B Complex Deficiency, Sympathetic Nervous Dysregulation, & Starvation

[Creative Nature]

Sorry to hear and I hope you find a solution. Protein being the worst suggests blood sugar may be at least part of the problem.

Yes, as with many stresses, I think dips in blood sugar do set off my sympathetic NS reaction. But I sometimes react to protein very quickly, even seconds after it reaches my stomach, before I'd expect much change in blood sugar. So it seems protein is also causing stress in some other way.

Did you mention dairy tolerance anywhere? Ice cream has been a medicine to me a few times for a few things including low blood sugar migraines (downward spiral with nausea and food aversion) and it's helping me again now. Given gut questions it would have to be gum and other irritant-free.

Good idea. Yes, when I can eat, I handle ice cream well. I don't expect I'll be able to eat much of it at once now, but I think I can increase calories by nibbling away at foods with sat fat throughout the day, in amounts that are too small to set off the sympathetic response.

Bicarb helps me so much I don't leave the house without it.

An essential part of the Ray Peat first aid kit. I'll try to make more use of it.

For heat tolerance, and flushing, but I find those are also blood sugar related (perhaps there's a pointer to progesterone here too?), so there could be a link.

Best of luck

Thank you.

 

[Creative Nature]

I didnt identify any particular nutrient deficiencies via blood testing or anything, but due to my symptoms I figured I was low in some key vitamins and minerals and eating nutrient dense foods made me feel better. Also when the er gave me a magnesium drip, it helped with some of my symptoms.

Which nutrient dense foods made you feel better?

I've been supplementing magnesium, but given the similarity of our symptoms, I wonder whether I'm getting enough. Do you know roughly how much magnesium you get daily?

The thyroid I used in very small amounts, like an eighth of a cynoplus tablet two times per day, it calmed the adrenaline down enough to give me an appetite somewhat and allow me to keep food down. Larger amounts of thyroid would've been too much to handle.

Great that it worked for you. Before my adrenergic symptoms started a couple of years ago, thyroid helped me, too. But when I've tried it in the last two years, any product with T3 in it has messed me up for weeks. I'll try again after I've fixed the B deficiencies and the sympathetic NS is under control.

Nibbling on food helped because at that point if I tried to eat a "meal" it would just sit in my stomach and potentially I'd end up throwing it up. The small amounts of food were able to digest without giving me nausea or being too taxing on my system...while providing some nutrition at the same time.

Makes sense. Nibbling helped me recover after my hospital stay in April. I need to return to it. Thanks for the reminder.

I'm still working on healing, and still have setbacks I guess, but my symptoms have improved drastically. Im still doing small amounts of thyroid, and that in combo with good nutrition my temps are near 98.6 each day.

Encouraging to hear that someone with a similar problem is making good progress.

 

[Creative Nature]

I was taking a liquid B complex. I needed to get my B12 level up and it was one of the only B12s I could find that didn't have junk excipients and cost an unreasonable amount (I'm looking at you Global Healing Center) so I thought having the extra Bs along with it would just be a bonus since there were members here sharing positive experiences with them. I should have known better. I react poorly to most isolated supplements, and I already had a ton of energy to start with.

OK, so it's hard to know which B(s) caused your troubles. Thanks anyway.

 

[Jennifer]

OK, so it's hard to know which B(s) caused your troubles. Thanks anyway.

Yep, no clue with the isolated Bs but in food form, none are a problem. Sorry I couldn't be of more help.

 

[Nemo]

My History, Part I: The Risks of Taking Peat's Ideas Out of Context
Like many newcomers to Ray Peat's work, I was captivated by the potential rewards of raising metabolism and did not pay enough attention to the less sexy tasks of correcting nutritional deficiencies and recovering from the stresses of years of excessive work and over-training. After experiencing great benefits from liver and B vitamins, I gradually lost interest in them -- figuring I'd fixed any deficiencies -- and increased use of thyroid, caffeine, white rice, and sucrose. But no matter how hard I pressed the metabolic accelerator, and no matter how many other improvements Peating brought me, I experienced long periods of fatigue, which should have been a warning sign.

Then the racing pulse and heart palpitations started, to be followed later by chest pains, elevated blood pressure, shortness of breath, and other fun symptoms. As time passed, even small stresses could set off these reactions.
Two problems brought the dream to an end.

