Thiamine: A Generator of Cellular Energy and Driver in Fighting Chronic Fatigue
Thiamine, or vitamin B1, is in my opinion, one of the most underrated B vitamins. Since it’s fairly present in food (or so we think), we tend to not consider it often and overlook its deficiency.
But we should! B1 plays an enormous role in cellular energy generation. And deficiency can be sneaky.
A thiamine derivative, thiamine pyrophosphate (which accounts for about 90% of circulating thiamine), is needed for the citric acid cycle to function properly. This cycle is how we get ATP - our cellular energy currency.
Thiamine Deficiency
In textbooks, thiamine deficiency can present as a syndrome called Beriberi, which there are two types; dry and wet (1)
Wet beriberi affects the cardiovascular system, and involves a fast heart rate, shortness of breath, and leg swelling.
Dry beriberi impacts the nervous system, and results in numbness of hands and feet, trouble moving extremities, and pain. Wernicke encephalopathy and Korsakoff syndrome are two forms.
But subclinical thiamine deficiency is certainly far more pervasive than previously recognized, and likely exists on a spectrum (2)
Documented risk factors for thiamine deficiency include:
Alcohol
Obesity
Diabetes
Pregnancy
High carbohydrate diet
Chronic diarrhea
Diuretic usage
Poor intake of dietary thiamine.
There are also some genes that will affect thiamine transport, which include SLC19A2, SLC19A1, SLC22A1, SLC35F3, and SLC19A3.
Chances are many of us have at least one risk factor.
From an intake perspective, there’s a bit of nuance when it comes to thiamine.
Nutritionally, many of us are not getting enough thiamine in from our daily diet. Foods high in thiamine include pork and wheat products, which are less frequently consumed than they used to be. In addition to the reduction of thiamine containing foods in the diet, many foods including fish, coffee and tea polyphenols contain thiaminase, an enzyme that degrades thiamine. Certain gut bacteria, including Bacillus and Clostridia also produce thiaminase (3).
Ultimately, because thiamine has a short half-life, is quickly consumed by metabolism, and is often under consumed and over-degraded by thiaminase, many of us are at risk for thiamine deficiency. This is especially the case for folks who are working extra hard to generate cellular energy.
And, because of its role in cellular energy generation, a subclinical thiamine deficiency can look a lot like…everything.
Fatigue
Brain fog
Sleep disturbances
GI dysmotility
Orthostatic intolerance
Food sensitivities.
Why?
Because insufficient thiamine deranges mitochondrial respiration, inducing what is termed “pseudo-hypoxia” (4).
In contrast to classical ischemic hypoxia, with pseudo-hypoxia, even though there’s enough oxygen, mitochondria are unable to use it. This forces a shift towards more anaerobic metabolism and majorly reduced energy output, where only 2 ATP molecules are generated, compared to the 38 made by standard oxidative phosphorylation.
So, ultimately, even sub-clinically thiamine deficient people are desperately lacking ATP and cellular energy.
And often in this population, thiamine replenishment does a great deal of good for energy levels.
A small pilot study from January to April 2011 gathered eight patients with ulcerative colitis and four patients with Crohn's disease to investigate this (1). They measured levels of thiamine and thiamine pyrophosphate in the blood, and all were “in range.” All patients were then assigned to receive high doses of thiamine orally. Researchers measured the chronic fatigue syndrome scale, as well as whole blood thiamine and thiamine pyrophosphate levels before and 20 days after the start of therapy. Ten patients out of twelve showed complete regression of fatigue, while the remaining two patients showed nearly complete regression of fatigue compared to the chronic fatigue syndrome scale scores before therapy.
It goes without saying, this is quite a small study. But it does identify an under-recognized nutrient that can help to curb the fatigue associated with inflammatory bowel disease, an insight many folks benefit from.
Even if you have “normal levels” we may boost your thiamine intake if you have a considerably high physiologic demand, which can include:
Metabolic syndrome
Hashimoto’s thyroiditis and other autoimmune conditions
Inflammatory bowel disease
Dysautonomia
Cardiovascular disease
Chronic Fatigue
SIBO
(1) Wiley KD, Gupta M. Vitamin B1 (Thiamine) Deficiency. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537204/
(2) Marrs C, Lonsdale D. Hiding in Plain Sight: Modern Thiamine Deficiency. Cells. 2021 Sep 29;10(10):2595. doi: 10.3390/cells10102595. PMID: 34685573; PMCID: PMC8533683.
(3) Kreinbring CA, Remillard SP, Hubbard P, Brodkin HR, Leeper FJ, Hawksley D, Lai EY, Fulton C, Petsko GA, Ringe D. Structure of a eukaryotic thiaminase I. Proc Natl Acad Sci U S A. 2014 Jan 7;111(1):137-42. doi: 10.1073/pnas.1315882110. Epub 2013 Dec 18. PMID: 24351929; PMCID: PMC3890816.
(4) Sweet RL, Zastre JA. HIF1-α-mediated gene expression induced by vitamin B1 deficiency. Int J Vitam Nutr Res. 2013;83(3):188-97. doi: 10.1024/0300-9831/a000159. PMID: 24846908.
(5) Costantini A, Pala MI. Thiamine and fatigue in inflammatory bowel diseases: an open-label pilot study. J Altern Complement Med. 2013 Aug;19(8):704-8. doi: 10.1089/acm.2011.0840. Epub 2013 Feb 4. PMID: 23379830.
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