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In this episode, you will learn about Thiamine Deficiency Disease.

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About My Guest

My guest for this episode is Dr. Chandler Marrs. Chandler Marrs, MS, MA, PhD is an independent health researcher and writer. She is the co-author of the book "Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition" and the author of over 200 articles on various topics, from women’s health and hormones, medication reactions, to mitochondrial function and dysfunction. She is the founder and editor of the online health journal "Hormones Matter" which boasts a rich archive of over 1400 articles including in-depth research analysis and patient case stories. She is also the founder and administrator of a patient research group on Facebook called "Understanding Mitochondrial Nutrients". In her spare time, she is a competitive powerlifter and works to support strength sports for older women through her website and Facebook group "Old Ladies Lift".

Key Takeaways

  • What is thiamine and its fundamental roles in the body?
  • How common is thiamine deficiency?
  • What is the ideal way to test for thiamine deficiency?
  • Does thiamine influence gene expression?
  • What role does thiamine play in medication and vaccine reactions?
  • What is the connection between thiamine deficiency and dysautonomia?
  • Might thiamine play a role in SIBO?
  • Can thiamine be helpful for those in a Cell Danger Response state?
  • Which environmental stressors may deplete the body of thiamine?
  • Does thiamine impact the limbic system?
  • How does thiamine lead to hypoxia and resulting sympathetic dominance?
  • Does thiamine play a role in glucose regulation?
  • Does thiamine repletion have the potential to lead to a worsening of symptoms?
  • What is the connection between elevated levels of lactic acid and thiamine deficiency?
  • Might toxic mold exposure interfere with the absorption of thiamine?
  • Has thiamine repletion been a helpful strategy in CFS/ME patients?
  • Does thiamine play a role in methylation?
  • Could glyphosate lead to large-scale thiamine deficiency?
  • Might thiamine be helpful in autism, PANS/PANDAS, or neurodegenerative conditions such as Alzheimer's or Parkinson's?
  • What form of thiamine is most health-supporting?

Connect With My Guest


Related Resources

Book - Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition

Article - Hiding in Plain Sight: Modern Thiamine Deficiency

Interview Date

March 29, 2022


Transcript Disclaimer: Transcripts are intended to provide optimized access to information contained in the podcast.  They are not a full replacement for the discussion.  Timestamps are provided to facilitate finding portions of the conversation.  Errors and omissions may be present as the transcript is not created by someone familiar with the topics being discussed.  Please Contact Me with any corrections.  

[00:00:01.00] Welcome to BetterHealthGuy Blogcasts, empowering your better health. And now, here's Scott, your Better Health Guy.

[00:00:14.02] The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority.

[00:00:34.23] Scott: Hello everyone, and welcome to episode number 163 of the BetterHealthGuy Blogcasts series. Today's guest is Dr. Chandler Marrs, and the topic of the show is Thiamine Deficiency Disease. Dr. Chandler Marrs is an independent health researcher and writer. She is the co-author of the book Thiamine Deficiency Disease, Dysautonomia, and High-Calorie Malnutrition, and the author of over 200 articles on various topics from women's health and hormones, medication reactions, to mitochondrial function and dysfunction.

She is the founder and editor of the online health journal Hormones Matter, which boasts a rich archive of over 1400 articles including in-depth research analysis and patient case stories. She is also the founder and administrator of a patient research group on Facebook called “Understanding Mitochondrial Nutrients”. In her spare time, she is a competitive power lifter and works to support strength sports for older women through her website and Facebook group “Old Ladies Lift”. And now, my interview with Dr. Chandler Marrs.

The topic of thiamine deficiency disease is one that was brought to my attention by Dr. Neil Nathan. He originally shared the Thiamine Deficiency Disease, Dysautonomia, and High-Calorie Malnutrition by Dr. Derrick Lonsdale and Dr. Chandler Marrs with me. I’m super honored today to have Dr. Chandler Marrs with us to talk about thiamine deficiency disease, and how it may be an important missing factor for our listeners.

[00:02:07.02] Dr. Chandler M.: Oh, thank you for having me.

[00:02:08.08] Scott: Did you have a personal connection to this topic? What drew you to writing a very extensive book about thiamine deficiency? And how did you and Dr. Lonsdale connect in this collaboration?

[00:02:20.12] Dr. Chandler M.: Yes and no on the personal connection. I didn't know I had a personal connection until I met Dr. Lonsdale, and we began doing the research on this. So, how did Dr. Lonsdale and I meet? So, I run a website called Hormones Matter, because my original background was in steroid neuroendocrinology hormones in the brain and women's health.

So over the years, I had moved into medication adverse reactions as a major component of my work, particularly women's reactions, because as you may or may not know, women are not typically tested sufficiently before medications are released into the market. I had begun doing research on Gardasil, and the Gardasil reactions.

One of the patients that I had been working with and that had a reaction and published a story, actually found Dr. Lonsdale’s work, a mom of the patient rather and she introduced us. Over time, he became a colleague, a mentor, introduced me to thiamine and the mitochondria, and all of those things, and we had a very good working relationship. So, when it came time to write this book, he asked if he would write it with me. For those of you who have read Dr. Lonsdale and followed him, he's an older gentleman, and so this would be his legacy work.

And he's brilliant, he's absolutely brilliant, and so it was quite an honor to do this. At the time he asked, however my mother was ill, life was crazy, and I didn't think I could actually do it frankly, because there was just so much going on. But he persisted, and I’m very proud of the work that we did together, and I’m very grateful for him to have selected me to write it with him, and for him persisting and pushing me and keeping me on deadline and all of those things that one needs to finish a work like this.

[00:04:22.16] Scott: Yes. It's amazing in reading the book, there's several decades of work that he put into this, in his clinical practice and into the book. I mean, kind of the word legend comes to mind. I believe now he's in his 90s, if I’m not mistaken.

[00:04:35.28] Dr. Chandler M.: He's turning 98 in the next couple weeks.

[00:04:38.18] Scott: Wow.

[00:04:39.00] Dr. Chandler M.: Yes, certainly.

[00:04:40.25] Scott: So, let's start with the basics, what is thiamine? And what are some of its fundamental roles in the body?

[00:04:47.19] Dr. Chandler M.: Well, so thiamine is vitamin B1, quite simply it's just another vitamin in that regard. But it's an important vitamin, because of its cofactor role in a number of enzymes that are involved in the metabolism of food and energy into ATP. So, because it is involved in those roles, and because it is frankly a gatekeeper, it's at the top of these pathways, if thiamine is insufficient, then the entire process gets derailed to some degree or another.

So, your ability to convert food into ATP diminishes. With that, since every cell in the body requires energy, ATP, cell function diminishes. As cell function diminishes, as you might suspect, you get injury and illness and all sorts of things. The problem with our interpretation of thiamine is that we have since the advent of food fortification in the 40s, we have assumed that we solved it, and that because we eat these foods, because there is sufficient per the RDA amounts of thiamine in these foods, that there's no thiamine deficiency.

The only cases that people consider thiamine deficiency, if they consider them at all, are chronic late-stage alcoholism, tend to be hyper metabolism and a severe illness. Although, that seems to be less and less, it seems to be the last thing that they consider. They've considered everything else, and then they look at thiamine.

It's very distinct in where we look for it, and unfortunately, the vast majority of people don't consume enough thiamine, and the very foods that we consume to get our thiamine, the processed foods have anti-thiamine factors in them. So, we end up doing more damage than good by the way we approach thiamine deficiency sufficiency.