Diet, Supplements, Lifestyle
When I can eat normally, my diet is mostly fruit, fruit juice, eggs, gelatin, shellfish, beef and beef liver, dairy, occasional low-fat fish, and carrots. I handle liquids fine and starch poorly. I'm currently taking around 4 g of thiamine HCl per day and a few hundred mg of allithiamine. For me, allithiamine is vastly more effective than Thiamine HCl. Other supplements include Energin B complex (20 drops per day), niacinamide (30 mg 0-5 times/day), magnesium, methylene blue, vitamins E and D. I also take clonidine, cyproheptadine, and very low doses of diamox. By necessity, I'm completely sedentary and get little sunlight.

I had symptoms like this for a few days when I increased pro-metabolic supplements quickly at the same time I cut fat rapidly from 25-30% of calories to <15%. I couldn't eat without setting off hyperventilation and many of the other symptoms you mention.

I reacted to it more quickly than you did, but when I increased fat back to about 20-25% of calories, cut methylene blue, cut all thiamine and niacinamide supplements except for the amount in 4-5 drops of Energin a day (one drop with each meal or snack), and cut the taurine supplement I was taking, plus did Buteyko breathing exercises and reduced sugar to strictly what came in 4-5 pieces of whole fruit per day (no cane sugar), I was back to normal in a couple of days but actually improved metabolically from the pre-crisis normal.

Now I've been able to add a mini-drop of MB back into my schedule once a week and a pinch of taurine every day. I also take one drop of TocoVit a day and K2 and make sure I get at least a couple of hours in the sun everyday.

I would cut the MB completely for now. Cut out the high doses of B vitamins and limit yourself to one drop of Energin with every meal and snack. Make sure you're getting carbs with every meal or snack, but no cane sugar for now. Continue your ounce of liver a day, and add a couple of oysters a day. Eat a big chunk of watermelon a day instead of taking magnesium supplements. Make sure you're getting enough manganese from grapes, rice, macadamia nuts or other food sources. Even stop or greatly reduce the E and D supplements until you're feeling better.

If you have a craving for something you don't usually eat, eat it. If you're drinking strictly skim milk, switch some of it to a good milk with fat.

In other words, eat more like a square for a short time to get your metabolism back in line with your nutrient and energy intake. When you feel well enough, go very slowly and carefully as you add back metabolic enhancing supplements and more sugar. But I mean VERY slowly and carefully.

 

[Nemo]

In October I went from fully functioning active though tired, human being to not being able to walk to my kitchen. My muscles were burning and cramping constantly, adrenaline was constantly shooting through my veins, my limbs felt like they were made of concrete, I had shortness of breath, chest pain, neck pain where my veins are in my neck, blood pressure was 158/108, heart rate of 130 at rest, panic attacks, light sensitivity, wanted to kill myself, creatine kinase of 5000, couldn't eat without throwing up, etc etc.
I too was trying to ramp up my metabolism (for several years) by using excessive amounts of coffee aspirin niacinimide progesterone and pregnenolone and was only eating milk oj sugar fruits gelatin small amounts of beef and rice. I completely neglected nutrition and my sole goal became eradicating pufa from my body...I went extremely low fat only getting like 6 g of total fat per day. I've had a history of eating disorders so I think this type of personality can make it easy to take any kind of diet to an extreme.

I just posted the same thing. I hope ten more of us who have been through this will post their stories, so people understand how important it is to take this slowly.

I don't think people realize how powerful Dr. Peat's recommendations are.

If you're starting out sick, and especially if you're older and sick, I don't think your body can switch overnight to full-out Peat, especially if you add a lot of supplements like methylene blue. You probably have vitamin and mineral and sunlight deficiencies that you will have to correct in order to be able to handle a real Peat diet.

In my experience, you can safely cut PUFAs fast, add gelatin and/or a good glycine-rich broth and fruit and a glass of OJ and milk and an ounce of liver a day to start. That's a lot.

Then cut fat to 30% of calories a day, but be realistic about your calorie requirements, which are probably at least 20% higher than what you think they are if you've been trying to lose weight by cutting calories (and will get even higher as your metabolism improves). Don't go straight to very low fat if you've been on a low-carb diet. You'll replace the fat with carbs and if you don't have the vitamins and minerals in place to handle the carbs, here comes your first crisis.

