• Taylor Leahy - Dietitian

Dysautonomia & Thiamin Deficiency. Could they be linked?



Thiamin is a crucial nutrient for…well…your whole body really. Thiamin is a B vitamin (B1 to be specific) and is involved in many processes in the body. Thiamin is needed in order to make energy out of glucose, protein, and fat. It is also needed for the growth and function of cells, and the proper functioning of your brain stem and nervous system1.


Thiamin is a water soluble vitamin, meaning it dissolves in water. When digested, it is absorbed in the small intestine where it is converted into the active form and then distributed throughout the body. There are some small stores of thiamin in the liver, but most excess thiamin is excreted in the urine. Since the body has such low stores, individuals need to consume thiamin on a regular basis.


A deficiency of thiamin can cause an illness known as beriberi – a harmful condition that can affect your memory, skin, muscle strength, and can even cause heart issues and swelling. There are several types of beriberi, specifically “wet” and “dry” beriberi. Dry beriberi leads to memory loss, peripheral neuropathy, and impaired motor functions. Wet beriberi can lead to heart failure and swelling throughout the body. A common cause of beriberi is alcohol abuse -- thought to be due to heavy amounts of alcohol out-competing thiamin (and other B Vitamins) for absorption. Beriberi symptoms can also be similar to dysautonomia symptoms, which is also thought to be associated with a thiamin deficiency however, research is still being done. A thiamin deficiency may also cause worsening symptoms associated with dysautonomia2.


Thiamin can be found in foods such as pork, beef, liver, fish, eggs, beans, nuts, and whole grains. Although thiamin is found in many foods, the vitamin is fragile and can easily be destroyed with cooking. Compounds known as polyphenols, found in coffee and tea can prevent absorption and utilization of the vitamin by converting it to its non-absorbable form. Individuals who consume heavy amounts of these beverages may have compromised thiamin levels2.

Some foods are also fortified with thiamin like rice, bread, pasta, and some cereals. Most supplements also contain some levels of thiamin and since it’s a water soluble vitamin, toxicities are rare1.


For individuals with dysautonomia, an increase in thiamin consumption has been shown to improve symptoms similar to that of beriberi. It is important to note that a thiamin deficiency may warrant IV supplementation with thiamin, as diet alone may not provide enough2. The RDA (Recommended Daily Allowance) for thiamin is 1.2 mg/day for adult males, and 1.1 mg/day for adult females. Levels of thiamin in the blood is not an accurate representation of thiamin status. To more accurately measure thiamin status, the activity of the transketolase enzyme can be evaluated, or analysis can be done on urinary extraction of the vitamin.


5 Recipes that are good sources of Thiamin


Source: Epicurious

Braised Pork Shoulder with Chimichurri

Pork recipe by Food and Wine

Chimichurri recipe by Bon Appetit

Pork is an excellent source of thiamin (1.1 mg/6oz3) as well as many other vitamins and minerals. For those of us who eat pork, pork can be a very versatile meat that can be incorporated into many dishes such as – tacos, sandwiches, and soups. This is a pork entrée recipe that incorporates a super potent, garlic-y chimichurri sauce that will make your mouth water. This dish can be served over rice, greens, or even noodles.

Ingredients for the pork:

2 tbsp unsalted butter

1 tbsp vegetable oil

5 lbs pork shoulder, trimmed and cut into 5 equal pieces

5 cloves garlic

2 large onions, roughly chopped

3 thyme sprigs

1 bay leaf

2 cups chicken stock

Ingredients for the chimichurri sauce:

1 shallot, finely chopped

1 Fresno chili or red jalapeño, finely diced

3-4 garlic cloves, thinly sliced

1/2 cup red wine vinegar

1 tsp salt

½ cup finely chopped cilantro

¼ cup finely chopped parsley

2 tbsp finely chopped oregano

¾ cup extra-virgin olive oil

Directions for Pork:

1. Preheat the oven to 275. Add butter and oil to a large skillet over high heat. Season pork with salt and pepper and transfer to hot skillet.

2. Sear pork for 3-4 minutes per side, and then transfer to casserole dish.

3. Add garlic, onion, thyme, bay leaf, the chicken stock and 2 cups of water to the casserole dish.

4. Cover with foil and bake for 2 ½ hours, until pork is tender.

5. Remove from oven, let sit for 20 minutes. Slice and serve with chimichurri.

Directions for chimichurri:

1. Combine shallot, diced jalapeño, garlic, and vinegar in small bowl. Let sit for 10 minutes.

2. Whisk in cilantro, parsley, oregano, and olive oil. If desired, mixture can be transferred into food processor for a more homogenous mixture.

3. Serve over sliced pork.


Overnight oats with Ground Flaxseed

Recipe by Quaker Oats

Source: Well Plated by Erin

Flaxseeds are a good source of thiamin (0.5 mg/oz3) and are an easy additive to breakfast recipes, smoothies, and in this case – overnight oats! If you aren’t familiar with overnight oats, they’re a super simple breakfast recipe made by combining raw oats with milk and soaking them overnight in the fridge.