[00:06:49.24] Scott: That's what I like about this conversation, and really took away from the book, is that this is so core when we're talking about energy metabolism and mitochondria and oxidative metabolism and all the pieces that come into this thiamine conversation, when we look at things like chronic Lyme disease or mold illness or Chronic Fatigue, and people dealing with brain fog and fatigue and so on, that ATP production that you talked about is so critical to giving us and giving the body, the energy that it needs to do essentially everything.

So how common is thiamine deficiency? Why do we not hear much about it? And what are some of the key conditions or symptoms that might lead you to think this is an area that someone should explore?

[00:07:32.23] Dr. Chandler M.: Well, I think it's very common. But this brings up actually a larger conversation that we need to have about how we define deficiency and sufficiency. So, our current standards of deficiency and sufficiency, there's a bright line between if you have x amount of thiamine in your blood, you are considered sufficient.

And if you have y, you are deficient or vice versa. And there's this clear demarcation, and within it, there's this huge range of varying degrees of sufficiency. But it's basically a blood marker that we go on. The problem with that is that not only are the lab tests insufficient at recognizing thiamine deficiency, but it's not a clear line. It's a matter of sufficiency relative to your own metabolic needs.

And so while you may be clinically sufficient per the laboratory tests, if you have underlying conditions, let's say even if we're talking about mold or Lyme, where the metabolism needs to be increased to the demands of that condition, then you need more than what is allotted for by this linear concept of sufficiency and deficiency. Your body needs more.

If you have medications, if you have dietary issues that prevent you from taking in too much or your diet is really poor, and you're taking high carbohydrates in, you're going to need more thiamine than the average person. If you have gut issues, so that the bacteria in your gut are not synthesizing thiamine, they produce about two percent of the thiamine, then you're going to need more thiamine to manage that. If you have transport genetic issues, then you're going to need more thiamine.

So this discussion of deficiency, sufficiency, is to use the same word, is insufficient to do what's actually happening molecularly at the body. So, to answer your question, how many people are potentially deficient? It depends on what measures you use and who you're talking to. It can be anywhere from 10 or 15%, which is well above the few percent that the NIH and CDC say, all the way up to certain cases if you get into critical care, where almost 90% of the people, by standard laboratory markers don't have sufficient thiamine.

But because we don't measure it consistently, these are one-off studies, who knows what the actual rate is? I think if we understood the chemistry better, and understood the cases where more thiamine might be needed, it might better allow us to prevent that frank deficiency that everyone talks about.

[00:10:20.00] Scott: I know in the book you talk about thiamine deficiency being called the great imitator, you already mentioned that it can have a connection in alcoholism and medication reactions, in vaccine reactions. In the book, you also mentioned a potential connection to cancer, diabetes, AIDS. 

[00:10:37.12] Dr. Chandler M.: So, you can keep going, it can be involved in virtually anything, because it is critical to mitochondrial function. Since the mitochondrial are critical to human function or organismal function in general, it can express itself in any number of ways, and it often does.

Often, some of the earliest symptoms are just really bizarre little symptoms, that it's a lack of energy in this local area, and you don't put it together. But ultimately, if it continues, you start to see the more common systemic symptoms arise. But it's mitochondrial, and mitochondrial can be anything and everything. So, yes, we have to look at it differently.

[00:11:26.14] Scott: You talked about the idea of lab ranges for certain tests, versus what is maybe optimal for ideal functioning. So, is there an ideal way to test for thiamine deficiency? Or is it something that many people might more empirically do a trial to see if their symptoms shift? How do we test for this deficiency?

[00:11:48.11] Dr. Chandler M.: I’d like to say there was a ideal way, and there are better ways versus worse ways. It depends on variables that are not well controlled, as to which lab tests might or might not be better for you. So, the advice is typically been, particularly in the more acute stages, to treat empirically and not wait for testing. Because if you suspect thiamine deficiency, you're really already too late in the game, because it's been going on for a long time at this point.

So the notion is that you can treat empirically. I think that's one area that needs to be developed more is testing, and it's not just of Thiamine, the way we test nutrients and a number of analytes is not sufficient to the needs of modern man, modern exposures, modern physiology, they're antiquated as far as I’m concerned. Even though we have a lot of cool technology, it's still asking the same question and I think we need to change some of the questions and change some of the tools we use.

[00:12:54.05] Scott: Is there a favorite test? If you are doing some type of testing?

[00:12:58.18] Dr. Chandler M.: Well, the two favorite tests are to measure thiamine from the erythrocytes. So, Dr. Lonsdale’s favorite test is the erythrocyte transketolase test, and that is not done but in two labs that we know of worldwide. So. it's very difficult to get that test. The second test is the HPLC erythrocyte test, and it breaks things down.

And it is comparable to the transketolase test in many ways, but it is not the same. And so in some cases, it's just not sufficient. In other cases, it's certainly more sufficient than whole blood or plasma, but it's not sufficient when you have down regulation of enzyme activity, which is what the trans-ketolase test looks at.

[00:13:48.11] Scott: And for listeners, HPLC is high performance liquid chromatography. Does thiamine play a role in the, see I read your book, that's how I knew that. Does thiamine play a role in the expression of genes? And would you think of it maybe as an epigenetic modifier or influencer of gene expression? Or is it more that the conditions that manifest from thiamine deficiency are truly genetic?

[00:14:21.23] Dr. Chandler M.: Both. We have to consider every exposure or lack of exposure epigenetic, because certainly, if you expose yourself to a toxin sufficiently, you are going to initiate epigenetic changes. You may also trigger genetic expression, trigger genetic illness. So, most genetic illness, I think is a combination of the gene and the exposure. So, just because you have the gene for something, does not mean that you're going to develop a particular disease. You may have certain genes that predispose you to cancer, but unless you are exposed to cancer-causing factors, you may not develop cancer, the two, it's not a 100 percent correlation, and so everything is epigenetic, in terms of whether it methylates to turn on.

But everything is epigenetic in terms of it takes whatever your genetic blueprint is, and it turns things on and off. So, yes, thiamine directly initiates gene expression in a number of areas, not just relative to thiamine genes and all of that, but other genes. For example, insufficient thiamine initiates the stabilization of hypoxia proteins. Those are the same proteins that are stabilized in cancers, and a variety of other things, and factors stabilized if you have an obstructive type of hypoxia. So, a nutrient here, the insufficiency of a nutrient activates those same genes, and begins those cascades as if your body was hypoxic.

Now, your body is not necessarily hypoxic, but you're unable to use that oxygen to make energy, okay. Just for cellular respiration. So, yes, thiamine is both. Now, are there people who have genetic predispositions towards thiamine deficiency? Certainly, there's a lot of them. I think there's far more of them than we recognize.

We tend to think of genetic illness as being rare or genetic risk as being rare. I think as more and more of the genetic tools have become available for masses of the population, you find that they're not really rare, they're just not triggered or identified. So, yes, there's a lot of genetic issues or genetic possibilities that make you someone more susceptible to a risk of thiamine deficiency than the average person.

[00:17:02.09] Scott: I’m going to throw out several questions on this next topic, and then let you run with it, that is my style. What role does thiamine deficiency play in reactions to medications or even you mentioned vaccinations? Are there specific medications that maybe are more likely to result in side effects when someone is deficient in thiamine?

Is that risk reduced or eliminated by having adequate levels prior to the use of that medication? Then how might these medications or vaccinations result in autonomic nervous system dysfunction, an imbalance of the sympathetic and parasympathetic balance or what we call and what you title in the book dysautonomia?

[00:17:46.26] Dr. Chandler M.: So, yes, that's a number of questions. Let's start with medications, medications by one mechanism or another damage the mitochondria, that is often their target. Maybe it's an off target, but it often is where they land. So, assuming they don't directly damage thiamine transport absorption or any of the enzymes, just the damage to the mitochondria alone is going to necessitate additional thiamine.

