Thiamine

 

A survey released by the U.S. Department of Agriculture on February 23, 1968, showed that 20% of all American families were eating what the USDA classified as a "poor" diet. The Department's food experts had interviewed 7.500 families and gathered information on all food either bought or home-produced in the preceding week, plus all snacks and meals they had eaten away from home. They graded the food on the basis of the National Academy of Sciences recommendations for daily requirements of calories, protein, minerals calcium and iron, and vitamins A, thiamine, riboflavin, and vitamin C. The USDA called a diet "poor" if it supplied less than two-thirds of one or more of the nutrients. For the purposes of this book, we will only mention the statistics as they relate to thiamine and riboflavin. In the Northeast, 9% of the diets were deficient in thiamine; 8% in the North Central, 7% in the South, and 10% in the West. For riboflavin, it was 5% in the Northeast, 6% in the North Central, 7% in the South, and 6% in the West.

Another survey, this one made by Dr. Arnold Schaefer when he was with the Public Health Service, showed shocking evidence of widespread malnutrition in the U.S. The survey had been amassed after thorough physical examination of over 83,000 persons. Because the news of widespread malnutrition became unpleasant to a number of politicians, Dr. Schaefer was forced to resign his post, after more than 15 years of service, and was forbidden to comment on the 10-state survey. It was through the efforts of Senator Ernest Hollings of South Carolina and others that we have been fed additional information from time to time.

At one point it was noted that 9% of those surveyed were short on thiamine, while 19% were getting too little riboflavin. In another report, 11% of all those examined above the poverty level in one state turned out to be deficient or low in vitamin C. The figures on riboflavin are much worse. Below the poverty level, state after state ranges from 5,3% of those deficient or low in vitamins, up to 31,6% in South Carolina. Above the poverty level, the figure is 23%. So far s ages go, the largest percent of those deficient and low in vitamin B2 occurred among children below six years of age- 48,2% in South Carolina. 

Beriberi was believed to have been conquered many many years ago. But the British Medical Journal for April 10, 1971 reports on two cases of beriberi which occurred in Blackpool, England. Beriberi, the disease of thiamine deficiency, is still prevalent in areas of the world where white rice is eaten almost exclusively, with little in the way of meat, fish, or vegetables, which might contribute enough thiamine to prevent the disease.

According to the Heinz Handbook of Nutrition,  there may be conditions even in the U.S. where so little thiamine is included in the diet that beriberi may result. Chronic alcoholics substitute drinks for foods that contain thiamine. And other conditions increase one's demands for this essential vitamin: pregnancy, breastfeeding, fevers, hyperthyroidism, or disease which interferes with proper absorption or utilization of food (like diarrhea, colitis, etc) or disorders of the liver.

What are the typical symptoms? The earliest are vague: lack of initiative, lack of appetite, depression, irritability, poor memory, tendency to tire, easily and to be unable to concentrate. Then there are vague abdominal and heart complaints. These are symptoms often associated with our senior citizen, especially those who live alone and prepare their own meals.   

As the deficiency grows worse, nerves are affected, chiefly in the legs. The victim suffers from neuritis and from a feeling of "pins and needles" in the toes, along with a burning sensation. Arms and fingers are generally affected next. The heart suffers injury resulting in shortness of breath and irregularities of heartbeat. There may also be accumulations of fluid, causing puffy swelling in ankles. The only remedy is large amounts of thiamine injected, if there is evidence that it will not be thoroughly absorbed.

The two British Beriberi patients were admitted to a psychiatric ward. The first was an 80-year-old widow who had lived alone since the death of her husband. She was depressed, slept poorly, ate little, was hopeless about the future, and thought frequently of suicide. She was underweight, and had a rash on her face and on parts of her hands and arms exposed to sunlight this is another symptom of beriberi. Her chest X-ray showed an enlarged heart.

The second patient was only 48. He has suffered from stomach ulcers and had part of his stomach removed. Because of his wife's death several years before, he also was depressed and apprehensive. He ate little. He could not sleep without barbiturates. His legs were wasted. His ankles showed swelling with fluid. 