I would strongly recommend taking the time to look closely at vitamin and mineral requirements. Chris Masterjohn has a great email series (or you can watch his videos) that covers every vitamin and mineral, looks at and evaluates the RDA, and discusses how to get the average requirement. You're going to need more as you improve your metabolism, but you have to start with at least the RDA or Masterjohn RDA.

The first supplements I'd start would be very low-dose K2 and E and a B multi, specifically Energin. That is the most wonderful B complex supplement ever invented, in my opinion. I doubt 1% of Americans are getting enough of any of these. I'd also start aspirin, one adult tablet a day to start. If you can't handle one adult aspirin a day, cut back to a baby aspirin or two a day.

Every step you take from there should be slow, one step at a time. It takes time to get to know your recovering body well enough to even realize when you're starting to overdo it.

 

[charlie]

I just posted the same thing. I hope ten more of us who have been through this will post their stories, so people understand how important it is to take this slowly.

I don't think people realize how powerful Dr. Peat's recommendations are.

If you're starting out sick, and especially if you're older and sick, I don't think your body can switch overnight to full-out Peat, especially if you add a lot of supplements like methylene blue. You probably have vitamin and mineral and sunlight deficiencies that you will have to correct in order to be able to handle a real Peat diet.

In my experience, you can safely cut PUFAs fast, add gelatin and/or a good glycine-rich broth and fruit and a glass of OJ and milk and an ounce of liver a day to start. That's a lot.

Then cut fat to 30% of calories a day, but be realistic about your calorie requirements, which are probably at least 20% higher than what you think they are if you've been trying to lose weight by cutting calories (and will get even higher as your metabolism improves). Don't go straight to very low fat if you've been on a low-carb diet. You'll replace the fat with carbs and if you don't have the vitamins and minerals in place to handle the carbs, here comes your first crisis.

I would strongly recommend taking the time to look closely at vitamin and mineral requirements. Chris Masterjohn has a great email series (or you can watch his videos) that covers every vitamin and mineral, looks at and evaluates the RDA, and discusses how to get the average requirement. You're going to need more as you improve your metabolism, but you have to start with at least the RDA or Masterjohn RDA.

The first supplements I'd start would be very low-dose K2 and E and a B multi, specifically Energin. That is the most wonderful B complex supplement ever invented, in my opinion. I doubt 1% of Americans are getting enough of any of these. I'd also start aspirin, one adult tablet a day to start. If you can't handle one adult aspirin a day, cut back to a baby aspirin or two a day.

Every step you take from there should be slow, one step at a time. It takes time to get to know your recovering body well enough to even realize when you're starting to overdo it.

This is a new phenomenon, 10 years ago this was not happening on the scale it is now. Something has changed in the environment in the past 2 or 3 years.

 

[Creative Nature]

I've been testing something similar to a re-feed (without any restrictions), and here are a few things that helped:

1. Salt - You've already seen my posts about this, but I suspect it's having an effect similar to Thyroid at larger doses throughout the day. Haidut posted that 50 years ago the average salt intake was 12-15G per day (2-3 Tbsp)

2. Carrot (large) every day.

3. Something to block pufa release (Niacinamide/aspirin or even Vitamin E)

Keep in mind, I have zero restrictions on what I eat. Instead, I am testing supplements to see how much of the damage I can mitigate. Oddly enough, I find myself craving more chocolate milk and juices, and am increasing them without even trying. But the first week, I had a ton of digestive distress, so I was eating carrots constantly.

Thanks for sharing your experience. Any idea why you crave chocolate milk as opposed to regular?

In the last few days, I've gone back to the small amounts of salt every 15-30 minutes when stressed, and they're helping. Good to know there's historical precedent.

I had cut back on carrots, assuming I was reacting to them as to other foods, but maybe I need to test that assumption. Starting with baby carrots, LOL.

I'm sure my adrenergic reactions are liberating lots of fatty acids, so something to limit their release makes sense. Too much B3 seems to aggravate my B1 deficiency symptoms, but I tolerate it in small amounts pretty well.

 

[Creative Nature]

I had symptoms like this for a few days when I increased pro-metabolic supplements quickly at the same time I cut fat rapidly from 25-30% of calories to <15%. I couldn't eat without setting off hyperventilation and many of the other symptoms you mention.