So that's one way. There are a number of medications, probably more than we even know at this point, that block thiamine uptake, the transporters. Metformin being a huge one, metronidazole or Flagyl if you will. Bactrim being another one, it also blocks folate. A number of the antibiotics block thiamine. A number of, Sertraline or Zoloft is another one that blocks thiamine transport.

There was a study here recently that tested 146 analytes medications for their ability to block thiamine transport, and of course, all of them did to varying degrees, and there's been study after study about the damage to mitochondria from medications. All environmental toxins tend to target the mitochondria too. Mitochondria are really the brains of the body if you will, they're kind of the global sensors of environmental healthy or unhealthiness.

So it makes sense that anything that you experience or are exposed to is going to adjust mitochondrial function in one way or another. So, in a healthy human, who has healthy mitochondria, some of these exposures will not be as big if you will, and it's not readily apparent. They still happen, they just can absorb them more easily I guess if you will.

In someone who is not as healthy, these exposures can be the tipping point that puts them into a very serious, sometimes acute, but often chronic illness state. It's just the exposure. They just have, their mitochondria were not healthy to begin with, and then they're hit with this other stressor that attacks them. To answer your question, it's yes, all of the above.

And once you get your mitochondria, once the mitochondria become damaged and don't have the energy to run all of the systems that they need, to run all the signals that they need to, and produce sufficient energy to run those systems, and tackle that toxin or tackle those immune factors and balance that, then things start down regulating and resources are reallocated towards primary survival resources. And those are typically reallocated in a clumsy manner, if you will.

They don't always, so you get too much too little energy here and there, you can't respond to stressors, and that I think is the foundation of dysautonomic function, because your autonomics function is essentially the brain above the mitochondria, one step above, that is managing the more global response to environmental cues, whether it's external or internal environment. So, mitochondria, then autonomic system are managing variables there.

[00:21:25.02] Scott: I loved everything that you said there, and your comments about mitochondria being the sensors of the environment is essentially in my interpretation of that statement, very similar to Bob Naviaux's work with the Cell Danger Response that we're going to talk about a little bit later. When it comes to potential side effects from medications or vaccinations, do you need to take the thiamine before that medication or inoculation to minimize negative effects? Or can it be helpful in restoring health after the fact post-medication injury or post-vaccination?

[00:22:04.15] Dr. Chandler M.: Well, again both. But ideally, before you were to take a vaccine, you would be healthy going in. Because think of illness in general, is you're using more energy to manage an illness. And so if you have an illness that is flaring, in particular a chronic illness, and you are one of those people that needs more energy to manage that, then just the stressor alone of the vaccination is going to cause problems. You don't even have to consider the vaccines mechanisms and actions.

The fact that it is an additional stressor to an already stressed system is going to be problematic. So, yes, ideally, people would be somewhat well, have nutrition going in, not just thiamine, but all of their vitamins would be up to speed. Certainly thiamine, but I wouldn't go into it in a state where I’m depleted in a number of factors, because that's just asking for problems.

And certainly after, I mean that's where I end up finding most people, is after they've had a reaction, they tend to come to us and say I had x or y, and I was healthy before, but somehow now I’m not, because of this particular medication or vaccine. And that's where you have to start building things back. But I always ask people were you really healthy before? Or were you just relatively symptom-free or were you just managing your symptoms? Because that's a huge question these days. Everybody thinks they're healthy, then they tell you they're taking five medications, and that's not an example of a healthy person.

[00:23:50.01] Scott: I remember that ad campaign “Got Milk?”. I feel like we need t-shirts that say “Got Thiamine?”, and that would be a good conversation starter. When we think about dysautonomias, POTS is one that comes to mind for me, that Postural Orthostatic Tachycardia Syndrome, fairly common or not uncommon at least in the chronic Lyme disease and mold illness community. What are some other conditions under this dysautonomia umbrella that we might then correlate to thiamine deficiency?

[00:24:24.15] Dr. Chandler M.: Well, vomiting, cyclic vomiting, IBS. Any of the reactions of the heart, any of the reactions of the psychiatric type of reactions. Mood-ability, where you're up and down, you're up and down, unable to control it. The anxiety disorders, they may not actually be anxiety, they may be a dysautonomia reaction, but we don't look at that.

And frankly, any dysregulation of autonomic function can be linked back to mitochondria and be linked back to Thiamine. So, anything that is responded to as too much, too little, too often, too few, too soon, too late that's dysautonomia. So, I think POTS is just I think the most widely observed, and I think it only became widely observed after Gardasil. I mean, that's really when POTS came onto the market, was with women that were being diagnosed with POTS on a very regular basis.

But think of immune function also, immune function can be dysautonomic too. How your immune system reacts in terms of too much or not enough, that's all, we just unpack the layers from the brain down to the mitochondria, down to the energy availability. And so the definition is, I think should be much broader than it actually is.

[00:25:55.04] Scott: You've touched on the fact that autonomic dysfunction can be an indicator of mitochondrial dysfunction. In the book, you talk about beriberi, the condition beriberi. So, wondering how is that similar to dysautonomia, and then is it possible that gastrointestinal beriberi with gut dysmotility could suggest thiamine deficiency, and that that could also play a role in what we think of now as SIBO or Small Intestinal Bacterial Overgrowth? Is there a potential connection between?

[00:26:28.05] Dr. Chandler M.: Oh, there's absolutely a connection there. In fact, the early researchers noted the gut dysfunction is one of the first symptoms of it. Sometimes, it became the only symptom, but the gut dysfunction was clearly identifiable with thiamine deficiency early on, and we just seem to have disregarded it. When you think about it, the gut has to both transport the thiamine into the bloodstream, but it also, the colonocytes produce their own thiamine. That is then transferred directly by separate thiamine transfers into the mitochondria there.

So when we look at the bacterial composition, all of these bacteria synthesize thiamine on their own. But what happens is when there's not sufficient thiamine, there are certain classes or species, I’m not a bacteriologist, species of bacteria that are more adept at stealing thiamine from what are called salvage pathways and salvage mechanisms.

So when the thiamine is low, those species of bacteria which tend to be the more pathogenic ones, upregulate and they kind of absorb all of that excess thiamine and synthesized from these other pathways, thiamine for themselves, where the other ones can't die off. So, you get this imbalance between the good and bad bacteria, relative to a nutrient deficiency.

[00:28:00.15] Scott: Wow, you are definitely throwing out the pearls today. That's another great connection if people are dealing with SIBO or dysbiosis in the gastrointestinal system, it's interesting to think that what seems like a relatively straightforward nutrient supplementation, could positively influence that condition. In the realm of our listeners dealing with chronic Lyme and mold illness from water damage building exposure, many types of dysautonomias, neurodegenerative conditions, there's this concept that we talked about briefly earlier that Dr. Bob Naviaux has put out, the Cell Danger Response model.

Where extracellular ATP is the danger signal, and attempts to more aggressively support mitochondrial function can in some people backfire if the body is still in what he terms the CDR1 phase, this protective phase. So, if someone is still dealing with their infection or toxicant or trauma, is thiamine generally well-tolerated or do we need to be more specific about when it might be introduced? Any observations about whether or not it's helpful or tolerated in someone that is still in that cell danger or protective response?

[00:29:18.10] Dr. Chandler M.: Well, firstly, let me say that Naviaux's work is brilliant and has influenced much of my work. That cell danger theory is very important. I tend to disagree with him on how you go about treating it per se. Not because it's not difficult when someone is in that state to upregulate energy, but because you still absolutely need the energy to resolve it. If someone is thiamine deficient, and still dealing with a toxin or exposure, certainly you have to remove that toxin exposure.