Ingredients

½ cup old fashioned oats

½ cup milk of choice (I prefer almond)

1/4 cup plain, non-fat yogurt

½ cup apple, roughly chopped

1/8 tsp cinnamon

1 teaspoon honey

1 heaping tbsp ground flaxseed

Directions

1. Add oats, yogurt, and milk of choice to mason jar.

2. Add in chopped apples, honey, cinnamon, and chia seeds. Stir.

3. Chill in fridge overnight and enjoy in the morning!

Lemon Rosemary Salmon

Source: The Better Nutrition Program

Salmon is another meat option that contains thiamin (0.6 mg/oz3) as well as heart healthy fatty acids like Omega-3. Salmon can be easily added to salads, sandwiches, or as an entrée. This salmon recipe is simple to put together and is perfect for busy families.

Ingredients

2 fresh salmon fillets

1 lemon, sliced into slices

1 tsp fresh, chopped rosemary

1 tsp salt

1 tsp pepper

3 cloves garlic, finely chopped

Directions

1. Preheat oven to 400.

2. Pat salmon fillets dry. Season tops of fillets with salt, and pepper. Sprinkle with garlic and rosemary.

3. Add 2 lemon slices to the top of each fillet.

4. Place the fillets on a piece of foil and place on a baking sheet. Gently wrap foil around fillets.

5. Bake for 20 minutes until cooked through.

6. Optional: serve on a bed of greens or with grilled asparagus



Fried Rice

Recipe by Food.com


Source: Food.com

Brown rice, peas and eggs are great sources of thiamin – and combined they pack a powerful vitamin filled punch. Peas have the highest thiamin content of any vegetable (0.4 mg/1 cup cooked3), eggs provide 0.07 mg/egg4, and brown rice provides 0.4 mg/1 cup3. This recipe combines the three in a Chinese fried rice.


Ingredients

¾ cup finely chopped onions

2 tbsp oil

1 egg, lightly beaten (can include more eggs if desired)

1 tsp soy sauce

1 tsp sesame oil

½ cup finely chopped carrot

½ cup frozen peas, thawed

4 cups cooked brown rice

4 green onions, chopped

2 cup green onions

2 tbsp light soy sauce (more for garnish if desired)

Directions

1. Cook brown rice per directions. Set aside.

2. In wok, heat 1 tbsp oil and stir-fry onions until brown, about 8-10 minutes. Remove from wok.

3. Allow wok to cool slightly

4. Mix egg with 1 tsp soy sauce and 1 tsp sesame oil.

5. Add ½ tbsp oil to wok, allow to heat and add egg mixture. Scramble eggs until cooked through. Remove from wok.

6. Heat 1 tbsp oil in wok, add carrots, peas, and cooked onion. Stir fry for 2 minutes.

7. Add rice, green onion, bean sprouts, scrambled egg, and heat on wok for around 3 minutes.

8. Add 2 tbsp soy sauce, fold in. Remove from wok and serve.


Acai Bowl

Recipe by The Forked Spoon

Source: Dinner at the Zoo

Acai bowls are customizable smoothie-style bowls that can be topped with many delicious thiamin rich toppings. Nuts are high in thiamin, and can be easily used as nutrient dense toppings for acai bowls. Almonds (0.29 mg/1 cup5) and sunflower seeds (0.68 mg/1 cup6) are the nuts most rich in thiamin. This acai recipe also contains yogurt, which has 0.1 mg of thiamin per 1 cup.


Ingredients:

1 frozen banana

½ cup frozen strawberries

½ cup frozen blueberries

¾ cup milk

½ cup plain yogurt

2 packets frozen acai


Directions

  1. Blend all ingredients together in a food processor or blender until smooth. Top with desired toppings.




Sources

  1. Lonsdale, D., & Marrs, C. (2017). Chapter 3—Mitochondria, Thiamine, and Autonomic Dysfunction. In D. Lonsdale & C. Marrs (Eds.), Thiamine Deficiency Disease, Dysautonomia, and High Calorie Malnutrition (pp. 59–103). Academic Press. https://doi.org/10.1016/B978-0-12-810387-6.00003-4

  2. Vitamin B1 (Thiamin): Foods, benefits, and deficiency symptoms. (2017, November 22). https://www.medicalnewstoday.com/articles/219545

  3. Top 10 Foods Highest in Thiamin (Vitamin B1). (n.d.). Myfooddata. Retrieved August 24, 2020, from https://www.myfooddata.com/articles/thiamin-b1-foods.php

  4. Food Data Chart—Vitamin B-1 (thiamin). (n.d.). Retrieved August 24, 2020, from http://apjcn.nhri.org.tw/server/info/books-phds/books/foodfacts/html/data/data4a.html

  5. Office of Dietary Supplements—Thiamin. (n.d.). Retrieved August 24, 2020, from https://ods.od.nih.gov/factsheets/Thiamin-HealthProfessional/

  6. FoodData Central. (n.d.). Retrieved August 24, 2020, from https://fdc.nal.usda.gov/fdc-app.html#/food-details/170567/nutrients

  7. Thiamine Deficiency and its Prevention and Control in Major Emergencies: Factors influencing content and utilization of thiamine in foods: Anti-thiamine factors. (n.d.). Retrieved August 26, 2020, from http://helid.digicollection.org/en/d/Js2900e/8.2.html

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