I remember discussing this previously as a sub-discussion in another thread, but I just thought folks here might be interested in this study and some of it's findings so I'm reposting it on its own.
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First, the findings of interest.
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"oral thiamine hydrochloride when given over a 1-week period produce blood levels that approach those obtained by intramuscular and intravenous administration"
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"This study has demonstrated that the absorption mechanism is not saturable up to 1500 mg. . . . .. These results contradict the results found by Thomson"
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My take . . . orally administered thiamine hcl is just as effective in achieving elevated levels of thiamine in the body as an injection, and contrary to previous research the more you eat the higher your thiamine levels go. Previous research suggested that thiamine uptake was limited if taken orally. This study says that was wrong.
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Then the study itself:
Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects
Yes, I actually found this study a while back, and it always made me wonder what information Dr. C had that made him sometimes recommend IM thiamine. It seemed to me that twice daily oral thiamine would be vastly superior to IM, but I'm not a doctor and I'm sure Dr. C has some logic behind his decision. Certainly IM will raise levels faster, but if one is pursuing a life long thiamine regimen then oral seems MUCH easier. Anyways, just putting the info out there for others to peruse and decide on their own.
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Perhaps someone that is in regular communication with Dr C can ask him to comment on this study.
But what happens with 3 g? Perhaps the speed it can be excreted is limited. It may peak much higher and stay at the high level for much longer pushing it through to the brain? Could the excess be stored in the liver rather than the blood once it reaches saturation then slowly be released into the blood? I’m not sure how these things work!
Within the study there was a reference made to older research on toxicity wherein people consumed 7.5 to 8 g per day for a year with only a handful of adverse events that were considered normal as the adverse events were things that occur even at smaller doses. Bottom line is I do not think there is a build up in any organs that is of concern.
Again, I am not a doctor, but if the goal is to raise plasma levels and keep them at a sustained and elevated level then oral ingestion seems best. I think the numerous anecdotes on this forum have shown without question that the proper "dose" is highly individualistic. Without a doctor testing your blood with a target in mind it comes down to how one feels. Sadly that is where we are with supplements today. Maybe someday we'll get better guidance and an ability to test whatever "levels" we want, but today it's pretty much guess work based on others experiences.
I am very excited to have a PhD and fellow Ivy League graduate on the forum to help fact check some of the less scientific discussions on HU.
(Dartmouth '88 BE - Magna Cum Laude myself)
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I reaIize my conclusion was not the paper's intent, but I felt the statement I quoted from the body of the paper was fairly clear, and backed up by two other studies cited that were specific to that issue and to my point in writing the post:
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Tissue thiamin levels of hospitalised alcoholics before and after oral or parenteral vitamins. - ncbi.nlm.nih.gov/pubmed/335...
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Plasma thiamine concentrations after intramuscular and oral multiple dosage regimens in healthy men - ncbi.nlm.nih.gov/pubmed/161...
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and in the abstract for the first paper it says:
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"The results suggest that except for alcoholics requiring thiamin urgently, for whom the parenteral route is demonstrably quicker at raising tissue levels, oral supplementation achieves the same result as parenteral."
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and the second study says this in the abstract:
"Ten healthy men were given 500 mg thiamine i.m. once a day (Group 1) and ten were given 250 mg p.o. every 12 h (Group 2). The times to reach steady state (7 and 5.6 days for Groups 1 and 2, respectively) were not different (P greater than 0.05)."
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Unfortunately, I am not a medical professional nor a researcher so I do not have access to the actual articles, but I took the abstract statements to be support enough for the statement made in the paper which I quoted and which was the basis for my post:
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". . . oral thiamine hydrochloride when given over a 1-week period produce(s) blood levels that approach those obtained by intramuscular and intravenous administration [31,32]."
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My purpose in citing the paper and writing the post was to help individuals who are using the parenteral route to administer thiamine decide for themselves if perhaps the oral route might not be equally efficacious and much safer and easier, and the graph from the study I quoted is, I think, an effective tool to get that point across.