But you can't just ignore the deficiency, because thiamine deficiency has some serious implications if it goes on chronically, and it often does, particularly in these types of states. I mean, it does damage in system-wide, but particularly in the brain. So, it's not something you want to wait until you have cleared the thing, because you're not going to be able to clear the thing without sufficient energy, and you need sufficient energy to maintain everything else.

So to the question is it difficult to replete thiamine who is someone in that state? Yes, absolutely it is. It's absolutely difficult, particularly in individuals who have had long-term, well-entrenched thiamine deficiency, where all sorts of adaptive mechanisms have been upregulated to keep the individual alive, and now need to be down regulated, and other more healthy mechanisms up regulated, that rewiring that has to occur. Is a very difficult process, the longer the deficiency goes on.

So do you have to treat the exposure? Yes. Can you ignore the thiamine simultaneously? No.

[00:31:11.04] Scott: In the book, you talk about high calorie malnutrition. So, when we think about thiamine deficiency, I’m guessing the answer is going to be both, but I just want to be clear. Is it that there's deficiencies in our nutritional intake? Or is it that environmental exposures, toxicants, other factors are leading to an increased need for thiamine than what we're maybe getting in our diet? And if it's those environmental toxicants or exposures, what are some environmental triggers that might be increasing our need for thiamine?

[00:31:47.04] Dr. Chandler M.: So, you're absolutely correct, it's both. In some cases, we're not taking it enough. Although, the latest name study says that the average intake is between 4 and 6 milligrams a day, and the RDA for thiamine is 1 to 1.2 milligrams a day. So, relative to the current definitions, we're getting plenty.

Now, relative to the need and relative to whether or not those definitions were sufficient to thiamine to begin with, they aren't and that's another topic. But relative to need, we certainly do need to take in more, because of not only the caloric content of the diet, which is the process nature of the diet, which has a number of anti-thiamine factors in medications, which damage things. Regular alcohol intake, whether you rise to the level of being an alcoholic or it's just a glass of wine a day, that blocks thiamine. High coffee, caffeine, tea, those polyphenols in there deplete thiamine.

So there's a number of factors that depending on the individual, all can combine to make their intake of thiamine insufficient to what the body needs to produce things, to produce that energy. With regards to the high calorie intake, the more sugars you take in, the more thiamine you need to process them, otherwise they just sit there and they go to alternate pathways and eventually things shut down.

With regard to things in ultra-processed foods that directly block thiamine, in addition to the ones I already gave you and all the preservatives and chemicals, seed oils. Seed oils actually downregulate, well they upregulate one of the enzymes that down regulates another enzyme that we need for thiamine. So, the more seed oil like foods you have, you're actually down regulating your pyruvate dehydrogenase enzyme.

[00:33:52.13] Scott: And is that seed oils that are in more processed foods or heated oils, or would you say that that's even a concern with properly processed things like hemp oil and flaxseed oil?

[00:34:05.27] Dr. Chandler M.: I certainly do not know with hemp oil or flaxseed oil. But it's obviously in the processed foods, the soy oils, the seed oils and the processed foods, those are problematic. And those are also unfortunately where we get the data, the fortified data that says that people are sufficient thiamine, because almost everything is enriched or fortified with thiamine these days.

And so by calculating those people think well, I’m getting sufficient thiamine. But with that food, not only are you getting excessive calories and excessive sugars and things that have to be metabolized, but you're getting all of the anti-thiamine factors that are down regulating. So, you're probably, if your diet consists in that, you're probably low in thiamine.

[00:34:52.15] Scott: And I’m going to guess and we'll talk more about this later, but I’m going to guess they're not fortifying foods with the optimal type or form.

[00:35:00.04] Dr. Chandler M.: Oh, certainly not. And I would prefer people just eat whole foods, whole organic foods. But you do have to work. So, if you don't eat meat, meat is one of the major sources, pork in particular of thiamine. If you are a vegetarian, and you rely predominantly on grains, depending upon how they're processed, you may be low in thiamine just because of your diet.

[00:35:27.12] Scott: In Lyme disease, mold illness, limbic system impairment often plays a role, people benefit from things like Annie Hopper's work with the Dynamic Neural Retraining System or DNRS or Ashok Gupta's work with the Gupta program. Can thiamine deficiency play a role in limbic system dysfunction in our sensing of what is safe or not safe in our environment?

[00:35:51.26] Dr. Chandler M.: Well again, absolutely, because everything feeds to the brain stem and cerebellum and everything else. But the limbic system is one of your areas of identifying fight or flight, what is safe and what is not, and it's that mood-ability, that kind of inability to gauge a situation and that's a fluctuation of one's, mood is just not a really good word, just the being all of that that mobility in general I think is definitely an indication of poor energy metabolism.

Because the brain sucks up a huge amount of energy metabolism energy in order to function appropriately. And if there is insufficient energy for periods of time or in areas, so if it waxes and wanes, you're going to get these responses that are not effective in dealing with the particular environment that you're on. You're going to be very reactive.

[00:36:51.15] Scott: I think this next question, we touched on earlier, so this maybe is just more of a confirmation that I understood it correctly, and that is the connection between thiamine deficiency and hypoxia or less than optimal delivery of oxygen in the body.

So if I understood correctly, thiamine plays a role in hypoxia and that lack of oxygen in the body then can keep the body in more of this alarm state reinforcing that autonomic dysregulation, and so that is then keeping the body in a sympathetic dominant state, which we know is not the right state to be conducive to healing.

[00:37:30.19] Dr. Chandler M.: Exactly. Not only is it that hypoxic state hyperactive sympathetic symptom, but that hypoxia is hyperactive inflammatory state. So, that is what's keeping the body ill, this inability to tamp down that inflammatory response. So, you may have removed the stress or the toxin, whatever it was, you know, quite some time ago. But because there's insufficient energy, you cannot bring those responses that were needed in life saving when they happened, but you can't bring them back down into control and re-regulate everything. That's fundamentally the lack of energy.

[00:38:12.13] Scott: What is the role of thiamine in glucose regulation, and maybe even potentially in diabetes. Could we minimize the severity of those conditions by using supplemental thiamine potentially?

[00:38:26.26] Dr. Chandler M.: Oh, absolutely. There's been study after study showing that if both type 1 and type 2 diabetics, when given varying dosages and varying formulations of thiamine brings their glucose levels down into check. And they think part of it is because of enhanced excretion in the kidneys, but I think really a lot of it is that they were just insufficient in thiamine to begin with. And the diet itself, our diet in the western world these days is absolutely horrid, it really is absolutely horrible for I’d say 90% of the population.

So I think that if we were to start looking at what patients needed, what people needed to be healthy and asking ourselves whether or not we're giving them those things, in many cases, the answer would be no, we're not giving them. We need actual nutrients in the body. And if you give the body nutrients, if you give it what it needs, it will regulate things to the best of its ability and that's generally pretty good. But we don't, we just keep slapping on pill after pill after pill and keep eating this absolutely garbage food.

[00:39:44.28] Scott: I want to talk a little bit about neurological or neurodegenerative conditions that have a myelination or demyelination component, like multiple sclerosis. Do we think that thiamine deficiency could play a role in those demyelinating conditions?

[00:40:02.22] Dr. Chandler M.: Yes. So, my answer I think to any of these where it's an energy-intensive process is going to be yes. Once you realize the fundamental role of energy and keeping the body moving, then you recognize the thiamine and certainly other nutrients as well. But again, because thiamine's at the top of the pathway are absolutely requisite.

So if we were to start giving people, if people will start recognizing this and perhaps, I suppose supplementing with thiamine more frequently, I think that perhaps they could resolve a lot of the chronic health issues that we see.

