Thursday, 18 July 2013

New Poll

I've just posted a new poll. The question is:

What fibromyalgia symptom do you find most problematic for you?

To vote, please visit my website

Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker
Multiple award-winning author of Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real

Wednesday, 17 July 2013

Vitamin B as a Treatment for Fibromyalgia: What is the evidence?

This past week, I was on the radio again, FM 101.1 in Dallas, Texas, speaking about herbal remedies. Specifically, I was asked to explain what the evidence is for and against using them.

As it turns out, I have been receiving a ton of questions lately about fibromyalgia and especially about how to treat it with herbals. So here I am beginning what I intend will be a series of blogs about herbal and other alternative remedies for fibromyalgia and its associated symptoms (especially pain, fatigue and insomnia). I say this in the context of a recent poll in which 36% of people with fibro felt that some alternative therapy (herbal or otherwise) was THE MOST HELPFUL part of their treatment... more effective than any pharmaceutical drug or conventional treatment.

Let me start with vitamin B1 (thiamine), because I just received an email today asking about it from my good friend Tamara in Windsor. But before I start with that, let me go back even further to remind you what my basic philosophy about treating fibro is, which is... I never treated fibro.

That's right. I don't believe in treating fibro.  Does that sound crazy?  Well let me put that in perspective by saying that I don't believe in treating rheumatoid arthritis or diabetes either. Or, in fact, any disease. I believe in the Patch Adams approach to medicine. Did you see the movie?  You should. In the movie called Patch Adams, Robin Williams plays the young Patch while he's still in medical school. Near the end of the movie, Patch is being threatened with expulsion from the school for setting up a free clinic to offer treatment to those who can't afford to pay the rates necessary to be seen at the hospital. He is specifically asked if he has been, without a license, treating diseases in this clinic. His response is that he never treats disease, and then explains:

"If you treat a disease, sometimes you win, sometimes you lose. But if you treat the person, I guarantee you will win every time."

This is especially true of treating any chronic disease which, by definition, lacks a cure.  And it is ESPECIALLY true of fibromyalgia, which has so many different symptoms.  Let me explain what I mean this way:


The key, then, is to work to improve those symptoms that are most troubling to you, because effectively managing them will most improve your overall quality of life.

And that brings me back to vitamin B1, which is also called thiamine. I did an extensive search of the medical literature today to find everything I could about vitamin B1 and fibromyalgia. What I found was... not much.

Thiamine deficiency is a known clinical condition that usually is associated with severe malnutrition. In North America and Europe, more wealthy countries, this degree of malnutrition is most commonly seen in alcoholics. Severe thiamine deficiency is associated with major neurological problems, especially affecting the brain. In such cases, death may result.  To begin with, very few with fibromyalgia are likely to have anywhere near this degree of malnutrition (unless they are alcoholic).

Thiamine is critical in the production of energy within cells, however, and low levels could be associated with fatigue, which is a prominent symptom in fibro.  Could undetected thiamine deficiency be causing the severe fatigue so many with fibro face?  The answer to this is that there is only a very small bit of evidence to support this. In a couple of papers from more than 20 years ago, this possibility was raised.  In these papers, the vitamin B1 abnormalities demonstrated in FM were found not to be induced by any nutritional deficiency, but more likely related to reduced activation of thiamine into thiamine pyrophosphate, which is important in energy production.  Sadly, almost no further research has been done on this, until a recent paper was published (in May 2013) in which vitamin B1 was said to help relieve the symptoms of fibromyalgia in three patients who were found to be low in it. The biggest problems with this last paper are (1) that only three patients were tested; and (2) that there was no comparison against placebo, which generally is required to determine if a drug (or herbal) actually works or not.

I'll get into the whys and wherefores of placebo trials in another blog (soon, I promise). But that only three patients were tested and there was no comparison group is a big problem, in terms of me saying that vitamin B works.

So what DO I recommend?  Let me say that, if you have an excellently balanced diet, you probably don't require vitamins of any kind (except perhaps vitamin D if you live in a northern climate, and that's to prevent osteoporosis/thinning of the bones). That being said, very, VERY few of us have well-balanced diets. So taking a daily multivitamin that contains a good dose of thiamine seems perfectly reasonable to me. Make sure you check that your multivitamin has enough thiamine, however, because some preparations may not. The recommended daily allowance of thiamine is 1.4 milligrams. Make sure that whatever vitamin you take has at least that much.

Thiamine is also found in a wide variety of foods at low concentrations. Yeast, yeast extract, and pork are the most highly concentrated sources of thiamine. But in general, cereal grains are where most people get most of their thiamine, with whole grains richer than refined grains. Other foods that are rich in thiamine are oatmeal, flax, sunflower seeds, brown rice, whole grain rye, asparagus, kale, cauliflower, potatoes, oranges, liver (beef, pork, and chicken), and eggs.

So actually treating fibro with thiamine is unproven and likely not necessary, beyond a good diet and a daily multivitamin. Starting your day with an egg on wheat toast and a glass of OJ to wash down your multivitamin might be a good place to start.

(Note: this advice comes from a man who typically eats his first meal of the day late in the afternoon... so do what I say, not what I do.)

In my next blog, I'll talk about a couple of herbal preparations that HAVE been tested and found to be helpful for improving sleep. But first, I need to take a nap.


Kevin White, MD, PhD, multiple award-winning researcher, author, teacher & speaker
Multiple award-winning author of Breaking Thru the Fibro Fog: Scientific Proof Fibromyalgia Is Real