Both patients were given thiamine by injection and within three weeks depression and swelling had cleared and they had gained weight. They were well physically and mentally and were discharged from hospital. One can only hope that they were told how easily and inexpensively the symptoms could be prevented, a diet which includes plenty of the foods in which thiamine is abundant plus food supplements containing plenty of all the B vitamins.

The British physician who treated these patients says that the disease may be commoner in England than is generally supposed. He says that vitamin deficiencies there are usually brought on by other factors disorders of the digestive tract and the mind, alcoholism, poor choices of food, and among the elderly, social isolation, which leads to loss of appetite and loss of desire to prepare nourishing food.

 He goes on to say, "Thiamine deficiency is frequently misdiagnosed and it is noteworthy that the first patient was initially treated for congestive heart failure. Beriberi would probably be frequently recognized if the possibility were considered in at-risk patients, particularly those in psychiatric and geriatric wards....".

In a later issue of the British Medical Journal (May 1, 1971), a London physician reports still another case. This was a 64-year-old man with a three-week history of shortness of breath and cough. He appeared to have all the symptoms of heart failure. His lungs showed infection. He was given large doses of antibiotics. His ankles were badly swollen and the swelling did not go down. He was given several diuretics, those drugs which usually cause urination and the disappearance of accumulation of water in tissues. There were no results.

Someone thought of beriberi. Ha was immediately given thiamine by injection. The swelling disappeared. The man lost considerable weight which had been largely unwanted water. And he was cured. The physician then asked about his diet. It seems he was a heavy drinker, ate a very poor diet, and had a mild deficiency in iron. All this would indicate that he was not eating nearly enough foods rich of thiamine. The recommended daily dietary allowances for thiamine, as released by the National Academy of Sciences in 1986, range from 0,2 milligrams for infants to 15 milligrams for growing teenage boys. Adults generally require from 1 to 1,4 milligrams each day. 

Other cases of beriberi have been reported in the British Medical Journal. Recently, two patients were admitted to a London hospital with the disease. Both patients were suffering from severe heart and respiratory symptoms. No one at first thought of beriberi as a possible diagnosis, of course.

The first patient was a young college student who had arrived in Britain only nine months before and was apparently living on a small budget since his diet had been "monotonous and much of it was carbohydrate". He had severe breathlessness, weakness, and pain in the chest and upper abdomen. His face and ankles were swollen. He was restless and agitated.

The doctors went to work on him and dosed him with many kinds of drugs, tested all aspects of his condition, and remained puzzled. Then someone suggested beriberi. It didn't seem possible, since he did not have some of the most important symptoms of this condition, in terms of heart damage. But they gave him thiamine. Almost immediately his condition began to improve. The swelling disappeared and the breathlessness and the pounding heart righted themselves. "Over a period of several days all clinical evidence of circulatory and renal abnormality cleared", the doctors reported.

They sent him home, apparently without any advice on diet, since nothing of this sort is mentioned in the article. He didn't return for follow-up, so presumably, he is back on his high carbohydrate diet which will undoubtedly produce the same condition again, as soon as he has exhausted his store of thiamine.

The second case was a 62 years old man, breathless, with swollen ankles, confusion, a poor memory. He lived alone, ate irregularly, and drank a lot of beer. He also had several symptoms of scurvy, the disease of vitamin C deficiency. 

 The doctors gave him thiamine and vitamin C and he began to improve at once. "All abnormalities of cardiopulmonary function resolved after thiamine therapy", said the two doctors.

In their discussion of these two cases, the doctors, Neil McIntyre and Nigel N. Stanley point out that what happened in these two patients did not show the usual symptoms of beriberi affecting the heart. Nevertheless, the B vitamin worked its miracle.

These two sensible doctors suggest, finally, that, since the treatment is completely harmless, it might be a good idea to give thiamine in any case where the patient has had heart failure without any clear evidence as to the cause! Why not indeed? And what might be even better, is why not try giving all the B vitamins as well as vitamins C, A, and E in large doses to all hospital patients the moment they come in the door, without waiting to diagnose, treat, or give drugs! Isn't it possible that many disorders that bring people to hospitals are the result of plain nutritional deficiency day after day and year after year?

