Abnormal brain changes in a patient with vegetarian diet‑induced subacute combined degeneration: A case report

[Technoid]

Interesting paper:

spandidos-publications.com/...

[wedgewood]

Was surprised to read that Vitamin B1 ( Thiamine ) was injected separately ,for this patient apart from B12 folate etc . I wonder why B1 ? Thanks for the information.

[Technoid in reply to wedgewood]

B1 is very important for neurological function and repair.

"Vitamin B1 (thiamine) plays a key role as a coenzyme in the carbohydrate metabolism, which is the main energy supply for nerve fibers. Thiamine pyrophosphate is essential for feeding pyruvate to the oxidative energy metabolism, eventually resulting in adenosine triphosphate (ATP) production [29, 31]. In addition, several studies suggest that it acts as a site-directed antioxidant, thereby protecting nerves from oxidative damage."

"vitamin B1 (thiamine) plays a pivotal role in the process of nerve regeneration: in nerve cells, it facilitates the usage of carbohydrates for energy production and protects them against oxidative stress, "

from "The Role of Neurotropic B Vitamins in Nerve Regeneration"

ncbi.nlm.nih.gov/pmc/articl...

There are some animal studies which show it can be helpful for nerve repair, at least in that context. Hopefully there will be more human studies. Benfotiamine is often promoted as the most effective form. Various naturopathic, chiropractic, integrative and alternative medicine practitioners promote very high dose Thiamin B1 treatments. These do not have strong evidence behind them but like B12, Thiamin has no tolerable upper limit. Very high doses may have side effects though so care is warranted.

[wedgewood in reply to Technoid]

I’ve never given vitamin B1 a moment’s thought —till now ! Thank you !

It never appears on a blood test . Should if it’s so important .

[Technoid in reply to wedgewood]

There are some difficulties with reliable testing but Mayo Clinic Labs have these guidelines:

"Serum or plasma thiamine testing suffers from poor sensitivity and specificity, and less than 10% of blood thiamine is contained in plasma. Transketolase determination, once considered the most reliable means of assessing thiamine status, is now considered an inadequate method. The transketolase method is an indirect assessment. Since transketolase activity requires thiamin, decreased transketolase activity is presumed to be due to the decrease of thiamin. However, the test is somewhat nonspecific, as other factors may decrease transketolase activity. Transketolase is less sensitive than liquid chromatography-tandem mass spectrometry), has poor precision, and specimen stability concerns."

"Liquid chromatography-tandem mass spectrometry analysis of TDP in whole blood is the most sensitive, specific, and precise method for determining the nutritional status of thiamine and is a reliable indicator of total body stores."

mayocliniclabs.com/test-cat...

[Technoid in reply to Technoid]

If my experience of the medical profession is any guide, asking them if they could please perform a test of B1 levels via "Liquid chromatography-tandem mass spectrometry analysis of TDP in whole blood" is likely to raise at best an eyebrow and a chortle if not an outright belly laugh. Unfortunately. Perhaps you deal with somewhat more informed professionals but I struggled to find any.

[wedgewood in reply to Technoid]

Thank you very much Technoid Sounds very tricky to determine amount of B1 , and maybe expensive .

[Technoid in reply to wedgewood]

Medichecks offer one for 120 pounds but I can't see any detail about the type of test it is so it may not be worth the money (at least if I'm dropping 120 quid I want to be sure the result is something reliable that I can act on). They may provide more detail if asked, not sure.

medichecks.com/products/vit...

[wedgewood in reply to Technoid]

You have earned more thanks 😊

[WiscGuy in reply to Technoid]

Since testing is dicey and expensive, perhaps a prudent course for people who want to promote nerve regeneration, and given that B1 is not toxic (though might have undesirable side effects at very high doses), might be to take daily doses two or three times the amount commonly contained in B-complex vitamins. For example, my B-complex contains 100mg of B12. (The treatment in the article was 100mg injected, but I don't know if there is any way of translating that into an oral equivalent.) So, maybe 300 or 400 mg daily, total from all sources, might be prudent???

[WiscGuy]

Interesting article. I was especially interested in the treatment section:

[Start quote]

Treatment. The patient was treated with the following:

Vitamin B1 injection [100 mg, intramuscular injection, every

day (QD)], and intravenous mecobalamin [1 mg, intravenous

injection (IV), QD] to improve nerve function and increase

vitamin B12 levels; Intravenous sodium chloride (100 ml, IV,

QD), and oral folic acid tablets (5 mg, per os, QD) cooperating

with mecobalamin, to improve symptoms.

[End quote]

Information included with my cyanocobalamin states that 50 to 98% of injected B12 "may appear in the urine" within 48 hours, with "the major portion" excreted in the first 8 hours. "Intravenous administration results in even more rapid excretion...". I wonder if that is why methylcobalamin was selected for IV administration with the patient in the case study, or if methylcobalamin was simply what they had on hand, rather than having an advantage over other forms of cobalamin.

On first reading, I misread "vitamin B1" as "vitamin B12", and my eyes got big when I saw daily doses of 100 mg, followed by disappointment when I discovered my error.

[WiscGuy]

It just occurred to me that IV might have been selected so that B12 could be administered in an IV drip.

[Astridnova]

As an ex-mental health nurse I learned about various neurological syndromes (notably dementias) associated with a range of B Vitamins. Beriberi, Korsakov's psychosis, and Wernicke's encephalopathy are all caused by Vit B1 (thiamine) deficiency, with the last two frequently associated with excessive alcohol consumption destroying the intrinsic factor. Pernicious anemia is caused by B12 deficiency. Pellagra is caused by B3 deficiency. Carpal Tunnel syndrome can be relieved (see linked info) by B6, apparently. Some B vitamins need other B vitamins to work. Consider that, if your gut doesn't digest one of the B Vitamins, maybe it isn't doing a good job with the others. Alcoholics used to be treated with the full spectrum of the B Vitamins in an injection known as B-Forte, which I used to administer at detox, as a psyche nurse.

Some time ago I got my doctor to prescribe B Forte injections for me and the person I live with, on the basis that if we didn't absorbe B12 in our guts, maybe we didn't do well with the other Bs, although we are only diagnosed with B12 deficiency/pernicious anaemia.

It made a big difference and we continue to use it instead of Vit B12 alone. Here are the full contents of the B Forte injection:

B1 - Thiamine hydrochloride,

B2 - Riboflavine sodium phosphate,

B3 - Nicotinamide,

B5 - Dexpanthenol,

B6 - Pyridoxine hydrochloride,

B12 - Cyanocobalamin.

Here is where you can read about the injection and the strengths of the doses, on an Australian manufacturing site. The injections are made in batches that last only 6 months. nps.org.au/assets/medicines...