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A Quick Clinical Tip of the day!
Thiamine, Magnesium, and Alcohol. We all have clients who over-consume alcohol. They don’t identify as alcoholics and don’t exhibit overtly dysfunctional or addictive behavior. However, regular alcohol intake (usually daily) can cause serious nutrient depletion in some people, *even if they aren’t consuming much at a time*. In particular, be on the lookout for B vitamin depletion due to alcohol, especially thiamine (Vitamin B1). Â B1 is required to detoxify alcohol, and alcohol also impairs its absorption. A double whammy. As an initial sign, one may wrestle with muscle cramps and tightness, especially in the calves. This is because thiamine is key for driving cellular metabolism (a key cofactor in pyruvate dehydrogenase) and preventing lactic acid build-up. Â Magnesium is also a critical cofactor for this process. A combination of B1 (typically within a good B-complex) and Magnesium (glycinate or malate) may give these clients dramatic relief while they are modifying their diet/habits.
In the FM world, we often think of insufficient magnesium being at the root of persistent muscle cramps, due to its master electrolyte function of increasing cellular potassium. Â And it often is! Â But if addressing these minerals alone doesn’t address the root cause, and regular intake of alcohol is at play, be sure to think of thiamine. Â Hydration is also key. Â And certainly other nutrient issues may be involved, but I have found this combination to be quite effective in a number of clients.
I hope this quick clinical tip serves you and your patients and clients. Â Follow-up questions are welcome!
Warmly,
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Is there a preferred thiamine form? We’ve talked of benfotiamine, but now I found lipothiamine and allithimaine, which are supposed to be good at crossing cell membranes. Which should I choose and under what circumstances?
Indeed there are quite a few different thiamine forms on the market and they have various effects. Here are a couple of references that will help you decide which thiamine form is best for the condition you have in mind:
https://pubmed.ncbi.nlm.nih.gov/32517031/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435522/
https://pubmed.ncbi.nlm.nih.gov/32987117/
https://pubmed.ncbi.nlm.nih.gov/28225048/
For someone who has a severe thiamine deficiency (WKS) recovering from the debilitating effects, what would be the case for magnesium glycinate as a supplement? Muscle spasms and tightness, along with relaxing in general? Also, knowing that magnesium is a co-factor, would this be the correct form?
Magnesium is an important co-factor for over 300 biochemical reactions in the body and it is also one of the top 3 nutritional deficiencies in the modern world, and yes it is helpful in recovering from WKS. Here’s an interesting case report:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5093844/
Magnesium glycinate is a good form for general magnesium needs replenishment.
If someone had low b-12 but thiamine and b-6 well within the reference range would you assume that the cause of the low b-12 is something other that heavy alcohol use?
Yes. This article is focused primarily on the role of B1 specifically. Indeed, I would not generally connect isolated low Vitamin B12 specifically with alcohol use at all. The impact of heavy alcohol use in the gut is more typically associated with malabsorption due to damage in the gut lining, while low Vitamin B12 on its own is nearly always due to low stomach acid (maldigestion). Just keep in mind that unless you are using a cellular or functional test (e.g. SpectraCell or Organic Acids testing) in examining these nutrients, there can be dramatic differences in the amount of a nutrient that is able to get into the blood vs. the sufficiency of what is able to get into cells. For example, a person can have optimal or even high circulating Vitamin B6 and still suffer due to poor cellular availability of the final, activated form.
Would systemic candida also have this effect (via endogenous alcohol production)
It certainly could in principle, but the case would have to be dramatic. I would just keep in mind that truly “systemic candida” overgrowth is quite rare – though highly promoted and often claimed in internet sharing outlets. Candida is endemic in the human body, so it’s presence is not alarming. It should just be in balance with other microbes in their rich diversity. I believe the body will at times *allow* an overgrowth of certain microbial species in order to sequester toxins from the rest of the body or to promote greater defense against true pathogens or increase competition against other species. It’s important that we are always looking at the full picture and considering the full interconnectedness of dynamics that might be at play in a unique body at a specific time.
Thanks, Tracy,
Are there certain labs that test for alcoholism?
I would think
ALT. AST. GGT and then HA1c, Fasting insulin? And of course RBC levels of certain nutrients?
Thanks, Kathleen
I want to break down your question a bit because I differentiate between poor alcohol metabolism (and thus increased oxidative stress and downstream negative effects) and alcoholism (an addiction to alcohol consumption which may or may not involve *high* intake of alcohol). My answer may be a little more rich or complex than you intended. 🙂 The markers you capture can be checked to see if there might be liver toxicity as a result of excessive alcohol intake (realizing that this may not speak at all to any neurological/addiction determination and may involve impaired detoxification of other substances as well). I would add triglycerides to your list which are usually elevated in the case of fatty liver. In my experience, those with familial addictive tendencies (not just alcohol but also drugs, food, pornography, gambling) may have issues with serotonin sufficiency, perhaps secondary to SNPs negatively impacting synthesis or receptor function or perhaps secondary to issues with Vitamin B6 utilization. In this latter case, you may find that ALT and AST are quite low in the reference range or even clinically low, as they are B6-activated enzymes. Poor availability of B6 may impair serotonin synthesis which would promote a desire to… Read more »