, the underlying causes for it and how to deal with it. Have a great weekend and good-bye.

Dr. Becker: Hi, this is Dr. Karen Becker. Today we're going to discuss anaemia in cats. Anaemia is a condition characterized by a below-normal number of circulating red blood cells. Red blood cells contain haemoglobin, a protein that carries oxygen to all the tissues of the body. When a cat doesn't have enough circulating red blood cells, oxygen can't get into the tissues as required. Anaemia can be caused by blood loss or red blood cell destruction which is called hemolysis which is considered regenerative anaemia.

In regenerative anemia the bone marrow is capable of producing more red blood cells but oftentimes not quickly enough to replace what's being lost. Anaemia can also be caused by inadequate red blood cell production which is considered non-regenerative anaemia, a condition in which the bone marrow is unable to produce more red blood cells.

Causes of regenerative anaemia include haemorrhage caused by an accident or internal bleeding, parasites, immune mediated hemolytic anaemia which is actually when a cat's body attacks its own red blood cells, Heinz body haemolytic anaemia, certain medications, foods or toxins like acetaminophen or propylene glycol, which is antifreeze, copper, zinc and onion toxicosis as well as a strange and pretty rare condition called neonatal isoerythrolysis which is a very rare condition. It's an immune mediated condition in which kittens with type A blood drink colostrum from a mother with type B blood. So the situation would be incredibly rare. Non-regenerative anaemia can be caused by feline leukaemia virus, FIV, chronic kidney failure and certain types of cancers as well as poor nutrition or starvation and chronic inflammatory disease.

A cat with anaemia isn't getting enough oxygen to the cells of her body so symptoms reflect oxygen deprivation. So symptoms can be pretty vague or diffuse, but they can include pale mucous membranes or gum colour, lethargy. Your cat may sleep more. She may have a loss of appetite or a diminished appetite. She may also have black, tarry stools if she's bleeding internally or from the GI tract. She may have weight loss, generalized weakness, a rapid pulse or breathing and a heart murmur.

One of the most common causes of anaemia in cats, especially middle-aged or older kitties, is chronic kidney disease. Production of red blood cells takes place in the bone marrow and in order for the process to work, the bone marrow needs an adequate supply of erythropoietin which we call EPO. EPO is a glycoprotein hormone. EPO is produced by the kidneys and cats with chronic kidney disease oftentimes can't produce enough of this hormone to supply the bone marrow. As a result the bone marrow can't get enough of the EPO which signals to it to produce red blood cells and that leads to anaemia.

In addition, the lifespan of red blood cells in kitties with kidney disease is about half that of healthy cats, which is another reason why cats with kidney problems often end up with secondary anaemia. A very important test for anaemia is of course the complete blood count. Elevated numbers of immature red blood cells are called reticula sites and they usually point towards regenerative anaemia which is the type caused by blood loss or red blood cell destruction.

A blood smear is used to help check for the presence of blood-borne parasites as well as to check for abnormalities of the physical appearance, the visual appearance of the red blood cells. A biochemical profile helps to evaluate a cat's general health and determine organ involvement, if there is any. A fecal exam is used to check for blood loss from the GI tract. X-rays and ultrasound exams can help your vet visualize internal organ size and the presence of foreign objects or potential tumours going on inside your cat's body.

In cats with non-regenerative anaemia, a Coombs test is performed to look for antibodies against red blood cells which indicates immune mediated haemolytic anaemia and in worse case scenarios, a bone marrow biopsy will be suggested to confirm certain types of cancers.

Finding the cause of why your cat is anaemic is really important since anaemia is actually a symptom of something else wrong in your cat's body. Treatment will then depend on the cause and the severity of the anaemia. In cases of mild regenerative anaemia no treatment may be needed since the body still has the ability to produce red blood cells. Your cat's blood work will be monitored until it returns to normal and then periodically thereafter to make sure she doesn't become anaemic again.

Holistic veterinarians will oftentimes supply the B vitamins as well as chlorophyll supplements during this time which can help mildly anaemic cats recover faster. In cases of non-regenerative anaemia caused by chronic kidney disease and depending on the severity of the anaemia, your vet may recommend the use of erythropoiesis-stimulating agents like Epogen to increase the production of erythropoietin in the kidneys. As with all medications however, these drugs do have some side effects so I would consider trying acupuncture and blood building supplements first.

Other traditional treatments depend on the cause of the anaemia. So again, getting a diagnosis as to why the anaemia is present is really important. In cases of acutely anaemic cats and certain other situations like trauma, blood transfusions may be necessary. Untreated feline anaemia really has the potential to become fatal so it's important to investigate both the anaemia and the underlying cause as soon as possible.

Doug: Thank you for that Zoya and thanks very much to Elliot and Gaby, my co-hosts on that interview. That was some great information. Elliot, we really appreciate that. So that is our show for today. Be sure to tune in to the other shows on the SOTT Radio Network. You can go to to check on the times. We'll be back next week with another Health & Wellness topic. Have a good week everybody.