Many people with inflammatory bowel disease experience chronic fatigue, negatively affecting their quality of life. However, fatigue can be reduced among about half of these people through high-dose thiamine (vitamin B1) if they have a specific species of gut bacteria.
About half the people living with inflammatory bowel disease and the associated chronic fatigue can be successfully treated for the chronic fatigue.
The treatment involves high-dose oral thiamine but only works for people who have a certain species of gut bacteria. A new study shows that thiamine could become a miracle cure for these people.
“Chronic fatigue is one of the most devastating symptoms among people with inflammatory bowel disease, even if it is quiescent. All we can currently do is to tell them to rest when they are tired. For some of these people, this is constant. Finding a treatment with almost no side-effects that works very well for many people with chronic fatigue is therefore fantastic,” explains a researcher behind the study, Christian Lodberg Hvas, Clinical professor and Consultant gastroenterologist, PhD, Department of Clinical Medicine, Health, Aarhus University and Department of Hepatology and Gastroenterology, Aarhus University Hospital.
The research has been published in Gastro Hep Advances.
Not everyone can benefit from high-dose thiamine
Researchers in Italy first found indications that thiamine might eliminate the chronic fatigue associated with inflammatory bowel disease.
Researchers in Denmark followed up these indications and showed that thiamine can completely alleviate chronic fatigue among some but not all people with inflammatory bowel disease.
The new study therefore aimed to determine why high-dose thiamine can be a miracle cure for some people but not others.
“We hypothesised that the gut microbiota of people who benefitted from thiamine differed from those who did not. Other disease areas demonstrate how the composition of gut microbiota affects how the diseases are expressed,” says Christian Lodberg Hvas.
Forty participants
Forty patients with inflammatory bowel disease and chronic fatigue participated. Each received thiamine for four weeks and placebo for four weeks or the other way round.
The treatment was randomised, and the participants did not know whether they were receiving thiamine or the placebo.
The participants completed validated questionnaires about their feelings of fatigue, and the researchers also examined faecal samples to determine the composition of the participants’ gut bacteria.
Effectiveness of thiamine depends on Faecalibacterium prausnitzii
The results were surprising.
Only about half the participants benefitted from thiamine, but it worked extremely well for them.
“The half who benefitted got their fatigue levels back up to that of the background population. This is fantastic for these people, who can now once again lead completely normal lives for the period that the effect lasts,” notes Christian Lodberg Hvas.
The study also found no major differences in the composition of gut microbiota among those who benefitted from thiamine and those who did not.
The most important difference between the groups was that those who benefitted had Faecalibacterium prausnitzii present in high amounts in their gut – whereas those without these bacteria did not benefit.
“F. prausnitzii is already known as a health-promoting bacterium that is associated with improved health in several other studies. However, we do not know whether it is just a marker for health or is part of the reason why healthy people are healthy,” explains Christian Lodberg Hvas.
Thiamine is available now
Christian Lodberg Hvas says that the discovery has several perspectives.
Investigating F. prausnitzii will be relevant to establish its role in the beneficial effect of thiamine supplementation.
Further, investigating whether high-dose thiamine can also benefit other people with chronic fatigue will also be relevant.
The researchers have already investigated the potential for people with primary sclerosing cholangitis, but thiamine was not effective in this group.
They would also like to examine the potential for people such as those with fatigue from long COVID.
Regardless of where the researchers look in the future, studies should be linked to simultaneous research on the gut microbiota to determine whether F. prausnitzii also influences the effectiveness among other groups of people.
However, the biggest and most immediate perspective is in treating people with inflammatory bowel disease.
“We can already advise our patients that they can try taking high-dose oral thiamine and see whether this helps. This will directly reduce the chronic fatigue for about half and will not work for the other half – but it has few side-effects. What we can do for people who do not have F. prausnitzii in their gut remains a question for future research. Some might envision that giving them F. prausnitzii orally will help, but many other studies have shown that the composition of a person’s gut microbiota cannot be easily modified so that it becomes health-promoting. Rather, we need to look at how we can help these individuals in other ways to achieve healthy gut microbiota that can promote their health and alleviate their fatigue by supplementing with thiamine,” concludes Christian Lodberg Hvas.
