Thiamine (Vitamin B1) improves fatigue in patients with IBD.
Fatigue is an extremely common symptom in patients with inflammatory bowel disease (IBD). Even if the disease is in remission, up to 50% of IBD patients still experience fatigue.
The cause of fatigue in these patients can be related to different factors such as iron, vitamin B12 or folate deficiency, or anaemia and hypothyroidism. However, most patients have not identified an underlying cause, and there are a few pharmacological drugs that have a documented effect on fatigue in IBD patients.
A recently published double blinded, placebo-controlled crossover trial study found a significant decrease in fatigue in patients with IBD in remission who were receiving high-dose oral thiamine (vitamin B1). The 40 patients involved in this study did not have any underlying cause of fatigue and were given 600-1800mg thiamine hydrochloride (dose dependent on gender and body weight) for 4 weeks. Improvement in fatigue (decrease of ≥3 points in IBD-Fatigue Questionnaire) was seen in 55-75% of participants whilst taking the thiamine supplement.
The mechanism behind thiamine helping to reduce fatigue in IBD is unknown, but it is hypothesised that IBD patients have impaired thiamine transport from blood to mitochondria. Hence, taking thiamine supplements increases cellular carbohydrate metabolism. Thiamine is a water-soluble vitamin that is found naturally in meat, legumes, and dairy products. Bager and colleagues concluded that thiamine was well tolerated and only mild side effects were reported. Also, thiamine accumulation is not a risk in patients with normal kidney function.
A smaller unblinded pilot study involving 12 participants was published in 2013 and found the same effect of thiamine on IBD patients in remission. This study reported an improvement in bowel symptoms after 20 days of high-dose thiamine. Bowel symptoms like abdominal pain and bloating are also commonly reported by patients with IBD in remission. This is often caused by small intestinal bacterial overgrowth (SIBO) or lactose intolerance. Both SIBO and lactose intolerance can easily be diagnosed by a simple hydrogen and methane breath test.
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References
Borren NZ, van der Woude CJ, Ananthakrishnan AN. Fatigue in IBD: epidemiology, pathophysiology and management. Nat Rev Gastroenterol Hepatol. 2019;16(4):247-59.
Bager P, Hvas CL, Rud CL, Dahlerup JF. Randomised clinical trial: high-dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease. Alimentary Pharmacology & Therapeutics. 2021;53(1):79-86.
Costantini A, Pala MI. Thiamine and fatigue in inflammatory bowel diseases: an open-label pilot study. J Altern Complement Med. 2013;19(8):704-8.
Shah A, Morrison M, Burger D, Martin N, Rich J, Jones M, et al. Systematic review with meta-analysis: the prevalence of small intestinal bacterial overgrowth in inflammatory bowel disease. Aliment Pharmacol Ther. 2019;49(6):624-35.