[00:40:45.01] Scott: Another connection that you made in the book was if we think about brain fog and fatigue, for example, as top symptoms in people that are listening to our conversation, and we think about how thiamine impacts the mitochondria and ATP production. Wondering if you can talk about kind of the logic around why certain places in the body are where symptoms might appear first?

[00:41:09.02] Dr. Chandler M.: Well, certainly because the brain requires so much energy, that's why you start to see things like brain fog. I mean, the cardinal symptom of insufficient Thiamine is fatigue, which is we tend to dismiss fatigue as an actual symptom, because everyone has fatigue to some degree or another. I mean, we live with fatigue on a regular basis in modern society. We drink coffee to power through it, because that's the demand that we have on society.

But when you think about what types of amounts of energy the brain has to use or the heart has to use or the GI system has to use, then you start to recognize that if your mitochondria are not functioning well, you're going to have symptoms in those areas. And they may be subtle at first, they may be such that you don't recognize them as anything wrong, just as the general situation of living in modern society. But over the long term, they accrue. And all sorts of things begin to go wrong.

[00:42:13.13] Scott: In the world of Lyme disease and co-infections, the right treatment can at times lead to a worsening of symptoms, what we might call a Herxheimer reaction or a detox reaction. Let's say if somebody has Bartonella for example, and they have the right treatment, that could potentially lead to more rage or OCD or anxiety for a short period of time.

You mentioned earlier in that Cell Danger Response conversation that repletion of thiamine can be difficult in some cases. And so, is that worsening of symptoms when you start reintroducing thiamine? Is that primarily with oral, with IV? Do we need to start slow and low as we're introducing thiamine into our supplement regime?

[00:42:59.20] Dr. Chandler M.: Yes, to all of the above and no to all the above. So, in the parlance of thiamine deficiency, it's typically called a paradoxical reaction, and it's a worsening of symptoms as you suggest before the symptoms improve. It's also the emergence of some new symptoms. Now the question is do you go in hard and fast, or low and slow. And there are two schools of thought on that, and both have are well thought out and well-reasoned.

So the hard and fast component is that you need to upregulate the down regulated enzymes, and so, the only way you're going to do that is with high dose. And that often happens in hospitalized cases, where it's actually emergent and acute, and if they don't re-regulate things quickly, the patient is going to pass. And so you'll get very high doses of iv over a short period of time, and then it's tapered down. That does carry over into chronic illness with oral, because most folks have to go this on their own, they will go a very high dose for a period of time and then regulate down.

Now, should you go a very high dose or should you start low, that is the question. Some people do fantastic on the high dose, and they have immediate relief and things go smoothly for the most part. There can be some pickups, but they do well. Other folks, people on the other hand, they take even a minimal dose and everything just is on fire, everything goes crazy. And how do you manage that? Because in often cases, those folks are lab confirmed Thiamine deficient.

So it's obvious they need the thiamine, but how do they manage that reaction? So, one way is to start the doses out very low, sometimes single micrograms, or milligrams rather, and titrate up very slowly in a stair step procedure. Another way is to start with some of the cofactors first, and then add the thiamine. Another way is to start at a low dose, and kind of figure out what the reaction that they're having is, and what is lacking based on the reaction that they present with.

Now, what I’ve learned over the years is that a lot of folks that that have some of these negative reactions, is because of the re-regulation of calcium. So, we tend to pay attention to magnesium, because magnesium activates the thiamine. And we look at potassium, because potassium is going to now be brought into the cell and you're going to end up with a little bit of a potassium deficiency, and we sometimes pay attention to salt, but we tend to ignore calcium. And the general thinking on calcium is that we shouldn't supplement calcium, because calcium is damaging to this, that.

Calcification of arteries, which is an entirely different mechanism. But in digging into how the mitochondria respond to different states, it became apparent to me that what was happening to a lot of these folks is we were giving them too much of everything else, and they didn't have sufficient calcium to manage the mitochondrial response. And you think well, you don't want a flood of calcium, but you need sufficient calcium to fire things appropriately. So, when people started taking magnesium or Cal/Magnesium supplements in a combination, as opposed to just straight magnesium. They tended to fare better with those paradoxical reactions. Now is that the only answer? Absolutely not, because there are so many weird things that happen when people are starting to replete thiamine that it's entirely individual. But that was one thing that we found or I found in digging in.

[00:47:02.18] Scott: What's the connection between thiamine deficiency and poor immunity, potentially leading to chronic infection? So, if we think about Lyme disease or maybe people with autoimmunity, for example. We touched on this earlier, that thiamine can play a role in the immune system in regulation of the immune system. Is it also playing a role in modulation of that immune response? Can thiamine potentially help to break the cycle of chronic infection or chronic autoimmunity?

[00:47:35.28] Dr. Chandler M.: Oh, I absolutely believe it can. Effectively again, it comes down to energy. You have sufficient energy for the pro-inflammatory response, but not enough energy for the anti-inflammatory response, so things get skewed, it gets stuck in that turned on position and you have no way to turn it off. So, I think that that's an important consideration when we're looking at chronic disease, is having the energy to manage whatever it is that's going on. I think that's just fundamentally what's lacking in the totality of our response to health and disease right now.

[00:48:14.04] Scott: How does the consumption of sugar potentially make these conditions worse?

[00:48:19.08] Dr. Chandler M.: So, the sugar is obvious. Sugar has to be metabolized in the … pathway, and you have no thiamine. It's not going to go in that pathway, it's going to go in some salvage pathways. So, that it can get whatever energy they can out of it. And those salvage pathways burn dirtier, and produce more oxidants and other things. So, a reactive oxygen species. 

[00:48:41.18] Scott: Why might conditions that are perceived to be psychosomatic, mental emotional, actually be autonomic dysregulation with underlying thiamine deficiency?

[00:48:53.08] Dr. Chandler M.: Well, I think we've touched on this one on throughout, this is the insufficient energy to manage neural firing. And autonomic response meaning like heart rate and all of those things relative to environmental changes.

So it's just, it's energy. And it seems so simple, doesn't it? You know just have sufficient energy and everything goes. And in many regards, it is. But we've made it so complicated with the way we approach medicine, the way we approach food, the way we approach living in general, that I think it's the missing piece in so many diseases.

[00:49:33.26] Scott: And it's interesting in these chronic conditions, having myself been in this realm for over 20 years now, people are often attracted to like the latest fancy supplement, the most expensive things. And I think sometimes, we miss these basic foundational things that in this case is not an expensive intervention at all, but most people have never really even explored it or considered it.

[00:49:58.14] Dr. Chandler M.: Oh, absolutely. And I get that all the time, I get that. Well, because it's like the TTFD formulations of thiamine are more expensive than the HCl, and in general people will come and tell me well, I just can't afford it. I’m spending XYZ money on all of this, I can't afford another one. I’m like well, you have a choice to make here. Are all of these things really necessary? And you're affording all these things, but I don't know.

It often takes people, once they go down the path of these other supplements and stuff, it will take them a few years to come back to thiamine. So, I see patients a lot of them that are very invested in this or that treatment protocol. And when it's obvious that they need thiamine, and obviously, other nutrients too, but they obviously need thiamine, and they won't recognize it sometimes for years, and after they've tried everything else, they'll come back.

[00:50:53.28] Scott: Well, and it's interesting, our mutual friend Dr. Neil Nathan, he talked about how he actually heard Dr. Lonsdale speak 30 years ago, and now is very excited about this topic and the role of thiamine deficiency. Now I don't know if the topic 30 years ago that he was presenting on was exactly this one, but to your point, sometimes it takes a while for the importance of these things to really become more obvious.