I reacted to it more quickly than you did, but when I increased fat back to about 20-25% of calories, cut methylene blue, cut all thiamine and niacinamide supplements except for the amount in 4-5 drops of Energin a day (one drop with each meal or snack), and cut the taurine supplement I was taking, plus did Buteyko breathing exercises and reduced sugar to strictly what came in 4-5 pieces of whole fruit per day (no cane sugar), I was back to normal in a couple of days but actually improved metabolically from the pre-crisis normal.

Glad you were able to fix the problem.

I'm trying to increase saturated fat to the extent I can without triggering my symptoms.

Thanks for mentioning Buteyko. You've reminded me that raising CO2 may be another way of dampening the sympathetic response. I find bag-breathing and wearing a surgical mask pretty effective for raising CO2, so I'm going to see if using them before I eat helps.

I would cut the MB completely for now. Cut out the high doses of B vitamins and limit yourself to one drop of Energin with every meal and snack.

I've cut out MB and played with the dose enough so that I don't think 1 mg/day hurts me, but I can try dropping it again.

All my experience suggests that B1 (or B complex) deficiency is the cause of my adrenergic symptoms. Keep in mind that I had a year and a half of terrible symptoms before I began using enough B1 to control them. Even now, I'm vastly better off than I was before starting B1, Energin, and liver.

Make sure you're getting carbs with every meal or snack, but no cane sugar for now. Continue your ounce of liver a day, and add a couple of oysters a day. Eat a big chunk of watermelon a day instead of taking magnesium supplements. Make sure you're getting enough manganese from grapes, rice, macadamia nuts or other food sources.

I haven't had cane sugar in a while. Include carbs in every meal/snack. To the extent I'm able, I do eat oysters frequently.

I drink grape juice daily. Any particular reason you mention manganese?

 

[theLaw]

Any idea why you crave chocolate milk as opposed to regular?

Probably just a delicious way to get more carbs. 1 Cup of Choc Milk = 200 calories, so that's 400 calories per glass. Not bad.

 

[Whichway?]

I've never read of anyone taking more than 1,600mg of B1 per day. That was a study to see if it would help Fibromyalgia patients. I would not be taking the doses you are for any prolonged period, even with the Energin as supporting the intake of the other B vitamins.

Metabolism is a network of processes that utilise vitamins as co-factors, proteins to form the enzymes that breakdown the food, and carbohydrates, proteins and fats as the substrates to produce energy.

I would drop all the supplements gradually and have a wash out period to see how you go. Then I would introduce one a week and monitor your reaction.

Also you have to exercise and get some sunlight. I appreciate that you can feel unwell, but movement is life. Stagnation is death. If you sit around all day and get no stimulation through exercise and sunlight your brain centres, particularly the hypothalamus which regulates your hormonal output, will adjust to that level as being normal. Then when you do try to go above that level of activity you'll experience symptoms as you are now pushing your body outside the metabolic boundaries that have become set. You have to do this sometimes very gradually, so each day walk for one minute more than the previous, and get one minute more sunlight. Build up slow and be prepared for the odd setback, but if that occurs rest up and then start again.

 

[Creative Nature]

Probably just a delicious way to get more carbs.

Good reason!

 

[Amazoniac]

- Thiamine (B1)

"Thiamine is widespread in nature, although generally in only relatively minute quantities (1, 35). In microorganisms it is found mainly intracellularly, although minute amounts are lost to the natural environment upon cell lysis. In higher plants the most abundant form is free thiamine along with lesser amounts of the phosphate esters (4–6)."

"In the tissues of animals, most thiamine is found as its phosphorylated esters (4–6) and is predominantly bound to enzymes as the pyrophosphate (5), the active coenzyme form. As expected for a factor involved in carbohydrate metabolism, the highest concentrations are generally found in organs with high activity, such as the heart, kidney, liver, and brain. In humans this typically amounts to 1–8 μg/g of wet tissue, with lesser amounts in the skeletal muscles (35). A typical healthy human body may contain about 30 mg of thiamine in all forms, about 40–50% of this being in the muscles owing to their bulk. Almost no excess is stored. Normal human blood contains about 90 ng/mL, mostly in the red cells and leukocytes. A value below 40 ng/mL is considered indicative of a possible deficiency. Amounts and proportions in the tissues of other animal species vary widely (31, 35)."​

If this form is available on the market, why people aren't trying it?

A person has to weigh the better regulation when ingested against the risk of fueling infections.
- Thiamine and selected thiamine antivitamins — biological activity and methods of synthesis

Yet..

the following might interest you (section #3):
- Citicoline: A Superior Form of Choline?

