Thursday, April 2, 2015

The multi-system symptomology of adrenal fatigue: Is thiamine deficiency at play?

People with adrenal fatigue tend to have symptomology that ranges across many body systems.  While these systems likely affect one another due to the fact that they must work in concert with one another to help us adapt to our environment and are controlled by the autonomic nervous system, it's an assumption that one system is throwing the others out of whack.  While this may be true, there is the potential that what we are seeing in adrenal fatigue isn't just one system throwing other systems off, but all systems being thrown off by a deficiency in a nutrient that they all rely on for proper function. 

Dr. Derrick Lonsdale, MD has written many articles on dysautonomia, dysfunction of the autonomic nervous system, which is the defining characteristic of adrenal fatigue.  He points to dysfunction in oxidative carbohydrate metabolism as the primary cause of dysautonomia(1).  He discusses the early stages of beriberi, a disease of thiamine deficiency, as the prototypical example of dysautonomia(2, 3).  His perspective is coming from the Standard America Diet and it's reliance on processed carbohydrate as being causative in thiamine deficiency.

It is interesting to note that beriberi was discovered as being caused by an imbalance between the level of dietary carbohydrate and thiamine.  In 19th century Japan, beriberi was extremely common in the Japanese Navy and the culprit was eventually determined to be diet related.  Rice that has been polished, white rice, is stripped of its thiamine content while leaving the carbohydrate levels intact.  Cadets who had relied solely on white rice were far more likely to experience beriberi than cadets fed a more varied diet.  This led to the discovery of accessory nutrients, aka vitamins, that were necessary for proper cellular metabolism.

It is assumed in modern medicine that the only people who experience thiamine deficiency are alcoholics or the malnourished.  Dr. Lonsdale and his co-workers have published multiple case studies showing thiamine deficiency as a product of micronutrient deficiency brought on by excess processed carbohydrate consumption.  Dr. Lonsdale calls this high calorie malnutrition.  These people are neither alcoholics nor malnourished by macronutrient standards.  Many of these people are told that their symptomns are in their head by their mainstream doctor, and when they are tested for thiamine deficiency by Dr. Lonsdale they are shown to be deficient because a mainstream doctor isn't on the look out for thiamine deficiency.  Thiamine defiency is known to affect the limbic system very hard.  The limbic system is an area of the brain responsible for emotion, adrenaline flow, motivation, long-term memory, and contains the hypothalamus: the H in the HPA axis,.

The symptomology of these case studies closely reflects autonomic dysfunction, similar to the early stages of beriberi(3), and are corrected by increased thiamine intake.  As mentioned above, thiamine needs are known to be dependent on carbohydrate intake, but the question is are they dependent simply on carbohydrate intake or are they also dependent on how much a person relies on oxidative carbohydrate metabolism for their physical activity?

In people on the Standard American Diet, high intake of processed carbohydrate in the absence of adequate thiamine presents as a thiamine deficiency because they are forcing glucose in to their cells which increases their need for the nutrients needed to efficiently oxidize glucose.  While these people may meet the RDA for thiamine, these RDAs were likely determined based on a lower consumption of carbohydrate.  Eating larger doses of carbohydrate with the same level of thiamine may actually reflect deficiency as cells are unable to oxidize the level of carbohydrate contained in the diet.  In addition, higher levels of free radicals brought on by hyperglycemia may require higher thiamine intake to produce NADPH in the pentose phosphate pathway for reduction of these free radicals via reduction of glutathione(We will cover this in the next blog).  Another problem is that people with insulin resistance and type 2 diabetes have dysregulated thiamine status evidenced by a 75% reduction in plasma thiamine levels in comparison to controls(4), most likely due to thiamine loss in the urine.  It's also interesting to note that these people also tend to be sedentary, so muscle stores of thiamine are likely to be fairly low as well.

Participating in intense exercise that relies on these same glycolytic pathways should cause the same problem.  Compounding the issue is that people doing this who also eschew grains and legumes are eliminating 2 of the better sources of thiamine in the diet.  One could probably meet thiamine needs with other food sources, particularly liver, the question is are you?  If a person is already at marginal thiamine status from insulin resistance or random bouts of hyperglycemia and they cut out 2 significant sources of thiamine, deficiency seems likely.  One has to question what would happen if a person with Type 2 diabetes/insulin resistance went from eating the Standard American Diet with already low to marginal thiamine status to cutting out grains and legumes from their diet and exercising intensely.  Sounds like a recipe for autonomic dysfunction, aka adrenal fatigue.

Hopefully this blog has put thaimine on your radar screen, particularly if you plan to undertake a diet such as the Paleo diet, which I hope you do.  A nutrient dense diet that limits processed food is universally considered the optimal human diet.  However, one has to be sure to meet thiamine requirements as well as not overdo the intense exercise portion of the lifestyle right off the bat.  Before you go out to the store and buy regular old thiamine, let me save you the time, if you already have adrenal fatigue it's not going to work.  Don't worry, we'll get to that later.  In the next blog we will look at the science of how thiamine deficiency affects adrenal function.

The importance of addressing thiamine status in adrenal fatigue