Medical journals occasionally describe modern cases pf pellagra, the disease of niacin deficiency. Deficiency in just one vitamin is uncommon. When the diet is so unbalanced that one vitamin is missing, others are bound to be missing, others are bound to be missing, too.

What kind of diet might produce beriberi or pellagra? A diet that relies almost completely on refined and processed cereals white, unanriched bread, and any of a number of popular breakfast cereals. To prevent these easily preventable disorders, one should make certain to eat enough meat, fish, poultry, eggs, milk, and green, leafy vegetables like spinach and chard. The other sources are wholegrain cereals and breads really wholegrain.

Interestingly enough, in the early days of vitamin research when pills were not available, doctors cured cases of pellagra and beriberi with brewer's yeast, wheat germ, bran, and liver. So include them in your meals as often as you can. Yeast can be added to everything you bake and every suitable dish like casseroles, soups, salads, etc. Wheat germ is great, eaten with milk and honey as a breakfast cereal. Its whopping big content of protein and minerals makes it a stick-to-the-ribs breakfast equivalent to bacon and eggs. The bran which is removed from whole grains to make refined flours is available as a cereal a food noted for its ability to preserve "regularity".

A worried Texas physician asked in the Journal of the American Medical Association, on February 6, 1967, "What are the usual causes of burning sensations in the soles of the feet in elderly persons? 

The JAMA editor talked about muscle cramping, impaired circulation and possible diabetes, and deficiency in thiamine and pyridoxine.

Nutritional Disorders of the Nervous System,  by John D. Spillane, describes the burning feet complaint of people with pellagra and prisoners of war who are given far too little of the B vitamins. Old folks have a tendency to eat foods that are easy to buy, prepare, and chew like white bread, refined cereals, and sweets. This is bound to result in B vitamin deficiency.

Three Australian physicians report in the July 10, 1971 issue of The Lancet, a British medical journal, on a 48-year-old alcoholic patient with brain deterioration due to long years of heavy drinking. Two weeks before he came to the hospital he found he had difficulty in walking. He staggered and could not coordinate the movement of his legs. Other symptoms pointed to quite serious brain damage the kind that heavy drinking eventually produces. He was given a richly nourishing diet and very high doses of thiamine. This was 200 milligrams by injection and 300 milligrams by mouth every day. Remember, the recommended daily allowance for a man is 2,4 milligrams daily.

So this alcoholic was getting more than 500 times the amount specified for a non-alcoholic. He was also given massive doses of riboflavin and niacin. Within about three weeks he was able to leave the hospital and was given thiamine to take in massive doses. His symptoms improved and he was able to walk almost normally. Had he been able to stay on the wagon, the physicians are sure he could have recovered completely. We will have more to say about alcoholism and B vitamin therapy later.

A University of Alabama medical researcher has discovered a significant relationship between the amount of thiamine in one's meals and the frequency of complaints related to heart disease and the possibility of heart attacks.

It has been known for some time, report Dr. E. Cheraskin and his colleagues, writing in the Journal of the American Geriatrics Society in November 1967, that there is a definite relation between the amount of carbohydrate food eaten -especially refined carbohydrates- and the frequency of these heart complaints. It is also well known, they go on, that thiamine is part of the complicated process that goes on in our bodies to change carbohydrate foods into energy.

To discover whether it's possible to relate conclusively a lack of vitamin B to a tendency to heart attacks, Dr. Cheraskin asked 74 dentists and their wives to participate in a study. Each of them was asked a series of questions which we reproduce here, all having to do with heart and artery health. Then he asked each of these people to keep records of what they ate and he checked their food intake for its content of thiamine.

TEST QUESTIONS ON HEART AND CIRCULATORY COMPLAINTS FROM THE CORNELL UNIVERSITY MEDICAL SCHOOL

1. Has a doctor ever said your blood pressure was too high?
2. Has a doctor ever said your blood pressure was too low?
3. Do you have pains in the heart or chest?
4. Are you often bothered by the thumping of the heart?
5. Does your heart often race like mad?
6. Do you often have difficulty breathing?
7. Do you get out of breath long before anyone else?
8. Do you sometimes get out of breath just sitting still?
9. Are your ankles often badly swollen?
10. Do cold hands or feet trouble you even in hot weather?
11. Do you suffer from frequent cramps in your legs?
12. Has a doctor ever said you have heart trouble?
13. Does heart trouble run in your family? 