 

[Creative Nature]

@Wichway?:

I agree that large doses of any one B vitamin risk imbalances and that at least gentle exercise is usually advisable....

...But when you have a deficiency that repeatedly sends you to the ER, puts you in the hospital, and prevents you from eating, you (1) address the deficiency and (2) try to stop doing stuff that aggravates the deficiency.

The first point needs no elaboration, but in case I didn't explain clearly above how activity affects my B1 deficiency symptoms, I'll try again here.

Each time the adrenergic symptoms occur, they intensify, and it gets easier to set them off. Set them off too often, and working, sleeping, and eating become next to impossible. The only ways to reverse this ratchet effect are to rest and take B1.

I love weightlifting, hiking, sprinting, yoga, long walks...But in the last two years I have repeatedly tried to exercise, and whenever I over-exerted myself, the result was disaster.

I now move as much as I can without aggravating my condition, no more. If this is all the exercise you're suggesting (i.e. not much), then we're on the same page. If you're suggesting enough exercise to trigger my symptoms, then I've tried that experiment, as I've tried going without Bs, and both failed.

 

[tara]

Thanks, good to know. I assume this is his general recommendation, not directed at people with any specific condition.

I think so. Maybe there are times more would be worthwhile. Personally, I aimed for small serves 2-3 times a week, but eventually drifted to less. If I overdo it or under do it, taste tells me.

 

[tara]

Haidut posted that 50 years ago the average salt intake was 12-15G per day (2-3 Tbsp)

I haven't followed your reference back to Haidut's post, but I think 1 tsp salt is about 6g. So 12-15 g would be 2-3 teaspoons (tsp) salt, not tablespoons (Tbsp).
And 2-3 Tbsp would be more like 35-50 g salt - probably quite a bit more than most people can use.

 

[Whichway?]

@Wichway?:

I agree that large doses of any one B vitamin risk imbalances and that at least gentle exercise is usually advisable....

...But when you have a deficiency that repeatedly sends you to the ER, puts you in the hospital, and prevents you from eating, you (1) address the deficiency and (2) try to stop doing stuff that aggravates the deficiency.

There is no way that you have a deficiency in B1. Even those with Beri Beri recover very quickly (within days) upon treatment with even moderate doses of B1.

You are using B1 to support your adrenal response. You need to investigate what is causing this response. If it was solely caused by B1, then your dosing would have resolved the condition, which it has not. B1 is helping, but you need a whole host of nutrients to help your body with its adrenal response until you find the root cause.

The first point needs no elaboration, but in case I didn't explain clearly above how activity affects my B1 deficiency symptoms, I'll try again here.

Each time the adrenergic symptoms occur, they intensify, and it gets easier to set them off. Set them off too often, and working, sleeping, and eating become next to impossible. The only ways to reverse this ratchet effect are to rest and take B1.

I love weightlifting, hiking, sprinting, yoga, long walks...But in the last two years I have repeatedly tried to exercise, and whenever I over-exerted myself, the result was disaster.

I now move as much as I can without aggravating my condition, no more. If this is all the exercise you're suggesting (i.e. not much), then we're on the same page. If you're suggesting enough exercise to trigger my symptoms, then I've tried that experiment, as I've tried going without Bs, and both failed.

I'm not suggesting you trigger your symptoms to the point where you become bed ridden. I realise that is counter productive. You need to find what other nutrients - vitamins, mineral, amino acids, foods help you with your recovery. Whether that is protein shakes, bone broths, elimination diets where you cut back to say red meat and pears, etc. B1 is a single nutrient and you are using it as a band aid, and as YOU ADMIT your recovery each time from this process is not complete, even when using B1. Your metabolism needs something else to help with the B1 and you need to find what that is.

I wish I could offer you something more tangible. However after decades of experimentation with my own fatigue using vitamins and minerals, I have lost faith in their ability to do anything too miraculous. Sure they are required and if you are deficient, which you would not be after taking 4 grams daily, then they help. After you reach your repletion threshold they do nothing further and in excess may be harmful. There are lots of other pieces to the health puzzle. Good luck.

 

[redsun]

@Wichway?:

I agree that large doses of any one B vitamin risk imbalances and that at least gentle exercise is usually advisable....