I want to talk a little bit about the connection between elevated levels of lactic acid and thiamine deficiency, and when we have that lactic acid buildup after exercise for example, could thiamine deficiency be an explanation for post-exertional malaise in chronically ill people? We see that a lot in Chronic Fatigue Syndrome or Myalgic Encephalomyelitis. So, wondering if you could talk about thiamine deficiency, and the connection to lactic acid?

[00:51:51.17] Dr. Chandler M.: Well, certainly. If thiamine can't be shunted into the mitochondria, the pyruvate is shunted up to the lactate dehydrogenase enzyme, and you get excessive lactate, if it doesn't, it's a two-way pathway. So, lactate can be used as energy, and in fact in the brain it's used as energy, and in the body it's used as energy under certain circumstances. But if you don't have the available thiamine, it doesn't get used as energy.

So I suspect that in those cases of chronic, the post-exertional malaise, that thiamine could certainly help. Now in athletes, they've done a lot of studies with athletes, in terms of thiamine and recovery. And high dose thiamine has been used for different sports for a long time, to help improve recovery of athletes after training, and has been found that all of their markers are better when they have thiamine than when they don't.

[00:52:51.15] Scott: In this Chronic Fatigue Syndrome, CFS/ME community, I think many people think that there is a core mitochondrial component to these conditions. And wondering in the many people that you've worked with, have you observed how people with CFS or ME respond to supplemental thiamine. Does it seem to move them forward in their recovery?

[00:53:13.23] Dr. Chandler M.: It does, but in some cases, it's very difficult. There are some of the more difficult patients to get through that paradox, and so I think that that dissuades a lot of folks from moving forward, because they already feel rotten. And the prospect of feeling rotten, even more rotten for an extended period of time. Because the paradox can go on for weeks to months, depending upon the individual and how it's titrated. It makes it very difficult. But those that do get through to the other side, express remarkable gratitude for being healthy again.

But it is not to diminish how difficult it is to get to the other side, and I wish there were a team of folks, physicians and physiologists and PTs and a variety of other people who could work with this patient population, and develop a more specific protocol if you will for it and figure out what the reactions, what is causing these reactions and how to mitigate some of them. I’m sure there are clusters.

Like I said, the Cal/Mag was one specific area that I found particularly the heart-related reactions that worked, I’m sure there are others that are out there that we could identify, if there were more than just a few of us working here and there independently trying to figure this out.

I also think that in those folks that if they could do IV therapy, and a consistent IV therapy with both the thiamine and other nutrients and someone could monitor their electrolytes and manage those, that they could navigate that paradoxical response much more quickly and effectively, than the way we have to do it now which is in one-off cases, the patient has to do it themselves they have to figure out what works and what doesn't and play trial and error, and it's miserable, it's absolutely miserable.

[00:55:22.19] Scott: I recently heard Dr. Neil Nathan in an interview say that mold toxins or mycotoxins interfere with the body's absorption of thiamine. And so I’m interested in your thoughts around whether or not toxic mold and mycotoxin exposures are one of those environmental toxicants that can lead to a need for supplemental thiamine, and where does mold illness from water damage building exposure enter this conversation?

[00:55:49.04] Dr. Chandler M.: Well, so mold illness is not my area of expertise. But I am not surprised that the mycotoxins don't derail thiamine metabolism, because again remember what the bacteria do, the more toxic ones are those that are able to kind of suck out the thiamine that the others produce or make their own thiamine by these salvage pathways. So, it's a survival of the fittest, so I could see that that would be happening with molds as well, I just have not studied that.

[00:56:21.16] Scott: Many with chronic conditions have sub-optimal methylation, which is important for detoxification, for silencing or managing certain viruses or even cancers for example. What role does thiamine play in optimizing methylation?

[00:56:37.20] Dr. Chandler M.: Well, methylation is energy-intensive. So, again, if you are insufficient, have insufficient energy, you're going to have insufficient methylation. I mean, that's just the way it is. And so Dr. Lonsdale likens the methylation process to the transmission, whereas thiamine is the spark plug of the engine. So, you can't get to the transmission if the spark plug doesn't turn the engine on.

[00:57:03.00] Scott: In the book, you review several cases that presented with lymphadenopathy. Listeners often are working on detoxification and drainage and supporting the lymphatic system. Is there a connection between thiamine deficiency and the lymphatics? 

[00:57:19.08] Dr. Chandler M.: Again, I think I feel like I’m saying the same thing, over and over and over. Well, firstly those are Dr. Lonsdale’s cases, so clinically, I have not had experience with that process. However, yes, energy intensive functions require energy, requires thiamine.

[00:57:41.08] Scott: We talked in this conversation about the importance of mitochondria and the production of ATP. We understand that thiamine can be a key vitamin for mitochondrial function. What are some of the other nutrients or cofactors that you have found are critical in supporting optimization of ATP production?

[00:58:01.00] Dr. Chandler M.: Well, so in the book, I think we list about 22 of them. The B vitamins in general are critical, for the first steps in that riboflavin is the second one in the queue. Oftentimes, when people are deficient in thiamine, and they begin taking thiamine, if they miss taking riboflavin then they develop something called air hunger, it's poor oxygenation, but it's not poor oxygen, the poor is an inability to use the oxygen, because if you take their pulse ox, it is fine.

And that's because the riboflavin is low. And so when riboflavin is needed in the PDH enzyme, as well as down the cycle, so riboflavin. And then all the other B vitamins, minerals, magnesium is critical at multiple junctures, but particularly with thiamine, because magnesium activates the thiamine. So, if you are titrating up thiamine and you don't take your magnesium, then you're doing no good because you can't activate it. So, that does, but simultaneously. If you're taking magnesium without taking thiamine, because of where magnesium works and because of activity of another enzyme in the cycle. It starts to down regulate and it'll shut things off.

So I am fundamentally against high-dose magnesium, if someone has not begun taking thiamine, because that will kick someone into thiamine deficiency and reduce ATP. And then you have things like CoQ10, which is critical for the electron transport. You have vitamin C obviously for glutathione, and I’m sure, I’m missing others, because it's been a while since I’ve looked at the chart. But effectively, you need just basic all of the nutrients. I mean, you need all the B vitamins and minerals and a good multivitamin is quite useful.

[00:59:57.03] Scott: One of the things that you just shared that was new to me as well that I loved was the connection between riboflavin and air hunger. In this community of people listening, a lot of times with air hunger, we jump to thinking that it's Babesia infection or we jump to thinking oh it's mast cell activation, and so you just gave us another important piece of information that maybe that air hunger is related to a need for riboflavin.

[01:00:21.22] Dr. Chandler M.: It often is, well, it's often, riboflavin after you've begun thiamine, so it could be thiamine alone if they have not begun thiamine. But if they began thiamine, and then develop air hunger, then it's often riboflavin. But it could be both.

[01:00:36.20] Scott: We touched on this a good bit through the conversation, but I’m just trying to get a little more sense around given that so many of our foods are processed, they're then fortified. There are the thiamine inhibitors that you talked about in a lot of foods, like do we really think it's even realistic to think that we're going to get adequate thiamine from our diet or do we think that maybe most people need some degree of supplemental thiamine?

[01:00:32.23] Dr. Chandler M.: That's a good question. I don't know if we can get adequate thiamine anymore, and I don't know if what we thought was adequate thiamine 80 years ago is adequate for today. I don't know what adequate thiamine means in today's environment.

And so, I think that yes, most people should be supplementing thiamine, I’m just booned to the supplement industry how unfortunately. But until we clean up the totality of our chemical landscape, I think that thiamine is going to be insufficient.