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Also, I used the term "injection" because this is HU and not a medical journal. Not sure that "parenteral" in the title would have the same meaning for most in this community.
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Anyways, I would welcome your thoughts on oral versus parenteral administration of thiamine hcl in terms of reaching and maintaining a steady state elevated level of thiamine in blood plasma, and what this study, and it's reference studies do or do not show. (Leaving aside for the moment the entire discussion of whether or not there is any evidence to support the role of thiamine as a treatment for PD.)
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Again thank you for participating on the forum and bringing your knowledge and intellect to discussions that often need some scientific input.
What I found interesting in these studies is that they never (perhaps I missed something) actually used an IV control group versus the "oral" groups to assess the actual real time difference (if any) between the two methods. I found that somewhat strange if someone (such as yourself) wanted to draw a conclusion that oral bio-availability and the length of the half-life of the substance in one's system is equal across all dose levels between the two (oral vs. IV infusion) methodologies.
Therefore, I find it difficult to believe they are similar. As an analogy, at one time athletes wee "injecting" vitamin b-12. Assuming your hypothesis is correct, why would they do so? Obviously, oral bio-availability was far less simply taking a handful of B-12 tablets. Similarly, we can examine the differences in Vitamin C therapy. Clearly they are not the same, not even close.
Sorry, but I simply don't agree with your conclusions. Nor do I feel these studies were intended to support your conclusions.
Oral thiamine administration is as effective as parenteral administration after five days."
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Of course, 100 mg delivered via I.V. has substantially greater impact than 100 mg taken orally on an immediate and intermediate basis , but it is equally clear that oral administration over a week or more substantially raises the level of thiamine found in the blood. Can you raise the level higher and faster using I.V.? Of course, but for PD patients who want to try HDT as recommended by Dr. Constantini they can use oral dosing to achieve elevated levels of thiamine identical to those achieved with the parenteral dosages recommended on this forum and by Dr. Constantini. Granted the oral dose will be substantially greater than the parenteral dose. I believe the papers I cite clearly show that to be the case.
Joe in NY
PS I'm not sure how you draw the conclusion that none of the papers used a control because that is exactly what this study did. (I was able to track down the actual paper offered for sale.)
Just got back from my workout and took a second look at the link above, and noticed something actually quite humorous. The two researchers who deal with Emergency Room medicine selected 2 out of 25 papers one of which is one of the papers I linked above. Obviously as the quote I listed above shows, they came to the opposite of your conclusion and agreed with my conclusion.
Don't pat yourself on the back without thinking it through.
As I understand it, you are using the "25" ER alcoholic papers reviewed in the study you are relying upon (which is your first mistake) of which they culled "2" (which should tell you quite a bit about the validity of this thesis) to conclude that oral administration of Thiamine for alcoholics would generate very similar results in "context" to administration of oral thiamine to PD patients. Without a comparison in any of the papers using the two populations.
Sorry, but you should know better. Drawing a unified conclusion from two very different populations is a "no-no" unless you actually use these populations simultaneously, which they didn't and certainly you can't. Apples and oranges. Back to the drawing board my friend.
(but nice try ) alcoholics without encephalopathy no less! Typical PD population!
You are discarding tons of literature and volumes of anecdotal info that tells us an IV (dehydration) or injection (steroids) or anal entry (cannabis) generates higher availability under normal circumstances than oral administration. But don't let that stop you.
I reviewed your posts on HU and see that 1) your posts tend to be attacking and unsupportive 2) you frequently attempt to denigrate others 3) you claim intellectual superiority and boast of unvalidated credentials. The internet has a word for such individuals. They are called trolls. If HU had an "ignore" function I would gladly use such.
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You are argumentative for the sake of being argumentative.
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The conclusion was not restricted to alcoholics and is in a journal on best practices in medicine and again the conclusion was oral = parenteral over a week or more. It didn't say just for alcoholics or just for apples. They meant everyone. Good day troll. Joe
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