...But when you have a deficiency that repeatedly sends you to the ER, puts you in the hospital, and prevents you from eating, you (1) address the deficiency and (2) try to stop doing stuff that aggravates the deficiency.

The first point needs no elaboration, but in case I didn't explain clearly above how activity affects my B1 deficiency symptoms, I'll try again here.

Each time the adrenergic symptoms occur, they intensify, and it gets easier to set them off. Set them off too often, and working, sleeping, and eating become next to impossible. The only ways to reverse this ratchet effect are to rest and take B1.

I love weightlifting, hiking, sprinting, yoga, long walks...But in the last two years I have repeatedly tried to exercise, and whenever I over-exerted myself, the result was disaster.

I now move as much as I can without aggravating my condition, no more. If this is all the exercise you're suggesting (i.e. not much), then we're on the same page. If you're suggesting enough exercise to trigger my symptoms, then I've tried that experiment, as I've tried going without Bs, and both failed.

This is not a B1 deficiency though, if there was ever a time you had beriberi, it is long gone by now. B1 is important but if you rely on B1 and B3 predominantly(with disproportionately higher doses) only you will deplete the other Bs. You will deplete the minerals and amino acids it interacts with at high enough doses. In the long run using high doses of B1 is using B1 like a drug and not a nutrient. At high doses B1 is no longer behaving like a nutrient which means it is not synergizing with the other nutrients to raise metabolism up. B1's effects are overriding everything else. I have read particularly that B1 can deplete B2 a lot especially if we are talking about high doses. In reality we have no clue the effect of taking nutrients that are both isolated and high dose and even worse is when they are taken at greater, less balanced doses compared to other nutrients.

Maybe your issue is your sympathetic nervous system (SNS) isn't being supported at all because of too much B1 and not enough of the other nutrients as well as B1 using the other nutrients up faster. B2 is needed to break down noradrenaline, perhaps all that B1 and B3 ate through your B2 stores and now you cant break down noradrenaline effectively. I highly doubt B2 is your saving grace, even if more B2 helps temporarily youll just be depleting something else. But make no mistake you NEED to have the SNS active when doing physical activity of any kind. If you crash too easily you clearly dont have the nutrients to support the SNS.

A methylated B complex can help as well as certain important minerals, especially copper, iron, zinc, are necessary to support SNS and physical activity in general. Higher protein intake will provide AAs for the catecholamines (which strenous activity heavily depends on) noradrenaline, and adrenaline. Adequate carbs of course as well.

 

[Creative Nature]

@Amazoniac: I'm interested in trying the pyrophosphate form. If I do, I'll report results here.

@tara: Thanks.

 

[Creative Nature]

There is no way that you have a deficiency in B1. Even those with Beri Beri recover very quickly (within days) upon treatment with even moderate doses of B1.

Discussing research on beriberi, Dr. Lonsdale, who wrote a book on thiamine deficiency, observed that
"beriberi symptomatology is extremely complex and not a matter of simply giving a few milligrams of thiamin. In fact, it took huge doses of the vitamin for months to abolish the symptoms."

Thiamin(e): the spark of life. - PubMed - NCBI

Dr. Lonsdale has also written that in his own practice, long periods of high doses were often necessary to correct severe B1 deficiencies.

Discussing treatment of B complex deficiencies, Morton Biskind, a member of the Biskind family of researchers Ray Peat cites, reported:
"Although many patients respond rapidly and dramatically to therapy with the vitamin B factors, not a few have severe lesions of nutritional deficiency which respond slowly despite intensive therapy (cf. Kruse, 1942, 1943). Sometimes rather sudden improvement occurs following protracted intensive therapy, as in some of the cases of diabetes observed by Biskind and Schreier (1945). Perseverance is therefore important."

Nutritional Therapy of Endocrine Disturbances - ScienceDirect

So B complex deficiencies are often not so quick and easy to fix.

(Thanks to @Amazoniac for providing these quotes and sources in his posts on B vitamins.)

I'm already addressing one of your other main concerns. I've noted a few places in this thread the likelihood that I'm deficient in other nutrients besides B1 and B3, particularly because, as the Biskinds observed, B vitamin deficiencies are correlated. This risk of other deficiencies is precisely why I'm taking Energin and magnesium, and trying (when I can) to eat plenty of liver, eggs, and oysters. If what I've written gives you (or anyone else reading this comment) any ideas about what nutrients I might be missing or what foods I should try, I'm all ears.