He found, interestingly enough, that more than one-fourth of these folks were getting less thiamine in their meals than the officially recommended daily allowance. He then divided the dentists and their wives into two groups those getting rather high amounts of the B vitamin, and those getting lower amounts. Then he checked on the heart and artery complaints of the two groups and found that, on an average basis for the whole group, those folks who were eating less thiamine had more heart and artery complaints than those who got more thiamine. In fact, almost twice as many had complaints in the group which got less thiamine.

Then Dr. Cheraskin reminded himself that age may have a considerable amount to do with health since any disorder tends to become worse as we grow older and less able to withstand it. so he decided to check the age of the different people having heart complaints and compare this with the amount of thiamine in their diets. He found that the older people who ate the least thiamine had the most complaints. The younger people who ate food containing most thiamine had the fewest complaints.

But he also found that the older people who ate food containing the most thiamine had fewer heart and artery complaints than young people whose meals tended to be short on the B vitamin. He warns us that these figures do not prove beyond a shadow of a doubt that the amount of thiamine you get every day is directly related to whether or not you have circulatory trouble. He thinks that more experiments must be done in which thiamine supplements are given to many people and their circulatory problems are checked before and after the vitamin is given.

We have several further comments on what we consider is an extremely valuable piece of research. First, since it is well known that thiamine is essential for the body's use of carbohydrates that is, starch and sugar it seems quite likely that anyone who eats a lot of food high in starch and sugar in such foods as grains and sugarcane. There is enough thiamine in both of these natural foods to provide for all the body's needs for digesting and assimilating the starches and sugars.

But when most of this thiamine is removed, as modern processors do when they refine cereals, make white flour out of whole grain flour, and white sugar out of sugarcane, the folks who eat these foods are almost bound to be short on thiamine unless they provide it in some other way.

Then, too, when we eat lots of such depleted foods as white flour and white sugar, we use up space in our menus that should be devoted to more nutritious foods. So we probably get far less thiamine in other foods, since we simply don't have room left to eat enough of these nutritious foods, stuffed as we are with refined carbohydrates.

The child or the overweight reducer, for example, who eats some refined sugar between meals in the form of soft drinks or candy may manage to spoil his appetite for the next meal, and, at the same time, he has given his digestive apparatus a problem it can't solve a lot of sugar or starch without the wherewithal to handle it. And, by spoiling his appetite for the next meal, he gets even less of the important nutrients which he might have gotten in meat, wholemeal bread, vegetables, nuts and seeds, etc. He just didn't have the appetite to eat them. The sugary snack spoiled it.

It seems reasonable that, the longer such a state of affairs goes on, the greater will be the strain on those parts of us that depend on thiamine for easy, successful functioning. The heart and arteries, for example. So as we grow older, the circulatory complaints increase as our shortage of thiamine increases. But not e, too, that if we have continually gotten enough thiamine, according to Dr. Cheraskin's investigation, our circulatory machinery tends to stay in good order, better order, in fact, than that of younger people who are short on thiamine.

We generally think of cirrhosis of the liver as the classical disease of alcoholics. But many other conditions contribute to the ill health of these unfortunates. Archives of Internal Medicine for October 1967 presented the case of a 36-year-old man suffering from heart failure and acute failure of the kidneys. He was found to be severely deficient in thiamine. So long had the deficiency been going on that his doctor thought that the man was suffering from beriberi. This man had depended on alcohol for the calories to keep himself going. He had stopped eating nourishing food.

Since pure carbohydrate, which is what alcohol is, makes heavy demands on the body's store of thiamine, it is no wonder that the patient eventually degenerated into beriberi patient. A massive dose of thiamine brought his kidneys back to normal, suggesting that the heart condition, brought on by the lack of thiamine, had caused the kidney condition.

Never underestimate the power of the B Vitamins and their essential place in your meals and food supplements.