Thiamine for MS

[NHE]

Two papers showing a benefit of thiamine in MS separated by 40 years without much published in between. Why?

High dose thiamine improves fatigue in multiple sclerosis (2013)
https://www.ncbi.nlm.nih.gov/pmc/articl ... 009144.pdf

Multiple sclerosis and other demyelinating diseases (1973)
https://www.ncbi.nlm.nih.gov/pmc/articl ... 9-0017.pdf

[jimmylegs]

it's also one of the most heavily emphasized components of the klenner protocol (1971)

Thiamin hydrochloride: 300mg to 500mg, 30 minutes before meals and bed hour, and during the night if awake. The higher amounts in long-standing cases. This requirement is high, since much is lost through action of gastric juices and loss due to perspiration; 400 mg [once or twice] daily by needle, given intramuscularly. ... Two to three times each week, and where office access is convenient, 20 mg. per kg. body weight, or at least 1000 mg. is administered intravenously.

i did B1 300mg before meals and bed. klenner did the most for me in 3 days than anything else i've ever done since. and if i had paid attention to the mineral side of things, probably would have been even better.

contrast best bet
Vitamin B complex: 100 mg
not even close

[NHE]

High dose thiamine improves fatigue in multiple sclerosis.
https://www.ncbi.nlm.nih.gov/pmc/articl ... 009144.pdf

According to the dosage guidelines in the above paper, I should be using ~ 600 mg of thiamine/day. Should this be taken all at once or split into smaller amounts taken throughout the day?

[jimmylegs]

interesting list

"All the patients also showed the other clinical manifestations of mild thiamine deficiency, such as sleep disorders, depression, anxiety, mood fragility, memory loss, attention disorders, lack of tolerance to stress, frequent lack of appetite, episodes of tachycardia and extrasistolia, generalised muscular weakness, muscular cramps, calf and feet sole pain, temperature-variation intolerance and dry skin.

High-dose thiamine therapy consisted of 600–1 500 mg/day orally or 100 mg/mL once a week parenterally. The oral reference doses were retrieved from our previous study on inflammatory bowel diseases.1 We used a dosage calibration according to the weight of the patients in this way:

Patients less than 60 kg → 10 mg/kg/day of thiamine;
60–65 kg → 14 mg/kg/day of thiamine;
65–70 kg → 17 mg/kg/day of thiamine;
70–75 kg → 20 mg/kg/day of thiamine;
75–80 kg → 23 mg/kg/day of thiamine.
In patients more than 80 kg, parenteral administration was performed due to the patient's reluctance to take large amount of pills. "

Thiamine (n.v. 2.1–4.3 µg/L)*
.........................................Before........ After
average subject serum thiamine: 8.7±3.9....... 121.3±346.6

no controls? hmm.

what a wide variation from patient to patient.. eg

Before.......After
7.0.............8.4
10.8........1414.9

"A detailed observation revealed that improvement of fatigue was obtained within hours from the first parenteral administration or within 2–3 days after the beginning of the oral therapy. ... The patients moreover reported an almost complete disappearance of fatigue-related symptoms such as an improvement of the intolerance to heat variations, sleep disorders, depression, anxiety, irritability, dry skin, lower leg swelling and tachycardia. Motor and other neurological symptoms did not show an appreciable clinical improvement.

During this study, we have never recorded any side effect.8 A recent check-up (after 18 months of treatment) did not show any decrease of the efficacy of the therapy."

the key to my mind is how long relief from symptoms would be maintained after stopping therapy and returning to healthy diet.

my opinion: thiamine should not be considered the one and only go to for fatigue in ms.
re essential nutrients associated with fatigue, iron is the most common issue for all, not just those with ms.
ms patients supplementing zinc need to watch iron status and associated risk of fatigue.

important: 18 months is the current max duration of this study's thiamine treatment during which no side effects were observed. any longer is untested.

from personal xp, klenner benefits kick in on the third day. consistent with the thiamine study's observations above. i don't know if there's any real justification for keeping it up over 18 months.

i don't recall how long i kept it up in 2006, but probably only as long as the first bottle of each separate b vit held up. i would have run out of the thiamine first.

after that, i was done with the klenner approach (my version thereof at least) for good. no temptation or need to revisit during the ensuing decade. the lasting changes are all associated with my ongoing dietary habits. b vits come mostly from natural food sources, with a multi and a sprinkling of b50 complex in the mix. these have done the trick since.

at long last, to your question. study quoted here does not specify timing at any finer grain than 'daily'.
as above, klenner does. think it's your choice, but to my mind divided doses gives you the best shot at absorption.

for context, healthy whole foods deliver thiamine in doses approaching 1 mg per serving.
http://www.whfoods.com/genpage.php?tnam ... #foodchart

nature will have its reasons. in general, we should listen.

[NHE]

for context, healthy whole foods deliver thiamine in doses approaching 1 mg per serving.
http://www.whfoods.com/genpage.php?tnam ... #foodchart

The highest I see in the list is a ¹/₄ cup of sunflower seeds providing 0.52 mg.

[jimmylegs]

yes. contrasting thiamine in other foods (not necessarily healthy per se) a handful of which can potentially get into the 10mg per serving ballpark per USDA http://bit.ly/2DVgSoh

so considering 600-1500mg/d oral thiamine for the 18 mo study above, and klenner which can approach 2000 mg oral thiamine per day, if this sort of therapeutic regimen's benefits are felt within the 2-3 day window (3 days for me but not using thiamine alone), great. top things up, test the effect of stopping periodically, and when possible then return to healthy whole food sources and recommended daily intakes. http://bit.ly/2mONJAy <- of note: no upper limit for thiamine due to lack of data. guinea pig territory. been there, done that :S some pros and some definite cons.

short term benefit not justification for keeping up such a drastically unnatural dose long term. i think we've both learned the hard way not to assume that more of a good thing is necessarily better. for long term maintenance, doubling or even tripling the daily requirement using healthy whole food options still keeps you well under 5mg per day. sounds good to me!