[01:01:37.07] Scott: You touched on the fact that pharmaceuticals damage mitochondria through multiple mechanisms, that they can deplete thiamine as well. We touched on the idea that Metformin, that many people in the biohacking world use for regulating blood sugar, can potentially negatively impact thiamine status, maybe not even potentially, it has that property of negatively impacting thiamine status, that can then damage the mitochondria.

So, if someone's using metformin, can the downsides be mitigated by taking thiamine similar to the use of CoQ10 with statin medications? Or would you say that we really should be avoiding these medications that have this potential?

[01:02:21.18] Dr. Chandler M.: Well personally, I say you should be avoiding medications. You can't be healthy if you're on medications, and that's just, I suppose that's my bias. Can you mitigate those? Possibly. I don't know that there's been studies on those showing that you can mitigate those. I know Metformin reduces ATP output and skeletal muscle by about 48%.

So, it's not something I would want to be taking as an athlete, certainly, because you need to maximize ATP output not minimize it. As a patient, can you imagine, particularly a diabetic patient, who probably was thiamine deficient before they were even started, to then take Metformin which blocks thiamine, and which blocks or minimizes ATP output, then being told to go exercise, to lose weight. I mean, it's just a cycle that they can't win. So, I would avoid it at all cost.

[01:03:20.22] Scott: Environmental toxicants like glyphosate have been said to block thiamine uptake. Do you think that it's possible that our modern use of glyphosate has been a significant contributor to larger scale thiamine deficiency?

[01:03:36.06] Dr. Chandler M.: Oh, absolutely. And not only glyphosate, but atrazine, all of the Ag chemicals that we use, have not only presented toxins to a system that we can't deal with, but they depleted critical minerals in the soils, such that the plants that are grown in them are depleted in minerals.

But have much higher sugar content now, than the vegetables or fruits and vegetables that we had decades ago. So, you've got no nutrient, substantive nutrient content in these products, and additional sugars, which is again, you think you're eating healthy, but if you eat conventionally grown produce, you're basically eating candies under the guise of a vegetable. That's how your body's viewing it.

[01:04:28.14] Scott: I knew there was a reason why I don't love my vegetables. They're just not good for me anymore.

[01:04:34.24] Dr. Chandler M.: Well, not the conventionally grown ones anymore, they don't have the same mineral content, and they're very high in sugar content.

[01:04:42.25] Scott: What role do we speculate thiamine deficiency could have in children with autism spectrum disorders or even PANS and PANDAS, which are really emerging as significant conditions over the last many years. Any thoughts on it?

[01:04:56.28] Dr. Chandler M.: I think it has a huge role. I think it's part and parcel, because this is a generational thing that's evolving. When you have a couple generations who have sub optimal thiamine deficiency, I mean thiamine input with additional exposures that all the toxins and then they have a child, and the next child has a child. We start to see these systems of dysregulation. Not only in the brain, but in the body and the immune system, everything becomes dysregulated.

So, the fact that it they tend to appear after a vaccination or medication or an illness, only indicates that the body at that point was barely functioning and that stressor tipped him over into this state. Now does that mean that these medications or vaccines are not toxic in and of themselves? And don't elicit all sorts of damages? No, it doesn't. It just means that that we've had so many of them. It's difficult now to find out, figure out which one was the culprit, there is no one that is the culprit.

This is the accumulation of all this stuff that we put into our bodies that is creating the damage. So, yes, I think thiamine is important, because mom was probably, dad was probably deficient. And now the baby comes into being somewhat deficient, maybe has down regulated enzymes to begin with, because of what was happening maternally or paternally.

And then is hit with a whole slew of toxins that we expose these children too right out of the gate, and there's just no way for them to come from that.

[01:06:39.09] Scott: Yes. Building on what you just said there in the book, you talk about the connection between thiamine deficiency and sudden infant death syndrome. So, that concept that an infant could already be born deficient in thiamine or have a lot of these early stressors that then are leading to thiamine deficiency and potentially a condition like SIDS.

[01:07:00.24] Dr. Chandler M.: Exactly. And they could have genetic markers too, because if this goes on sufficiently, generation after generation, you're going to rewire the genetic blueprint in terms of how it receives these nutrients and utilizes them. There's going to be things that are going to be altered. And so children this generation forward, the last couple generations actually, we're going to start to see I think more and more of it unfortunately.

[01:07:27.00] Scott: In the neurodegenerative condition realm, things like Alzheimer’s disease or Parkinson’s disease. Do you think that thiamine supplementation could be helpful in those conditions?

[01:07:39.08] Dr. Chandler M.: Oh, absolutely. And Costantini, the researcher in Italy who passed from COVID last year, showed remarkable improvement with high-dose thiamine and Parkinson’s patients. Now unfortunately, again, we're not getting this late stage, late stage by the time you start seeing the tremors, it's been working its way through the brain for a while. If we were to start treating people earlier or start giving people thiamine or just keep their thiamine levels normal, I think we could prevent and that's important.

Additionally, Alzheimer’s, there's been a number of studies showing that one, that Alzheimer’s patients are thiamine deficient. And two, that by giving them thiamine deficient, their symptoms improve. So, had we been doing this all along, had we been recognizing, would we not prevent at the onset of these diseases. 

[01:08:36.07] Scott: Now I see why Dr. Nathan said hey Scott, you really need to go read this book. Are there some pain syndromes that can be the result of sympathetic dominance or a form of dysautonomia that repleting thiamine could actually help with some of these chronic pain syndromes?

[01:08:56.25] Dr. Chandler M.: Well, not just the pains, but the neuralgias. The nerve pains, that you get peripheral neuropathies and neuralgias tend to be related to longer standing thiamine deficiency. So, again, yes, I mean my answer is going to be yes to all of this, unfortunately. It sounds like I’m talking about some magic pill, that makes all of the world's ills go away.

But it's just a vitamin, but it's a very important one because it is a gatekeeper to energy metabolism. And so, if you derail energy metabolism, everything else is going to follow suit. And so anything you can imagine that creates illness is going to require energy to manage or resolve. And if you don't have that energy, it's going to become chronic and worsen.

[01:09:48.01] Scott: Let's talk now a little bit about supplementing thiamine or repleting thiamine. What are some of the key forms of thiamine? And what form might be best to consider from a supplemental perspective? How is TTFD for example different from Benfotiamine?

[01:10:06.06] Dr. Chandler M.: Okay. So, there's a couple forms of thiamine on the market, there's the thiamine mononitrate, and that's typically the cheapest most or at least accessible, but most accessible because it's put in every food, every cheap supplement that exists. It's not the one you want, there's a number of reasons for it, doesn't matter, it's not the one you want. A little bit better is thiamine HCl, hydrochloride, that is what's used in IVs, it is also in supplements in your multivitamins, a little bit more expensive multivitamins, but it's more readily accessible, it's a common, it's what Costantini uses in his Parkinson's patients.

A lot of thyroid patients will use, Hashimoto's thyroid, we use thiamine HCl. You have to take it in very high doses because it's poorly absorbed, particularly in high doses, it requires a transporter. So, the doses of those can be anywhere from like 1500 milligrams to three or four thousand milligrams. And I read a study the other day where they were using six thousand milligrams. So, exceedingly high doses of that, because only about eight percent of it is absorbed. Okay, so then there is a form called Thiamine TTFD and Benfotiamine.

The TTFD comes in a couple brands right now, Allithiamine, Lipothiamine and Thiamax , and Benfotiamine is its own brand. They're different formulations, they've attached some things to the molecules in both of those that make that molecule not need a thiamine transporter. So, in someone who has gut dysbiosis and someone who has genetic problems with the thiamine transporters, they're going to need either the TTFD or the Benfotiamine, because the HCl will not absorb in high enough doses for them to get what they need.

[01:12:04.01] Scott: One of the things that I read in the book is that TTFD crosses the blood-brain barrier, where Benfotiamine does not. Is that?

