The vitamin B1 in almost every multivitamin and B-complex vitamin is either thiamine mononitrate or thiamine hydrochloride. The body’s ability to absorb these two forms of thiamine is limited to about 2 mg per dose (see David Bender, “The Nutritional Biochemistry of the Vitamins”, an authoritative text on vitamins). Any thiamine mononitrate or hydrochloride in excess of about 2 mg exits the body into the toilet entrained with the solids (no wonder side effects from thiamine supplements are unknown!). There is another class of thiamine molecules called allithiamines. The ability of the body to absorb allithiamines is unlimited. A 150 mg capsule of an allithiamine delivers almost the entire 150 mgs into the bloodstream. I recommend that multivitamin manufacturers consider formulating their multivitamins with a mixture of thiamine mononitrate/hydrochloride and allithiamines.

Some fraction of young women will have impaired digestive machinery for the absorption of thiamine mononitrate/hydrochloride. Others may have impaired machinery for delivering thiamine mononitrate/hydrochloride from the bloodstream into the cells of all or some subset of the multitude of nervous systems cells that need it. For these young women, today’s multivitamins and B-complex tablets formulated without allithiamines may not be sufficient to prevent anorexia.

Beriberi is the disease caused by a deficiency of thiamine. Beriberi can cause a bewildering variety of symptoms, and can be difficult to diagnose. Anorexia, however, was almost always observed and was considered an important clinical marker for beriberi. Unlike pellagra and scurvy (niacin and vitamin C deficiency diseases respectively), beriberi does not typically respond rapidly and completely to supplementation. Only the fortunate fully recover.

Like many other vitamin B1 molecules, the allithiamines are miracles of nature. Garlic was recognized in the distant past to have healing powers. The allithiamines were identified in the first half of the 20th century as a result of investigations into the chemicals in garlic that are likely responsible. Continuous work has led to a growing understanding of the possible health benefits of pure allithiamines, and they are now readily available. The most readily available allithiamine goes by the name “benfotiamine”. Typical doses are 80, 150, and 250 mg capsules. 300 mg doses have been reported to cause “skunk-like body odors” as a side effect. Sustained use of these doses is highly likely to be associated with a considerable variety of side effects, and should be carried out under the supervision of an experienced physician. There is every reason to believe that such large doses are substantially excessive for the prevention of anorexia in light of the fact that the RDA for thiamine ranges from 0.5 to 1.2 mg depending upon age.

Excellent information on thiamine is available at Wikipedia. The Wikipedia article points to two remarkable articles by Derrick Lonsdale. One of these is a recent review of thiamine. Beriberi (and therefore anorexia) has been historically associated with high carbohydrate, calorie rich diets. This type of diet remains fashionable in the developed world as a whole, and particularly in the United States.

All professionals and family members responsible for the healthcare of adolescent girls should learn more about beriberi and thiamine, and be on the lookout for the earliest possible signs of trouble with thiamine metabolism. All parents of adolescent girls should consider requiring regular supplementation with vitamin C, niacin, and multivitamins. In the likely event that the multivitamin does not contain an allithiamine, parents should consider an occasional separate benfotiamine supplement – once a month is likely to be plenty. It’s high time to put an end to the large majority of tragic cases of anorexia that can be prevented with safe, inexpensive, and readily available vitamin supplements.