[01:12:12.21] Dr. Chandler M.: Well, there's much debate about that. I don't think Benfotiamine itself crosses the blood-brain better from what we can tell. But a metabolite of it does. Because it has been used in Alzheimer’s treatment, and obviously Alzheimer’s treatment needs it's across the blood brain barrier and they've had success. So, both of those, because they don't require transported, because they're not technically lipid soluble in the traditional sense, but they do move across the membranes without transport, because of their configuration.

So both of those would work. So, which one do you choose? I have learned over the years it really is a matter of individual response and preference. So, there are some people for whom the TTFD and the Benfo work remarkably well, and there are a lot of people that is the one that they need. But there are some that it's too potent for them initially, especially those sometimes with chronic fatigue, they tend to have to start with an HCl and micro dose it. So, it's trial and error, unfortunately. As to which one is going to work for you.

[01:13:31.12] Scott: Well, I like what you just said. And actually, Dr. Nathan and I had this conversation recently, where for some people, starting with those less effective forms and working up to TTFD over time, might be another strategy to minimize some of those repletion symptoms that you were talking about.

[01:13:50.00] Dr. Chandler M.: It is, and it doesn't always work. Sometimes because of their unique genetic, they have to go hard and fast initially and just power through it. So, it really is, at this point, it's trial and error, unfortunately.

[01:14:03.08] Scott: Do you think there's any advantage to liposomal preparations of these nutrients, rather than just capsule type forms like we have currently with TTFD and Benfotiamine?

[01:14:15.13] Dr. Chandler M.: Oh, possibly. I think ideally, we would do more IV frankly. But we can't, because most physicians don't recognize it. And the reason I think IV would be so much better than anything else, is because there's so much gut dysbiosis these days. That if we could bypass that, at least initially, we could probably resolve some of the dysbiosis resolve, some of the other symptoms and then they could go to oral and it wouldn't be such a problem.

[01:14:45.09] Scott: Yes. And that's potentially another advantage of an oral liposomal liquid, rather than a capsule, because some of it is getting absorbed before it hits the gastrointestinal tract. So, is TTFD available in IV form, Or only the?

[01:15:01.00] Dr. Chandler M.: You know, I understood that it was. It is available in IM. And someone had it indicated that it had been available in IV, but I am not aware of that.

[01:15:13.08] Scott: Where does supplemental thiamine come from? And does it come from a natural material, or is it synthetically created like what's the source of thiamine?

[01:15:22.24] Dr. Chandler M.: It is a synthetic, unfortunately. Well originally, in the research, they were Allithiamine is a derivative allicin of garlic. And so I guess there's a component of it since it's natural, but they've added the molecules to make it more active. And so because when they tried to do the allicin, the allithiamine that was natural, it didn't have the same response.

[01:15:47.02] Scott: Can you talk a little bit about physiologic doses versus mega dosing, in terms of potential clinical outcomes? And then building on that, can we become thiamine toxic if we overshoot the mark?

[01:16:01.12] Dr. Chandler M.: That's a big question these days. There's quite a bit of debate on, there's no toxicity in the traditional sense, and studies have gone up to many grams of thiamine and found that there were no toxicity by traditional measures. Now, can you take too much and it have a negative effect? Yes, certainly. So, how much is too much? I don't know. There are patients, MS patients for example that of the TTFD will take a gram or two of TTFD.

In comparison, the Parkinson’s patients from Costantini’s research, which take the HCl, which is far less absorbable, but will take three grams is one of their high doses. So, that's kind of apples to oranges there in terms of the potency, but you can see. Now where do most people land in the dosing? It's all over the place.

I see a lot of people who do quite well on 150 to 300 milligrams of the Allithiamine, Lipothiamine; of the TTFD version. Where others have to take higher, but others can barely tolerate 50 milligrams. So, all of those are considered super physiological doses, because remember, the RDA says that we only need a milligram of thiamine per day.

[01:17:18.09] Scott: And that probably hasn't been revised for quite a long time, would be my guess.

[01:17:23.05] Dr. Chandler M.: Since it was set, it was set in the 80s, the 80s, in the 40s. And when they set it up, it was interesting if you go back and read the original documentation which I did for something else I was working on. Even the early researchers said that while one can survive on this, and it was better to have two or three milligrams which is still quite low in comparison. But they went to the lowest possible dosage to set their standards.

[01:17:50.02] Scott: I’m super excited to have you on as a guest today. I know people can learn more about you at HormonesMatter.com. But I know you do a lot of other great work outside of this conversation. So, what are some of the other things that people potentially can find by connecting with you through your website HormonesMatter.com?

[01:18:08.11] Dr. Chandler M.: Well, so in addition to the website and the book that you've mentioned a couple times, Thiamine Deficiency Disease, Dysautonomia, and High-Calorie Malnutrition. We published another article here recently that people might find abuse, that kind of is a, I suppose a synopsis of the entire book called “Hiding in Plain Sight: Modern Thiamine Deficiency”, and that's available online.

I have a Facebook group called “Understanding Mitochondrial Nutrients”, and it's a private Facebook group, and it is comprised of researchers, patients, physicians and whomever is interested in mitochondrial nutrients. And we talk about the spectrum of nutrients related to the mitochondria, not just thiamine.

Thiamine is obviously an important role and we talked about that a lot, but some of the other ones as well. And then I suppose if you're really interested in something fun, I am a power lifter and I run a website called “Old Ladies Lift”, because I’m old and I have a Facebook group of the same name. It's private as well for any woman over 40 years old, who is a power lifter, weightlifter, cross fitter, bodybuilder or the like.

[01:19:20.14] Scott: One of my not so long-ago podcast gets Ruth Kriz, we did a conversation on chronic UTIs and interstitial cystitis, and she is also a power lifter. So, now I know two of you.

[01:19:34.27] Dr. Chandler M.: Oh, very cool. In that group, we have almost 12,000 women, and that blew me away when I started it, I had 30 or 40 and I thought well, maybe we'll get 100 or two, there can't be that many of us old ladies. And it just grew and grew, there's a lot of them.

[01:19:55.20] Scott: My last question is the same for every guest, and that is what are some of the key things that you do on a daily basis in support of your own health?

[01:20:02.09] Dr. Chandler M.: Well, I lift weights. I do take my thiamine and other vitamins, and I eat organic to the extent possible. I don't eat a lot of carbs, let's see what else. I walk every day, just to get some sunshine. I try to sleep, but I’m old and menopausal and sleep is not as forthcoming as it used to be.

[01:20:26.28] Scott: Progesterone sometimes can be magical for sleep.

[01:20:29.29] Dr. Chandler M.: Yes, I have a SNP in one of those pathways that doesn't allow me to take it. But yes, I I do what I can just like everybody else. I eat well, I work out. I don't drink, don't smoke, those things.

[01:20:46.11] Scott: And it sounds to me like you're doing important work that is consistent with your purpose and your passion, and really helping other people. I absolutely love this conversation, even after having read the book, you made new connections and put other pearls and gems throughout.

So just want to thank you for spending time with us today, for sharing your knowledge and wisdom, and really appreciate all that you do, and want to honor you for the book and for everything you're doing to make life a little better for people. So, thank you so much for being here.

[01:21:17.28] Dr. Chandler M.: Oh thank you for having me, I enjoyed it.

[01:21:13.02] To learn more about today's guest visit HormonesMatter.com.

[01:21:29.23] Thanks for listening to today's episode. If you're enjoying the show, please leave a positive rating or review, as doing so will help the show reach a broader audience. To follow me on Facebook, Instagram, Twitter, or MeWe, you can find me there as BetterHealthGuy.

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